Dr Jeremy Brown
Text Publishing
Otago Daily Times, March 9th 2019
In 1918, just as the world was emerging from WWI, a second and equally deadly struggle began, this one between Man and one of its oldest foes, influenza. That year Spanish Flu swept the globe, killing between 50 and 100 million people, a death toll higher than any other illness in recorded history. We do not know when or where the next viral pandemic will occur, but occur it will, and Influenza traces the deadly pandemic and subsequent medical, scientific and policy developments to understand how we would cope with such an outbreak today.
The good news is that the prognosis for most flu patients is much better today than a century ago when many people died not from the virus but as a result of medical interventions such as blood-letting the use of mercury-containing enemas and massive overdoses of the new wonder-drug, Aspirin, or from bacterial pneumonia. We now understand that in most otherwise healthy people, influenza is a self-limiting illness that requires no medical intervention; even the use of paracetamol for symptomatic relief is not necessarily advisable since, as people feel better, they tend to get out of bed and thus spread the illness to others. Even more importantly, we have access to antibiotics and technologies such as heart-lung machines for those who do develop life-threatening secondary infections (although, interestingly, the problem of antibiotic resistance is one of the few topics he does not address)
On the other hand, there is a lot we do not know about the 1918 influenza virus. Although we have made considerable progress in understanding its eæteology and even managed to decode and recreate its genome in the lab, we still do not know exactly where it started (not Spain), nor why there was such a high mortality rate among fit, healthy young people. Nor, for that matter, do we have any particularly effective ways to treat the virus itself, and its management poses several challenges to epidemiologists and policymakers. We have no good way to accurately track the trajectory of influenza outbreaks (most diagnoses are based on gut instinct rather than genetic testing), and our ability to identify what strains are likely to predominate in any given flu season is severely limited. Vaccination provides some protection, but because they can only be produced in fertilised eggs and it takes 6 months to prepare enough doses for widespread use, year-on-year efficacy ranges from 10-60% depending on how accurate these predictions are and whether the virus mutates in the intervening period. There is the problem of whether to vaccinate those most at risk or the whole population, a cost-benefit analysis that varies depending on whether you are measuring only morbidity and mortality or other factors such as productivity losses. And then there is the problem of the ‘Boy Who Cried Wolf’ syndrome when risks are overestimated, as the WHO did in 2009. The resulting pandemic planning was not entirely a wasted effort, however. Among other things, it helped Canterbury DHB respond more effectively to the crisis caused by the 2011 quake.
Brown’s aim in writing this book is to restore the 1918 pandemic to collective memory so we can use this knowledge plan for the future. The result is highly accessible, informative and thoroughly researched, with an extensive index and 50 pages of notes and bibliography for those who want to read more widely on the many fascinating topics it covers, from the economics of influenza to the hunt for the original virus. And Brown’s advice for flu victims this coming winter? Bed rest and chicken soup.
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