Tamiflu, the anti-viral drug touted for its ability to mitigate the impact of avian flu, however, is another matter. “The data on Tamiflu is really weak,” Frieden says. “I don’t think we should stockpile it. It would cost more than $100 million, which is a lot of money for something that might not be needed and, if it is needed, might not work.”
Frieden believes that buying the hard-to-get Tamiflu is, in any event, a federal responsibility. Last week, in an attempt to try to get out in front of a potential crisis, President Bush announced he would ask Congress for $1 billion to stockpile Tamiflu. Even if approved, those funds will not pay for nearly enough doses of the drug if there is a pandemic. Frieden, however, may have an ace in the hole. He spent five years in India as a medical officer for the World Health Organization, and during that time he developed relationships with health officials and the pharmaceutical companies. He has already been in touch with drug manufacturers in India about their plans to make Tamiflu. “If we have a crisis,” he says, “we’ll get it through any safe source we can.”
There are also experimental vaccines. They are not commercially available, and no one knows if they will work once the flu virus mutates to enable easy person-to-person transmission. But the federal government has bought 2.3 million doses of one of them. Distributing anti-viral medicines, if they’re available, and vaccinating millions of people, if there’s a vaccine that works, would be a logistical nightmare—so the Health Department has been doing distribution drills.
But there is an even more vexing problem: What if there are only limited supplies of lifesaving medicine? Who will get it? “It would be unethical to use Tamiflu for prevention when people who are sick can’t get enough of it,” Frieden says. “It should go first to those most likely to die if they don’t get it.”
Ironically, all the media coverage of avian flu has begun to produce a backlash among some in the medical community. There are experts who say all this attention is creating unnecessary panic.
“This is a dangerous attitude,” Redlener says. “This country doesn’t respond well to carefully worded warnings. Look at New Orleans. Civil engineers were saying for years that the levees were too fragile. We need to amp up the message, not throttle back.”
The storm is named Rudy. When it reaches the coast of the Carolinas, it is a Category 2 hurricane with winds in the 96-to-110-mile-an-hour range. Rather than turn inland, as expected, it suddenly heads north, making its way up the East Coast toward New York. If it continues on its present path, it will hit the city in 48 hours.
The mayor has decided to wait another 24 hours before taking any drastic action. There is still a chance that Rudy will head out to sea before reaching the metropolitan area.
A day later, with the storm moving at an incredibly fast 34 miles an hour (triple the speed of the average southern storm), it appears to be headed straight for the city. Acting quickly now, the mayor orders the evacuation of lower Manhattan, as well as much of coastal Brooklyn, Queens, and Staten Island.
Extra subway and bus service is added, but the systems quickly become overwhelmed. Roads out of town are immediately clogged. In all, more than 2 million people need to get to higher ground. With the storm now only hours away, the Verrazano-Narrows and George Washington Bridges are closed owing to the danger from high winds, which are now well over 100 miles an hour.
Panic begins to take hold when many people realize they won’t make it out of the city. Some just leave their cars and head on foot for one of the reception centers spread across the five boroughs. There is plenty of chaos, but despite scattered pockets of hysteria and violence, the cops remain in overall control.
The power of the storm is intensified by what is known as the “New York Bight.” The narrow mouth of the harbor and the land formation create a natural chute to direct and focus the hurricane on the city. When the 30-foot storm surge hits the coast, the thunderous wall of water is, as a 1998 Army Corps of Engineers report predicted, “like a giant bulldozer sweeping away everything in its path.” Cars are overturned and tossed like toys, windows are blown out, small buildings and storefronts are completely destroyed. The most vulnerable areas near the coastline, including Wall Street, are left under nearly ten feet of water.
Weather trackers still talk about 1938, when a Category 3 hurricane with sustained winds of more than 100 miles an hour tore through parts of the city and Long Island. The storm knocked out all power above 59th Street, including the entire Bronx, destroyed more than 100 large trees in Central Park, and shut down the new IND subway line. But Long Island bore the brunt of it. There were 32 deaths in Westhampton alone. During an 1821 hurricane, the East River and the Hudson both overflowed their banks and were connected along Canal Street, which was under water from one edge of Manhattan to the other.