"The Great Influenza"

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"The Great Influenza"

Postby rapturos » Thu Feb 16, 2006 12:35 am

The Great Influenza: The Epic Story of the Deadliest Plague in History
By John M. Barry

Be forewarned: this is one scary read, but if you are into prophecy it is illuminating. This book details the horrors and heroism surrounding the events of 1918 brought on by the so-called Spanish Flu pandemic that raced around the world and killed millions. Doubly scary because of the speed and scope of the plague, and because it could come again in the form of a derivation of the Avian or Bird Flu we are reading about constantly it seems nowadays.

If you are queasy or generally jumpy, read no further. The excerpts from the book tell the tale with no commentary needed. Truthfully, I couldn't bring myself to include the truly grisly passages for fear of offending.

"Vaughn recorded this sight: 'hundreds of stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full and yet others crowd in. The faces wear a bluish cast; a distressing cough brings up the blood-stained sputum'".
Care was almost nonexistent. The base hospital, designed for twelve hundred, could accommodate at most - even with crowding "beyond what is deemed permissible," according to Welch - twenty five hundred. It now held in excess of six thousand."

"When Welch arrived seventy out of two hundred nurses were already sick in bed themselves, with more falling ill each hour. Many of them would not recover."

"Blood was everywhere, on linens, clothes, pouring out of some men's nostrils and even ears while others coughed it up. Many of the soldiers, boys in their teens, men in their twenties - healthy, normally ruddy men - were turning blue. Their color would prove a deadly indicator."

"On September 17, five doctors and fourteen nurses in that civilian hospital suddenly collapsed. None had exhibited any prior symptoms whatsoever. One moment they felt normal; the next, they were being carried in agony to hospital beds."

"On October 4, for the first time more than one hundred men at Camp Grant died in a single day. Nearly five thousand were ill, with hundreds more falling ill each day. And the graph of contagion still pointed nearly straight up.
Soon, in a single day, 1,810 soldiers would report ill. At some other army camps even more soldiers would collapse almost simultaneously; indeed, at Camp Custer outside Battle Creek, Michigan, twenty-eight hundred troops would report ill - in a single day."

"But the most terrifying aspect of the epidemic was the piling up of bodies. Undertakers, themselves sick, were overwhelmed. They had no place to put bodies. Gravediggers either were sick or refused to bury influenza victims."

"Then undertakers ran short of coffins. The few coffins available suddenly became priceless. Michael Donohue's family operated a funeral home: 'We had caskets stacked up outside the funeral home. We had to have guards kept on them because people were stealing the caskets ... You'd equate that to grave robbing.'"

"The city was frozen with fear, frozen quite literally into stillness. Starr lived twelve miles from the hospital, in Chestnut Hill. The streets were silent on his drive home, silent. They were so silent he took to counting the cars he saw. One night he saw no cars at all. He thought, 'The life of the city had almost stopped.'"

"It was impossible to get a doctor, and perhaps more impossible to get a nurse. Reports came in that nurses were being held by force in the homes of patients too frightened and desperate to allow them to leave. Nurses were literally being kidnapped."

"The professionals had continued to do their duty. One physician at Philadelphia Hospital, a woman, had said she was certain she was going to die if she remained, and fled. But that was a rarity. Doctors died, and others kept working. Nurses died, and others kept working. Philadelphia Hospital had twenty student nurses from Vassar. Already two had died but the others 'have behaved splendidly.... They say they will work all the harder.'"

"As the crest of the wave that broke over Philadelphia began its sweep across the country, it was accompanied by the same terror that had silenced the streets there. Most men and women sacrificed and risked their lives only for those they loved most deeply; a child, a wife, a husband. Others, loving chiefly themselves, fled in terror even from them."

"It completely destroyed all family and community life. People were afraid to kiss one another, people were afraid to eat with one another, they were afraid to have anything that made contact because that's how you got the flu....It destroyed those contacts and destroyed the intimacy that existed amongst people.... You were constantly afraid, you were afraid because you saw so much death around you, you were surrounded by death...."

"When each day dawned you didn't know whether you would be there when the sun set that day. It wiped out entire families from the time that the day began in the morning to bedtime at night - entire families were gone completely, there wasn't any single soul left and that didn't happen just intermittently, it happened all the way across the neighborhoods, it was a terrifying experience."

"Prescott, Arizona, made it illegal to shake hands."

"The panic came anyway. Dogs told the story of terror, but not with their barking. Rumors spread that dogs carried the influenza. The police began killing all dogs on the street. And people began killing their own dogs, dogs they loved, and if they had not the heart to kill them themselves, they gave them to the police to be killed."

"The virus pierced the ice of the Arctic and climbed the roadless mountains of Kentucky. It also penetrated the jungle."

"In Gambia, 8 percent of the Europeans would die, but from the interior one British visitor reported, 'I found whole villages of 300 to 400 families completely wiped out, the houses having fallen in on the unburied dead, and the jungle having crept in within two months, obliterating whole settlements.'"

"Normally corpses there were cremated in burning ghats, level spaces at the top of the stepped riverbank, and the ashes given to the river. The supply of firewood was quickly exhausted, making cremation impossible, and the rivers became clogged with corpses.
In the Indian subcontinent alone, it is likely that close to twenty million died, and quite possibly the death toll exceeded that number."

"'If the epidemic continues its mathematical rate of acceleration, civilization could easily', he wrote in hand, 'disappear...from the face of the earth within a matter of a few more weeks.'"

"But my original intent in writing this book has been somewhat overtaken by events, as new avian influenza viruses infect humans at an increasing rate - and hence threaten to spark a new pandemic, which many experts fear is imminent."

"The World Health Organization, the National Academy of Sciences (through its medical arm, the Institute of Medicine), and the U.S. Centers for Disease Control and Prevention all agree that influenza pandemics are virtually certain to recur."

"The threat of new reassorted viruses crossing the species barrier has always existed, but it is increasing as the direct infection of humans by avian viruses increases."

"Of course, every time the virus infects a person it has a new opportunity to jump species. As anyone who has read the chapters in this book about the virus itself knows, all influenza viruses originate in birds, but they mutate with extraordinary speed and can trade genes with other influenza viruses. Whenever a bird virus infects a person - or possibly another mammal, especially a pig - then either reassorts with an existing human influenza virus or, conceivably, mutates directly to create a new virus capable of passing from person to person, a new influenza pandemic may erupt."

"For these reasons, virologists and public health official consider new pandemics almost inevitable. But they cannot predict when one will occur. As one influenza expert has said, 'The clock is ticking. We just don't know what time it is'."
Last edited by rapturos on Sat Mar 11, 2006 12:54 am, edited 1 time in total.
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Considerations for prospect of Bird Flu Pandemic

Postby rapturos » Sun Mar 05, 2006 1:18 am

The following paraphrased comments were taken from the recent television interview of Dr. Michael Osterholm, an infectious disease expert, on the Oprah Winfrey show episode that was dedicated to the issue of a possible bird flu pandemic.

Not any particular flu shot will work for any type of flu. You would need a specific one for a human influenza strain that developed out of the current bird flu variety.

The current global manufacturing capacity would only yield enough flu vaccine for about 300 million people.

The mutation process that could produce an influenza strain that could pass from human to human might cause it to happen today or ten years from now.

A bird flu pandemic would probably last from nine to eighteen months. It could kill 180 to 360 million people in a single year. By comparison, AIDS has taken 24 years to kill 30 million people.

The simple masks seen on TV coverage of the SARS crisis in Asia would not be effective in stopping communication of the disease. A surgical mask is designed to keep the surgeon from breathing onto the patient not to keep the surgeon safe from inhaled microbes. You would need a mask that seals tightly against the face and that would use replaceable filters since the filters would be contaminated with each use.

There would likely be a massive shock to the global economy since many factory workers and transportation workers would be sick and unable to work. The supply of specialized masks would soon be exhausted with little prospect of resupply. Even the rich would find vital supplies exhausted and unavailable at any price.

Winter would be particularly dangerous since the perfume-like infectious particles breathed into the air by affected people would dry more quickly and fall out of the air more quickly thereby contaminating the surfaces that they fell onto. People tend to touch their eyes, nose, and mouths habitually and would readily infect themselves from touching these contaminated surfaces.

A major concern during a pandemic would be not so much food and water shortages but drug shortages for ailments like diabetes and cancer. So much of the world's commodities are currently produced by outsourced, just-in-time processes that if any one country or source of a particular component for a drug were shut down, that particular drug would run out even though all but that one component were available. Estimates are that 80% of current drug manufacturing is outsourced to areas outside the U.S. Even food supplies could be expected to be affected since the just-in-time nature of modern manufacturing almost precludes the prospect of large inventories being available at any one time or place.

As for stockpiling drugs, most health plans would only allow for a maximum 30-day supply anyway.

The supply of clean water could be affected since cities currently maintain only a five to seven day supply of chlorine to purify drinking water and the supply of chlorine could be expected to be disrupted also.

A backlog in handling of the dead could occur. In the 1969 flu epidemic in the U.S. the average time for processing of victims' bodies was six months.

By comparison, during the Hurricane Katrina crisis, many unaffected regions of the country were available to supply aid to the stricken area. In a pandemic episode, almost all regions would be dealing with their own pandemic crisis and would be unable to respond to external calls for help.

Troubling comparison: in 1969 there were only 12 million chickens in China to catch the bird flu and possibly incubate a mutated form that could pass from human to human. Today their are 50 billion chickens in China acting as living test tubes, any of which could be the one to produce the human-to-human communicable version.

President Bush recently asked for $7 billion to prepare for a possible bird flu pandemic but congress appropriated only $3 billion. Global awareness of the threat is growing but committment of actual funds and resources is not matching the awareness level.

Dr. Osterholm's recommendation is that this should be the absolute highest resource-committment priority because of the collateral threat to the global economy and geopolitical stability.

The most vulnerable individuals are those between the ages of twenty and forty since this is a disease that causes the immune system to attack its own host's body and these are the people classes expected to have the strongest immune systems. In the 1918 flu pandemic 55% of the pregnant women died, again, because of the high activity of the immune system in at once trying to protect the baby and also warding off something perceived foreign to the host body.

The Tamiflu drug cannot be expected to be a panacea since the other two drugs that initially appeared effective against the flu went from a 3% resistance level by the flu virus to a 91% level in a very short time. So the current wisdom is that Tamiflu should be held in reserve so that the flu will not be able to develop resistance to it as it has with the other two drugs. The other suggestion by Dr. Osterholm is that Tamiflu supplies be stockpiled specifically for health care workers who would be desperately needed in a pandemic situation.

Other great strains would be put on the medical system. Of the 105,000 mechanical ventilators available today, 80,000 are already in constant use. If elderly or similar end-of-life patients were using the few ventilators available, would they be appropriated for use with younger patients?

The emergency blood supply would be affected. Demand for elective surgeries would cease immediately.

During the Hurricane Katria crisis, when FEMA put out a call to truckers from other states with refrigerated trucks to make their way over to the region to help with handling the overflow of bodies, very soon after shortages developed because of those truckers being absent from their regular routes and duties. So far, the issue of disruption of the supply transport system during a pandemic has not been adequately addressed by planners.

In an attempt to further understand the threat, five gene elements were taken from medical slides from flu victims of the 1918 pandemic and combined (using genetic reverse engineering techniques) with three gene elements taken from victims' bodies exhumed from Alaskan permafrost where they had been buried in 1918. The result was the recreation of the actual flu virus that caused the 1918 flu pandemic. It turned out to be a bird flu that had mutated to a form that could be passed from human to human.
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