influenza: exponential growth.

I've been reading The Great Influenza: The Epic Story of the Deadliest Plague in History by John M. Barry. It's shocking and terrifying. This is the biggest thing I'd never heard of, and learning about it makes me wash my hands a lot. I'm thinking of stocking up on gauze masks. Seriously.
The "spanish" flu of 1918 killed 30,000 people in New York City and more than half a million in the United States. It was most likely to be fatal in otherwise healthy adults aged 20-40. Healthy immune systems attacked the virus so powerfully that debris from the immune response clogged the lungs. People suffocated in their own blood. Overcrowded army barracks and troop movements facilitated the rapid spread of the virus. They were running out of coffins in New York City. Corpses literally piled up. The flu could kill within hours of exposure. The virus can stay viable in the air for an hour.

Here's the scenario that scares me:

1. Alfred is exposed to the flu virus. (Let's not worry about how it mutates or crosses the species barrier right now.)


2. The virus starts invading a few cells in Alfred's lungs.


3. A few hours later, the first generation of invaded cells burst, releasing around 10,000 virii copies per cel.


4. Alfred sits down for a meeting with Betty. They pass a whiteboard marker back and forth. Alfred is shedding virus; a few get onto the marker.


5. After the meeting, Betty touches her nose. Now Betty's infected.


6. Charles has a question for Alfred about how to use Microsoft Exchange. Alfred pulls up a chair to Charles' computer, and they work together for an hour. Alfred breathes out; Charles breathes in. Now Charles is infected.


7. Betty goes to the gym after work and works out on a treadmill. Dave and Edward are working out on the treadmills on either side. Now they're infected.


8. Alfred heads home for the day. He's standing in a crowded subway then he starts coughing. His immune system has mounted its first defense against the virus, sending a cascade of defender cells and antibodies to the lungs, where the virus is reproducing. Alfred is young and healthy, so his immune response is powerful. Infected epithelial cells are killed by the immune system; antibodies stick to virii and make clumps; the virus itself bursts and kills infected cells. So much debris accumulates that Alfred's alveoli can't exchange carbon dioxide for oxygen anymore. He is choking on his own immune response... and he's doing it on the subway, shedding thousands of virii. Alfred collapses and his lips start to turn blue. Alarmed, subway riders call 911; an ambulance comes and takes Alfred to the emergency room. His lungs are so clogged with virii and debris that he is put on a ventilator.


9. After the gym, Betty goes home, goes to sleep, wakes up in the middle of the night coughing, and dies.


10. Charles starts to feel ill the next morning. He stays home from work for a day, then another day, and another day. He has the flu, and he recovers without incident.


11. Dave starts to feel ill. He stays home from work. He conquers the viral infection, but his immune system is so depleted by the effort that it can't defend itself against normal airborne bacteria. After a week of the flu, Dave gets pneumonia. His family takes him to the doctor, who recognizes bacterial pneumonia, and puts him on amoxycillin. Alas, Dave's bacteria is resistant to amoxycillin. He doesn't get better after a full course, so his doctor puts him on erithromycin. After weeks of illness, Dave recovers.


12. Edward wakes up feeling ill the day after he was at the gym with Betty. He feels short of breath, and is scared, so he goes to the emergency room... but finds dozens of people in the waiting room, all as sick as him. Edward is admitted to an overcrowded hospital ward; not enough beds, doctors, nurses, or ventilators. Edward dies.


13. The paramedics who took care of Alfred when he went to the emergency room become ill. So do the other healthcare workers who treated him. So many healthcare workers become ill that hospitals and doctors offices cannot be fully staffed. More deaths.

That's probably enough of that: easy transmission in close conditions, rapid virus replication and shedding while asymptomatic, viral infection raises susceptibility to bacterial infection. Breakdown of healthcare institutions, then breakdown of civil society. It's going to happen. I'm not worried about will I get sick and die? I'm worried about, will modern society survive the pandemic?