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.
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.
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.