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Remain Calm

Avian flu, hurricane, chemical spill, terrorist bomb, earthquake: Whatever the next apocalypse is, New York—and New Yorkers—are getting ready for it. But have we done enough? The strategies and tactics of survival.

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On an early-winter Monday morning in Hong Kong, a businessman boards a plane for New York. The man, who’d spent a few days touring the Chinese countryside during his trip, is not feeling great. He’s tired and achy. He can’t decide if it’s the wear and tear of his travels or the beginning of a cold, but after coughing and sneezing throughout his sixteen-hour flight, he’s certain he’s getting sick.

By the time he goes through Customs at JFK, gets his bags, and finds a cab, he has only enough energy left to check into his midtown hotel and collapse on the bed in his room. The next day, feeling even sicker, he heads to the nearest emergency room. By now, he’s got a high fever and he’s coughing up blood. Given his robust flulike symptoms and his international travel, alarm bells go off in the ER.

Though word hasn’t yet reached the U.S., there have been several dozen confirmed cases of human-to-human transmission of the H5N1 virus—better known as avian flu—in the Chinese countryside and several other spots in Asia. But even without the new information, the ER doctors, who’ve been drilled on what to watch for, are convinced it’s avian flu. Taking no chances, they isolate the patient. But the damage has been done—the businessman has infected people on the plane, at JFK, in his hotel, and even in the hospital’s waiting room.

The city’s ability to deal with the pandemic is severely hampered by three problems. There is no vaccine and won’t be for months. Tamiflu, an anti-viral drug that is the principal form of treatment, is in shockingly short supply. And people are now getting sick in other cities as well.

The city’s hospitals are unprepared to deal with the large number of incoming patients flooding the system. More than 2 million people will be infected over the course of the six-to-seven-month flu season. Of these, 10 percent, or 200,000 people, will need to be hospitalized. That’s 1,000 admissions a day. The fatality rate will be about 2 percent, which translates to 40,000 dead, many of them children and healthy people between the ages of 18 and 50.

The social fabric begins to fray. As in New Orleans, there is a disparity between the white community and the nonwhite community, between richer neighborhoods and poorer neighborhoods. The mayor has to take draconian measures, practically instituting martial law, to contain the spread of the disease. Public gatherings are forbidden. Movie theaters, Broadway shows, concerts, and sporting events are all suspended. Even the subway is shut down.

Is New York ready? With the growing fear of an avian-flu pandemic, and in the aftermath of Katrina, that’s the most pressing question in the city right now. Hurricane Katrina showed that logistics aren’t mere details; they can mean the difference between life and death. And it furthermore showed (as if New York needed more convincing) that the federal government can’t be counted on to secure our safety.

“Four years after 9/11, we are, as a nation, extraordinarily, inexplicably unprepared to deal with a major catastrophic event,” says Dr. Irwin Redlener, the head of the National Center for Disaster Preparedness at Columbia.

Redlener, who is also the president of the Children’s Health Fund, traveled to the Gulf in the immediate aftermath of Katrina with several mobile medical units to assist in the recovery effort. I talked to him the evening he returned from Mississippi; what he saw there made him angry. “We’ve had terrible leadership in Washington. We have less accountability in place on the issue of preparedness than we have for making ice cream. We’ve spent tens of billions of dollars,” he says, exasperated, “and I challenge anyone to find a person or even an agency in Washington that knows what we’ve purchased. What we have are random acts of preparedness with no overall strategic plan.”

The city itself gets a much better grade. “There’s no question,” says Dr. Shelley Hearne, executive director of Trust for America’s Health, “that New York is far more advanced in its preparedness than any other city.”

Redlener concurs. Though most of his blistering criticism is directed at federal authorities, he says the city has shown too little foresight. To illustrate his point, he uses decontamination facilities, which a handful of concerned New York hospitals rushed to put in after 9/11. He argues that even though the hospitals are proud of these facilities and it makes them feel like they’re doing something, no one really knows how many decon showers New York City needs to effectively deal with a major event. Is it 500 or 5,000? Maybe it’s 10,000.

“I spoke to the head of infection control at one of the major medical centers in New York recently,” Redlener says, “and I asked her how many SARS patients her hospital could accommodate in isolation. She said, ‘We’re in pretty good shape. We can handle five.’ And I said five—what? Five hundred? And she said, ‘No, five.’ The degree to which we can’t get this together from an overall strategic point of view is almost surreal. We still don’t even have a definition of what preparedness is.”


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