In the spring of 1918, a deadly strain of influenza spread through North America and the rest of the world. As Word War I raged in Europe, American and Canadian soldiers arriving to the front lines carried Spanish flu across the Atlantic. Three waves of infection swept the world over the course of the year: the first in the spring and early summer, the second in late summer, and the third that winter.
This is a rare pattern of infection, as influenza epidemics are usually common during the fall and winter months. The first wave was relatively mild. Most victims died during the second and third waves. Over one third of the world’s population was infected. Between 50 and 100 million people died. The mortality rate was between 2.5 and 3 percent. Normal influenza strains have a mortality rate of only about 0.1 percent, and of that, most deaths occur in young children and the elderly. The 1918 strain killed mostly healthy people between the ages of 20 and 40 years old.
Fatal cases developed severe pneumonia often accompanied by pulmonary hemorrhaging, with many victims drowning in their own blood. Physicians reported cases where death followed less than 24 hours after the onset of symptoms. Recently, the Spanish Flu virus was reconstructed from the remains of a woman who died from the disease. It has been classified as type A (H1N1) virus with genetic components found in avian viruses.
By most accounts, the earliest cases of this new strain of swine flu originated in Veracruz. The highest concentrations of infection in Mexico are currently in Veracruz, Oaxaca, Distrito Federal, San Luis Potosí, and Baja, with the majority of case reports coming out of Mexico City.
There have been between 1,300 and 2,400 officially reported cases of swine flu in Mexico to date with around 159 officially reported deaths. A large percentage of these fatal cases were people between the ages of 20 and 40 years old.
If the reported cases and deaths are representative, the mortality rate of this virus could be as high as 7 to 12 percent. It is unlikely that it really is that high since many mild cases may go unreported. The Centers for Disease Control and Prevention have examined the virus. This swine flu strain is a type A (H1N1) influenza like the 1918 Spanish flu virus.
As of 1 p.m., April 29, The CDC have confirmed 91 cases of swine flu infection in the United States by genetic testing. At least several hundred more are highly suspected, especially in New York City. One of the tested U.S. cases has resulted in death, the death of a 23-month-old boy in Houston. Several patients have been hospitalized.
The CDC report genetically confirmed cases in Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York City, Ohio and Texas. The majority of U.S. cases have been in New York City. There have been confirmed cases in Nova Scotia, Alberta, British Columbia and Ontario in Canada. There are confirmed cases in Spain, Scotland, New Zealand, Israel, Germany, Austria and South Korea.
There are suspected cases in Wisconsin, Minnesota, Illinois, North Carolina, South Carolina, Tennessee, Alabama, Missouri, Louisiana, Florida, Maine, New Jersey, Pennsylvania, Delaware, Montana, Oklahoma, Nebraska, Idaho, Hawaii, Quebec, Puerto Rico, the Dominican Republic, much of South America and Western Europe, Hong Kong, Singapore, South Korea, China and Australia.
A map can be found at the Web site http://tinyurl.com/swinemap09/. April 29, the World Health Organization raised its pandemic threat level to Phase 5, meaning that a pandemic was beginning. Phase 6 represents a pandemic in progress.
The CDC reports that the swine flu virus is susceptible to the antiviral drugs Tamiflu and Relenza, but that it is resistant to Symmetrel and Flumadine. That is fairly good news as long as the virus does not spontaneously mutate or acquire genetic material from another virus for resistance to Tamiflu, which is the major antiviral medication stockpiled by the U.S. government.
However, antiviral treatment is only moderately effective against an already symptomatic infection, especially after more than two days of symptoms. It works much better as a prophylactic treatment for people who have been exposed but are not yet showing symptoms.
Though they will likely be used if there are urban epidemics, it is unlikely that antivirals will be very effective in containing this virus. The CDC is currently growing a seed stock of virus for a vaccine. However, it is unknown whether or not a vaccine can be effective against such a new virus. The CDC and World Health Organization say that it will take at least four to six months before any vaccine is available.
According to the CDC, those infected with swine flu are contagious starting about one day before symptoms begin until about seven days after the onset of symptoms, unless symptoms last longer than seven days. Children may be contagious for up to three weeks after the onset of symptoms.
Symptoms include cough, sore throat, runny nose, muscle aches and headaches. There are reports that a small percentage of people with this virus also experience vomiting and diarrhea. Again, severe cases develop potentially fatal pneumonia. The incubation period, the time between exposure and onset of symptoms, is between two and five days.
The best ways to reduce risk of infection are to constantly wash your hands well with soap, not touch your face, avoid close contact with people and crowds, and stay home if you get sick. Facemasks designed and sold as medical equipment, or labeled for use by doctors, may reduce the probability of transmission for both the sick and healthy alike. The CDC recommends a filtered respirator with an N95 or higher rating for better protection.
There is no telling how far this swine flu will spread or how many people it will kill before it is done. This virus has some similarities to the 1918 Spanish flu, including genetic components and the season of its outbreak. However, this virus will get to ride on nonstop international air services to hundreds of cities containing millions of people living in proximity to each other.
The effects of globalization and modern transit have made this a far different world than the one ravaged by the Spanish flu, and it is unlikely that either antiviral medications or vaccination programs will be highly effective in dealing with a similar virus today.
On the other hand, all viruses are self-limiting. It is quite possible that this one will mutate into a less virulent or less deadly form, or simply die out altogether, as another swine flu virus did after an outbreak at Fort Dix, N.J. in 1976.
Students and faculty proficient in statistics might gather data on the infection and mortality trends of this virus and do a cross-correlative analysis between them and those of the 1918 Spanish Flu. The results would provide a better idea of what may be in store for us in the next year or so.
It would be prudent for the Lawrence University administration to consider purchasing a bulk supply of cloth masks rated for use in hospital settings to be passed out to students and staff, perhaps along with small bottles of hand sanitizer. If cases begin to occur in the Appleton area, the administration should also consider enforcing the use of such masks in interior public areas such as classrooms and hallways, and even outdoor gatherings of more than several people. Good luck to everyone.
Swine flu epidemic
