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.

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.

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

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

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.

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.

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.

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

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

One way in which grief gets hidden is that death now occurs largely offstage. 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.

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.

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.

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.

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.

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.

To a large degree, the extent of the devastation that the flu caused on American cities depended on how they reacted to it. Those that took prompt action and made good choices had more limited devastation than others.

Perhaps, in some innocent encounter in China between a child and a bird, a new killer flu is on its way. Or perhaps, even now, a young man or a young woman has become infected with two different strains of flu viruses. They are mixing together in the person’s lungs, their genes reassorting. Emerging from that witches’ brew is a new virus, a chimera, that, like the 1918 flu virus, is perfectly suited for destruction. Perhaps, as we grow almost smug about influenza, that most quotidian of infections, a new plague is now gathering deadly force. Except this time we stand armed with a better understanding of the past to better survive the next pandemic.

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 flu.

knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our nation.” With that preamble, Ford announced that he was asking Congress to appropriate $135 million “for the production of sufficient vaccine to inoculate every man, woman, and child in the United States,” for a disease that no one could even prove to exist.

air cannot flow out of the room, only in. There they are bathed in blue ultraviolet light, which kills viruses. After that, they tug on

There are three different types of influenza viruses: A, B, and C. Type C rarely causes disease in humans. Type B does cause disease, but not epidemics. Only influenza A viruses cause epidemics or pandemics, an epidemic being a local or national outbreak, a pandemic a worldwide one.

A Journal of the Plague Year

In a truly lethal pandemic, state and local authorities could take much more aggressive steps, such as closing theaters, bars, and even banning sports events—in 1919 even the Stanley Cup finals were canceled—and church services.

Today’s world population is 6.3 billion. To give a sense of the impact in today’s world of the 1918 pandemic, one has to adjust for population. If one uses the lowest estimate of deaths—the 21 million figure—that means a comparable figure today would be 73 million dead. The higher estimates translate into between 175 and 350 million dead.

If it is hot enough to barbecue,” a patient of mine once told me as I sutured the knife wounds on his chest, “it’s hot enough to stab someone.

Pandemics often come in waves, and the cumulative “morbidity” rate—the number of people who get sick in all the waves combined—often exceeds 50 percent.

In other cases, the reasons for forgetting are more prosaic, more epidemiological, more related to numbers: the particular pandemic disease was not fatal enough (2009 H1N1 influenza), or it did not afflict enough people because it was not infectious enough (MERS), or it burned out too fast (SARS-1), or it afflicted a confined subgroup of the human population (Ebola), or it was brought low by a vaccine (measles and polio), or by treatment (HIV), or by eradication (smallpox), allowing most people to simply push the disease out of their minds. While the way we have come to live in the time of the COVID-19 pandemic might feel alien and unnatural, it is actually neither of those things. Plagues are a feature of the human experience. What happened in 2020 was not new to our species. It was just new to us.

in 2004, the National Intelligence Council, a research organization in the U.S. intelligence community, had published a report titled Mapping the Global Future, which presented scenarios for the year 2020. One of the scenarios imagined was a pandemic in 2020. It was eerily prophetic, even as to the year: It is only a matter of time before a new pandemic appears, such as the 1918–1919 influenza virus that killed an estimated twenty million worldwide. Such a pandemic in megacities of the developing world . . . would be devastating and could spread rapidly throughout the world.

In 1918 pathologists did see at autopsy the normal devastation of the lungs caused by the usual lobar and bronchopneumonias. But the lungs from those who died quickly during the pandemic, the lungs that so confused even Welch, those lungs were different. Said one pathologist, “Physical signs were confusing. Typical consolidation was seldom found.” And another: “The old classification by distribution of the lesions was inappropriate.” And another: “Essentially toxic damage to alveolar walls and exudation of blood and fluid. Very little evidence of bacterial action could be found in some of these cases.

Influenza robbed countless youngsters of normal childhoods. For them, attending school had been a regular part of life. The pandemic, however, forced local authorities to decide whether to keep public schools open.

For young survivors of the pandemic, life would never be the same. Like shell shocked soldiers, they bore emotional scars. These children had similar experiences and shared similar feelings of anxiety, of terror, of despair.

Ecco a cosa sono utili le zoonosi: ci ricordano, come versioni moderne di san Francesco, che in quanto esseri umani siamo parte della natura, e che la stessa idea di un mondo naturale distinto da noi è sbagliata e artificiale. C’è un mondo solo, di cui l’umanità fa parte, così come l’HIV, i virus di Ebola e dell’influenza, Nipah, Hendra e la SARS, gli scimpanzé, i pipistrelli, gli zibetti e le oche indiane. E ne fa parte anche il prossimo virus killer che ci colpirà, quello che ancora non abbiamo scoperto.

The disease has survived in memory more than in any literature. Nearly all those who were adults during the pandemic have died now. Now the memory lives in the minds of those who only heard stories, who heard how their mother lost her father, how an uncle became an orphan, or heard an aunt say, “It was the only time I ever saw my father cry.” Memory dies with people. The writers of the 1920s had little to say about it.

Statistics also confirmed what every physician, indeed every person, already knew. In the civilian population as well, young adults had died at extraordinary, and frightening, rates. The elderly, normally the group most susceptible to influenza, not only survived attacks of the disease but were attacked far less often. This resistance of the elderly was a worldwide phenomenon. The most likely explanation is that an earlier pandemic (later analysis of antibodies proved it was not the 1889–90 one), so mild as to not attract attention, resembled the 1918 virus closely enough that it provided protection.

Societies, especially in the developed world, were thought to be on the verge of becoming invulnerable to new plagues. Unfortunately, this expectation has proved to be spectacularly misplaced. Well into the twenty-first century smallpox remains the only disease to have been successfully eradicated. Worldwide, infectious diseases remain leading causes of death and serious impediments to economic growth and political stability. Newly emerging diseases such as Ebola, Lassa fever, West Nile virus, avian flu, Zika, and dengue present new challenges, while familiar afflictions such as tuberculosis and malaria have reemerged, often in menacing drug-resistant forms. Public health authorities have particularly targeted the persisting threat of a devastating new pandemic of influenza such as the “Spanish lady” that swept the world with such ferocity in 1918 and 1919.

The 1918 influenza pandemic famously had a W-shaped curve. The very young and the very old were at increased risk, but there was also elevated risk in the middle of the age distribution, spiking in patients around twenty-five years old. Scientists have been studying this for decades but are still unsure why it happened.

journalist asked her about it. “What scares me most and what I think about most,” said Charity, “is our ability to respond to a new pathogen, maybe one we’ve never seen before, or an old pathogen, like influenza that’s just mutated. The H1N1 pandemic of 1918 was over 100 years ago now. The world is overdue for a pandemic like that, whether it’s influenza or something else. And in public health, we know that we have to be prepared for that.

What scares me most and what I think about most,” said Charity, “is our ability to respond to a new pathogen, maybe one we’ve never seen before, or an old pathogen, like influenza that’s just mutated. The H1N1 pandemic of 1918 was over 100 years ago now. The world is overdue for a pandemic like that, whether it’s influenza or something else. And in public health, we know that we have to be prepared for that.

John Barry’s The Great Influenza: The Story of the Deadliest Pandemic in History.

With them heredity, diatheses, the vicissitudes of weather and other meteorological conditions, elements of decomposition, impure atmosphere, gluttony, insufficient and unwholesome food, inebriety and other environments, potent factors in the formation of disease, are entirely overlooked. Having their gaze fixed upon the one ignis fatuus, they become oblivious to all things else in heaven, earth or sea.79

In more recent history, we learn from other viruses, including Measles, Ebola, Rabies, Herpes, how important it is to respond immediately to prevent the spread of infection. I was shocked when I learned more about the influenza pandemic, otherwise known as the Spanish Flu of 1918–1919. It began in the US, swiftly traveled across the world, and killed more people than any disease before or since.

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

Our work is not to get rid of viruses, or we would, by definition, fail. Our work is to live alongside viruses and to protect as many human lives as we can. This depends, in part, on what viral stories we tell, what viral metaphors we use. A virus killed my friend. I miss her every day. I live alongside viruses every day, missing her. Her memory will make me smile; her memory will make me cry. It will make me angry, forever, at influenza, the virus that took her away, but that anger won’t get her, or us, a second chance. As individual humans and the collective we together form, death or symbiosis are our only options. The planet cannot continue to sustain our abuse. Will we eat it alive, use up its resources, and leave it an unsuitable host for further human reproduction? What will this earn us? Continued wealth for a small number of human animals is all. Human reproduction is not driving global warming; wealth production is. Human wealth will be lytic, killing our host planet and us with it. Lysogeny may still be an option. Symbiosis. We could understand, like one of lambda’s stories, that treating the host well is treating us well. The earth’s well-being is our own well-being. Lambda has its choice made for it by molecules and circumstances and luck. We have our molecules and circumstances, but we can make more than luck. We must choose it, actively and every day, a lysogenic viral story, a living with and caring for the earth because it means caring for ourselves. A virus is not an enemy; if it is, we will only lose. Viruses aren’t the problem, they’re a fact of the world. We are the problem when we refuse to protect one another’s lives as the most precious things we have. You are precious to me. We might well prefer a world without viruses, their everyday annoyances, the fever or runny nose, the cold sores, the never-ending possibility of pandemic. We won’t get a day without them. I miss Sarah every day. Viruses aren’t going anywhere. We get to choose what we become. For my part, I live to be lysogenic. Won’t you join me here?

The National Institutes of Health in Maryland keeps samples of the 1918 flu virus in a freezer at an undisclosed location. It’s not easy to get anywhere near that locked freezer, let alone inside it. First, you have to get onto the campus of the NIH, which requires identification, a reason to be admitted, and a PhD, preferably in one of the life sciences. Once you get through and find the building, a guard has to buzz you in via an airlocked entrance with double doors. Inside, you will pass through a metal detector and then be firmly guided toward a locker, where your cell phone, thumb drive, computer, pager, and camera must be deposited. Then, and only then, will you be escorted farther into the building.

All this tinkering was creating superviruses that did not exist outside the lab and that might be more easily transmissible between different species, or more virulent, or more resistant to any influenza vaccine. Most researchers were insistent that these “gain of function” studies were needed to better understand how the flu virus might evolve, but the federal government saw things differently. These experiments were a security risk.

The 2009 “pandemic,” which was not really a pandemic at all, taught us that language is both a weapon and a handicap when waging a campaign against influenza.

labs that enrolled in the FluNet Global Influenza Surveillance System—a network of reference labs that sample for flu as a way to track its global spread—recorded 4,623 cases of flu in 2019 but just 53 in 2020. In Chile, there were 5,000 cases in 2019 and 12 in 2020; and in South Africa, the network’s labs detected 1,094 cases in 2019 and just 6 in 2020.53 In New Zealand there was a “near extinction” of influenza.54 With so little flu virus migrating, a similar scenario played out in the US during our fall and winter. By the end of January 2021, the CDC had recorded only 1,316 positive flu cases in its surveillance network, compared to 129,997 they had recorded over the same time frame in 2019.55 The mitigation we put into place was designed to deal with a pandemic flu, not COVID, and it worked much better against its intended viral target.

Robert Graves, the poet and British Army officer, was in London, too, still shaky from the German metal he had received in his chest and thigh the year before. His mother-in-law contracted influenza, but deceived her physician in order to make the rounds of the latest London plays with her son, Tony, on leave from France. She died July 13: “her chief feeling was one of pleasure that Tony had got his leave prolonged on her account.” On the day she died, Grave’s friend and fellow poet, Sigfried Sassoon, who had been shot through the throat in 1917, was shot through the head while on patrol in No-Man’s-Land. He recovered. Tony was killed two months later.27 Yes, the war was much more engrossing than Spanish flu.

Spanish influenza had rounded the globe in four months following its appearance in the United States and fully earned a promotion from epidemic to pandemic. It had infected so many that, for all its mildness, it had doubtlessly killed tens of thousands already. In its next wave it would kill millions.

The characteristic of the influenza virus that makes it so dangerous and gives rise to epidemic after epidemic is its extreme mutability. It perpetually is changing the nature of its outer surface, which antibodies, the body’s most important defense system, must zero in on to be effective.

No other influenza before or since has had such a propensity for pneumonic complications. And pneumonia kills.

The case and death rates of communities which had “strict” closing orders were no better and often worse than elsewhere. However, public health officials had to do something, and closing up theatres, schools, pool halls, and even churches was the style in fall 1918.

In its first Spanish influenza pamphlet, issued in September, the USPHS recommended that those nursing flu patients wear gauze masks.37 Soon laymen decided that what was a sensible caution in the sickroom would be just as sensible in every situation. Gauze masks became a common sight in the streets and department stores of communities in the eastern United States. People could and did honestly believe that a few layers of gauze would keep out flu bugs, just as screens kept the flies off the front porch. The influenza virus itself is, of course, so infinitely tiny that it can pass through any cloth, no matter how tightly woven, but a mask can catch some of the motes of dust and droplettes of water on which the virus may be riding. However, to be even slightly effective during a flu epidemic masks must be worn at all times when people are together, at home and at work and in between, must be of a proper and probably uncomfortable thickness, must be tied firmly, and must be washed and dried at least once daily. Enforcement of such conditions is impossible and so the communities where masking was compulsory during the Spanish influenza pandemic almost always had health records the same as those of adjacent communities without masking.

The Great Influenza, a book by the historian John Barry about the 1918 flu pandemic.

Some spent years undermining Pfeiffer’s theory, and others—among them many of the most brilliant scientists of the era—took off after other alleged villains, spending untold thousands of man-hours in the crucially important but thankless task of proving themselves wrong.

Today, we know that viruses are submicroscopic entities twenty times smaller than a bacterium. They contain a core of genetic material covered by a protein capsule, and they reproduce exclusively within living cells.

The most useful definition we have is that an epidemic is a severe local outbreak, while a pandemic is a global outbreak that makes people very sick, and spreads rapidly from a point of origin.

Antigenic shift generated the deadly 1918 influenza virus and the swine flu outbreak of 2009.

We now think that the majority of deaths in the 1918 pandemic resulted from these secondary infections, not from the flu virus itself.

The third explanation for 1918’s lethality is that the flu virus triggered an overreactive immune response that turned the body against itself.

Today, influenza kills fewer than 0.1 percent of those who catch it. Nearly everyone recovers. In the 1918 pandemic most still recovered, but the death rate was twenty-five times greater. So many died in the U.S. that the average life expectancy in 1918 fell from fifty-one to thirty-nine years.

The history of the 1918 influenza pandemic is depressing reading. It’s like watching a horror movie that you have seen before. You know who the killer is, but you can’t jump in and save the victim.

World War I killed upwards of fifteen millions, wreaked immeasurable physical, social, and psychic damage, and left most of the citizens of the belligerent powers with a deep conviction that war must in some way be prohibited.

When did the pandemic end? That is more difficult to say, for while flu pandemics often begin abruptly, they normally disappear only after several renewals of virulency and then a long tailing off. The pandemic of Spanish influenza subsided and sank below the level of general and even scientific perception in the United States and almost everywhere else in the world in spring 1919.

But the 1920 edition of the Spanish influenza virus was an attenuated variant of the original strain, and the human population was more resistent than in 1918 and 1919.

The pandemic of Spanish influenza is easier to measure if it is restricted to the years of 1918 and 1919 and its farewell performance of 1920 is excluded.

The pandemic of 1918–1919 was clearly one of influenza, except in two of its features. One, it killed more humans than any other disease in a period of similar duration in the history of the world. Two, it killed an unprecedentedly large proportion of the members of a group who, according to records before and since, should have survived it with no permanent injury. The year 1918 was an actuarial nightmare: the flu and pneumonia death rate of life insurance policy holders over 45 and 50, for whose deaths the insurance companies were at least partly prepared, did, of course, rise, but only slightly as compared to the rate of young adults, whose deaths in great numbers no insurance company anticipated.16

It seems that the returns of pandemic flu, every 30 or 40 years, are arbitrary. The return in 1918 happened to come in the midst of a world war, with all its crowds and migrations, and perhaps that coincidence created Spanish influenza. Perhaps, but can we be sure that crowds and migrations have much to do with increasing the virulency of flu? There is the annoying fact that two of the last three pandemics, those of 1889–1890 and 1957, appear to have originated not among the most cosmopolitan of the world—the citizens of New York or Panama City—but among the relatively isolated and static populations of the interior of Asia.24

A highly respected pair of researchers put the odds that such an effort (in this case involving a hypothetical strain of a novel influenza) could create a dangerous pathogen that would accidentally escape from a lab and trigger a pandemic at 1 in 10,000 to 1 in 100,000 per lab year.64 This was a meaningful risk. The US government imposed a moratorium on gain-of-function studies in 2014. No such restrictions were imposed in China. The US moratorium was later lifted by the NIH in 2017 and gain of function experiments continued including one widely cited study that was done by US researchers in collaboration with the WIV.65

In all, SARS-1 had been the subject of six outbreaks since its last-known natural occurrence, each one the consequence of its escape from a laboratory: one time each in Singapore and Taiwan, and then four separate escapes from the same lab in Beijing.69 Another instance where an experiment in China had gone awry, and triggered the global spread of a novel virus, had occurred in 1977 and involved a strain of H1N1 influenza.

most deadly disease event in the history of humanity.

The pandemic may have originated in the American military post at Fort Riley, Kansas, where a dust storm whipping about tons of incinerated manure had sent hundreds of coughing, stumbling doughboys diagnosed with influenza into the post hospital, where many died. Soon after, American troopships disembarked at Brest and Saint-Nazaire, and French poilus began to fall ill, then British soldiers. Then, as the malady rolled across France, German troops were stricken. The fatality rate was appalling. In the AEF, roughly one out of every three soldiers with influenza died, far worse odds than a man faced in battle.

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.

. . . 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.

He estimates the number of deaths worldwide as 100 million, a larger number than the conventional estimate of 20 to 40 million. But, he said, 20 million people died in India alone, making it impossible for the 20 to 40 million figure to be correct.

Ebola, West Nile, Marburg, the SARS bug, monkeypox, rabies, Machupo, dengue, the yellow fever agent, Nipah, Hendra, Hantaan (the namesake of the hantaviruses, first identified in Korea), chikungunya, Junin, Borna, the influenzas, and the HIVs (HIV-1, which mainly accounts for the AIDS pandemic, and HIV-2, which is less widespread) are all viruses.

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

Ironically, it was not the flu that actually killed people but the way in which it weakened them in ways that allowed pneumonia or meningitis could set in.

As the early outbreak at Fort Riley suggested, the primary breeding ground for the influenza consisted of army camps that were springing up all over America in the early days of 1918. America had entered World War I the previous October, and many young men were anxious to do their part and join the fight.  As a result, the camps soon became overcrowded with recruits and service veterans brought in from all over the country to train them.

the Indians who were our neighbors, they were only six miles away. So Dad and the city marshal rode up there one day to see how things were going at the Indian camps and they were horrified at what they saw. After an Indian died, his family and friends would sit around chanting him to the Happy Hunting Grounds and they’d spend all night there. And, by that time, they were all exposed, everybody had the flu. Ultimately, it killed about half the Indians.

Since that time there have been numerous epidemics of the disease. In 1889 and 1890 the disease was epidemic over practically the entire civilized world. Three years later there was another flare-up of the disease. Both times the epidemic spread widely over the United States. Although the recent epidemic is called ‘Spanish influenza,’ investigation has shown that it did not originate in Spain.  We now know that there was an undue prevalence of influenza in the United States for several years preceding the recent great pandemic. Because the disease occurred in mild form, and because the public mind was focused on the war, this increased prevalence of the disease escaped attention. Not until the epidemic appeared in severe form in Boston in September, 1918, did it excite any special interest.” - U.S. Public Health Service Report, prepared by Surgeon General Rupert Blue

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

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

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.

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.

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.

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.

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

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.

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

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.

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.

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 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.

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.

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.

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.

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

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.

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.

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.

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.)

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

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.

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.

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.

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

The small town of Gunnison, Colorado, lies at the bottom of the valley carved by the Gunnison River into the Rocky Mountains. It is now crossed by the Colorado stretch of U.S. Highway 50, but in 1918, the town was mainly supplied by train and two at best mediocre roads. When the 1918–19 influenza pandemic reached Colorado as an unwelcome stowaway on a train carrying servicemen from Montana to Boulder, the town of Gunnison took decisive action. As the November 1, 1918, edition of the Gunnison News-Champion documents, a Dr. Rockefeller from the nearby town of Crested Butte was "given entire charge of both towns and county to enforce a quarantine against all the world". He instituted a strict reverse quarantine regime that almost entirely isolated Gunnison from the rest of the world. Gunnison became one of the few communities that largely escaped the ravages of the influenza pandemic, at least in the beginning – in an instructive example of the limited human patience for the social, psychological and economic disruption of quarantine, adherence eventually waned and the front page of the Gunnison News-Champion's March 14, 1919, issue reports that the influenza pandemic got to Gunnison, too. Nevertheless, Gunnison had a very lucky escape – of a population of over 6,900 (including the county), there were only a few cases and a single death.

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.

Fall and winter 2020-21 may be COVID-19 brutal!

The environment is changing and so are the viruses.

Being a germaphobe is a trait I share with Nikola Tesla.

The elderly, normally the group most susceptible to influenza, not only survived attacks of the disease but were attacked far less often. This resistance of the elderly was a worldwide phenomenon. The most likely explanation is that an earlier pandemic , so mild as to not attract attention, resembled the 1918 virus closely enough that it provided protection. (p. 408 paperback edition)

which a "pandemic that the world had been anticipating for years finally hit. Unlike 2009’s H1N1, this new influenza

Zanamivir.

problems presented by a pandemic are, obviously, immense. But the biggest problem lies in the relationship between governments and the truth. • • • Part of that relationship requires political leaders to understand the truth—and to be able to handle the truth. If there’s a lesson from the 2009 pandemic, it’s that too many governments were incapable of doing so.

Influenza pandemics generally infect from 15 to 40 percent of a population; any influenza virus infecting that many people and killing a significant percentage would be beyond a nightmare. In recent years public health authorities have at least twice identified a new virus infecting humans but successfully prevented it from adapting to man. To prevent the 1997 Hong Kong virus, which killed six of eighteen people infected, from adapting to people, public health authorities had every single chicken then in Hong Kong, 1.2 million of them, slaughtered.

NO ONE WILL EVER KNOW with absolute certainty whether the 1918–19 influenza pandemic actually did originate in Haskell County, Kansas. There are other theories of origin, including France, Vietnam, and China. But Frank Macfarlane Burnet, a Nobel laureate who lived through the pandemic and spent most of his scientific career studying influenza, later concluded that the evidence was “strongly suggestive” that the 1918 influenza pandemic began in the United States, and that its spread was “intimately related to war conditions and especially the arrival of American troops in France.

The Purple Death was actually part of a great wave of influenza, a lethal virus that swept across America and around the world starting in the spring of 1918. A second, even deadlier wave of influenza appeared in late summer and autumn of 1918, and a third wave continued into 1919. This highly contagious disease, later widely known as Spanish flu, killed an estimated 675,000 Americans in one year, according to historian and professor Alfred Crosby. Consider this perspective: more Americans died from the flu in this short time than all the U.S. soldiers who died fighting in World War I, World War II, the Korean War, and the Vietnam War combined. Indeed, the Spanish flu killed as many Americans in about a year as did HIV/AIDS, the most notorious epidemic of modern times, in more than thirty years. According to the Centers for Disease Control and Prevention (CDC), the estimated number of deaths from diagnosed HIV infection classified as AIDS in the United States since the first reported death in 1981 through 2014 was 678,509—about the same number that died of Spanish flu from 1918 to 1919.

It seems the government was marketing Coronavirus as the Flu for decades!

How lethal was it? It was twenty-five times more deadly than ordinary influenzas. This flu killed 2.5 percent of its victims. Normally, just one-tenth of 1 percent of people who get the flu die. And since a fifth of the world’s population got the flu that year, including 28 percent of Americans, the number of deaths was stunning.

But in the rest of the world, the illness came to be called the Spanish flu, to Spain’s consternation. After all, the other countries of Europe, as well as the United States and countries in Asia, were hit too in that spring of 1918. Maybe the name stuck because Spain, still unaligned, did not censor its news reports, unlike other European countries. And so Spain’s flu was no secret, unlike the flu elsewhere.

The victory over cholera was only a beginning. With the growing and profound knowledge that many diseases are caused by microscopic organisms and that the spread of disease can be prevented, the Western world was transformed. It took years for the change to be complete, but the result was a vigorous public health movement that emphasized simple but powerful measures like cleaning up water supplies and teaching people what now seem to be basic lessons of health and hygiene—keep flies away from food, wash your hands before handling food, give your babies milk, not beer, quarantine the sick. The results were dramatic. In large areas of the world, many of the killer diseases seemed tamed, or even vanquished, and deadly epidemics seemed to be relics of the past.

[T]he only epidemic disease that plagued the troops during the early years of World War I was syphilis.

Medical historians believe the sickness began in China in 1331. Along with a civil war, it halved the Chinese population. From there, the plague moved along trade routes of Asia and arrived in the Crimea fifteen years later, in 1346. Then it entered Europe, North Africa, and the Middle East. It disrupted society in ways eerily reminiscent of the Athens plague so long before. It emptied streets and public places like the flu epidemic that followed it. And its very name became emblematic of the horrors of epidemics. It was known as the Black Death. At the time the illness was as mysterious as the plague of Athens but now it is known that the Black Death bacteria, Yersinia pestis, were spread by fleas that lived on black rats. The rats, in turn, moved from port to port on ships, taking the illness with them. The fleas would bite people, infecting them with the bacteria. The plague would not have been so overwhelming if it could only spread through flea bites. It turned out that once the bacteria began infecting people, they found another way of spreading. They would infect the lungs and cause a pneumonia, whereupon sick people could infect the healthy simply by coughing or sneezing.

Giovanni Boccaccio wrote in his Decameron that people, afraid of contamination by the rotting corpses, would drag the dead outside their houses and leave them in front of their doors to be picked up, like so much garbage.

Smart people buy cheap and Chinese before the 2020-21 influenza season combines with COVID-19 to slow down production.

Hang on tight, as we are going into the first full influenza season with COVID-19!

It is almost certain that the 2020-21 influenza season in conjunction with COVID-19 will slow production from China.

People with common sense buy what they need prior to the anticipated rise in COVID-19 during China’s 2020-21 influenza season.

Epidemics are local and occur in one place every 1 - 3 years, while Pandemics occur worldwide and happen at irregular intervals of several decades.

Henderson coauthored a paper in 2006 that refutes the Glass work and the CDC guidelines. The Henderson paper states, “Historically, it has been all but impossible to prevent influenza from being imported into a country or political jurisdiction, and there has been little evidence that any particular disease mitigation measure has significantly slowed the spread of flu. . . . The negative consequences of large-scale quarantine are so extreme (forced confinement of sick people with the well; complete restriction of movement of large populations . . .) that this mitigation measure should be eliminated from serious consideration. . . . Travel restrictions, such as closing airports . . . have historically been ineffective . . . and will likely be even less effective in the modern era.

Oliver Sacks’s The Awakening were victims of the 1918 influenza pandemic.)

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.

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.

RNA viruses mutate relatively quickly, and many, like influenza, are able to undergo a process known as antigenic drift, by which the virus is able to alter the surface antigens that are the targets of our antibodies—thus evading our existing immunity. Some viruses, like measles, cannot change their genomic sequence in ways that substantially alter enough of their surface proteins, so measles remains susceptible to our vaccines or the immunity that we get from prior infection. However, for viruses like influenza, as their surface proteins undergo change, the virus is able to dodge the protective antibodies that we’ve developed from past infection or vaccination

All of our focus was on flu. The next pandemic, it was firmly believed, would be triggered by a novel influenza. It’s likely that the next pandemic will indeed be from a new strain of influenza, and it will be a lot worse than COVID. However, we need to be prepared for the unknowns. That starts with the analytical systems to identify and characterize a new pathogen. It could be a new strain of influenza with features that are irregular. Or another coronavirus that’s even deadlier and more contagious than SARS-CoV-2. Or, instead, something else that we never anticipated.

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.

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.

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.

Inhabitants of isolated or remote regions where there has been little or no contact with the outside world are often described as “epidemiologically naive.” What this means is that they have limited immunity to diseases like influenza and measles that are endemic in other parts of the world, and when exposed to them they often suffer high rates of death. One of the best-known examples comes from the pandemic of 1918, in which certain populations, notably indigenous Alaskans and Pacific Islanders, died at rates that were four, five, and in some cases even ten times those of other populations. The pandemic is thought to have killed between 3 and 6 percent of the global population; in Western Samoa, 20 percent of the population died. In the nineteenth-century Pacific, this scenario played itself out over and over.

But the flu was expunged from newspapers, magazines, textbooks, and society’s collective memory. Crosby calls the 1918 flu “America’s forgotten pandemic,” noting:

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.

William Park, Oswald Avery, and Paul Lewis each approached science in his own way. Park, a man who almost became a medical missionary, saw it as a means to a larger end; he saw it as a tool to relieve suffering. Disciplined and methodical, his interest lay chiefly in immediate results that he could apply to his purpose. His contributions, particularly those made with Anna Williams, were enormous; their improvement of diphtheria antitoxin alone doubtless saved hundreds of thousands of lives over the past century. But his purpose also limited him, narrowed him, and limited the kind of findings he and those under him would make. Avery was driven and obsessive. Part artist and part hunter, he had vision, patience, and persistence. His artist’s eye let him see a landscape from a new perspective and in exquisite detail, the hunter in him told him when something, no matter how seemingly trivial, was out of place, and he wondered. The wonder moved him to the sacrifice of all else. He had no choice but to sacrifice. It was his nature. Cutting a Gordian knot gave him no satisfaction. He wanted to unfold and understand mysteries, not cut through them. So he tugged at a thread and kept tugging, untangling it, following where it led, until he unraveled an entire fabric. Then others wove a new fabric for a different world. T. S. Eliot said any new work of art alters slightly the existing order. Avery accomplished that all right, and far more. Paul Lewis was a romantic, and a lover. He wanted. He wanted more and loved more passionately than Park or Avery. But as is true of many romantics, it was the idea of the thing as much or more than the thing itself that he loved. He loved science, and he loved the laboratory. But it did not yield to him. The deepest secrets of the laboratory showed themselves to Lewis when he was guided by others, when others opened a crack for him. But when he came alone to the laboratory, that crack closed. He could not find the right loose thread to tug at, the way to ask the question. To him the laboratory presented a stone face, unyielding to his pleadings. And whether his death was a suicide or a true accident, his failure to win what he loved killed him. One could consider Lewis, in a way meaningful only to him, the last victim of the 1918 pandemic.

For a paper delivered to the Royal Society of Edinburgh, he plotted sharp up-and-down graphs of case numbers, week by week or month by month, from the empirical records of several disease outbreaks—plague in London (1665), measles in Glasgow (1808), cholera in London (1832), scarlet fever in Halifax (1880), influenza in London (1891), and others—and then matched them with smooth rollercoaster curves derived from a certain mathematical equation.

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. (The strain influenza puts on health care was driven home to me in a personal way on my book tour. In Kansas City, a flare-up of ordinary seasonal influenza forced eight hospitals to close emergency rooms, yet this was only a tiny fraction of the pressure a pandemic would exert.) This and similar problems—such as if a particular secondary bacterial invader is resistant to antibiotics, or shortages of such seemingly trivial items as hypodermic needles or bags to hold IV fluids (a severe shortage of these bags is a major problem as I write this)—could easily moot many medical advances since 1918.

As I write in 2015, scientists are looking at the next potential pandemics. It may take only a few mutations for a strain of bird flu to evolve into a new strain of human influenza virus. Reassortment could accelerate the change. No one can say when, or if, any particular strain will make the jump. But we are not helpless as we wait to see what evolution has in store for us. We can do things to slow the spread of the flu, such as washing our hands. And scientists are learning how to make more effective vaccines by tracking the evolution of the flu virus so they can do a better job of predicting which strains will be most dangerous in flu seasons to come.

Don’t panic! Just have rational fear of COVID-19.

The cholera epidemic was a turning point marking the last time the disease would rage without simple precautions of public health.

Then the influenza epidemic arrived. Unlike the plague of Athens, unlike the Black Death, unlike even the cholera epidemic that felled William Sproat and the other cholera epidemics to come in that century, the flu epidemic had no chronicler.

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall. And it seemed that the two flu strains were closely related. Infection with the first strain protected against the second