ANNOUNCER: Thursday night, Sept. 15, 2005. It's time for "Primetime." Katrina's barely over. Is the worst disaster ever finally behind us? Not on your life. Tonight, "Primetime" puts you in the hot zone. But it's not just what can go wrong. It's what you can do right to save yourself in the next three big disasters experts say are just waiting to happen. A catastrophic earthquake.
FIRE AND RESCUE WORKER, MALE: Prepare yourselves. Shut off the gas and shut off electricity.
ANNOUNCER: An epidemic of avian flu, the whole world over.
MICHAEL OSTERHOLM, CENTER FOR INFECTIOUS DISEASE RESEARCH AND POLICY: I can't imagine anything that would be closer to a living hell.
ANNOUNCER: And a nuclear bomb in an American city.
CHRIS CUOMO, ABC NEWS: I get in my car, if I have one, and I take off.
ANNOUNCER: But what if we told you your first instincts to save yourself are wrong? Tonight, the warnings are here, and so are the answers. Ready or not? The next big one. Here now, Chris Cuomo.
CHRIS CUOMO: Good evening and welcome to "Primetime." Imagine a huge bridge like the one behind me being the only way out of your town and it's crammed with desperate drivers trying to evacuate. Now, we saw something like it during Hurricane Katrina, and the problem may well arise again during the now unthinkable next big disaster. It's a subject the president addressed in his speech tonight.
PRESIDENT BUSH: I consider detailed emergency planning to be a national security priority.
CHRIS CUOMO: So what does that mean to you? What would you do in a hurricane or a manmade catastrophe like a nuclear or biological attack? These are frightening thoughts, of course they are. But tonight is not just about what can go wrong. It's about what you can do right.
We start with a virus poised to create a global epidemic. Are we ready? Here's ABC News chief investigative correspondent Brian Ross.
BRIAN ROSS, ABC NEWS: It has the potential to turn parts of major cities into ghost towns.
MICHAEL OSTERHOLM: We would expect between 1.5 and 1.7 million Americans to die.
BRIAN ROSS: Officials in London are already quietly looking for extra morgue space.
DR. IRWIN REDLENER, COLUMBIA UNIVERSITY: We could have a billion people dying worldwide.
BRIAN ROSS: It could hit as early as this winter, and there's no vaccine and not enough medicine to fight it.
DOCTOR, MALE: There is very much a sense of a race against time.
BRIAN ROSS: Against this, a microscopic view of a never before seen strain of the flu that scientists say could pose a much more real and greater threat than smallpox, AIDS or anthrax. Known to scientists as H5N1.
LAURIE GARRETT, COUNCIL ON FOREIGN RELATIONS: Right now in human beings, it kills 55 percent of the people it infects. That makes it the most lethal flu we know of that has ever been on planet Earth affecting human beings.
BRIAN ROSS: Laurie Garrett is a senior fellow for global health at the Council on Foreign Relations. The most recent issue of its prestigious Foreign Affairs journal contains a special report on what it calls the coming global epidemic, a pandemic.
LAURIE GARRETT: Each year different flues come, but your immune says, I've seen that guy before, no problem, crank out some antibodies. Might not feel great for a couple of days, but I'll recover. Now what's scaring us is that this constellation of H number 5 and N number 1, to our knowledge has never in history been in our species. So absolutely nobody watching this has any natural immunity to this form of flu.
BRIAN ROSS: This form of the flu started as do almost all flu viruses, in wild birds in Asia.
BILL KARESH, WILDLIFE CONSERVATION SOCIETY: They die of pneumonia just like people. When you open them up, you do a post-mortem exam, their lungs are just full of fluid and full of blood.
BRIAN ROSS: Bill Karesh, the lead veterinarian for the Wildlife Conservation Society, has been tracking this rare flu strain since it first emerged in the 1990s, and has watched it as it's gained strength going from wild birds to chickens to humans.
BILL KARESH: The last outbreak in July that was reported was this part of China. It started in a market somewhere in the Guangdong Province. It's just packed with cages. you'll have chickens, you'll have ducks, cats, dogs, turtles, snakes. And they're all stacked in cages and they're all spreading their germs to each other.
BRIAN ROSS: Asian governments have killed millions of chickens in a futile attempt to stop the flu's spread. Dr. Irwin Redlener heads Columbia University's Center for Disaster Preparedness.
DR. IRWIN REDLENER: The tipping point, the place where it becomes something of immediate concern is when that virus mutates to something that is able to go from human to human.
BRIAN ROSS: So now, scientists in Asia and around the world, on a literally hour-to-hour basis, are watching for that tipping point to occur.
DR. MALIK PEIRIS, RESEARCH SCIENTIST: This virus is a pretty nasty piece of work.
BRIAN ROSS: Dr. Malik Peiris is the scientist who first identified the so- called SARS virus two years ago, which killed more than 700 people and triggered a worldwide scare. This, he says, is much worse.
DR. MALIK PEIRIS: Unlike the normal human flu where the virus is predominantly in the upper respiratory tract, so you get a runny nose, sore throat, the H5N1 virus seems to go directly deep into the lungs. So it goes down into the lung tissue, causes a severe pneumonia.
BRIAN ROSS: To date, there have been 57 confirmed human deaths and another suspected one just last week in Indonesia. Scientists say the humans who have been infected so far have been infected by birds, but that every infected person represents one step closer to the tipping point.
DR. IRWIN REDLENER: Once that virus is capable of not needing the bird to infect humans, so in other words, you have it, I can get it from being in contact with you, then we have the beginnings of what can turn out to be this worldwide epidemic problem that the experts call pandemics.
BRIAN ROSS: That's what happened in 1918. A shocking reminder of the worst-case scenario. It was known as the Spanish flu.
DOCTOR: It was the most horrible time. By the hundreds they were dying, and no doctor could stop the epidemic.
DOCTOR: We had little caskets for the little babies that stretched for four and five blocks.
BILL KARESH: The Spanish flu was killing people in two or three days once they got sick. It started at the end of World War I. It actually came to America with returning soldiers from Europe and then spread through the United States.
LAURIE GARRETT: In 1918, my now quite elderly uncle was a young boy, and the flu came through. And his family insisted that he could not go outside for any reason until the whole epidemic was over. He spent his afternoons looking out the window and counting the hearses going up and down the neighborhood and trying to guess which of his schoolmates had died and keeping a little scorecard.
BRIAN ROSS: That was before the international air travel routes of today with non-stop flights from flu ground zero to the United States.
BILL KARESH: So it's going to come out of Bangkok or Hanoi or Hong Kong or Shanghai, get into Japan. It'll get to New York. It'll get to San Francisco. It'll get to Vancouver. It'll get to Paris and London, all within a matter of the first week.
LAURIE GARRETT: It's on people's hands. You shake hands. You touch a doorknob that somebody recently touched.
BRIAN ROSS: And that's how this particular strain, never seen before, could spread?
LAURIE GARRETT: Absolutely. There's no reason to believe that if H5N1 manages to make that crucial punch through genetically, it won't spread like every other flu.
BRIAN ROSS: And once it hits a city like New York ...
DR. IRWIN REDLENER: It's extremely possible we'd have to quarantine hospitals, we'd have to quarantine sections of the city.
BRIAN ROSS: Dr. Redlener has been working with New York City officials to get ready for the deadly epidemic.
DR. IRWIN REDLENER: The city would look like a science fiction movie. This would look like an armed camp, basically.
BRIAN ROSS: You would ring a neighborhood in New York City with armed officers to keep people from leaving or going in?
DR. IRWIN REDLENER: Yes.
BRIAN ROSS: Actually shut down parts of New York City?
DR. IRWIN REDLENER: We might have to do that, correct.
LAURIE GARRETT: I could imagine that you would look at Grand Central Station and not see much of anybody wandering around at all. People would be afraid to take the subways because who wants to be in an enclosed airspace with a whole lot of other strangers never knowing which ones are carrying flu?
DR. IRWIN REDLENER: We might be seeing 200 to 350 people every single day dying from the flu in New York City.
BRIAN ROSS: Every single day?
DR. IRWIN REDLENER: Every single day. And a quarter to a third of those might be children.
BRIAN ROSS: And for hospitals, there would be scenes like the ones this month in Houston and New Orleans. Except the cots would be full of dying people.
LAURIE GARRETT: There wouldn't be equipment and personnel to staff them adequately that you could really call them a hospital. You might more or less call them warehouses for the ailing.
BRIAN ROSS: And as happened in New Orleans, there would be no place for the dead.
MICHAEL OSTERHOLM: If you look at the expected number of deaths that could occur in cities across the United States, we are wholly unprepared to process those bodies in a dignified and respectful way. We will run out of caskets literally within days.
BRIAN ROSS: University of Minnesota Professor Michael Osterholm is the director of the Center for Infectious Disease Research.
MICHAEL OSTERHOLM: That's the kind of realities that we have to start planning for now that unfortunately in most communities in this country we just haven't even begun to think about.
BRIAN ROSS: The prospects have been so bleak that in planning sessions held in New York City, some veteran emergency preparedness officials have been overwhelmed.
MICHAEL OSTERHOLM: If we have a repeat of a 1918-like experience, I can't imagine anything to be closer to a living hell than that experience of 12 to 24 months of pandemic influenza.
ANNOUNCER: Up next, some good news. There is a medicine that can help you survive. But can you get it in time? When we come back.
ANNOUNCER: "Primetime." Once again, Brian Ross.
EMCEE, MALE: Mr. George W. Bush, president of the United States of America.
BRIAN ROSS: On the same stage where he has warned the world of terrorism and weapons of mass destruction, President Bush this week warned the world must prepare for a new weapon of mass destruction, a global epidemic of killer flu.
PRESIDENT BUSH: If left unchallenged, this virus could become the first pandemic of the 21st century.
BRIAN ROSS: Are we prepared in this country today?
DR. IRWIN REDLENER: We're not even close to being prepared in this country. I mean, the short answer to the question are we prepared is absolutely not.
BRIAN ROSS: If that flu were to hit this country this winter, how bad?
DR. IRWIN REDLENER: If we had a significant worldwide epidemic of this particular avian flu, the H5N1 virus, I think we would see outcomes that would be virtually impossible to imagine, even to a world that has just witnessed some of the most horrible scenes of a natural disaster that any of us will ever see in our lifetimes.
BRIAN ROSS: For the victims, they at first wouldn't know if it's the kind of routine flu that comes every year or the killer flu called H5N1. If it's the killer flu, the world will stop, too.
MICHAEL LEAVITT, SECRETARY OF HEALTH AND HUMAN SERVICES: We'd do all we could to quarantine. We'd do all we could -- it's not a happy thought. It's something that keeps the president of the United States awake. It keeps me awake.
BRIAN ROSS: The man in charge of making sure this country is prepared for a killer flu epidemic is Secretary of Health and Human Services Michael Leavitt, who took office just this January. The plan calls for him to run operations out of this crisis center in Washington.
MICHAEL LEAVITT: This is a very serious version of a disease that can literally take lives by the millions.
BRIAN ROSS: Is this country prepared today for this epidemic?
MICHAEL LEAVITT: Not as prepared as we need to be. We're better prepared today than we were yesterday. We'll be better prepared tomorrow than we are today. But no one in the world is prepared enough yet.
BRIAN ROSS: So the answer is, no, we are not prepared?
MICHAEL LEAVITT: Not as prepared as we need to be.
BRIAN ROSS: The draft report of the Federal government's own emergency plan, examined by "Primetime," predicts as many as 200,000 Americans will die within a few months, considered a conservative estimate.
LAURIE GARRETT: Well, the first thing is everybody in America is going to say, where's a vaccine? And they're going to find out that it's really darn hard to make vaccine. It takes a really long time, and they may queue up in demand, but it's not there for them.
BRIAN ROSS: In fact, the draft report says it won't be until six months after the first outbreak that any vaccine will be available, and then only in limited supply.
LAURIE GARRETT: And even that's optimistic.
BRIAN ROSS: So if we're hit by this epidemic, there's not going to be vaccine for everybody.
LAURIE GARRETT: No.
BRIAN ROSS: But while there's no vaccine to stop the flu, there is one medicine to treat it and only one. Made at this plant in Switzerland by the Roche pharmaceutical company, it's called Tamiflu.
ADVERTISEMENT VOICE, MALE: If you feel flu-ish, see your doctor early.
BRIAN ROSS: Roche has been selling Tamiflu for years, but it was only recently that scientists realized it is the one medicine so far proven effective against the killer flu, H5N1. And that has created a huge demand and a critical shortage.
BRIAN ROSS: The whole world wants what's coming out of that one plant in Switzerland.
LAURIE GARRETT: Exactly.
BRIAN ROSS: Can they supply the whole world?
LAURIE GARRETT: No. All of the wealthiest countries in the world are trying to purchase stockpiles of Tamiflu. Our stockpile is around 2.5 million courses of treatment.
BRIAN ROSS: And the government knows that at least, or predicts, 200 million people would be infected?
LAURIE GARRETT: Looks like we have a shortage.
BRIAN ROSS: How many doses do we have of Tamiflu?
MICHAEL LEAVITT: Our objective is to have 20 million doses of Tamiflu, or enough for 20 million people.
BRIAN ROSS: Today?
MICHAEL LEAVITT: No, we don't have that today, but most ...
BRIAN ROSS: How much do we have today?
MICHAEL LEAVITT: Currently, we have about 6 million that have been both ordered and will be delivered this year.
BRIAN ROSS: On hand today?
MICHAEL LEAVITT: No, we have 2 million that are on hand today.
BRIAN ROSS: How is it that we don't have more?
MICHAEL LEAVITT: Well, first of all, no one does.
BRIAN ROSS: But officials in Australia say they do have more. And in Great Britain, officials say they will soon have enough for 1/4 of the population.
PROFESSOR JOHN OXFORD, ROYAL LONDON HOSPITAL: I think at the moment, with 2.5 million doses, it -you're pretty vulnerable.
BRIAN ROSS: European health officials at a conference this week in Malta said they were astonished at the U.S. lack of planning. Professor John Oxford of the Royal London Hospital.
PREOFESSOR JOHN OXFORD: The lack of advanced planning up to the moment in the United States in the sense of not having a huge stockpile, which I think your citizens deserve, has surprised me and I've been rather dismayed about it.
BRIAN ROSS: Faced with worldwide demand, the Roche company, which makes Tamiflu, has set up a first come, first serve waiting list with the United States nowhere near the top.
MICHAEL LEAVITT: Do we wish we had ordered it sooner and more of it? I suspect one could say, yes. Are we moving rapidly to assure that we have it? The answer to that is also yes.
BRIAN ROSS: Why didn't the U.S. order it sooner?
MICHAEL LEAVITT: I can't answer that. I don't know the answer.
BRIAN ROSS: It once again, just two weeks after Hurricane Katrina, raises questions about the Bush administration and its ability to plan for a predictable natural disaster.
DR. IRWIN REDLENER: We can't just wing it. When we wing it, we get New Orleans.
BRIAN ROSS: Even the president's closest ally on Capitol Hill, the Republican leader of the Senate, Bill Frist, is now sounding the alarm about the country's lack of Tamiflu.
SEN. BILL FRIST, MAJORITY LEADER: We are way under-prepared. What if it does break out? And it could, it could be tomorrow here in the United States. So the Tamiflu is what people would go after. It's what you're going to ask for, I'm going to ask for immediately.
BRIAN ROSS: Tamiflu is already in short supply for the public, and officials of the Roche company say there could well be a run on the medicine before this winter's flu season.
BRIAN ROSS: How will it work? Who will get the lifesaving drug? Who won't?
LAURIE GARRETT: As far as I know, there is no coherent plan for who will get the meager supplies.
BRIAN ROSS: With 300 million people, how do you decide who gets the 2.5 million doses?
MICHAEL LEAVITT: Well, that's part of our planning process.
BRIAN ROSS: Won't everyone want Tamiflu for themselves, for their families, if this hits? And you're going to have to say we don't have enough.
MICHAEL LEAVITT: Well, that's not something I want to say, and that's the reason we're moving so rapidly.
BRIAN ROSS: But you're going to have to, aren't you?
MICHAEL LEAVITT: Well, it isn't going to happen tomorrow. But if it happened the day after that, we would not be in as good a position as we -- as we will be in six months.
BRIAN ROSS: So for at least this coming winter, this country will be in much the same situation as it was in 1918.
DR. IRWIN REDLENER: We didn't have Tamiflu then and we didn't have the vaccine then. And we struggled to try to save people through the medical care that we had, which was pretty good. And we had a pretty sophisticated public health system. But the fact is, a lot of people died then.
BRIAN ROSS: And this time?
DR. IRWIN REDLENER: A lot of people will die.
This "Primetime" segment aired on Sept. 15, 2005.