Friday, May 01, 2009

1918 Spanish Flu Pandemic: The First Wave Was Mild

Here's a video from TED I enjoyed. I don't know how interesting it would be to people outside of public health, and it's a few years old, but I'm posting it because I think it's relevant right now.

It's a talk by Laurie Garrett, from the Council on Foreign Relations, from 2007. She discusses lessons learned from the 1918 Spanish flu (that also derived from birds) and how that knowledge can help formulate plans for the possible H5N1 bird flu pandemic. (I'll put her bio in footnotes.1)

A few things I learned from this video:
  • Curiously, 100% of pregnant women who were infected with the 1918 Spanish flu died. They don't know why.
  • There were two (or three?) waves of the Spanish flu. The first wave was considered "mild"...
    "The 1918 Spanish flu virus went around the world in a mild enough form that the British army, in World War I, actually certified that it was not a threat and it would not affect the outcome of the war. After circulating around the world again it came back in a form that was tremendously lethal."
  • Re: Tamiflu - Only about 20% of what we takes gets used by the body. The rest gets excreted, enters the environment, is taken up by waterfowl, and encourages the virus to mutate to a strain that is resistant to, you guessed it - Tamiflu:
    "When a human being ingests Tamiflu only 20% is metabolized appropriately to be an active compound in the human being, the rest turns into a stable compound which survives filtration into the water systems thereby exposing the very aquatic birds that would carry flu and providing them a chance to breed resistant strains. We now have seen Tamiflu resistant strain in Vietnam."
    Also, regarding Tamiflu, no nation had enough stockpiled (in 2007) to cover their populations for more than a few weeks, and the virus is likely to remain present, in some form, for 18 to 24 months. (Do we really want to be taking Tamiflu every day for 2 years?)
This is why it's vital that the CDC monitor the health of people who handle livestock. Prevention is going to be key. The words, "it's too late to contain it," is a death knell.
1 "Garrett is the author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance and Betrayal of Trust: The Collapse of Global Public Health. As a science writer for Newsday, Garrett won a Pulitzer, a Peabody and two Polk awards; in 2004, she joined the Council on Foreign Relations as Senior Fellow for Global Health. She is an expert on public health -- and the fascinating ways that health policy affects foreign policy and national security."


Laura in Arizona said...

Thank you so much for the post. I learned a lot from the video and it is very appropriate right now. I do not think the Swine flu virus we are dealing with today is in the same ball park as the bird flu, but I look at how things are being handled today as a real life dry run for the real thing (and so far I am not impressed).

Interesting to note she (Laurie Garrett) speaks about Lipitor being helpful. We know that Lipitor in some way increases vitamin D and I wonder if the protective factor is in fact because of the this. There is a lot of buzz about vitamin D and influenza right now. Interesting to contemplate.

Just found your blog and am very interested in many of the things you post. Thanks!

Bix said...

Wasn't it great?

I think the US is, figuratively, building walls around itself in an attempt to keep these things out. But we have a global economy now, not a local one, and what happens in Mexico, China, Southeast Asia, (and here), the methods they (and we) use to produce food, affects everyone (and the planet).

There's probably a lot more to know about vitamin D, rather hormone D. As a hormone, it's powerful. But as we've seen with hormone replacement therapy in menopausal women, supplementing may carry risks.

Laura in Arizona said...

Because of air travel around the world these days, closing borders and such is not going to help keep it out. As we have seen, by the time we know there is a problem it is already here. You are right that we need to start looking at the world in a different way because what happens in some far away place will be on our doorstep the next day.

My take away message from the video was as citizens we are going to be pretty much on our own. A vaccine is going to be 6 or 8 months away after an outbreak. Tamiflu and other antivirals have limited shelf life and by then the bugs may be resistant to it anyway. Plus you can't take it long enough to protect yourself for the duration of an outbreak.

For myself, my focus has always been keeping myself healthy and my immune system in peak performance. This will become increasingly important not only with viral outbreaks but with the increase in antibiotic resistant bacteria as well.

To that end, I have been increasingly interested in the D connection. As you rightly point out "hormone" not "vitamin". While there is lots to learn I am supplementing myself to bring my levels up. When my body can make 20,000 units in 20 minutes of sun exposure I really think we need to seriously consider that as a species we need way more than most of us have been getting. But as you said, supplementing may carry risks that are unknown at this time. I don't habitually jump on too many band wagons but what I've researched thus far, this is one I am.

EldoubleVee said...

I’ve heard a lot of ranting about how they should close the border to prevent the spread of H1N1, but the spread of the disease into the US comes from US citizens who returned after visiting Mexico. I wonder how people would feel if they did close the border, not allow anyone in or out, actually not allow US citizens in Mexico back into the country. Obviously they would be vectors for the disease and shouldn’t be allowed back and so they would be stuck in Mexico. Taking this further maybe we shouldn’t allow any travelers back into the country once the flu is discovered, i.e. vacationing US citizens wouldn’t be allowed to reenter the country. After all the flu does not discriminate between ethnicities, or was the whole close the borders scenario based on racial profiling?

Bix said...

ElDoubleVee, good point. Right after I read your comment I saw this cartoon:
The Swine/Avian Contagion