Imagine the next flu pandemic has reached Sydney, and the infection is spiralling out of control. Health-care workers are becoming sick, and dying at the same pace as the public, and the city's hospitals are overwhelmed.
Emergency departments turn away all but the seriously ill. The rest are issued with surgical masks, sent home with antiviral drugs (while these are still in stock) and told to await mobile medical teams.
Coordination of medical services begins to unravel as the number of new cases each day quickly overtakes the availability of medical staff. People who have not yet fallen sick start to abandon Sydney in droves.
New clusters of cases arise in rural New South Wales and soon in Melbourne, Adelaide and Brisbane, and along the eastern seaboard. Schools are closed, movie theatres and restaurants are avoided and public gatherings are banned.
As the number of deaths continues to mount, reports in the media spread alarm across the country as quickly as the virus itself. The disease reaches Perth, Darwin and Tasmania.
Laboratories work around the clock to develop a vaccine targeting the new strain, but no supplies are yet available. New Zealand, as yet free from infection, closes its borders to flights from Australia. All flights in Australia, both domestic and international, are grounded.
Incoming flights are turned back and only returning Australians are allowed into the country. The police and the military are empowered to enforce the sweeping powers of the Quarantine Act (1908), allowing them to detain anyone disembarking from a pandemic country and put them in mandatory quarantine.
Borders have closed to international trade, exacerbating shortages of food, soap, paper, light bulbs, fuel and medicines, including vaccines unrelated to the pandemic.
As more and more employees call in sick, businesses close one-by one and all but essential services grind to a halt. Australia's transportation system is reduced to skeletal operations and trains and buses are cancelled to prevent further viral spread.
In major metropolitan areas, looting starts as police absenteeism becomes chronic. Unpleasant ethical dilemmas have to be faced: who should have priority access to the limited antiviral supplies? Is enough antiviral medication stockpiled to keep those involved in maintaining essential services healthy until a vaccine is ready?
When it is available, who should be first in line to receive it? What will become of the vaccinated population when the world economy disintegrates under the global pandemic? How will the immense number of dead bodies be handled when the numbers start to outstrip the ability to process them?
It's a nightmare scenario, but one that could happen, according to the World Health Organisation (WHO). Lee Jong-wook, a South Korean doctor and head of the United Nations agency, warned in September 2005 that a pandemic is likely. (Editor's note: this article was first published in Cosmos Magazine in November 2005.)
The arrival of a pandemic-grade avian influenza H5N1 – capable of being transmitted from person to person, rather than having to be caught directly from poultry – was inevitable.
The WHO director was blunt in addressing a press conference in New York, saying avian influenza H5N1 "will acquire this capability – it's just an issue of timing".
And he said the fact that the virus is spreading via migratory birds means the threat is indeed global. "Human influenza is coming, we know that. We must pounce on human pandemic outbreaks with all medicines at our disposal and at the earliest possible moment. When the pandemic starts, it is simply too late."
Better known as 'bird flu', the deadly virus may not have yet reached Australia and New Zealand, nor mutated into a strain capable of efficient transmission between people. But experts believe it won't stay that way for long. The WHO considers Highly Pathogenic Avian Influenza A Virus H5N1 (as it is officially known) to be the world's most serious health threat, far greater than severe acute respiratory syndrome (SARS) or bioterrorism.
