Friday, June 5, 2009

La Grippe Espagnole

This spring’s scare over the H1N1 virus, the so-called Swine Flu, prompted me to order John M. Barry’s book “The Great Influenza, The Story of the Deadliest Pandemic in History.” I do not necessarily recommend that you read this book. It scared the crap out of me. Suit yourself. What follows is sort of a book report and you can assume that when I mention figures and facts, that I have drawn them directly from Mr. Barry.


The pandemic of 1918-1920, called the Spanish flu, has special meaning for me. My maternal grandfather and grandmother died within one week of each other, leaving my three month old mother, five older brothers and a sister orphans. This was a common problem as 675,000 Americans, out of a population of 105 million, died, most during the horrendous twelve weeks in the fall and winter of 1918.

It is unclear exactly where all her siblings went to live but we know that her Aunt Lottie raised my mother. No finer woman ever drew breath. I know this because she also raised me until about the age of eight and intermittently for years afterward.

(Photo: young Bessie with her cousin, Percy, Lottie's son, c. 1920.)

It is now believed that the virus first jumped from swine to humans in the winter of 1917 and first surfaced in the spring in Haskell County, Kansas, a small farming community. Soldiers visiting on leave from nearby Camp Folsom, home of 56,000 recruits training before heading off to fight WWI, carried the virus back to the base and the flu spread rapidly through the crowded soldiers. Although highly contagious, this first wave of the disease was relatively mild and few deaths occurred. It traveled from base to base and then on the troop ships to Europe where it spread rapidly. It went underground and mutated. The new improved version had become a deadly killer and was erroneously renamed the Spanish Influenza.

As the war ended in Europe returning US troops brought the deadly virus back with them and introduced it to the teaming cities on the east coast. It spread quickly to all parts of North America even the remote Inuits of Alaska and islands in the Pacific where whole villages were wiped out due to their lack of prior exposure to any kind of influenza. Indeed, no part of the globe was spared. Estimates are difficult but it is now commonly believed that 50 million to as many as 100 million people died. Global population at that time was about 1.8 billion people or 28% of the population today. In other words, nearly 5% of the world’s population died in the pandemic. Extrapolating those figures to the population today of 6.1 billion would give you a butcher’s bill of some 200 million souls. Even allowing for advances in modern medicine that’s a sobering number.

In a normal year influenza kills about 36,000 people compared with about 1/3 that number for AIDs. In fact, AIDs, also caused by a virus, has killed 23 million in 24 years. That is not a trivial number but the Spanish flu killed at least double that number in 24 months!

The influenza virus is the most perfect of all organisms, and the simplest. Consisting of little more than a membrane containing the genome, the simple RNA genetic material, it has only one function: to replicate itself. Even the simple bacteria have a normal cell structure and function. A virus does not burn oxygen for metabolism or produce any by products. The influenza virus attaches itself to a cell in the mucus membrane and invades that cell. It enters the nucleus of that cell and modifies the genetic code of the cell so that it produces new proteins that enable rapid replication of the virus. Ten hours after infecting the cell a “swarm” of between 100,000 and one million new viruses escape the single cell to invade its neighbors. Because the genome of the virus is so simple and because of the vast numbers, there are many mutations. If more than one different virus has also infected the cell, you get even more variations. You can easily see why the immune system has trouble keeping up.

One of the oddities of the Spanish flu pandemic was the disproportionate number of people in the 20-30 age group that died. Normal influenza outbreaks kill the old and the young and those with compromised immune systems. 50% of the deaths were people in the 20-30 age group, those with the healthiest immune systems. Scientists now believe that the over reaction of the immune systems of these young, healthy people actually caused their deaths. This violent reaction of the immune system is called the “cytokine storm”. Their lungs literally exploded and they bled from all orifices. Young healthy males dropped dead in the streets only a day or two after being infected. Many who recovered later experienced serious neurological disorders. Of course, many people also died from secondary infections of pneumonia, leading many researchers of the time to blame the disease on bacteria. It was not until years after the storm had passed that the real culprit was identified.

To understand how this thing got out of hand it is important to recognize the period in which it occurred. Medicine, of course, was just emerging from the dark ages and many doctors still practiced bleeding their patients for all manner of ailments. More importantly, the country was at war. Wilson had been reluctant to enter WWI that had started in 1914, but events finally forced the US into the fray in April of 1917. Once in, Wilson went at it with gusto. He nationalized almost all means of production, controlling food, fuel and industry. He stifled free speech and any form of dissent. The government controlled the press and the flow of information. Every able-bodied young man got drafted into the army and almost all the trained doctors and nurses were conscripted. Nothing was allowed to interfere with the war effort.

The result of these policies found massive numbers of men congregated in small places either on army bases or crammed into cities where they worked on shipbuilding or armament production. A lot of people in close proximity created a ripe environment for the rapid transmission of this highly communicable disease. When the troops started returning from Europe and brought the new improved virus back with them, the army failed to confine the soldiers to the bases and the disease spread rapidly to other installations and into the cities on the east coast. Other ships carried it to Louisiana and Seattle. From there it marched across the continent. From Europe it migrated to the Far East. An estimated 20 million people died in India alone. In China? Anybody’s guess.

In Philadelphia at its peak some 4700 people died each day. It was impossible to keep up with the bodies and finally steam shovels were employed to bury victims in mass graves. People were rightfully scared into immobility, a situation made worse by the heavily censored press that kept telling them the worst was over and everything would be just fine.

After dying out in 1919 a third wave came back in 1920 but by then the virus had again modified and was now less lethal.

Barry contends that we are not spending enough on influenza that historically has surfaced as pandemics three or four times each century. We have spent more money on West Nile Virus that has killed less than 900 people in five years than we spend on influenza. Given the body count, this makes little sense. And, we are probably overdue for another pandemic.
No one knows if the recent wave of swine flu that swept the globe this spring will return in the fall in a more deadly form.

I am pretty wary of this flu business after I caught the H3N2 “Hong Kong flu” in 1968. Fresh out of the Navy and in great shape, the damn thing nearly killed me. (Considered mild, it still killed 700,000 worldwide). It had me flat on my back for nearly two weeks and I tore my rib muscles coughing.

I hope the powers that be are working 24/7 developing a vaccine even though the virus that finally shows up will likely be different than anticipated. Of course, we have Tami flu and Relenza and anti-biotics to fight off secondary infections so we’re not totally defenseless like the poor souls in 1918. I don’t think the surgical masks help much. I would go with a respirator rated N95 and full face mask.

During the Spanish flu pandemic the only thing that worked was isolation. A few western towns, realizing it was coming, cordoned off the town and kept everyone out… at gunpoint. A few islands did the same. They escaped.

When it’s “flu season” this winter, hold your breath.

2 comments:

Heide said...

Crap, I work with little germ frigates who constantly pick their noses, lick pencils, doorknobs and other surfaces and would never dream of covering their mouths or noses when they cough or sneeze. Because of having Multiple Sclerosis I take shots (overly priced to the point of being ridiculous, but that's another post) which suppress my immune system and set up decoys for my white cells to attack instead of my myelin. If I take immune inhancers then my M.S. flares up. As a result I'm always walking a fine line trying to balance not getting sick with not over-stimulating my immune system. The flu, and other illnesses cause me to worry relentlessly because if I get sick and become disabled I won't be able to work or take care of my children. I'm a firm believer in hand washing (most schools now just squirt hand sanitizer on the students in lieu of soap and water). Come next September I will probably bring disposable gloves, disinfectant spray and masks to work. Yuck, yuck, yuck!

Heide said...

Happy Father's Day!