The Washington Post National Weekly - February 4, 2018 by The Wenatchee World

SUNDAY, FEBRUARY 4, 2018

. IN COLLABORATION WITH

ABCDE NATIONAL WEEKLY

The rest of the story She was the poster child for freezing your eggs. But it didnâ&#x20AC;&#x2122;t work out how she imagined.

Politics GOP seeks path forward 4

Nation The 401(k) splurge 8

History When the flu killed millions 23

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THE FIX

Tax-cut gamble may yet pay off A ARON B LAKE

when they’re dispersed over two dozen biweekly paychecks. For middle- and lowerincome Americans, for instance, that might be month ago Republicans passed what $20 or $30 per paycheck, and it could even be was, according to some measures, the offset by other changes, like rising health inmost unpopular bill in decades: their surance premiums or changes in benefits. In tax plan. contrast, the George W. Bush tax cuts of 2001 Today, it’s looking more and more as if that delivered instant rebate checks across the was a risk well worth taking. country. A day after President Trump played up The most immediate and noticeable the tax cuts in his State of the Union adimpact of the GOP’s tax plan has been dress, a Monmouth poll showed a huge that millions of people who have reswing in favor of the bill. Although 26 ceived one-time bonuses (many of them percent of Americans approved of the $1,000) that companies handed out afpackage in mid-December, as lawmakers ter the bill passed. But that’s still a very were putting the final touches on it, supsmall portion of the American electorate port in the latest poll rose to 44 percent. — a poll last week showed 2 percent said For a bill that sometimes polled with they had benefited from the law already twice as many opponents as supporters, — and there seems to be only room for it’s now on level terms, with just as many improvement when it comes to people’s supporters as opponents (44 percent). perceptions of how the law affects them. Other polls have shown smaller Which brings us back to the Monbumps in the plan’s popularity — a mouth poll. Perhaps an even bigger findWashington Post-ABC News poll a couing for the GOP — and one probably reple of weeks back, for instance, showed JABIN BOTSFORD/THE WASHINGTON POST lated to improving views of the tax plan support rising to 34 percent — but none until Wednesday had shown the law as President Trump signs the $1.5 trillion tax overhaul package — is a huge shrinking of the generic ballot, on which Republicans have trailed by drawing level. So it’s possible the Moninto law in the Oval Office on Dec. 22. double digits in many recent polls. The mouth poll is an outlier. poll shows it closer than any other recent poll, We’re just now entering February, which is But there are plenty of positive signs here with Democrats ahead by 2 points — 47-45 — so when people’s paychecks will start getting for Republicans. And there are reasons to beagain, it could be an outlier. But it’s not the first slightly bigger as their withholding changes to lieve things could get better. poll conducted since the law’s passage to sugreflect the new tax laws. Republicans seem to Unlike other polls, for instance, Mongest that the Democrats’ big advantage has narbe counting on Americans seeing that extra mouth’s question about the tax plan doesn’t tie rowed; several have shown the Democrats’ gemoney in order for the law to become even it to Republicans or to Trump. That suggests neric-ballot lead down to the single digits. more popular. Which isn’t a bad bet. If people partisanship and Trump fatigue may have deThere is plenty that will play out before the are expecting their taxes to go up (36 percent) pressed support while it was the subject of in2018 election is held in 10 months, but for a Reor even stay the same (32 percent) and taxes go tense debate, and that people might warm to it publican Party that seemed on a course for disdown, that should be a pleasant surprise and as they judge it more on its merits. aster, passing a severely unpopular piece of legcould fuel more support for the bill. And speaking of those merits, there’s someislation may just turn out to be a good move. n The question, as Politico has noted, is thing important about all these polls that we whether people will recognize the changes need to keep in mind: People still don’t seem to © The Washington Post

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recognize how the tax cuts will benefit them personally. Polls have routinely shown more people expect to see their taxes increase rather than decrease, but that’s simply not what will happen — at least not for many years. The Monmouth poll, for instance, shows the law drawing even on popularity while 24 percent believe their own taxes will go down.

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2018 The Washington Post / Year 4, No. 17

CONTENTS POLITICS THE NATION THE WORLD COVER STORY FASHION BOOKS OPINION HISTORY

4 8 10 12 16 18 20 23

ON THE COVER Brigitte Adams walks her dog, Grace, near her home in Manhattan Beach, Calif. She froze her eggs in her late 30s, but conceiving didn’t go as planned. Photograph by CAROLYN VAN HOUTEN, The Washington Post.

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POLITICS

Appeal for unity, then back to division

TONI L. SANDYS/THE WASHINGTON POST

After State of the Union, a fractured GOP in a gridlocked Congress discusses challenges BY S EAN S ULLIVAN AND R OBERT C OSTA

White Sulphur Springs, W.Va.

resident Trump’s State of the Union pledge to “extend an open hand” to both parties in pursuit of an ambitious policy agenda quickly came up against the reality of a largely gridlocked Congress and a Republican Party gripped by fear of a brutal midterm election cycle. Republican senators and House

members headed out of town Wednesday to their annual retreat uncertain over how to contend with another spending deadline, stalled immigration negotiations, the year’s electoral challenges — and Trump, whose controversies have compounded their troubles. Plans to address these issues were jarred when an Amtrak train carrying lawmakers to the conference crashed into a truck near Crozet, Va., killing one person in the truck and injuring others.

But lawmakers pressed ahead at their retreat — perhaps all too aware of how many difficult matters they intend to address over the coming days. Vice President Pence spoke here Wednesday evening, urging Republicans not to trust the “conventional wisdom” on the midterms and advising them to tout the party’s policy achievements, with help from him and the president. Trump visited Thursday, with the president’s lofty rhetoric Tuesday night

President Trump on Tuesday urged lawmakers to work with him on immigration and infrastructure, but many Democrats didn’t buy it.

about bipartisanship and his ambitious promises to tackle infrastructure and immigration likely to come up against the internal divisions within the GOP. “I certainly want us to address how we, House Republicans, can work better with the Senate Republicans, because I don’t think we had a good working relationship last year,” said Rep. Bradley Byrne (Ala.). Settling on a policy agenda is especially critical in an election

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POLITICS year that will test the staying power of the GOP’s majorities. Republicans believe their political survival will rest heavily on convincing voters that tax legislation passed in December will help them — and on doing more legislatively to demonstrate that the party can govern. “I still worry, you know, I said all along, if we don’t accomplish what we said we would do then, that’s going to be hardship for us,” said Sen. Cory Gardner (Colo.), the chairman of the Senate Republican campaign arm. Republicans in swing districts facing a potential Democratic wave according to most nonpartisan analysts said they are focused on selling the Republican tax law. “Folks in my district want to learn about why the tax bill is good,” said Rep. Ryan Costello (R-Pa.), who represents the Philadelphia suburbs. “I’m hearing as much about the president’s style and tone as I am about his policies. They’re allergic to that, and it makes a member like me have to speak out.” But coming to agreement will not be easy. After Trump’s speech, conservatives expressed alarm that Trump had offered to put more than 1 million young undocumented immigrants on a path to citizenship. Rep. Steve King (R-Iowa), an advocate for a more restrictive immigration system, said Trump’s remarks on letting young undocumented immigrants gain citizenship were not well received by many of his colleagues. “You notice the Republicans were pretty flat on that?” King asked. On infrastructure, Trump drew bipartisan praise when he pledged to build “gleaming new roads, bridges, highways, railways and waterways all across our land.” Yet some GOP lawmakers expressed concern about how to pay for the $1.5 trillion plan. That amount would apparently be matched by $1.5 trillion at the state level, prompting Gardner to ask, “Where does that come from, how does that work? A lot of details that need to be worked out.” Although infrastructure has been viewed as a potentially unifying issue for the two parties, Democrats and Republicans remain far apart on how to proceed. Most Republicans, as they mingled at the Capitol on Tuesday after

JONATHAN NEWTON/THE WASHINGTON POST

Trump’s speech, talked up infrastructure as public-private partnerships driven by tax credits for corporations. Democrats, however, talked about infrastructure as federal spending that should be driven by Congress, not by companies. “It’s totally different,” Sen. Richard J. Durbin (Ill.), the No. 2 Democrat, said of the Democrats’ understanding of infrastructure. Referring to Trump’s comments on funding, Durbin added: “To me, it’s a throwaway line; it avoids coming up with serious funding.” On spending, Republicans face similar fractures. GOP hawks are clamoring for a boost in military spending, but the party’s hardliners are unhappy with proposals that would increase the federal deficit. Some Republicans, meanwhile, also fretted about the high hurdle of securing Democratic votes to pass a new spending bill by Feb. 8 to avoid another government shutdown. Sen. Ted Cruz (R-Tex.), a former Trump campaign rival who has become an ally, emerged from the speech and noted the partisan breach and the disconnect between Trump’s words and the dynamics on Capitol Hill. “I have never seen the Senate more divided than it is right now,” Cruz said. Factoring into the atmosphere are the retirements of Republicans who have shepherded legislative deals. Rep. Rodney Frelinghuysen (N.J.), the chairman of the House

Appropriations Committee, announced Monday that he will not seek reelection, making him the eighth House committee chairman to do so in recent months. In other words, the president isn’t likely to have many options for grand bargains among either Republicans or Democrats. Even Trump’s allies acknowledged that there is little the president can do to bring the warring factions together. “The fights and the disagreements have nothing to do with who is at 1600 Pennsylvania Avenue,” said Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus. “There are fundamental gaps in the Senate and the House that are keeping us from consensus.” A shutdown in January left congressional leaders at odds and without a long-term spending deal. Democrats continue to insist that any agreement made in February must include protections for 1.8 million “dreamers,” undocumented immigrants brought to the country as children. Republicans have resisted those calls to link a vote on the next spending bill to immigration legislation — and they are split on specifics. “We keep kicking the can down the road,” said Sen. David Perdue (R-Ga.), a close ally of Trump who is part of a budget panel at the retreat. “There’s a growing sense that we’ve come to the end of kicking this

Lawmakers watch President Trump deliver his State of the Union speech Tuesday. On spending, Republicans face a fracture. Hawks want a boost in military spending; hard-liners don’t want to increase the deficit.

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budget issue down the road.” Those divisions were apparent in the aftermath of Trump’s speech, in which he said many of the young undocumented immigrants would be able to gain citizenship over a 12-year period. That legalization would be granted in return for increased spending on border security, including Trump’s proposed wall along the U.S.-Mexico border, an end to the visa lottery and limits on family reunification policies. Trump terminated the Obamaera Deferred Action for Childhood Arrivals program last fall and set March 5 as the deadline when the bulk of their work permits would begin to expire. A federal judge has issued a temporary restraining order reinstating the program, although legal analysts said the decision probably would be overturned if challenged. Moderate Senate Republicans, meanwhile, are urging their colleagues to let them work out an agreement with moderate Senate Democrats. Trump’s low approval ratings have raised alarm bells in the party. Historically, first midterms have tended to be bad for the president’s party. Trump’s rhetoric and positions, coupled with a special counsel investigation into Russian meddling in the 2016 election that has ensnared his associates, threaten to make it an even tougher task. Senate Republicans were once hopeful about padding their narrow majority on a map they saw as ripe for gains in November. Democrats are defending 10 seats in states Trump won. But a special election loss in Alabama late last year narrowed the GOP advantage to 51 to 49, and Trump’s unpopularity has left many Republicans to conclude that simply holding the majority would be victory under the circumstances. There is more concern about the House majority among strategists, donors and lawmakers. A string of high-profile retirements has only heightened worries. With that in mind, there is now debate about what is realistic for this year’s legislative agenda. “Their tendency is to sort of sit on the lead,” said Rep. Tom Cole (R-Okla.), speaking of the Senate. “Our tendency is to press it more aggressively. We think our majority is much more at risk than theirs.” n ©The Washington Post

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NATION

401(k) boom brings urge to splurge

BY T ODD C . F RANKEL AND T HOMAS H EATH

ISTOCK

Surging stocks prompt spending on home projects, vacations

inancial adviser Joseph Kelly was visiting a client in January who had seen the value of his retirement savings soar, thanks to a surging stock market. “He said his account was up 18 percent, and he asked me, ‘What should I do with it?’ ” recalled Kelly, who works in Berkeley Heights, N.J. His client was modestly wealthy, but Kelly still suggested holding tight. The client had another idea: He wanted to take out $75,000 to help his son buy a house. Later the same day, Kelly visited another client — comfortable in the upper middle class — who wanted to take out $20,000 from her 401(k) to splurge on a vacation. She was even willing to pay a 10 percent penalty, which is required under the law if an individual is not yet 59½ years old. Kelly couldn’t dissuade her. “People are cautiously optimistic,” he said. The remarkable stock market rally of 2017 — in which the Standard & Poor’s 500-stock index shot up 22 percent and the Dow Jones industrial average rose 25 percent — has boosted the nation’s retirement accounts to record heights, making the painful 2008-2009 stock market crash feel like ancient history. And that fervor has not faded with the new year. That feeling of optimism could spread as more Americans receive their year-end retirement account statements in the mail and online, providing concrete evidence of

newfound paper wealth. And some are so confident that they are taking money out — despite it being taxed and potentially hit by an early-withdrawal penalty — assuming it will be replaced as markets continue to surge upward. “I’ve seen more money requests for extraneous items in the last six weeks than I have in the last five years,” said Jamie Cox of Richmond, Va.-based Harris Financial Group, which manages $500 million in savings for about 800 middle-class families. “There’s a lot of people that are feeling comfortable spending their retirement money right now,” Cox said. Cox said he is seeing more people take larger withdrawals, $20,000 to $40,000, to fund dream vacations or home improvements. “I hear, ‘I want to take that Viking Cruise I didn’t go on two years ago.’ Lots of these things were holdovers from the financial crisis,” Cox said. Megan Caldwell, 33, who works in sales operations for Higher Logic, a company that manufactures cloud-based software, was tempted to tap her 401(k) to buy a house as an investment property. Her retirement account has grown to more than $140,000. It was less than $100,000 about a year ago. “It’s a hard decision, but I think I will make more money in the stock market,” Caldwell said. She has been saving in her 401(k) for a decade but didn’t contribute the maximum under law until last year. The 2017 market returns

combined with her savings in the account were “a little eye-opening.” The average annual return for 401(k)s hit 15.7 percent by the third quarter of 2017, according to Fidelity. And for most Americans, it’s these retirement accounts — 401(k), 403(b), SEP and IRA — that provide the closest evidence of a revving stock market. Retirement assets — including annuity reserves, pensions and defined contribution plans such as 401(k)s and IRAs — exploded in the United States from $11.6 trillion in 2000 to $27.2 trillion as of Sept. 30, 2017, according to the Investment Company Institute, which represents the mutual fund industry. Kelly Shue, a finance professor at the Yale School of Management, said the wealth effect tends to change the way people invest and consume. “Stock market booms make people more tolerant of risk,” she said. “They tend to increase their consumption. We know people spend more when they are wealthier and when the market goes up.” There are plenty of signs of 401(k) exuberance. The personal finance sector on Reddit and other message boards are littered with tales of people becoming 401(k) millionaires. People are even tweeting proud photos of their 401(k) balances. Yet the increase in 401(k) balances has done little to calm worries that Americans still are not saving enough for retirement. The Center for Retirement Research at Boston College found that the median household approaching re-

tirement age had a median balance in its 401(k) or IRA of just $135,000 in 2016. “Balances in these accounts are woefully inadequate,” said center director Alicia Munnell, a management professor at the school. And the stock market rally can’t go on forever. Vanguard Group Chairman F. William McNabb told Bloomberg News recently that he thinks the U.S. stock market is “getting pretty close” to irrational prices. He said he expects stocks to continue to skyrocket for the next few months but produce “very modest” gains over the next decade. Douglas Boneparth, president of Bone Fide Wealth in New York, said his clients — millennials, mostly in their late 20s and early 30s — have not shown sudden interest in their retirement account balances. After all, they expect to work four to five more decades. For some older workers in or nearing retirement, the run-up can, paradoxically, be scary, said Lynn Ballou, a certified financial planner in San Francisco. Ballou pointed out that most of her clients lived through the 2000 dot-com bust and the 2008 market crash — seeing their savings rise and disappear each time. And they feel trapped into keeping their accounts heavily invested in stocks now because interest rates remain so low for safer certificates of deposit and bonds. When they get their 401(k) statements, Ballou said, they look at the eye-popping numbers and wonder how long it will last — and whether they’ll get out in time. Linda Ramsdell, 57 and knowing that her retirement horizon is getting shorter, barely looks at her 401(k) statements. “I’m in it for the long haul,” said Ramsdell, human resources manager at Gat Creek furniture in Berkeley Springs, W.Va. “My account does what it’s going to do, and I just leave it alone. I am feeling more comfortable in my safety net, but my spending habits haven’t changed. I like saving money.” n ©The Washington Post

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WORLD

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Military grapples with use of apps BY L IZ S LY, D AN L AMOTHE AND C RAIG T IMBERG

Beirut

he U.S. military said this past week that it is reviewing its guidelines for the use of wireless devices at military facilities after revelations that popular fitness apps can be used to expose the locations and identities of individuals working in sensitive areas. The review came after reports by The Washington Post and other outlets that a “heat map” had been posted online by the fitness-tracking company Strava showing where users jog, bike and exercise. It inadvertently highlighted the locations of U.S. military facilities in some of the most dangerous spots in the world. The concerns raised by the online map went beyond sensitive military sites, with evidence that Strava could help reveal the movements of international aid workers, intelligence operatives and millions of other people in many countries. Internet sleuths also found ways of using the publicly available Strava data to identify individual users of the tracking service by name, along with the jogging routes they use in war zones such as Iraq and Afghanistan. On one of the Strava sites, it is possible to click on a frequently used jogging route and see who runs the route and at what times. One Strava user demonstrated how to use the map and Google to identify by name a U.S. Army major and his running route at a base in Afghanistan. On a separate Internet site, it is possible to establish the names and home towns of individuals who have signed up for a social sharing network on which runners post their routes and speeds. One popular route on a base in Iraq has been nicknamed “Base Perimeter” by the U.S. runners who regularly use it. Another outside the big U.S. base in Kandahar, Afghanistan, is called “Sniper Alley.” On Monday, the Defense Department launched a review to determine whether new policies are

STRAVA

Guidelines are being reexamined after it was discovered that fitness apps revealed troop info needed, according to Army Col. Robert Manning III, a Pentagon spokesman. The review will be led by Essye B. Miller, the Pentagon’s acting chief information officer. “Recent data releases emphasize the need for situational awareness when members of the military share personal information,” Manning said. “We take these matters seriously, and we are reviewing the situation to determine if any additional training or guidance is required, and if any additional policy must be developed to ensure the continued safety of DOD personnel at home and abroad.” Privacy experts noted that Strava is far from alone in collecting and using location data and that such granular information about the movements of individuals could reveal where they live, work, shop and socialize. Devices and smartphone apps that track steps or other fitness goals typically work by monitoring the movements of their users, even when they are not exercising. Strava has drawn scrutiny for making such data widely available

and for constructing its app in ways that allow users to easily find each other by name. The functions were designed in part to spur Strava users to measure themselves against one another, but the extent of the data publicly available surprised many users when revealed in news reports. Privacy experts have long warned that tech companies often make personal information — including contact lists, social media posts and location data — available by default. That means users who do not routinely read privacy notices and tweak settings can be surprised by how much information is collected by private companies, as well as how that data ultimately is used. “It’s very jarring when the curtain on these things is lifted a little bit,” said John Scott-Railton, a senior researcher for Citizen Lab at the University of Toronto’s Munk School of Global Affairs. At the Pentagon, Manning said that he was not aware of the release of information on Strava’s interactive map resulting in any

A portion of the Strava Labs heat map from Baghdad made by tracking users’ activities.

compromise of security. But Defense Department personnel are, he said, “advised to place strict privacy settings on wireless technologies and applications, and such technologies are forbidden at specific DOD sites and during specific activities.” Service members are also expected to limit their use of social media such as Facebook and Twitter when they are deployed to sensitive locations, he said. The U.S.-led coalition against the Islamic State is reviewing procedures on bases in Iraq and Syria where some of the most readily identifiable bases exposed by the Strava data are located and where U.S. service members are still fighting remnants of the Islamic State. Rapidly changing technologies pose “potential challenges to operational security and force protection,” said a statement from the Central Command press office in Kuwait, which speaks for the U.S.-led coalition. “We constantly refine policies and procedures to address such challenges.” The rules on the privacy settings relating to devices such as fitness apps are being “refined” and commanders at bases are being urged to enforce those that are in place, the statement added. Privacy experts say companies should be more forceful in drawing users’ attention to what personal data is being shared and how. Even when companies are careful about restricting access to data, sensitive location information when paired with names and other identifying details make valuable targets for hackers, including those working for foreign intelligence services, experts said. Tobias Schneider, a Berlin-based security analyst, has identified the names of 573 people who jog every morning around the parking lot of the headquarters of British intelligence, making it highly likely they work for the agency. “You could, for example, identify somebody who works at a known secret facility,” he said, “and then track his movements to other facilities through which he may rotate.” n © The Washington Post

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BLOOMBERG BUSINESSWEEK MAGAZINE COVER

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COVER STORY

WHEN HOPE MEETS REALITY BY ARIANA EUNJUNG CHA in Manhattan Beach, Calif.

rigitte Adams caused a sensation four years ago when she appeared on the cover of Bloomberg Businessweek under the headline, “Freeze your eggs, Free your career.” She was single and blond, a Vassar graduate who spoke fluent Italian, and was working in tech marketing for a number of prestigious companies. Her story was one of empowerment, how a new fertility procedure was giving women more choices, as the magazine noted provocatively, “in the quest to have it all.” Adams remembers feeling a wonderful sense of freedom after she froze her eggs in her late 30s, despite the $19,000 cost. Her plan was to work a few more years, find a great guy to marry and still have a house full of her own children. Things didn’t turn out the way she hoped. In early 2017, with her 45th birthday looming and no sign of Mr. Right, she decided to start a family on her own. She excitedly unfroze the 11 eggs she had stored and selected a sperm donor. Two eggs failed to survive the thawing process. Three more failed to fertilize. That left six embryos, of which five appeared to be abnormal. The last one was implanted in her uterus. On the morning of March 7, she got the devastating news that it, too, had failed. Adams was not pregnant, and her chances continues on next page

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COVER STORY

from previous page

of carrying her genetic child had just dropped to near zero. She remembers screaming like “a wild animal,” throwing books, papers, her laptop — and collapsing to the ground. “It was one of the worst days of my life. There were so many emotions. I was sad. I was angry. I was ashamed,” she said. “I questioned, ‘Why me?’ ‘What did I do wrong?’ ” In an age when egg freezing has become so popular that hip employers such as Apple and Facebook cover it as a perk and grandparents help finance the procedure as they might a down payment for a house, there’s surprisingly little discussion about what happens years later when women try to use them. Fertility companies tend to advertise egg freezing — “oocyte cryopreservation” — in scientific terms, as something that can “stop time.” And many women believe they are investing in an insurance policy for future babies. But the math doesn’t always hold up. On average, a woman freezing 10 eggs at age 36 has a 30 to 60 percent chance of having a baby with them, according to published studies. The odds are higher for younger women, but they drop precipitously for older women. They also go up with the number of eggs stored (as does the cost). But the chance of success varies so wildly by individual that reproductive specialists say it’s nearly impossible to predict the outcome based on aggregate data. A number of Adams’s friends were also early adopters of egg freezing; today they are facing a similar reckoning. Amy West, 43, a professor in Los Angeles, is one of the lucky ones. She had a baby boy 22 months ago and has numerous eggs left over. Carolyn Goerig Lee, 46, a nurse from Haymarket, Va., froze 25 eggs and planned to have a large family with them. She successfully gave birth to twins, but the other eggs were abnormal or lost to miscarriage. Then there is MeiMei Fox. After the 44-year-old Honolulubased writer got married, she tried to use her frozen eggs. The whole batch of 18 was destroyed while being shipped from one clinic to another. The four women’s experiences underscore the incredible uncertainty involved in egg freezing. James A. Grifo, a fertility specialist at NYU Langone Health who is one of the pioneers of the procedure, calls the whole notion of being able to “control” your fertility — perpetuated by the media and embraced by feminists — destructive. “It’s total fiction. It’s incorrect,” Grifo said. “Your whole life it’s beaten into your head that you’re in control and if you can’t have a baby, you blame yourself. There has to be more dialogue about what women can be responsible for and what they are not responsible for.” NYU Langone began offering elective egg freezing in 2004, one of the first programs in the nation. Since then, about 150 babies have been born using thawed eggs, Grifo said. That represents a 50 to 60 percent success rate —

Eggs frozen at an earlier age have a higher chance of success Probabilities of at least one live birth, by woman’s age at time of egg freezing and number of eggs frozen. Many clinics advise women to try to freeze 10 to 20 eggs. 6 eggs

97%

100%

83% 58%

50%

30% 21%

16%

Age ≤ 35

Study uses mathematical model based on extrapolated data, not real-world percentages of successful live births. Source: Human Reproduction, April 2017

SHELLY TAN/THE WASHINGTON POST

Number of women freezing their eggs has skyrocketed As of 2015, about 20,000 women had frozen their eggs in the United States. 7,518

8,000

6,000

4,000

2,488 2,000

475 0

2009

2012

2015

The information is based on member clinics for the Society for Assisted Reproductive Technology. The group represents the majority of U.S. clinics. Source: Society for Assisted Reproductive Technology

hardly a guarantee. Increasingly popular Forty years ago, before “let’s chill” egg freezing parties were in vogue, before “The Bachelorette’s” Kaitlyn Bristowe and other celebrities were tweeting about “taking control” of their future, young working women were already being warned about their waning fertility. Washington Post columnist Richard Cohen famously wrote in 1978 that a woman’s “biological time clock can create real panic.” Since then, countless scientific experiments, advice books and talk show hosts have delved into the topic. Doctors now know that the No. 1 factor affecting a woman’s ability to have children as

SHELLY TAN/THE WASHINGTON POST

she grows older has to do with eggs. At the moment she is born, a woman has all the eggs she will ever have already in her body. They are finite, and they sit there in the ovaries, aging. Each month, beginning at puberty, a single egg is released. Even in a healthy young person, the eggs are of varying quality with a certain percentage being flawed in structure or number of chromosomes. That’s one reason it can take months or years to get pregnant, and why miscarriage is common. Around the age of 35, women confront a “fertility cliff,” when the chances of becoming pregnant decline sharply as the eggs decrease in number and quality. By age 40, the average woman has a 5 percent chance of getting pregnant in any given month. By 45, it’s 1 percent. In an unfortunate and unfair twist of nature, men are believed to replenish their sperm at a rate of 1,500 a second through most of their lives; there are documented cases of men remaining fertile into their 90s. Age also affects the quality of sperm, according to numerous studies. But the effect on fertility is markedly less dramatic than in women. Thus the need for “social” egg freezing as it exists today, and why more and more women are willing to pay $10,000 to $16,000 per retrieval cycle, plus hundreds of dollars in yearly storage fees, to put their eggs on ice. While there are no comprehensive national statistics, the Society for Assisted Reproductive Technology, which represents the majority of fertility clinics in the United States, found in its latest survey that the number of women freezing their eggs is skyrocketing — from 475 in 2009 to nearly 8,000 in 2015. The procedure is growing rapidly in popularity: Gina Bartasi, the former chief executive at fertility benefits company Progyny, predicts that as many as 76,000 women could elect to freeze their eggs this year. Amy Amy West, an academic with degrees from the University of Virginia and Stanford University, is well aware of the research on female fertility. In her 20s, she vowed to have a child by the age of 37. But as 37 approached, she was unmarried and working long hours as a not-yet-tenured assistant professor. So in 2011, she decided to freeze her eggs. Everything went great, and she got 26 eggs — a very large number. Three years later, at the age of 40, West was ready to use them. It took two tries and four months to get pregnant, but today, West is the mother of a healthy toddler, with plenty of eggs left over. “Those eggs really paid off for me. I never imagined being a single mom. Now I think about having more,” she said. Carolyn Carolyn Goerig Lee first got the idea to freeze her eggs from Oprah Winfrey. The show aired many years ago, before the

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COVER STORY procedure was commercially available, but Lee vividly recalls a female doctor, single and in her 30s, talking about the need for the technology. In 2008, Lee was 37 and starting to think about children just as egg freezing was taking off. She had been dating a great guy she met at the McLean Bible Church and, despite their different backgrounds — he is a Korean American engineer and entrepreneur, she is a Hungarian-German-Irish nurse from a military family — they seemed to click. But she was in Seattle and he was in Virginia, which made their future somewhat iffy. So with his support, she froze her eggs. Because of her age — 39 by the time she decided on a clinic and went through with the procedure — and the results of her bloodwork, her doctor advised two rounds. It nearly doubled the cost, but it gave her a better shot at having a baby. She got a total of 25 eggs. Fast-forward a few years: Lee and the engineer married and were ready to have a family. Initially, they were worried they had too many eggs. “The idea of fertilizing 25 eggs was a little overwhelming,” Lee recalled. But once they started the process, they realized that each egg was not necessarily fated to become a child. Reproductive health specialists sometimes describe the success rates of thawing eggs, fertilizing them and transferring them to the womb as resembling an inverted pyramid: You start with a certain number of eggs and lose some at every step. While the freezing process has advanced significantly in recent years, 5 to 15 percent typically don’t survive the thawing process. The eggs that make it are fertilized with sperm. The resulting embryos are left to grow for three to five days and graded on certain characteristics. The most promising are then transferred to the woman’s womb, where only some adhere to the wall of the uterus, the first step in a successful pregnancy. From there, the pregnancy faces the usual risks, including spontaneous, unexplained miscarriage. Lee says she is grateful for her twins, a boy and a girl who are now 41/2. But she and her husband always yearned for a larger family. After losing the rest of her eggs, Lee had another set of twins using eggs donated by her younger sister and, last week, she gave birth to a fifth child also using a donor egg. She says she’s “over the moon” happy. “The best piece of advice I have is have a backup plan if your eggs don’t work. It’s not the end of the world,” she said. “You can still be a mom.” MeiMei When MeiMei Fox froze her eggs at 37, the process went more smoothly than she expected. The retrieval, where the doctor removes eggs from the ovaries with a long needle, went without a hitch. She remembers going home and taking a nap.

CAROLYN VAN HOUTEN/THE WASHINGTON POST

“I was thrilled and thought it was the best decision I ever made,” she said. Fox immediately started dating “without thinking about long-term commitments but just enjoying the moment.” She blogged about her experience in HuffPost. As fate would have it, she found “the love of her life,” a filmmaker and fellow writer, months later. The two were soon married. For almost two years, they tried to get pregnant naturally. When Fox was about to turn 40, she decided to use her frozen eggs. She was living in Los Angeles; her eggs were in San Francisco. Her new clinic called her old clinic and had them shipped south. “They knew from the minute they opened the package something was wrong,” Fox recalled. A lab tech later showed her the straws in which the eggs were stored, and how they had leaked. Fox was beyond devastated. But after three years of traditional IVF and fertility treatments with her current eggs, she gave birth to twin boys. “There’s a happy ending, but with a lot of pain and heartbreak and $100,000 along the way,” she said. “Their grandparents are always asking if I started their college fund. I’m like, ‘The college fund went into creating them.’ ” Brigitte Soon after the Bloomberg Businessweek story ran, emails began pouring into Brigitte Adams’s inbox. Women from all over the world wrote to ask for her advice. She launched a blog, Eggsurance, which grew into a thriving community where people shared tips about egg freezing. In Adams’s story, many other young women saw a road map for a happy life. As the years passed and egg freezing took off, she became the de facto poster child for a generation of women considering the procedure. But that painful March day, when the last of her frozen eggs failed to produce a pregnancy, Adams said she realized how one-sided the

Carolyn Goerig Lee embraces David, 2, while Clara and Michael, both 4, play at their home in Haymarket, Va. Lee froze 25 eggs and planned to have a large family with them; most were unusable.

KLMNO WEEKLY

conversation about egg freezing had been, and how little information was available about what she calls “part two” — when you actually try to use those eggs to get pregnant. “There is a huge marketing hype of it, and overpromising,” she said. So Adams dusted off her laptop and began trying to make sense of her situation. First, she said she learned that the fertility industry is very “cagey” about providing data on success rates. “It’s easy for them to say there isn’t data right now. And really there is. There is some data. It’s just not pretty data,” she said. Individual clinics are often reluctant to share their own information, she said, and many don’t refer patients to academic studies that attempt to quantify the probability of success. Only a few such studies exist: A 2016 Fertility and Sterility study of 137 women who tried to use their frozen eggs found that women who froze 10 eggs at the age of 36 faced a 30 percent likelihood of achieving a live birth. Last year, researchers writing in Human Reproduction calculated that the same women should have a 60 percent success rate based on their mathematical model. Second, Adams said many clinics sell women on a single egg retrieval procedure without mentioning that more may be needed to harvest enough eggs to produce a successful pregnancy. This is what happened with Adams. When she recently reviewed her tests, she said they clearly showed that her fertility already had been in decline, suggesting that she would need more than 11 eggs to conceive. The lack of advice was “unconscionable,” she said. “I was never told that x, y and z were a possibility.” While she is still a proponent of egg freezing, Adams said women need to be better educated about the possible outcomes, including the bad ones, and the industry needs to be more transparent. “We are only seeing half the story, which is a very optimistic story,” she said. “But, really, you need to see both.” Her own story has a happy twist. After a dark period of mourning and soul-searching, Adams began IVF again, this time with a donor egg and donor sperm. On a recent weekday afternoon, she was lying on an exam table staring at a computer screen — her first ultrasound. Picking out a sperm donor was fun, she said, like perusing an online dating site to find the ideal mate. Trying to select an egg donor, on the other hand, was “excruciating,” she says: “You are thinking, ‘This should be me.’ ” Adams says she is trying to control her emotions, given the ups and downs of her long journey. But then the doctor comes in and locates the thud-thud of a heartbeat, and her eyes start to water. The baby, a girl, is due in May. n © The Washington Post

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DATA CRUNCH

Crunched

KLMNO WEEKLY

Looking at gaps in longevity

In December, the Centers for Disease Control and Prevention announced that life expectancy in the United States had fallen slightly for the second year in a row, dropping from 78.9 in 2014 to 78.6 years in 2016. The measure is closely tied to income and healthy n December, Centers forit’s Disease Control and Prevention announced thatwith life expectancy in the United had fallen for the behaviors,the which is why perhaps not surprising that residents of Hawaii, the second-highest medianStates household incomeslightly in second year in a row, dropping from 78.9 in 2014 to 78.6 years in 2016. The measure is closely tied to income and healthy behaviors, which is why the United States and an active lifestyle, have the longest life expectancy (81.2 years), while Mississippians, with the lowest household it’s perhaps not surprising that residents of Hawaii, with the second-highest median household income in the United States and an active income, the highest rates of obesity and thewhile sixth-highest rate of smoking, have the shortest (74.9 years). 24/7highest Wall Street, lifestyle, haveone theoflongest life expectancy (81.2 years), Mississippians, with the lowest household income, oneAs of the rates of obesity a financial news opinion site, found out by looking at metropolitan areas, there’s also a wide gapand in life expectancy withinout states and the sixth-highest rateand of smoking, have the shortest (74.9 years). As 24/7 Wall Street, a financial news opinion site, found by looking at such as California, Florida, South and Texas,within muchstates of it explained by variations in theSouth metropolitan household metropolitan areas, there’s also a wide gapCarolina in life expectancy such as California, Florida, Carolinaareas’ and Texas, muchincome of it explained by variations in the areas’ household income rates Island of smoking and obesity. Other states, such as Rhode Island and on Vermont, are and rates ofmetropolitan smoking and obesity. Other states, such and as Rhode and Vermont, are remarkably homogeneous. Below, based remarkably homogeneous. Below, based 2014 data,and areshortest the five states with the longest and shortest expectancies, andlife theexpectancies longest and shortest 2014 data, are the five states withon the longest life expectancies, and the longest andlife shortest metro area metro area life expectancies in each of them. For those wondering, the life District of Columbia’s life expectancy 2014 (on the low end for in each of them. For those wondering, the District of Columbia’s expectancy in 2014 was 76.8 (on thein low endwas for 76.8 longevity), longevity), according to the Institute for Health Metrics and Evaluation. For more information, visit 247wallst.com. n — Elizabeth Chang according to the Institute for Health Metrics and Evaluation. For more information, visit 247wallst.com. — Elizabeth Chang

HIGHEST LIFE EXPECTANCY

LOWEST LIFE EXPECTANCY

1. Hawaii 81.2 years High metro area: Urban Honolulu, 81.4 years Low metro area: Kahului-Wailuku-Lahaina, 81 years

1. Mississippi 74.9 years High metro area: Hattiesburg, 76 years Low metro area: Gulfport-Biloxi-Pascagoula, 75.4 years

2. Minnesota 80.9 years High: Rochester, 82 years Low: Duluth (Minn.-Wis.), 79 years

2. Alabama 75.7 years High: Daphne-fairhope-foley, 78.1 years Low: Gadsden, 73.9 years

3. California 80.8 years High: San Jose-Sunnyvale-Santa Clara, 83.1 years Low: Redding, 76.7 years

3. Louisiana 75.8 years High: New orleans-Metairie, 76.7 years Low: Hammond, 74.3 years

4. Connecticut 80.6 years High: Bridgeport-Stamford-Norwalk, 81.8 years Low: Worcester (Mass.-Conn.), 79.6 years

4. West Virginia 76 years High: Morgantown, 78.7 years Low: Beckley, 74.9 years

5. Massachusetts 80.4 years High: Boston-Cambridge-Newton (Mass.-N.H.), 80.8 years Low: Springfield, 79.3 years

5. Oklahoma 76.1 years High: oklahoma City, 76.7 years Low: Lawton, 76 years

SoURCe: 24/7 WaLL StReet, WHiCH USeD 2014 Data fRoM tHe iNStitUte foR HeaLtH MetRiCS aND evaLUatioN aND tHe aMeRiCaN CoMMUNity SURvey

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KLMNO WEEKLY

BOOKS

Bill of Rights has a dynamic history N ONFICTION

E THE HEART OF THE CONSTITUTION How the Bill of Rights Became the Bill of Rights By Gerard N. Magliocca Oxford. 235 pp. $29.95

REVIEWED BY

K . S ABEEL R AHMAN

very week, Americans are confronted with a growing sense of political and economic crisis, from the inequalities of the new economy to renewed debates about racial and gender discrimination to fresh stresses on our political institutions. During periods of crisis, the Constitution can provide a backstop, spelling out foundational rules and rights that offer a bulwark against the vicissitudes of politics. But the meaning of the Constitution can change precisely during these moments of pressure and flux. In his timely new book, “The Heart of the Constitution,” Gerard N. Magliocca highlights how a key component of our Constitution, the Bill of Rights, has been a central touchstone for Americans throughout history, especially when faced with existential challenges to the legitimacy of American government. Today, we colloquially see the Bill of Rights as encompassing that first batch of 1791 amendments to the Constitution, running from the First Amendment’s freedoms of speech and association to the 10th Amendment reservation of powers to state governments. But these aren’t the only rights spelled out in the Constitution. We tend to understand these rights as judicially enforceable limits on governmental action. But of course the Constitution articulates many other rights limiting government and, in some cases, implying affirmative obligations on the part of government. So why are these rights not considered part of the core Bill of Rights? Magliocca argues that the very idea of a bill of rights is a political and social construction. Our understandings of the existence of a bill of rights, which rights are part of the bill and what those rights mean have changed over time in response to different threats to the legitima-

PETER HORREE/ALAMY STOCK PHOTO

World War II propaganda contrasted the Bill of Rights to Nazism.

cy and viability of American democracy. “The Bill of Rights,” Magliocca writes, “is a mirror for how America sees itself,” taking a different form “every political season.” The story of the elevation of the Bill of Rights to its central position in constitutional and political consciousness is also a story of the shifting meaning of the Bill itself. Indeed, the political purposes of the Bill of Rights over time help explain why our constitutional and political dis-

course today seems ill-equipped to handle the three central crises now facing American politics: the crisis of perpetual war and the post-9/11 surveillance state, the crisis of economic inequality, and the crises of systemic racial and gender discrimination and exclusion. First, Magliocca highlights the role of the Bill of Rights in distinguishing America during the 20th century from the totalitarianism of Hitler’s Nazi regime and Stalin’s Soviet Union. But

this also meant that the existence of the Bill of Rights was used to sanction expansive U.S. military intervention around the world. Second, the Cold War context of the elevation of the Bill of Rights meant that it was the civil liberties of the 1791 amendments — and not FDR’s “Second Bill of Rights” for socioeconomic necessities — that got pride of place. The idea of a second bill faded away in the reaction against communism, as the Supreme Court during the 1970s systematically turned away from appeals to find implicit socioeconomic rights in the Constitution, often suggesting that these economic rights were not of the same stature or importance as the core Bill of Rights. Third, the elevation of the Bill of Rights over the past century and a half has consistently effaced efforts to achieve a more inclusive and egalitarian view of American society. The 13th, 14th and 15th Amendments together espouse a radical commitment to establishing racial, economic, social and political equality, specifically aimed at uprooting the legacy of slavery. The 19th Amendment secured the vote for women, following decades of effort by feminist activists. Indeed, the punchline of Magliocca’s book is that our modern view of the Bill of Rights is far too stultifying. Giving pride of place to the 1791 amendments means the Bill is “locked in a gilded cage.” Yet history shows that it was precisely the fluidity of the concept of a bill of rights that enabled it to serve as a vessel for debates over American values and identity. n Rahman is an assistant professor of law at Brooklyn Law School and a fellow at the Roosevelt Institute. He is the author of “Democracy Against Domination.” This was written for The Washington Post.

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KLMNO WEEKLY

OPINIONS

Democrats need a strong message, not childish acts DANA MILBANK writes about political theater in the nation’s capital. He joined The Washington Post as a political reporter in 2000.

It gives me no pleasure to say this, but the Democrats’ behavior at the State of the Union was embarrassing. I take a back seat to nobody in decrying President Trump’s cynical and divisive performance. He repeatedly exploited Americans’ divisions on race, guns, God, immigration — anything to distract from the broken promises, vulgarity and worse that define his presidency. But the Democrats, with their childish protests, took the bait. Symbolic dissent is fine, but this was a cacophony of causes: black clothing (for #MeToo), kente ties and sashes (because of Trump’s Africa insult), butterfly stickers (for the “dreamers”), red buttons (for a victim of racial crime) and the more bipartisan purple ribbons (for the opioid epidemic). Worse, dozens of Democrats refused to stand when the president entered the House chamber, forgetting that one stands out of respect for the office, not the officeholder. Rep. Bennie Thompson (DMiss.) grabbed a middleaisle seat only to turn his back on the president when he walked past. Democrats groaned, scoffed, heckled and made lemonbiting faces. Others simply boycotted. In short, they did the same sort of things they (and I) denounced Republican lawmakers for when they did them to President Barack Obama. This matters, because as nasty as Trump’s speech was, his first 20-or-so minutes contained an effective message — false, but effective — about how his plutocratic policies have boosted the economy and benefited working people. Democrats need a simple, clear and effective counter to that claim, and it is not to be found in the unfocused protests and reflexive petulance they showed Tuesday and again Wednesday. Trump’s message is straightforward: Businesses are coming home, jobs are increasing, wages are growing, and American confidence is returning. There’s a simple counter to this, and it has the virtue of being more accurate than Trump’s economic claims.

(Like the rooster believing his cock-a-doodle-doo causes the sun to rise, Trump takes credit for the continuation of eight years of job growth.) It goes like this: Trump promised to bring change to Washington, but instead he brought more politics as usual. Breaking his promises to working people, he enacted a huge tax cut for billionaires and corporations that will enrich him and his big donors. To pay for the billionaires’ tax cut, Trump and Republicans will have to make huge cuts to Medicare, Medicaid and Social Security — on top of changes to health care that will cause millions to lose coverage and premiums to soar for all. Is that so hard? Apparently. On Wednesday morning,

AARON P. BERNSTEIN/BLOOMBERG NEWS

Sen. Joe Manchin III (D-W.Va.) stands and claps as other Democrats stay seated while President Trump delivers the State of the Union.

House Democratic leaders went before the cameras to give their thoughts on the State of the Union. They were discursive and aimless. Rep. Joe Crowley (D-N.Y.) denounced Trump’s “racist, demonizing comments on immigrants” and the absence of any mention of Russian election interference. Rep. Linda Sánchez (D-Calif.) said that her “first step” would be the “dreamers.” Minority Leader Nancy Pelosi (D-Calif.) hopped from immigration to opioids, budget funding caps, Trump’s selfcongratulation and lack of vision. She briefly pivoted to the economy (“he pads the pockets of the top 1 percent”) before returning to immigration, then Russia sanctions. Rep. James Clyburn (D-S.C.) chipped in mentions of #MeToo, Trump’s insults of African nations, African American unemployment, air safety, schools, broadband, the environment and clean energy. All important issues. But when the whole thing was over, 40 long minutes later, the only message the Democratic leaders managed to convey was that they really do not like Trump, for any number of reasons. That there were no fewer than five Democratic speeches in response to the State of the Union only compounded the confusion.

The Democrats’ need to keep focus is all the more pressing because of the uncritical devotion Republicans have decided to show Trump, applauding the leader Tuesday night like so many mechanical chimpanzees clapping cymbals, and offering over-the-top praise of his absolutely incredible, greatest-inhistory speech. More ominous are their increasingly brazen attempts to protect Trump by taking down the Russia probe. Now there’s Republicans’ decision to declassify a memo they wrote (possibly with White House coordination; the leader of the effort won’t say) attacking the integrity of the FBI, refusing to declassify a memo by Democrats that would contradict the GOP claims, and ignoring a plea by the FBI (under a Trump-appointed director) that it has “grave concerns about the material omissions of fact that fundamentally impact the memo’s accuracy.” Trump said he was “100 percent” behind this defamation of the nation’s premier law enforcement agency for political purposes and approved the memo’s release Friday. With so many checks on Trump’s power failing, it’s more important than ever for the opposition party to behave like one — and not a patchwork of disparate grievances. n

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OPINIONS

KLMNO WEEKLY

TOM TOLES

Here’s a better N. Korea strategy VICTOR CHA is a professor at Georgetown University and senior adviser at the Center for Strategic and International Studies. This was written for The Washington Post.

North Korea, if not stopped, will build an arsenal with multiple nuclear missiles meant to threaten the U.S. homeland and blackmail us into abandoning our allies in Asia. North Korean dictator Kim Jong Un will sell these weapons to state and nonstate actors, and he will inspire other rogue actors who want to undermine the U.S.-backed postwar order. These are real and unprecedented threats. But the answer is not, as some Trump administration officials have suggested, a preventive military strike. Instead, there is a forceful military option available that can address the threat without escalating into a war that would probably kill tens, if not hundreds, of thousands of Americans. When I was under consideration for a position in this administration, I shared some of these views. Some may argue that U.S. casualties and even a wider war on the Korean Peninsula are risks worth taking, given what is at stake. But a strike (even a large one) would only delay North Korea’s missile-building and nuclear programs, which are buried in deep, unknown places impenetrable to bunker-busting bombs. A strike also would not stem the threat of proliferation but rather exacerbate it, turning what might be a North Korean moneymaking endeavor into a vengeful effort intended to equip other bad actors against us. I empathize with the hope, espoused by some Trump

officials, that a military strike would shock Pyongyang into appreciating U.S. strength, after years of inaction, and force the regime to the denuclearization negotiating table. I also hope that if North Korea did retaliate militarily, the United States could control the escalation ladder to minimize collateral damage and prevent a collapse of financial markets. In either event, the rationale is that a strike that demonstrates U.S. resolve to pursue “all options” is necessary to give the mercurial Kim a “bloody nose.” Otherwise he will remain undeterred in his nuclear ambitions. Yet, there is a point at which hope must give in to logic. If we believe that Kim is undeterrable without such a strike, how can we

also believe that a strike will deter him from responding in kind? And if Kim is unpredictable, impulsive and bordering on irrational, how can we control the escalation ladder, which is premised on an adversary’s rational understanding of signals and deterrence? Some have argued the risks are still worth taking because it’s better that people die “over there” than “over here.” On any given day, there are 230,000 Americans in South Korea and 90,000 or so in Japan. These Americans would most likely have to hunker down until the war was over. To be clear: The president would be putting at risk an American population the size of a medium-size U.S. city — Pittsburgh, say, or Cincinnati — on the assumption that a crazy and undeterrable dictator will be rationally cowed by a demonstration of U.S. power. An alternative coercive strategy involves enhanced and sustained U.S., regional and global pressure on Pyongyang to denuclearize. This strategy is likely to deliver the same potential benefits as a limited strike, along with other advantages, without the selfdestructive costs. There are four elements to this strategy. First, the Trump

administration must continue to strengthen the coalition of U.N. member states it has mustered in its thus far highly successful sanctions campaign. Second, the United States must significantly strengthen its alliances with Japan and South Korea with integrated missile defense, intelligence-sharing and anti-submarine warfare and strike capabilities to convey to North Korea that an attack on one is an attack on all. Third, the United States must build a maritime coalition around North Korea involving rings of South Korean, Japanese and broader U.S. assets to intercept any nuclear missiles or technologies leaving the country. China and Russia should be prepared to face consequences if they allow North Korean proliferation across their borders. Lastly, the United States must continue to prepare military options. Force will be necessary to deal with North Korea if it attacks first, but not through a preventive strike that could start a nuclear war. A sustained and long-term competitive strategy such as this plays to U.S. strengths, exploits our adversary’s weaknesses and does not risk hundreds of thousands of American lives. n

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HISTORY

Can devastating 1918 flu happen again? BY

A SHLEY H ALSEY III

he flu arrived as a great war raged in Europe, a conflict that would leave about 20 million people dead over four years. In 1918, the flu would kill more than twice that number — and perhaps five times as many — in just 15 months. Though mostly forgotten, it has been called “the greatest medical holocaust in history.” Experts believe between 50 million and 100 million people were killed. More than two-thirds of them died in a single 10-week period in the autumn of 1918. Never have so many died so swiftly from a single disease. In the United States, it killed about 675,000 in about a year — the same number who have died of AIDS in nearly 40 years. As the country muddles through a particularly nasty flu season, the 1918 nightmare serves a reminder. If a virulent enough strain were to emerge again, a century of modern medicine might not save millions from dying. One hundred years ago, a third of the world’s population came down with what was dubbed the Spanish flu. (It got its name when the king of Spain, Alfonso XIII, his prime minister and several cabinet ministers came down with the disease.) The flu brought life to a standstill, emptying city streets, closing churches, pool halls, saloons and theaters. Coffin makers couldn’t keep up with demand, so mass graves were dug to bury the dead. People cowered behind closed doors for fear they would be struck down. In Philadelphia, news stories described priests driving carts through the streets, encouraging people to bring out the dead so that they might be buried. In New York there were accounts of people feeling perfectly healthy when they boarded the subway in Coney Island and being taken off dead when they reached Columbus Circle. In 10 weeks, the flu killed 20,000 in New York City and produced 31,000 orphans. There is debate among historians about where the flu first surfaced — did it come from China or a British encampment in northern France or rural Kansas? But it spread worldwide practically overnight. By the end of November, 50,000 had died in South Africa, where at its peak, flu killed 600 people each day. In Egypt, the death count reached 41,000 in Cairo and Alexandria by January. In Tahiti, trucks roamed the streets of Papeete to collect the dead, and great funeral pyres burned day and night to incinerate the bodies.

LIBRARY OF CONGRESS/ASSOCIATED PRESS

Normally the most vulnerable to influenza are infants, whose immune systems are not yet up to the test, and the elderly, whose ability to fight disease diminishes with age. In 1918, more than half the people it killed were in the prime of their lives. Many died within hours, turning blue from lack of oxygen as they coughed foamy blood up from their lungs and bled from the nose, ears and eyes. The Spanish flu infected the upper respiratory tract and then dove deep into the lungs with viral or bacterial pneumonia. How did it kill so many young healthy adults? Their immune systems attacked the influenza invader with such force that it killed them. The world’s most successful vaccinations against measles, polio, tetanus and small pox generally work in the same way. They introduce a minuscule amount of the disease so that if it ever arrives in full-blown form, the body will recognize and neutralize it with an immune system counterattack. Influenza, however, never gives the immune system a stable target. Instead, it can transform into something that appears innocent to the white blood cells and enzymes intended to wage war against it. That explains why a vaccine against the flu is a hit-or-miss proposition, based on the best guess of scientists about what flu strains are most likely to emerge six months later. The CDC estimates flu vaccines will be about 30 percent effective against this year’s predominant strain, H3N2, but about 60 percent effective against the other influenza A strain, H1N1, and about 50 percent effective against influenza B viruses.

In October 1918, St. Louis Red Cross personnel prepare for victims of the flu epidemic. The flu that year is believed to have killed between 50 million and 100 million worldwide.

In 1918 there were no flu vaccinations, and it would not have mattered anyway. After the “touch of the flu” that proved deadly only here and there during the spring, the influenza apparently mutated into a killer. By early autumn, the public face of America and the Western world had a gauze mask on it. People wore them to church, the military marched in them, police posed for photos in them and doctors wore them to visit patients. In Seattle, anyone who tried to board street cars without a gauze mask was arrested. The masks served little purpose. The fine spray of a sneeze creates a cloud of more than half a million virus particles, and the virus can live for hours on any hard surface where they settle. The frightening spread of the disease led to official and self-imposed quarantines. Schools, theaters, bars and other gathering places were ordered closed. Mothers were told their children should be confined to their own yards. In New York, officials so feared transmission on overcrowded subways that they ordered people to work staggered shifts. Many flu victims died in their homes of starvation, and not the disease, because they were too weak to seek food and no one dared bring it to them. A century later, science has revolutionized the medical profession, producing miracle drugs and surgical procedures that no one could have imagined in 1918. But when Thomas Frieden stepped down as head of the CDC last year, he was asked in an interview what keeps him awake at night. “We always worry about pandemic influenza because this has the potential to kill so many people,” he said. “We stockpile antivirals for an emergency. But much more is needed to both track influenza better around the world and develop a better flu vaccine.” The flu kills up to 646,000 people worldwide each year, sometimes as many as 56,000 of them in the United States. Since 1918, there have been three flu pandemics. (An epidemic is when an infectious disease spreads rapidly to many people. A pandemic is a global disease outbreak). “Obviously, we still have no control over the virus,” said historian John M. Barry, author of the bestseller “The Great Influenza” who gave the keynote speech in 2004 when the National Academies of Science gathered to discuss pandemic influenza. “In a lot of ways, we’re arguably as vulnerable, or more vulnerable, to another pandemic as we were in 1918 because there’s more economic interdependence.” n ©The Washington Post

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A Wenatchee native returns home and finds a niche in the field of musical instrument repair.

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