Implications of pandemic influenza for bioterrorism response

The 1918-1919 influenza pandemic (Spanish flu) had catastrophic effects upo n urban populations in the United States. Large numbers of frightened, crit ically ill people overwhelmed health care providers. Mortuaries and cemeter ies were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment me asures was obscured by the swiftness of the disease and an inadequate healt h reporting system. Epidemic controls such as closing public gathering plac es elicited both community support and resistance, and fear of contagion in cited social and ethnic tensions. Review of this infamous outbreak is inten ded to advance discussions among health professionals and policymakers abou t an effective medical and public health response to bioterrorism, an infec tious disease crisis of increasing likelihood. Elements of an adequate resp onse include building capacity to care for mass casualties, providing emerg ency burials that respect social mores, properly characterizing the outbrea k, earning public confidence in epidemic containment measures, protecting a gainst social discrimination, and fairly allocating health resources.