100 Years Later: The Flu

Guest Essay by Kip Hansen

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One hundred years have passed since the Great Influenza Pandemic of 1918 swept around the world, circumnavigating at least twice between 1918 and 1920, killing outright between 50 and 100 million human beings. The pandemic was so shattering, so pervasive that more accurate numbers of the dead cannot be calculated. Those who lived in developed countries like the United States fared little better than those in less developed nations — once the influenza struck, the victim either recovered after a week of unpleasant flu symptoms or died rapidly, sometimes within hours., with lungs filled with fluids and blood. Influenza, caused by a virus, usually kills the very young, the weak and the very old. But the 1918 Flu, sometimes called “the Spanish Flu”, seemed to preferentially kill young, strong, otherwise healthy men and women in their 20’s, a demographic that normally fared well with only mild symptoms in other flu seasons.

An oddity about the 1918 Flu Pandemic is the fact that despite its horrendous toll, it usually warrants only a paragraph or so in most history books and is often mentioned as if it were part of or an outcome of the First World War. Only at the end of the 20th century, with the threat of avian flu prominent in the daily news, have the details been brought into our public consciousness. PBS did a special titled Influenza 1918 as part of their American Experience series in 1998. Gina Kolata, science journalist with the New York Times, wrote FLU: The Story of the Great Influenza Pandemic of 1918 in 1999. John Barry, you recently wrote the story of the Great Flood of 1927, wrote The Great Influenza in 2004.

W_shape_of_1918_fluW_shape_of_1918_flu

In the news, just a week ago:

Dad rages after 4-year-old daughter dies of flu complications

Sonja Haller, Feb. 11, 2019

A Texas father is mad. His 4-year-old daughter, Ashanti Grinage, developed a high fever on Jan. 29. She was taken to the emergency room where she was diagnosed with the flu and sent home with medicine, according to father Martel Grinage.

Two days later, she died. Grinage told Dallas news outlet WFAA that doctors failed to diagnose his daughter’s persistent cough as pneumonia.

“On Tuesday when she went to the doctor, she had pneumonia, and we didn’t know,” he said.

The Garland, Texas, family said their 4-year-old didn’t receive a flu shot. Her death came amid a flu season that hasn’t seemed as urgent as last year’s because there have been fewer deaths. Last year, flu complications claimed the lives of 180 children, according to the Centers for Disease Control.

The latest CDC weekly report shows that 28 children have died this flu season.

But New York City and 24 states, such as Colorado, Indiana and Virginia, are reporting “high” activity. Flu outbreaks are responsible for closing schools in at least four states.

Influenza sweeps around the world every year — sometimes the prevalent strain of flu is mild and sometimes not. Virologists (doctors and biologists that specialize in viruses), especially those in public health agencies, are, to put it mildly, terrified of influenza. Not terrified of our unpleasant but comparatively mild flus, but terrified that one of these years a flu virus will mutate once more into a 1918-type flu — easily contagious via the air, causing a rapid onset of serious breakdown of the body’s defenses and fatal in a significant percent of the population.

Pediatric deaths are common, but the numbers are not very high, around 100 per flu season for the United States — 2017-2018 saw almost double that at 185. This number is very close to the number of annual child deaths involving bicycles. We see that so far, in this season, the number of pediatric deaths remains low but may yet have to peak.

PedFluDeath_WeeklyImagePedFluDeath_WeeklyImage

Among adults, flu deaths reach up to ten percent of ALL weekly deaths as in two recent years in the United States:

national_flu_mortalitynational_flu_mortality

How Many Deaths?:

There were 675,000 deaths in the US in the 1918 pandemic, not counting the number of US soldiers fighting in Europe that died of the flu — there “It ultimately killed more American military personnel than did enemy machine guns and artillery”. US Eastern cities like Boston, Baltimore, Philadelphia had to use mass burials to handle the corpse burden. Not only soldiers and civilians died; doctors, nurses and flu researchers died as well.

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In 2017-2018, the last flu season, 49 million Americans became sick with the flu, almost a million of those requiring hospitalization and 79,000 Americans died of flu and its complications.

What we don’t see in this graphic is the panic that spread through the international public health sector in 2009….

World now at the start of 2009 influenza pandemic

Dr Margaret Chan — Director-General of the World Health Organization

[Excerpts from her Statement to the press]

11 June 2009

In late April, WHO announced the emergence of a novel influenza A virus.

This particular H1N1 strain has not circulated previously in humans. The virus is entirely new.

The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.

We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch.

No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.

We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

The public health community was put on high alert — here we had a flu that sounded very much like the 1918 flu: highly contagious (spreading easily from one person to another), and spreading from nation to nation. An entirely new, never-seen-before H1N1 flu strain. And ominously, “one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people” — just like the 1918 Spanish Flu. The 2009-2010 flu season started earlier in the year than in other seasons:

2009_20102009_2010

Thoroughly terrified, the World Health Organization and national public health bodies felt they were ready. And, as it turned out, the world was spared another disaster — only a comparatively very low 2,195 deaths were reported in the United States for the 2009-2010 flu season. The somber tone in the press release from the director of WHO informs us just how serious the situation could have been.

Public Health had learned a hard lesson from the panic in the United States which stemmed from an incident at Fort Dix, New Jersey. An Army private, young, hale and hearty, suddenly fell ill with flu symptoms in February 1976. The soldier reported for sick call, and returned to bed. By evening, he felt a bit better and decided to join his unit for a five mile hike. Halfway through the hike he was stumbling and was returned to the base hospital, where he died hours later. Army doctors were shocked, shaken, and at once recognized the similarity in pattern to the 1918 eruption of flu among army recruits: Healthy young men with a brief flu-like illness that leads to death in 24 to 48 hours.

When even more soldiers at Fort Dix became ill with flu-symptoms, the Army doctors and the CDC called secret meetings of health officials from all over the US to decide on a course of action for “the swine flu”. Panicked, health officials realized that a return of the 1918 flu was possibly beginning; they convinced then-President Gerald Ford to authorize a national program to immunize every American with federal funding for the program and for the federal government to offer indemnity to vaccine manufacturers against possible future law suits. Once the program spun up and was running, many of the officials that had supported the idea had second thoughts, but it was too late to call it off. The vaccine that was produced has been rushed through and had not undergone much testing, there just wasn’t time.

In this rush to prevent another 1918 flu epidemic, the massive vaccination program ran into trouble — several people died of heart attacks shortly after being vaccinated, cases of Guillain-Barré syndrome began to show up coincident with vaccination.

Epidemiologists knew full well that anytime a population-wide vaccination program takes place, be it flu or polio, the sheer number patients guarantees that some of them will have medical issues coincident with vaccination and these may thus look like they were caused by the vaccine itself. A certain percentage of the population will have, on average, a heart attack in any given year, about one tenth of those inevitable heart attacked will take place in the five weeks following vaccination. Lawyers will then weigh in for the kill – which is exactly what happened. The vaccination program was suspended and eventually dropped altogether.

In the present, the CDC (The Centers for Disease Control and Prevention) and vaccine manufacturers guess at which strains of the flu virus will be prevalent in the coming year’s flu season. They then manufacture a vaccine that they think will protect most people from the viruses actually circulating. And of course, the public is encouraged to get their “flu shot”, preferably early enough to be preventative for the season. How does this work out? The CDC says: “…flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.”

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[Yes, I have had mine, my wife has had hers — we get them every year now that we are based here in the US — we had lots more vaccinations for life in the Dominican Republic and Northern Caribbean, North Africa, etc. I encourage you to get yours. ]

The Story of 1976 Swine Flu contains some cautionary elements.

What did Dr. Margaret Chan — Director-General of the World Health Organization — say in 2009? “We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.

Laurence Gostin in his article At Law: Swine Flu Vaccine: What Is Fair? [doi: 10.1353/hcr.0.0184 ] writes that “…the swine flu affair fails to tell us whether, in the face of scientific uncertainty, it is better to err on the side of caution or aggressive intervention.”

In the case of the 1976 Swine Flu episode, President Ford, acting on the advice from the country’s best medical advisors, authorized dramatic action — aggressive intervention, in the form of a national immunization campaign — which turned out badly. Many of the advisors that had originally convinced President Ford to act almost immediately had second thoughts, long before the adverse effects started to turn up. Historians have been critical of Ford but the blame stems from the difficulty of decision making under deep uncertainty.

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Each of us has to face these types of decision many times in our lives. We are faced with the possibility of a serious threat — but we don’t have enough information to make a decision or the information we do have is very uncertain — yet we still have to make a decision. Should we “Do nothing and wait and see”? Should we rush to make big and consequential changes to protect against the possibility of the threat?

Today national leaders are confronted with this choice in the Climate Change arena. The public, continuously bombarded with scare stories about the possible future effects of climate change, demand action or at least reassurance. Politicians and policy makers demand expert advice. There are voices calling for immediate, drastic action. Others are calling for caution and a more nuanced “no regrets” approach. All base their demands on the same set of highly uncertain scientific knowledge. Many of our best scientists are involved in political advocacy for various approaches, which advocacy erodes the public’s confidence in their advice.

Yet any climate decision will necessarily be based on currently available but highly uncertain scientific knowledge. That’s all we have. Our historical data is vague with huge uncertainty bars and present day data from one field often seems in direct contradiction to data from another field. Journal papers written by scientists at NASA, published in the same week, have reported mutually exclusive results on Antarctic ice. [ see here, paragraph beginning “As for Antarctica?”] Climate models produce chaotic, wildly varying results even when initiated with very-near-identical parameters, yet are claimed to accurately predict the average climate of specific cities 60 years into the future. Every week, it seems, there are new papers describing new understandings about aspects of the Earth’s climate adding to both to our knowledge base and discovering new questions that need answering, giving us a better understanding of how much we still don’t know. There are political activists pushing for, demanding, solutions which are not only impossible, but for which even making the attempt to achieve them will certainly cause serious damage to human society and its infrastructure.

Decision Making Under Deep Uncertainty has become a standalone subject and now even has its own learned society.

We live in interesting times. It is this author’s hope that governments and policy makers will resist the urge to make society-destroying decisions in their rush to solve a problem which is not yet well understood.

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Author’s Comment Policy:

Taking a look at the history of influenza pandemics reveals what the scope of a real existential threat looks like — it looks like the 1918 Influenza Pandemic or worse. In today’s more crowded world, a high-mortality flu would kill far more than the 1918-1920 record of up to 100 million.

There have been weather related disasters in the last 100 years — in 1970, The Bhola Cyclone hit Bangladesh and took an estimated 500,000 lives, “primarily as a result of the storm surge that flooded much of the low-lying islands of the Ganges Delta.” The weather and geography conspired together to create the deadliest natural disasters of modern time. Political disasters have killed far more, but none in such a short time.

Climate policies will necessarily be set while we are still highly uncertain about the causes and effects of climate across time.

There are some opinions in this essay, which are mine and mine alone. Addressing your comment to “Kip…” will bring it to my attention and I’ll try to answer your questions or supply missing data.

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via Watts Up With That?

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February 22, 2019 at 03:06AM

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