In a Pandemic, Who Gets to Live?

And, of course, there's that familiar American concern: Can you really trust the people at the top to make the right decisions? Another study found that 72 percent of Americans thought "wealthy and influential persons" would receive a vaccine first if shortages existed.

All of this would be happening during a time of great confusion. Nearly a century after the Spanish flu killed approximately 50 million people around the world, scientists are still trying to answer some fundamental questions about the 1918-20 pandemic. Researchers are re-examining records of 24,000 mortalities in the United Kingdom to try and answer a basic question.

The Most Vulnerable

Young children and older adults are normally the most vulnerable to an influenza pandemic. But the records show that healthy young adults were most likely to die during three waves of the epidemic.

"We don't really understand why children and older adults were at lesser risk," said John Mathews of the University of Melbourne, who is leading the research. Theories abound, but no one is sure, all these years later.

The effort to respond to a pandemic will place some people at greater risk, simply because they will have to be around other people, and that's part of the price they will pay to be on the survivors list.

But some, no doubt, will refuse to show up for work.

Another study out of Johns Hopkins found that nearly half of the public health employees in Maryland said they would stay away from work rather than risk exposing their families to the virus. Physicians and nurses were more likely to show up than support personnel. Clerical and some technical personnel were less likely to work, chiefly because of their perception of the value of their own roles.

Two-thirds of the public health workers in that study said their role is not important in combating a pandemic, and thus, they were less likely to show up.

The new study emphasizes that if essential workers fail to come through, the entire structure of any society will begin to unravel. And thus, the aftermath of the epidemic could claim more lives than the virus.

And you wonder how many people underestimate the potency of an influenza pandemic. We all have to struggle with the flu from time to time, so how can it be all that threatening? But in the United States, an average of 36,000 people die each year from influenza, and 200,000 are hospitalized. And contrary to what happened in the United Kingdom nearly a century ago, elders and young children are the most common victims.

Those are large numbers, but they shrink compared to projections for a global pandemic. The Harvard University study extrapolated the number of deaths during the 1918-20 pandemic to the worldwide population in 2004. It estimates that 62 million persons would die each year from the pandemic. About 96 percent would be in developing countries.

Of course, we've learned a lot since 1920, right? True enough, but analyzing a specific virus and finding a treatment can still take time, and by its very nature, time is on the side of the virus. It's not something anyone really wants to think about. But it's coming, anyway.

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