I recently read a book called “The Great Influenza” which I picked up at Costco, I think. The author, John M. Barry, makes very human the doctors who tried to figure out what happened during the Great Influenza of 1918-1919. They didn’t figure it out at the time, of course, but they were trying. If it had been a bacterium, they probably would have figured it out. But it was a virus, the H1N1 virus strain. History has mostly forgotten the Great Influenza — I know we only read a paragraph or two about it when I was going to school in the 60’s. Now there are plenty of websites that have info and pictures about it.

Here on the ranch, we assembled a lot of information and a bunch of links to educate our family. I’ll share some of that here:

Introduction

This page is an introduction to the subject of Avian Flu (Bird Flu) and the history of such flus.

First and most importantly, in the immortal words of Douglas Adams in the “Hitchhiker’s Guide to the Galaxy”:

Don’t Panic!

Our purpose in putting together this information about Avian Flu is not to cause alarm or spread panic, but to give you background information and facts you can use to stay healthy and protect yourself and your loved ones in case this particular flu becomes pandemic among humans, which it may or may not do.

Our prayers and postulates are that it absolutely does not ever become a problem for the great masses of people in the world, and especially for our family.

The World Health Organization (WHO) and Centers for Disease Control (CDC) are making preparations for Avian Flu IF it becomes pandemic among humans. From a review of their public statements, they appear to be confronting the possibility of an Avian Flu pandemic scenario with utter seriousness. The WHO and CDC seem to consider it likely at this point, that it will start to spread quickly between humans, but they can’t predict the severity of it if it does.

Background & Summary:

What’s all the fuss? After all, we have flu going around all the time.

Avian Flu (also called “Bird Flu” or “H5N1”) is similar in effects to a flu pandemic that happened in 1918-1919, during the last years of World War I. At the time, it was called “The Great Influenza”, the “Spanish Influenza” and sometimes “The Grippe”. It was a strain of flu known as the “H1N1” strain. [Recommended reading: “The Great Influenza” (2004) by John M. Barry.] Here’s some background from that book about The Great Influenza. It will give you an idea of the “Worst Case Scenario” for a flu pandemic.

• The “Great Influenza” flu pandemic of 1918-1919 killed between 50 and 100 million people worldwide. Estimates of the numbers were poor at the time because most basic social structures broke down. Often there was no one officially counting or reporting those being buried, so the numbers are fuzzy. Morgues and funeral services were inundated with corpses. Photos from the day show them “stacked like cordwood”.
• It appeared to have first crossed over from birds to pigs and then to people. The pandemic was first recorded in Kansas, and it was then spread through human contact to a nearby army base. From there, it spread to crowded troop ships and army barracks and the hellish front line trenches (during World War I). Overcrowding helped to create higher casualty rates and spread the disease. The Army kept the best statistics. According to their recrods, 1 of every 67 Americans in uniform worldwide died of this disease.
• The masks everyone wore in public (you’ll observe the masks in most photographs from the period) were completely ineffective at stopping the spread of the disease.
• It could strike very quickly, often killing an otherwise healthy person within 12 hours of the first noticeable symptoms.
• It selected out as victims healthy young adults as well as infants and the elderly. Being vitally healthy in the prime of life with a perfect immune system only made it more likely you would get this flu.
• The Great Influenza flu virus killed in two ways: 1) directly and quickly, or 2) if the person survived the direct assault, their immune systems were so damaged that they frequently died of secondary illnesses like pneumonia. It was confusing. Deaths were often attributed to “pneumonia” as the cause of death, even though it was the flu that started the process.
• People panicked. Many people that could have been saved weren’t because they didn’t get any care (food, water, or heat) afterward, even though they survived the flu itself. They died in their homes because neighbors were afraid to help them, bring them food or water or stoke their fires, for fear of catching it themselves.
• The US Government was ineffective in helping, mostly because it was distracted by WW I. President Wilson was leading America in “total war”; bluntly, the war effort came first. Factual information about the disease was hard to come by, and the truth was often suppressed because publishing the news in American papers would have been good for German morale. Rumors were rife. A huge military parade in Philadelphia (the Liberty Loan parade meant to raise millions in funds for the war) that should have been cancelled was held anyway. Thousands caught the Great Influenza and died as a result of attending the parade.
• Hospitals were mobbed and utterly overwhelmed with a hundred times their normal traffic; doctors, nurses and police died by the thousands. Skilled physicians and nurses were in terribly short supply; those who survived were overworked, exhausted and helpless to do much about it.
• At various times all public gatherings were banned including weddings, funerals and meetings of all kinds. (It was done too late, and it doesn’t seem to have helped any.)
• Shops were closed, schools empty and silent (except where they were being used as temporary hospitals) and many basic services went unstaffed. In the cities, food became scarce and police and firemen failed to answer when called, as often as not. Fires were left to burn themselves out. Looting was widespread.
• In America, city and state officials often resorted to mass graves to clear the piles of bodies. Wagons went from home to home collecting the dead for mass burial.
• By most estimates, the Great Influenza killed about half of one percent of the entire population of humans on the globe. Put another way, one out of every 200 people alive at the time died from the flu.
• It went everywhere on Earth in waves and killed uncounted millions in Africa, Asia, Europe, South America, North America, Australia and New Zealand, and the islands of the Pacific. No place was safe, and no one knew where it might strike next.
• Estimates in the US alone were of about 600,000 dead, out of about 103 million US citizens at that time. From 1917 to 1918 the US population dropped for the only time in the 20th century; a product of the Great Influenza and WW I.
• It killed entire Eskimo villages, leaving no one alive, and decimated the populations of many tropical islands.
• In 1918-1919, there were no vaccines that would work to prevent it or lessen its effects. Nothing effective could be done to help those who got it except holding them while they either lived or died (and nursing them back to health if they survived), and nothing was effective in preventing it from spreading — excepting only quarantine. They didn’t even know that the Great Influenza was actually a virus until years later. Many thought it a mysterious invisible bacterium.
• The only defense against the Great Influenza was utter and complete quarantine. Two towns in Colorado did this, and had no casualties. They called it a “shotgun” quarantine because that’s how it was enforced.
• It went around the world in three waves. Australia (the island nation) quarantined itself through the first two waves with complete success, then was devastated when the third wave hit and their quarantine failed.
• Like the Holocaust it is a part of human history that people prefer to downplay rather than dwell upon; it gets short mention in most history books despite the profound influence it had on those who lived through it.
• People who did live through it didn’t like to talk about it. An old man was interviewed in 1993 as part of a family history project. He was born in 1900, and in 1918 was enrolled in college while serving in the Army. (That was common at the time, while the Army figured out how to utilize all the young volunteers.) He was called up to work on active duty in an overcrowded hospital. During the interview he still wept at the memory of having held so many friends while they died, helpless to prevent it.

How is Avian Flu similar to The Great Influenza?

• The Avian Flu is similar to the Great Influenza in its virulence: if someone does get it, it is a toss-up whether they will live or die. If they do live, they’ll still be really sick for a week or two.
• The big difference between the two is that Avian Flu does not NOT pass easily from one human to another at this time, although some human-to-human Bird Flu infections have already been reported by the WHO.
• If and when it ever begins to easily pass from one human to another, we could have a pandemic — it could show up everywhere very quickly, spreading similar to the way the Great Influenza spread. Would it be as lethal then as the Great Influenza was? Nobody can say, but that possibility is certainly very worrisome to every informed public health official.
• With faster modern global transportation, rapid transit systems in our cities, and our terrific highway system, it might spread even more rapidly than the Great Influenza did.
• Avian Flu is currently being spread by migratory birds. It is passing from those birds to domestic birds and to other species, including humans and big cats (over 100 tigers have died from this disease in the last 3 years).

How is Avian Flu different than the Great Influenza?

• The Avian Flu is not easily passed between humans at this time. Note well: That may change–the WHO and CDC seem to be expecting that factor to change as the disease mutates over time.
• The Avian Flu has only infected 115 people worldwide so far, that the World Health Organization (WHO) knows about. About half of the infected people have died. It seems likely there have been more casualties that the WHO does not know about.
• The humans who are getting infected with Avian Flu now mostly are working with birds and livestock (such as veterinary workers and poultry farmers) and those in close contact with them. (The Great Influenza spread like wildfire amongst all walks of life through simple human contact.)
• The WHO is actively trying to stay on top of the Avian Flu, with many people constantly monitoring birds and other livestock and veterinary services around the world. They are on high alert for Avian Flu and reporting every possible instance; quarantining humans and destroying animals that have caught it. This kind of coordinated international activity was missing and basically impossible during the Great Influenza, in part because of WWI but mostly because the disease moved faster than it could be tracked or predicted or reported back then. International communication was much slower then, limited to telegrams and letters. International communication now is basically instantaneous and does not have to go through official channels.
• So far, about 200 million birds have either died from this flu, or been destroyed to slow the spread of it. That kind of “preventative destruction” campaign was not done back in 1918 and 1919, although rumors that dogs and cats were spreading it caused many people to kill their family pets in 1918-1919. (That didn’t help either.)
• Vaccines exist today and are being rushed into production that MAY help the first-line workers (doctors, nurses, EMTs, police) survive the first wave of Avian Flu, if it hits. There’s no guarantee that these vaccines will be effective; there’s just no way to tell in advance. No such vaccines were available during the Great Influenza. Although innoculations and wacky treatments of various kinds were done out of desperation, they were utterly ineffective back then.
• Basic Hygiene: although it is impossible to quantify, common sense would tell you that Americans especially are much more clean and hygienic now than they were in 1918. Soap, showers, and clean water are much more prevalent now.
• Many of the secondary illnesses (pneumonia, etc., that killed so many of the victims of the Great Influenza flu) are now treatable and curable with vaccines and antibiotics.
• Latex gloves are widely available now, as are masks.
• Doctors and hospital staff are much more informed about how to prevent the spread of diseases like this than they were then, and less likely to make the spread of this flu worse, as they did then. In 1918, at first they had no inkling that such a flu existed, and didn’t readily quarantine people, which let it spread widely and get a stronghold everywhere. We know better now.

Our Advice

If a truly virulent human-to-human version of the Avian Flu pandemic starts to spread across the world, we believe that only active, utter quarantine will guarantee surviving it. That means no physical contact with the outside, period.

If a flu pandemic starts, hunker down (quarantine yourself) as best you can. Wear latex gloves and a mask when going outdoors, avoid skin contact with door knobs, handrails, shopping carts, etc. Don’t go to public places or use busses or subways if you can avoid it. Avoid all crowds.

It won’t hurt to stock up now on some extra food staples: tuna, soup, pasta, peanut butter, canned veggies and the like. And get yourself a box of latex gloves (from the drug store) and masks (from the hardware store). You can always eat the food later and laugh about the scare we all had. Hopefully that’s all it will come to, some laughter over our own foolishness. Hey, I still have some rice left over from Y2K!

The Pandemic Influenza Threat

Quoted from the US Dept Health Human Services – Pandemic Flu Plan:

Influenza A viruses have infected many different animals including ducks, chickens, pigs, whales, horses, and seals. Influenza A viruses normally seen in one species can sometimes cross over and cause illness in another species. This creates the possibility that a new virus will develop, either through mutation or mixing of individual viruses, in turn creating the possibility for new viral strains that can be highly infective, readily transmissible, and highly lethal in humans.

When a pandemic virus strain emerges, 25% to 35% of the population could develop clinical disease, and a substantial fraction of these individuals could die. The direct and indirect health costs alone (not including disruptions in trade and other costs to business and industry) have been estimated to approach $181 billion for a moderate pandemic (similar to those in 1957 and 1968) with no interventions. Faced with such a threat, the U.S. and its international partners will need to respond quickly and forcefully to reduce the scope and magnitude of the potentially catastrophic consequences.

Such a threat currently exists in the form of the H5N1 virus, which is spreading widely and rapidly in domestic and migratory fowl across Asia and Europe. As of October 2005, this strain has infected more than 115 humans, killing approximately 50% of those known to be infected.  The virus is now endemic in many bird species so that elimination of the virus is not feasible.

If this virus mutates in such a way that it becomes capable of spreading efficiently from person to person, the feared pandemic could become a reality.

General Information

• Ten Things You Need to Know About Pandemic Influenza – from World Health Organization
• General Information – from PandemicFlu.com
• Pandemic Influenza: Key Facts from the Centers for Disease Control and Prevention (CDC)
• Avian Influenza Fact Sheet – from World Health Organization
• Avian Influenza Frequently Asked Questions – from World Health Organization
• Flu Treatment – from Healthinschools.org. They recommend Tylenol for children, aspirin for adults. They warn not to give aspirin to children or teenagers who have the flu.

Statistics and Documentation

• Timeline of H5N1 Avian Influenza as of March 24, 2006 – from World Health Organization. Read the right-hand column on “humans”. It goes back to 1996.
• Avian Influenza: Latest Information Links – from World Health Organization
• Confirmed Cases – regularly updated links from World Health Organization
• H5N1 Maps – from World Health Organization

History

• Influenza 1918 – from PBS, The American Experience. This one has maps, stories and pictures.

Planning & Preparedness

• Planning for Individuals & Families – from PandemicFlu.gov

Government Plans

National Strategy for Pandemic
Influenza
Oregon Pandemic Influenza Plan
WHO pandemic influenza draft protocol for rapid response and containment (17 March 2006)