When the Spanish flu crushed New York City in 1918, killing more than 12,300 people in a single November week, Diane Dobbins' grandparents lived in an apartment in Brooklyn and made their living in the garment industry.
Like swine flu, the virus was mild when it emerged in the spring of 1918, with illnesses lasting only a few days. But in the fall, it exploded into a pandemic. Mailmen wore doctor's masks on their routes. Parents of soldiers lived in fear -- not just of World War I, but because the flu whipped through barracks, decimating one man after another.
About 50 million people died worldwide -- more than three times as many as in the war -- spawning the stories Dobbins' 90-year-old mother grew up hearing.
"She remembers her mother telling her how people would put dead bodies out on the back porch and they would pick them up with a horse and cart," said Dobbins, leader of a Ventura County public health emergency office that once focused on bioterrorism and now fights H1N1.
The horror of what happened before, and the uncertainty of what a mostly moderate virus could still become, drives an unprecedented public health battle that continues after many of the people who worried about swine flu now label it as old news.
The county's Public Health Department has vaccinated more than 40,000 people and wants to reach three times that count. Add vaccine from private clinics and doctors and the target is inoculating 400,000 people.
Public health officials have spent an estimated $200,000 but could have used twice that without a massive volunteer effort involving seniors, retired healthcare workers and community college nursing students.
On Monday, for the ninth time in the past two months, volunteers helped conduct a mass vaccination event, this time in Newbury Park. About 550 people a day are vaccinated at the county's four public health clinics.
Though cases are declining throughout the state and the dangers of the virus are still compared to seasonal flu, the mass vaccinations and daily strategy briefings go way beyond that. Public health workers explain by citing the wild-card nature of the flu and how almost all pandemics come in three waves. They say that means the flu could surge again in weeks or months.
"If we don't do a good job and this becomes more severe, we're going to see a lot more illnesses, a lot more hospitalizations, a lot more fatalities," Dobbins said.
100,000 cases in the county
Estimates suggest virtually everyone has been exposed to the virus. Officials from the Centers for Disease Control and Prevention said on Thursday that nearly 50 million Americans -- about one of every six people -- may have caught the virus since April. Close to 10,000 people have died.
State officials are more conservative. They estimate 4.3 million Californians -- or about 12 percent of the state's population -- have been infected with swine flu since April. The vast majority of the state's cases have been mild, but there have been about 7,500 hospitalizations and 397 deaths.
County officials have no way to count cases. But the 12 percent rate would mean close to 100,000 people have contracted the virus. Hospitals have admitted 38 people for the virus, almost all needing intensive care and some requiring ventilators.
When a 50-year-old man from Santa Paula died on Dec. 5, it was the 11th death in the county and the first in which the victim had no pre-existing conditions. Out of a sample of 17 intensive care cases in the county, three of the patients were otherwise healthy, according to county records.
"When you can point to something else ... you can breathe easier," Dobbins said. "But when someone dies to this that we're all exposed to, you think 'Gee that person is just like me.' "
Though more than one of every 10 deaths across the nation have involved children, all of the local victims have been adults ages 43 or older.
Burned out on H1N1
County public health briefings once focused on shortages of vaccine and delays in deliveries from manufacturers. In addition to the vaccine sent to private clinics, about 90,000 doses have been sent to the county. About 5,000 doses expire in January.
Strategy has shifted to pushing out vaccine as quickly as it comes.
"It's a simple formula," said Dr. Robert Levin, county public health officer. "As long as we have vaccine, we want it in people's arms."
At least once a week, refrigerators of vaccine are trucked out of storage sites, including an undisclosed warehouse that would be guarded by SWAT teams if the epidemic exploded into a worst-case scenario.
The medicine is taken to community centers and school cafeterias for mass vaccinations. The efforts are headed by an emergency preparedness office created to cope with the anthrax fears that followed 9-11.
Nearly 3,000 people -- all in high-risk groups -- came to a Simi Valley clinic two weeks before Thanksgiving, waiting for two hours or more in lines marked by traffic cones. About 860 people came for vaccinations last week at an Ojai high school, on the day the county became among the first in the state to expand its eligibility for vaccine to anyone who wants it.
The change in numbers has sparked speculation that people are tired of hearing about swine flu and have decided on their own they're not at risk. Dobbins doesn't want people to panic. But she's more comfortable with fear than disinterest.
"If they have some fear of it, they'll read a little more," she said. "They'll listen a little more. They'll pay attention."
There are lots of worries: Convincing pregnant women to get vaccinated. Holiday travel spreading the virus. Vaccinating enough people so that if a third wave comes it's more ripple than wall.
Los Angeles County has already ended its mass clinics. Ventura County officials say they'll hold events through the end of the year and then assess where to go from there.
'Jaws' vs. Chicken Little
Healthcare leaders can choose to be like the town leaders in the movie "Jaws" and ignore the risks facing them, said Dan Jordan, a research psychologist in the county Public Health Department. Or they can be like Chicken Little and interpret every flu case as the return of 1918.
If Jordan had to pick between extremes, he'd choose the fable.
"The risk of being criticized for doing too much is better than the risk of doing too little," he said.
Peter Katona, a UCLA doctor who studies public health and infectious disease, says public health officials have been forced to make instant decisions without enough information. Even if the flu stays mild, the efforts are sort of an exercise that will prepare them for the next crisis.
But it's too early to offer any kind of judgment.
"The final answer to your questions won't be until April," he said. "That's when we'll know if it's too much or too little." To see more of the Ventura County Star, or to subscribe to the newspaper, go to http://www.venturacountystar.com. Copyright (c) 2009, Ventura County Star, Calif. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.
Copyright (C) 2009, Ventura County Star, Calif.