Thursday, December 13, 2007

Book Group: The Last Town on Earth

The Last Town on Earth by Thomas Mullen was suggested for our library book groups by the Multnomah County Health Department. If a book group chose to read this, the department would contribute the books, and send a pandemic health department expert to the group. We chose this for our November read.

Jessica, our pandemic expert, was excited about this opportunity to work with the library. She loves the library, and participates in Everybody Reads as a library patron. This was her brainchild, and she hopes to make something like this as big an event as Everybody Reads. (Believe me, it is big here in Stumptown, known for its readers. I've had people stop me and exclaim, "Oh, that's the book everybody's reading, isn't it? Do you like it?") The health department? Not so well-known. She was excited about the greater visibility the department could gain by partnering with the library. She'd heard the author on NPR, and took it from there.

The Great Influenza, a non-fiction book about the 1918 flu pandemic, was considered for this joint venture, but she and the other planners felt this fictional account would be more approachable.

Up to a point, it was. We readers enjoyed the background history we learned, not only about the flu epidemic, but about the unions, the Wobblies, feminists, and their influence in the Pacific Northwest. As a group, we felt the characters and plot failed to live up to the subject. (It's unusual for us all to share the same opinion, to be fair our numbers were small just before the Thanksgiving holiday.) I tend to enjoy a plot that is driven by interesting characters. This seemed more to us like the author had a plot in mind, and created characters to fill those roles...not so believable to us. One person summed it up, that it seemed to be written with the movie in mind. She already knew the actors: Tommy Lee Jones for the town's leader, Jude Law for Graham, the stiff-upper-lipped young man just trying to protect his family. I was a little annoyed at the implication that an attempt to create a utopia was doomed due to human nature. Another felt the book started out well, but then got too simplistic.

One of the first things Jessica told us is that this story is a good illustration that quarantines don't work. I'd been wondering about the effectiveness of the masks. Wouldn't a sick person contaminating the outside of a healthy person's mask still manage to spread the disease? Just so. It would be more effective to have sick people wear the masks. The 1918 flu epidemic was what they would call a "category 5" flu. The world hasn't seen such a flu since. There were some global pandemics in the 50s and 60s, but not like this. Recently it was discovered that this flu did indeed come from a bird. (They got samples from bodies frozen in the permafrost.)

The bird flu existing now is difficult to pass from person to person, but a few cases have. As to whether there will be a bird flu that is easily's a crap shoot. Jessica told us plans would trigger if "anywhere in the world a confirmed cluster of a new flu" has a certain "fatality ratio." Plans can't include a vaccine really, because we can't predict the strain of a pandemic. Part of the problem in 1918, the US government so controlled the media that communities couldn't learn needed details about what worked in other communities.

We learned that here in Multnomah County, the "community mitigation strategies" for a category 5 pandemic come from the best practices that cities and towns took in 1918. Portland happened to utilize these, and didn't fare quite so badly.

These practices are:

  • multiple social distancing strategies (don't get too close)
  • cancelling school classes for up to 3 months
  • urging businesses to stagger shifts so less people are working at one time
  • if an individual is sick, urging families to stay home voluntarily

Another health dept expert, Amy S, has been perusing the archives about the 1918 epidemic in Portland. The first case of "Spanish influenza" in Multnomah County was reported on October 15, 1918. Because of the US media blackout, the big news coming out of Spain made it seem as though it originated there, thus the name. In the Oregonian, on September 29, 1918, 85,000 reported dead in Boston. In Portland, shipyards were affected, businesses "concerned as to the loss of ship production."

Challenges faced in a pandemic? Jessica said, "The closing of the schools: teens get antsy." [spoiler alert] In the book, 20-something adults were the culprits when they got antsy. Also, the global nature of businesses. For instance, if the health department seeks cooperation from businesses in closing the Lloyd Center Mall, they may have to call owners in China. Jessica was clear that Multnomah County doesn't have the authority to enforce martial law, nor did it seem she wished for it. She emphasized that within the department they work towards consensus. Her overall message seemed to be that best practices involved cooperation, not authoritarianism.

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