Times Writers Group: Why worry about flu? See 1918
By Derek Larson • May 6, 2009
St. Cloud (MN) Times
How worried should we be about "novel H1N1 influenza" or swine flu?
The World Health Organization has issued a "phase five pandemic alert," indicating a pandemic is imminent. The U.S. Centers for Disease Control and Prevention recommended schools with proven cases be closed for two weeks and shipped stockpiled antiviral medications to every state. On the fringes of the Internet, survivalists are chatting excitedly about which guns are best for home defense if civil order collapses during a pandemic.
So what's all the fuss? It's clearly not about the numbers because swine flu has so far been confirmed in less than 1,100 people worldwide and only 26 deaths have been documented. Compared to typical seasonal influenza, which kills about 36,000 in the United States alone each year, the swine flu is a joke. Globally, malaria kills in excess of 1 million people annually and rotavirus another 400,000. Most of these victims are children, and both diseases are preventable.
So why the panic over a rare outbreak of swine flu? History.
In the spring of 1918, cases of an especially virulent influenza appeared among soldiers in Europe and the United States, though not enough to spark great concern. Indeed, in April of 1918, The New York Times reported that despite some cases of the flu "the health of the Army in the United States continues good." Two months later, amid reports of widespread infection among the German troops, the paper patriotically reported "no influenza in our Army."
But in August, passengers on a Norwegian liner arriving in New York had taken ill, leading to discussions about quarantine. By September, officials were warning people to be on the lookout for symptoms and urging them to practice the now familiar steps of avoiding crowds, covering coughs and frequently washing hands. (They also recommended loose-fitting clothes and chewing your food well.)
The state of medicine in 1918 was primitive by today's standards, as was the ability of the media to raise public awareness and that of the common citizen to understand the threat of an emerging pandemic. That fall the first confirmed case of flu in Minnesota was announced Sept. 25. Within a week there were more than 1,000 cases in Minneapolis alone. On Oct. 10, public meetings were banned, and the following day schools, churches and theaters were ordered closed. By Oct. 17 nearly 3,000 people had died in Minneapolis, part of a pandemic that sickened some 75,000 Minnesotans and killed almost 12,000.As frightening as the Minnesota numbers might be, the death toll here was much lower than in many other states. While accurate figures are hard to come by — cause of death was often listed as pneumonia, rather than influenza — conservative estimates suggest about 675,000 Americans died in the 1918 pandemic. Worldwide, the total was 50 million to 100 million dead.
It is the 1918 pandemic that scares public health officials today. While later outbreaks took far fewer lives in the United States (70,000 in 1957 and 33,000 in 1968), scientists have warned for decades that a natural mutation could once again produce a virus as deadly as the 1918 strain. With modern travel, it would be nearly impossible to prevent its rapid spread. Models of a 21st century pandemic predict in excess of 100 million dead worldwide, with 1.9 million dead in the United States and 32,000 in Minnesota. In sum, about 50 years' worth of typical seasonal flu deaths could come in the space of 18 months.
Before we dismiss the concerns of the doctors, researchers and public health professionals charged with warning us about possible disease outbreaks, we should understand the magnitude of the threat. The difference between 1918 and today, of course, is that now we have modern medicine and communications on our side. Antiviral medications have been stockpiled, and the odds of developing a vaccine before the virus becomes widespread are promising. And there's always the chance that this strain won't turn out to be as bad as the 1918 version.
But until we're sure, taking reasonable precautions to prevent the spread of influenza seems like a minor inconvenience.-Dr. DRL
