The last pandemic flu was in 1918, killing some 50 million to 100 million people worldwide -- between 2.5 and 5 percent of the human population -- during the course of 18 months. The flu was a close relative to today's H5N1 bird flu.
Andrew Pavia, chief of pediatric infectious diseases at the University of Utah, warned of a pandemic flu to congressional staffers on Tuesday as part of a briefing.
"There will be a flu pandemic, and it will be a disaster and kill many people," he said.
Pavia posited that the flu would make one-third of the U.S. population sick and kill 2 million Americans.
The heaviest affected would be the less financially wealthy, who often lack the resources to pay to fight diseases. More than 46 million Americans lack health insurance, which affects their ability to see health service providers due to prohibitive health care costs.
The pandemic could put up to half of the civilian labor force off of work, either home sick or sent home to care for loved ones. It also could dramatically affect the education of many in public schools, closing them for weeks.
Problems for low-income Americans could multiply from there, said Georges Benjamin, the executive director of the American Public Health Association, as many low-income Americans. Many either do not have sick leave and thus face consequences to their employment for not coming into work -- the case in many retail sales jobs -- or, lacking paid sick leave, will need to go to work to pay for their daily lives from hourly jobs.
"If you don't work, you don't eat," Benjamin told United Press International.
This means that, for example, a fast-food restaurant worker, forced with the choice of staying home sick and getting fired versus coming in to keep their job, could spread the flu from working in the kitchen or serving the food.
In addition, nearly 30 million children in low-income families rely on going to school for free or no-cost lunches. For them, no school likely means no meal.
"There is now no plan in place to help parents afford nutritious meals when schools are closed," reported UPI.
In the wake of a pandemic flu or other national epidemic, the United States is potentially unprepared to care for the sick. According to UPI, the secretary of health and human services does not have the authority to start up national emergency health care coverage to tend to those who are uninsured or affected during a national emergency.
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