DR. PETER L. Beilenson has just finished his fourth summer of talking about dead crows and mosquitoes and standing water and all the other elements that go into the West Nile virus story.

"I've done between 200 and 250 television interviews this year," the Baltimore health commissioner says. "At least a quarter of them were on West Nile."

This astounds Beilenson.

"The city has had two West Nile deaths in the last four years," he says. "I would much rather be talking about the drug problem and hepatitis C and universal health care. Compared to those, the public health threat of West Nile is tiny."

Beilenson points out that 1,000 people die of influenza in the state each year - 183 in the city in 2000. "But you just get a teeny-weeny notice in the paper announcing a clinic giving out flu shots."

For whatever reason, the West Nile virus - which shows no symptoms in most who get it, and appears as a mild flu in the vast majority of the rest - has captivated the attention of the nation, or at least much of its media.

It might be the name. If West Nile had turned out, as many thought when it first appeared in 1999, to be another appearance of St. Louis encephalitis - which infected more than 2,500 people between 1974 and 1977 in the latest large outbreak - it might not have attracted the same attention.

A disease coming out of St. Louis may not have seemed as threatening as one from the West Nile. That is a river in Africa, a continent that is purported to have given us AIDS and Ebola and is often depicted in apocalyptic health dramas as the source of unknown pathogens waiting in the jungles, ready to wreak havoc on the civilized world. The name also ties in to America's long-standing association of epidemics with immigrant groups.

It might also be the method of transmission. Mosquito bites have never been more than a harmless annoyance of American summers. Everybody gets them. Now they are suddenly a ticket in a fearsome lottery - the odds are long, but the payoff is deadly.

Margaret Humphreys, who studies the history of epidemics in Duke University's history department, notes that by the time it was discovered in 1897 that malaria was transmitted by mosquitoes, the disease had become relatively rare in the United States.

"I don't think most Americans have the sense of the American mosquito being particularly dangerous," she says.

Or it could be because West Nile is quite dangerous.

"I think it is a really important infectious disease that is going to be here forever," says Dr. John G.Bartlett, who studies infectious diseases at the Johns Hopkins medical school. He says that West Nile is the major cause in this country of encephalitis, a brain infection.

Bartlett dismisses the idea that the attention paid to West Nile is because of its name. "Anything that causes 2,500 cases of brain infection in this county is going to catch people's attention no matter what appellation is put on it," he says.

He also argues the comparison to influenza is specious because he says, though flu shows up as No. 7 on the annual causes of death list with 65,313 in 2000, no one dies of the flu. It just tips people already sick with other things over the edge.

Originally, West Nile's deaths were from the same already-vulnerable population, but recently it has been having devastating effects on a few people who otherwise appeared healthy.

"With West Nile, you are talking about people who are functioning and working and all of a sudden they have bad encephalitis and they die or are paralyzed," Bartlett says. "In Chicago right now, you've got 30 or 40 patients really sick with West Nile. I don't overreact to infectious diseases, but this is a pretty scary epidemic. If I were in Chicago right now, I'd be scared to death."

Jonathan Patz of the Hopkins School of Public Health calls West Nile "a real wake-up call."

"It shows that a new disease can emerge at any time, given the right conditions," he says. "For a long time we have been quite complacent about monitoring infectious diseases, especially tropical diseases and to the extent we need to beef up those public health preventative and surveillance activities, in that regard, it is a serious disease."

Patz says that the surprisingly quick spread of West Nile during this mosquito season could be because of the combination of a mild winter that allowed infected mosquitoes to survive and a drought that concentrated animals around sources of water making it easier for a large number of them to be infected by a few mosquitoes.

The appearance of West Nile should alert us to the possibility that climate change brought about by global warming could make America more susceptible to such diseases, he says.

Still, Beilenson says there are far larger public health problems to deal with. "Less than one-half of 1 percent of those who are infected with West Nile face serious consequences," he says. "It can be deadly, and every death is regrettable and tragic, but it primarily effects a high-risk population - the elderly, particularly those with chronic debilitating conditions or compromised immune systems - which is the exact same population at high risk from the flu."

Obesity a bigger risk

Beilenson says the Baltimore population is at much greater risk from an epidemic of obesity sweeping through the teen population, bad diets and lack of exercise leading to premature onset of adult diabetes and degenerative arthritis and many other problems. But there is far more call to spray for mosquitoes than to get rid of junk-food vending machines in schools.

One reason that West Nile attracts such attention is because the United States is not used to such threats to its health. In other countries where it is present, West Nile plays a small role in the background as the much more deadly epidemics of malaria and acquired immune deficiency syndrome and typhus and various other tropical diseases occupy the foreground.

That was not always the case, of course. In the 19th century, several epidemics of yellow fever were centered in Fells Point and killed thousands. Influenza was responsible for the worst epidemic in the country's history as the Spanish flu killed 500,000 in 1918. Polio outbreaks in 1949 and 1952 killed more than 6,000. AIDS has killed more than 450,000 since 1981.

For the most part today, the U.S. population does not see itself as at risk from something coming out of the air to kill. That puts West Nile in the same category as traffic fatalities or homicide - or terrorism.

"Most of what people are dealing with is chronic illnesses - even AIDS is a chronic disease now - but those aren't as sexy, not as exciting as an acute disease," Beilenson says.

'Herd immunity'

All seem to agree that West Nile will probably follow the same path taken by St. Louis encephalitis - it will not die out but will be limited to small, intermittent outbreaks as the country develops "herd immunity." That means that so many people will get the disease - and probably not even know it - and develop a natural immunity, it will get more and more difficult for mosquitoes to infect people.

For now, Beilenson says to take sensible precautions to avoid breeding mosquitoes. Patz says he has cleaned out his gutters and some drains that created standing water. Bartlett recommends insect repellents with the ingredient DEET, considered unequaled in repelling mosquitoes.

Beilenson is pleased with the reaction he sees from most in the city. "Compared to 1999, when we were out there all the time picking up dead birds, people in Baltimore City are not that terribly concerned," he says. "I think they are realizing, only a two cases this year, maybe it's not that big a deal."

Humphreys says it is a disease that has its biggest impact on the media. "I don't think most people are as worried about it as the newspapers are," she says.