H1N1 Flu Virus. By NIAID (H1N1 Flu Virus) [CC BY 2.0], via Wikimedia Commons
Back in 1918, the infamous flu pandemic killed an estimated 3-5% of the population of the time – 50-100 million people. The awful potential of a new 1918 style flu Pandemic to sweep the world and kill millions, perhaps billions, despite all our medical advances, makes every flicker of infectious ability for novel strains of flu newsworthy.
Almost all of these flu scares are groundless – but one day the real new pandemic strain will arise.
Bird flu strain taking a toll on humans
By Dennis Normile Feb. 17, 2017 , 1:30 PM
SHANGHAI, CHINA—An avian influenza virus that emerged in 2013 is suddenly spreading widely in China, causing a sharp spike in human infections and deaths. Last month alone it sickened 192 people, killing 79, according to an announcement this week by China’s National Health and Family Planning Commission in Beijing.
The surge in human cases is cause for alarm, says Guan Yi, an expert in emerging viral diseases at the University of Hong Kong in China. “We are facing the largest pandemic threat in the last 100 years,” he says.
As of 16 January, the cumulative toll from H7N9 was 918 laboratory-confirmed human infections and 359 deaths, according to the World Health Organization (WHO). Despite its high mortality rate, H7N9 had gotten less attention of late than two other new strains—H5N8 and H5N6—that have spread swiftly, killing or forcing authorities to cull millions of poultry. But so far, H5N8 has apparently not infected people; H5N6 has caused 14 human infections and six deaths.
Why am I mentioning this likely false alarm? The reason – how can we be totally sure it is a false alarm? This problem, the risk of a new Pandemic, is fixable – but we aren’t doing enough to fix it.
Most influenza outbreaks disproportionately kill juvenile, elderly, or already weakened patients; in contrast, the 1918 pandemic predominantly killed previously healthy young adults.
There are several possible explanations for the high mortality of the 1918 influenza pandemic. Some research suggests that the specific variant of the virus had an unusual aggressive nature. One group of researchers recovered the original virus from the bodies of frozen victims, and found that transfection in animals caused a rapid progressive respiratory failure and death through a cytokine storm (overreaction of the body’s immune system). It was then postulated that the strong immune reactions of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults resulted in fewer deaths among those groups.
What more could be done to prevent the next Pandemic?
Flu is notoriously difficult to vaccinate against, because of its high mutation rate. Advances have meant we have a yearly flu vaccine which provides substantial protection – but it can be very hit or miss, because preparation of the vaccine is based on a model of which strains will likely be prevalent at the time the vaccine provides its protection.
A better way to produce vaccines, say a desktop system for producing vaccines on the spot for novel flu strains, would massively decrease the turnaround time for providing protection to people in hot zones. At the moment such a desktop system is science fiction – but I wonder how close we could get to such a system, if for a few years flu research received funding on the same scale as our climate heroes?
Other areas worth researching are how to handle cytokine storms, the body’s panic overreaction to novel diseases.
One of the treatments administered during the SARS outbreak in 2002-4 was to flood sick people with corticosteroids, to try to suppress their immune over-response, including cytokines. Not only has subsequent research demonstrated administration of steroids probably wasn’t very effective, some people who survived the SARS infection suffered crippling bone and joint problems, as a consequence of all the steroids they received to try to suppress immune system cytokine storm.
The following from PLOS Medicine is telling;
Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage and timing, and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment.
There has been research to try to find a better way of handling cytokine storms, which is believed to have made the 1918 strain so deadly for young, healthy adults. For example in one study the drug Gemfibrozil apparently helped to protect lab mice against death from flu infection.
But we need more than a few mouse studies.
Research into managing cytokine storms in people, without completely depressing a patient’s immune system, or destroying their life with crippling bone and joint disease after treatment, could help prevent deaths when the next Pandemic strikes.
We won’t know when the next scare turns into a 1918 style Pandemic, or worse, until it is too late. The next Pandemic will almost certainly not emerge fully formed, it will likely stumble into the news like any other flu scare, like the latest China flu scare – a few deaths, low transmission rates, hiding on the tattered edges of modern medical care. But the new disease won’t quite die away, it will linger on, clinging to survival, just barely escaping eradication efforts, maintaining a small reservoir of infected hosts. Then suddenly something will change, a mutation which dramatically increases infection rates. The new Pandemic will leap across the world in days, bringing death to every human population centre on Earth.
We have to be better prepared, for when the inevitable happens. We have to focus the attention of our politicians on real threats, not the imaginary climate bogeyman which has ensnared their attention for far too long.