Here's what we know about avian influenza: It may savage the global human population, or it may restrict itself to savaging the chicken population. If the virus evolves to jump from human to human, it may wreak untold suffering, or weaken and disappear. The antiviral drug, Tamiflu, may be our salvation, or it may prove useless. Scientists are hoping for a vaccine, which we may be able to develop, or not. Prognosis? In the words of World Health Organization official David Nabarro, "the range of deaths could be anything between five and 150 million."
Avian influenza is the most malleable of news stories, a loose collection of "what if?" conjectures, apocalyptic scenarios, history lessons and science-based guesswork. Faced with potential panic, Southeast Asian governments have shaped the facts at will. Thailand, Indonesia, and China initially avoided panic by simply lying about outbreaks. Vietnam complies with the WHO but insists on vetting information before handing it over. Myanmar explicitly forbids the local press to report incidents within its borders (though any mention of the flu striking rival nations, such as Thailand, is encouraged.)
The message from the White House, meanwhile, has been exactly what one would expect in a situation rife with bad information, questionable statistics, and the vague potential of mass destruction: Send in the troops. President Bush says that idea came to him after reading The Great Influenza, John Barry's account of the 1918 flu pandemic that killed 100 million worldwide. "Who [is] best to be able to effect a quarantine?" Bush asked at a press conference this month. "One option is the use of a military that's able to plan and move."
It's a somewhat surprising conclusion to draw from Barry's book, in which we learn that the 1918 flu exploded inside military camps and then bled into the civilian population. The situations are different, of course; in 1918, hundreds of thousands of troops were packed together in cantonments in Georgia, South Carolina, Massachusetts and elsewhere, tinderboxes for a disease that strikes hardest at the young and healthy. President Bush and the director of the Centers for Disease Control and Prevention are suggesting that the military be used to enforce a quarantine, presumably some sort of lockdown that would cordon off unsafe areas and restrict the movement of people on both sides of the line.
Economist and blogger Tyler Cowen, who has written extensively on the subject for his avian flu blog, notes that after months of thinking and writing about the virus "Bush's idea had not crossed my mind." An enforced quarantine, suggests Cowen, is more likely to spread the disease than stop it. Those charged with enforcing the order—in this case, the military—are as likely to be carriers as anyone. In contrast to SARS, flu carriers can easily spread disease without knowing they're infected.
Cowen isn't totally averse to the idea of a quarantine, but there are diseases for which a quarantine makes sense, and diseases for which it does not; countries in which quarantine is plausible, and countries in which it is unthinkable. He suggests quarantines might be effective for small countries (as with American Samoa in 1918) that can conceivably shut their borders and close the airports. A country of 300 million, dotted with densely packed cities, bounded by porous borders—not so much.
It is the rational response of any community hit by disease to clear the streets and retreat inside, and that is largely what people did in 1918. But quarantines can be counterproductive in that they induce panic, encouraging people to flee before their options run out. Hundreds of thousands fled Beijing during the SARS epidemic when rumors of quarantines circulated more quickly than the epidemic itself.
More cracked than the idea of an enforced quarantine is the blithe suggestion that men and women trained to kill outside U.S. borders are the ideal candidates for dealing with vulnerable flu victims stateside. The Great Influenza is, as much as anything, a work that limns the dangers of ignoring the 1878 Posse Comitatus Act, which bans the military from taking police action in domestic situations.
The 1918 flu struck at a time when U.S. forces were repeatedly asked to keep order at home, and repeatedly trampled individual rights to do so. The War Department was busily and brutally quashing strikes, U.S. army intelligence operatives were gathering intelligence on suspicious Americans, and government officials actively encouraged Americans to inform on one another.
The information freeze was, in Barry's telling, a major contribution to the spread of the epidemic; no one wanted to bear bad news and risk hurting morale. Speech was restricted through an expanded Sedition Act, and if someone was going to shut you up, it would more than likely be the military. To read Barry's account, consider the dearth of facts surrounding the current epidemic-in-waiting, and cry "call out the cavalry!" requires a special kind of hyper-militarized mindset.
Barry's explanation of why so many of the young and healthy fell prey to flu is perhaps the most chilling paragraph in a deeply disturbing book. "Young adults have the strongest immunes system in the population," he explains, "most capable of mounting a massive immune response." The response was often more harmful than the disease; it was often the body's cure, in other words, that killed. Overreaction can be deadly. That, if anything, is a history lesson worth learning.