Commentary: The Flu of 1918
By Justin Isherwood
We well know the invocation … on the eleventh hour, of the eleventh day, of the eleventh month, 17 million dead, 21 million wounded, 7.7 million missing. A hundred years ago and at last, World War One was over and humanity could give a sigh of relief. Silent were the guns. Silent the trenches. Silent the skies. Life was good again. It was November 1918. And then began what virologist Jeffrey Taubenberger coined “the mother of pandemics.”
Ironically the name of the pandemic is a simple three letter word, flu, for influenza, the Italian word that had been applied to epidemics since 1504, the first was probably scarlet fever. Influenza later to be adopted to the English as the name of a particular kind of respiratory disease. Originally the word influenza slash influence invoked by fatalists who found their predictive fate in the stars, the zodiacal foretelling, the influenza of the stars.
The November 1918 flu was misnamed Spanish Flu, seems somebody had to be blamed. It didn’t begin in Spain, if its reach included Spain as well as the rest of the world. A world that for very good cause wanted nothing more than a return to normalcy. The Flu of 1918 was anything but normal.
Still debated is why this November ’18 flu was the killer it turned out to be. Its statistics are only estimated, in round numbers 20-50 million dead, a figure now questioned as wildly inadequate, being 18-20 million died in India alone. Some believe worldwide numbers support 500 million were sickened by this disease that came with a very short critical time frame from disease onset to death. Most curiously, the 1918 flu killed the young, the strong, the virile adults, it killed the war’s veterans, killed their sweethearts, their wives, killed their children. Classically flu is a disease of infants, the elderly and the compromised. The Great War Flu did the most uncouth thing, it killed the young, the strong, the healthy, individuals 20 to 30 years were the bulls-eye of this influenza, most died of secondary bacterial infection, namely pneumonia. A rapid onset pneumonia that overwhelmed its young strong victims. The 1918 flu had all the manner of a Biblical plague unleashed by an angry God.
Michael Worobey of the University of Arizona and his team’s published findings in the Proceedings of the National Academy of Sciences suggests a rather straightforward explanation of how the Great War Flu killed so abundantly and so ruthlessly.
It is known that some immunity to a flu strain is conferred by the subject previously having a similar flu strain, emphasis on the similar. Exposure to these flu strains with our modern application of immunization confers some protection. One can get picky here but the difference between some headache and cough is different than dead in a week. This process of a flu strain’s introduction, the debutant’s ball of immunization, presents to our bodies a weakened form, the protein markers on the surface of the virus, recognized and countered by our antibodies. The increased difference in the virus’ identifying proteins is in turn the measure of the antibody’s ability to attack the virus in a time frame short of the virus overwhelming impact.
It is surmised the flu type of the period 1880-1900 was of the type H3N8, this virus what circulated in the 20-30 year olds just back from the war, ready to gain their lives back. The so-called Spanish Flu presented a different protein array, the H1N1 virus. People born earlier or later than the 1880-1900 period had gained some exposure to an H1N1 flu and thus some measured immunity.
The research of Prof. Worobey challenges some of our broad assumptions of modern flu immunization, those autumnal flu shots offered at every clinic, grocery store and pharmacy. The 1918 flu was a classified H1N1 that circulated from 1918 into the late ‘50s, DNA analysis shows that just prior to 1918 the H1N1 virus picked up genetic material from a bird flu virus that increased the camouflage of the virus, delaying or forestalling the antibody reaction. And a population all the more susceptible if the antibodies had evolved around a very different flu strain.
The on-going research into the Flu of 1918 seems to suggest a new approach to immunization, beginning with and primarily focused on early childhood. To the goal of immunizing with multiple H factors including those not currently in circulation. Humans don’t (yet) catch such flus as H5N1, that in the known examples has a 60% mortality rate. H5N1 currently is a bird flu with only occasional human disease incidence. Should H5N1 mutate as did the Spanish flu virus, it could unleash the unkindness of the 1918 pandemic. There are other similarly non-infective strains, as could mutate. Current immunization is a crap-shoot, a high-stakes bet on what will be the most likely candidates for that season’s flu. Effectiveness varies with the ability to predict the most active factors for that immunization shot. Research now suggests immunization be strategically administered to include long-range potential flu, such as the H5, H7 that have demonstrated a high percentage of mortality. Enacting such a strategy would be a decade-long effort to gain an “in-place” population protection. To also know how equally important for our collective safety to push immunization into the Third World for their protection as well as ours.
The flu of the 11th month, the 11th day, the 11th hour was made all the worse and the more widespread by a world-sized army being brought home to their loving families. Modern world transport matches that war’s demobilizing in volume every day of the year. To the end a pandemic in our modern world is all the faster than what was the influenza of 1918.
In case you’re wondering, flu shots don’t just protect you, they protect everybody.