endure it. In 1918, Philadelphia, a city of about two million people, hobbled by corrupt and incompetent officials, had been crushed by the Spanish flu. Philadelphians died by the hundreds and then by the thousands—4,597 in a single week in October 1918 alone—ten times the number of citizens who had died of all causes prior to the outbreak. Doctors and nurses worked heroically, but they suffered the highest death rates of all. Gravediggers either died or stopped working. The accumulation of corpses posed its own health problem, but more than anything else it broke the city’s morale. Bodies remained for days in the homes where they died; cemeteries hiked up the price for burials and then forced family members to dig the graves themselves. Eventually, the city excavated mass graves with steam shovels, with priests giving committal prayers as the bodies were hurled into the trenches.
More than a century later, Kongoli crept into Philadelphia, seeding itself across the city with little notice. On Easter Sunday, hundreds of thousands of churchgoers attended services, and many of them were exposed to freshly infected parishioners. Within days, the city was brought to its knees.
The Penn Presbyterian Medical Center was as well equipped as any top-level big-city medical center to handle an epidemic, but not at all prepared for thousands of desperately ill citizens. The same was true in every hospital in the surrounding counties in Pennsylvania and New Jersey.
Philadelphia mayor Shirley Jackson had studied the history of pandemics. Her mother had been a nurse, so she had grown up around the medical profession. She had participated in a table-top exercise at Johns Hopkins concerning a hypothetical deadly disease outbreak. She knew the protocol. And she was decisive by nature. As soon as the disease was detected outside Saudi Arabia, she put into effect the Incident Command System, imposing coordination between local health officials, hospitals, emergency responders, and federal agencies. She got in touch with Lieutenant Commander Bartlett at the Public Health Service, who, in addition to her White House liaison duties, was coordinating urban health responses. Mayor Jackson demanded additional medical supplies from the nation’s emergency storehouse. She called the heads of the three medical schools in the metropolitan area, instructing them to immediately train their students in emergency care. All first responders in the greater metropolitan area received infrared thermal cameras that attached to their smartphones so that they could instantly detect fever. Provisional hospital space was created in the Wells Fargo Center, where the 76ers played. No big-city leader did a better job of preparing for the contagion. She was lauded for her leadership on the front page of The New York Times.
What Mayor Jackson wasn’t prepared for was the panic. There was a startling rise in suicides and homicides, as well as hate crimes, especially against the large Muslim community in the northern part of town. By now the origin of the disease—in an Indonesian detention camp for Muslim homosexuals—was well known, and the conspiracists were inflaming fears that Kongoli was a plot. According to one theory, Muslims had created the disease to destroy Christian civilization. Another theory posited that Muslims were being targeted for elimination by neo-Nazi scientists. A third theory postulated a worldwide war against homosexuals. These fantasies were promulgated in social media, led by Russian bots and amplified by internet rumor-mongers, stirring strife by remote control, urging people to take to the streets when they had been warned repeatedly to shelter at home. The imam of Philadelphia’s main mosque urged his parishioners to ignore the conspiracy theories, but while he was speaking, two firebombs were thrown into the building.
Until now, Shirley Jackson had not been seen as one of the nation’s great civic leaders. She had gone into politics after her husband, an Episcopal priest, died of cancer. Jackson had thrown herself into public service because it gave meaning to her own suffering. She instinctively knew how to talk to people who were frightened or grieving. “Philadelphians are being tested,” she observed in one of the daily video council meetings she instituted. She was nakedly candid. “Our hospitals are crippled, not just by the toll the influenza is taking on doctors and nurses but also by the loss of technical workers, medical assistants, therapists, pharmacists, and—critically—janitorial staff, which are so diminished in some facilities that bacterial infections are killing more patients than the influenza.” She went on to describe how illness and fear had ravaged the death industry. Private ambulances were essentially absent. She commandeered FedEx and