Are we ill-prepared for pandemic influenza?

America was a nation at war.

In September of 1918, soldiers at an army base near Boston suddenly began to die. The cause of death was identified as influenza, but it was unlike any strain ever seen. As the killer virus spread across the country, hospitals overfilled, death carts roamed the streets and helpless city officials dug mass graves. It was the worst epidemic in American history, killing over 600,000--until it disappeared as mysteriously as it had begun.

It was like a horror movie.

It's been 35 years since the world experienced a flu pandemic, the Hong Kong flu of 1968-69. And it, by pandemic terms, was a mild one, killing only an estimated one to four million people in the developed world.

So many of us don't have a clue what a flu pandemic would be like. Getting a picture of what it could entail might make it easier to understand why the World Health Organization and governments around the globe are desperate to keep the current avian influenza outbreak from sparking a pandemic among humans.

Let's put it this way: When it comes, it won't be pretty.

We've been warned.

Following are some facts about pandemic influenza:

WHAT IS IT? A flu pandemic happens when an influenza virus that hasn't circulated before in humans emerges from nature. No one has immunity and millions around the world get sick.

HOW DOES IT HAPPEN? A pandemic flu strain can be created two ways. An existing strain can mutate; flu viruses are prone to mutation. Or an animal virus can reassort or mate with a human flu virus, acquiring the ability to spread from human to human.

HOW OFTEN DOES IT HAPPEN? On average about three times a century. In the 20th century, pandemics occurred in 1918-19 (the Spanish flu), 1957-57 (the Asian flu) and 1968-69 (the Hong Kong flu).

WHO GETS SICK? In regular years, the very young and very old are hardest hit. But that's not necessarily the case during pandemics. The death toll for the Spanish flu was highest among people aged 25 to 34.

HOW MANY LIVES COULD IT CLAIM? That depends on the severity of the strain. The Spanish flu killed an estimated 20-to-50 million people; the Hong Kong flu, a mild strain, killed between one to four million people in developed countries. The WHO predicts the next pandemic could kill between 280,000 and 650,000 people in the developed world. Health Canada predicts 11,000 to 58,000 deaths in this country if a vaccine cannot be developed.

WILL THERE BE A VACCINE? The WHO, in conjunction with manufacturers like Shire Biologics of Canada, will work feverishly to produce one. But there are no guarantees a vaccine will be available in time to protect large portions of the general public.

It's a good thing the government has everything under control.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said it's too soon to tell if there will be a flu crisis this year.

"Well, we're just at the beginning of the flu season, so we can't predict whether this is going to be a serious year or not," Gerberding said Monday. "We have 20 million more doses of flu vaccine to get out there, and our goal is to get those doses to the people who need it the most before the season really speeds up."

The shortage also has become an issue on the campaign trail, with Democratic candidate Sen. John Kerry blaming the Bush administration for not paying attention to warning signs about possible shortages and the Bush campaign inferring that vaccine manufacturers are hindered by fears of lawsuits, something the campaign said Kerry would not move to fix.

"I'm sorry that this is becoming a political issue. This is really a health issue," Gerberding said. "I think the bottom line is that the administration has requested a great deal [of] increase in the support for influenza.

"We have a stockpile. We have more drugs than we've ever had to treat this condition. I feel like we are taking responsible steps, but we need to solve the problem with the vaccine manufacturing and that's a problem that's been 25 years in the making."

Gerberding said vaccine manufacturers need "a guaranteed market, they need a fair price and they need liability protection."

Does that sound like the CDC might be engaging in the political debate?

Both candidates for President of the United States indicated in the presidential debates that the greatest threat to national security is the potential for nuclear proliferation in the hands of terrorists. I guess that could change.