Inside the Fight Against a Flu Pandemic

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To better understand how this bug might move through the U.S. in coming months, officials have spent part of this summer monitoring the way H1N1 has been behaving during the southern hemisphere's winter months. It has been spreading fast, attendance has dropped at Patagonian ski resorts, and flu fears have crippled the Buenos Aires theater business. Across the region, countries are reporting that H1N1 has become the dominant strain of the flu season. But the most positive development is that the virus has so far not mutated — a fact that makes it possible for scientists to create a vaccine for it. All these developments are being tracked at the White House, where flu meetings happen usually twice a week in the Situation Room and President Barack Obama gets updates in the Oval Office every other day or so. (See the 5 things you need to know about swine flu.)

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But with some schools opening this month, a few decisions must be made. If the virus does not mutate into something more deadly, federal officials will urge local schools to stay open unless so many children or staffers are sick that teaching becomes difficult. This is a change from the spring, when some school districts simply shut down for a week or more as students began getting symptoms. U.S. officials now believe wholesale shutdowns are unnecessary, given the fact that the bug is already so widespread, and potentially too disruptive. When schools close, many parents have to stay home from work, disabling an already fragile economy. Janet Napolitano, Secretary of the Department of Homeland Security, recommends that all families begin planning contingencies for handling a child who has to spend a week or more home from school. (Some schools may be advised to create quarantine areas for sick children whose parents cannot keep them at home.)

But the big move, which now appears likely, will be a decision by Washington to undertake potentially one of the largest and fastest public vaccination campaigns in U.S. history. Sometime in October and November, federal officials will probably recommend inoculating 160 million Americans who are most at risk of infection. Despite the fact that the shots will be free, the campaign will not be easy: last year only 40% of the U.S. population took the time to get a regular flu shot. And the H1N1 vaccine is going to require some commitment. Officials say health workers will need to administer at least two shots in the arm spaced four weeks apart before the end of the year. (See TIME's health and medicine covers.)

Not everyone will be recommended for the H1N1 vaccine. The target group includes pregnant women, caretakers of infants, adults with chronic illnesses like diabetes and asthma and every child, teen and young adult between the ages of 6 months and 24 years. H1N1 is particularly tough on these populations. Pregnant women, for example, are more than four times as likely as others to be admitted to the hospital for the flu. Because the serum, which is still being developed, won't be ready until at least mid-October, full immunity may not kick in until early December — after the second doses are administered and an additional couple of weeks pass. "In all likelihood, this flu will hit before vaccine is available for people," explains Napolitano. "We are asking people to be resilient."

Translation: Everyone remain calm. Officials are working overtime to find health-care workers and public spaces to administer the vaccines this fall — and it will be a few weeks before more is known about where and when the shots will be given. The sheer size of the vaccination task causes some of the greatest concern for public-health experts, and it has begun to hit home for people like Kevin Sherin, the public-health director in Orlando, Fla. He oversees a school system with about 175,000 students, a county with more than 1 million residents and a tourist industry that cycles through 49 million visitors in a typical year. He says he has eight nurses in the schools and 20 other nurses ready to do immunizations. But if they each spend five minutes per injection, it would take them a month and a half — working 24 hours a day — to deliver the vaccine to all the local students. "For most of the local health departments, they are not going to have the resources to do the job," Sherin says. "We are really going to be relying on volunteers to help us." In addition to turning to private-sector doctors and nurses to aide the effort, Sherin is looking into renting empty storefronts, reopening vacant schools and even using the downtown Amway Arena, home to the Orlando Magic, for mass-vaccination campaigns. "It could be a little bit of pandemic pandemonium in the beginning," he says.

See more about swine flu.

Read: "Battling Swine Flu: The Lessons from SARS."