Generally, when flu season comes around, I'm somewhat blase about it. I know I shouldn't be, especially since one of my historical insterests happens to be the 1918 Spanish Flu pandemic and the World War I era. I also know that history has a nasty habit of repeating itself.
For the past two years, I've been nervously watching the H5N1 flu, aka the Avian Flu, march across Asia. It has all the earmarks of frightening world pandemic once the virus mutates enough to allow human-to-human transmission. Thus far, the transmission is still bird-to-human, which is why the infection and mortality rate is (relatively) low.
It isn't a matter of if this will change. It's a matter of when.
At first I was tempted to go into the whole scientfic rigamorole on what makes H5N1 so very special (and inspires flashbacks to the 1918 flu pandemic in me), but you're better off reading the experts as they explain science behind the difference between the usual flu and a flu with the potential to be a deadly pandemic.
The fact is, we already know what a flu pandemic looks like. During the 1918 pandemic, 20% of the global population became ill and the mortality rate was estimated to be 2.5% to 5% (I've seen arguments that it was as high as 12.5%). The global deaths during the 1918 pandemic are estimated to be between 25 million to 50 million people (some estimates run as high as 100 million). The reason for the uncertain numbers is because at the time, influenza was not reportable and there were no international health organizations monitoring the emergency or tracking the influenza. (Let's leave behind a moment that World War I was raging across Europe and much of the media in the combatant countries were under wartime censorship.)
During the 1918 pandemic in the U.S. alone, 28% of the American population fell ill and an estimated 1.5 million Americans died. That's more than the number of people killed in a single year by heart disease, cancers, strokes, chronic pulmonary disease, complications of AIDS, and Alzheimer's disease combined. (Source: Flu, Kolata, 1999, p7)
What also makes the 1918 flu pandemic unique is that it didn't kill the "usual suspects:" the elderly, young children, the immunocompromised, or people with chronic respiratory conditions. It killed people in the prime of their lives (age 20 to 50) and (theoretically) at the height of health.
The H5N1 virus is now emigrating across the globe via migratory birds. The H5N1 virus has left its Southeast Asian confines and within the past month or so has appeared in western Russia, Romania, Turkey, and Greece.
There have been documented cases of bird-to-human transmission and the virus has already adapted itself to attack pigs and large wild cats. It has not yet achieved human-to-human transmission, but because the virus is transmissable between birds and people, H5N1 is at Phase 3, which is the first step in a Pandemic Alert.
Remember, due to the nature of how viruses adapt and evolve, it's not a matter of if, it's a matter of when human-to-human transmission will occur.
Although only 60 people are known to have died from H5N1, it's not the overall death toll that makes flu a potential killer, it's the lethality. Approximately 50% of the people who contract H5N1 die.
I'll be the first to say that the high lethality of H5N1 in Southeast Asia may have secondary reasons: access to healthcare and medicines being two major factors contributing to the lethality. Even if we take those into account, if we use the 1918 flu pandemic as a model, H5N1 could achieve 12.5% rate of global lethality. In a world with an estimated population of 6.6 billion people, that translates to a lot of dead bodies. The economic impact ranging from hard-hit families to entire nations could be devastating.
Scared yet? If you know history, you should be.
I could jump up and down right here and mention that we've known for 2 years that H5N1 is a monster just waiting to be unleashed. I could also mention that the U.S. preparedness for a true flu pandemic is about on par with our hurricane preparedness.
At least some governmental agencies (aside from the CDC) are finally getting with the program, although it seems to be more on the local level as opposed to a nation-wide plan to respond to a pandemic. My home state of Massachusetts, for example, is already pushing people to get their flu and pneumonia vaccines and to put aside an emergency stash of nonperishable foods and bottled water. (The exact phrase from our governor is, I believe, "Prepare like you're going to be in a winter-long nor'easter.")
However, I won't get into the screaming bit. Instead, culled from various sources, I will point out that western industrialized nations do have tools that its citizens can use.
Let me jump back a moment and say that the historical record of the 1918 pandemic shows that people died for several reasons: no resistance to the either the regular or pandemic strain, pneumonia, constriction of the bronchial tubes, fluid in the lungs, and dehydration and high fevers that caused physical damage, such as the breakdown of critical organs and tissues.
Let's hear it for the 21st century. We have some defenses today that the people of 1918 didn't have.
1. Get your flu shot
I'm a two-minded person when it comes to the flu shot. I'm not 100% convinced it actually helps and I've not seen any difference between years I've gotten it and years I haven't. However, on the off-chance that I've just been lucky, I got jabbed today and will suffer being under-the-weather for the next few days.
The flu shot (live virus version) will not protect you from H5N1 because there is no vaccine yet available for it. What it will do is protect you from the usual flu strains. It has been suggested that part of the high mortaility rate in 1918 was because people would get the "normal" flu, and then get hit with the pandemic flu while their immune system was still recovering and resistance to new infection was low. The same principal applies. Protect yourself from what's known, and you have a better shot at avoiding or lessening the impact of what's unknown.
Most U.S. states reserve the first wave of flu vaccines for populations considered at high risk, such as (again) the elderly, very young children, people with chronic respiratory conditions (asthma counts, which is how I got mine so early, even if my asthma less than Type 1), and the immunocompromised. However, most states declare "open season" (that is, everyone can get a shot) after October 24. Check with your state department of health to determine the cut-off date and the locations, dates, and times of flu clinics.
2. Get your pneumonia shot.
Merck's Pnemovax 23 is good for 5 years.
Bacteria are sneaky little bastards and they will take advantage if your immune system is compromised or too weakened to fight back. In a pandemic flu like H5N1, it's a very plausible scenario. Again, looking back to 1918, a certain percentage of the dead actually died as a result of bacteria-causing pneumonia that colonized the lungs while the immune system was too weak. The vaccine will strenthen your defenses and help keep the little bastards in check.
You will have to go to your physician to get it, since I don't know of any public health clinics that give these shots out.
3. If you smoke, quit. Now.
This should be pretty obvious. Tobacco smoke constantly irritates the lungs and mucus membranes, making them more hospitable to bacterial and viral infections. Tobacco also increases blood pressure, inflames the bronchial tubes, and increases heart rate, all conditions that can hinder body functions (like breathing) and distracts the immune system from fighting an infection.
4. If you're asthmatic, keep your bronchodilator supply at a high level.
Bronchodilators help open up the bronchial tubes, which brings more oxygen into the lungs. This isn't going to be a huge help if your lungs are full of fluid, but it should ease breathing.
5. Gatorade for dummies.
I say "for dummies," because I usually forget how wonderful Gatorade can be when you need to get fluid in you very fast. Keep a supply on hand. If you're losing fluid from both ends of the digestive tract, this might be your best bet to stave off dangerous dehydration. It's not just fluid loss, it's also electrolyte imbalance that's a problem, since electrolytes ensure that cellular activities continue. Water, juice, tea, and broth might not be enough to restore all the fluids you need. Remember, dehydration was a huge problem in the 1918 flu epidemic and was partially responsible for some of the deaths.
6. Your friends, acetaminophen and iboprofen.
This is something I didn't know until I read through Flu Wiki, but in case of high fevers (and fevers can run dangrously high at 104 degrees F), it is perfectly acceptable to take acetaminophen (Tylenol) and iboprofen (Advil) concomitantly. The two agents have different mechanisms of action, but they both fight fevers, bring down swelling, and relieve the usual flu symptoms. It's sort of like getting a two-fer: double the benefit, but not double the potential adverse side effects.
Tamiflu from Roche Laboratories is by prescription only in the U.S. Ask your physician for a prescription and then go and buy it so you'll have it in your medicine cabinet. You have 48 from the onset of flu symptoms to take this drug. Reports are that it is very effective.
8. Get informed. The information is out there, but you have to get it.
If you're interested in the H5N1 flu and how you can protect yourself in the case of a pandamic, here are some places you surf to:
Flu Wiki is such a wealth of information that it'll make you dizzy. And paranoid. However, it offers a fantastic overview of what we know, and what we don't know, about the flu, and especially H5N1.
For some commonsense advice on what to do to prepare for a pandemic, check out Dr. Grattan Woodson's article on Flu Wiki.
The Wikipedia entry on influenza offers an embarassment of links to additional information and is worth the visit.
In the U.S. The Centers for Disease Control has an Avian Flu page that is chock full of information.
For a more international view of H5N1, the World Health Organization page on the avian flu is a damn fine place to start.
Books I highly recommend (especially since I've read them and can say they're very good) if you're looking for a historical perspective:
Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata
The Great Influenza: The Epic Story of the Deadliest Plague in History by John M. Barry.
Stay healthy, everyone.