March 31 (Bloomberg) -- In 1957, the University of North Carolina turned a dormitory into a hospital for dozens of students stricken by an Asian flu circling the globe. Eleven years later, Nashville medical centers filled beyond capacity when another worldwide epidemic hit.

The famous 1918 Spanish flu that killed 50 million people isn't the only pandemic that caused a global health crisis in the past century. Two other pandemics, though much milder than the more well-known one, also strained national health-care systems, researchers say. The Asian flu killed at least 2 million in 1957, and about 700,000 died during the Hong Kong flu in 1968.

If the current wave of bird flu turns into a human infection that is only as widespread and deadly as the one in 1968, the American health-care system will be severely tested, said Nancy Cox, head of the Centers for Disease Control and Prevention's influenza branch in Atlanta. ``Emergency rooms would be overflowing, doctors offices would be overflowing and hospital beds would be overflowing,'' she said March 20.

An outbreak roughly equivalent to the Hong Kong flu might kill only about 209,000 worldwide as a result of new medicines and improved care, U.S. health officials estimate. Yet, a bird- flu pandemic similar to the one that hit almost 40 years ago is almost certain to be catastrophic, perhaps sickening one in three Americans and over-burdening the nation's 4,000 hospitals, 20 percent fewer than in 1968, health officials predict.

Illness Rates

U.S. hospitals are ``simply not set up to accommodate'' illness rates of up to 35 percent, levels seen in past pandemics, CDC's Cox said. Even in the most severe seasonal flu outbreaks, illness rates top out at 15 percent of the population, said William Schaffner, an infectious-disease specialist at Vanderbilt University School of Medicine in Nashville.

The H5N1 avian influenza has spread among birds throughout most of the Eastern Hemisphere since late 2003 and threatens to reach North America this year, health officials say. Infections in 186 people, almost all through direct contact with birds, including 105 deaths, have been reported to the World Health Organization in Geneva.

Indonesia reported an additional fatality from the disease today, a 1-year-old girl who died March 23. Jordan's health ministry reported the country's first human case of the virus, in a 31-year-old Egyptian worker, Agence France-Presse said. The man was in the hospital in ``stable'' condition, the health minister, Saeed Darwazeh, was quoted.

Scientists worry the virus may mutate into a form transmissible from human-to-human that could travel around the world in days to weeks.

Business Survey

A lethal virus spreading this way might kill millions of people worldwide, while halting shipping, transportation, trade, agriculture and other important activities, researchers have forecast. A Mercer Human Resource Consulting survey found 70 percent of businesses said a severe outbreak would hurt profitability. Only 17 percent have budgeted for preparations.

Public health advocates worldwide have also expressed concern about the potential consequences. In the U.K., for instance, a health official writing in the British Medical Journal today said the government's estimate there of possible fatalities in a flu outbreak, which are based on the 1957 pandemic, is too low.

The U.K. should anticipate a death rate more than double that of the current plan, wrote Hilary Pickles, public health director at Hillingdon Primary Care Trust in west London.

``Pandemic flu could be the biggest disruptive challenge that society will face,'' Pickles wrote. ``The world population is now much bigger, and domestic and international travel is more extensive.''

Emergency Rooms

In the U.S., emergency rooms would be first to be flooded with pandemic flu cases, even if the flu comes in a relatively mild form, said Andrew Bern, a physician at Delray Medical Center in Delray Beach, Florida.

Health authorities will have to ``close off access to care'' for patients who use emergency rooms for colds, children's ear infections, cuts and broken bones, said Bern, who founded the American College of Emergency Physicians' disaster medicine section.

Emergency care in the U.S. is ``like a house of cards,'' he said, ``waiting for a big wind to collapse it.''

Visits to U.S. hospital emergency rooms rose 26 percent to 114 million in the 10 years ending in 2003 as the population increased, Bern said. During the same period the number of emergency rooms fell 14 percent due to cost-cutting by medical centers, said David Seaberg, a director with the Physicians' College, in Feb. 8 testimony before the House Committee on Homeland Security.

Limits on Life-Saving Technology

The demands of a pandemic may limit the availability of life-saving technology for such things as lung diseases, Minnesota scientists said in a Jan. 6 study in Academic Emergency Medicine. If only 10 percent of the 2.6 million people around Minneapolis were infected, the city would quickly run out of ventilators that help patients breathe, said John Hick of Hennepin County Medical Center and Daniel O'Laughlin of Abbott Northwestern Hospital.

David Costello and Paul Glezen have vivid memories of the Asian flu pandemic in 1957, and Vanderbilt's Schaffner easily recalls the 1968 Hong King outbreak.

A fever of 101 wasn't high enough to rate entry into the University of Notre Dame infirmary in 1957, when Costello, then a 19-year-old sophomore, got hit with the Asian flu pandemic.

Sick students lay on hallway cots at the South Bend, Indiana, college as they did in clinics and hospitals throughout that region, said the 69-year-old Costello, now a retired history teacher in Buffalo, New York.

Makeshift Hospital

During that same outbreak, the University of North Carolina in Chapel Hill converted a dormitory into a hospital for Asian flu-stricken students, said Glezen, 75, a Baylor University epidemiologist and a public health worker in 1957.

The makeshift Chapel Hill hospital ``was just for the students who lived too far away to go home,'' Glezen recalled. ``It was only a fraction of the kids who were really ill.''

In 1968, Nashville hospitals that normally had beds to spare were filled to capacity, said Schaffner, who now consults to the U.S. government on flu issues. Schaffner said he caught the flu caring for patients a day after running a dangerous 103- degree fever.

``There was concern that people being admitted were acquiring flu in the hospital,'' he said in a March 10 telephone interview. ``Every hospital was full and there were patients waiting in the emergency rooms.''

Today, U.S. hospital officials say reductions in capacity mean even small increases in patient volume can stress a community's health services. Regular seasonal flu outbreaks force most New York City area hospitals to divert or limit emergency room admissions for part of the year, said Nathaniel Hupert, assistant profess of public health and medicine at Weill Cornell Medical College in New York.

Mutation Unclear

``Our U.S. hospital system gets crushed in a normal flu year,'' he said in a March 16 interview.

It remains unclear, though, whether H5N1 will change into a form that transmits among humans easily enough to cause a pandemic, said Cox, the CDC flu branch head. Even if bird flu become contagious to people, it may do so by exchanging genes with seasonal influenza virus the human immune system is already familiar with, making a mild pandemic more likely, she said. The Spanish flu was so deadly because it was a virus the immune system hadn't encountered before.

``You have to prepare for the worst, but it's entirely conceivable that we could have a moderate one,'' Anthony S. Fauci, 65, head of the Bethesda, Maryland-based National Institute of Allergy and Infectious Diseases, said in a March 10 telephone interview. ``You have to prepare for a horrendous problem, but the general public shouldn't assume that we're going to see the worst case.''

To contact the reporters on this story: John Lauerman in Boston at jlauerman@bloomberg.net; Kristen Hallam in London at khallam@bloomberg.net

Last Updated: March 31, 2006 11:13 EST