Illustration by Jane Sherman / Shutterstock by Mariyal and Babaroga

They all take center stage in a similar manner. Epidemics, when they first strike a city, enter public consciousness via a newspaper headline, or a chyron dramatically sweeps onto the TV screen, trailed by the pepped up stenographic voice of a local newscaster. An ominous acronym or initialism—SARS or MERS or EVD—comes to your attention, maybe for the first time, and you hope it’s not an all-caps bullet with your name on it.

Our current public health crisis was like this, of course, the contours of its arrival familiar. The contours of a news cycle. International curiosity to local news story to something, suddenly, disrupting our lives in previously unimaginable ways. Covid-19 is the biggest, most life-changing public health crisis to hit Seattle since the Spanish flu outbreak in 1918, but plenty of others emerged in between.

In the past 40 years, four events—HIV in the 1980s, an E. coli cluster in the 1990s, SARS in the early aughts, and hantavirus just three years ago—provide a snapshot of how our region has reacted, and continues to react, to such crises. An epidemic, and perhaps a few lessons, every decade.

Testing blood samples for HIV at Seattle's Public Health Lab.

In 1982, a copy of The Seattle Times would have set you back 25 cents. And on Friday, November 11, after you parted with your quarter and unfolded the 88 pages of newsprint that was that morning’s edition, below the story about the former KGB head turned Soviet Communist Party chief—and the one about Vietnam War veterans, and the one about a ballot initiative concerning a nuclear power plant—your eyes would have come to rest, finally, at this headline: “Deadly disease that mainly affects gay men surfaces in Seattle.”

For two years, the disease eventually known as Acquired Immune Deficiency Syndrome had plagued U.S. cities, mostly in LA, New York, and San Francisco. Its victims, otherwise healthy gay men, suddenly contracted pneumonia. Other symptoms included weight loss, mild fever, sore throat, swollen lymph nodes, and a cancer that presented as bruises and purple lesions. In 1981, the disease took 121 lives in the U.S. By the end of 1982, when health officials identified the first Seattle case, the number had jumped to 283. Along with that initial Seattle diagnosis, 50 other men had checked in at Harborview Medical Center with similar symptoms. In an interview with the Times, a hospital official cautioned against drug use with needles and that homosexuals should limit sexual relations to people they know.

For the rest of the decade, and well into the next, AIDS and the human immunodeficiency virus (HIV), the infection that leads to the disease, dominated local headlines. In the spring of ’83 it took its first local victim, a man from Tacoma the Times described as, “an office worker and family man in his early 30s.” He died in San Francisco; a Tacoma hospital transferred him there because it lacked proper ventilators—a pandemic-related complication that would repeat itself almost 40 years later.

Some 170,000 people have died of AIDS worldwide, though now almost 40 million victims live in relative comfort. It took nearly 20 years before the disease became a chronic but manageable condition rather than a certain death sentence, thanks to drugs agonizingly slow to hit the market. In the interim, Seattle clocked a lot of firsts.

We were the first region in the U.S. to establish a needle exchange program, started by activists in Tacoma in 1989 and then Seattle, and soon taken over by King County Public Health. That helped take off the street dirty syringes, major culprits in spreading the virus among intravenous drug users. We were also the first, in June 1992, to open a long-term care facility for people diagnosed with the disease, in the form of Bailey-Boushay House, which still stands in Madison Valley today, a monument to a city late to the crisis, but early with solutions.

 

They seem so harmless. Mice, especially out in the wild, minding their own murine business, not even raiding some homeowner’s kitchen for Cheez-Its, appear innocuous enough, bopping along in a meadow, along a desert floor, or under the floorboards of an abandoned cabin.

The problem arises when humans sleep among them. That is, when humans sleep among them and the little guys drop pellets of fecal matter that carry a particular virus. That’s what happened in 2017 when a 34-year-old Issaquah man, apparently unbeknownst to him, shared his home with deer mice and contracted hantavirus pulmonary syndrome, a serious respiratory infection that kills nearly 36 percent of its victims. “Hantavirus cases confirmed in King County; 1 man dies,” a Seattle Times headline offered on March 22, nearly a month after the  death. County health officials had opted not to announce the cases when they appeared, because they ID’d only two—a woman near Redmond who spent 10 days in the ICU the previous fall and the deceased Issaquah man—too few, presumably, to worry the public.

Even after the media learned of the cases and reported them there seemed little cause for alarm. Until April, when another suspected infection, again in Issaquah, emerged, this time a 50-year-old woman in the ICU.

She lived near Squak Mountain, as did the other Issaquah victim, albeit on the other side, both in rural areas. Informing the public saved the day. Health officials shared their worries about the region surrounding Squak, and the media spread the word about Centers for Disease Control guidelines: When cleaning after rodents people should not use a vacuum, lest they kick up dried fecal matter; clean the area with disinfectants and paper towels; and—like you do at QFC these days—wear gloves.

  

Dr. Jeffrey Duchin has led the region’s response to multiple epidemics over the decades.

The symptoms for severe acute respiratory syndrome, or SARS, will sound familiar to anyone with even the most glancing knowledge of life on planet Earth in 2020. Fever. Cough. Shortness of breath. SARS, like Covid-19, is a coronavirus, one similarly first detected in China. Suspected cases in the Seattle-region appeared in the spring of 2003—a 44-year-old sailor who’d been on the crew of a freighter that dropped anchor in Singapore and Hong Kong, and a two-year-old boy who traveled with his family to Hong Kong. Other cases followed.

“I think it’s not something that’s going away,” the county’s director of communicable-disease control told the Times. That director was Jeff Duchin, the very Jeff Duchin leading the county’s charge against Covid-19 today. And he was right. By year’s end, SARS would infect more than 8,000 people, and kill more than 700. The numbers paled compared to our current coronavirus outbreak, and there were no deaths in the U.S., but SARS functioned, in many ways, as a dry run. Quarantines. Travel bans. You know—by now—the drill. Seattle was instrumental in the dissemination of information to frontline workers, hosting 15,000 doctors, nurses, and medical researchers who discussed the virus at the American Thoracic Society at the Washington State Convention and Trade Center. Nearly 20 years later, many of those health experts are no doubt on the frontlines again throughout the nation during the pandemic fight now.

 

Past the balloons and the throng of TV cameras, beyond the staff bearing cards and hugs, the black limo idled, waiting to take her away. The 10-year-old girl from Redmond had spent 167 days at Seattle Children’s Hospital, where she was never expected to survive. Now she and a bear—a big plushy teddy bear nearly her size—were going home. This celebration, amid a balmy, 69 degrees on the last day of spring, June 29, 1993, belied the horrors of the preceding months, when a deadly outbreak lurked throughout the region. 

It started in January, when a pediatrician at UW filed a report about a series of cases involving children with bloody diarrhea and other symptoms consistent with Escherichia coli infection. By interviewing the parents of the victims, health inspectors followed a trail that linked all the victims to Jack in the Box, the fast-food burger chain. Most of the children had eaten the Monster Burger, a new item on the kids menu, and inspectors sought the meat source, narrowing it down to five slaughter houses. 

The E. coli strain had made its way into more than 70 Jack in the Box outlets in California, Idaho, Nevada, and Washington. Some employees, presumably in a rush, had not cooked the meat at the recommended temperature of 155, allowing the bacteria to thrive. It would ultimately infect 7oo people, all but 98 in Washington state. Hospitals admitted 170 E. coli patients. And there were four deaths, all children.

There were almost five.

The girl bound for the limo on the last day of spring had been admitted to Children’s on January 13. Her symptoms were so bad doctors placed her on life support and kidney dialysis. She languished in a coma for 40 days. Part of her colon had to be removed. The staff warned her parents she wasn’t likely to make it.

There would be years of work ahead, more operations, repeated hospital stays, brain damage that required her to relearn how to read and how to tell colors apart. And surviving an outbreak that killed other children—a six-year-old, a two-year-old, another two-year-old, and a 17-month-old—is cold comfort. Fortunately important changes at the USDA would soon come, requiring more rigorous regulation of the meat and food service industries. And the girl’s family ultimately won a $15.6 million settlement from Jack in the Box and its parent company.

And of course there would be more crises for all of us. The effects of viruses would play out in public and private through the decades. Until we came, ultimately, to this, here in the spring of 2020, our current pandemic, the one that’s wormed its way into our lives, sacked the economy, and made us all look like masked bandits when we’re out in the world—or when we take to our laptops and communicate with colleagues or family—like that barely recognizable person who stares back at us from our photo IDs.

For now, after nearly six months without leaving the hospital grounds, the girl slipped into that long black car, big bear in tow, and rolled into summer.

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