Wednesday, June 06, 2018

Review: The Great Influenza

I've really only had the 'flu a couple of times in my life, both times it's been one of those "knock you down and keep you in bed for 3 days" experience. But yet most people are fond of saying "it's only the 'flu". The Great Influenza describes the influenza epidemic of 1918-1919, and will change your mind as to how serious the 'flu could be.

During that time, the 'flu would kill as much as 10% of the entire population. That's not 10% of people who were infected, 10% of the entire population! Doctors and nurses died helping patients. Nurses would be kidnapped (they were harder to find than doctors). Much like SARS, that 'flu epidemic killed young adults faster than it killed older adults and children because of ARDS.

Whats great about this book is that back then, we didn't know what caused the 'flu, and researchers were led down the wrong path by thinking that it was a bacteria rather than a virus. The 'flu virus killed not just by itself, but through secondary infections, and in the case of ARDS by triggering the immune system into a "scorched earth" attack on the lungs, making it difficult to isolate what pathogen that caused it. John Barry provides the context on what created the medical infrastructure and system at the start of the century, and what the state of medicine was as well.

In addition, the political and military response hurt the public's perception of the pandemic as well: newspaper and posters repeatedly lied to the public about the seriousness of the situation, and the public was much less prepared than it could have been to face the onslaught. Even worse, military policy (this was near the end of World War 1) concentrated young men in large, overcrowded military camps in close quarters, creating ideal conditions for spreading 'flu. There's even evidence that the 'flu infected Woodrow Wilson during critical negotiations, and caused the problems in the treaty of Versailles that eventually led to World War 2.

The big question in my mind is: "Are we better prepared today for such an Influenza pandemic?" The answer appears to be "No."
Consider for a moment that prior to the emergence of H5N1, the U.S. government was spending more money on the West Nile virus than on influenza. While influenza was killing as many as 56,000 Americans a year, West Nile in its deadliest year killed 284. And West Nile will never be a major threat; it is not a disease that will ever explode through the human population. Yet it was receiving more research dollars than influenza. (Kindle Loc. 7432)
 much of the U.S. vaccine supply is manufactured outside the country; in a lethal pandemic, there is a question whether another government would allow its export before its own population was protected. (Kindle Loc. 7453)
To this day, we have neither an effective vaccine for the 'flu (though the author does point out that even a 10% protection  ineffective vaccine is still worth getting), nor do we have a cure. We would do better at the secondary infections, but our hospitals would be immediately overwhelmed:
Hospitals, like every other industry, have gotten more efficient by cutting costs, which means virtually no excess capacity—on a per capita basis the United States has far fewer hospital beds than a few decades ago. Indeed, during a routine influenza season, usage of respirators rises to nearly 100 percent; in a pandemic, most people who needed a mechanical respirator probably would not get one. (Kindle Loc. 7374)
All in all, this is a great book and well worth reading. Recommended.

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