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On a wing and a prayer

An epidemic of avian flu could potentially claim at least 50,000 British lives. If it does strike, it will reveal much about our contemporary attitudes to mortality and our capacity for altruism

THERE?S NOTHING like a death in the family to prompt thoughts of mortality. My mother died recently, aged 91; as we gathered for her funeral, several of us remarked on our family?s remarkable avoidance of the Grim Reaper. Our birth dates ? mother, father, five children, many grandchildren and great-grandchildren ? span an era that stretches from 1911 to 2005. So my mother was the first of us to die in the course of almost a hundred years. Death had been what happened in other people?s families. For the very first time, we could now say: ?Who?s next??

Since the First World War, and the Spanish flu pandemic of 1918-19, the British people have enjoyed a similar sense of blessed immunity from sudden and mass mortal afflictions. In the early part of the century tuberculosis cut swathes through the population; but death invariably came slowly over a number of years and tended to hit the poorest. There have been isolated disasters like the coal slide that killed 144 people (109 of them children) at Aberfan in 1966; there was the scourge of mad cow disease, when it was the animals that faced mass death rather than the humans; the occasional flu epidemic; the bombings of the IRA, and now the terror of 7 July. But compared with much of the rest of the world, Britain has been a temperate haven of health and safety, free from geological fault lines, tidal waves and plague. Even in the Second World War, the air raids killed in the space of five years fewer civilians (some 50,000) than died during the course of one night in the city of Dresden. Sudden mass death is what happens elsewhere.

The prospect of avian flu seems set to change that. As the experts keep telling us: it is not a question of whether, but when. According to the Government, an Avian flu pandemic could kill 50,000 people in the UK. The calculation is probably an underestimate. The authoritative monthly journal Foreign Affairs, backed by a panel of experts, has reckoned that some 6 million could die in the US if the pandemic hits there, indicating a comparable mortality rate of more than a million in this country. Last month the World Health Organisation (WHO), revised its original forecast of 150 million deaths globally down to between 2 million and 7.4 million The revision had all the signs of combating potential panic. The fact is, nobody really knows how many will die: although we do know that the H5N1 virus, the guilty bird-flu disease in South-East Asia, has to date killed about half its victims. According to the WHO, a quarter of the population could catch the virus if it begins to spread from human to human. This could mean that, even at a 5 per cent death rate of the infected, some 750,000 Britons could die. Yet, whatever the number, high or low, the deaths are not the only consideration. There would be two waves, several months apart, involving calamitous pressures on food supplies, travel and a slump in trade, industry, finance and security.

Britain?s mettle was tested during the First World War when some 900,000 British troops lost their lives; the Spanish flu accounted for another 250,000 British deaths. The culling of an entire generation was endured with more or less fatalistic fortitude. It was the young things of the 1920s who, in reaction, gave vent to hedonistic abandon. Even so, the flapper generation depicted in novels like Evelyn Waugh?s A Handful of Dust and Decline and Fall were an over-privileged few. My late mother was representative of the less privileged major-ity. ?People?, she used to say, ?were just grateful to have survived.?

After the mass casualties in the trenches, Britain had taken the Spanish flu in its stride. If an avian flu pandemic erupts, how will we react as a nation? After a long period of peace and prosperity since the end of the Second World War, we are unlikely to face the avian flu with anything like fatalistic equanimity.

Reading the runes of press coverage on the topic this past week, I was put in mind less of modern precedents and more of the historic example of that great fourteenth-century pandemic, the Black Death. During the Black Death many of the canny rich, guessing the contagious nature of the disease, quarantined themselves in bastions on protected hilltops waiting for the plague to spend itself.

The Sunday Times, in an article entitled ?How to Survive Bird Flu?, suggested, similarly, that the best prospect for survival was to head for the hills, an apparent encouragement for those with remote second homes to take their families into hiding, having hoarded stores of tinned groceries. According to the paper, however, the Government will deploy tough quarantine measures in infected communities, ?so you would need to act fast?.

The Black Death killed an estimated third of Britain?s population, so there is no comparison in death rates, but indications that the privileged will stand the best chance of survival are already prevalent. I have heard people boasting how they are stocking anti-viral medicines through private prescription for the exclusive use of their families; and it has been reported that members of the Government will be recipients of the first vaccines. With empty supermarkets, depletion of medicines, and reduction through illness of policing, it is unlikely that the have-nots would remain sanguine about the advantages seized by the haves. The Sunday Times recommendation of survival by ?heading for the hills? seems a recipe for civil disorder.

The Black Death prompted another widespread response, all too familiar in our Christian past. Convinced that the plague was God?s vengeance, people covered themselves in sackcloth and ashes and formed self-flagellation rings. Acting on a similar impetus, the Christian Right in America has been invoking local sinfulness, and God?s righteous anger, following the New Orleans flood. In Britain, however, a more likely reaction ? and there have been plenty of reports in anticipation ? will be to blame the Government, and/or the scientists, and/or the NHS, for failing to keep the disease at bay, and for failing to provide everything from vaccines to face masks in sufficient quantities.

What has been noticeably absent, however, in the ?flu frenzy? coverage is sober discussion as to how the medically unqualified healthy will be able to care for their sick families and neighbours, including people who live alone. We are not talking sophisticated medicine here. During the 1956 flu outbreak, when I was a pupil in a junior seminary, the entire college came down with flu, including all our teachers, the nuns who cared for us, and the local doctor. That is how pandemics strike within many communities: everybody gets it. For the space of one whole day and night just two boys were free of the illness. Instead of ?heading for the hills?, they rolled up their sleeves. There was a lot to be done: making sure that we had sufficient liquid, changing sheets, emptying urine bottles, distributing aspirins: just the basic corporal works of mercy. Simple nursing of this kind during a pandemic could mean, in many cases, the difference between a patient overcoming the virus or succumbing to it.

REPORTS OF the coming avian flu have been punctuated through the past week by ever more calamitous news from Pakistan. There has been much criticism of the Pakistani Government by its people, alongside pleas for international aid. There have also been looting and clashes in the scramble to grab provisions. But the most impressive of the images have revealed how destitute and homeless victims have been helping each other.

There could be no clearer indication of the extent to which the religion of Islam sustains the impulse of care of others. And it raises questions as to whether a similar impulse is to be found in Britain. Altruistic care for others no doubt exists in secular societies, where it appears all the more noble in the absence of spiritual rewards.

The Christian faith was founded on the selfless, non-conditional love that is agape. Yet the focus of our ethics has, in different eras, and under various pressures, tended to shift towards preoccupations that have little or nothing to do with selfless generosity and care for our neighbours. Avian flu may well put the fundamentals of our faith to the severest of tests.

John Cornwell is director of the Science and Human Dimension Project, Jesus College, Cambridge.

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