That was the same message that city officials delivered to Brother Leonard around 5:15 p.m. “I had to play the bad guy” he recalls, “and send everyone home. And that’s when the media found out.” By Monday, more than two dozen TV field units—eventually including crews from Korea, Japan, and Ukraine—were camped outside St. Francis, which remained closed for a week.
Initial tests at the lab were inconclusive but ominous. One of the things the city learned in the spring is that the commercial test kits that quickly distinguish Flu A viruses (which include H1N1) from Flu B (which circulate as seasonal flu) can give false-negative results up to 70 percent of the time. By the following morning, the city knew many of the St. Francis samples were “Flu A untypeable”—lab shorthand for a new, unknown strain of influenza A. The lab sent samples overnight to the CDC for more definitive five-hour tests known as PCR that confirmed the worst: The new strain of H1N1 had reached New York. Soon after, samples began to flood into the lab. In a typical flu season, the city lab (which also does PCR testing) would process about 100 samples. “When we jumped to 100 samples a day,” says Sara Beatrice, the lab’s director, “it was a reminder that we weren’t in Kansas anymore.”
The other shoe that dropped during that 72-hour period came from Mexico. U.S. health authorities had been belatedly alerted to the epidemic of respiratory illness that began there in late March. Although information was slow to trickle northward—the first big Mexico swine-flu stories wouldn’t hit local news until Saturday, April 25—Mexico City was in the process of proving that medical panic could also be an export in the globalized economy.
The Mexican government abruptly closed museums and schools, barred crowds from sporting events, canceled other public gatherings, and declared a national emergency on the same day that St. Francis canceled its International Night. Images of Mexico City residents wearing blue surgical masks were soon seen from New York to Tokyo.
Some public-health officials and scientists now suggest that Mexican authorities may have overreacted to the initial outbreak. “We knew that there were 100-some-odd people in Mexico who had died,” says Thomas A. Farley, New York’s new health commissioner. “It wasn’t clear if that was 100 out of 1,000, in which case it would have been severe pandemic influenza, or if it was 100 out of 100,000. And it turns out that it was probably more like 100 out of 100,000.” One well-respected U.S.-based flu expert told me, “The end result in Mexico was a disaster. It was a disaster in terms of damage to tourism, to children’s education, and to the overall economy, and it was a disaster in terms of getting the numbers right.”
Less than 72 hours after the first St. Francis student walked into Nurse Pappas’s office, the story had gone, well, viral. Any hopes that the H1N1 strain might not have spread too far locally were quashed when the city learned of two confirmed cases a few days later: one was of a student athlete from Suffolk County, the other of someone who had flown in for a party. Neither had a connection to either St. Francis or Mexico.
H1N1 teased New York for about a week. After a brief rise, the number of cases began to drop, hinting at a short-lived epidemic. Then, suddenly, the outbreak exploded, with all sorts of medical and social implications. Some office workers returning from ill-timed trips to Mexico were told to take another week off. Many New Yorkers, especially parents with young children who had heard reports from Mexico about seriously ill children, began to clog the city’s hospitals. By the peak of the outbreak, in late May, many emergency rooms struggled with two to three times the normal patient flow.
“When anyone said ‘swine flu’ in the spring, it was like people said ‘Ebola,’ ” says Dr. Christopher Doty, head of the New York chapter of the American Academy of Emergency Medicine. “Everyone assumed [it] meant you were going to die.”
In June, the World Health Organization declared a global H1N1 pandemic. Pharmaceutical companies raced to prepare special vaccines. Government agencies began to sketch out worst-case scenarios. And the first question everyone struggled with was, What are we dealing with?
Peter Palese, who heads the microbiology department at Mount Sinai School of Medicine, brings a lot of street cred to this particular conversation. He works at one of five federally funded “centers of excellence” in flu research in the U.S., and he served on the working group of scientific experts who advised President Obama on the prospects for an H1N1 pandemic in the fall. Palese has an Italian surname, an Austrian accent, and a blunt, plain-speaking manner that cuts through the usual influenza hedging.