Chapter Six
Daddy Is Under the Roses
H5N1 was spreading, fast, through the world. A few countries tried, hard, to close their borders. Some of them thought they'd done a good job. Cuba slammed the door fast but the sucker got in anyway. Then their "universal health care system" kicked in. Raoul wasn't as stupid as the Chinese; the soldiers he sent out were immunized. But the "universal health care system" in Cuba wasn't anywhere near what it was cracked up to be. If you weren't someone important, say a liberal celebrity licking a dictator's boot, you had to wait and wait for any kind of treatment. And trust levels were, to say the least, low. So when Cuba's patient zeros turned up it was the same problem as Chicago. People ran from the soldiers who weren't all that happy dealing with a plague. And when people went to the hospital because they were afraid they were dying they generally died. And infected everyone around them, some of whom could escape one way or another.
Then the soldiers started deserting and the doctors started deserting, taking as many medications as they could carry with them, and Cuba took right at 60% casualties, primarily among the mid-range of adults. Classic H5N1.
Britain's an island. It's hard to get to Britain if you don't have a plane or a boat. Britain cut off aerial communication with the U.S. when Ching Mao was reported. Didn't matter. A Thai doctor who was a British citizen landed at Heathrow the day prior to Ching's discovery. He had just returned from visiting family in Thailand via India. He landed in India prior to it cutting off contact with Thailand and India still wasn't on the quarantine list.
Two days later, Britain cut off all communication. But by that time it was too late. The doctor and nine other infecteds had spread out across the country. He was in frank symptoms for less than twenty-four hours when Dr. Van realized what he had and reported to his local health clinic. Where, despite being an MD, he had to wait. He'd worn a mask, not wanting to infect anyone else, and was gloved. He told the triage nurse he suspected he had H5N1. That was on the records of admission.
The records also listed his time of speaking to the first person about his condition. It was nine hours later when he was finally examined by the on-call MD who admitted him as a possible H5N1 patient. He was subjected to a battery of anti-viral drugs and put in quarantine while being questioned. He was fully conscious, in the first stage of bird flu. He gave a very comprehensive list of his contacts and had even taken the time in the waiting room to make notes.
During his stay in the waiting room, despite his best efforts, he was later determined to have infected eighteen persons. Total infectants was never quite determined but was believed to be on the order of two hundred.
Two things were important here. The first is that, as with any illness or injury, speed of the response mattered with the Plague. Dr. Van died. Because he is one of the classic cases, there have been many articles written about Dr. Van. He had waited twenty-four hours after showing first symptoms, normal cold and flu symptoms, to go to the medical clinic. When asked why, he admitted he knew he would deal with much hassle and red-tape and hoped it was just a normal flu.
Even an MD didn't want to deal with British Health.
He waited nine hours for treatment. In the U.S., unless you were going to an emergency room with the flu, you weren't going to wait that long. Most people of any economic substance, and many who were on medicare or medicaid, had personal doctors. There were "emergency medical clinics" (Doc-In-The-Box) scattered at random.
From the first reports of H5N1 anyone with a sniffle flooded to their nearest MD. While in some cases there was little to be done, they were all instructed on basic necessities and in most cases pumped with anti-virals. The most effective in original tests, Zanamivir from Glaxo, had, again by the Chinese, been made useless. They'd used it in chicken populations in the years before the Plague and H5N1 had developed a resistance. A newer one, Maxavir, also from Glaxo, had just been distributed. Stocks ran out fast, but people who were treated in the first few hours of frank symptoms, instead of nearly 36 hours after the first sniffle, recovered at a rate of 80%. There was even an over-the-counter medication that increased survival rate if taken immediately on first symptom. Many people started using it as a prophylactic until it ran out and probably caused H5N1 to develop its resistance. But they survived.
Most of this wasn't available in a "socialized medicine" country unless you went to the local clinic and waited all fucking day to see a doctor.
Study done in 2004 by the CDC. The way that good science works is that the scientist looks at something and says "What if?" He then develops a statement from that (a hypothesis) then tries to disprove his hypothesis. "The sky is yellow." He first defines yellow. He then tests to see if the sky is yellow. If it turns out that the sky is actually blue, his hypothesis gets disproved. But he still publishes the paper and comes up with another hypothesis. Say that the world is really round. If he cannot disprove his hypothesis, it then and only then becomes a theory. This is Science 101. Man-induced global warming was an hypothesis that had been repeatedly disproven. Anthropogenic (man-caused) global warming proponents weren't scientists, they were religious zealots.
Anyway, the CDC liked "universal healthcare." It was a government health program and government health programs were good. They were a government health program so any government health program had to be good.
Hypothesis: "Universal health care will increase the lifespan and general health of a population over free-market health care."
Conclusion: "Fuck, we were not only wrong we were really wrong!"
How could that possibly be? Seriously. Universal healthcare is, well, universal healthcare! Everybody gets the same quality of treatment, young and old, rich and poor! Nobody is turned away! It's perfect communism! With doctors!
Yeah, everybody gets the same quality of treatment: Bad.
Look, if you're between the ages of 7 and 50, in reasonably good overall condition, don't have fucked up genetics and don't really lose the lottery, you generally don't really need a doctor. People between the ages of 7 and 50 rarely realize how bad socialist medicine is. Because they don't have to depend on doctors.
Try getting a hip replacement in a country with socialized medicine. Or a gall bladder operation. Hell, try getting drugs that improve a heart condition without surgery. And even though you can't, you also can't get surgery. Not in any sort of real time. Go rushing into a socialized medicine hospital with a clogged artery. You're going to get a stent if you're lucky. And get put on a waiting list for a bypass. For various political reasons, drugs that in free-market economies are the first line of defense just aren't available.
In the U.S. the standard time to wait for a gall bladder operation was two weeks. In the UK it was nine months. In the U.S., if you needed a bypass you'd be out of the surgery less than fourteen hours after emergency admission. In the UK it was emergency admission, minimal support therapy, months wait. Some 35% of persons waiting for a bypass operation died before they got one.
They found an interesting statistical anomaly as well. Death rates amongst the elderly climbed sharply as the end of the fiscal year approached.
Doctors in socialized medicine programs worked for the same pay whether they fixed people or not. But they had quotas for operations. As the end of the fiscal year approached, most of them had filled their quotas and went on actual or virtual vacation.
And people died.
Average population age in most of the socialized medicine countries were only starting to climb to the levels where death rates due to poor medical care were going to be noticeable. But the truncation of ages was clear. As were quality of life indicators.
Persons in free-market medical environments lived longer, healthier, less pain-filled lives. Despite the evil doctors and HMOs and pharmaceutical companies? No, because of the evil doctors and HMOs and pharmaceutical companies. All three groups had a vested interest in keeping patients alive as long as possible. The longer they lived, the more money the "evil" guys made.
The U.S. had been repeatedly castigated for the cost of healthcare and especially pharmaceuticals. Also for over-prescription of the newest and most costly.
But.
In Europe there was no pressure to use pharmaceuticals. With costs capped by the government, there was no incentive for the pharmaceutical companies. Modern pharmaceuticals are enormously expensive to field. The first problem is the cost of development. Many of them are derived from natural substances, but it takes relentless searching to find a new natural substance. Cancer drugs were derived from rare South African pansies, new antibiotics were derived from fungus found on a stone in a Japanese temple. Then they had to be tested to find out if any benefits could be derived.
Here's the numbers:
Animal (screening) in rats—about 1–2 years, cost about $500k/year, in monkeys—about 2–5 years, cost $2 million a year. Phase I in humans is strictly toxicology: 2 years, $10–20 million a year. If it doesn't kill anybody, then move to Phase II testing for effectiveness: up to 10 years, cost $100+ million/year. If statistics suggest a beneficial effect, then on to Phase III to determine effective dosage, side effects, other benefits and "off-label" uses: 5–10 years at another. $100+ million a year. A (large) Pharma company will start with 10,000 compounds in screening, take about 200 into animal testing, then possibly get ten into Phase I to maybe get one into Phase II. In the last 10–20 years, about 95% of Alzheimer's disease drugs that got to Phase II on the basis of rodent testing were sent back because they had no effect in humans—hence the necessity for the added expense of monkey testing . . .
It was a hideously expensive process. Again, Do. The. Math. Easily a billion dollars invested in one drug. The reason that a new pharmaceutical was so expensive was not just the cost of developing that pharmaceutical but the brutal necessity of so many thousands and millions of failures that that one new shining hope bore upon its back. Billions of dollars lost when "miracle" drugs failed at one step or another. And all that money only being recouped by those limited shining hopes that made it through the process.
But the results were worth every penny. New drugs that cut the need for bypasses; one of the most lucrative surgeries of the 1980s had been almost eliminated in the U.S. by the time of the Plague. Stroke reducing medicines, anti-cancer medicines, cancer prophylactics and, of course, Viagra, every old man's fantasy made real.
In Europe, in contrast, it was considered cheaper to just operate. Much more unpleasant for the patient but the doctors filled their quotas and the government wasn't forced to pay for the development of pharmaceuticals. Which was why most of the modern wonder drugs were coming out of America or from European businesses that were making most of their nut selling them in America.
Doctors in socialized medicine countries, and their bosses and the heads of departments, had no vested interest in keeping old people or the chronically sick alive. The doctors might have a personal desire to help people, otherwise they wouldn't have become doctors. But they had no actual benefit and if you've ever dealt with a bunch of crotchety old people you can see some of the actual detraction.
For doctors, hospitals and pharmaceutical companies in the U.S., those crotchety old people spelled money, money, money! So they researched and they worked and they studied ways to extend the time they could continue to suck the money out of them.
In the case of governments of socialized medicine countries, the primary users of the services, see: "crotchety old people," were their worst nightmares. The patients worked their whole lives, contributed to the economies of the countries and now expected to be paid back. Heavily. Socialized medicine wasn't the only benefit they expected. They retired early with pensions that nearly equalled their salaries when working. And they paid little or no taxes. And as any health insurance actuary will tell you, they consumed 90+% of the health budget. Mostly in their last six months of life. And what was the point of that?
It would be unfair to say that the politicians just wanted to see them all go away and that cutting off access to vital health services thus killed two birds with one stone. Save money and quietly kill off the primary users.
Or would it? Health care spending as adjusted for inflation had dropped steadily in socialized medicine countries in Europe even as the need had increased. All access to medicine was rationed. And in the Netherlands people who were "beyond help" were denied access to healthcare on a regular basis and even "medically terminated," put to death, against the wishes of their care-givers. Not only old people but children with chronic health care problems. "Terminal" cancer? Which sometimes was treatable or even erasable in the U.S.? In the Netherlands, they just turned up the morphine drip until you quietly passed into the Long Dark.
A corollary effect was on the members of the health profession. A doctor in Britain who worked ninety hours a week got paid exactly the same as a doctor who worked forty hours per week. (Often they worked less.) And it was rare that there were any changes for quality. World-renowned surgeons in Germany and France made only a fraction more than less competent doctors.
In the U.S., on the other hand, they could write their ticket.
The brain drain was not severe at the time of the Plague but it was telling. More and more top-flight doctors had left to find greener pastures. For that matter, doctors in less developed countries had flooded into the U.S., where they might not make a fortune but they got paid in more than chickens and hummus. They filled the corner "Minor Emergency Centers" as well as being the front line general practitioners, a field most American born doctors disdained as the most plebian of medical fields.
This was what the good doctors at the CDC learned when they set out to prove that American healthcare, with its dependence on the free-market, doctor/patient choice, HMOs and pharmaceutical companies was far inferior to the enlightened healthcare of "socialized medicine" countries.
They discovered the irrefutable truth that when you put the same sort of people that run the Post Office in charge of your healthcare you get Postal Workers for health care providers. And more people die in less necessary ways.
So let's go back and look at the effect of H5N1 on populations.
In its initial discovery, mortality among affected populations, primarily Chinese poultry workers, was right at 60%. Two out of three who were infected died despite best efforts on the part of local (socialized medicine) doctors. This continued as a pattern during the long period that H5N1 was confined to avian to human transmission.
Across the board in unimmunized populations with access to "universal healthcare" the same pattern emerged. Two in three unimmunized patients who were admitted to healthcare environments (less than 10% of the affected at the height of the Plague) died.
In the U.S. the rate was one in three.
Thirty percent vs. sixty percent. Still a horrific number, total death-toll from direct effects of the Plague are estimated to be around a hundred million. But if the rate had been the same as Europe's, the death toll would have been twice that.
Why?
It had been a puzzler even before the Plague. One reason that there was a somewhat slower response among the public to H5N1 was that there had been an earlier scare involving something called SARS, Severe Acute Respiratory Syndrome. It had also started in China, there had been a cover-up that affected a large and never clearly documented number of cases with estimates ranging from five hundred to fifty thousand and mortality rates similar to H5N1. It had broken out into Thailand and Singapore and even spread into Canada. Everywhere the rate was the same, serious pulmonary distress that led to death in five of ten cases. Including in Canada, which was prepared for it and responded very fast to the discovered cases.
Cases that reached the U.S. were given a different name: MARS; Mild Acute Respiratory Syndrome.
Same exact bug. Fifty documented cases in the U.S. No. One. Died.
Why?
Think of Dr. Van. A physician who cooled his heels for nine hours in a waiting room after telling the triage nurse that he probably had a deathly illness.
By the same token, cases in the U.S. called their private general practitioner and told him that they were very sick. They were seen within no more than two hours and admitted within less than an hour afterwards to the hospital.
Cases in Canada which were detected through investigation got similar speedy care. More of them survived than those who were first cases. Speed of care was preeminent. Yes, too often it simply didn't work. And as cases burgeoned the healthcare system in every country became overloaded. But in the U.S., people didn't just have to go to the local health clinic. As hospitals became overloaded, doctors often shifted to the old fashioned home-visit. Where they could not, there were thousands of minor healthcare providers, mostly LPNs and Medical Assistants, from that increasingly lucrative industry who were pressed into service. The number of providers in the healthcare industry in the U.S. had been exploding as the population aged while it had been more or less stagnant in Europe. Because there was money in them there old people there were just more healthcare workers per patient.
Many of them worked through the height of the Plague for little or no money. The economy was tanking, fast. They worked in the hopes that they'd get paid and eventually most of them did.
This was one reason that the mortality rate from direct effect of the Plague was lower in the U.S. than in other modern countries. (Countries which never had their act together simply sank lower. I'll discuss my personal experiences of that later.)
A secondary reason is debatable. It had been debated as far back as the SARS scare and still remains questionable. But there is now some corroborating evidence based on analysis of mortality rates in various populations based on their lifestyle. It is, however, detested by most health care persons and every remaining "organic lifestyle" lover on the planet.
Hormones.
We're back to industrial farming. Yep, we injected our livestock with all sorts of shit. Growth hormones for the beef and goat stock. (Yes, we raised goats for meat. There was a pretty good market before the Plague.) Milk generating hormones in the milk cows. We used "genetically modified" seeds that were hyper-resistant to dozens of pathogens. We sprayed herbicides and pesticides and laid down fields with ammonium nitrate (the stuff terrorists use in big bombs) to increase yields. We used every trick in the book and most of the bigger farm corporations we competed against used the same tricks, just not as well as we did or we'd have gone out of business.
And you all ate it every day. For that matter, at the food factories, and there is no other term for the way that food was processed, it was then injected with more "stuff." In some cases it was vitamins. Preservatives. Colorations.
The U.S. was the most heavily chemicaled food on earth. Sure it had some effect. Was it a contributor to obesity? Don't know and there's no clinical evidence. Ditto "early maturation": those cute little girls that got their boobies way too soon. But it was in your bodies. If you weren't a health nut. And be glad you weren't.
One study that is roundly castigated still but pretty hard to argue showed that people who were "uncaring" in their food choices had a five percent lower mortality rate than people who were "careful" in their food choices. The language of "uncaring" vs. "caring" was explained in the codicil that "caring" meant they ate, to the greatest extent possible, organic and natural foods. Uncaring meant they stuffed whatever in their maw and didn't give a shit how it was raised or what was in it as long as it was tasty.
The problem with the study, with which I agree, is that there is no mechanism explained for the effect. Got that. But that was what the pope's Inquisition said about Galileo. Sure, he thought that the Earth revolved around the sun but he didn't have a mechanism. Gosh, he might even have evidence, but he couldn't show why that was the case whereas the "scientists" of his day had thousands of years of built-up stories about how the sun revolved around the Earth. And my answer is the same as his: "It still moves!"
In the U.S. SARS, a huge health threat everywhere else it touched, became MARS, a very bad cold.
Part of that was, unquestionably, free-market medicine vs. socialized. Absolutely. But another fraction, also as unquestionably, was that Americans had so much shit in their bodies it was amazing we decayed at all. All those chemicals had some negative effects, sure. But they also have some positive. That's the part that healthcare nuts and organic fruits don't want anyone to realize or talk about.
Fuck 'em. It still moves.
Here is another that relates purely to H5N1. It's just a hypothesis because nobody has been able to do a good clinical study on it. (Several people have tried.) And it's kind of weird.
Social distance.
First I've got to talk about, yeah, virology and binding. (Lord I was trying to avoid this.) Prepare for major MEGO.
The common "seasonal" flus are referred to as H3N2 and H1N1. Both have a binding protein that binds to specific proteins in the upper respiratory system. (Can you say sinus pain? And fever and all the rest once your good old immune system kicks in.) Then, maybe, it moves to the lungs and you get coughing and if it gets bad a secondary bacterial infection (pneumonia or bronchitis depending on how bad it is).
H5N1 in its classic "bird flu" form bound to receptors in avian intestines. (It's an intestinal flu for them.) Which was why at first only poultry workers got it. They got it from breathing in chicken poop. Because there are similar receptor proteins in human lungs. Not the same. Similar.
(By the way, on an interesting aside. Influenza, in general, may be the oldest pathogen around. The genetics indicate that it goes all the way back to intestinal flu in dinosaurs. So the next time you're sneezing and coughing, just remember: Species come and go but the flu is here to stay. Take it like a man. End aside.)
(Oh, serious technical note. The bird binding sites are referred to as alpha 2,3. Human lung receptors are alpha 2,6.)
What caused the pandemic was a switch in one little gene code. That permitted the flu to bind to the proteins in the lungs.
Which was a good thing. A "normal" flu that bound to the upper respiratory system with the same lethality as H5N1 would have been truly a world killer. What kept a lot of people alive was they just never caught the flu. Because it had to get all the way into the lungs. That required a much higher viral load.
Which gets to social distance.
Everyone knows what social distance is. "I need my space." In the U.S. it's about two and a half to three feet. Anyone who is "non-intimate" (which doesn't mean just family/lovers, get to that) coming inside that space causes a social reaction. People back up or a fight breaks out. I need my space.
Every society has a social distance. But "classic" Americans (white, black, you name it, but fully assimilated) have the largest social space on the planet. Arab social space is about sixteen inches. When they're just moving around. If it's crowded it can drop to ten or even in contact with no social issues. Asians (Orientals for the non-PC) are even closer. Standard is around ten. Africans even work closer than Americans. We're very stand-offish people. Germans get closer to each other than Americans and we probably got the social meme from the Germans.
Heavy viral load requires you to breathe somebody else's breath. In general, people don't do that much in the U.S. In Asian societies it's just everyday living.
The "in general" gets to "intimate contact." Intimate contact is getting down to less than arm's distance. People go "ain't happening" but it happens with several categories of jobs. Medical profession and early elementary teachers (K–4 more or less) being the top two. Kids, for that matter, get much closer to each other than adults do.
Guess which professions had the highest infection rates?
Probably one of the reasons that Americans just didn't infect as much as other societies is that we're grouchy, touchy SOBs. For that matter, it may be why some of the more "socially prominent" zones (San Francisco) got hit so hard. People were "accepting" of entrance to their personal space and it killed them.
The last factor is back to trust. Thought that was a big sideline, didn't you?
Let's go back to our standard family of four living in a house with a white picket fence. Mom's a teacher, dad works for a local gas distribution center and the kids are, well, kids. For this narrative we will make them twelve and nine, boy and girl respectively.
This is about to get . . . Well, those of you who were that family, you know where this is going. This isn't going to be your narrative, but most of you lived one like it.
The Plague is definitely spreading. Mommy and Daddy decide that they're going to sit it out with what they have in the house. They'd had a bad ice storm a while back and they have some preparedness. Daddy makes one more run to the store and the gas lines. He finally finds what they desperately need and comes home.
Doesn't matter. Daddy didn't bring the Plague into the house, Mommy did. She got it from one of her Hispanic kids who barely had the sniffles. She doesn't know it.
The nine year old shows the first frank symptoms. They all put on dust masks Daddy usually uses for painting and go to the doctor. The office is overrun. They do wait, probably two hours, to see a nurse. The nurse administers (at the doctor's orders as he shouts them down the corridor) an antiviral to all four. It's probably pissing in the wind but it's the best that you can do with a virus. The doctor doesn't have any immunizations; they went bad waiting for someone to figure out what to do with them. They are also given an antibiotic shot and a bottle of antibiotics for each of them. This is for the pneumonic stage so that there's a chance secondaries won't kill them. They're told the hospital is overloaded. Don't bother.
They go home. They hold hands. They watch TV. They get sick and then they get sicker. Mommy and Daddy take care of the children as well as they can until they are at the point of collapse then lie in bed to wait it out. There's a box of bottled water in every room and that's about all they can do.
They go through the pneumonic stage. Mommy and Daddy come out of it at about the same time. They check the children and make sure they're taking their antibiotics. The kids are both alive, thank God.
They relapse, almost at the same time. Mommy doesn't remember much of that period except shouting at her husband to stop screaming.
Mommy wakes up covered in sweat but clear-headed. Her husband is dead by her side. She finds her children in the kitchen eating cereal; the only thing they know how to make. There is no power and the water runs for a moment then stops. She hugs her children and tells them that Daddy has gone up to heaven. The children are shell-shocked. They know Daddy is dead. And he said bad things to them before he died. So did Mommy. They're terrified but she comforts them as well as she can and gets them something better to eat. That, at the moment, is the most she can do.
Mommy tells the children to go out in the front yard and not to come in the back yard or the house until she tells them. Weak, dehydrated and just recovered from a killer illness, she nonetheless drags her late husband's heavy body into the backyard. There she digs a shallow hole and puts him in it, wrapped in the sheet from the bed. It's spring. She looks around the yard and, despite her aching bones and fatigue, picks up the plastic tray filled with pansies that were supposed to eventually ornament a planter on the front porch and arrays them across the tilled earth that is all she has left of her lover, her friend, her mate.
Across the United States there are these small monuments to the horror and glory of the Plague and the response of just everyday people. Flower beds across our God-kissed nation rear up from the bones of the dead, their death bringing new life and beauty into the world they have left.
My father is buried under roses.
Yes, there were the charnel pits. There were the death trucks with their slowly tolling bell. Manned mostly by garbage men in cities they carried away thousands and do so still in places. But when people really grasped how messed up things had become and when they had the land many of their family members ended up in a flower bed.
Personally, I'd have preferred that, wouldn't you?
But then came the next step. What do you do when the world has so clearly come apart? Radio reports indicate that nothing is working, anywhere. The Federal government is telling people to do the best they can until help arrives.
I'll describe later what happened in low trust countries. But this narrative is about the happy suburban family, an environment where societal trust, believe me, is probably the highest it has been in recorded history. People growing up in suburbs just don't know how unusual they are. That "it looks the same all over" is boring as hell but it's a function of high trust.
The U.S. is a strange country. Growing up in it I never realized that, but spending those tours overseas really brought it home. We're just fucking weird.
Alex de Touqueville spoke of this weirdness in his book Democracy in America way back in the 1800s. "Americans, contrary to every other society I have studied, form voluntary random social alliances."
Look, let's drill that down a bit and look at that most American of activities: The Barn Raising.
I know that virtually none of you have ever participated in a barn raising. But everyone knows what I mean. A family in an established community that has gotten to the point they can build a barn or need a new one or maybe a new pioneer family that needs a barn puts out the word. There's going to be a barn raising on x day, usually Saturday or Sunday.
People from miles around walk over to the family's farm and work all day raising the barn. Mostly the guys do the heavy work while women work on food. That evening everybody gets together for a party. They sleep out or in the new barn, then walk home the next day to their usual routine.
ONLY HAPPENS IN AMERICA.
Only ever happened in America. It is a purely American invention and is from inconceivable to repugnant to other cultures.
A group of very near strangers in that they are not family or some extended tribe gather together in a "voluntary random social alliance" to aid another family for no direct benefit to themselves. The family that is getting the barn would normally supply some major food and if culturally acceptable and available some form of alcohol. But the people gathering to aid them have access to the same or better. There is a bit of a party afterwards but a social gathering does not pay for a hard day's work. (And raising a barn is a hard day's work.)
The benefit rests solely in the trust that when another family needs aid, the aided family will do their best to provide such aid.
Trust.
Americans form "voluntary random social alliances." Other societies do not. Low trust societies in the U.S. do not. The kumbayas trying to build swings for the neighborhood children assumed the willingness of their "rainbow" neighbors to form a "voluntary random social alliance" for mutual benefit and discovered how rare American are.
In other countries an extended family might gather together to raise the barn or some other major endeavor. But this is not a voluntary random alliance. They turn up because the matriarch or patriarch has ordered it. And family is anything but random societally. (However random it may seem from the inside.)
This leads to the next stage of the narrative of our family. The mother performs an inventory of what they have. She considers heading to the hills. Many did. But most, those that survived and lived in high trust areas, then did something unthinkable in most areas of the world: They set out to help their neighbors.
Note: In many areas of the world, most neighbors would be extended family. In those areas, similar things happened. But they stopped at the level of extended family. From there on out, it became the government's problem. The king is supposed to fix big disasters. Individuals help their family as much as they can and then it's up to the king. The king will tell us what to do.
The mother of this narrative, and it's documented in at least twenty studies that it happened in all "high trust" zones in the United States, then went next door. There she found one of her neighor's children dead, another alive and very nearly psychotic. The child clings to her and she comforts her. Then she suggests that the child go play with her children. Children will recover their feet quickly when given anything orderly and common. The child is marginally functional by the time she goes back to the house. Long-term effects may be high, but right now functional is all that matters.
She returns to the house. In this case the wife is dead and the husband in the last throes of the cerebral portion of the progression. She removes her friend's body from the bed and gives the husband as much support as she can.
Note: One function of the H5N1 is that children rarely suffered from the cerebral infection stage or did so moderately. This was across the board and the clinical rationale is still poorly understood. The hypothesis (unproven) is that kids' bodies, due to growth hormones and such, tended to hold the blood in despite systemic flu. Thus they didn't suffer as much from cerebral and other organic breakdown. No solid clinical data but that's the hypothesis.
Thus, unfortunately, children often broke out of their illness to find dead parents. Kids, keep that in mind when your parents are freaking out if you get a mild fever. The reason you only have one or two grandparents is that your parents found their parents dead of the Plague.
The support helps. One of the secondary mortality effects of H5N1 was often death from dehydration. She manages to get him to swallow some water, to take some analgesics to drop the fever. Perhaps she finds some remaining ice and, over his incoherent protests packs some of the precious substance around him.
She performs an inventory of her neighbor's material. While she is doing so a neighbor from down the street, well ahead of her on the curve, turns up to find out how people are doing.
The neighbor's final fever breaks. She informs him his wife and one child didn't make it and neither did her husband.
Yes, there is a new voluntary association starting to happen. Okay, it's becoming familial fast.
They bury the wife and child. They may rebury the husband deeper. Their children are playing with neighborhood children, recounting their tales of horror this time in whispers and even occasional giggles. Kids jump back fast.
People walk out on the road and look around. They start counting heads. Houses that still haven't suffered from the bug shout for them to stay away. Those who have stay back, not wanting to infect another family. But if one of those families gets sick, neighbors gather to help.
Neighbors gather to help. They bring over bottled water and administer medicines from their own dwindling stores. Larger groups gather and begin to inventory group material and food. A bit of shifting occurs. The female moves into the male's house and now has three children. There is a slight surplus of some food stock because of that. It is offered to others in the community.
Why? There is no benefit. Why minister to the neighbor? There is no fixed benefit. Loot the house? Fixed benefit. Provide your own precious bottled water to a man who may die anyway? Why?
Trust. Trust that when you need help, they will provide that help. That even if there's no policeman watching to make them return the lawn mower they will anyway.
This was not purely a function of the Plague. In every major disaster studied, response of random individuals in first moments was a key factor in initial recovery. "There's never a cop when you need one." By the same token, in a disaster during the first portion of recovery there is never a recovery worker when you need one.
All societies show an initial positive reaction amongst generalized individuals. Yes, there is also looting and scavenging (two different things discussed later.) But the "severe outbreak of violence" generally follows the disaster at long intervals.
However, in "high trust" societies, the "voluntary random response" continues and grows. In "low trust" societies it falters after a short period, usually less than 24 hours. See studies of the Northridge and Kobe quakes "individual persons response" vs. those in Turkey all from near the same time-period. For that matter, find if you can the study of "evacuation response" in New York post-9/11. A purely random and voluntary "Dunkirk" movement of boat and ferry owners evacuated twice the number of people out of New York as the "official" evacuation.
If you're going to be in a disaster, the best place to be is in a high-trust society. And if the disaster is Asian bird flu the best place is a high-trust, standoffish society.
Let's hear it for the red, white and blue and a chorus of badly sung "Star Spangled Banner." Just don't stand too close to me while you're mangling it.