100 Years Later: A Look At The Deadliest Pandemic In Human History

John M. Barry's book, 'The Great Influenza', ought to be one of priority  interest for every citizen, especially in a government shutdown - even one spawned by a monumentally stupid unforced error committed by arguably the worst president in American history.  As NY Times columnist Paul Krugman described it in a recent column:

"There have been many policy disasters over the course of U.S. history. It’s hard, however, to think of a calamity as gratuitous, an error as unforced, as the current federal shutdown."

In terms of influenza - which now appears to be flickering out in the U.S. (WSJ,  'Flu Season Looks Less Dire Than Last One',  Jan. 11, p. A3)  we also know that in 1918 the first emergence of what was to become "the Great Influenza" began with a weak initial foray (akin to a 'mild flu' today) in the spring.  It then abated, and returned with a vengeance in the fall. 

How bad was it near the end? Barry's description of the scene in Philadelphia in the winter of 1918-19 says it all (p. 326): 

 "The corpses had backed up at undertakers, filling every area of these establishments and pressing up into living quarters; in hospitals morgues overflowing into corridors; in the city morgue overflowing into the street. And they had backed up in homes. They lay on porches, in closets, in corners of the floor, on beds."    

Obviously no corpses were actually counted but best estimates - according to Mr. Barry and other researchers -put the infected global total at 500 million, and up to 100 million dead.   If this is an upper limit estimate it means 5 % of the world population dead from this flu pandemic.  (The lower limit is generally taken to be 1.9 % of the world's population dead.) By contrast, the Black Death which raged from 1347- 1351, is estimated to have wiped out over a third of Europe's population, and reduced the global numbers from 450m to between 350 m and 375m.  At the upper limit this means up to 22 percent of the world's population removed by this pestilence.  In other words, while the Black Death took out a larger proportion of the world's population, the 1918 Influenza pandemic took out more in sheer numbers - but not as a proportion of the total (estimated at about 1.5 b at the time).

Why is this germane now?  Well, because a government shutdown with reduced resources, for example at the TSA  (to check for biological material or infected victims) leaves us more exposed than it would otherwise. 

Now it is true that the influenza winding down has been much less virulent than last year. According to the previously cited WSJ piece:  "As many as 7.3 million have fallen ill" and there've been about 12,000 deaths.  Last year's H3N2 outbreak felled 48.8 million and killed over 80,000.  Maybe we were fortunate  - at least thus far- that the H3N2 epidemic did not occur this year with the shutdown going on.

Anyway, the question we ask here is what manner of pestilence was this 1918 influenza that it could have bodies piled up like cordwood in many cities (estimated 675,000 dead in the U.S.) . Barry translates this death toll - more than killed in the Civil War (620, 000 in the line of duty) -  to 1,750, 000 in the context of our proportionately greater population today.   This is a bit larger (by roughly 200,000) than the population of Philadelphia today. 

So how account for this horror which felled so many humans and caused more deaths than the Black Plague of the Middle Ages?   The best way to appreciate the magnitude of the catastrophe is to go inside Barry's medical records and descriptions of the time, and in particular to see the literal holocaust this influenza inflicted on human bodies in its 1918 fall re-emergence.  

First, an idea of the relative proportion of flu deaths relative to others  (p. 238):  "During the course of the epidemic, 47 percent of all deaths in the United States, nearly half of all those who died from all causes combined, resulted from influenza and its complications."

In other words, the toll from influenza exceeded that for cancer, heart disease, stroke, tuberculosis, accidents, suicide and murder.

Another curious aspect of the re-emerged influenza lay in the age groups targeted, not so much the elderly or the very young but rather the young, healthy adult. From p. 239:

"The single greatest number of deaths occurred in men and women aged twenty -five to twenty nine, the second greatest number in those aged thirty to thirty four.  The third gresatest in those aged twenty to twenty -four."

One of the myths circulated in the ensuing years about the 1918 pandemic is that it killed just about everyone infected. This misconception, given the actual death rate was closer to 3-  5 percent, likely got started when people saw or read headlines of the accumulated dead, e.g. p. 223: "Undertakers, themselves sick, were overwhelmed. They had no place to put bodies. Grave diggers were either sick or refused to bury victims." 

Or (p. 224): "In homes, corpses were wrapped in sheets, pushed into corners, left there sometimes for days, the horror of it sinking in deeper each hour. People too sick to cook for themselves, too sick to clean themselves, too sick to move the corpse off the bed- often lying on the same bed with the corpse"

Reading this would even prompt many today to believe that anyone who contracted the 1918 flu was killed by it. In fact, the 1918 virus' reproduction number (an estimate of its transmissibility) was only slightly higher (1.8) than the H1N1 (1.4 to 1.5)  that caused the 2009 pandemic - and for which Obama declared a legitimate national emergency . (For reference, a reproduction number of 1.0  means that each person infected will, on average infect one other person).  Still, the slightly higher transmissibilty meant (p. 231): "This virus is transmitted so effectively that it exhausts its supply of susceptible hosts".  Which meant that tens of millions had been sickened in the U.S.

The point missed here, is that our civilization stands on a much more tenuous threshold than many believe, say between stability and chaos and collapse.   In other words, it doesn't take a 100 percent or even 50 percent fatality level to bring us to our knees. Five percent or ten percent can do it, especially if critical manpower is affected.  Then yes, corpses will "pile up" and there won't be the people to deal with them, or the space, venues. Let's again hope no Avian flu (H5 N1) outbreak occurs during this stupid Trump-McConnell-Ann Coulter shutdown.

 Moving on, it's instructive to read the level of carnage inflicted on the organs of many victims by this newly spawned  H1N1 influenza virus. 

E.g. p. 227: "Most striking was the cyanosis, the patients sometimes turning almost black. After gasping for several hours they became delirious and incontinent, many died struggling to clear their airways of a blood tinged froth that sometimes gushed from their mouth and nose."

P. 235:  "In Proceedings of the Royal Society of Medicine, a British physician noted 'one thing I have never seen before - the occurrence of subcutaneous emphysema - pocket of air accumulating just beneath the skin. Beginning in the neck and spreading sometimes over the whole body'. "

Further (ibid.):

"Those pockets of air leaking through ruptured lungs made patients crackle when rolled onto their sides. One navy nurse later compared the sound to a bowl of Rice Crispies."

And(ibid.):  "Extreme earaches were common. One physician noted inflammation of the middle ear - marked by pain, fever and dizziness- 'developed with surprising rapidity and rupture of the drum membrane' was observed sometimes a few hours after the onset of pain....Discharge of pus from the ear was also noted."

Further (p. 236):  

"Then there was the blood spurting from the body. To see blood trickle, and in some cases spurt from someone's nose, mouth, even from the ears or around the eyes had to terrify. ...."

P. 237:  "In U.S. Army cantonments, from 5 to 15 percent of all men hospitalized suffered from epistaxis - bleeding from the nose, as with hemorrhagic viruses such as Ebola. There were many reports that blood sometimes spurted with such power to travel several feet."

"Female patients had a hemorrhagic vaginal discharge - which was at first considered to be coincident menstruation. But later was interpreted as a hemorrhage from the uterine mucosa."

P. 240:  "In the meantime this influenza, for after all it was only influenza, left almost no internal organ untouched. One distinguished pathologist noted blood flooding from the brain, probably because of an out of control inflammatory response.... the virus also affected the pericardium, the sac of tissue that protects the heart.

"The amount of damage to the kidneys varied but at least some damage 'occurred in nearly every case'.  The liver also was sometimes damaged. The adrenal glands suffered 'necrotic areas, frank hemorrhage and occasional abscesses...muscles along the rib cage were torn apart both by internal toxic processes and the external stress of coughing.... even the testes showed striking changes encountered in nearly every case."

And p. 241: "Only one known disease - a particularly virulent form of bubonic plague called pneumonic plague, which kills approximately 90 percent of its victims - ripped the lungs apart the way this disease did."

The preceding documentation leads us to ask what aspect of the virus led to its sheer lethality and violence - especially for young adults. Barry provides the clues on pages 247-48, and these have to do with an over reaction of a too strong immune system.  As he writes, "the immune system is at its core a killing machine. It targets infecting organisms with an arsenal of weapons...and can behave like a SWAT team  that kills the hostage along with the hostage taker."

Such is the case when an invader like the 1918 flu virus enters the lungs given the first line of defense involve the entire respiratoruy tract and lungs - which cells "secrete enzymes that attacks bacteria and viruses - including influenza - or block them from attaching to tissue beneath the mucus."

The problem is that this attack can lead to unintended consequences, as if a biological SWAT team - comprised of macrophages and 'natural killer cells"- targeted the body instead od the invaders.  As Barry writes (p. 247):

"The virus was often so efficient at invading the lungs that the immune system had to mount a massive response to it. What was killing young adults a few days after the first symptom was not the virus. The killer was the massive immune response itself."

He then describes the mechanism  of inflammation that unleashes the so called   'cytokine storm'  which has the most devastating effects on young organs:

"Once an infection gains a foothold the immune system responds 
with inflammation .The actual process of inflammation involves the release of proteins called 'cytokines'. .. When cytokines bind to receptors in the hypothalamus, body temperature goes up, the entire boy becomes inflamed. In influenza, fever regularly climbs to 103 and even higher."

He then points out that cytokines themselves "can have toxic effects."   This means the typical symptoms of influenza, e.g. wracking cough, headache, body aches are "not caused by the virus but by cytokines."   Hence, your own body's defense mechanisms are what's making you feel so god awful.   And these defenders can kill as well, turning the lungs into a bloody mass by destroying the alveoli and wreaking other havoc in the aforementioned cytokine storm.  His description of the immediate process is stunning and bears repeating (p. 249):  

"The same capillaries that moved blood past the alveoli delivered this attack. The capillaries dilated, pouring out fluid, every kind of white blood cell, antibodies, and cytokines into the lung.. Then these cytokines and other enzymes virtually obliterate the capillaries. Even more fluid pours into the lung...The cells that line the alveoli are damaged even if they survive the virus itself. 

Pink, glassy membranes, called hyaline membranes, form on the insides of the alveoli. Once these form, surfactant - a slippery, soap like protein that reduces surface tension and eases the transfer of oxygen into red blood cells - disappears from the alveoli and more blood floods the lungs."

And there you have-   in blunt and brutal biological prose -  how a young adult (most often) drowns in his or her own fluids - while fighting the flu. In this case the misnamed "Spanish flu".   The purpose of this post has been to provide blog readers with an oversight of what transpired 100 years ago with the pandemic that wiped out more people than any other. It is also, hopefully, to encourage you to get hold of Barry's book or any other (like Pale Rider: The Spanish Flu of 1918 and How It Changed the World) because I believe all these works contribute to a better understanding of a history that's too often been ignored or de-emphasized. We need to understand these pandemics - especially of influenza - in the event an even more virulent and deadly virus awaits. 

In their book, 'The End of Epidemics', authors Jonathan D. Quick and Bronwyn Fryer argue that the most frightening future risk is the potential for a new, highly contagious and deadly influenza arising from a "viral stirring pot".  Such a "pot" would include avian, animal (e.g. swine) and human-infecting viruses.  They also note the opportunity for such mixing abounds as beasts, birds and humans rub shoulders in places like factory farms.  Like Dr. Sanjay Gupta's ominous warning given some years ago. e.g.


https://www.cnn.com/2017/04/07/health/flu-pandemic-sanjay-gupta/index.html

Excerpt:

"Pandemic flu is apolitical and does not discriminate between rich and poor. Geographical boundaries are meaningless, and it can circle the globe within hours. In terms of potential impact on mankind, the only thing that comes close is climate change. And, like climate change, pandemic flu is so vast, it can be challenging to wrap your head around it."

Dr. Quick's take is this is not a matter of if but "when".  All of us need to pay attention, and hope to Hell that when that monster bug strikes we are not in the middle of another government shutdown dictated and orchestrated by Ann Coulter and Donald Trump.

Addendum:  Virologist Vincent Racaniello has a list of  pet peeves about a number of Barry's claims which you can find on his "Virology blog".    My take is most are far too technical to cause readers of Barry's fine book to lose sleep, and even Racaniello admits they should not detract from reading it.  See e.g.

The problems with Barry's “The Great Influenza” - virology blog

Mail Call Brane: Readers Seeking Answers

Just curious as to the latest on Colorado’s MJ laws, and Implementing them.- Allan, Montreal, Quebec

A. The latest news is that on Wednesday the Colorado legislature made history, becoming the first in the nation to pass laws regulating recreational marijuana use. This now makes 4 major bills passed this year on marijuana legalization, and now the legislature awaits Gov. Hickenlooper to sign them. If he does sign them, and as a Dem Governor presiding over a D-legislature he ought to, then we will see the following (Denver Post, Thurs. May 9, p. 1A):


1-Marijuana will be sold in specially licensed stores that can also sell pot-related items such as pipes. However, only Colorado residents can own and invest in the stores, and only current medical marijuana dispensary owners can apply to open recreational pot shops for the first nine months. The first stores will open on Jan, 1, 2014.

2- Colorado residents will be able to buy up to an ounce of marijuana, the maximum legal amount for non-medical needs. Out of staters will be able to purchase only a quarter ounce at a time. The pot must also be sold in child-resistant packages, with labels that specify potency.

3- Voters will have the option of imposing heavy taxes on pot sales. A ballot measure set for November will ask voters to approve a 15 % excise tax and an additional 10 percent sales tax on marijuana. The excise tax will fund school construction while the sales tax will fund MJ regulation. Hickenlooper has already advised voters to pass the bills, and one wonders given his past MJ opposition, whether he will postpone signing the passed bills until November. And also, if the tax ballots don’t pass, then vetoing the four already passed MJ bills. I wouldn’t put this past a guy that once drank fracked water and claimed it was fine.

4- Incorporated marijuana collectives will be banned, so will MJ coffee shops, MJ-smoking in bars and gov’t run MJ stores. Though Colo. will have the most liberal MJ laws in the country – it will have the most restrictive laws in the country for MJ-themed magazines. These, like pornography, will have to be kept under the counter. (Publications such as 'High Times' have vowed to sue.)


5-Colorado drivers for the first time will be subject to a “stoned driving limit” (which is still being worked out). Juries will be allowed to presume that anyone testing above the limit was too high to drive.


Q. Were you aware that Sally Jewel, President Barack Obama's newest appointed Secretary of the Interior, is a pro-fracking hireling? Having read your blogs on fracking I wonder what you make of this appointment?
- Cheryl T., Wauwatosa, Wisc.


A. Okay, what Jewell actually said is: “ We must develop our domestic energy resources armed with the best available science, and this unbiased, objective information will help private, nonprofit and government decision makers at all levels make informed decisions about the responsible development of these resources. “ And yes, a number of right wing papers (i.e. The Washington Examiner) have taken this to be a strong endorsement of fracking. But as the Examiner puts it:


"Jewell was referring to hydraulic fracturing, or 'fracking, ' the process by which a pressurized mixture of (mostly) water and chemicals is injected into shale rock formations deep underground. The process provides access to natural gas deposits that would otherwise be impossible to reach. The technology has been in use for 60 years in Texas and Oklahoma, but its phenomenally successful use more recently in Pennsylvania to develop the Marcellus Shale and in North Dakota to develop the Bakken formation has sparked an energy revolution in this country.  Environmentalists oppose fracking, claiming it threatens groundwater even though the evidence for this claim is all but nonexistent.”


Of course, assuming this is so, then it would be an unmitigated disaster. Anyone who has read my prior blogs on fracking would see why, e.g. http://brane-space.blogspot.com/2013/02/that-disgusting-oil-reeking-fluid.html
and  http://brane-space.blogspot.com/2013/03/doctors-muzzled-to-prevent-warning.html


The facts are substantial so that appeal to scientific basis must mean not going forward with fracking and applying the precautionary principle: the frackers must prove their methods aren’t harmful to ground water supplies, not the converse- that potential victims must prove the harm. Already there have been more than 1,000 documented cases of water contamination while methane leaks associated with hydraulic fracturing have caused houses and wells to explode.  Moreover, fracking doesn’t just contaminate water but air as well. Residents in Dish, TX have repeatedly complained of illness since frackers arrived. Air quality tests have revealed high levels of benzene in the air.


The notion of natural gas as “clean energy” is also a myth. While it emits half as much carbon as coal and 70% as much as oil, it still imposes a carbon burden. In addition, it emits large quantities of methane gas which is 30 times more potent than CO2.  These figures, though smaller than the coal and oil carbon burdens ought not be ignored given that we have now hit 400 ppm of CO2 in the atmosphere, a threshold not reached for nearly 3 million years (Denver Post, today, p. 1B). What the new threshold means is that we have far less margin for error. Do we really want to conduct an aberrant experiment to turn our planet into another Venus, with a runaway Greenhouse effect - making it uninhabitable for future generations?

The production of this fuel also isn’t “clean” as it damages water, air and infrastructure. It is, in reality, no different from fouling our own nest to get a temporary solution to an energy problem –which is really spawned by too high a global population and too concentrated energy use.


Here are 5 other facts on fracking that ought to cause alarm and get the attention of our politicos who are too often hostage to special (read 'monied') interests:

1- Fracking a single well requires more than a million gallons of water. Here in COS, a number of wells have consumed over 3 million gallons, and many have come up empty. This insanity is occurring in an arid region in which we’ve had severe drought the past three years. The wastewater produced by fracking also contains high levels of radioactivity that wastewater treatment plants aren’t equipped to deal with.


2- Dangerous fracking chemicals are kept secret. In many states, the drilling companies won’t disclose the chemicals used in the fracking fluid, claiming the mixture is a “trade secret”. But independent analysts have identified 41 known chemicals most highly toxic carcinogens.


3- There exists a “Halliburton Loophole” with respect to most laws and oversight applied to fracking. This means the effluent generate by the frackers as well as their shale driller cohorts is exempt the Clean Air Act and the Safe Drinking Water Act So, E coli, is controlled in your water but it’s A-ok if carcinogenic benzene piles up.  Pardon me, but this selective regulation shows the paws of big, I mean BIG, lobby money!


4- The number of fracking wells is now growing at an exponential rate, in 28 states.

5- Turning on your tap (see image in previous links) liberates water accompanied by methane which can catch fire.

Fracking is unacceptable as an energy extraction process, since it imposes severe long term health costs to extract a temporary energy fix.


Q. In your April 13 blog on Bird Flu you mentioned the reported mortality rate of highly pathogenic H5N1 avian influenza and that “studies of the levels of cytokines in humans infected by the H5N1 flu virus show elevated levels of tumor necrosis factor-alpha a protein associated with tissue destruction at sites of infection and increased production of other cytokines” What does this mean for getting sick? How sick can you get? - Delores, Bellingham, WA


A. Pretty damned sick! So sick in fact, that even if you don't die you will likely want to. The tumor necrosis factor-alpha a protein is implicated in severe inflammation and also potential degeneration of organs affected, including kidneys and lungs. Similar effects were reported during the Spanish Flu pandemic but of course the micro-biological, genetic marker tie- ins weren’t then available. However, doctors who performed the autopsies of some patients reported lungs turned to jelly as well as other organs. Basically, with the cytokine storm and tumor necrosis factor-alpha a protein, your whole body is sent into a death spiral of organ shutdown, shock,coma from immune system over-stimulation.

The closest I came to this was in December, 1968 when I got the Hong Kong Flu. I vomited for days, could barely breathe as I coughed up bloody mucus with each spasm, and felt like I had burst at least one lung. It was a god-awful experience I never want to repeat, and that flu barely killed 1 m around the world. The H5N1 will likely be 100 to 500 times more lethal and brutal.  I took more than 2 months to recuperate.


Q. I got a kick out of your brother Mike’s comments in your April 21 blog on the biblical exegesis test. He claimed that “the Jesuits themselves are the “storm troopers” of the RCC, and their purpose is propagation of the RC faith by any means possible? (i.e., SATAN!)”

What is he some kind of a crackpot? I couldn’t believe this guy couldn’t take the bible test or even answer one little question. And he claims to read the good book! It seems to me he’s got a lot of talk but little to show for it. I notice that since April 30 you have totally ignored him. Is this intentional? Alice K, Joliet, IL


It is. I think I mentioned in my blog on Colorado MJ issues and Mike's onerous errors (‘Reefer Madness Redux’, April 30) that since it's useless to try to argue or debate him (since he’s totally ignorant of the basic parameters that apply to the content of any worthwhile argument) . there'd be no further exchanges. At least not until he could pass a basic test in logic, for which I provided a link at the end of the blog.


Up to now, he’s not taken the test - which indicates to me he has no logic to demonstrate, nor is he the least interested in using logic in his arguments. This being the case, he's all about making noise and nothing more.

Therefore,  it’s a waste of time to engage him on any issue. He can believe whatever he wants to believe, but I don't have to give any heed to what I regard as noise.  If then he chooses to come to this blog (which he probably does to dredge for new material since he can’t think of any on his own) that’s his choice. As far as I am concerned his blog exists only as background noise in the blogosphere. It merits no more attention than noise, and certainly not being considered as any signal.  And if it is noise, then none of his harangues or "issues"  merit being dignified by any response.

Q. My husband of 44 just had his lab test come back and his PSA has tripled in 2 yrs. from 1.8 to 5.5.  I have pleaded with him to get a biopsy but he's terrified of sepsis as he read that this occurs in any cases with these biopsies. He also fears, after reading your own blog of July 19 last year (Notes on a prostate biopsy) having a young female physician assistant doing the procedure and not the actual urologist. He also fears the type of pain you described. Is there any way to get him to change? I fear he might have an aggressive cancer that might kill him!- Genevieve R.,  Los Angeles, CA

A. Your husband is actually quite right to be concerned, as the incidence of deaths, infections (including from sepsis, or massive blood poisoning via infection) have risen sharply, see e.g. http://www.naturalnews.com/033660_prostate_biopsy.html

As the article notes:

"....the research team found that having a prostate biopsy resulted in men being more than twice as likely to need hospitalization in the immediate post-procedure period. And once hospitalized, the men were at an increased risk of serious complications including bleeding and infection, flare-ups of underlying medical conditions (such as heart failure or breathing disorders) and death.


The researchers emphasized in their paper that their new data should remind doctors to carefully consider the risks and benefits of biopsy for individual patients before performing biopsies to look for cancer in the prostate"

See also: http://www.npr.org/2011/05/23/136501992/doctors-fret-over-rise-in-prostate-biopsy-infections


So what to do?  The best advice is to discuss the problem with one's personal physician, and this includes a cost -benefits assessment. In my case, the biopsy was done after PSA doubling, and then after the free PSA test, which also yielded a high probability of cancer. (The free PSA may actually be the most sensible next step. It measures the concentration of free prostate specific antigen, i.e. in the blood, relative to the bound form. The result comes back as a percentage. If it is 25% or higher then the chances are more than 90% the problem is enlargement of the prostate, not cancer. If the result is 5% or less, then the odds switch in the other direction: 77% that it's cancer and not benign hypertrophy.)


My biopsy, done after the free PSA,  then found an aggressive adenocarcinoma in two cores (Gleason socre 4+3) , and cancer present in five (lowest score Gleason 3+3). I was told by the urologist that watchful waiting could not be an option, so elected to have high dose radiotherapy. 

The infection risk from prostate biopsies can be contained with scrupulous cleanliness, and that means a thorough enema before hand. Also, the biopsy patient  takes a ciproflaxin  pill just before. Another alternative is to have the biopsy performed via the trans-perineal route (through the perineum) which carries vastly less risk of infection because the rectum wall isn't being penetrated by the tissue extracting needles. The problem is that this trans-perineal procedure is usually more costly, since in general the patient has to be put under (general anesthesia) and more staff are needed to be present.

Re: the physician assistant, I don't think the sex ought to matter - but whether the person is competent. A good way to find out is to become a temporary member of 'Angie's List' and then look up urologists and see what the reviews say.  The fact is that more and more physician assistants are now doing these procedures, and if they have the proper training - which most do - then the expertise should not be an issue.

What IF the Bird Flu Pandemic Is Coming: What Do You DO? (1)

The ABC news report last night that a 7-year old Chinese girl has contracted Avian flu in Beijing, nearly 750 miles from Shanghai – the source of the outbreak-  ought to send chills down the spine of every sentient being. Though we don’t know exactly how she contracted the disease, whether from a distant wild bird or human – this we do know- this virus is evolving even as I write.

If we soon learn the virus has fully mutated to the highly pathological H5N1 form, and a global pandemic may be imminent what do you do? Of course, the first reaction (dumb!) of many will be denial: ‘It’s just a flu for cripes’ sakes!’, or ‘Look, the government is hyping it to try and get us under control!’ or: ‘I ain’t doin’ nuthin’ until I actually see people in my neighborhood getting’ sick!’


Devoid of any knowledge of the Spanish Flu Pandemic – which killed over 50 million over 1918-19- it is probably human nature to treat any flu outbreak as ‘no biggie’ but that could be a fatal error. I saw what my wife endured, with H3N2 flu and it was perhaps only one or two more days (unless she recovered) before I’d have had to rush her to an ER.

In the case of Avian H5N1 Flu, you'll not likely have weeks to endure and recover, but maybe a day or two. In that time you or a loved one will know if you or your loved one(s)  will live or die. And bear in mind here, hospitals will be overrun and switchboards clogged, so there will be little they can do once hordes of Avian-flu infected people begin pouring in.  This is also why a Will is essential for any Avian flu planning as well and I will go into that in the next blog.

What do you do when no one is yet ill but the Avian flu is rapidly spreading? First, note a huge difference between the H3N2 outbreak last year and a future Avian flu is that in the former one could still make multiple runs to the supermarket, and supplies didn’t run out. There were only limited numbers of the severely ill, perhaps 10,000 in a given community. This will not be so if Avian flu strikes the U.S. and millions of severe cases emerge within very short time spans. (Refer to the highly pathological effects, symptoms listed in the previous blog post)

Then, multiple runs will be made on every major supermarket,  corner grocery and even 7-11s as the outbreak takes down hundreds of thousands in the first week. So you can almost bet that will mean scarcity of grocery supplies within days. Don't be in the position of trying to build up your supplies, food stores when everyone else is, unless you don't mind getting stuck with Kibbles 'n Bits, lima beans and lemons.  The cautious move then is to begin (gradually) stockpiling food, water, etc. as soon as the CDC confirms human- to- human transmission of the H5N1 flu. Even if this is in Asia! So yes, that means you set to work BEFORE the first case is confirmed in the U.S.  Bear in mind here that this thing can and will be transmitted at the speed of modern jet flight - so after you hear the human-human transmission is verified in China, it may only be a day - perhaps 2 or 3 at most, before the first U.S. case shows up.  When that announcement is made by the health authorities, look for all hell to break loose!


The Y2K scare, though bogus, did provide an insight into how much food to cache. You are basically looking at a minimum of perhaps 3 months in isolation (with little or no gov't help)  and possibly local quarantines, once the flu strikes. Obviously, with runs on supermarkets the rule, there’ s little room for mathematical error. You begin by stocking as many diverse canned goods as possible: tuna, salmon, Spam, pineapple, chicken, beans, corn, spinach, whatever your family can go with and over a fairly long time. (In the next blog I will discuss cooking options, even if there’s no electric.)

How much to stockpile? That begins with the size of your household. Let’s say there are three people: 2 parents and one child. You will likely need (daily) the equivalent of 2 gallons of fresh water, and eight cans of tuna (or 4 cans tuna, 4 cans Spam) and three cans of corn (or three cans of beans, or pineapples). The sheer volume of stocked food is also another reason why it’s ridiculous to try and grab everything needed once the flu lands in your area. By then, you’ll only be able to get the dregs! So, what you’re likely looking at is a 2-3 week time interval to try to collect all the canned goods, water you estimate you will need.

Btw, that implies having a manual can opener – since electricity can’t be assumed to remain unaffected!

Re: water, remember to fill any bathtubs as well, since if the water ceases to be available (remember it depends on pumping which depends on electricity) you will still be able to flush the toilet.  Use the available water filled in bathtubs and  in any other containers you can find to flush toilets. Save the purchased bottled water for drinking. Since this flu brings on a “cytokine storm” as an over reaction of many human immune systems (see prior blog) and is liable to cause severe diarrhea and vomiting, you will definitely want to have enough to flush toilets!

Other items you will need to buy and store before the U.S. outbreak:

1- Functioning cellular phone with well-charged battery (rapid re-chargers should also be kept in reserve)

2- Obtain one or more dependable self-winding watches so you don't have to use batteries, or chargers to get the time.

3- Flashlights (e.g. Mag-lite) , and also keyring-sized LED lights such as those from Photon-Microlight,which can be worn on a ring.

4- A small AM/FM radio - to receive emergency broadcasts - and note there are several compact, magneto-driven wind up models  (Eton Emergency radio) available for most uses. Battery -operated models are also ok, provided you have on hand extra long life batteries.

5- A good First Aid kit, which contains adhesive bandages, antiseptic wipes, burn cream and other supplies. It's also a good idea to have plenty of boxes of spare antiseptic wipes on hand to wipe down surfaces if one or more in  your household becomes ill.

6- Disposable dust masks to filter out air pollutants (e.g. from mass- disposal pyres)  if you need to go outside. Also be sure to have a good supply of face masks, or "flu masks" - see e.g. .
http://www.webmd.com/cold-and-flu/features/swine-flu-h1n1-and-face-masks especially in the early phases of the U.S. Avian incursion.

7- Cash. Always have enough cash available, for example if food stores run out - or other critical stores (batteries) - and you may have only scalpers to buy from. One Survival Handbook recommends having on hand at least ten $100 bills, and at least twenty smaller denomination ($20) especially since if the electricity supply is interrupted there won't be any working ATMs.

More in Part 2 (Including hygiene, cooking without electricity and Will preparation)

Evidence Found Bird Flu Is Evolving: Will There Be A Pandemic Within 6 Months?

Electron micrograph of H5N1 influenza virus particles. 

The report appearing in yesterday's Milwaukee Journal -Sentinel was brief but had the impact of a blow to the solar plexus. Word, for word, it reported:

"Genetic analysis of the H5 N1 avian flu virus responsible for at least nine human deaths in China portrays a virus evolving to adapt to human cells, raising concern about its potential to spark a new global flu pandemic.

The collaborative study, conducted by a group led by Masato Tashiro of the Influenza Virus Research Center, National Institute of Infectious Diseases, and Yoshihiro Kawaoka of the University of Wisconsin-Madison and the University of Tokyo, appears in the current edition of the journal Eurosurveillance. The group examined the genetic sequences of H7N9 isolates from four of the pathogen's human victims as well as samples derived from birds and the environs of a Shanghai market.

"The human isolates, but not the avian and environmental ones, have a protein mutation that allows for efficient growth in human cells and that also allows them to grow at a temperature that corresponds to the upper respiratory tract of humans, which is lower than you find in birds," Kawaoka, a leading expert on avian influenza, said in a news release from UW-Madison.

The findings, drawn from genetic sequences deposited by Chinese researchers into an international database, provide some of the first molecular clues about a worrisome new strain of bird flu, the first human cases of which were reported on March 31 by the Chinese Center for Disease Control and Prevention. So far, the new virus has sickened at least 33 people, killing nine. Although it is too early to predict its potential to cause a pandemic, signs that the virus is adapting to mammalian and, in particular, human hosts are unmistakable, says Kawaoka.

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The preceding ought to be enough to get any normal human's nerves on edge. Also, if unleashed in an outbreak against an essentially 'naked" (from immunity) populace, the results would be devastating. In 2003, world-renowned virologist Robert G. Webster published an article titled:  "The world is teetering on the edge of a pandemic that could kill a large fraction of the human population" in American Scientist. He called for adequate resources to fight what he sees as a major world threat to possibly billions of lives. 

On September 29, 2005, David Nabarro, the newly appointed Senior United Nations System Coordinator for Avian and Human Influenza, warned the world that an outbreak of avian influenza could kill anywhere between 5 million and 150 million people. The reported mortality rate of highly pathogenic H5N1 avian influenza in a human is high; WHO data indicate 60% of cases classified as H5N1 resulted in death.

My take, given the H5N1 would (from cases analyzed thus far) incept a "cytokine storm" - similar to what the H1N1 Spanish Flu did, is that at least 500 million would perish, and possibly as many as 1 billion. I believe the reason the CDC is now barely a step from emergency mode (their website info now is partially 'redded out' with reference to old info and the emphasis is now on 'real time information) is because they are fully aware of the fact the Avian flu in its H5N1 human-to human manifestation could wipe out up to one seventh of the global populace.

Richard Besser, former CDC doc and now medical correspondent with ABC News, sounded downright nervous in his report last night from China, talking about a "race against the clock".

Back to the phenomenon of the cytokine storm: Research on genetically restored Spanish flu discloses that death likely arrived via a cytokine storm. In the current Avian flu cases,  one boy documented with H5N1 experienced diarrhea followed rapidly by a coma without developing respiratory or flu-like symptom. This shows that one can perish that suddenly, and with no evident breathing problems. There have been studies of the levels of cytokines in humans infected by the H5N1 flu virus. Of particular concern is elevated levels of tumor necrosis factor-alpha, a protein associated with tissue destruction at sites of infection and increased production of other cytokines. Flu virus-induced increases in the level of cytokines is also associated with flu symptoms, including fever, chills, vomiting and headache.

The inflammatory cascade triggered by H5N1 has been called a 'cytokine storm' by some, because of what seems to be a positive feedback process of damage to the body resulting from immune system stimulation. H5N1 induces higher levels of cytokines than the more common flu virus types.

The latest CDC Notice is given as follows:

The highly pathogenic avian influenza A (H5N1) epizootic (animal outbreak) in Asia, Europe, the Near East, and Africa is not expected to diminish significantly in the short term. It is likely that H5N1 virus infections among domestic poultry have become endemic in certain areas and that sporadic human infections resulting from direct contact with infected poultry and/or wild birds will continue to occur. So far, the spread of H5N1 virus from person-to-person has been very rare, limited and unsustained. However, this epizootic continues to pose an important public health threat.

There is little pre-existing natural immunity to H5N1 virus infection in the human population. If H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death worldwide. No evidence for genetic reassortment between human and avian influenza A virus genes has been found to date, and there is no evidence of any significant changes to circulating H5N1 virus strains to suggest greater transmissibility to or among humans.

Genetic sequencing of avian influenza A (H5N1) viruses from human cases in Vietnam, Thailand, and Indonesia shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This leaves two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 viruses. A small number of oseltamivir resistant H5N1 virus infections of humans have been reported. Efforts to produce pre-pandemic vaccine candidates for humans that would be effective against avian influenza A (H5N1) viruses are ongoing. However, no H5N1 vaccines are currently available for human use.

Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in animals than were earlier H5N1 viruses. One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5N1 virus infection among pigs in China and Vietnam; H5N1 virus infection of cats (experimental infection of housecats in the Netherlands, isolation of H5N1 virus from domestic cats in Germany and Thailand, and detection of H5N1 viral RNA in domestic cats in Iraq and Austria); H5N1 virus infection of dogs (isolation of H5N1 virus from a domestic dog in Thailand); and isolation of H5N1 viruses from tigers and leopards at zoos in Thailand). In addition, H5N1 virus infection in a wild stone marten (a weasel-like mammal) was reported in Germany and in a wild civet cat in Vietnam. Avian influenza A (H5N1) virus strains that emerged in Asia in 2003 continue to evolve and may adapt so that other mammals may be susceptible to it as well.

Highly pathogenic H5N1 in people can include:


Symptoms:

• Fever and cough

• Acute respiratory distress

• Shortness of breath/difficulty breathing

• Abdominal pain

• Diarrhea

Complications:

• Pneumonia

• Respiratory failure

• Shock

  * Altered mental state


• Seizures


• Failure of multiple organs (e.g. kidney failure)


• Death


The other bit of news (from flu.gov) is  that Thailand has begun a phase 1 clinical trial to test an H5N1 avian, or bird, influenza vaccine in a needle-free, nasal spray form. This trial is a result of international collaboration with health agencies around the world, including the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA). This is the first step in testing the new vaccine in humans. The study and data analysis is expected to be complete by May 2013.


People need to also grasp that even if an initial vaccine is successful, such virulent influenza outbreaks often come in waves. In the case of the Spanish flu there was a first relatively mild wave, then a much more deadly form (that incepted more cytokine storms).  The flu virus also mutates so that a vaccine that may work for the initial H5N1 onslaught may not work for a later one.  For a fairly good depiction of what could transpire, see the movie: 'Fatal Contact: Bird Flu in America'.  We are talking of so many dead that corpses have to be collected daily in the streets by garbage trucks, driven to landfills, stacked like cordwood and buried or set afire. We're also talking of massive dislocation of supply lines, supermarket shelves bare, and even the possibility of water, electricity output affected.  As for hospitals....the floods of patients in every city and town will overwhelm them and their resources within days!

Having seen what my own wife suffered - barely able to breathe at times-  with the H3N2 flu last December (written about in my Dec. 25 blog post) I don't want to see anything any worse! We may need to pare down the world's burgeoning populace- but not this way!