Just this last January, The New York Times reported that
this year’s influenza outbreak had crossed into the epidemic domain, having hospitalized
record numbers and killing thousands of Americans, despite an ongoing and very
active vaccination program.
This flu is a Type A flu, for which we prepare vaccines designed
on apparent new strains each year. This winter, the H3N2 variant, appears to be
the real culprit wafting the flames of death from pneumonia this now well
documented killer brings. It appears that the epidemic reached its zenith in
January, but the influenza outbreak remains, and its effects a real concern for
future outbreak patterns, attacking and killing most of us over 65 with
concomitant disease or poor immune response and even some who have been
vaccinated, with stealth and speed.
Having had this flu in January, I can count myself as one
of its survivors, fighting back with antiviral medication, anti-inflammatory
drugs, and other “magic potions” for palliation of my very icky symptoms. The
illness I experienced lasted about 10 days, with the first 4 seeing me miss work
due to extreme difficulty in breathing through my nose and throat, making it impossible
to eat, all the while coughing my head off, reeling from throbbing headaches,
muscle pain, and running a fever. But at no time did I feel my health was in
danger, as my symptoms were initially very intense but tapered quickly and only
involved catarrhal effects. And unlike many of my friends and colleagues who
suffered the flu this winter, I felt fully recovered after 2 weeks. But I also
attribute this to a vegetarian diet, my bicycle, and a personal fitness trainer who never lets up, even when I’m ill. A subject which will be discussed in future posts.
This whole experience prompted me to discuss why we worry
about the flu so much, vaccinate against it annually, and have government
agencies watch each new strain so carefully. In addition to being a physician
and professor of medical science, I am also an American History professor. So
for me, the answer is quite obvious when we peer back 95 years. An epidemic of
influenza occurred then that literally brought the world to its knees, and keep
in mind that the First World War was in full swing. But the epidemic killed
more than this horrible war could ever consume. This plague killed so many that
the death toll from the war paled when compared to this assault on Mankind.
A true pandemic, The 1918 Flu, also known as the Spanish
Flu, Infected 500 million humans worldwide, and estimated to have killed 50
million. In eleven short months between January and November of 1918 it killed
700 thousand humans inside the borders of the United States alone, shutting
down whole cities and local governments. Some states went as far as to shut
down their legislative sessions to thwart exposure to our leadership. To this
day, it is considered the worst human natural disaster in history. And many
have almost forgotten this epic and even “Biblical” event.
Because of the ominous size of the war and its inevitable
line changing outcome, to maintain morale, Department of War censors minimized
early reports of illness and mortality in Germany, Britain, France, and the
United States, but the press was free to report the epidemic's effects in neutral
Spain, where the grave illness and subsequent recovery of the King of Spain,
Alfonso the XIII, created a false impression of Spain as especially hard hit, thus
the pandemic's nickname, the “Spanish Flu.”
It is not truly known from
where it was spawned, perhaps the battlefields in France, and Belgium, where
most of the western front was fought. A trench war where axes of advance moved
so slowly they never really budged until the war’s final weeks. A trench war that lasted 4 years. A trench
war of deep mud, sewage, and blood, that stretched for hundreds of miles on
each side, dug ten feet deep to protect whole columns of men, and shored up
with dead bodies and body parts of humans, and horses. Body parts that soldiers
utilized so often, they became inert to the macabre vision of this war torn
Martian Landscape. If you can only imagine protruding arms, hands, legs, and
other body parts as utility hangers and weapon racks. Or a dead man’s face
staring at you while you set your cup of coffee on the side of his cheek to
lean it against the blood streaked mud, while bullets fly over the trench’s
roof of ashen and putrid sky. “The war to end all wars”, it was called.
What we do know for sure? Modern
transportation systems made it easier for soldiers, sailors, and civilian
travelers to spread the disease, and spread it throughout the planet very
But here’s the deal. Back here in the United States,
there were 2 niduses of outbreak that are now well accepted. In January of 1918
there was an outbreak at Fort Riley in Kansas followed by an outbreak of an
apparently more virulent strain in Boston 6 months later. By November, 700
thousand Americans lay dead. Not overseas fighting a war, but at home, minding
their own business. What is really scary is that this viral attack on humanity
was especially evil. Most influenza outbreaks disproportionately kill little
children, elderly, or already weakened patients. But in contrast, the 1918
pandemic killed predominantly robust healthy young adults. Yeah, the strength
and future of our post war nation, succumbing to a hemorrhagic pneumonia
sometimes within 24 hours of initial infection.
Needless to say, America was horrified and almost morally
undone by this specter of death and an ongoing war in Europe. Understand, we
didn’t know it was a virus back then, and even though the nineteenth
century had heralded in the great science of microbiology and the knowledge of
bacterial infectious disease, little was known about viruses, and many
considered virology a fringe science.
Let’s put this in perspective. If there was an influenza
outbreak now that started in January and killed almost a million Americans by
November, we would be a nation in full panic, buying hand sanitizers; antiviral
medication; folk medicine and herbs of all kinds; gloves, masks, and
respirators; never going out; staying away from any public event; not allowing
people into our homes; and certainly not travel from city to city. Police and
fire fighters would be slow to respond to anything. We would be absolutely
terrified and paralyzed.
But the real truth is this. If you translate those
numbers from 1918 to the equal and proportionate numbers in 2013, the
frightening and ominous specter speaks for itself. And this is why we as
physicians and scientists pay very close attention to “The Flu”. If the same
pandemic of 1918 occurred now, 10 million Americans would be killed in less
than 10 months, 500 million would be dead worldwide, that’s half a billion!
Seven percent of the world’s population snuffed out in less than a year. So
maybe now, you understand just how big the 1918 Flu really was.
A plague so big, only the infamous “Black Plague” of
medieval Europe which killed nearly 200 million in five years can even come
close. But the Black Plague was a bacterial infection from Yersinia pestis, spread by rodents and flees, hanging around for
years, possibly burning out after a decade, it still pops up annually all over
the world and is treated with antibiotics. The Spanish Flu on the other hand,
vanished almost as quickly as it attacked. It apparently hit us so hard that
it’s host sources died fast, leaving only exposed survivors who were now immune
to this virus, leaving no one to infect. “A self cleaning oven”.
So what do we know about this truly brutal and powerful threat
that brought us to our knees almost a century ago? In 2005 the genetic
sequencing of this virus was reproduced, revealing it to be an H5N1 variant
type virus. Yeah, an Avian Strain. A "Bird Flu" which had mutated into
a human killer. And now you know why we have a government employee stationed at
every airport in the United States whose sole purpose is to monitor all
individuals who travel to our country from countries where bird flu deaths have
been reported. We will never, and I mean never let this happen to us again.
So why did this virus cause such death and destruction on
a scale unseen before? No one answer is reachable, and many of us in the
medical profession continue to scratch our heads. One thing is evident though.
In the late twentieth century, victims of the 1918 Flu were exhumed and
studied for pathogenic profiling. What we found, especially in our young adults
who died so quickly, was evidence of a Cytokine Storm. Cytokines are part of an
immunomodulating cascade of proteins that can flood our vascular system when
prompted by a strong pathogen. Especially in robust battle hardened immune
systems, this can go awry, releasing immunologic agents in a vicious feedback
loop of inflammatory response and phagocytosis that destroys alveoli and
capillary vascular beds rapidly, leaving the victim with hemorrhaging and
infected lung tissue and imminently quick death, thus, killing humans with
strong immune systems. You guessed it, killing our healthy 20 to 30 year olds.
On the battlefields of Europe in 1918, there were no
field radios. There were no telephones or telegraphs to communicate from the front to
the rear command centers. In the “No Man’s Land" of Trench Warfare there were no
telephone poles to run wire. There weren’t even any trees on the scorched surface
Isn’t it interesting that during World War I, both sides
used Carrier Pigeons to send messages back and forth from fighting on the
fronts to their rear guards and commanding brass. One can only suspect what
gave birth to the most vicious killer of humans in history.
So yeah, we pay very close attention to Influenza, particularly
the A strains and their ever changing variant intruders.
In my next article we will discuss how vaccination
changed humankind forever. I will leave you with this. One hundred years ago
any American’s definition of “good health” would have been “the absence of
disease”. Keep in mind that the top killers in 1913 were Tuberculosis, Small
Pox, Diphtheria, and Influenza. What would you say is your definition of good
health now, especially those of you who are into “personal fitness”?