As with AIDS, most of the deaths were of young adults, aged 20-45. The mortality was comparable: the flu killed 1% of the adult population in 4 months, while AIDS has killed 2.5% of our adult population in 14 years.

The difference between the City's response to the two epidemics, however, is striking. This is what San Francisco authorities accomplished in three weeks in October 1918:

• shut down all schools, theaters, and public gathering places
• forbade church services
• converted Police Department patrol wagons into ambulances, and assigned cops to be medical orderlies
• motivated thousands of citizens to provide simple medical care, or to replace essential workers in the City's infrastructure
• passed an ordinance requiring the wearing of gauze masks
• distributed 100,000 gauze masks in four days
• inoculated 18,000 citizens with a newly-developed flu vaccine

It is not necessarily true that these measures had any effect; Boston, with a minimum of preventive measures of any sort, had roughly the same death rate. Also, then as now, the public chafed at the limitations on civil rights, especially the mandate to wear masks during the holiday season. The point is that the City authorities tried their best to stop the epidemic.

It is sobering, and disheartening, to compare the City's response to the AIDS epidemic to that to the flu epidemic. In June 1983, I participated in a meeting at Community Substance Abuse Services, during which it was clearly stated that the City's IDUs were in imminent danger from an infectious disease which had already killed a hundred New York City IDUs. The meeting participants made a number of suggestions, very like what would be made now except that nobody knew about HIV nor about the specific efficacy of bleach as a disinfectant. Had these suggestions been acted upon with the same alacrity as in 1918, this is what would have happened in the first three weeks of July 1983:

• ample broadcast over radio and TV of the "needles transmit AIDS" message
• printing and focused distribution of public health pamphlets meant to inform IDUs of the danger of needles
• establishment of needle exchange programs at 10 or so sites
• funding of extra slots in treatment programs for rapid admission of IDUs at greatest risk for infection
• recruitment of volunteers to locate IDUs on the streets and show them how to disinfect "works" with boiling water or isopropyl alcohol [i.e., the state of the art in 1983]

We don't know what the HIV+ rate was among IDUs in mid-1983; my guess is about 1.5%, a prevalence rate which doubled each year until it reached 12% in 1986. We also don't how well the above measures would have worked, if at all.

We've now logged about 1,150 AIDS deaths of IDUs, of which as many as 1,000 could have been avoided if the above-described public health blitz had worked (i.e., if the IDU HIV+ rate had stopped rising at 1.5% rather than 12%.) But the City authorities chose not even to try. Will there ever be any punishment for this failure to act? Will there ever be an formal investigation into the matter, a judging of numbers, a naming of names? Of course not. The single great difference between the moral space of public health policymakers now as compared to 1918 is that now they fear being blamed for what they do, whereas then they feared being blamed for what they didn't do. This is the paramount sad truth about America's response to AIDS, and it is inexpressibly depressing to contemplate it. God help us if an airborne Ebola virus ever reaches these shores...

(MidCity Numbers, January 1997)