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The 0.5 Pandemic


Despite the widespread outbreaks, the virus seems to have evolved—not genetically, but in the minds of public-health officials. What looked like a lethal miscreant in the spring looks a little different now—still capable of causing serious disease and rare deaths in vulnerable groups, like pregnant women and young children—but not the second coming of 1918’s global pandemic. Officials just hope it stays that way.

It seemed to come out of the blue, although scientists now think the new strain of H1N1 was years, and probably decades, in the making. And there’s not a mad scientist on Earth who can cook up a flu virus as devilishly as nature’s ultimate weapons laboratory: an infected cell.

As the name implies, swine flu has its origins in pigs, and researchers recently were able to read enough of its genealogy to suggest that this strain has a complicated and exotic history. Part of its heritage traces back to a North American swine virus that has infected pigs for decades, part of it comes from a seasonal H3N2 human flu that was circulating around 1997, part of it comes from bird-flu viruses, and part of it seems to have come from a Eurasian pig. If all this sounds impossibly promiscuous and confusing, remember that flu viruses travel widely and well (the new H1N1 blew through more than 70 countries in little more than two months), and then think about the kind of place where pigs and humans typically come together. The new H1N1 was probably born on a farm.

Where that farm was we’ll probably never know, nor is there a documented “sentinel case” like the famous “Patient Zero” for AIDS. A Mexican politician, however, recently proposed erecting a statue to Édgar Hernández, a 5-year-old from the state of Veracruz who is said to be the first person to have had a confirmed case of swine flu. (He reportedly suffered flulike symptoms in early March and later tested positive. He made a full recovery.) What’s clear is that a pneumonia-like illness began to move through Mexico in March and early April, and it worried flu experts, who have been dreading a new pandemic strain of influenza for a long time.

This one looked like it had a pretty good pedigree. It was swine H1N1, and genetically similar to the famously deadly 1918 strain. Doctors in Mexico were spooked by two things. The disease spread very rapidly. And it seemed to specialize in attacking, and sometimes killing, children and healthy young adults. As fate would have it, the virus made its first ruckus in a country not known for sophisticated disease surveillance, then landed in a city with one of the best municipal surveillance shops in the business.

You would never have guessed on Friday, April 24, that a pandemic was coming to town. In local news, the Mets were already five games out of first, and Madonna was still recovering from being thrown by a horse in the Hamptons. The big news out of Mexico was that the recently arrested chief of a drug cartel claimed to have offered personal-development and ethics training to his employees. Really.

Meanwhile, all hell was breaking loose at a parochial school in Fresh Meadows.

It actually began around 1 p.m. that Thursday, when dozens of students at St. Francis began showing up in nurse Mary Pappas’s office, complaining of nausea, fever, and a cough. By the time the number reached 75 that afternoon, Pappas decided to contact the city’s Health Department. Nobody from the city came out that day, according to principal Brother Leonard Conway, and by 9:30 the next morning, the line outside the nurse’s office had already begun to form. The timing couldn’t have been worse: One of the school’s biggest annual events, International Night, was scheduled for that evening.

As soon as word of the St. Francis outbreak reached 125 Worth Street, the question was simple, recalls Scott A. Harper, a medical epidemiologist: “Is it here?”

The epi shop had been on the lookout for unusual flu cases since April 15, when the CDC had published a report about a new strain of influenza, dubbed “2009 H1N1,” which had been identified in California. In fact, the same Thursday as the St. Francis episode, the city had asked private labs to send any influenza-A samples to the Public Health Lab for testing. But it was the call from Nurse Pappas that began to connect two epidemiological dots.

On that frenetic Friday, while Weiss’s team chased down sick students at St. Francis, the Public Health Lab, located near Bellevue, was alerted to expect some samples. Few municipal laboratories were better positioned to test an anonymous bug under emergency circumstances; the PHL had lived through the anthrax scare in 2001 and West Nile–virus outbreaks. The first whiff of a problem reached the upper echelons of city government by the afternoon, when then–Health Commissioner Thomas R. Frieden (now head of the CDC) contacted Linda I. Gibbs, deputy mayor for health and human services. “I got a call from Tom Frieden to say that he was recommending closing down a school event,” Gibbs recalls. “[He said], ‘This is a big deal, families in from out of town, lots of people will be upset, but we just have this huge number of kids that are out absent. We don’t know what it is yet, but we need to take this precaution.’ ”


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