We Heard the Bells: The Influenza of 1918

in nineteen and eighteen I lived in Sequoia County in 1918 my family living in South Philadelphia in 1918 we were living in El Paso Texas I born and raised in Baltimore in bustling cities and remote villages in the United States and around the world orphaned children cried for their parents in 1918 people of all cultures struggled with the same terrible threat and within a matter of months as many as 50 million would be dead in the United States the death toll reached six hundred seventy five thousand five times the number of US soldiers killed in World War one what was that deadly threat there were so many many people that I have died we had just come from a few years before from Mexico where we were living on account of the Revolution the Mexican Revolution I was about 10 years old I was the oldest and my four brothers and sisters I was a family only my dad and my sister my certain poorer sister did not get it my two brothers were in one room sick I was sick in the other bedroom with my mother my poor dad and sister had to be our attendants and Steve what they could do for us influence I gave you such high fever mother told me that I thought her black hair was a cat and I was afraid of it with the Delirium from the high fever people who were left very weak with it will in the conative high fever and all schools at all public places and every place was close I guess nearly 2 or 3 weeks I was eight years old we lived near my dad's mother and she and her daughter and two grandchildren we're living close to us and when they got the flu and got sick my parents we just moved in with them to where my mother could nurse them older patients and take care of them at that time my mother was 25 years old and she had three children and she was expecting another baby in May and this was in February and she taken care of eight patients at one time very sick patients with the flu with no convenience no modern facilities whatsoever and mother had to get the wood to keep heat in the house to keep all those cars going plus do the nursing care with eight patients my father's name is tell us for Reina but he always went by tellus good morning good morning was his Indian name at that time he was working in Tennessee for a DuPont company every time anybody was sick he would always bring up the story about how he got sick while he was in Tennessee and how a lot of people from the village that had gone were brought back sick they were brought back in a train he said some of them had passed away in Tennessee in 1918 my mother was like just 11 years old but she's she remembers the lift on the south side of the village she remembers that church bell would ring every day that there's a certain Bell for a notice for the death and she said she remembers as a little girl how awful it sounded in 1918 as now most people didn't think of influenza as a disease that could lead to death we suffer through the flu season every winter in the u.s. the flu season usually Peaks between January and the end of March the symptoms of a cola usually a runny nose sometimes low-grade fever and just feeling a little wiped out influenza on the other hand is much much more pronounced than that people will generally have a high-grade fever absolutely no energy whatsoever muscle aches headaches a fairly dry cough with a common cold you may feel bad for a couple of days but after four to five days you're starting to feel yourself again with influenza it's sometimes two weeks or more of really severe can go on to cause a pneumonia complications from the flu caused an average of more than 200,000 hospitalizations every year in the US and an average 36,000 people die from those complications during seasonal influenza epidemics in the United States there are certain groups that are higher risk for complications young children in particular those less than two years of age elderly people particularly people 65 years and older persons of any age who may have certain underlying chronic conditions for example asthma chronic lung disease chronic cardiovascular disease and in addition pregnant women are at higher risk for complications from seasonal influenza while seasonal influenza is a serious health threat for people at risk of complications the outbreak of influenza that swept the nation in 1918 and early 1919 killed over half a million people in the US when the population was only a third of what it is today I was four years old at that time I was leaving at that through Hill Ranch in members Haywood New Mexico my mother was the Midwife and she tended to the people delivery of babies and all that kind of things that she used to take me with her to go and visit the new mothers and I'd love to go see the new babies and I cried because at that time she didn't want to take me with her because she was tending to the sick and the die but the miracle about it is a Chilean get it and according to her none of us at home got it either she would tell me about how people would die sometimes two in the same bed and they had no funeral services or anything like that they we just carried them off to bury them it was very hard for them to keep up burying the dead because they were dying so fast but one thing that stayed in my mind because I used to hear it even later was the founding of the nailing up boards together making I call them boxes coffins for the people whether people called it influenza the grip or the Spanish flu it was clear this was not the flu that comes every winter today we know that influenza is caused by a virus the influenza virus we know that the virus spreads from one person to another through droplets when people coffin sneeze or through contact with the virus on someone's hand or a contaminated surface in 1918 no one knew what caused it where it started or how to stop it they were scared because it happened so rapidly they didn't know what was going on what was happening why there were few communities in the u.s. so small or isolated that they were sheltered from the waves of deadly disease that swept around the world the influenza of 1918 even touched remote Inuit villages in Alaska sometimes killing every man woman and child or killing the adults and leaving the children with no one to care for them the 1918 influenza struck some native peoples in the southwest very hard to I don't think the doctor resided here but he came from Albuquerque a lot of our people older people didn't speak the English language so my dad would interpret for him what he was asking him to do how to take care of themselves they would work from from early morning till late night trying to visit every home in the Pueblo in the morning when they got to some of the homes they would find out maybe two or three people in the family that had passed away during the night every day they were buried people the church bell would be tolling from morning to evening because of so many deaths the Bureau of Indian Affairs sent dr. da Richardson to investigate the situation in the pueblos near Albuquerque New Mexico he wrote the strength of the pueblos was not taken with the aged or markedly with the infants but from the young adult life of the tribe and this was true around the world with the influenza that hits us every fall in winter most healthy adults are sick for a week or two and recover when people die of the flu it's almost always the very young and the very old but the influenza of 1918 was not only much more lethal than seasonal flu the death rate was very high among young adults strong young men and women working to support and care for their families my parents came to this country from Romania best arabiya in 1918 my family was living in South Philadelphia I think it was the neighborhood mostly of immigrants it was a hard life it was a rough life my mother and father and my two sisters all had the flu it was a very sad period there was like a sadness over the city when you looked out your so hardly anybody walking around people stayed in their houses because they were afraid and they said that it seems that if it killed you it did it fast because they Rim I remember them telling me that a young neighbor they saw him coming home they watched from the window he coming from work and the next afternoon they saw him carried out he died of all the cities in the u.s. Philadelphia had one of the highest rates of sickness and death and the most disruption the city resisted putting measures in place that might have limited the spread of the flu measures such as prohibiting public gatherings where the flu could spread easily the city allowed a large parade to take place to raise money for the troops fighting World War one although the marchers and crowd wore gauze masks many people caught the flu from those who were already infected Baltimore fared almost as badly as Philadelphia soldiers at Camp Meade south of the city became sick in mid-september and by early October there were 2,000 cases in Baltimore officials hesitated to close schools and other meeting places which would have reduced contact between the sick and the well hospitals and funeral homes were overwhelmed and the workers who kept the city and its businesses running were too sick to get out of bed Beth of Steel went around and got all these men from down south to operate the Mills and there was just thousands of men coming off from the mills my father worked for the path of Steel company's bakery the only black Baker they ever had was my father Henry Lindsay the people were very kind to one another and there was a place where everybody looked after one another and the Bears nobody lived in there but the men who worked for the Bethlehem Steel so on and there died and men who were around him didn't know they were dead come home and Adam and Ed don't know how long had been dead cuz they went to work who leave him there in the morning come back he's dead and even my mother was sick him everything and they quarantine we didn't visit nobody and nobody visited us except this lady this mrs. Kizzy Thornton she went round helping everybody who was sick and I declare that lady never got sick of anything back in 1918 I was a between 10 and 12 years old lava sea and I got the flu and it was just my mother and I were two of our friends we went to elementary school together and for them was stricken with the flu and I would go out to then Bayview hospital to go visit her and they put her out on a porch in the cold winter time and they had blankets blankets a hood on but she died both of them died at a young age people didn't understand and there was no vaccine but your parents did the best they could for you the influenza of 1918 1919 was a pandemic an outbreak of disease around the world which caused serious illness and death why was the influenza of 1918 so much more deadly than the seasonal flu we experienced every winter what was different about the influenza virus in 1918 the seasonal influenza viruses that cause annual outbreaks epidemics in the United States during our fall winter and early spring those are influenza viruses that are circulating among people worldwide and they are evolving they're changing just a little bit but they're human viruses and so some percentage of the u.s. population and the world's population gets infected every year some become ill some percent recover from a self-limited illness and all these people who survive will have some immunity other people get vaccinated and we receive some immunity through that vaccine so there are two ways to acquire immune protection one is through natural infection in which you recover you survive then you have immunity the other is through vaccination and vaccination stimulates our body's immune system to produce antibodies against the specific virus strains that are in the vaccine an influenza pandemic is different an influenza pandemic is the emergence of a very new influenza A virus to which most of the population has not previously been exposed and does not have any immunity no immune protection and so what you see is very high numbers very high percentage of people becoming sick worldwide in the last 100 years new influenza viruses have caused four pandemics in 1918 1957 1968 and 2009 ultimately they come from birds wild waterfowl ducks and geese and various other birds they can get into domestic poultry chickens they can also as we know get into human beings directly pigs various aquatic mammals it can get into horses they can get into dogs and cats so they can take any of these paths and in theory they could end up getting into people by either coming directly from a bird or going through a circuitous route in another animal by a variety of mutations that occur for a number of reasons these types of viruses can under certain circumstances adapt themselves to other species and then as they propagate themselves in these other species they adapt themselves better to spread from pig to pagal from bird to bird open person to person and the host we worry about the most obviously from a human health standpoint is the human species one of my dad's sisters lived pretty close to us and she had a family of four children and her husband and she was expecting and she taken the flu and of course she passed away just she she was very sick she passed away the ladies are taking a flu they were pregnant oh we ever know died and my mother didn't get it we don't know why pregnant women died of influenza at a high rate but it's been documented for well over 500 years one of the biggest risk factors for a fatal outcome from influenza is pregnancy whatever the reason it's pretty clear that pregnant women in 1918 were very high-risk pregnant women of course are going to be in the younger age ranges but non pregnant women and men in that age range were also at much higher risk of dying why this happened we don't know in any flu pandemic people die from pneumonia some percentage will always die but it tends to be the older folks people who have chronic conditions like heart disease and lung disease pregnant women infants and so on this time in 1918 something very different happened otherwise healthy young adults died at a very high rate and constituted a fairly large percentage of the total deaths something that's never been seen before why that happened is a mystery Brevig mission is north west of Nome Alaska on the Bering Sea the fact that brevity exists today is remarkable sense of the 80 residents in 1918 only five adults and three children survived the flu pandemic over 50 years ago a young man with an interest in viruses found his way to the village I was a medical student in in Sweden and I decided to travel to the United States and get a masters degree in biology and then one thing led to the next that are the next and I decided that to go for my PhD and one day we had a visitor very prominent very viral oddest and I remember he's talking about everything that had been done to find out what was it - cause the 1918 flu an energy like a 15-second comment at the end of his talk he said somebody ought to go to the northern part of the world and try to find a victim of the 1918 Spanish flu pandemic buried in the permafrost and that victim she is likely to have been remained frozen from for since 1918 at that time it was something of 35 years or 40 years and try to recover the virus and then is if he went to something else and that's 15 seconds I happened to be that her here at horrid immediately went to my faculty advisor to ask him could I be a subject for my PhD study oh yeah won't you go ahead I happen to have work during the summer in 1949 for a paleontologist in Alaska the paleontologist Otto Geist had worked on the Brevik Peninsula and knew the missionaries in the villages there with Geist's help Hulton was able to review copies of records from the fall of 1918 he found that the military had very good records showing the location and thickness of the permafrost in Alaska on the basis of that I came with decided on on three three villages I showed up in June and I went to the first village is called Norma's brother Lord city actually Nome I went into the mass grave is a cemetery and discovered that the river that normally had flowed on the side of the village at some distance away it had changed course his 1989 had come into the village and melted this permafrost I could you see it and then I engaged a bush pilot to fly me to an other village called Wales it appearing straight I found him where the mass grave was clearly marked with a large cross and a bluff had fallen on through the beach and almost excavator invaded the mass grave so I figured there is no permafrost here so the bush pilot flew me to what today's is braving but there was no way to lambda I had to land on the beach at some distance away in another village and then I had to cross some water with the whaleboat got across this really sizable water and in a head of walk but six miles in soggy Tundra is just begin to melt and in Srilanka braving they had a village council the Council of the elders and it's a matriarchal society so the eldest woman of the largest family makes decisions or order heavily influences decisions and little did I know that that was going to be very important later on fortunately for me there were three survivors of the 1918 pandemic still alive so I asked them to please tell the other members here to come what it was like that November we where 90% of the village died then I said I if if you allow me to enter the grave and if I'm fortunate enough to come find the right specimen I will take it back just passing them back to my laboratory and if everything works out well it would be possible for us to develop a vaccine so in the next pandemic coming threatening you we will have a vaccine to immunize you protect you they understood what vaccine was because they had been immunized against smallpox the matriarch Olivier Geneva lana was in favor of that so Baron influenced the decision till they allowed me to to open the grave so I went out on the grave site and started today and imported foot down I came onto permafrost very hard enough rose the ground I started a fire got driftwood from the beach had climbed up on the bluff and they ever the masquerade has started to melt the permafrost and on the end of the second day I came down about four feet and there I found the first victim young child a girl an estimated 12 years aged but the condition of her body at four feet from the survey was so good that I was confident that Don deeper they will be even be better better preservative and adults the song 72 bodies in that grave now I didn't come alone to Alaska I had my faculty advisor influence of I Rolla gist I had a pathologist one of the professors in the department in Iowa to perform the post-mortem examinations and then Otto Geist so there were four I was out there ahead of them to scout the grade to scout the testing the day later they came to the same Beach where they had landed earlier and we traveled the same way back to two brave e now over four of his diggings if he could do it very rapidly about three days later we were down six feet and then we found a three perfectly preserved bodies and a pathologist he performed with postmoderns on them and the longest were four perfectly preserved then we'd be left Thank You villages close to grave and I took some pictures across all that all the time so until he got to eat while I was with ease and I started to try to grow the virus trying to find an alive influence of ours we kept the week after week after week I got more and more discouraged and eventually I had no more specimen and the virus was dead and there went my PhD I could see it fly out through the window in the in the non air-conditioned office by the way lab I had I decided to go back to Sweden to continue my medical education and I was exceeding extremely fortunate or they always offer to continue medical school at Iowa then I got my MD there become a pathologist but back in my mind I had just memory or not getting my PhD all the effort we do to that if it was just counter collapsed molecular pathology is a specialty of Medicine where pathologists use the tools of molecular biology and molecular genetics to make diagnoses and provide insight into patient care decisions you can make diagnoses of infectious diseases by looking for the genetic material of the infectious organism the virus or the bacteria for example I was in the National Cancer Institute as a pathologist in the 80s and in 1993 I moved to the Armed Forces Institute of Pathology to set up a new group devoted to molecular pathology both for clinical molecular pathology as well as research and one of the things we had to do for both sides of that is to work out ways to recover genetic material from typical biopsy material the tissue repository the FIP goes back to the Civil War so they have a huge collection of millions of tissue samples reflecting all aspects of clinical disease tumors and infectious disease including autopsies of soldiers who died of flu in 1918 I wanted to think of a project that would highlight the utility of having such an old tissue archive as well as our new molecular techniques in which we could do analyses and the way those two things came together in my mind was to go after the 1918 flu we thought that it might be possible to recover fragments of the genetic material of the virus still preserved in autopsy tissues of people who died in 1918 when we started the project there were really two fundamental questions that we wanted to answer that is one why was this virus so particularly virulent why did it kill so many people especially young healthy adults and secondly where did this virus come from we're hoping to learn from what we see in 1918 to apply it to the future that we could understand how pandemics form and why particular flu virus has caused more disease than others these tissues were extremely old and it was not clear that we could actually recover any genetic material at all from these samples we had to work out techniques and continue to refine the techniques to extract nucleic acids DNA and RNA from these samples we had started this project in 1995 and it took over a year to find it for positive case to work out our techniques to make sure that we actually could find influenza once we had found the first positive case and we started to generate sequence and compare it to known influenza virus as we were convinced that we had really found the 1918 virus but we were really concerned that there would be inadequate amounts of material available to us to sequence the whole virus from that material in March of 1997 in science news there it was 1918 pandemic virus found if small sequence had been discovered by jeffery taubenberger i wrote a letter saying if you need more specimens let me know and I will go back to Alaska I've been there before I know where it is I can go back and I I didn't hear anything I didn't hear anything and I thought well he knows it thinks I'm a nut and it was desert bad he happened to be on vacation sadena carries mail we were extremely excited about the possibility we we had hoped that if we could recover material from a frozen victim that the quality of genetic material of the virus might be improved over what we had in these formalin-fixed blocks and he called me here so I asked when can you go I said I can't go this week but I can't go next week and I call up to braving know this time when I come the second visit on in 1990 1997 it so happened it was in August that's it much better time to dig in the permafrost what is he the missionary it's another another one now Pastor Brian Crockett is is his name he's still there and he knew of the excavation that I had carried out in 1951 and he also knew that I had to get a permission to do it again so he said it was very difficult as you may not be able to to get a permission this time but I will I will introduce you to Rita olanna me she was a matriarch at it 1997 when little did I know that her grandmother was it Janie Oh Lara that was it it would never have happy now otherwise everything doesn't go wrong all the time it just looks like that but it did it is crucial dr. Halton presented his case to the Brevik village council including Rita olanna he made sure they understood that the virus was dead and could not cause disease I also told them how important it is because your participation this is where it begins and you're part of the team now the delicious of braving and I'm specimen collected and then dr. taubenberger in the end all Forces Institute of Pathology these are the three but it begins with you and I got the permission to go I figure no one wants to go in a grave with David bodies so I'm all set do it myself and so one of the members said would you like to have some help for young man Eskimos assigned by the village council assigned to help me because I photograph with me I knew where the where the gray was so marked it off at the end of the first day we were down to about four feet and I didn't see anything at all and five feet and the following day that noticed there is some bodies at seven feet fall asleep a skeleton and then next to the skeleton was a a woman and perfectly preserved with clothing had fallen off rotted away but I can see the skin and it was over the base woman I got it to do the postmortem and then took the ribcage off and there expose their lungs and they were the textbook pictural a person who had died from acute viral pneumonitis exactly what I needed the subcutaneous fatty layer elusive and fat the inside the inside of course also that had protected their lungs from the occasional thaws of the permafrost that had reached seven feet down the Eskimos are not obese there's not that much food around and they were active in hard work in particularly 1918 so find one who was had extra calories storage calories is just remarkable and here was a woman who had ample food had a good husband good seal odor walrus on her brought all this food for her he imagined unfortunate then I decided before I leave I gonna make new crosses show my gratitude to the village I had photographs of the original crosses I knew how tall they were the width of everything I finished my work with the crosses that one o'clock and about eight o'clock the next morning the high school kids came and they helped me put the crosses in and about an hour later the bush pilot landed and I got all my specimens on board and then I shipped into jeffery taubenberger the advantage that we had was that the formalin-fixed autopsy tissue samples were extremely tiny just the size of a fingernail and so we're very limiting where he was able to provide as large sections of an entire lung so that even though the quality of RNA was lower we had so much more material to work with it became absolutely clear that we would be able to sequence the rest of the virus from that material and I figured it will take weeks and weeks before he had in any inkling of that the specimens were good like ten days later he called and he said yo have we have it specimen is good maybe are lots of specimen great material and this is gonna beep wonderful it was a great day me apricot started in 1955 finally in 97 period here it is made it but again without the Eskimos in braving nasty would have come the effort to sequence the entire genome of the 1918 virus from beginning to end took ten years I was very laborious process more than thirteen thousand pieces of genetic information that had to be put together as a total so he gets a seek a sacrum sort of a stretch of the UM of the dead gene a little piece so he has it you're looking at it here and in her genius is long but it's fully built and this piece for us it fit in here fit in here or is it in this end here or is it this way and what comes to the left and the right and day after day month after month putting putting these things together she had after year so 13,000 pieces plus pieces had to form this root proper place and in it's incredible it's clearly a virus that was human adapted but genetically it's very bird-like in its sequence it's very avian life and so what we think is that it is an entirely avian like influenza virus that somehow adapted to humans we now know that there are a number of mutations in several of the genes that are absolutely crucial in the adaptation to humans and so you could imagine using these mutations as a screening tool to assess the significance of a bird strain as to whether it was actually moving along the path that would make it adapt to humans if we identify changes that were crucial to allow a bird virus to replicate in humans you could particularly design drugs that might block or bind to that particular change to prevent a bird virus from actually functioning in humans the 1918 flu had as its most unique feature the fact that it had a high propensity to kill young adults ages 15 to 40 even having the entire sequence of the virus in front of us we do not yet understand why behaved in that manner our favor the idea that people in that particular age group might have had the wrong sort of immunity to the 1918 virus some kind of immune response that actually made them more susceptible to die in people older than about age 45 or 50 in 1918 there might have been pre-existing immunity to viruses similar to the 1918 virus we're trying to identify influenza virus positive autopsy tissue samples from before 1918 to try to help us figure out his problem jeffery taubenberger x' right-hand woman and read very accomplished she was sent up with a plaque from the AFP to presented to the village council if this turbine workers work brings antiviral drugs and good vaccines and the savings of hundreds of millions of lives it began with Rita Alana and Jennie Alana another question about the death toll in the 1918 flu pandemic was how people died after they became ill with the flu dr. taubenberger and doctor morons examined not only the autopsy tissues in the AF IP collection but also autopsy reports from all over the world of people who had died of pandemic influenza we find that the vast majority of people dying died because of secondary bacterial pneumonia what we think happened is that a very virulent influenza virus caused such an extensive inflammatory response in the lungs and cause such tissue damage that bacteria like strep or pneumococcus that are very commonly carried in the throat of normal individuals could spread down into the lung and cause disease that would ultimately actually kill the person the evidence of the bacterial pneumonias I think helps explain why you had such high mortality in military camps particularly well this is very important in trying to understand what happened in 1918 it also has significant implications for pandemic planning in the future we've really seen an explosion and information about influenza in the last 10 or so years because primarily I think of sequencing of the 1918 virus but also the unusual events associated with the h5n1 virus the bird flu virus we've been watching this particular avian influenza virus for over 10 years now these viruses are highly transmissible from bird to bird and they can destroy a flock of birds but the most important thing from the public health perspective is that humans who have very close contact with the infected birds occasionally can become infected by this virus over 60% of those who have become infected have died many more people have been exposed to the virus than have become infected in order for this avian influenza virus to cause a pandemic we would have to see a number of changes that would occur in the virus so that the virus could be transmitted easily from human to human to the fact that the avian influenza viruses that were monitoring so closely have been circulating for 10 years and still haven't cause depend emic doesn't mean that these viruses will not cause a pandemic we don't know for past pandemics how long those virus is actually circulated caused infections in humans and then gain that ability to be transmitted efficiently so we don't know enough about past history to predict the future I think the biggest lesson is that we can't predict what influenza will do as scientists continue to look for answers in the 1918 flu virus we can also learn from the men and women who responded to the health crisis by taking it upon themselves to care for their relatives their neighbors and their communities dr. John Tappan was a physician with the Public Health Service in El Paso Texas he wrote to a colleague serving at an army field hospital and France we have all been awfully busy with the flu I made on an average of 30 calls a day for about a month and everyone else did is much or more the Public Health Service and the Red Cross opened a hospital in the old high school where we treated the Mexican part of town the epidemic here was fierce we had about 10,000 cases in El Paso and the Mexicans died like sheep old families were exterminated the white population feared almost as badly I was three days behind in my calls the other doctors all had the same experience of course when the people living in other parts of El Paso learned of the many deaths in the southern part of the city near the border with Juarez many volunteered to use their cars as ambulances picking up the sick and delivering them to hospitals in other parts of town when the OI school in the chihuahua the neighborhood was turned into a hospital for flu patients El Paso ins from all over the city volunteered as nurses drivers and clerks so you see we have been serving our country right here at home the epidemic helped the community to get together because everybody helped that good gave their officers their help or whatever their people needed that the need is acute so that's helped a community both Flores and here there is a shortage of doctors and nurses during the 1918 influenza pandemic because so many of the physicians and nurses were serving in the war effort so you had a mixture of both trained medical personnel and those with some training and those who basically were very civically minded individuals who wanted to participate in tending to the ill the women who volunteered during the 1918 influenza pandemic were literally putting their lives on the line they were stepping into a deadly pandemic because they believed that it was their calling and they wanted to do what they believed was their duty I would say that the activities of volunteers and particularly women volunteers who rose to the challenge was absolutely crucial this is a story of unsung heroes are forgotten people who really rose to the gravity of the moment in villages in Alaska for example the whole village would become sick at once there'd be nobody to provide food nobody provides shelter these things can make a difference and even in wealthy nations like the United States the conclusion at the end of 1918 in 1919 was that the single most important thing that could save your life from flu was good nursing care not medicines not doctors not hospitals but good nursing care when you first read those things you're likely to say that can't be true what could they do in those days you know what's chicken soup going to do what's a blanket going to do I believe the data they're strong and some of the best and smartest physicians nurses and other observers said it again and again good nursing care even though no one knew what caused influenza in 1918 some communities took steps to prevent the spread of the disease in our group at the Center for the history of Medicine we have been looking at 43 American cities during that pandemic to see exactly what they did to stave off the epidemic or what they didn't do for that matter what worked what didn't work and what were their records and what we find is that those that acted very early with a suite of classical public health interventions things like quarantine closure of schools banning public gatherings if they acted very early before the epidemic had a chance to spread to a lot of people kept these measures on for a long time and use more than one of these measures at the same time those cities had a much better record in terms of cases and deaths than those cities that did not I think there's a mountain of stuff that we're learning from the 1918 pandemic that applies to people today or in the near and distant future we have learned from the experiences of the 1918-1919 pandemic but that's only one of the factors that makes us better prepared to deal with influenza pandemics than the world was in 1918 there are extraordinary advantages some of them are pretty simple like experience of what seemed to work in some cities like social distancing and avoiding crowded places things that were not necessarily fully appreciated some cities did it and did well but most importantly we have biomedical and health care and technical advances that we didn't have we have vaccines we didn't have vaccines then for flu we didn't even know what the microbe was when they were dealing with it many people thought it was some strange form of a bacteria and not necessarily a virus number two we have antiviral drugs for example Tamiflu and Relenza and others we didn't have it then we have antibiotics to treat the secondary complications the bacterial complications of influenza we have much better technologies to treat acutely and seriously ill individuals like efficient good respirators intensive care units people who have expertise in medicine that's acute care medicine all of these things we did not have back then we have them now our parents and grandparents had little warning or chance to prepare but we know now that influenza has caused pandemics at intervals for at least the last 500 years public health officials have been preparing for the next flu pandemic knowing that it could be a mild pandemic as in 1968 or a severe as in 1918 the world is watching a new pandemic flu virus the novel h1n1 flu virus which emerged in the spring of 2009 we know that the new 2009 h1n1 virus is in almost every country of the world already fortunately so far the 2009 h1n1 virus doesn't appear to have that level of severity that the 1918 one had the 2009 h1n1 virus is affecting people differently than seasonal flu strains the illness is most common in young people children and young adults but we're also seeing hospitalizations and deaths in particular in people who have conditions that increase their risk of complications pregnant women have really been heavily hit by this virus in the United States and reports around the world suggest that native populations may have a higher risk of severe illness caused by the 2009 h1n1 strain we want to be ready and we want to make sure that these populations are served and that they have good access to health care into the vaccination everyone has the experience throughout the world that the best way to contain influenza is by getting a very efficient and safe vaccine vaccines given the current technology and even in more modern technology you don't make a vaccine overnight you have to first find out what the virus is you're dealing with and then you go through a multi-step process in order to get enough vaccine to protect the population that multi-step process generally takes several months usually alone the line of six or more months vaccination is a really important part of our response to the 2009 h1n1 virus but it's important to say it's not the only part of it we have a whole series of mitigation efforts and a whole series of communication efforts public health officials are fighting the spread of influenza with the health hygiene we learned as children stay home when you're sick wash your hands frequently with warm water and soap for 20 seconds practice cough and sneeze etiquette and avoid touching your eyes nose or mouth at the start of a pandemic that's that's that's the most efficient tool we'll have in addition to obviously social distancing like staying home when you're sick and so on but um um you know we our community that hugs that shakes that have elevators that you need to ride on to go to different parts of a building we go grocery shopping and we need to push our cards everything you do basically need to touch something that other people touch and so that hand-washing bit will be very critical these good habits and vaccinations also prevent the spread of seasonal flu an annual immunization for the seasonal flu helps people stay healthy and helps health workers prepare to vaccinate the population during a pandemic these immunizations are widely available every year it's very important for people particularly people who are 65 and over to take the influenza immunizations it's important to have the vaccine every year and the vaccine is a covered medicare benefit there's absolutely no way you would get the flu from the flu shot based on what I know and what I have been observing with this 2009 h1n1 virus and based on what I know about influenza vaccines the risk of getting influenza or having a complication from influenza is much higher than any theoretical risk of from the vaccines it's important for people to know that not getting vaccinated also puts you at risk a hundred million people get influenza vaccine every year in the United States they have a strong safety track record and the 2009 h1n1 influenza vaccines are being made exactly the same way that the seasonal flu vaccines are made a long-term goal for scientists working on flu vaccine is to develop a vaccine that would protect against all seasonal and pandemic influenza we generally refer to that as a universal influenza vaccine and I think there's a real possibility to that I don't think it's gonna be easy to do what we're working on when I say we I mean the scientists in the field is to identify the components of all influenza viruses that don't change as the virus drifts or even shifts and then you've got to put that in what we call an immuno genic form namely a form that when you inject it into a person or you spray it into the nose of a person that that person will make an immune response that's very robust there are a lot of people working on it's a high priority project every year we have fewer elders to remind us of the terrible time they their families and their communities endured in 1918 and 1919 but we need to keep those memories alive there's a lot of things to be learned from continuing to study the 1918 flu I think the important lesson is that pandemics can be very serious but also pandemics can be widespread but not that serious there's a gradation of severity of pandemics you always must prepare for the worst case scenario even though you might have a mild pandemic like occurred in 1968 or an intermediate pandemic that occurred in 1957 the pandemic is much less severe so far than the planning scenario is that most of us had had it could be that it becomes less severe and doesn't affect a lot of people it could be that it becomes more severe and mutates to a deadlier virus which would be terrible and very difficult to manage it could be that it continues along the way it's been so far only time will tell we have to be ready to pivot and respond differently if the virus changes the one thing you could predict about influenza is that it's unpredictable we still know much less than we'd like about influenza but the experiences of the individuals who endured the pandemic of 1918 and the research into that pandemic continue to contribute to our understanding of the disease we are infinitely better prepared now than we were a hundred years ago back in the beginning of the 20th century for more information about pandemic influenza visit www.nasa.gov/twan you

Channel: PublicResourceOrg

Views: 98,994

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Keywords: hhs.gov, public.resource.org, flue, influenza, epidemic

Id: XbEefT_M6xY

Length: 56min 49sec (3409 seconds)

Published: Sun Apr 25 2010