MODERN MEDICINE HELPS AGAINST DEADLY FLU OUTBREAK

A century later, the “Spanish Flu” remains a chilling, cautionary tale about the potential deadly threat of viruses.

On Feb. 14, Mt. Hood history instructor Elizabeth Milliken and Carl Eckrode, MHCC Respiratory Care program director, talked about the historical impact of influenza (flu) and the mechanics of how a virus works and infects.

The instructors compared this season’s, aggressive strain of the flu – which has killed many otherwise healthy persons – with the pandemic of 1918-19.

Milliken described the word pandemic as an “epidemic on a very large scale; either continental, or even global.” During the pandemic of 1918-19, approximately 500 million people were infected and between 50 million and 100 million people died from influenza.

The episode was largely lost to history until the 1990s, according to Milliken. “There was really not a whole lot of attention paid to it, and it used to be called the forgotten epidemic,” she said. Instead, historians tended to focus on events related to World War I, which ended just as the flu spiked.

Mobilization triggers outbreak

According to Milliken, the flu can be traced back to the 1500s, and spread more broadly as human transportation developed. “You start to see more and more major outbreaks of influenza as global connections become more prevalent,” she said.

One of the first major influenza epidemics was in the 1760s, right about the time of the Seven Years War, she explained. At this time, Great Britain was moving troops all across the Atlantic Ocean. This mass mobilization created a perfect opportunity for the flu to travel between continents.

Another mass mobilization happened during World War I, once the U.S. entered the war in 1917 to fight with the Allies.

“There was a big mobilization of troops, kind of an unusual circumstance for the United States that has not been in a really major military conflict since the Civil War,” Milliken explained. “What you had (in) January and February of 1918 are the first really solidly documented cases of influenza that is going to be part of this pandemic.” During those winter months, the first soldiers at Fort Riley in Kansas started reporting sick. Within a week, 500 soldiers were ill. The flu spread from there, she said.

However, there are alternative theories of the flu’s origins in WWI.

There are reports of the flu as far back as 1916 in France, plus an outbreak in France that coincided with that at Fort Riley. A possible outbreak also happened in China in 1915 and 1916, which was thought to be “pneumatic (airborne) form of a plague,” but in hindsight, researchers say could have been flu, said Milliken.

Deadly impact

“You have at least three possible areas where this particular strain of influenza seems to take hold and begin to spread. Then you have whole conflicts of World War I where you have large-scale troop movements, you have men being put together into barracks,” she said. “Once they’re sick, they’re put together into large facilities.”

The flu spread throughout U.S. military camps and beyond, with two waves, the first being relatively mild, “then, in the fall of 1918, the second, much more lethal wave spread,” said Milliken. “It swept again around the globe… as much as 80 percent of the people who died in the pandemic died in (those) 10 weeks – mortality rates were much higher, symptoms were much more severe.”

Rather than targeting only infants and elderly individuals, the flu infected high numbers of young people who began dying.

The flu was looked at it the same manner as the Black Plague that had ravaged the world in the 14th century: People wore ineffective face masks and stopped congregating in public spaces, said Milliken. Bars and saloons were packed with people who believed alcohol and tobacco smoke killed the flu.

U.S. President Woodrow Wilson was said to have suffered from the flu, recovering only to suffer a debilitating stroke which led to his wife effectively running the White House for the last few months of his presidency.

‘Vulnerable’ targets

Eckrode, a trained epidemiologist, discussed the other pandemics people lived through in the 20th, and early 21st, centuries. The 1918-19 flu is the same H1N1 virus that was called the “Swine Flu” in 2009.

The swine flu didn’t cause as much of a pandemic, because 90 years earlier “We did not understand a virus at the time; we didn’t even know there was a virus– viruses had not been identified,” said Eckrode. Back then, there were no antibiotics or immunizations. The drafted military members were mostly poor farmers experiencing relocation and drastic changes in diet and living conditions. They were placed “in concentrated settings (and) put under stress,” he said.

“If you do that to any animal… when you put too many animals in a pen, don’t feed them adequately and stress them – they turn on each other, but they also become vulnerable to disease,” he said.

Over time, the H1N1 virus emerged. It was never seen by anyone, never infected anything.

The conditions were ideal for the virus to start spreading. Then, in 2009, it was first isolated on a cruise ship off the coast of Mexico.

Lower pandemic threat today

Eckrode said that a mass pandemic is possible today, but isn’t likely.

“We can type the virus, we know what a virus is. We have electron microscopes, we have pictures of this little bad boy,” he said. “We have vaccinations.”

Even if a vaccine today has a low rate of effectiveness, “it works a lot better than the one they didn’t have in 1918,” he added.

Influenza is drawn to the exterior of our respiratory tract, Eckrode said. It strips the outer layer of a cell so it can enter that cell, then take over and reproduce itself.

In 1918, soldiers were often not far from where mustard gas was being stored. “If somebody had a sub-clinical exposure to a noxious agent like mustard gas, or some blistering agent that works by stripping a cell wall and causing release of cellular fluids – that could in fact predispose the individual to infection,” said Eckrode.

The H1N1 has an “infectivity rate” of four, meaning anyone infected will likely pass it on to four people. The current 2017-18 seasonal flu has a rate of 15, while the regular infectivity rate of a flu is 1.5, said Eckrode – which could explain this season’s greater impact.

Shots, and soap

Flu is constant in our world, yet is constantly changing.

It’s normally present in various birds, including chickens. On farms, the flu moves from chickens to pigs, mutating on its way. “It undergoes a genetic ‘re-assortment’ in the pig and then it can be given to us,” said Eckrode. It also can infect pet dogs and cats, and is “like a Rubik’s cube of DNA re-assorting itself so it can infect you.”

Viruses don’t necessarily “live” and so don’t need to feed to stay alive. “(Flu is) a machine to make more machines; a highly pathogenic one like this burns through a susceptible host, it burns through all its resources,” said Eckrode. “Flu is constantly evolving, shifting and drifting to evade your immune system.”

What’s our best way to avoid it?

Eckrode recommends that people wash hands often, and engage in “social distancing” during the flu season. He also recommends getting a flu vaccine: “Vaccinations are one of the great miracles of public health.”