I love "alternate history" science fiction, as well as its grown-up cousin "counterfactual" history—speculation by historians on what might have resulted if Napoleon had won at Waterloo, or Hitler had died in World War I. We know it didn't happen that way, but...what if?
Since it's a quiet flu-news day, and I have a little time, here's a speculation on what might have happened if H5N1 had become a pandemic in the fall of 1997.
The first human H5N1 case kills a little boy in Hong Kong in the spring of 1997. That summer Prince Charles arrives to hand the Crown Colony over to the People's Republic of China, and has to wear a gorgeous uniform in pouring rain.
That fall, as Hong Kong is getting used to its new status as a Special Administrative Region, more human cases occur. Margaret Chan herself falls ill, and spends weeks in intensive care. Public-health officials hesitate to act without her approval.
H5N1, spreading from birds to humans, has learned early how to move from human to human. By Christmas 1997, people in Hong Kong and southern China are falling seriously ill.
China tries to suppress or downplay news of the spreading disease. This only lends credence to rumors, both accurate and wild. Many Hong Kong residents are "astronauts"—they work in Hong Kong while their families live in Vancouver or Toronto or various American cities. Many such astronauts, clutching their Canadian and American passports, head for Kai Tak Airport to celebrate Christmas with the family. Others leave for Australia or Britain.
Some carry H5N1, and arrive in Vancouver and London still well enough to go home and infect their families—especially their children. So while Father is home in bed, the kids are off to school, spreading avian flu.
By mid-January 1998, the new disease seems to have sprung up everywhere, and its lethal effect on children shocks healthcare workers in North America, Australia, and Europe. Hospitals are swamped with emergency patients, while staff—untrained and unprepared for such a surge—either fall ill or stay home.
Let's assume that this H2H strain could infect a third of those exposed to it, with a 10 percent case fatality ratio—far, far less than that currently seen in Indonesia. In a 2000-student high school in the San Francisco Bay Area, almost 700 teenagers fall ill and over 60 die. Some teachers fall ill also, mostly younger ones, and six of them die.
Coming out of nowhere, H5N1 staggers that Bay Area community—and the hundreds of other communities where it appears in January and February. Across North America, governments scramble to cope. The Clinton administration comes under fire for allowing this disease to sneak into the US. The death of Chelsea Clinton mutes this criticism. The bereaved president is forgiven for his misdeeds.
Since so many of the first North American victims are Chinese, racism disguised as hygiene inspires boycotts of Chinese restaurants and other businesses. The Canadian prime minister and his cabinet meet for dinner at a Chinese restaurant in Toronto, bravely digging into their kung pao chicken while photographers (wearing masks) take pictures.
By the end of February, however, the new normal is suspended classes in most schools, businesses running at one-third capacity if at all, and pre-emptive quarantine of military bases: No one in, no one out. The same is true of US bases overseas, since H5N1 by now is causing thousands of deaths in Europe and Asia. Prince Harry's death inspires a paroxysm of grief almost as great as that inspired by his mother's, six months earlier.
By the end of March 1998, however, the pandemic appears to have ended. The world economy staggers into a recession, made even worse by the collapse of China's government. Not until years later does the world learn that 100 million people died in China between mid-December 1997 and mid-February 1998—most of them of "collateral damage" including other diseases, starvation and civil unrest.
The Second Strike, as CNN calls it, begins in October 1998. The CFR climbs to 15 percent, and collateral damage includes millions of people who die for lack of routine medical care. The pandemic now rages though Africa and Latin America while revisiting North America and Europe.
While researchers learn a lot about the virus, and vaccines are soon ready, production is slow and limited. Bitter political arguments break out over who should receive the vaccine. In France, the government falls over the issue.
President Clinton falls ill on October 6, and Vice-President Gore takes over four days later. By October 15, Gore has ordered all US naval units to remain at sea or to quarantine themselves at the nearest US base. The bombing of Iraq by US and UK aircraft ceases because not enough personnel are well enough to fly. Rumors indicate that Uday and Qusay Hussein, the dictator's son, are both dead of the flu. On October 22, Saddam Hussein is in hospital in Baghdad. Next day he is dead, perhaps not of H5N1, and a junta assumes power. Its first act is to appeal to the US for medical assistance.
The US congressional elections in November see a record low turnout of voters thanks to social distancing. The Democrats win control of the House and Senate. By the time Congress convenes in 1999, President Clinton has recovered, but remains physically and mentally disabled—strikingly like Woodrow Wilson, who probably contracted Spanish influenza during the Paris peace conference in 1919. Clinton resigns, and Gore becomes president.
He has his hands full: a worldwide recession, China prostrated, a renewed civil war in ex-Yugoslavia that the European Union can't deal with, and an American healthcare system in ruins. Accurate estimates of worldwide fatalities are hard to find, but it looks like 75 million from H5N1 alone. In the US, 10 million have died of avian flu.
But by now everyone in the world expects a Third Strike, and governments frantically train volunteer and retired healthcare workers to cope with it. When it does arrive, starting in Russia in October 1999, it is mercifully brief and weak, and vaccine supplies are less inadequate. By the end of the year the pandemic is over.
In North America, Australia, the European Union, and Japan, governments' first priority is to rebuild their healthcare systems. Gore pushes through a universal health-insurance program, funded in part by closure of many overseas bases. This measure is highly popular, and in the 2000 election Gore is re-elected by a landslide.
Early in 2001, at a meeting of the National Security Council, one small item on a crowded agenda goes almost unnoticed: The death of Osama bin Laden, a little-known Saudi terrorist in Afghanistan, where H5N1 has killed scores of thousands. The Taliban, incapable of dealing with the pandemic, has been overthrown by General Massoud.
The country seems headed for more chaos, but Gore decides that a "convalescent" US has no role to play there. The task now is to make the US, and the world, healthy enough to withstand the next pandemic. Only time will tell whether he will succeed in that task.