It all sounds really scary doesn’t it? A flu pandemic, spreading out from Mexico. Even The (Gloucester) Citizen ran a headline story yesterday – two people in quarantine at home. OK, I was surprised when it turned out to be Tony and Kandia of Inkubbus Sukkubus – I had no idea they were gigging in Mexico City, way to go guys! (they are a rather fun local pagan rock band and decent folks) — but I’m more interested than frightened at the moment. Yes that’s right, CJ, Captain Paranoid about Epidemics, is not remotely bothered. Why?
Well the 1968 and 1957 pandemics were before I was born – and hell, I’m pretty certain that to a global economy in trouble, yep, this is seriously bad news. I note the failure to close borders and ban international flights – I agree it would be too late now, shutting the stable door after the horse has bolted, and in todays world such isolation would be difficult and I hate to imagine the economic consequences. But while flu pandemic are outside of my life experience, my grandmother Alice lived through all three of the twentieth centuries great flu pandemics, and my parents two of them.
So how bad is it? Well, lets start with worst case scenario. Wiki reminds us of a very sobering fact
As many as 25 million may have been killed in the first 25 weeks; in contrast, HIV/AIDS has killed 25 million in its first 25 years.
Ouch! Yep, up to 5% of the global population may have died in the 1917-1920 pandemic (usually referred to as 1918 flu as I recall. ) A new book came out on it just a few weeks ago — I doubt the author is jubilant, but sales will be GREAT! – not read that one yet, but I have Barry’s The Great Influenza and my favourite book on the subject, Gina Kolata’s wonderful book Flu on my shelves. Why my interest?
Remember I said my grandmother lived through all three pandemics? She was 18 when it struck Bury St Edmunds, in the final weeks of the Great War. Hardwick Heath had a German prisoner of war camp, and I get the impression Alice really liked the handsome young Germans there, and many of the girls were “walking out” with these fine young men. Not exactly patriotic, but I think they worked on local farms and businesses, and security seems to have been pretty lax, and hey romance can bloom in adversity. Then in October or November of 1918, the camp was struck by tragedy. The men, kept in close proximity, contracted the flu, and day after day she reports seeing the coffins of these young, virile men, certainly strong and fit, survivors of trench warfare, as they were taken off for burial. And I recall Alice, then in her late eighties, shedding a silent tear and her voice cracking with emotion as she told me about it. It was the soldiers she said, German and British alike, who died. That and the kids, and the farm girls – the young and the fit…
Hang on? The young and the fit? WTF? Even as a teenager I knew better — infants, the elderly, the asthmatic and those ill, they should hav died. Why “the young and the fit?” What the hell? I assumed Alice was wrong, and then I thought of a solution. 1918 flu hit at a time when NAval Blockade, U boat warfare, and the terrible experience of trench warfare had rendered the population ill equipped. Millions of mern in close proximity on the Western Front, in appalling conditions. Of coure now I know a little better. In fact in terms of public health rationing during the 1950’s actually saw Britian’s population at a fitness peak. I have no idea about the Great War, but it may be similar. And trench warfare, well our understanding of it is deeply flawed, and permaeated with myths. (Mud, Blood & Poppycock is an excellent recent history examining this whole issue of the myths of the Great War. Recommended) So why the young and the fit?
Now of course I had already noted that very fit people can succumb to pneumonia very fast, and there are plenty of theories. Also, one thing that is absolutely clear to me is that depending upon genetic resistance various populations have varying degrees of susceptibility. It could be that outside of the Mexican population this will not prove too virulent – there may be a genetic factor. You can look up genetic variance and casualty rates for the earlier pandemics easily enough the wikipedia link above on Flu pandemics will get you started. A disaese with a 4% fatality rate would be absolutely terrifying – but I think we may be looking at 0.0001% – but who knows, it’s not like we have any accurate figures yet. Any deaths is a tragedy – but huge casualty figures probably will require vast numbers of infections, and most people will get better. It’s nothing like the Ryanair’s CEO Michael O’Leary incredibly panglossian, tactless and blackly comic comment about “ a couple of strepsils” being all that is required to solve the problem – hell I do hope he has put his money where his mouth is and gone on holiday to Mexico City to test this first hand – but he has a pretty good point. If the disease is effecting mainly malnourished people in the slums, and that is where the casualties are, well we might expect that. Unfortunately well nourished and rather well heeled western tourists are succumbing, and one wonders…
This looks a lot like 1918 flu to me. Sorry, it just does. I’m sure it’s not the same virus – we have live cultures I think in America at Fort Derrick, USAMRIID or the CDC have them, excavated from bodies buried in the Arctic permafrost from that outbreak. Pathogenic Archeology – I’m not sure if this is a triumph or just damned scary, but if it was 1918 back I’m thinking we might already have a vaccine – dunno. If instead it’s actually a new mutation, from the incredibly mild in humans Swine Fever, well then six months to vaccine I expect ( I should probably have read the news reports before starting this piece, but what reporting I have seen does not actually fill me with confidence in the accuracy thereof. ) So am I an apostle of doom?
Nah, not a chance. Got tickets to see Girls Aloud at the O2 and want to avoid the risk of crowds? Give ’em to me. I’m not a huge fan but free concert tickets are not to be sneezed at. To be honest if there was an Inkubus Sukkubus gig tonight I’d not be worried about attending, even knowing the risk. Of course I wouldn’t – no one wants to make their friends and families ill, and I stay away from Andy’s house if I have a cold, rather than infect Mel and Bel. However, I’m not afraid of swine flu. James Blunt – he scares me. 🙂
So why has “Captain Doom” got all cheerful about this threat? Because at the moment i don’t see much of one. Remember the Bird Flu threat? Yes, it was real, and yes, it was scary, and we got lucky – it never spread to this stage, human to human contact. We could be facing the End of the World as we know it, but I feel fine, and i don’t think we are. Why? Because the Bird Flu threat made us prepare, and prepare well. Millions of doses of anti-virals, and if pneumonia develops, millions of doses of antibiotics – things the world in 1918 just did not have. I’ve had pneumonia, and I’ve had pleurisy, and I’m still here – whereas in the 1930’s my fthers beloved sister Dolly died of pleurisy, in an age before modern medicine cvould combat the infections.
We understand the importance of infection control, we have major medical advances, and there is no comparison. We are far better prepared than even forty years ago when the last pandemic struck. Don’t worry, be happy…
I’m about to walk down to TESCO, under the railway arch at the bottom of the High Street, and another sobering thought. Few people know that back in the early twentieth century one of Cheltenhams five railway stations was here, and you can still see the bricked up arches. Anyone know it’s history? It closed in the Great War, and never reopened, but in 1918 its empty corridors, now demolished, and waiting rooms and platforms were a temporary morgue for the victims of the flu. There were too many bodies for the morgue, and this was where masked men and women laid out the dead. I think of that every night when I walk through, and mutter a prayer for the dead. I never forget the spectre of the past, and I’m a lot more aware of the 1918 pandemic than most people i think – but with that knowledge comes confidence. I think we be just fine…
If that is not gloomy enough, I’m going to end on a note of real caution, and perhaps strike one alarmist note. You know I said the epidemic of 1918 was really 1917-1920? It actually (off the top of my head) began in the summer of 1917, on the Western Front (exactly where it started, China or Kansas, and if a pig flu or avian flu is heavily disputed by historians and medical experts). The epidemic becomes established in Spain, and in France, and in Germany. And to start with its just a mild flu – a first wave that kills very few, but may have actually inoculated those who had it against the horror to come. Because in October/November 1918 the flu came in a second wave, and it was the grim Reaper we all know of. IF, and I have no understanding of the pathology, this was to happen again, we could be in serious trouble. There is no room for complacency – and stopping the flu now, and obeying any medical directives is vital – but unless a second wave of deadly virulence does appear, for goodness sake don’t we all have enough to worry about without scaring ourselves with media panic about flu? This gloomy prediction of a second wave is CJ talking as a historian, not with any medical authority or knowledge.
My thoughts and prayers are with the people of Mexico City, and I hope an international effort helps them too. And I hope I’m right, and this is nothing to worry about because the second wave theory explains the thing that puzzled me – why the young and the fit? Because the elderly and infirm had already caught the milder sumer 1917 version before it mutated and gained resistance? No idea.
Hey, it’s Beltane today- let’s think of happier things — who can extend their life by a single hour by worrying as the Jewish carpenter said in Galilee on that hill all those years ago.
Have fun guys, and keep well!
cj x
"And sometimes he's so nameless" 
Pingback: Daily News About Science : A few links about Science - Thursday, 30 April 2009 05:33
Deaths from swine flu outside Mexico: 1 (a Mexican citizen who went to a doctor over the border in Texas)
Deaths from normal flu this year alone, in the USA alone: 13,000 (thirteen thousand)
Source: http://edition.cnn.com/2009/HEALTH/04/28/regular.flu/index.html
Yep, about standard. Note deaths from flu are actually usually from secondary infections, bacterial ones, that antibiotics can treat – so even if the antivirals were inefficient, and nothing suggest they are, antibiotics prevent many more deaths. And vaccination also lowers the effectiveness of many flu viruses, acting as a firewall.
Chris, check out this article:
http://tinyurl.com/cqg395
Especially the following quote:
“Among the factors disease detectives have discounted are Mexico’s air pollution, secondary infections and poor health care…A common danger in flu is that the patient is co-infected with pneumonia or other bacteria, which can lead to death. But lab tests of 33 Mexican patients, including seven who died, did not find that problem.”
P.S. cj, do you have an email I can reach you at? I’d like to ask you a few questions about parapsychological research.
Cheers JD, absolutely excellent article. It’s interesting that pneumonia, a secondary infection is not cause of death – and frightening. That means we are actually reliant on anti-virals, as antibiotics will be worthless – there is no bacteria to fight. Again, I’m thinking of the descriptions of 1918, of patients drowning as their lungs fill. Again, I have no medical knowledge here, just a historians thoughts.
Even that is not as frightening as a 6 or 7% lethality – that must be a mistake, and if it’s not, well the virus might not last too long, killing all potential hosts before they can spread. There is a trade off between lethality and the chance to infect more victims – unfortunately I suspect that 6 to 7% in flu might be entirely sustainable, owing to the high rate of infection, and the contagion period being before symptoms appear.
Luckily I also think its complete bollocks, based on taking the (presumably very small) number of hospital admissions, and then dividing by number of deaths. As most people might have no more than a mild sniffle, well this is not going to give an accurate picture, and the article makes this very clear.
Still, many many questions, but I’m still not worried. 🙂 Thanks JD, and I have dropped you an email as requested.
The following should be noted too, however:
http://news.bbc.co.uk/2/hi/health/8028371.stm
It seems for now the flu virus is quite mild. But if it should mutate in the fall, there’s a chance that even if governments start working on a vaccine right now, it might already be obsolete by the time the next wave hits. But if it continues to hit only the nose and throat instead of the lungs, even if it does become more severe there should be less pneumonia-type deaths.
Absolutely! I think at the moment we are looking at a very positive picture. I had an odd idea, but my pc crashed before I had finished the rather long reply, so I’ll ask the short version – has anyone actually yet noted the ethnic origin of the Mexicans? I’m wondering if it could be that long exposure to pigs has given a lot of European descended folks resistance to this illness, whereas the inhabitants of South America presumably did not have a lot of pigs in their history? That might explain the deaths in Mexico and lack of any anywhere else? Of course Jewish and Islamic nations are also not going to have a lot of pigs one assumes, and I’m not sure how such an “ancient resistance” would work but it might explain what we are seeing.
Still as you say JD, absolutely every reason for confidence this will blow over, with decent medical and scientific work.