A Local History, copyright 2008, by Bruce Laing

“I had a little bird
Its name was Enza
I opened up the window
And In-flu-enza.”

*a Skip-rope song sung by children, Fall, 1918

Early Friday morning, August 23, 1918, in a small coastal town of Ipswich, on the North Shore of Boston, the Chronicle went on sale, and for three cents a copy citizens could read front-page news about the progress of the Great War. Or, buried a few pages inside, the reader might have noticed, in the column called “Condensed World News”, the following single sentence, byline:

NEW YORK — The Health Department took active steps to prevent the spreading of Spanish Influenza here after the discovery of several cases recently arrived on board ships from Europe.

This appears to be the first citing of the Pandemic of 1918 in the Chronicle. Such was our medical knowledge at that time that in the same issue, Lydia E. Pinkham’s Vegetable Compound, the Prozac of its day, advertised its restorative powers for nervous breakdowns; Dr. Kilmar’s Swamp Root was extolled for good results with kidney disease; and Bone Healing Ointment could be mail-ordered to cure man or beast.

Worldwide, there remain questions as to the origin of this Spanish Flu pandemic. The term ‘origin’ is odd anyway. As we understand it today, influenza of this type first occurs as a virus in birds, and may be harmless or harmful. Sometimes these avian viruses change so that they can infect other animals like pigs and horses, and, rarely, can be passed from these animals to humans. To us, the gravest of these viruses are the ones that develop even further, such that they can pass from one human to the next. That is where our trouble starts.

In 1918, the most often cited origin of the pandemic was Spain, where quite a bit of this illness had been detected and reported the previous May, earning this disease the popular name “Spanish Flu”. The speculation got more interesting, including the possibility that it was caused by a German biological weapon, or the bad fortune of the Chinese; or perhaps a deadly miasma resulting from the close quarters and horrid hygienic conditions of trench warfare steeped in mustard gas.

In March, 1918, the earliest known case in the United States was diagnosed at Fort Riley, Kansas. An unfortunate soldier — Albert Gitchell — was struck. One week later, over 500 soldiers at the Fort were ill. One wonders how the first case in the US cropped up in the Heartlands, rather than on the docks of a coastal port, as one might suspect of a human-to-human transmission in-coming from a foreign country like Spain. Years later, scientists determine that the Flu originated from birds, and poultry is usually the number one suspect. Gitchell was a cook at the Fort, and likely to be handling chickens, so it all fits.

Fast-forward to August 27, back to local affairs (four days after the previous issue of the Chronicle made it to the streets) there is news that an infected person has been diagnosed at Commonwealth Pier in Boston. Three days later 60 are ill. It has arrived, and it is spreading; within three weeks it crosses the continental United States. In this month of August, more virulent strains pop up not only in Boston, but also in Brest, France, and in Freetown, Sierra Leone.

On September 20, 1918 the Ipswich Chronicle reports “editorial paragraphs” about: the war; the virtues of gas-less Sundays; fashionable pineapple straw hats; a ban on sugar “sirup”; and this rather odd patriotic announcement, considering that thousands of US Military personnel are also infected with the Flu:

“An epidemic of Influenza is rampant in the German army, but it goes without saying that they are not sneezing at the Americans.”

The Influenza has indeed been infecting the Germans throughout  Europe  — as well as others throughout the rest of the world — for months. In the fog of war, no one seemed to be paying much attention to the Flu’s entry into the United States.

Either the connection has not been made, or people are denying it. Witness the euphemisms: Three columns away, we learn the sad news that Miss Lena Marcaurelle of Mt. Pleasant Avenue, 21 years of age, has died after an illness of only a few days duration. Also, we notice that John P. Hills is home on sick leave from Fort Andrews in Boston Harbor.

On the other hand, in the same September edition of the Chronicle, local awareness opens its lazy eyes and mouths speak out with the parochial war cry: us versus them!

Cable Hospital in Ipswich

Hospital Closed to All Visitors — In order to prevent as far as possible any epidemic here of the Spanish Influenza that is prevailing in other places steps are being taken in many ways. At the Cable Memorial Hospital visitors are not admitted until further notice. This action is taken by the Executive Committee in order not to endanger the patients at this institution.

By Monday September 27th, one long week later, the game has changed significantly. The Pandemic is raging and has made the front-page of the paper for the first time. Mrs. Calvin Holmes, another 21 year-old, dies of the Influenza. Her funeral services — held by Reverend William J. Kelly at the Methodist Episcopal Church — were likely well attended as she was well-known. Her parents, the Ralph Pickards of Warren Street, who might very well have attended the services, are also ill with the Influenza. Her husband, a merchant marine stationed in Boston, is also seriously ill with the Influenza.

Oddly, we learn that this Flu attacks healthy 20 to 40 year-olds far more often than infants and the elderly, whom flu viruses typically prey upon.

Ralph K. Whittier has taken out a front-page advertisement promoting his undertaking and embalming services offered at 7 Summer Street, noting that he is available “day or night”.  The Ipswich Opera House has closed its doors until further notice from the Board of Health.

The “condensed news column” gives us another bit:

NEW YORK — Spanish Influenza is rapidly spreading among soldiers in training, with epidemics at Camp Devens, Upton, Dix…”

We can gather substantial insight into the situation from this detailed and prescient letter written by a doctor at Fort Devens:

“Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis [BL: bluish skin resulting from oxygen deprivation] extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible.”

 “It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows.”

(Sgd) Roy | Camp Devens, Mass. | Surgical Ward No 16,

 29 September 1918

In this eventful week, estimates are more than 700 cases in Ipswich, and all public resorts are closed by the authorities. The Ipswich Mills are short-handed due to absenteeism. The public schools are closed down. Miss Maude Schofield is home from her teaching assignment since the Brookline Schools are closed as well. Mrs. Reuben Andrews of Liberty Street, 48 years of age, related to the Hills family, dies of pneumonia and her funeral is served by the same Reverend William J. Kelly who served Mrs. Calvin Holmes. Walter Dodge of East Street, merchant marine on the steamship Gavin Austin, is confined in his home. Julian Smith of Meeting House Green has it too. Miss Louise Grant of Water Street has it but is improving. James J. Merrill of High Street is not improving. Dr. McGinley of Central Street, has the disease. It is rampant; three Influenza deaths have been confirmed, then Albin Benedix of Manning Street dies, that makes four and counting. Churches, fraternities, and other  gatherings are discontinued by the Board of Health.

The Chronicle reports that the worst should be over. In this instance, hindsight is 20/20.

But only three days later, national news reports that the disease has broken out wildly. On the 2nd day of October alone, 851 New Yorkers will perish. Locally, this same Wednesday, the Chronicle front page notes that over 100 new cases were reported.

The National Guard set at Cable Hospital

By October 4th, the Influenza is a regular item in the Chronicle. In an upbeat article, the Trustees of the Cable Memorial Hospital have dedicated the Institution to treatment, and Martha Stewart (an improbably coincidental name) of the Coburn Home has volunteered to supervise volunteer school teachers who will act as nurses. (We can imagine that they were impeccably turned out!)

The Cable has also made its grounds available for a tent hospital that may be requested from the state. Another editorial column presents the State Department of Health’s advice for avoiding the Influenza.

From Saltonstall Street to Steep Bank, the Polish section of town, the Influenza is now rampant, as it has been in the Greek section of town. Most area residents are non-English speakers. At least two Polish immigrants and two Greek immigrants die this week. Doctors and druggists are working 24 hour days;  fortunately Dr. McGinley’s condition is improving, as he is needed back on the job.

Harry Joyce of Argilla Road, confined at the Long Island Hospital in Boston Harbor, is improving. Mrs. George A. Schofield returns home after several weeks at Cable. But all is not well. Five year-old Mary Rose Gallant, a French girl of Mt. Pleasant Street succumbs, as does five year-old Frank Comeau, Jr. of North Main Street. Harry E. Ward, also of North Main Street, dies at 31 years of age. Mrs. Helen Byron of County Street is confined.  (As would be most of the clerks who worked at her store, in a week’s time.) Charles S. Garette of Fruit Street has taken ill.

The First Church, disregarding the notice from the Board of Health, holds a large evening meeting. All the Churches decide to cancel Sunday services. The town Library is asked to close. Reverend Guy E. Margeson of the Immanuel Bapist Church is taken ill to Cable.

This week, there were 470 workers absent from the Ipswich Mills.

Mrs. Frank T. Waters, on behalf of the District Nursing Association, requests that those fortunate owners of automobiles, that still new-fangled contraption, loan them to the cause, and she seeks volunteers to assist the sick and the families of the sick.

From the condensed news, an extraordinary postponement of orders in a time of war:

WASHINGTON — Because of the epidemic of Spanish Influenza in Army camps… cancelled orders for 142,000 ‘draftees’…

On Friday the 11th, the pages of the Chronicle are spotted with items. The lead:

THE OUTLOOK MORE FAVORABLE — For the six days  commencing Monday… local doctors reported a total of 475 new cases…”

Lodges, clubs, bowling alleys, billiard rooms, pool halls, coffee rooms, and soda fountains are shut down. Right here in RiverCity. Funerals must be private, for family members only, and in many areas they are restricted to 15 minutes duration. A news writer prescribes that treatment outdoors is much preferred, ergo the tents at Cable. Volunteers are knitting blue wool sweaters and now there is a call for gray outing flannel ‘Johnnies’ . Thirty patients are at the hospital with pneumonia, where, and from which, the young French girl had died.

Good news: Mrs. William Garrette of South Main Street is much improved, as is Dorothy Hall of Market Street. Mrs. Kyes of 26 High Street is coordinating an effort to make 100 comforters for the Red Cross. Curiously, in Chicago the crime rate drops 43%, as criminals are struck down alongside honest citizens.

On the other hand, while Mrs. Helen Byron has improved, the clerks in her store have caught the flu: Miss Bertha Duguay of Topsfield Road and Miss Rosa Marcourelle of Mt. Pleasant Avenue. (Perhaps this Rosa lost her older sister Lena a few weeks ago.) Miss Annie Arkin of Mt. Pleasant Street has died. Miss Margaret Player, 12 years old of High Street, has been taken to Hospital as has Miss Laura Chaput. The former Principal of the Junior High School, Ralph W. Wescott, is critically ill, at Camp Upton. The Chief of Police, John F. Dupray, takes a fifteen day leave of absence for reasons unstated.

Miss Stella Goldsmith of Rowley, a top graduate of the Manning High School when she was only 15 years of age, has died at age 17. Miss Cleola Davis of Ward Street, Miss Marjorie Morris of High Street, and A. Warner of County Street are ill.

Several daughters of Nova Scotia have succumbed: Mrs. Frank Scahill, 34, of Central Street, nee Emma Wright, and Mrs. Christina Jones, mother of Mrs. Fred L. Grant, at age 70. Starvors Poulos of 106 5th Avenue died. (Did the newspaper misspell this immigrant’s name?)

The Ipswich Grange cancels its annual meeting, as do other organizations. The Chronicle reports that the epidemic has slowed troop shipments to Europe as well as re-supply of troops already deployed. In New York City the Board of Health has changed the hours of offices, stores, and theaters to thin out the number of passengers on public transportation at the same time.

Camp Mason, the tent field hospital at Cable, is being set up by Company N of the 15th Infantry, steam pipes are being trenched in, lights wired, and they plan to be busy taking in Rowley residents as well those from Ipswich. The Camp consists of one street, 50 tents, and 2 cots per tent. The Federal government has agreed to build a 180 foot long medical building as well, and the lumber is arriving.

Mrs. Harry K. Damon of Manning Street is coordinating a group of ladies who are making the gauze masks used by the doctors and nurses. The prevailing medical opinion in the paper is worth quoting:

“In cases of pneumonia, the patient suffers from lack of oxygen in the lungs. It stands to reason that if the patient is as near to out of doors as possible, that a larger and better supply of oxygen will be had than if the patient were confined in a closed room where the air is none too pure.”

A third front page story notes that “the state of public mind in Ipswich has been disturbed”, and takes a chastising tone with the populace for  spreading rumors about death. (BL: Hmmm… in reflection, what are the facts, what are the sensibilities, with which we analyze and decide our opinions, our impositions on others, our beliefs about what is, and what should be? There is a lost lesson in here, for all of us.)

Inside the pages of the Chronicle, the Spanish authorities deny that the influenza has Spanish origins, even though the paper notes that King Alphonso caught it. (So did President Wilson.) Surgeon General Rupert Blue has released the Federal government’s official wisdom, noting that we do not know if it originated in Spain, but also noting that the first influenza in the British colonies, in 1647, arrived from Valencia, Spain. It also seems that the Germans observed the illness as early as the summer of 1817. It is explained by the Surgeon General that the disease is caused by “long-named” germs and spread by expelling droplets of mucus that are air-born. The Surgeon General reminds us that King Alphonso also caught this same Influenza in 1893, asserting that it was possible to get it more than once. Blue also warns us to get fresh air and not live in over-crowded spaces.

October 18: The headlines declare that “Influenza on the Wane”. This week there are “only” 174 new cases, and only five new cases are admitted to Camp Mason. The Board of Health gives its approval for public organizations to resume their normal operations. The schools re-open.

But the flu is still in business. Mrs. Sarah Nichols of Green Street dies. Her funeral services celebrated by Robert B. Parker (another improbable coincidence of names) of the Episcopal Church. Mrs. Chrisola Skraka of High Street, born in Greece, 21 years of age, who immigrated to the United State of America in 1917, and her infant daughter of eight months both die. Her services were held in the funeral home of Ralph K. Whittier, on Summer Street. Also, the paper tells us the sad fact that “a Polish man whose name was not learned” has died. Six year-old Welsford Sheppard of Manning Street dies, and his father is seriously ill. A woman from Rowley, Mrs. Elsie Carey [Green] Collins, wife of Dr. Collins, a 30 year-old, a 1906 graduate of Manning High School, a teacher in the Ipswich Public Schools, passes away.

A week later, October 25, 1918, Miss Maude Schofield has fully recovered, as has Dr. McGinley, and CampMason closes. George Dexter of Central Street has taken several good snapshots of the Camp to show us its likeness.

Surgeon General Blue offers another press release, this one urges home care for patients in the face of a shortage of doctors and nurses, explaining, in the good Surgeon’s opinion, that “the present generation has been spoiled”, so home care is indicated, as is the removal of all the furniture in the room, and a prescription including “fresh smoothed sheets, hair combed.” It is difficult to reconcile these measured comments in light of the statistics. Before this month of October, 1918 is up, an unimaginable 195,000 Americans will have succumbed to this killer virus.

November 1st passes, painfully for some, as it is not over for them, regardless of what the authorities are telling us. The Chronicle reports that funeral services were held for Ralph LaCount of Poplar Street, 28 years young, who had worked for ‘The Shoe’ in Beverly. Only a few hours after his funeral, Mrs. LaCount dies. Mr. and Mrs. LaCount had no children or survivors. The Flu blankets the country, it is both indiscriminant and coincidental in its selection, and dispersed family members are no safer than the rest of us: we learn that Roberta Myrtle Brisbee has just died in Ipswich, and her father, Walter C. Brisbee has passed away at Camp Devens.

The Board of Managers of the Nursing Association thanks all the volunteers for their hard work.

Judge Hayes goes back to work.

Out of balance with the diminishing threat, stylishly late treatment tips are espoused in another lengthy column. This one makes the extraordinary claim that this pandemic is “La Grippe”, like the one in 1889, and that the mortality rate would calculate out to .25%, which is to say that for every 400 people who fell ill with the flu, 1 would die. This estimated percentage actually suggests a rather virulent version of the flu, since the average mortality rate for previous flu’s was closer to .1%, or 1 death out of every 1000 infected.

In truth, both of these estimated mortality rates were woefully low, by a factor of 10. After the smoke of this Pandemic has cleared, the mortality rate would calculate out to an unprecedented 2.5%, which indicates that for every 400 to become ill, 10 would die. This statistic becomes even more horrific when you do the math on a state, national, or global level.

November 8, 1918 the Chronicle reports about a South Carolina druggist who has a remedy, new to New England and apparently of interest to Flu victims, called Vicks VapoRub, a salve of Menthol, Camphor, and volatile oils. On closer inspection, what appears to be a scientific news column is a thinly disguised “paid advertisement”.

On November 11, 1918, at 5:45 AM, the Ipswich Fire Station blasts the fire horn 10 times in succession, rousing the populace and signaling the good news that the Armistice has been signed. The celebration begins. Churches throughout the town pick up the message and all the bells are ringing. The day is filled with tears of happiness, parades, a bonfire on Market Street, marching bands, and people embracing.

Unfortunately, the large public celebrations, not just in Ipswich but around the country and the world, are a public health disaster. The Spanish Flu virus takes full advantage of the closely packed crowds, rekindles itself and spreads again.

On November 22, we hear an alarming but deceptively low statistic: a Chronicle article reports that 78,000 in major metropolitan areas of the US have died from the Spanish Flu over just the past few months. That is only a small slice of the pie, as we soon find out.

The Broader Perspective

In the 19 months of US involvement in the Great War, approximately 55,000 U.S. soldiers lose their lives in European combat. In nine weeks just prior to the end of the War, approximately 60,000 U.S. soldiers — back in camps within the United States — lose their lives to the Flu.

For those who are interested in additional comparisons, AIDS is one tragic example. HIV2 infections are estimated at 9 million mostly in Africa. HIV1 is a more virulent form infecting an estimated 5 million, mostly not in Africa. Over the last 25 years, 25 million have died from the effects of the AIDS virus; this painful pandemic has extended over many more years than the Spanish Flu, and is permanently infectious for the balance of life, unlike the relatively short-lived but virulent avian flu varieties. Herpes, Ebola, and Hepatitis are other dreadful viruses worthy of attention.

Of SARS, a recent avian-flu in the news, 800 died. Approximately 8000 were infected with SARS, making mortality an unprecedented 10%, four times the rate of the Spanish Flu. And the estimate of economic damage from SARS was in the range of USD $40 billion in Asia-Pacific alone. (Sad to note that this shocking regional loss is less than what Americans — who are gaining more weight than they lose — spend on unproven diet products in just one year.)

Of course things change, our knowledge of viruses and what to do about them, the speed with which we can mobilize against such threats, on-going research, the ability to communicate and forewarn instantly, and much more. The good news is that SARS was tracked, studied, and contained. While the mortality rate is a huge concern, the volume of deaths has been extremely low. The societal toll was heavy on the economic impact.

This suggests some ways to think about our reactions to the two viruses. Perhaps the reaction to SARS is about personal economics, along the lines of “If I get it, it will kill me. If I don’t get it, it will destroy my business. We can do little about it other than demand that our governments and scientists put an end to it.” Perhaps our reactions to the Spanish Flu are about “If it comes, we will get it. Lots of us will die. It will destroy our families. We can do little about it other than deny its virulence.”

In either scenario, there are still many unknowns. We can reflect on these viruses from many perspectives in time. As you read the quote below, you can reflect that it was written 60 years after the Pandemic of 1918, or you can look at the fact that it was written 26 years ago, or you can apply the point-of-view of the present, when we always seem to be on the edge of the abyss of the next great pandemic. Here are the thoughts of one appropriately named medical professional who gives us reason to puzzle about our safety:

“It is salutary to remember that we do not really understand why the devastating pandemic of 1918-19 was so severe, and that we cannot therefore be confident that our modern medical measures would succeed against a similar future challenge.”

Professor N R GRIST
British Medical Journal of 22-29 December 1979

The most recent viral entry, H5N1, a code that refers to the basic chemistry and structure of the virus, is basically a disease in birds. Poultry. Chickens. It can also pass from infected birds to humans via direct contact with an infected bird or items that have been in contact with infected birds. Know that horses and pigs are also susceptible to influenza viruses.

This H5N1 strain appeared in Hong Kong in 1997; 18 humans were infected. Six died, which is an unprecedented 33% mortality rate. In 2003 in China and South East Asia, particularly in Vietnam, there have been reports of 130 humans infected, of whom 67 died, for a whooping 51% mortality rate.

Chances are, if the H5N1 virus gets into your body, you will die virtual moments later.

So far, H5N1 has not made the fearful genetic shift of being able to transmit from one infected human to another. That is the big danger. Before you can say “quarantine” three times, the virus will have been  transported along with the carrier and their baggage, through security lines and x-ray machines at the airport, across our close-quartered and well-traveled world that is separated only by the closed cabin air of 15 hours flying time Ho Chi Min City to New York City. This sealed metal incubator offers scant protection. Rather, the airplane virtually lends the virus a third skin, along with a sardine-packed environment perfect for immediate transmission as well as an extraordinary burst of dissemination at its destination, infected passengers dispersing by their various modes of transport to their various nearby communities.

That is why officials around the world are concerned and taking action.

Simply put, the strategy for dealing with H5N1 and others of this ilk   goes like this: the current drug development technology requires that truly preventative vaccines can only be designed in reaction to the exact virus strain that infects humans. Those strains of course can be acquired only after they have mutated into existence, so we cannot  design or manufacture a vaccine ahead of time. Unless we purposefully  mutate the virus strains ahead of time, which is a rather dicey proposition replete with ethical and safety issues, and there are so many possibilities that it would be the work of a truly mad scientist, or one bent to a truly evil will. So the second best idea is to design and manufacture and administer a vaccine that’s “for the birds”: poultry… chickens, turkeys, ducks. That is the idea for the healthy birds, anyway.

And meanwhile fight the fight on the soil— in the coop — where it’s proliferating. The sick birds get destroyed along with all their coop-mates, on the guess that they, too, are infected. “A bird in hand” so to speak. Get to it before it gets to us.

It sounds like a trivial threat — who’s afraid of a big-bad chicken — in the face of the US administration’s coincidentally similar “nip it at the bud” logic of fighting terrorism in Iraq. Comically, it suggests a whole new set of answers to “why did the chicken cross the road?”

One wonders about chicken prices if it goes bad, will they go the way of oil, $11.50 per pound let’s say? If not, why not? Geo-political economic complexities abound.

Ultimately, it is far from funny. For sure, it is deadly serious. If the chicken flies the coop (sorry, couldn’t resist), it could emerge all over the world rather quickly. By the time a vaccine had been designed, manufactured, distributed, and taken effect, applying the current mortality rate of H5N1 we might roll-back concerns about the problems of over-population.

(Not to mention all those chicken carcasses that must have been piling up. If the avian mortality rate is similar to the human rate, there would be billions of dead chickens just in China. What to do… all that tea, all that rice… where will they put the dead chickens? If they shipped them to the US along with all the other imports, perhaps they could be sealed into all those pots they showed up in back in the thirties, then packed up into all those cars people got for every garage, then the whole assemblage buried out-of-site out-of-mind in the auto-parts junk yards of side-road America. Good gravy! Herbert Hoover and Frank Perdue will be spinning like pinwheels in their graves.)

There is evidence that such a virus could go to either side of the scale for mortality.

Matt Steinglass in the Boston Globe November 27, 2005 reported that specialists see the disease as “endemic — widespread and ineradicable — in Asian poultry.” But it not only an asian problem, it is spreading elsewhere. Turkeys in turkey are dying. Really. A human victim succumbed half-way around the world from Asia, in the Netherlands. Even Flamingoes, and a variety of migratory birds have it. The thing is, truly, airborne. Birds in Siberia carry it, and closer to the homeland, ducks in Quebec.

November 12, 2005 The Economist reported that Japan and Malaysia had acted quickly and eradicated the avian virus, whereas poorer countries did not have the capabilities so continue to be a source of risk. The cost of eradicating the threat at the source is estimated at $1BB. The World Bank is coughing up half of it, $500MM. Based on my reading, I believe this is just the cost of destruction and defeat, much as we measure the costs of our wars while they are in progress. I do not believe this includes the economic costs of making these poor countries and farmers and processors and distributors whole, again. But I could be wrong. In any event, the reasons given for appropriating funds are not exactly in direct correlation with the way the money is spent. (I know, you are shocked.)

The US is chewing over the allocation of $7.1BB, mostly to buy potentially useful drugs for potentially useful citizens of the USA. Of the $7.1BB, $250MM may be sent in support of the international effort to destroy and inoculate birds. The math suggests that there is a national and chauvinistic fear function in this equation somewhere.

Other strategies have surely been considered, and one hopes there are other investments being made, perhaps into research labs and production facilities so they are better able to analyze and produce and distribute effective vaccines and treatments. Surveillance is on-going, there is some stock-piling of a limited supply of anti-viral medications, there is a bit of preventative education.

December 2, 2005 byline China, Howard French of The New York Times reports that live-stock workers in China are inoculating poultry day and night, but not always wearing protective masks and gloves, which would seem to open them up as prime targets for outbreak.

Bird Flu has been reported in Greece, Italy, Turkey, Croatia, Russia, Azerbaijan, Mongolia, Romania, Iraq, Iran Nigeria, Nairobi. Several hundred human deaths due to the virus has been confirmed in Cambodia, China, Indonesia, Thailand, Turkey, and Viet Nam. So far, almost all of the deaths are in small households where chicken are raised for food, and not in large commercial chicken processing plants.

February 16, 2006 byline Sydney, Australia Geoff Hiscock of CNN reports a Lowy Institute study estimates possible losses from a pandemic ranging from 1.4 million to 142 million dead, and costs from $330 billion to $4.4 trillion. H5N1 has been verified in Germany and Austria. There are several deaths in Turkey, another in China. To date, the US has invested about $400 million in seeking ways of preventing an epidemic.

People are eating fewer chicken, fewer eggs. There is talk of four versions of the H5N1 virus, making it geometrically harder to create vaccines. In some cases, infected birds appear normal, in other cases, the flu is characterized as Chicken Ebola, due to the fierce bleeding that it causes. Hundreds of millions of birds have been destroyed. Meanwhile the virus sustains its structure and potential for up to 35 days in bird droppings, and lives longer in cooler climates.

March 30, 2006 byline Los Angeles Jia-Rui Chong and Denise Gellene report in the LA Times, that a study in the New England Journal of Medicine found that vaccines for the flu needed to be 12 times stronger than normal, meaning the stockpile is 12 times smaller than thought, basically enough for 4 million health care workers.

This year, eight members of a family in Sumatra die, as do four of eight infected family members in Turkey. The fear is that these may be incidences of the virus mutating and passing directly from human to human. Based on statistics from US history with annual flu, 20% of infected individuals pass it on.

In an effort to prepare for the worst, US Navy doctors recall injecting blood from recovered victims of Spanish Flu into sick patients, thereby cutting mortality rates in half. It is characterized as a method “worth a shot”.

October 11, 2006 byline Washington America.gov Charlene Porter reports 14 human deaths from the virus in Egypt.

The virus has reached 50 countries. Cats in Indonesia are getting the disease, but it is not known if they transmit it. The World Bank estimates that the cost to South-East Asia is $10 billion so far; they  pony-up $28 million in grants.

February through July, 2007 byline Washington America.gov Cheryl Pellerin reports the first human death in Nigeria. In the United Kingdom, the flu is detected for the first time, in turkeys. Bird gatherings are outlawed throughout the British Isles. In an article on 20 March, we learn that the official mortality rate based on the statistics of the World Health Organization is a staggering 169 out of 281, or 60%.  This is utterly unimaginable. When it gets you, it gets you good. In April, the same reporter tells us that as 16 year-old boy has died of the flu, with no known contact with birds. On 5 July the statistic is 191 of 317. The virulent flu continues to bat over 600.

Ruled by the Stars

What is this thing we call “influenza”? One definition has it that “influenza” means “influenced by the stars”, expressing our ignorance about illness and epidemics, and therefore our sense that the flu must be caused by some imperceptible process in the heavens. To work at a better answer will take us on a journey to the confluence of micro-biology, chemistry, geometry, a bit of physics, psychology, a hint of social patterns and ethics, topped off with a dusting of economics, politics, and philosophy.

Let’s begin with a sense of what influenza viruses are and how they work. First of all, and most interesting, is that viruses are inert. That is, they cannot move or do anything of their own accord. Those very characteristics of movement and action have always seemed to be a good way to start out a definition of life. So is a virus alive? No, not if being alive requires the ability to move, and eat, and adapt. No, not if being alive requires you to be able to reproduce. By other definitions of life, perhaps yes they are sort of alive, because these inert viruses can be propelled by outside forces into specific conditions where their inert presence can actively cause circumstances in which they can produce and simultaneously destroy, wildly.

Ironically, since viruses are such effective copy machines, they may some day be put to work cloning good DNA for gene therapies that could mitigate a wide variety of dastardly illnesses caused by faulty DNA.

On the sunny side, it is easy to imagine that the occurrence of this simple viral structure was a necessary sub-development prior to the occurrence of more complex and recognizable life. The virus is, you will be interested to learn, the smallest and simplest of all the  biological-like things. This category of things is labeled “microbes”, and they have been detected in the fossil records all the way back close to the formation of planet Earth, 3.5 billion years ago. Scientists believe they found evidence of viruses on a meteorite that was ejected from Mars even before the Earth formed.

Back to the dark side, how do you kill something that may endanger your health and life, but is itself probably already dead? How do you kill a rock?

Close-Up on Influenza

Influenza is a nasty infection of the respiratory tract. We recognize the symptoms: feverish, headachy, really exhausted, a dry cough and maybe muscle aches and the chills. With kids, sometimes a runny nose or upset stomach.

But let’s move in closer.

Take a look at the chair you are seated in. If you were to search for an influenza virus affixed to that cozy armchair, you would need an electron microscope. What you would see through your microscope would be a lima bean glob, the surface completely covered in thousands of tiny spiked protuberances. If you collected and lined up the particles, one million would fit in one inch. For perspective, let’s do that old Medieval standby, the head-of-the-pin routine. Four or five hundred million virus particles can fit on the head of a pin. At the same time.

Up close to a single particle, the virus we are looking at has an inert outer waxy layer surrounding eight strand-like molecules. Like most occurrences, a virus is basically all about molecular forces and how some atoms just go ahead and combine and form structures with each other in certain circumstances, or don’t, in other circumstances. That’s basically it.

Slightly deeper science teaches us that these virus molecules (made of atoms, in turn made of protons, neutrons, electrons, made of quarks, made of hadrons, maybe made of strings of energy… ) in proximity with other molecules (made of specific amino acids, which are substances that underlie all the processes we associate with life) rapidly combine and begin manufacturing molecules identical or similar to themselves (made of specific proteins).

In the beginning, the molecular process of the inert virus is in many ways just like the molecular process in a rusting piece of iron or in a growing plant reaching for the sun or in your brain cells as you read this page. The molecular process is simply an inevitable series of perfectly orderly bio-mechanical-physical interactions among forces that result in this or that outcome, based on this or that set of conditions.

There are no ethics here, no morals, just molecules and forces doing what molecules and forces do. The virus just sits around until it is subjected to various external physical forces that move it about. As it bumps against other molecules, it is subjected to their chemistry, which along with positive and negative charges (so-named by Benjamin Franklin) continue to move things into positions from which they can get down to their work.

Inside the virus particle there are eight complex strand-shaped molecules of either DNA or RNA. This is an important difference with life forms, since all life forms contain both DNA and RNA. To over-simplify, we can think of DNA as the components (puppy-dog tails and spice) that we are made, and the RNA as the instructions for making and assembling the components. These eight molecules can combine in a variety of ways to create a single complex macro-molecule, which  enables the virus to “recombine” into entirely new structures, be it benign or virulent.

What Happens

Sometimes, the inert virus molecule — which would make a feather look like a ton of bricks — gets airborne, and gets into a passerby by happenstance. Incoming!

From here on, the process amounts to teeny inert dead things routinely interacting with bigger attentive live things. The  molecules do whatever it is they are compelled to do. They cannot go against nature, they are nature.

It seems creepy… weightless and invisible zombie lima beans hanging around the water cooler until a slight breeze from a passerby launches them toward your unsuspecting airways, to breathe into your vulnerable lungs along with your next great gasp with which you plan to share the latest gossip about last night’s episode of American Idol.

Once it (the virus is still an “it”, at this point) gets inside you, most likely through the Achilles’ heal of your mouth or nose, it lands next to a living cell that is obliged to interact and exchange bodily fluids with other tiny entities. This, after all, is the stuff of which we are made and the way it works.

But it is then that the trouble really begins. The mechanics are elegant. The virus is a bit like a sack whose physical proximity to a healthy cell is a virtual set of instructions that often begins with an unfolding of the healthy cell which acts as if it is receiving a nutrient, enabling the virus to snuggle up. Like two children thick as thieves, the virus and the cell interact in the only way that is possible for them, given their composition and charges. The molecules bump and the forces whir them into position. Shapes turn and click into position like the tumblers of a combination lock, falling into the only order that that the forces and shapes can. The virus cell  docks with the body cell, and one way or the other it penetrates and enters.

In odd cases, the virus simply takes up residence and does not activate, sometimes, for years. But typically, fluids are exchanged within the cell, more micro phenomenon are compelled, the cell produces copies of the virus, those copies are packaged up and bud their way out of the hijacked cell.

Sometimes the new virus cell takes along some of the hijacked cell’s DNA, which can work for the good or the bad. Muscular dystrophy, hemophilia, and cholera are possible examples of the ill effects.

In any event, too much of this viral manufacturing and the previously healthy cell pops, destroyed. This is bad bad bad. Worst case, death by pneumonia.

Viruses do their thing with animals, vegetables, and minerals. It is our perspective as mortal beings — who wish to live long and prosper — that gives the virus negative connotation. From our modern vantage point, we might make an analogy: the behavior of viruses to the behavior of business owners who acquire a manufacturing company. The new owners (the spiked viruses) impose their will on the production line (the host cells), the new management provides enhanced manufacturing processes (the RNA) and then the new owners reallocate factory assets (the host cell again, using its own materials such as enzymes) to the production of the new product (replicas of the virus called virions), which is made to the specifications of the new owner.

By the way, other types of non-flu viruses cause the common cold that sends us crawling and clawing for our Kleenex boxes to stop up our runny noses, a symptom that the flu does not typically exhibit.

And So It Goes…

At one time or another, all of us struggle to remember the difference between viruses and bacteria. Bacteria are much bigger and very much alive. Illnesses caused by bacteria, like the infamous e-coli, need to be treated with antibiotics. Antibiotics have little or no effect on viruses like influenza. Incidentally, viruses often snuggle right up to bacteria and infect them the same way they infect humans!

There are also several entities that are in fact related to viruses. The viroid is like a shell-less virus thought to cause Hepatitis D. Prions are virus-like proteins that may cause Alzheimer’s and so-called Mad Cow Disease.

At the end of the day, if there was ever anything even remotely credible to the idea of intelligent design, it would appear to have given disproportionate advantage to viruses over humans. Given their size, you could carry enough virus molecules on just one fingertip to dose the entire global population 10 times over. Perhaps pestilence will win out after all, and Armageddon will turn out to be no larger or distant or more violent than cells floating around in our lungs, and us coughing ourselves to death in the foreground.

As a matter of annual battles with routine flu bugs, and based on several admittedly shaky estimates, we can calculate that somewhere around 45 million US residents can expect to be stricken every year, as many as 450,000 will end up in hospitals, and 20,000 will die.

There are treatments for influenza. Most of them are in the column labeled “preventative”, starting with vaccines recommended primarily for the 65-and-over crowd, people with certain chronic diseases, and of course health care workers. There is a problem getting the vaccines right, however, since viruses are constantly undergoing one or another kind of change. “Anti-genetic drift” is a relatively slow process in which a random build-up of extraneous genes in a virus eventually changes it enough to make it newly contagious. “Anti-genetic shift” is a relatively sudden appearance of a virus that has  jumped from one species to another, such as from birds to people.

Educating the masses about the flu and how to avoid is another preventative measure: viruses live on surfaces, you can kill them with a strong disinfectant, or with heat. Ideally, in times of trouble one keeps his or her hands away from his or her mouth and nose. We see air filter masks on concerned citizens, and several potions such as Tamiflu are on the market claiming to reduce the impact of the illness. We are far from defenseless.

Some of the preventative measures released by the US government are called “hand hygiene” and “social distancing”. Remember to cover your mouth and nose when sneezing, please. And of course you can kill the hosts, the birds, and try to stop it at the source.

But be forewarned. All tallied, 675,000 U.S. citizens died of the Spanish Flu in only seven months. Worldwide statistics are far more tragic. By way of comparison, In the four years of the Great War, 15,000,000 combatants and civilians die world-wide. Incidentally, France lost far more combatants than any others, about 1.4 million, with repercussions that would echo in that country for the rest of the century. In far less time than it took to fight that Great War, the Epidemic of 1918 took in the neighborhood of 40 million lives world-wide. Updated percentages lost of these populations would forecast about 2,000,000 American deaths, and somewhere in the vicinity of 200,000,000 around the globe.

Worst case, you ask? What we would do with a 51% mortality rate of 3,287,531,212 bodies I don’t know. I do recall having read that all the humans who have ever lived and died, over the course of all of existence, could be buried in one modest corner of the Grand Canyon…

At that calamitous scale, H5N1 would earn the right to a more illustrious and gutsy label, perhaps like the Apocalypse.

2 thoughts on “From the Pandemic of 1918 to the Bird Flu

  1. Excellent article Gordon. You bring to life the tragedy as it effected our small town while placing it in a larger, global context. Well researched and thoroughly entertaining.

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