Influenza Pandemic Quotes

Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.

You don't manage the truth. You tell the truth.

In fact, biology is chaos. Biological systems are the product not of logic but of evolution, an inelegant process. Life does not choose the logically best design to meet a new situation. It adapts what already exists...The result, unlike the clean straight lines of logic, is often irregular, messy.

The influenza pandemic of 1918 killed more people than the First World War—an estimated 3 to 6 per cent of the human race.

As terrifying the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read. Uncertainty follows distrust, fear follow uncertainty, and, under conditions such as these, terror follows fear.

Throughout the pandemic, the nation lacked a uniform policy about gathering places, and there was no central authority with the power to make and enforce rules that everyone had to obey. Each community acted on its own, doing as its elected officials thought best.12

When the next pandemic comes, as it surely will someday, perhaps we will be ready to meet it. If we are not, the outcome will be very, very, very dreadful.

How about a global pandemic? A novel strain of influenza for which we humans have no natural defense.

I was born in 1920, during the influenza pandemic, and I’m going to die in 2020, during the outbreak of coronavirus. What an elegant name for such a terrible scourge.

However, as bad as things were, the worst was yet to come, for germs would kill more people than bullets. By the time that last fever broke and the last quarantine sign came down, the world had lost 3-5% of its population.

For the influenza pandemic that erupted in 1918 was the first great collision between nature and modern science. It was the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds.

Ebola is a zoonosis. So is bubonic plague. So was the so-called Spanish influenza of 1918–1919, which had its ultimate source in a wild aquatic bird and, after passing through some combination of domesticated animals (a duck in southern China, a sow in Iowa?) emerged to kill as many as 50 million people before receding into obscurity.

No other disease, no war, no natural disaster, no famine comes close to the great pandemic. In the space of eighteen months in 1918–1919, about 500 million people, one-third of the human race at the time, came down with influenza. The exact total of lives lost will never be known. An early estimate, made in 1920, claimed 21.5 million died worldwide. Since then, researchers have been continually raising the number as they find new information. Today, the best estimate of flu deaths in 1918–1919 is between 50 million and 100 million worldwide, and probably closer to the latter figure. 7

Should we add the 40 to 50 million victims of the 1918 influenza pandemic to the 15 million who were killed in World War I, because the flu virus would not have evolved its virulence if the war hadn’t packed so many troops into trenches?

Another explanation for the failure of logic and observation alone to advance medicine is that unlike, say, physics, which uses a form of logic - mathematics - as its natural language, biology does not lend itself to logic. Leo Szilard, a prominent physicist, made this point when he complained that after switching from physics to biology he never had a peaceful bath again. As a physicist he would soak in the warmth of a bathtub and contemplate a problem, turn it in his mind, reason his way through it. But once he became a biologist, he constantly had to climb out of the bathtub to look up a fact.

White Christians often explained the disaster in a time-honored way: it was God's punishment of humanity for its sings. To the seven deadly sins--anger, greed, lust, envy, pride, laziness, gluttony--they added an eighth sin: 'worshiping science.

What we really need is a game-changing influenza vaccine that will target the conserved—or unchanging—features of the influenza viruses that are more likely to cause human influenza pandemics and subsequently seasonal influenza in the following years.

Most parents thought they were being good parents. They learned from their parents or their grandparents, many of whom were severely traumatized and emotionally disconnected coming out of the devastation of a 1918 influenza pandemic and two world wars.

In the United States, influenza death rates were so high that the average life span fell by twelve years, from fifty-one in 1917 to thirty-nine in 1918. If you were a “doughboy”—slang for an American soldier—you had a better chance of dying in bed from flu or flu-related complications than from enemy action.

Edward Jenner’s discovery of vaccination drew harsh criticism from the pulpit. Clergymen denounced the doctor for having put himself above God. Only the Almighty, they said, sends illness and only the Almighty cures it. Vaccination, critics charged, was “a diabolical operation,” and its inventor was “flying in the face of Providence

What are the odds that a killer flu virus will spread around the world like a tidal wave, killing millions? “The burning question is, will there be a human influenza pandemic,” Secretary Leavitt told reporters. “On behalf of the WHO, I can tell you that there will be. The only question is the virulence and rapidity of transmission from human to human.

For instance, one reason that the Ebola virus doesn’t spread widely among humans is that it is too efficient—mortality is as high as 90 percent—which

the disturbing possibility that the Spanish Lady might stage a return visit,

We domesticated pigs and got whooping cough, domesticated chickens and got typhoid fever,894 and domesticated ducks and got influenza.

Isolation is my COVID-19 insurance policy.

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall.

Influenza had brought the all-conquering German army to its knees, while the Allies, stricken too, took advantage of their enemy’s weakness to regroup.

Despite the name, Spanish flu struck the entire world — that’s what made it a pandemic instead of simply an epidemic. It was not the first influenza pandemic, nor the most recent (1957 and 1968 also saw pandemics), but it was by far the most deadly. Whereas AIDS took roughly twenty-four years to kill 24 million people, the Spanish flu killed as many in twenty- four weeks.

With influenza and many other diseases the order is reversed, high infectivity preceding symptoms by a matter of days. A perverse pattern: the danger, then the warning. That probably helped account for the scale of worldwide misery and death during the 1918–1919 influenza: high infectivity among cases before they experienced the most obvious and debilitating stages of illness.

In the earlier tradition from which Mrs. Post wrote, the act of dying had not yet been professionalized. It did not typically involve hospitals. Women died in childbirth. Children died of fevers. Cancer was untreatable. At the time she undertook her book of etiquette, there would have been few American households untouched by the influenza pandemic of 1918. Death was up close, at home.

Nowadays, the disease claims, on average, 36,000 Americans each year, out of a population of 320 million. Contrast this with another number: 35,092 Americans died in motor vehicle accidents in 2015.

A zoonosis is an animal infection transmissible to humans. There are more such diseases than you might expect. AIDS is one. Influenza is a whole category of others. Pondering them as a group tends to reaffirm the old Darwinian truth (the darkest of his truths, well known and persistently forgotten) that humanity is a kind of animal, inextricably connected with other animals: in origin and in descent, in sickness and in health.

Influenza transmission is legendary. The dying cells in the respiratory tract trigger an inflammatory response, which triggers the cough reflex. The virus thus uses the body’s own defenses to infect other potential hosts.

Hamer was especially interested in why diseases such as influenza, diphtheria, and measles seem to mount into major outbreaks in a cyclical pattern—rising to a high case count, fading away, rising again after a certain interval

THE ACTUAL WORD ‘influenza’ dates from around 1500, when the Italians introduced the term for diseases that they attributed to the ‘influence’ of the stars. Another possible origin was the Italian phrase influenza di freddo, the influence of the cold.

The CDC and three other research groups submitted a paper for publication in the journal Science detailing how they had reconstructed the 1918 H1N1 influenza virus, using virus genes that had been identified in lung samples of patients who died during the 1918 pandemic.

In many ways, it is hard for modern people living in First World countries to conceive of a pandemic sweeping around the world and killing millions of people, and it is even harder to believe that something as common as influenza could cause such widespread illness and death.

When we think of a pandemic, we often conjure images of deadly infectious diseases that spread rapidly across countries causing unimaginable human suffering (like the Black Death, the Spanish influenza, AIDS, or the ongoing COVID-19 crisis). The West is currently suffering from such a devastating pandemic, a collective malady that destroys people’s capacity to think rationally. Unlike other pandemics where biological pathogens are to blame, the current culprit is composed of a collection of bad ideas, spawned on university campuses, that chip away at

But as the program got going, the smallest details became issues, even the very name of the disease. Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey

Increase in Reports of Influenza. A masterpiece of understatement, as if it were only the reporting that had increased, or perhaps the pandemic was a figment of the collective imagination. I wondered whether it was the newspaper publisher’s decision to play down the danger or if he’d received orders from above.

in a letter to the New York Times, Dr. Hans Neumann from the New Haven Department of Health noted that based on the projected scale of the immunizations, within two days of getting a flu shot, about 2,300 people would have a stroke and 7,000 would have a heart attack. “Why?” he asked. “Because that is the number statistically expected, flu shots or no flu shots.” Likewise, in the week following a flu vaccine, another 9,000 people would contract pneumonia, of whom 900 would die. These would certainly occur after a flu shot, but not as a consequence of it. “Yet,” wrote Neumann, “can one expect a person who received a flu shot at noon and who that same night had a stroke not to associate somehow the two in his mind?” Grandma got the flu vaccine in the morning, and she was dead in the afternoon. Although association does not equal causation, this thinking could lead to a public backlash against vaccinations that would threaten future programs.

On the landing yesterday’s poster hooked my attention ‘Would they be dead if they’d stayed in bed?’ I had an impulse to rip it down, but that probably constituted conduct unbecoming to a nurse, as well as treason. ‘Yes, they’d be bloody dead,’ I ranted silently. ‘Dead in their beds or at the kitchen table eating their onion a day. Dead on the tram, falling down in the street, whenever the bone-man happened to catch up with them. Blame the germs, the unburied corpses, the dust of war, the circulation of wind and weather, but Lord God Almighty, blame the stars, just don’t blame the dead, because none of them wished this on themselves.

new influenza virus emerges, it is highly competitive, even cannibalistic. It usually drives older types into extinction. This happens because infection stimulates the body’s immune system to generate all its defenses against all influenza viruses to which the body has ever been exposed. When older viruses attempt to infect someone, they cannot gain a foothold. They cease replicating. They die out. So, unlike practically every other known virus, only one type—one swarm or quasi species—of influenza virus dominates at any given time. This itself helps prepare the way for a new pandemic, since the more time passes, the fewer people’s immune systems will recognize other antigens.

Flu pandemics are nothing new. Medical historians think the first one struck in 1510, infecting Asia, Africa, Europe, and the New World. Between the years 1700 and 1900, there were at least sixteen pandemics, some of them killing up to one million people. Yet these were tame compared to the 1918 calamity. It was by far the worst thing that has ever happened to humankind; not even the Black Death of the Middle Ages comes close in the number of lives it took. A 1994 report by the World Health Organization pulled no punches. The 1918 pandemic, it said, “killed more people in less time than any other disease before or since.” It was the “most deadly disease event in the history of humanity.

Influenza is caused by three types of viruses, of which the most worrisome and widespread is influenza A. Viruses of that type all share certain genetic traits: a single-stranded RNA genome, which is partitioned into eight segments, which serve as templates for eleven different proteins. In other words, they have eight discrete stretches of RNA coding, linked together like eight railroad cars, with eleven different deliverable cargoes. The eleven deliverables are the molecules that comprise the structure and functional machinery of the virus. They are what the genes make. Two of those molecules become spiky protuberances from the outer surface of the viral envelope: hemagglutinin and neuraminidase. Those two, recognizable by an immune system, and crucial for penetrating and exiting cells of a host, give the various subtypes of influenza A their definitive labels: H5N1, H1N1, and so on. The term “H5N1” indicates a virus featuring subtype 5 of the hemagglutinin protein combined with subtype 1 of the neuraminidase protein. Sixteen different kinds of hemagglutinin, plus nine kinds of neuraminidase, have been detected in the natural world. Hemagglutinin is the key that unlocks a cell membrane so that the virus can get in, and neuraminidase is the key for getting back out. Okay so far? Having absorbed this simple paragraph, you understand more about influenza than 99.9 percent of the people on Earth. Pat yourself on the back and get a flu shot in November. At

For propagandists, whatever promoted the Allied cause was true, whether factual or not. What counted was the noble end--victory--not the sordid means of achieving it. 'Truth and falsehood are arbitrary terms,' declared a CPI official. 'There is nothing in experience to tell us that one is always preferable to the other....There are lifeless truths and vital lies....The force of an idea lies in its inspirational value. It matters very little if it is true or false.

As poorly transmissible as it was, however, SARS exposed the absence of “surge capacity” in the hospitals and health-care systems of the prosperous and well-resourced countries it affected. The events of 2003 thereby raised the specter of what might have happened had SARS been pandemic influenza, and if it had traveled to resource-poor nations at the outset instead of mercifully visiting cities with well-equipped and well-staffed modern hospitals and public health-care systems.

We follow what is happening with influenza virus strains in the Southern Hemisphere when it is their fall (our spring) to predict which influenza viruses will likely be with us the next winter. Some years that educated guess is more accurate than others. So is it worth getting the vaccination each year? I give that a qualified yes. It might or might not prevent you from getting flu. But even if it is only 30 to 60 percent effective, it sure beats zero protection. What we really need is a game-changing influenza vaccine that will target the conserved—or unchanging—features of the influenza viruses that are more likely to cause human influenza pandemics and subsequently seasonal influenza in the following years. How difficult would such a game-changing influenza vaccine be to achieve? The simple truth is that we don’t know, because we’ve never gotten a prototype into, let alone through, the valley of death. We need a new paradigm—a new business model that pairs public money with private pharmaceutical company partnerships and foundation support and guidance.

Today, we share no fewer than 300 diseases with domesticated animals. For example, humans get 45 diseases from cattle, including tuberculosis; 46 from sheep and goats; 42 from pigs; 35 from horses, including the common cold; and 26 from poultry. Rats and mice carry 33 diseases to humans, including bubonic plague. Sixty-five diseases, including measles, originated in man’s best friend, the dog. We can still get parasitic worms from pet dogs and cats. That is why it is not a good idea to kiss a pet on the mouth or sleep with it in bed.4

If they would have acknowledged this [SARS] early, and we could have seen the virus as it occurred in south China, we probably could have isolated it before it got out of hand,” explained one infectious disease expert. “But they completely hid it. They hide everything. You can’t even find out how many people die from earthquakes.”2438 The foundation of the theoretical models is openness and cooperation for rapid detection of outbreaks of influenza. “Would they admit to it if it was here?” one Asian diplomat asked. “That’s the big question, since they deny everything left, right and center.

increases of the infectivity rate may lead to large epidemics.” This quiet warning has echoed loudly ever since. It’s a cardinal truth, over which public health officials obsess each year during influenza season. Another implication was that epidemics don’t end because all the susceptible individuals are either dead or recovered. They end because susceptible individuals are no longer sufficiently dense within the population. W. H. Hamer had said so in 1906, remember? Ross had made the same point in 1916. But the paper by Kermack and McKendrick turned it into a working principle of mathematical epidemiology.

Since the body does a better job of fighting infection when it is a few degrees hotter, might reducing the fever lead to a worse outcome for the patient? A group from McMaster University in Canada looked at what happens in a large group of people when some of them—infected with, say, influenza—take medicine to reduce their fever. Once they feel better, patients with the flu get out of bed and start to socialize, spreading the virus. On a population level the effect is rather drastic. The McMaster group concluded that the practice of frequently treating fevers with medication enhances the transmission of influenza by at least 1 percent. I know that doesn’t sound like a lot, but remember that as many as 49,000 people die from the flu each year in the United States. If you plug the McMaster estimates into these flu numbers, almost 500 deaths per year in the U.S. (and perhaps many more elsewhere) could be prevented by avoiding fever medication during the treatment of influenza.

Early on it is clear that Addie has a rebellious streak, joining the library group and running away to Rockport Lodge. Is Addie right to disobey her parents? Where does she get her courage? 2. Addie’s mother refuses to see Celia’s death as anything but an accident, and Addie comments that “whenever I heard my mother’s version of what happened, I felt sick to my stomach.” Did Celia commit suicide? How might the guilt that Addie feels differ from the guilt her mother feels? 3. When Addie tries on pants for the first time, she feels emotionally as well as physically liberated, and confesses that she would like to go to college (page 108). How does the social significance of clothing and hairstyle differ for Addie, Gussie, and Filomena in the book? 4. Diamant fills her narrative with a number of historical events and figures, from the psychological effects of World War I and the pandemic outbreak of influenza in 1918 to child labor laws to the cultural impact of Betty Friedan. How do real-life people and events affect how we read Addie’s fictional story? 5. Gussie is one of the most forward-thinking characters in the novel; however, despite her law degree she has trouble finding a job as an attorney because “no one would hire a lady lawyer.” What other limitations do Addie and her friends face in the workforce? What limitations do women and minorities face today? 6. After distancing herself from Ernie when he suffers a nervous episode brought on by combat stress, Addie sees a community of war veterans come forward to assist him (page 155). What does the remorse that Addie later feels suggest about the challenges American soldiers face as they reintegrate into society? Do you think soldiers today face similar challenges? 7. Addie notices that the Rockport locals seem related to one another, and the cook Mrs. Morse confides in her sister that, although she is usually suspicious of immigrant boarders, “some of them are nicer than Americans.” How does tolerance of the immigrant population vary between city and town in the novel? For whom might Mrs. Morse reserve the term Americans? 8. Addie is initially drawn to Tessa Thorndike because she is a Boston Brahmin who isn’t afraid to poke fun at her own class on the women’s page of the newspaper. What strengths and weaknesses does Tessa’s character represent for educated women of the time? How does Addie’s description of Tessa bring her reliability into question? 9. Addie’s parents frequently admonish her for being ungrateful, but Addie feels she has earned her freedom to move into a boardinghouse when her parents move to Roxbury, in part because she contributed to the family income (page 185). How does the Baum family’s move to Roxbury show the ways Betty and Addie think differently from their parents about household roles? Why does their father take such offense at Herman Levine’s offer to house the family? 10. The last meaningful conversation between Addie and her mother turns out to be an apology her mother meant for Celia, and for a moment during her mother’s funeral Addie thinks, “She won’t be able to make me feel like there’s something wrong with me anymore.” Does Addie find any closure from her mother’s death? 11. Filomena draws a distinction between love and marriage when she spends time catching up with Addie before her wedding, but Addie disagrees with the assertion that “you only get one great love in a lifetime.” In what ways do the different romantic experiences of each woman inform the ideas each has about love? 12. Filomena and Addie share a deep friendship. Addie tells Ada that “sometimes friends grow apart. . . . But sometimes, it doesn’t matter how far apart you live or how little you talk—it’s still there.” What qualities do you think friends must share in order to have that kind of connection? Discuss your relationship with a best friend. Enhance

Because the second wave was so much more severe than the first, a lot of people refused to believe it could be the same disease. It had to be terrorism. They didn't care what medical experts kept telling them, about how it was the nature of influenza to occur in waves and that there was nothing about this pandemic, terrible though it was, that wasn't happening more or less as had long been predicted. No, not bioterrorism, others said, but a virus that had escaped from a laboratory. These were the same people who believed that both Lyme disease and West Nile virus were caused by germs that had escaped many years ago from a government lab off the coast of Long Island. They scoffed at the assertion that it was impossible to say for sure where the flu had begun because cases had appeared in several different countries at exactly the same time. Cover-up! Everyone knew the government was involved in the development of bioweapons. And although the Americans were not the only ones who were working on such weapons, the belief that they were somehow to blame--that the monster germ had most likely been created in an American lab, for American military purposes--would outlive the pandemic itself. In any case, according to a poll, eighty-two percent of Americans believed the government knew more about the flu than it was saying. And the number of people who declared themselves dead set against any vaccine the government came up with was steadily growing.

A highly regarded infectious-disease epidemiologist named Donald S. Burke, presently dean of the Graduate School of Public Health at the University of Pittsburgh, gave a lecture (later published) back in 1997 in which he listed the criteria that might implicate certain kinds of viruses as likeliest candidates to cause a new pandemic. “The first criterion is the most obvious: recent pandemics in human history,” Burke told his audience. That would point to the orthomyxoviruses (including the influenzas) and the retroviruses (including the HIVs), among others. “The second criterion is proven ability to cause major epidemics in non-human animal populations.” This would again spotlight the orthomyxoviruses, but also the family of paramyxoviruses, such as Hendra and Nipah, and the coronaviruses, such as that virus later known as SARS-CoV. Burke’s third criterion was “intrinsic evolvability,” meaning readiness to mutate and to recombine (or reassort), which “confers on a virus the potential to emerge into and to cause pandemics in human populations.” As examples he returned to retroviruses, orthomyxoviruses, and coronaviruses. “Some of these viruses,” he warned, citing coronaviruses in particular, “should be considered as serious threats to human health. These are viruses with high evolvability and proven ability to cause epidemics in animal populations.” It’s interesting in retrospect to note that he had augured the SARS epidemic six years before it occurred. Much more recently, Burke told me: “I made a lucky guess.” He laughed a self-deprecating hoot and then added that “prediction is too strong a word” for what he had been doing.

Today, such studies are illegal. Medical scientists cannot offer inducements like pardons to persuade prisoners to take part in their studies. Although they can award small cash payments to research subjects, they are forbidden from giving anyone so much money or such tempting favors that their compensations might constitute what ethicists term an inappropriate inducement, an irresistible temptation to join the study. Now, more than eighty years after the 1918 flu, people enter studies for several reasons—to get free medical care, to get an experimental drug that, they hope, might cure them of a disease like cancer or AIDS, or to help further scientific knowledge. In theory at least, study participants are supposed to be true volunteers, taking part in research of their own free will. But in 1918, such ethical arguments were rarely considered. Instead, the justification for a risky study with human beings was that it was better to subject a few to a great danger in order to save the many. Prisoners were thought to be the ideal study subjects. They could offer up their bodies for science and, if they survived, their pardons could be justified because they gave something back to society. The Navy inmates were perfect for another reason. Thirty-nine of them had never had influenza, as far as anyone knew. So they might be uniquely susceptible to the disease. If the doctors wanted to deliberately transmit the 1918 flu, what better subjects? Was influenza really so easily transmitted? the doctors asked. Why did some people get it and others not? Why did it kill the young and healthy? Could the wartime disruptions and movements of troops explain the spread of the flu? If it was as contagious as it seemed, how was it being spread? What kind of microorganism was causing the illness? The normal way to try to answer such questions would be to study the spread of the disease in animals. Give the disease to a few cages of laboratory rats, or perhaps to some white rabbits. Isolate whatever was causing the illness. Show how it spread and test ways to protect animals—and people—against the disease. But influenza, it seemed, was a uniquely human disease. No animal was known to be susceptible to it. Medical researchers felt they had no choice but to study influenza in people. Either the Navy doctors were uncommonly persuasive or the enticement of a pardon was overwhelmingly compelling. For whatever reason, the sixty-two men agreed to be subjects in the medical experiment. And so the study began. First the sailors were transferred to a quarantine station on Gallops Island in Boston Harbor. Then the Navy doctors did their best to give the men the flu. Influenza is a respiratory disease—it is spread from person to person, presumably carried on droplets of mucus sprayed in the air when sick people cough or sneeze, or carried on their hands and spread when the sick touch the healthy. Whatever was causing the flu should be present in mucus taken from the ill. The experiments, then, were straightforward. The Navy doctors collected mucus from men who were desperately ill with the flu, gathering thick viscous secretions from their noses and throats. They sprayed mucus from flu patients into the noses and throats of some men, and dropped it into other men’s eyes. In one attempt, they swabbed mucus from the back of the nose of a man with the flu and then directly swabbed that mucus into the back of a volunteer’s nose.

. . . the two families were about to be impacted in a major way as Philadelphia and the rest of the world were slammed with a pandemic so catastrophic that it killed more people than World War I.

A specialty among public relations consultants has evolved in recent decades called "risk communication." I don't much care for the term. It implies managing the truth. You don't manage the truth. You tell the truth.

In the fall of 2020, as we got closer to flu season, I started to worry. Every year, influenza kills tens of thousands of Americans and hundreds of thousands of people around the world, nearly all of them elderly. Even more are hospitalized. At a time when COVID was overwhelming or at least sorely testing virtually every health system on the planet, a bad flu season could have been disastrous. But there was not a bad flu season that year. In fact, there was hardly any flu season at all. Between the flu seasons of 2019–20 and 2020–21, cases dropped 99 percent. As of late 2021, one particular type of flu known as B/Yamagata had not been detected anywhere in the world since April 2020. Other respiratory viruses also dropped dramatically. By the time you read this book, of course, things may have changed. Flu strains have a way of disappearing for long periods and then suddenly recurring without explanation. But the huge decline in cases across the board is unmistakable, however long it lasts, and we know why: Nonpharmaceutical interventions made a dramatic difference in reducing flu transmission when combined with the prior immunity and vaccinations that people had.

I could find no support for Trump’s claim, repeated several times in public remarks, that the Obama administration left behind “obsolete” or “broken” tests. Obama’s National Security Council had left behind a 69-page document titled “Playbook for Early Response to High-Consequence Emerging Infectious Disease Threats and Biological Incidents” that included instructions for dealing with novel influenza viruses which “would produce an estimate of between 700,000 and 1.4 billion fatalities from a pandemic of a virulent influenza virus strain.” The document recommended officials in the early stages of such a pandemic check the nation’s diagnostic testing capacity and the amount of personal protective equipment available for health care workers.

The 1918 influenza pandemic (also known as the Spanish Flu) was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. It’s estimated that about 500 million people—one-third of the world’s population—became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide, with about 675,000 occurring in the United States. This virus is still with us today, and is the reason for our annual flu shots.

By the dawn of the twentieth century, for the first time since cities had come into existence 5,000 years before, infectious diseases were staunched to such an extent that cities were able to remain stable, and even grow, without depending on a constant stream of migrants from the countryside. It was a remarkable change.

Covid hasn't finished with us yet, because it's only just getting started.

the 2009 H1N1 virus so alarming is that its recent forebears infected three species—humans, birds and pigs.

These alterations arise through small mutations in the gene that constitutes the blueprint for that protein. Sometimes a mutation makes little difference in the protein’s stability or activity. Sometimes it damages the protein and reduces the viability of the virus. Other times, though, it enhances survival, such as by reconfiguring a site on hemagglutinin that was formerly recognized by an antibody.

When antigenic shift occurs, strains crop up bearing a totally new hemagglutinin spike, and sometimes also a new neuraminidase molecule, that most people have never encountered. As a result the virus may evade the antibody repertoire carried by all populations around the globe and trigger a pandemic. In today’s jet-linked world, people can spread a dangerous new virus from one part of the earth to another in a day. Such a drastic metamorphosis cannot occur through simple genetic mutation. The best-studied process leading to antigenic shift involves the mixing of two viral strains in one host cell, so that the genes packaged in new viral particles (and their corresponding proteins) come partly from one strain and partly from the other. This reassortment can take place because the genome, or genetic complement, of the influenza virus consists of eight discrete strands of RNA (each of which codes for one or two proteins). These strands are easily mixed and matched when new influenza A particles form in a dually infected cell. For instance, some influenza viruses infect both people and pigs. If a pig were somehow invaded by a human virus and by a strain that typically infected only birds, the pig might end up producing a hybrid strain that was like the human virus in every way except for displaying, say, a hemagglutinin molecule from the bird virus.

Various pathogens that can cause life-threatening infections such as HIV, hepatitis C virus, Mycobacterium tuberculosis and Plasmodium parasites (the source of malaria) can evade antibodies, and an effective vaccine against these pathogens would need to stimulate robust T cell responses.

mild cases of H5N1 have gone underreported or do not register in tests, which has artificially driven up the mortality rate. Others argue that deaths from H5N1 have gone underreported, which may make the mortality rate appear lower than it actually is.

Although regular human flu viruses bound easily with the receptors found in the nose and throat cells, H5N1 strains attached only to those receptors on cells found in the deepest regions of the lungs.

For the viruses to be transmitted efficiently, they have to multiply in the upper portion of the respiratory system so that they can be transmitted by coughing and sneezing.

You could call pigs the Achilles’ heel of global influenza surveillance.

When the hemagglutinin or neuraminidase genes and proteins accumulate several alterations, they can become virtually unrecognizable to most of the antibodies in a population and may initiate a new epidemic.

Many natural infections have at least one benefit in that a bout of illness confers lifelong immunity against the causative pathogen. An ideal vaccine would also offer such lasting protection, preferably with a single dose, and perhaps even protect against related threats, such as all members of the ever evolving family of human flu viruses.

So your solution is a universal vaccine. You need a vaccine that is not invalidated by drift and shift.

Indeed, two researchers have charged into the already fraught H5N1 publication controversy insisting the numbers are wrong, that the true mortality rate is likely to be much, much lower and that bad policy is being driven by the inflated figures.

Swine influenza is not even a reportable disease, a classification saved for diseases deemed a threat to the entire industry, such as foot-and-mouth disease. On the other hand, pig flu viruses can be a big problem for the general population. That is because pigs are a genetic crucible for new flu viruses. They can be infected with flu viruses from birds, other pigs and people, creating opportunities for a melding of genes in new combinations known as reassortants. The fear is these new hybrids will prove capable of infecting people readily, while being sufficiently foreign to cause serious illness once they do.

Influenza strains that colonize humans have a particular affinity for the epithelial cells that form the lining of the respiratory tract. Successful infection typically leads after a day or two to such classic symptoms as runny or stuffy nose, dry cough, chills, fever, aches, deep tiredness and loss of appetite. Historical descriptions based on symptoms indicate that flu epidemics have probably plagued human populations since well before the 5th century B.C.

Webster’s hunch about birds being a reservoir for precursors to human viruses is now conventional wisdom.

A virus's ability to spread is the key to its ability to create a pandemic.

Although the 2009 pandemic of influenza A H1N1 ended up being relatively mild— killing about one in 10,000 people who came down with it—it still claimed more than 14,000 lives across the globe. The relatively low mortality rate was a relief to forecasters because the outbreak's origin in Mexico and type had taken many by surprise.

The researchers, under the direction of Yoshihiro Kawaoka at the University of Wisconsin at Madison, crossed an H5N1 virus with the H1N1 pandemic virus of 2009, which spread like wildfire from one end of the world to another. The 2009 pandemic, you’ll recall, caught public health officials by surprise but luckily turned out to be mild. Kawaoka’s lab-made hybrid virus spreads among ferrets by airborne droplets expelled during the course of respiration–just as human influenza viruses such as the 2009 pandemic strain spread from person to person. Kawaoka’s concoction does not kill ferrets, and probably wouldn’t kill humans, but the feat is troubling because it demonstrates that an H5N1 virus that can spread among humans is most likely possible. (We don’t know for sure because it was tested only on ferrets, not humans, of course.)

In the U.S., livestock farms often bar health officials from testing their pigs even though precursors of the 2009 H1N1 pandemic are thought to have kicked around U.S. pig farms for years before emerging in Mexico.

Intensive monitoring of pig viruses is unlikely to come any time soon, however. Most pork-producing countries do not test their pigs at all, and in some that do—such as the U.S.—the testing is done on behalf of the pork producers, who have little economic incentive to share what they find.

this bird flu currently lacks the protein key to unlock certain cells in the human upper respiratory tract, preventing it from spreading via a sneeze or a cough.

Flu viruses mutate constantly.

Someday there may be a vaccine that can fend off all subtypes of influenza, but such a vaccine remains a dream for now.

Scientists isolated an influenza strain from a human for the first time in 1933. Since then, they have learned that influenza viruses come in two main “flavors”— types A and B—that differ in certain of their internal proteins. A third type (C) does not seem to cause serious disease.

Type A influenzas, in contrast, affect pigs, horses, seals, whales and birds as well as humans, although not all strains infect all species. (Indeed, only four subtypes have been found in humans.) They are also responsible for all of this century’s pandemics.

The neuraminidase molecules on the freshly made particles can cleave sialic acid. In other words, the neuraminidase spikes essentially dissolve the unwanted sialic acid “glue,” thereby enabling the viral particles to travel. The enzyme also helps the virus to plow through the mucus between cells in the airways.

Systematic sampling and mandatory reporting of disease in swine herds are limited to a handful of commercially devastating illnesses, including classical swine fever and nipah virus.

feces. If a wild bird infects a chicken on a poultry farm, the virus may get opportunities to interact with a range of additional viruses through close contact with pigs and other animals. This is indeed what has happened in the live animal markets and backyard farms of China and southern Asia. Influenza viruses are notorious for their ability to change, through a combination of mutation and “reassortment”—a borrowing of genes from other viruses. An open farm acts like a virus convention, where different strains swap genetic material like conventioneers swap business cards.

In 1918 and 1919 came the Great Influenza, the Spanish Flu.  The only global pandemic in modern times.  Fifty million to a hundred million dead.  How did Tibet fare this time, you ask?” McAlister’s face was stoic, immobile. Suddenly angry, Undertaker said, “No. You don’t ask, Dr. McAlister; you don’t ask because you already know.  Tibet was barely touched.  A few sick, no one reported dead.

It worries the flu scientists because they know that H5N1 influenza is (1) extremely virulent in people, with a high lethality though a relatively low number of cases, and yet (2) poorly transmissible, so far, from human to human. It’ll kill you if you catch it, very likely, but you’re unlikely to catch it except

RNA viruses because I already had that list in my mind: Hendra and Nipah, Ebola and Marburg, West Nile, Machupo, Junin, the influenzas, the hantas, dengue and yellow fever, rabies and its cousins, chikungunya, SARS-CoV, and Lassa, not to mention HIV-1 and HIV-2. All of them carry their genomes as RNA. The

Because influenza viruses continually evolve, new influenza strains continually threaten human populations.

The 1918–19 influenza virus strain, a pandemic which killed forty million people in Europe, Asia and America, was not confined to the war areas, though it struck them hardest.

Still, this particularly virulent and infectious strain of the flu virus is thought to have killed as many as 40 million people around the world between 1918 and 1919.

Instead, the dean had said, “Take a look at the person sitting to your left and to your right. Chances are that person will not be there four years from now.” Every

A pandemic would have a cascading effect. Always eager for a sensational story, the media - particularly television - would spread panic. The labor force - because of sickness, fear, or having to tend to sick family members would not report for work. Soon, the economy would come to a standstill as industries shut down, businesses closed, and unemployment soared. Growing shortages of vital goods, from food to fuel to medical supplies would bring chaos. Government would cease to function. Hospitals, mortuaries, and cemeteries would overflow as in 1918, only more so. Taken by surprise, drug companies would not have the time or healthy scientific personnel to develop a new generation of vaccines.

To be a scientist requires not only intelligence and curiosity, but passion, patience, creativity, self-sufficiency, and courage. It is not the courage to venture into the unknown. It is the courage to accept (indeed, embrace) uncertainty. For as Claude Bernard, the great French physiologist of the nineteenth century, said, 'Science teaches us to doubt.' A scientist must accept the fact that all his or her work, even beliefs, may break apart upon the sharp edge of a single laboratory finding. And just as Einstein refused to accept his own theory until his predictions were tested, one must seek out such findings. Ultimately a scientist has nothing to believe in but the process of inquiry. To move forcefully and aggressively even while uncertain requires a confidence and strength deeper than physical courage. All real scientists exist on the frontier. Even the least ambitious among them deal with the unknown, if only one step beyond the known. The best among them move deep into a wilderness region where they know almost nothing, where the very tools and techniques needed to clear the wilderness, to bring order to it, do not exist. There they probe in a disciplined way. There a single step can take them through the looking glass into a world that seems entirely different, and if they are at least partly correct their probing acts like a crystal to precipitate an order out of chaos, to create form, structure, and direction. A single step can also take one off a cliff.