Re: What to look for in August....
The discussion is about what to look for in the coming months regarding H1N1 (aka Swine Flu). The following are notes taken from The Great Influenza by John M. Barry that dealt with the Spanish Flu of 1918 (page number is cited for the material from the book). The heading of the paragraph has been added.
LIKE A/H1N1 2009, THE SPANISH FLU STARTED OFF MILD IN THE SPRING
p. 170 The first unusual outbreaks in Europe occurred in Brest in early April, where American troops disembarked?.Still, although many got sick, these outbreaks were, like those in the United States, generally mild??the complications were few and nearly all troops recovered.
SOME EARLY WORRISOME CASES FROM THE SPANISH FLU (ditto for H1N1)
p.173 as influenza surged across Europe?they (researchers) had heard of some worrisome exceptions, some hints that perhaps this disease wasn?t always so benign after all?.One army report noted?.a rapidly escalating infection and lungs choked with blood ??fatal in from 24 to 48 hours.? Such a quick death from pneumonia is extraordinary.
THE SPANISH FLU ATTACHED THE YOUNG (ditto for H1N1)
p. 173 And in Louisville, Kentucky, a disturbing anomaly appeared in the influenza statistics. There deaths were not so few, and ? more surprisingly ? 40% of those who died were aged 20 to 35, a statistically extraordinary occurrence.
p. 173 In France in late May, at one small station of 1,018 French army recruits, 688 men were ill enough to be hospitalized and 49 died. When 5 percent of an entire population ? especially healthy young adults ? dies in a few weeks, that is frightening.
PNEUMONIA ACCOMPANIED THE SPANISH FLU (ditto for H1N1)
p. 174 Medical Service of the American Expeditionary Force in France ??Many cases have been mistaken for meningitis?Pneumonias have been more common sequelae in July than in April(1918) ?
RESISTANCE FROM EXPOSURE
p. 176 Many victims of the first wave demonstrated significant resistance to the second wave, which provides strong evidence that the deadly virus was a variant of the mild one.
PASSAGE THROUGH SUCCESSIVE HOSTS MAY INCREASE VIRULENCE (or why we should not let our guard down)
(Note: The following is why we all should have been concerned about limiting the spread of the current H1N1 regardless of whether it was mild or not)
p.177 ?Passage??.reflects an organism?s ability to adapt to its environment. When an organism of weak pathogenicity passes from living animal to living animal, it reproduces more proficiently, growing and spreading more efficiently. This often increases virulence. In other words, it becomes a better and more efficient killer.
If a pathogen kills too efficiently, it will run out of hosts and destroy itself..
p. 178 When the 1918 virus jumped from animals to people and began to spread, it may have suffered a shock of its own as it adapted to a new species. Although it always retained hints of virulence, this shock may well have weakened it, making it relatively mild; then, as it became better and better at infecting its new host, it turned lethal.
QUARANTINE DOES HELP!!!!!!!!!
p. 178-179 On June 30, 1918, the British freighter City of Exeter docked at Philadelphia. Dozens of crewmembers were ?in desperate condition??they seemed to die of pneumonia, but it was a pneumonia accompanied?by strange symptoms, including bleeding from the nose. ?.The brief quarantine had held the ship long enough that the crew members were no longer contagious when the ship docked. This particular virulent virus, finding no fresh fuel, had burned itself out. The city had dodged a bullet.
THE SPANISH FLU WORSENED DURING THE SUMMER OF 1918
p. 179 Even while medical journals were commenting on the mild nature of the disease, all over the world hints of a malevolent outbreak were appearing. In London the week of July 8 (1918), 287 people died of influenzal pneumonia, and 126 died in Birmingham.
SPANISH FLU TURNED VIRULENT SLOWLY
p. 180 Many histories of the pandemic portray the eruption of deadly disease?.as sudden and simultaneous?..In fact the second wave developed gradually.
SPANISH FLU SHOWED SIGNIFICANT INCREASES FROM AUGUST 1918
p. 181 Epidemiological studies?..noted ??a progressive increase in cases reported as influenza beginning with the week ending August 4, 1918 and of the influenzal pneumonia cases beginning with the week ending August 18.
VIRULENT SPANISH FLU VICTIMS HAD DARK SPOTS & TURNED BLUE
p. 180 Lack of oxygen was sometimes so severe that victims were becoming cyanotic ? part or all of their bodies were turning blue, occasionally a very dark blue.
p. 187 ..one of the army physicians?.wrote ?These men start with what appears to be an ordinary attack of?.Influenza?..they very rapidly develop the most vicious type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you will begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white.? P. 188 ?It is only a matter of a few hours then until death comes?It is horrible?
p. 187 In 1918 cyanosis was so extreme, turning some victims so dark ? the entire body would take on color resembling that of the veins on one?s wrists
VIRULENT SPANISH FLU VICTIMS COUGHED UP BLOOD OR BLED FROM OTHER PLACES (i.e. nose, ears)
p. 189 ?hundreds of young stalwart men in the uniform of their country?..The faces wear a bluish cast; a distressing cough brings up the blood-stained sputum.? Blood was everywhere?.pouring out of some men?s nostrils and even ears while others coughed it up. Many of the soldiers, boys in their teens, men in their twenties ? healthy, normally ruddy men ? were turning blue. Their color would prove a deadly indicator.
p. 226-227 Isaac Starr?thought at first his patients had ?what appeared to be a minor illness?with fever but little else. Unhappily the clinical features of many soon changed.? Most striking again was the cyanosis, his patients sometimes turning almost black. ?After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth.? Nearly one-quarter of all the patients in his hospital died each day.
VIRULENT SPANISH FLU KILLED THE YOUNG
p. 222 (October 1918, Philadelphia) ?nearly two-thirds of the dead were under forty?A lot of young people, just married, they were the first to die.
VIRULENT SPANISH FLU KILLED TWO PEOPLE IN A FAMILY
p. 224 Routinely two people in a single family would die.
MOST PEOPLE RECOVERED FROM THE SPANISH FLU IN TEN DAYS
p.231 Influenza ?.is transmitted so effectively that it exhausts the supply of susceptible hosts?.in many cities more than half of all families had at least one victim ill with influenza; in San Antonio the virus made more than half the entire population ill?The overwhelming majority of victims got well?.Victims had an extremely unpleasant several days (the unpleasantness multiplied by terror that they would develop serious complications) and then recovered within ten days?.But in a minority of cases, and not just in a tiny minority, the virus manifested itself in an influenza that did not follow normal patterns?.
SPANISH FLU KILLED MOST IN ISOLATED, ?GERM VIRGINAL? AREAS
p. 232 Generally in the Western world, the virus demonstrated extreme virulence or led to pneumonia in from 10 to 20 percent of all cases?.In other parts of the world, chiefly in isolated areas where people had rarely been exposed to influenza viruses ? in Eskimo settlements of Alaska, in jungle villages of Africa, in islands of the Pacific ? the virus demonstrated extreme virulence in far more than 20 percent of cases.
(will add more when time permits)
