If health officials and media prognosticators are accurate, this coming winter may bring with it one of the most sweeping, deadly outbreaks of killer flu that the world has ever seen.
While that prospect would terrify the average person, it also intrigues Jim Higgins, a doctoral candidate at Lehigh University, who has been researching the 1918 flu pandemic that killed an estimated 50 million worldwide.
Higgins, who came to Lehigh after earning his B.A. in history and sociology at St. Vincent's College and his M.A. in history at Duquesne University, has spent the last several years combing through old coroner's reports, newspaper accounts, historical archives, hospital record and military files to piece together an accurate historical portrayal of the outbreak and spread of the 1918 flu. Higgins also cold-called nursing homes in the state to locate individuals with recollections on the 1918 flu outbreak.
What he's found, he says, should concern anyone.
"Most communities were woefully unprepared for the health crisis they faced," said Higgins, who is focusing his research efforts on the ability of Pennsylvania cities to respond. "Those cities that passed muster, relatively speaking, had been building a strong medical infrastructure for decades, and had sound public health policies based more upon science than politics. I'm not sure that's the case today."
Higgins' research has been done under the guidance of three Lehigh history professors: Roger Simon, John Pettegrew and John Smith, as well Dan Wilson, professor of history at Muhlenberg College. In each case, Higgins said, the professors have helped him focus on a component of the flu epidemic to gain a clear perspective on its causes, scope, legacy and lessons.
As a result, Higgins has found himself growing increasingly concerned with what he describes as a "bifurcated health care system where the best, state-of-the-art care is available to some, but not to others at the lower end of the socio-economic spectrum."
"What happens," he asks, "when people in South Side Chicago or Compton or the Bronx see people dying of this, while others get the care they need? What happens if the hospitals which traditionally serve the needs of the inner city begin to run out of beds? Do we think that people will sit pat in the projects and poor neighborhoods of our country and watch as their family and friends, their very communities, die? I don't see why there wouldn't be civil unrest."
What is certainly likely to repeat itself is the swiftness with which the flu raced through communities. In many cases, he said, those who are most vulnerable are the very young, the very old, and the immuno-suppressed, such as those fighting cancer, AIDS, or other devastating illnesses, to say nothing of people suffering from drug addictions and malnourishment. All of those high-risk factors are found in combination in the nation's inner cities, he said.
"With the 1918 flu, though, the exact opposite happened," he said. "Those who tended to be very vulnerable were those between the ages of 20 and 40, which really points up the folly of assuming the military might be able to help in such a crisis. What's to say members of the military wouldn't be impacted?"
In reading through coroner's records, Higgins found that account after account repeated the same pattern.
"Someone might have gone to work on Monday, developed a headache Monday night, was in bed Tuesday and Wednesday, and was dead by Thursday," he said. "Some went peacefully, through pneumonia, which they called the 'old man's friend' because it provided an easy passage. Others weren't so lucky." Many others – ironically, the typically healthy younger patients -- fell victim to acute respiratory distress syndrome, which replicated the sense of a chemical burn searing the lungs.
"It wasn't always that quick, either," Higgins said. "And along the way, you had symptoms like fingers and genitals turning black, and people reporting being able to literally smell the body decaying before the patient died."