The Coming Influenza Pandemic (Part I)

Oakland, CA Hospital Ward 1918 (from Wikipedia)

 

 

 

 

As 2012-2013 shapes up to be a particularly bad year for seasonal flu, it is worth remembering that even during a good year, influenza kills an average of more than 30,000 Americans. More disturbingly, every 30-50 years the world sees a particularly deadly pandemic strain that kills hundreds of thousands or even millions of people.

When talking about plagues, pandemics and infectious holocausts, people generally think of modern day plagues, such as AIDS, which had killed 25 million people by 2008,² or ancient ones, like the Black Death, which killed an estimated 75-100 million people over the 50 years between 1348 and 1400.⁹  Many people don’t realize that the deadliest pandemic of all time was the Influenza pandemic of 1918-1919, which killed between 50 and 100 million people in just 2 years.^3(p25) 25 million people may have died in just the first 25 weeks of the pandemic.¹⁰ Over 15 million people died in India. 14% of Fiji and 20% of Western Samoa perished. In Europe, 250,000 British and 400,000 French died. In the U.S., five to six hundred thousand people died. Entire villages in Alaska were wiped out.¹⁰ Overall, morbidity rates were close to 50% and mortality rates ranged from 10 to 20%.^7,10

Because seasonal influenza returns each year and most adults have fairly robust immune responses due to repeated exposures to related influenza strains over their lifetimes, people tend to think of influenza as an unpleasant, but relatively harmless pest. The reality is that even the seasonal flu kills thirty to forty thousand Americans per year,^3(p22) while killing hundreds of thousands worldwide.⁷  Most of those who die are elderly, very young, immune-compromised, poor or malnourished.^3(p22)  However, a deadly strain, such as the 1918 influenza strain, can harm anyone due to its particular virulence and novelty, which leaves much of society lacking in any immunity.⁷

Spanish Flu (From Naval History & Heritage)

The name Spanish Flu is a misnomer, as the outbreak did not start in Spain, nor was Spain the hardest hit. The pandemic came in the midst of World War I. Most European countries, as well as the U.S., were censoring their media. Spain, being a neutral country, was one of the first to accurately report on this deadly new disease.¹⁰ 

Some scientists speculate that the pandemic started in a U.S. military barracks in Boston or Kansas in early 1918, from a mutated influenza virus that originated in China.¹⁰ From there it spread to Brest, France, with U.S. soldiers as the primary vectors. In the early stages of the outbreak, it resembled a typical flu season, with the elderly and sick being the hardest hit. By August, a second, deadlier wave of the virus hit Europe, the U.S. and Sierra Leone. Because the world was entrenched in a bloody war, many of those who were infected either stayed in the trenches, spreading the disease to their comrades and enemies, or were placed on transport trains and sent to field hospitals, where they spread the more virulent form of the disease to civilians.¹⁰

Electron Micrograph of 1918 Flu (from Wikipedia)

 

Influenza generally hits the very young and old the hardest, but it usually kills less than 1% of those who are infected.⁷ The 1918 pandemic was unusual in that it killed 10-20% of those infected, many of whom were young adults and otherwise healthy people. The elderly seemed to have had some degree of immunity. There had been another pandemic in 1889, known as the Russian flu. Many scientists believe that older people may have had some immunity to the 1918 strain through their exposure to this 1889 strain.¹⁰  Everyone else had little or no immunity; hence, the high morbidity rates.^3,10 

So where did this new strain come from? What made it so virulent? Why did pandemic influenza disappear for 29 years and then return in such a deadly and highly transmissible form? Could it happen again?

Image from Wikipedia

Influenza, is an RNA virus in the Orthomyxoviridae family.¹³ The enzymes that replicate RNA, unlike those that copy DNA, tend not to have the ability to proofread and repair mistakes. As a result, RNA viruses mutate rapidly, producing new forms that can evade our immune systems, leaving us vulnerable to infection. ^3(p15),7 Occasionally, these new forms are also particularly virulent, increasing the likelihood of death once we are infected. To make matters worse, influenza can readily swap genes with other influenza viruses. Thus, if a suitable vector, such as a pig, is infected with two different strains, a new strain can develop that is either particularly infectious or particularly virulent, or both, like the 1918 strain. 

 

Influenza A is endemic and usually harmless in birds, but it can cause serious illness in humans.^3,7 It is responsible for the majority of seasonal flu cases.^13(p582) Influenza A mutates rapidly and is readily able to swap genes with other influenza strains.^3,7 Some strains have the ability to infect multiple species. This is particularly dangerous and gives it high potential for creating deadly pandemics.^3,7 

Influenza B is endemic in humans, but rare in other species.⁷ It is usually very mild.¹³ It mutates 2-3 times more slowly than Influenza A.⁷  The combination of low mutation rate and low zoonotic potential makes Influenza B a very unlikely candidate for a deadly pandemic and, therefore, has very low pandemic potential.⁷ 

Influenza C can infect humans and some other mammals.⁷ It is usually mild and generally infects only children, though occasionally it does cause severe illness and epidemics. It is also considered to have low pandemic potential.^7,13

Influenza Morphology (from Wikipedia)

Hemagglutinin (HA) is a glycoprotein in the surface of the influenza virus that causes red blood cells to agglutinate.^3,7,13 It is the molecular key that allows the  influenza virus to enter the host cell. It is also considered an antigen, since it can stimulate the production of antibodies against it. Avian hemagglutinins can usually only infect avian gut cells; whereas human hemagglutinins can usually only unlock human respiratory cells. The species barrier between birds and humans is high (i.e., it is difficult for pure avian flu to mutate directly to a human flu). However, transmission between pigs and birds is relatively easy and the barrier between swine and humans is low. Hence, swine are an ideal mixing pot for mammalian and avian antigens.^{3, p17}

Neuraminidase is an enzyme that aids in cell lysis and the escape of virions from host cells. It is another antigen on the surface of the influenza virus.^3,7,13  Oseltamivir (trade name Tamiflu) is a neuraminidase inhibitor that functions by blocking the escape of new influenza virions from host cells, thus halting the progression and spread of the disease. It is one of the only drugs able to stop H5N1 and H1N1 influenza. ^3(p19),7

Influenza strains are named for the types of surface antigens in their envelopes. H1N1 has hemagglutinin 1 and neuraminidase 1, whereas H5N1 has hemagglutinin 5 and neuraminidase 1. There are 16 known HA antigens and 9 known NA antigens.⁷

^{This ends Part I of "The Coming Influenza Pandemic"}

^{Stay tuned for Part II, coming tomorrow} 

^References:

 

1.      AVERT, 2009, AVERTing AIDS website, October 28, 2009: http://www.avert.org/worldstats.htm

2.      Bartlett, Donald L.,  and James B. Steele, 2004, “The Health of Nations,” New York Times, Oct 24,

3.      Davis, Mike, 2005, The Monster at Our Door, The New Press, New York

4.      Enserink, Martin, 2004, Science, 306, Dec ember 17, 2004

5.      Kash, John C., Tumpey, Terrence M., Proll, Sean C., Carter, Victoria, Perwitasari, Olivia, Thomas, Matthew J., Basler, Christopher F., Palese, Peter, Taubenberger, Jeffery K., García-Sastre, Adolfo, Swayne, David E., and Katze, Michael G., 2006, “Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus,” Nature. October 5; 2006, 443(7111): 578–581.

6.      Soares, Christine, 2009, “Pandemic Payoff,” Scientific American, November, 2009, p19-20

7.      Various Authors, 2009, “Influenza:,” from Wikipedia, accessed November 7, 2009, http://en.wikipedia.org/wiki/Influenza

8.      Various Authors, 2009, “Cytokine Storm,” from Wikipedia, accessed November 7, 2009: http://en.wikipedia.org/wiki/Cytokine_storm

9.      Various Authors, 2009, “Black Death,” from Wikipedia, accessed November 8, 2009: http://en.wikipedia.org/wiki/Black_Death

10.  Various Authors, 2009, “1918 flu pandemic,” from Wikipedia, accessed November 8, 2009: http://en.wikipedia.org/wiki/1918_flu_pandemic

11.  Various Authors, 2009, “Seasonal Influenza: the Disease,” Centers For Disease Control and Prevention website, accessed November 14, 2009: http://www.cdc.gov/flu/about/disease/

12.  Wallace, Amy, 2009, “An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All,” Wired, October 19, 2009: http://www.wired.com/magazine/2009/10/ff_waronscience/

13.  Willey, Joanne M., Sherwood, Linda M., and Woolverton, Christopher J.,  2009, Prescott’s Principles of Microbiology, New York, NY, McGraw Hill

14.  Various Authors, 2009, “Pearl River Delta” from Wikipedia, accessed November 14, 2009: http://en.wikipedia.org/wiki/Pearl_River_Delta

15.  Various Authors, 2009, “Cortisol,” from Wikipedia,  accessed November 16, 2009: http://en.wikipedia.org/wiki/Cortisol

16.  California Newsreel, 2008, “Unnatural Causes,”  video.  Transcript accessed November 16, 2009: http://www.unnaturalcauses.org/assets/uploads/file/UC_Transcript_1.pdf

17.  President’s Council of Advisors on Science and Technology, 2009, “Report to the President on U.S. Preparations for 2009-H1N1 Influenza,” August 7, 2009: http://www.whitehouse.gov/assets/documents/PCAST_H1N1_Report.pdf

Influenza: Vaccinating Kids Could Save Thousands of Infants and Seniors

Adapted from Flick Image by Immer_Lebend

Flu season arrived early this year and is turning out to be a particularly bad one, with several states (including New York) having already declared public health states of emergency. As usual, only a small fraction of Americans have been vaccinated. Yet seasonal influenza continues to be one of the deadliest diseases in the world, killing an average of 35,000 people per year in the U.S. alone, while every 20-40 years, a particularly deadly new pandemic variety of influenza evolves killing far more than this. The 1918 pandemic was the worst, with worldwide mortality estimated at 50 million.

A similar deadly outbreak could happen again at any time and scientists predict that such an outbreak is inevitable. Some believe it could be far worse than in 1918, as it is much easier to travel long distances to spread the disease and there are far more large crowded slums in which germs can easily spread from person to person and far more malnourished individuals with weakened immune systems. There are also more people selling and buying at “wet markets” where highly infectious avian strains of influenza sometime proliferate. Furthermore, there are several deadly avian strains still circulating among wild birds for which we have little or no immunity. Scientists have recently shown that it would only take a few random mutations to make one of these strains (H5N1) easily transmissible between people.

With seasonal flu, the majority of deaths occur among the elderly, infants and immune-compromised (including the malnourished). However, even for the majority of those who get the disease and survive, the consequences are serious, including costly hospital and doctor’s visits, lost income and missed school days. It is estimated that the U.S. loses $10 billion per year due to influenza.

There is no reason why so many people must die from this disease or even be sickened from it. Contrary to the delusions of the anti-vaccination movement, seasonal flu vaccines are generally quite effective, especially when 70-80% of community members are vaccinated, as this leads to “herd” immunity which protects those who have not been vaccinated as well as those who received the vaccine but still did not get immunity. Furthermore, serious side effects from flu vaccines are rare, while mild side effects are generally quite mild (e.g., soreness, headache, fever).

While the oldest and youngest members of our society are the most vulnerable to influenza deaths, school-age children continue to be the most fertile incubators of the virus, spreading the germ at school and day care centers with their peers and then bringing the germ home to share with their families and neighbors. Not only do small children tend to put their fingers in their own (and each other’s) noses, eyes and mouths more often than adults (and wash less frequently), they are also “super-spreaders,” according to a recent piece in Scientific American, since they “shed” more virus particles for longer periods of time than do adults.

Image from Flickr, by MilitaryHealth

 Consequently, the most effective way to protect seniors, as well as the rest of us, is to vaccinate children. According to the Scientific American article, studies indicate that immunizing 20% of children in a community is more effective at protecting seniors than immunizing 90% of the seniors, while immunizing 70% of schoolchildren may protect everyone in the community (including the elderly).

There is actually hard evidence to support this. One of the last deadly flu pandemics occurred in 1957 (there was another deadly one in 1968 that killed 500,000 worldwide). In response, the Japanese launched a mandatory vaccination program for all schoolchildren that lasted for the next ten years (1957-1967). During this time, excess deaths from influenza and complications related to influenza fell by half. Once the program ended, however, vaccination rates declined and death rates increased significantly, Scientific American reports.

Requiring mandatory flu vaccines is not likely to happen in the U.S. (except for health care workers), even though other vaccinations (e.g., measles, mumps, polio) are required before kids can go to school and despite the fact that so many lives could be saved by initiating such a program. Anti-vaccination propaganda and misinformation continue to fuel a hysteria that has resulted in a powerful lobby against vaccinations. Furthermore, flu vaccines must be reconfigured each year, which means that, unlike polio and measles vaccines, one must receive a new flu inoculation each year. Lastly, only a couple of companies are currently producing flu vaccines in the U.S. and few are willing to start because of fears of liability and low profitability (they must produce the vaccine well in advance of flu season based on scientific predictions and models and then hope that enough consumers will later purchase the vaccine).

Nevertheless, sufficiently high immunization rates can be obtained through voluntary community programs centered on schools, particularly with an effective outreach program. Some schools already offer FluMist nasal spray free of charge to students. In one district in Florida, vaccination rates have reached 65% as a result of their free immunization program, while the incidence of influenza over the last two years has been reduced to nearly zero. The consequences for kids are far fewer absences and more time in school learning. For the rest of us, it means fewer days lying in bed with fevers and chills, and fewer hospital visits and deaths for our infants and grandparents.

Today in Labor History—January 21

January 21, 1967 – Workers and peasants clashed with Red Guards in Kiangsi, Chins. (From the Daily Bleed)

January 21, 1974 – A four-day postal strike began at Jersey City, N.J. (From the Daily Bleed)

January 21, 1999 – Striking miners used stones and clubs to force their way through riot police in Bucharest Romania. (From the Daily Bleed)

Today in Labor History—January 20

January 20, 1872 – Filipino soldiers and workers staged a bloody revolt against Spanish rule. (From the Daily Bleed)

January 20, 1920 – American Civil Liberties Union was founded. (From the Daily Bleed)

January 20, 1934 – Nazis abolished collective bargaining and union elections. (From the Daily Bleed)

January 20, 1946 – 750,000 US steel workers struck as part of a post war strike wave that encompassed well over a million workers. (From the Daily Bleed. See also, Modern School Labor History Timeline, Daily Kos, New York Times, Marxists.org)

January 20, 1986 - Bruce Springsteen's "My Hometown" topped the music charts on this date in 1986. The song, a eulogy for dying industrial cities, includes the lines: "Now Main Street's whitewashed windows and vacant stores / Seems like there ain't nobody wants to come down here no more / They're closing down the textile mill across the railroad tracks / Foreman says these jobs are going boys and they ain't coming back to your hometown / Your hometown / Your hometown / Your hometown . . ." (From Workday Minnesota)

Today in Labor History—January 19

Joe Hill

January 19, 1812 – Luddites torched Oatlands Mill in Yorkshire, England. (From the Daily Bleed)

January 19, 1915—Joe Hill was arrested on this date in Salt Lake City and later convicted on trumped up murder charges. He was executed 21 months later despite worldwide protests and two attempts to intervene by President Woodrow Wilson. In a letter to Bill Haywood shortly before his death he penned the famous words, "Don't mourn - organize!" (From Lutins.org, Wikipedia, Joe Hill Project)

January 19, 1915 – 20 rioting striking workers were shot by factory guards at Roosevelt, New Jersey. (From the Daily Bleed)

January 19, 1932 – An armed miners' uprising occurred in Barcelona region as part of the general anarchist uprisings in Catalonia. "Libertarian communism" was declared, including the abolition of money and property, followed by general strikes and armed uprisings throughout Spain for the next five days.

Teacher Fired For Being Poor Role Model

Madonna in Sorrow or The Perfect Teacher?

In another stunning defeat for free speech and privacy, the California Commission on Professional Competence (CPC) has upheld the dismissal of Stacie Halas, finding her “unfit” to teach 8^th-grade science because she had acted in pornographic films in the past, the Los Angeles Times recently reported. (An East Coast appellate court just ruled that a school could fire a teacher for a Facebook posting)

The CPC argued that her pornographic past prevented her from being a good role model in the present. Even though she made the films from 2005-2006, before she was employed as a teacher, “the continued availability of the films will hamper her ability to be an effective teacher,” according to Judge Julie Cabos-Owen. The commission also took offense at her “dishonesty” and her failure to convince them of her “redemption.”

This ruling (along with the recent ruling against Jennifer O’Brian, for her Facebook posting) is chilling to all teachers and anyone who hopes to enter the teaching profession. While there is a broad public consensus that teachers should be good role models for their students, there is no consensus about what this actually means. A teacher can be accused of being a poor role model for any number of protected actions, including having tattoos, being an atheist, belonging to the wrong political organization, or for questioning the authority of her principal, superintendent or Arne Duncan. Any of these could become a distraction in the classroom (if the teacher lacks the skill or experience to prevent it), but none of them (including a past experience in pornography) necessarily prevents a teacher from doing a good job.

Another disturbing aspect to her firing is that it was in response to a past behavior that occurred well before she entered the teaching profession, that had no direct relevance to her ability to teach, and that she shows no sign of doing again. Considering how easy it now is to dredge up a person’s history on the internet, one can imagine all sorts of other “distracting” past behaviors that could ruin a teacher’s career (e.g., high school or college photos of drunkenness or nudity, arrests for civil disobedience, addiction).

Madonna? 

The ruling is indicative of the Madonna/whore schizophrenia society has around teaching. Despite the fact that teachers can now stay on the job when pregnant and usually even when gay or living in sin, they are still expected to live lives of moral perfection, even when outside of school and in the privacy of their own homes. They should not drink or do drugs, perform in or watch pornography, fight, swear, scream or get angry. In short, teachers are not permitted the luxury of being human.

Or Whore? 

The ruling is moralistic—a product of adults’ discomfort with sexuality, not Halas’ competence in the classroom. It should be remembered that her students are not old enough to legally access her videos and are unlikely to actually see their teacher nude (though their parent might be scouring the internet this very moment). It is precisely people’s moralism that has made it a distraction by turning an insignificant part of her past into a maelstrom and portraying her behavior as something terribly shameful.

Even her lawyer has been complicit in this moralism, portraying her as a person who made a mistake (i.e., choosing a lucrative but despicable job) out of financial desperation, but who then went on to do something glorious (i.e.,  become a teacher). According to her attorney, had her district allowed her back on the job, the message to children would have been that one can make a mistake and redeem herself; whereas the ruling against her sends the message that you better not make any mistakes.

However, it is inaccurate to call her past behavior a mistake. She made a rational choice to act in pornographic films. It happened to be one of the quickest ways to help her family out of their financial mess. It is perfectly legal, pays really well, and theoretically harms nobody. Calling it a mistake implies that porn acting is deplorable or unacceptable and that it is preferable to accept low paid, tedious and backbreaking work instead. The message to children (and to teachers) is that one’s material security and wellbeing are subordinate to the need to shelter children from all turpitude, both real and imaginary.

The dishonesty charges stem primarily from her failure to come clean before being hired. Yet had she included her acting career on the job application it is virtually guaranteed that she would never have been hired in the first place, even with a valiant public appeal for redemption. Thus, she was faced with a choice of never becoming a teacher (something she apparently felt was more desirable than porn acting) or being deceitful. Ironically, had she been a prostitute, which is illegal, they likely never would have found out and she would still be teaching today.