100 Years Later: The Flu

Guest Essay by Kip Hansen

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One hundred years have passed since the Great Influenza Pandemic of 1918 swept around the world, circumnavigating at least twice between 1918 and 1920, killing outright between 50 and 100 million human beings. The pandemic was so shattering, so pervasive that more accurate numbers of the dead cannot be calculated. Those who lived in developed countries like the United States fared little better than those in less developed nations — once the influenza struck, the victim either recovered after a week of unpleasant flu symptoms or died rapidly, sometimes within hours., with lungs filled with fluids and blood. Influenza, caused by a virus, usually kills the very young, the weak and the very old. But the 1918 Flu, sometimes called “the Spanish Flu”, seemed to preferentially kill young, strong, otherwise healthy men and women in their 20’s, a demographic that normally fared well with only mild symptoms in other flu seasons.

An oddity about the 1918 Flu Pandemic is the fact that despite its horrendous toll, it usually warrants only a paragraph or so in most history books and is often mentioned as if it were part of or an outcome of the First World War. Only at the end of the 20th century, with the threat of avian flu prominent in the daily news, have the details been brought into our public consciousness. PBS did a special titled Influenza 1918 as part of their American Experience series in 1998. Gina Kolata, science journalist with the New York Times, wrote FLU: The Story of the Great Influenza Pandemic of 1918 in 1999. John Barry, you who recently wrote the story of the Great Flood of 1927, wrote The Great Influenza in 2004.

W_shape_of_1918_flu

In the news, just a week ago:

Dad rages after 4-year-old daughter dies of flu complications

Sonja Haller, Feb. 11, 2019

A Texas father is mad. His 4-year-old daughter, Ashanti Grinage, developed a high fever on Jan. 29. She was taken to the emergency room where she was diagnosed with the flu and sent home with medicine, according to father Martel Grinage.

Two days later, she died. Grinage told Dallas news outlet WFAA that doctors failed to diagnose his daughter’s persistent cough as pneumonia.

“On Tuesday when she went to the doctor, she had pneumonia, and we didn’t know,” he said.

The Garland, Texas, family said their 4-year-old didn’t receive a flu shot. Her death came amid a flu season that hasn’t seemed as urgent as last year’s because there have been fewer deaths. Last year, flu complications claimed the lives of 180 children, according to the Centers for Disease Control.

The latest CDC weekly report shows that 28 children have died this flu season.

But New York City and 24 states, such as Colorado, Indiana and Virginia, are reporting “high” activity. Flu outbreaks are responsible for closing schools in at least four states.

Influenza sweeps around the world every year — sometimes the prevalent strain of flu is mild and sometimes not. Virologists (doctors and biologists that specialize in viruses), especially those in public health agencies, are, to put it mildly, terrified of influenza. Not terrified of our unpleasant but comparatively mild flus, but terrified that one of these years a flu virus will mutate once more into a 1918-type flu — easily contagious via the air, causing a rapid onset of serious breakdown of the body’s defenses and fatal in a significant percent of the population.

Pediatric deaths are common, but the numbers are not very high, around 100 per flu season for the United States — 2017-2018 saw almost double that at 185. This number is very close to the number of annual child deaths involving bicycles. We see that so far, in this season, the number of pediatric deaths remains low but may yet have to peak.

PedFluDeath_WeeklyImage

Among adults, flu deaths reach up to ten percent of ALL weekly deaths as in two recent years in the United States:

national_flu_mortality

How Many Deaths?:

There were 675,000 deaths in the US in the 1918 pandemic, not counting the number of US soldiers fighting in Europe that died of the flu — there “It ultimately killed more American military personnel than did enemy machine guns and artillery”. US Eastern cities like Boston, Baltimore, Philadelphia had to use mass burials to handle the corpse burden. Not only soldiers and civilians died; doctors, nurses and flu researchers died as well.

decade_of_deaths

In 2017-2018, the last flu season, 49 million Americans became sick with the flu, almost a million of those requiring hospitalization and 79,000 Americans died of flu and its complications.

What we don’t see in this graphic is the panic that spread through the international public health sector in 2009….

World now at the start of 2009 influenza pandemic

Dr Margaret Chan — Director-General of the World Health Organization

[Excerpts from her Statement to the press]

11 June 2009

In late April, WHO announced the emergence of a novel influenza A virus.

This particular H1N1 strain has not circulated previously in humans. The virus is entirely new.

The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.

We are in the earliest days of the pandemic. The virus is spreading under a close and careful watch.

No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.

We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.

Most cases of severe and fatal infections have been in adults between the ages of 30 and 50 years.

At the same time, it is important to note that around one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people.

The public health community was put on high alert — here we had a flu that sounded very much like the 1918 flu: highly contagious (spreading easily from one person to another), and spreading from nation to nation. An entirely new, never-seen-before H1N1 flu strain. And ominously, “one third to half of the severe and fatal infections are occurring in previously healthy young and middle-aged people” — just like the 1918 Spanish Flu. The 2009-2010 flu season started earlier in the year than in other seasons:

2009_2010

Thoroughly terrified, the World Health Organization and national public health bodies felt they were ready. And, as it turned out, the world was spared another disaster — only a comparatively very low 2,195 deaths were reported in the United States for the 2009-2010 flu season. The somber tone in the press release from the director of WHO informs us just how serious the situation could have been.

Public Health had learned a hard lesson from the panic in the United States which stemmed from an incident at Fort Dix, New Jersey. An Army private, young, hale and hearty, suddenly fell ill with flu symptoms in February 1976. The soldier reported for sick call, and returned to bed. By evening, he felt a bit better and decided to join his unit for a five mile hike. Halfway through the hike he was stumbling and was returned to the base hospital, where he died hours later. Army doctors were shocked, shaken, and at once recognized the similarity in pattern to the 1918 eruption of flu among army recruits: Healthy young men with a brief flu-like illness that leads to death in 24 to 48 hours.

When even more soldiers at Fort Dix became ill with flu-symptoms, the Army doctors and the CDC called secret meetings of health officials from all over the US to decide on a course of action for “the swine flu”. Panicked, health officials realized that a return of the 1918 flu was possibly beginning; they convinced then-President Gerald Ford to authorize a national program to immunize every American with federal funding for the program and for the federal government to offer indemnity to vaccine manufacturers against possible future law suits. Once the program spun up and was running, many of the officials that had supported the idea had second thoughts, but it was too late to call it off. The vaccine that was produced has been rushed through and had not undergone much testing, there just wasn’t time.

In this rush to prevent another 1918 flu epidemic, the massive vaccination program ran into trouble — several people died of heart attacks shortly after being vaccinated, cases of Guillain-Barré syndrome began to show up coincident with vaccination.

Epidemiologists knew full well that anytime a population-wide vaccination program takes place, be it flu or polio, the sheer number patients guarantees that some of them will have medical issues coincident with vaccination and these may thus look like they were caused by the vaccine itself. A certain percentage of the population will have, on average, a heart attack in any given year, about one tenth of those inevitable heart attacked will take place in the five weeks following vaccination. Lawyers will then weigh in for the kill – which is exactly what happened. The vaccination program was suspended and eventually dropped altogether.

In the present, the CDC (The Centers for Disease Control and Prevention) and vaccine manufacturers guess at which strains of the flu virus will be prevalent in the coming year’s flu season. They then manufacture a vaccine that they think will protect most people from the viruses actually circulating. And of course, the public is encouraged to get their “flu shot”, preferably early enough to be preventative for the season. How does this work out? The CDC says: “…flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.”

2018-2019_flu_season_featur

[Yes, I have had mine, my wife has had hers — we get them every year now that we are based here in the US — we had lots more vaccinations for life in the Dominican Republic and Northern Caribbean, North Africa, etc. I encourage you to get yours. ]

The Story of 1976 Swine Flu contains some cautionary elements.

What did Dr. Margaret Chan — Director-General of the World Health Organization — say in 2009? “We have a head start. This places us in a strong position. But it also creates a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty.

Laurence Gostin in his article At Law: Swine Flu Vaccine: What Is Fair? [doi: 10.1353/hcr.0.0184 ] writes that “…the swine flu affair fails to tell us whether, in the face of scientific uncertainty, it is better to err on the side of caution or aggressive intervention.”

In the case of the 1976 Swine Flu episode, President Ford, acting on the advice from the country’s best medical advisors, authorized dramatic action — aggressive intervention, in the form of a national immunization campaign — which turned out badly. Many of the advisors that had originally convinced President Ford to act almost immediately had second thoughts, long before the adverse effects started to turn up. Historians have been critical of Ford but the blame stems from the difficulty of decision making under deep uncertainty.

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Each of us has to face these types of decision many times in our lives. We are faced with the possibility of a serious threat — but we don’t have enough information to make a decision or the information we do have is very uncertain — yet we still have to make a decision. Should we “Do nothing and wait and see”? Should we rush to make big and consequential changes to protect against the possibility of the threat?

Today national leaders are confronted with this choice in the Climate Change arena. The public, continuously bombarded with scare stories about the possible future effects of climate change, demand action or at least reassurance. Politicians and policy makers demand expert advice. There are voices calling for immediate, drastic action. Others are calling for caution and a more nuanced “no regrets” approach. All base their demands on the same set of highly uncertain scientific knowledge. Many of our best scientists are involved in political advocacy for various approaches, which advocacy erodes the public’s confidence in their advice.

Yet any climate decision will necessarily be based on currently available but highly uncertain scientific knowledge. That’s all we have. Our historical data is vague with huge uncertainty bars and present day data from one field often seems in direct contradiction to data from another field. Journal papers written by scientists at NASA, published in the same week, have reported mutually exclusive results on Antarctic ice. [ see here, paragraph beginning “As for Antarctica?”] Climate models produce chaotic, wildly varying results even when initiated with very-near-identical parameters, yet are claimed to accurately predict the average climate of specific cities 60 years into the future. Every week, it seems, there are new papers describing new understandings about aspects of the Earth’s climate adding to both to our knowledge base and discovering new questions that need answering, giving us a better understanding of how much we still don’t know. There are political activists pushing for, demanding, solutions which are not only impossible, but for which even making the attempt to achieve them will certainly cause serious damage to human society and its infrastructure.

Decision Making Under Deep Uncertainty has become a standalone subject and now even has its own learned society.

We live in interesting times. It is this author’s hope that governments and policy makers will resist the urge to make society-destroying decisions in their rush to solve a problem which is not yet well understood.

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Author’s Comment Policy:

Taking a look at the history of influenza pandemics reveals what the scope of a real existential threat looks like — it looks like the 1918 Influenza Pandemic or worse. In today’s more crowded world, a high-mortality flu would kill far more than the 1918-1920 record of up to 100 million.

There have been weather related disasters in the last 100 years — in 1970, The Bhola Cyclone hit Bangladesh and took an estimated 500,000 lives, “primarily as a result of the storm surge that flooded much of the low-lying islands of the Ganges Delta.” The weather and geography conspired together to create the deadliest natural disasters of modern time. Political disasters have killed far more, but none in such a short time.

Climate policies will necessarily be set while we are still highly uncertain about the causes and effects of climate across time.

There are some opinions in this essay, which are mine and mine alone. Addressing your comment to “Kip…” will bring it to my attention and I’ll try to answer your questions or supply missing data.

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164 thoughts on “100 Years Later: The Flu

  1. Fascinating and very worthwhile reading. Thank you.
    In the face of the sudden outbreak of a future “Spanish” type flu in the modern world the ability of people to travel from one side of the globe to the other before they even realise they are ill poses challenges that were not present in the aftermath of WW1. Such a scenario would likely overwhelm attempts to mitigate the disaster. Not a pleasant prospect.

  2. I fail to see what lessons can be learnt for climate change from the flu decisions in 1976. As far as i can see, the heart attacks were not related, and of course you have to balance lives gained against lives lost from unforeseen consequences. It is not clear to me that the vaccine program should have been halted. We have also been lucky with the AIDS epidemic, at the start there were a lot of shocking advertisements which had a positive effect.

    If there is a lesson to be learnt, it is to be ready and tested before an epidemic arises – maybe difficult with different strains of flu, but I don’t think there are different strains of climate change?

    • Nigel ==> The overall similarity is the problem of Decision Making Under Deep Uncertainty.

      DMDU methods help decision makers make robust choices when facing deep uncertainties about the future variables affecting their projects, like climate change or demography.”

      If it wasn’t for the problems of DMDU, there would be no climate wars, no climate fight, no political polarization — we’d just do what was necessary. As it stands, we don’t know what the problem is or how big it is, we don’t know what to do about it once we answer the first question, we do know that certain “solutions” being proposed will be worse than the problem, etc, — DEEP uncertainty.

      Uncertainty is the hallmark of climate science and climate politics — follow Judith Curry’s blog where the subject comes up a lot.

      • I’m thrilled to see more discussion space given to decision-making under uncertainty. We’re told to trust scientists because they’re scientists. Yet scientists who advocate for radical action seem so profoundly ignorant of even basic principles in this key area of study that it’s as if they’ve never heard of it.

        Learning how to construct decision trees, evaluating the do-nothing scenario, and weighing expected costs and expected benefits is too hard for them I guess. It’s incomprehensible to me that anyone would ask us to expend the equivalent of MILLIONS of man-years of labor based on such a paucity of supporting analysis.

        • There’s another level of difficulty with prevailing “climate change science” beyond misplaced grandiose extensions of trends (with which any scientist worth the name must be familiar enough to humbly admit the remaining uncertainties), and that is namely our customary presumption of a simple honest reporting of what has been with all due care observed. An element of herd behavior has lately swept the discipline, at a minimum influenced by what garners money and social prestige; not to mention what promotes a costly power play to remake a high-functioning political/economic/energy delivery system into an alternative little more substantive than presumptuous ‘hope and change’.

    • The AIDS epidemic was enabled by the decision to require that the infected person give the names of recent sex partners (required by law for some other STDs). A lot of people have been infected because of this decision.

  3. I read the whole thing and this is the line that jumped out at me:

    Lawyers will then weigh in for the kill – which is exactly what happened

    Says a lot about the structure of out current society.

    • Steve ==> Yes, that was true even back in 1976….and everyone was very aware of it. Vaccine makers were refusing to make and provide a vaccine for national immunization because their insurance companies told them they would not unsure them against the risks. This forced Congress to pass legislation guaranteeing that the government would indemnify the vaccine makers.

      All this despite knowing that adverse effects to the vaccine were probably just a trick of epidemiology.

  4. WW1 may have had something to do with the virulence of the 1918 flu, with the idea something like the following:

    -Thousands of mostly young men were living in filthy trenches over long periods, sometimes wounded and infected, collectively lowering their immune systems.
    -This gave fast-evolving viruses a greater and longer chance to evolve and mutate into something more virulent, along with other opportunistic viruses/bacteria, within a large population of mostly young adults with lowered immune systems. (This is also the broader demographic who seemed to succumb the most).
    -The effect of chemical weapons towards the end of the war is a wild card, on both the immune system and evolving viruses/bacteria.
    -Note the flu occurred only after 4 years of such conditions, and there are also previous pandemics in history which seem to strike hardest after a population is down; the idea being that viruses and bacteria ‘kick populations when they are down’, in the same way they do with individuals. Once the strain has gotten a foothold into a population through larger numbers of sick and wounded people, it mutates and goes on to infect otherwise healthy individuals of much the same demographic.

    Just a thought.

    • The young and healthy victims included not only soldiers but civilians, male and female.

      Still, the war might have provided opportunities for bird and pig viruses to combine. It’s also possible that Chinese laborers on the Western Front might have carried the virus, which otherwise would have remained localized or regional.

      • the youngtend to have stronger immune systems
        which means a larger immune response
        ie creating a cytokine storm which is what kills so fast
        ebola creates the same response from what i have read
        an interesting program on abc radio national in aus i heard a part of this week on pandemics, suggested that american troops were being shipped TO europe with flu and a comment about deathships was made by one of your pollies at that time
        i will try and find the link

        as for the comment that the badly designed flu vaccine in the 70s didnt cause heart attacks?
        well, Id suggest fit healthy young soldier keeling over wih heart attacks and being jabbed prior IS suggestive of serious adverse event status.
        as far as i know that vaccine was used ON mil only at the time

        • The heart attacks was a reference to the 1976 outbreak, not the 1918 outbreak and there was no data given regarding the age or health of those who did have heart attacks.

        • In the US it was used. A good friend had a very serious reaction to a flu vaccination in the 70s.
          She was in her 20’s then, from the Bronx.

      • For some reason a longer post of mine on the subject has yet to appear but the fact is it appears that most of the mortality from the 1918 pandemic resulted from a superinfection of bacterial pneumonia that would be treatable with antibiotics today.

        • thingadonta, John, ozspeakup, rah ==> The CDC and NIH, etc have been studying this thing for 100 years, each year bringing advances in medicine and medical technologies.

          The generally accepted explanation is the one offered by ozspeakup.

    • One hundred years ago today my grandfather wrote in his diary about suffering from a severe “cold” while he was in central France returning from service in WWI with the 42nd Balloon Company. It was never diagnosed as influenza and he recovered in about a week. He treated it with a mustard plaster and thought that the military doctors were not too helpful.

      • Gary ==> Thank you for the “eye witness” account. It is generally accepted that the flu may have determined the outcome of WW1 by killing more Axis troops than Allied troops. The pattern your grandfather mentions matches the historical record — the Spanish flue either caused a nasty weeklong flu episode, or killedoutright in a few days.

        The Army, desperate for more troops actually considered halting troop shipments to Europe knowing that the flu would spread to so many in the crowded transport ships. In the end, they decided to keep sending them, even though so many arrived already too sick to fight.

      • Gary ==> Yes, thank you for the “eye witness” report from your grandfather’s diary.

        His account agrees with the generally accepted historical record — your grandfather was one of the lucky ones — getting a nasty week-long flu — rather than the alternative of getting sick and dying within days.

    • It depends which sources you find most credible. The long-standing theory has been that it started in US military camps in 1917, in the USA where troops were training to go overseas, long before it was spotted in Étaples, France. In any event, it appears not to have evolved in the trenches, but well away from those conditions.

    • thingadonta ==> Good thinking . . . but virologists have been studying the 1918 flu for a hundred years, paralleling advances in medicine and medical technology, genomics, microscopy, etc.

      Ozspeaksup below offers the generally accepted explanation for the 1918 flu taking so many young, previously healthy, strong young people — their own immune systems end up killing them.

      Note that no one want’s do resurrect the 1918 flu, not even for experimental purposes, for fear it will get loose.

      • Lost my grandfather in 1918 from the pandemic–an immigrant from the Austrian Empire specifically the current Czech Republic.
        As a child in the 50s our greatest fear ( notwithstanding nuclear annihilation ) was POLIO. The day the Sauk Vaccine was available in our community we ran to the advertised treatment center.
        Having survived the mumps, measles and chicken pox my parents were delighted their son would hopefully survive this debilitating menace.
        I’m not certain when the first flu vaccine became available but I made sure, I and my love ones got inoculated. We continue to receive the yearly shots.
        Of interest I received a Pneumonia Booster ( now available & recommended ) at my doctor’s yesterday. The yearly Medicare Exam is something we need to continue and I highly recommend those eligible do so.
        That is how we deal with the threat–a word to the wise is sufficient.

        • Carbon Bigfoot ==> Thanks for your personal story — your grandfather story is all-too-typical of the time.

          Good advice for the readers — including the Pneumonia Booster — especially for those of us who are on their second or third wind.

      • Kip Hansen==>ok thanks for the response.

        Without going into more details regarding over-reactive immune responses (e.g. why do we have ‘allergies’ at all-it is an elaborate and complicated immune response that seems to serve no evolutionary purpose, but evolution rarely designs such elaborate mechanisms without some purpose/function) , but note that both allergies and over-reactive immune responses in general have been theorized to relate to evolutionary mechanisms related to stressed individuals/populations.

      • Jenn ==> Thanks for that link. There is so much we don’t know about the human body and the ills that affect it. The example in the linked paper is a virus that is enabled by a clinical deficiency of selenium, a very trace element. (There is a know illness in sheep that results from a lack of selenium in the soil, thus in the grass….a tiny bit of selenium added to any feed supplement takes care of it.)

        For me, as good one-a-day A-Z vitamin and mineral supplement is hoped to take care of this aspect of
        nutrition, plus a truly varied diet.

      • This is a most excellent study (t/u). Reading through it now. This particularly amused me, so I had to comment…

        Homeopaths, who thought aspirin was a poison, claimed few deaths …

        • Oof! Spanish flu didn’t kill a lot of chilluns.

          The lower mortality of children may be a result of less aspirin use. The major pediatric text [69] of 1918 recommended hydrotherapy for fever, not salicylate; its 1920 edition [70] condemned the practice of giving “coal tar products” in full doses for reduction of fever.

  5. I read the whole thing, and this is the line that jumped out at me:

    Lawyers will then weigh in for the kill – which is exactly what happened.

    Says a lot about our current society.

  6. Indeed, great article, hopefully eye opening, particularly to those ignorantly dependent on modern medicine.

    Thanks for the mention of DMDU. For a gentle introduction read N. N. Taleb, or remember Rumsfeld’s knowns and unknowns.

  7. “Today national leaders are confronted with this choice in the Climate Change arena.”

    No they are not.
    They were confronted with it 30 years ago, and it was found to be a false alarm. Climate change, such as it is, is only happening slowly, and much of it is actually beneficial. Any problematic changes can clearly be adapted to with relative ease, and at an almost leisurely pace.
    Time to return the national leaders’ attention to real problems, of which there remain many.

    • Michael ==> Tell that to AOC and the Green New Dealers in Washington. Tell that to the state Governors and City councils passing crazy “100% renewable energy bu 20XX” legislation.

      • I believe the point is that the Deep Uncertainty is not as deep as it was 30 years ago.
        The fact that there are people still trying to ride this train to whatever destination they were already determined to go, not with standing.

        • MarkW ==> Well, we know something now we didn’t know then — but as for the future and the effects of climate change we are still operating under Deep Uncertainty — we chipping away at that uncertainty but we don’t know enough to justify drastic action being called for by many on the left.

          • Yes MarkW, that was indeed my point. Thirty years is considered climatalogically significant. Politicians have had long enough to recognise that the worst predictions are manifestly not coming true.

  8. There is no doubt that influenza morbidity is greatly under reported. I’m sure many of here, being in a relatively good state of health, have managed to ride it out multiple times without so much as a call to the doctor. Being a truck driver and having relatively little contact with people I have worked right through several times.

    I would also submit that mortality due to influenza , even in developed nations, is greatly underreported. I believe that far more of the old and infirmed or those that are immunocompromised due to poor state of health and/or other various conditions succumb to the flu than are reported. Their deaths generally officially attributed to pneumonia or some other disease when the genesis was the flu. I put my mother who passed last December in this category. So the numbers the CDC gives are not truly accurate and should be taken only as a guide to assess the severity of any particular season or strain. And of course in a historical context their value is limited due to advancements in access to health care, improving treatment and supportive care, etc, and the ever changing demographics.

    I write the above not to minimize in any way the Pandemic of 1918 at all. It killed more people than there were killed in the war. But the fact is that in that time before there were antibiotics the majority of deaths appear to have resulted from a superinfection of bacterial pneumonia that would be highly treatable today but for which only supportive care could be given then.

    • rah ==> Yes, correct. The CDC uses the ICD-10 codes for cause of death and in a general sense counts all deaths coded with “Influenza Like Illness” (ILI) as a flu death.

      On your second point — advances in supportive care — last flu season, 79,000 Americans dies of ILI — over a period of just a few months. That’s a lot of deaths that even today’s modern hospitals were not able to prevent — deaths that took place, mostly, in hospitals.

      Let’s hope that modern medicine can save more today than they could in 1918 — when they really had nothing that could help flu patients that were dying.

  9. Do’nt worry too much. During the 1918 flu epidemic people died of pneumonia. At that time no antibiotics were available. Nowadays they are.

    • Henri Beijersbergen ==> Thank you for your optimism. As I just mentioned above, even with up-to-the-minute advances in antibiotics and supportive care — 79,000 Americans died in the last flu season, mostly in hospitals. And the flu last season was a relatively mild strain….

      • I totally disagree it was a mild strain. I’m 63 years old. Only twice in my life have I been bed ridden by the flu. In the over 10 years I had gone without calling off a load for any reason during my time with this current employer until I got this flu bug in October and it caused severe acute bronchitis. I was not hospitalized but for the first time in my life I took breathing treatments (ibuterol) and used an inhaler for a time. I missed two days of work until the antibiotics kicked in. Quite a few people at my place of work were off work for two weeks and more with the bug.

      • William Grubel ==> You are right that influenza is a virus — but antibiotics are a part of treatment for those who must be hospitalized (and sometimes for outpatients) to protect against pneumonia and other opportunistic bacterial infections that often accompany the flu.

      • Hi Kip,
        Thanks for another well researched and well written essay. My memories of Swine Flu were faulty – bumbling Ford and arrogant bureaucrats in league with Big Parma – probably from reading the Washington Post and watching 60 Minutes. Nice to have a fuller story. Sad about David Sencer, who among many accomplishments led the research that discovered the source of Legionnaire’s Disease.

        It is coming up on the fourth anniversary of me not dying of pneumonia – probably initially an ILI that I thought I could tough out, as I always had before. A week in an induced coma in ICU receiving every anti-viral and anti-biotic on-hand was my reward for not bothering the doctors with ‘the flu’. Much to everyone’s surprise I survived – but the doctors didn’t expect me to (everything but my liver failed) and weren’t even sure what the main culprit may have been (they settled on a virus followed by a soil Legionella, but only because I am a gardener: they never cultured anything). That is a note of warning about modern medicine – they can only do so much and once you’ve used up your reserves there isn’t much they can do.

        • DavidW == Well, I’m glad you stuck around….the trick is to be personally knowledgeable and seek treatment early rather than late. Maintaining general health and (fitness — and a few but not a lot of ) extra pounds sees one through the normal illneses of advanced age.

  10. Kip, thank you for an interesting and understandable essay.

    Word change?
    John Barry, you —> John Barry, who

  11. “The Stand” by Stephen King 1978 – the unabridged novel.

    The “Russian Flu” took me thru the wringer that year. I was 26 and healthy but that one laid me flat for days!

    • Dan ==> Yes, Stephen King wrote of a 1918-like “super-flu”. There have been a number of novels based on the idea.

      Try a web search on the term “weaponized influenza” a common theme in fiction and non-fiction alike.

  12. Flu viruses mutate at will. If they can’t infect a host organism, they shift and mutate until they cause an infection. They also share RNA in the wild, which was part of the problem with the Swine Flue panic in 2009.

    Now the flu shots are admitted to be only 26% effective against whatever the current strains are; this time around, it was mostly H1N1. I got mine in November early in the afternoon, and by suppertime, I was as sick as a dog. I may skip it next time. It’s no fun when you do the “right” thing and it backfires on you.

    The real problem here is that the effectiveness of the vaccines is dropping. I do not know if it’s because CDC is unable to anticipate what may happen with these viruses, or if they are simply floundering because they’ve run out of ideas. The smallpox vaxx I got in early childhood was supposed to give you lifetime immunity. Got another one at 21, and it “took”, meaning my vaunted immunity had faded, and the CDC now admits that the immunity on most of those vaxxes fades after a length of time. There is no lifetime immunity unless you’re born with an immunity gene.

    Vaxxes are fine. They do reduce the spread of some very bad bugs. But the bugs can mutate rapidly enough to infect a host, any time they need to, and then move on to other hosts. It’s just how it is.

    • No vaccine has ever slowed or stopped any bug.
      An exercise for you…plot on a graph EVERY infectious disease ever known to man, with the disease on the left / vertical axis and time on the horizontal axis. Pick anything you want to plot. Polio, measles, etc. They all plot the same, really high on the left, diminishing rapidly over time and leveling out close to zero and stabalizing there. Then mark the place on those curves where the vaccine was introduced. Every single one was introduced AFTER the disease was already mostly gone, proving beyond a doubt that factors other than vaccines eradicated those bugs.
      You vaccine cheerleaders should try reading Dr. Suzanne Humphries’, Dissolving Illusions.

      • Here’s another exercise folks can do. Vaccines create immunity: true or false?

        If you said true, then you’ve been duped. The immune system creates immunity. At the very best, vaccines can only stimulate that natural process, but immunity is in no way dependent upon them. The key to immunity is keeping the immune system healthy. But it’s almost like many have come to believe that immunity can’t exist apart from vaccines.

        • Correct immunizations only enter an antigen which causes the bodies immune response to produce the appropriate antibodies.

          It takes an immunoglobulin to provide a direct injection of antibodies.

          Example: Tetanus Toxoid vaccine verses Hypertet for direct treatment of a Tetanus infection.

      • And yet outbreaks like measles and mumps are mostly confined to those who were not vaccinated. SMH. And smallpox is not hovering around zero; it is zero.

        Please plot what a graph would look like if a working vaccine were developed and distributed after the high-point of the infection rate. It would look the same graphs you are touting.

        The real proof of the effectiveness is the lack of future outbreaks in an immunized population compared to a non-immunized population. That has been documented frequently.

      • D.Andersen ==> An important point — flu viruses mutate — and truthfully we don’t know exactly how or why. That’s why they have Public Health so terrified.

    • Another thing not addressed in the article: Every year the “flu” statistics are conflated with the aggregate of “flu-like illnesses” seen by doctors in clinical settings. In fact, very few of these are cases confirmed as actual influenza virus by lab work. Anyone who walks into a doc-in-the-box with a bad cold, bronchitis, seasonal allergies, etc. can therefore be lumped into this much-inflated “statistic.”

      I’ve been told (“off the record,” you understand) by MD’s that flu shots aren’t worth jack spit. Washing one’s hands asssiduously, and just plain avoiding large concentrations of humans breathing the same air during flu season are a good deal more effective.

      Our culture is now so risk averse we are being exhorted to freak out more and more over less and less.
      And does anyone ever mention how as little as 25 grams of sugar suppresses your immunities almost completely for around 6 hours? Hell, no. Of course not!

    • Sara ==> Vaccination is one of today’s Hot Topics — and there is a lot of misinformation floating in with the other carp on the ‘Net.

      Flu vaccines are based on guessing. Can’t characterize it as anything more. The CDC has to guess because they can’t see the future any better than the rest of us. The choice involves looking at flu surveillance programs around the world, seeing what types are active in China and SE Asia and then guessing…. A vaccine for one year’s H1N1 flu doesn’t protect against the next year’s — they will be different — or a flu season may have multiple strains and types circulating at the same time.

      On the upside, measles, polio, smallpox, and a lot of other nasty killers have nearly been eliminated by vaccination programs.

  13. Do some other research on the Spanish Flu.. Bayer aspirin killed many,, never take aspirin with a fever.!
    Plus the WHO and the CDC are corrupt organizations! How many have had Flu shots in recent times then got the Flu??? Please research this.

    • There are many articles on how Aspirin caused many deaths during the 1918 Flu epidemic.
      It was considered a wonder drug at the time,, People OD on it.. Never take aspirin with a fever..
      Good read from Lew Rockwellhttps://www.lewrockwell.com/2009/10/bill-sardi/did-aspirin-contribute-to-flu-deaths/

    • Craig ==> There were recorded aspirin-overdose deaths associated with the 1918 flu, but not that many as far as we know — it was a mis-application of “if a little bit is good, a lot is better.”

      • They really didn’t know about aspirin toxicity until the 1950s (I think). Too late for autopsies. Consequently, aspirin in the early 1900s was sold without warnings or dosage instructions. Kind of like buying cod liver oil. I think aspirin toxicity starts at 8 grams daily.

    • “never take aspirin with a fever.!”

      When I was a kid that’s what aspirin was used for besides headaches. Now I read this. And scientists wonder why when they’re not taken seriously.

      The Centers for Disease Control and Prevention (CDC), the U.S. Surgeon General, the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA) recommend that aspirin and combination products containing aspirin not be given to children under 19 years of age during episodes of fever-causing illnesses.

      https://en.wikipedia.org/wiki/Reye_syndrome#Aspirin

      • icisil ==> Did you read the link you give? The aspirin rule if for children — because there is a rare but serious adverse affect found in association to aspirin. There has been no proof that aspirin causes the syndrome. Nevertheless, as there are lots of good options, aspirin is generally not given to children these days.

        • Yeah I read it. I posted the link for attribution; no other reason. My comment was not about Reye Syndrome, but to point out how medical science now contradicts what it formerly advocated (prescribing aspirin for children’s fever).

          • icisil ==> Medical science advances and learns new things every day . . . . some of the new things it learns demands changes in clinical practice. This is a feature of modern medicine, not a bug.

  14. Yes, we can show similarities between the combination of uncertainty and panic in the case of flu, and in the case of climate. It’s as if we think we have been promised some kind of complete control over nature, that was never available before, and yet, what’s this? Storms and epidemics. How can this be?

    One former public health official here in Ontario (Richard Schabas) used to weigh in on the various flu panics: flu viruses mutate as an epidemic spreads; they mutate in the direction of less virulence (likelihood of making us very sick or killing us) rather than more virulence. To some extent the more infectious (fast or easily spreading) the less virulent. This makes sense as an evolutionary strategy. If a virus lives in wild birds, who don’t touch each other all that much, it may be super infectious, exploiting every possible contact; if the virus was highly virulent, it would kill a host before that host could spread the infection. If birds then get crowded together, such as in Asian cities or markets, for a while virulence might go up so you have a combination of high infectiousness and high virulence; if a host is killed, there are lots more where that one came from. But then the virulence goes down as infectiousness stays high; viruses are adapted to live with us, exploiting us, more than to kill us. We live of course with many viruses, all the time. I’m so old I can remember when there were supposedly very few herpes viruses–maybe three. Now there are many.

    Schabas used to say: the one apparent famous exception to all this is the 1918-19 flu, assuming it was the same virus in both years. In 1918 the flu was both infectious and virulent from the time it came to sight. It died down over the winter, and then was both infectious and virulent again in 1919 before it died down again. If this was all the same virus, it doesn’t fit the usual pattern. If it was two different viruses, it does.

    See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1534081/ and http://www.spiegel.de/international/world/reconstruction-of-a-mass-hysteria-the-swine-flu-panic-of-2009-a-682613.html and http://www.pressreader.com/ (reproducing an article from the Toronto Star, July 22, 2009)

    • Lloyd W. Robertson ==> Good discussion. I am not a fan of a purely Darwinian-evolution Just So story approach on flu mutation. I’m sticking with the “we just don’t know, yet” about viruses and their mutations — we know that they do mutate — and that has Pubic Health worried.

        • Phil ==> Public Health (initial caps) stands in for the agencies and organizations that make policy and do research on the basis of public health, as opposed to treatment of individuals.

      • My impression is that most evolutionary biologists aren’t all that fond of ‘purely Darwinian evolution’ (assuming this means Spencer’s ‘survival of the fittest’ rather than the more nuanced ‘natural selection’ – I tend towards ‘survival of the fit enough and lucky’), but that virulence and infectivity have a complicated relationship. It does seem reasonable, and also true, that long-term associations between an animal and a disease-causing microbe tend towards low virulence – especially if the disease is restricted to one animal species. If the microbe has other hosts, though, it can be maintained in those reservoir hosts, but jump to a novel host and slay them all. Plague has a long history jumping out of its rodent reservoir hosts and killing domestic rats, people and even the primary vectors, rat fleas, whose guts get clogged and starve (adaptive for plague transmission because the hungry fleas keep biting). Most of the really worrisome diseases are zoonotic (reside in some other animal), including bird and swine flu. Influenza-type viruses are especially worrisome because different strains seem to be able to recombine in a host. We don’t understand viruses all that well. We aren’t even sure about many aspects of Bubonic Plague.

  15. I’m older and have taken two pneumonia vaccines including the newer Prevnar 13. Since it is pneumonia that is generally the killer, hopefully these will help me if I ever contract the flu, especially a virulent one. I also get the flu shot and am very active, which helps keep the immune system going.

    It’s interesting that I really have no symptoms after getting the flu shot or any vaccine for that matter, while some react to it. I don’t know if that is good or bad for me.

    With the expanding world population, the chances of a killer plague like Ebola or even the flu is also expanding. The good news is overall the standard of living is also going up. This will go on until we price energy out of reach of the lower economic groups, then who knows.

    Great article, Kip.

    • rbabcock ==> My wife and I have the same approach for the same reason. With massive vaccination programs, such as the yearly flu program, a certain percentage of people will get a flu shot and then have a case of the flu, a cold, or other “influenza like illness” — just luck of the draw — and will blame the vaccine.

      My wife and I survived living in the Dominican Republic for ten years — never got dengue (most of our friends did), we ate street food (usually strictly forbidden for gringos — for health reasons) and had a great time.

      I test positive for malaria and TB — from my travels in my 20s. Hasn’t hurt me none….

  16. Since a longer post on the subject I wrote has not appeared and two have since I posted the missing one I will try again.

    It is obvious that the morbidity of influenza is way under reported. I and I am sure plenty of others here that enjoy a relatively good state of health and normal immune function have continued to work through it and never so much as called a doctor. So though we had the bug it was never diagnosed or reported.

    The mortality of influenza is also way under reported. Many are reported as succumbing to pneumonia or some other disease when in fact the genesis was influenza.

    Thus even the modern reporting and stats is nothing more than a general guide to the severity of a particular outbreak and the historical context of reporting is even less of value. In 1918 they simply did not have the ability to treat the disease or provide the level of supportive care, nor did was the availability of health care treatment near what it is today. Then there are the ever changing demographics. All of these factors combine to make comparisons of severity of influenza outbreaks over time a very dicey endeavor.

    For example, it is believed that the majority of those that succumbed to the Spanish flu pandemic did so as result of a secondary superinfection of bacterial pneumonia. A disease that would be treatable today with antibiotics. Penicillin, the first of the truly effective synthetic produced antimicrobials, did not come into use until the early 40s and saved a lot of allied soldiers during WW II.

    • ” In 1918 they simply did not have the ability to treat the disease or provide the level of supportive care…”

      I believe at the time they basically had sulfa drugs and aspirin. Worldwide sales of aspirin more than doubled between 1918-20.

      • rah, Goldrider, and icisil ==> Despite all our advances, 79,000 Americans died, mostly in hospitals, from flu like illnesses during the 2017-2018 flu season in the United States.

        Your best bet is to get your flu shots and your pneumonia vaccination. Stay active and healthy as long as you can.

        (There does seem to be some oddity going on with comments today – some delayed and some failing to show altogether. I blame ‘net pixies.)

  17. Catch the flu. Overdose on new wonder drug, Aspirin, and subsequently die from acute pulmonary edema. Blame death on flu.

    • Rinse and repeat millions of times and call it a flu epidemic.

      This is what’s known as iatrogenesis – when a doctor prescribed remedy for an illness kills the patient. Not uncommon in medical history. Caveat emptor.

  18. I suppose this is what happens when a flu and vaccine article appears on a climate site. It misses the mark. I don’t have time to educate you, I’ll just say two things. One, you didn’t look close enough on the 1918 flu. The US government gave an experimental vaccine to all our soldiers and THEY then went and spread/shed that virus all over the world. It was a manufactured pandemic. Two, there is NO SUCH THING as a safe and effective flu vaccine! Lord mercy they are not designed to prevent the flu! They’re designed to make money by keeping people sick in the short and long term. The facts are ALL on my side and if I have time after work I’ll try to enlighten you. Answer this question: how many vaccine patents does the CDC own?

    I expect more from this site than crap like this. You understand the establishment lies about climate but you don’t understand they lie even more about medicine?? Wow.

    • Rubbish. Vaccines were first developed in the 1938. The cause of the 1918-1920 flu was not determined at the time and there was no treatment known at the time. Read “The Great Influenza.” You might learn something.

      • Edward Jenner was the first out of the box with smallpox in 1796. Just a little earlier than 1938. And of course, Louis Pasteur and rabies, in 1885.

        • As an SF medic responsible for maintaining the immunizations of my team members for all kinds of different diseases I will attest to the effectiveness of vaccinations. Despite multiple deployments to all kinds of different places including many in the “third world” neither I nor my team members ever came down with any disease for which we had received vaccinations nor did we ever contract a disease for which we received a specific prophylaxis due to a particular disease being endemic to the area where we were being deployed.

          • rah ==> Comments here are like a box of chocolates….

            Thanks for giving readers your first hand, professional, experience with vaccines. As with all things, some vaccines are better than others. I grew up in a medical family, my father was a leading pediatrician in the LA area of California, and when it came time for my kids to get their multitude of childhood vaccinations, and in consultation with my father, we opted out of one of them, and had the doctor order a different type of vaccine for one illness….can’t remember which one.

          • Kip
            We got and I gave a heck of a lot of different ones. But the one we hated was not a vaccine by a prophylactic dose of Gamma Globulins we were sometimes required to receive before deployment to places endemic for certain communicable diseases. Like getting a golf ball injected deep IM in your butt. Most of my guys asked me to split the dose between two injections to give equal amounts to each glute.

            Of the plethora of injections I gave only once during the injection of the first of the three shot rabies series did I have to deal with an anaphylactic reaction.

  19. “Politicians and policy makers demand expert advice”

    No, they take the advice they want to hear. Jay Inslee, Gov of Washington State is a prime example. In his world, every problem is caused by climate change. He completely ignores data which is contrary to that narrative.

  20. Dan Davis
    Yes, I had that one here in Vancouver in 1978.
    You would be too hot.
    Then too cold that even every blanket you had was not enough.
    Fortunatelyy, I have not had a fever like that since.

  21. I lost a granddaughter to the flu around 18 months ago. She died at home in her mother’s arms in a matter of minutes after saying that she could not breathe.. She had also been to a doctor, and given meds several days before. I have read many similar stories in news accounts from different towns and cities of similar deaths since then.

    • goldminor ==> Condolences == the little ones can be so delicate. My father was a pediatrician and this fact was a specter that lived in our home 27/7 — we always knew when The Doc has lost a patient — usually a baby, despite all his best efforts.

      Your sad story is typical of how the flu kills….

    • goldminor ==> My condolences — reminds us that influenza is not just a minor inconvenience — but a serious matter not to be taken lightly. My father was a pediatrician and we lived with the fact of the fragility of little lives as a ever present specter in our home.

      • Did I mention that I am experiencing a little bit of weirding with the comments today? Some not showing up, some delayed? Dang pixies1

  22. Another difference between now and the world of 1918 is the amount of high speed international travel.
    The ability to get from New York to Paris in just a couple of hours did not exist in 1918.

    • wrnsay ==> The current CDC recommendation for children is “Children younger than 5 years of age –especially those younger than 2 years old– are at high risk of serious flu-related complications. A flu vaccine offers the best defense against getting flu and spreading it to others. “

  23. During my career I have spent a lot more time than I ever imagined around epidemiologists and virologists (I am a marine fishery biologist). Most of our discussions related to arthropod vectored diseases primarily mosquito vectored diseases which sicken millions and kills hundreds of thousands each year in the world. Well before any discussions on AGW and “emerging new diseases” they were concern with the spread of “old” diseases primarily due to rapid modern travel AND illegal immigration. After all malaria, dengue, yellow fever, etc, all have been common diseases in the USA since before the country’s founding until relatively recently. However, what literally scared the heck out of these experts was the flu. This was about the same time the anti-vaccine crowd was developing. That scared them even more. We have the technologies to at least mitigate the spread of arthropod vectored diseases but they only real tool for the flu is an annual vaccine. If you understand how vaccines actually function in preventing the spread of disease what percentage of a population which is vaccinate makes a big difference. The flu virus that scared them the most was any H1N1, strain.

    • Edwin ==> Thanks for the insight from a professional. And, yes, virologists are terrified of the flu — H1N1 the most.

  24. Better to spend $trillions on “fighting climate change” and embarking on “green new deals” to fight imaginary future global threats, than to spend that money of more pragmatic currently-known global issues like, oh, trying to prevent another 19818-like influenza pandemic.

    That’s not my thinking . . . but anyone with an IQ above room temperature (Fahrenheit scale) knows who’s fronting it today.

      • Gordon ==> Climate Pragmatism calls for handling such things as profound poverty, lack of basic health care, basic electrification, basic schools — all before embarking on decarbonization.

  25. Kip..

    Some random thoughts about the 1918 Spanish flu, its deaths and the relatively recent H1N1 2009 flu epidemic which was alarming yet not as devastating world wide. Years after the 1918 epidemic, cultures of lung fluids kept from that time and analyzed with new bacterial growing techniques identified a bacteria then named Hemophylis influenza (H flu). Hemophylis because it caused hemolysis (lysing red blood cell walls) of blood auger culture plates and influenza because it came from the lungs of people who died of pneumonia. Today, because of the devastating impact of H flu causing meningitis in infants, a vaccine was developed and now provided to most infants. A treatment for H flu, Ampicillin has been broadly available in the armamentarium of the medical world as well. Today, large numbers of infants world wide have received the H flu vaccine along with one of the first vaccines (1938) of pertussis (Whooping cough which prior to the vaccine killed 7,000 children and impaired for life 225,000 children every year in the US).

    A possible reason for the failure of the influenza epidemic in 2009 not causing such devastation vs 1918, may be the combination of implementation of wide spread H flu vaccination and a specific anti-bacterial agent. A conjecture to be sure: the Spanish flu of 1918 may be a predisposing precursor to H flu pneumonia via antigen/antibody initiation. Prior to 1900, the mean age of survival in the US was somewhere around age 45 yo. A lot of infants died in their first 5 years of life possibly from H flu. Because of persistent respiratory colonization with H flu, when the individual acquired H1N1 in 1918, there was an overwhelming impact; ie, the so called: cytokine storm.

    Vaccines do save lives far beyond the numbers reported today.

  26. “… in 1970, The Bhola Cyclone hit Bangladesh and took an estimated 500,000 lives”

    Imagine the calls for action to influence the global climate if that were to happen today. Or next year. Such disasters need to be commemorated lest they be forgotten.

  27. The cause of death in most of the flu cases in 1918 were actually due to bacterial pneumonia. There were no antibiotics in 1918.

    Read one theory where experimental meningitis vaccines may be behind the outbreak at Fort Dix and subsequently the world as soldiers were then sent to Europe via East Coast cities. No proof beyond the fact flu usually kills the elderly and very young, not healthy adults in their prime, and bacterial infections found in the lungs of the dead that were autopsied

    • Pft ==> The 1918 Influenza Pandemic has been very closely studies, time lines carefully built, evidence examined. It is very unlikely that there is some hidden cause or that any of these conspiracy-like theories hold any water.

      I give links to two very exhaustive books on the subject in the first couple of paragraphs. Gina Kolata’s book is shorter and a quick, if somewhat dry, read. Barry’s book is longer and even more exhaustive.

  28. What I heard had flu doctors really scared is they took a low pathogenic version of H7N9 and gave it two tweeks to give it features from two other circulating versions that they believed would make it more transmissable and then gave the result to caged ferrets. They then placed those ferrets in the vicinity of unaffected animals. The ferrets got sick and passed the virus on to all of the new ferrets and all of the ferrets in the test died. So contrary to belief, the virus doesn’t automatically get less deadly as it turns into a pandemic version. It can get even more so.

    They immediately stopped the research. Partly because there could have been an accident and partly because they were documenting the mother of all weapons.

    What has them baffled is why a virus that can make all the necessary mutations in one strain, hasn’t.

    How do you prepare for that? The same as you should for CAGW. Have a radical plan of action you’d never implement until the worst was already starting. The reason is that people won’t do what is necessary until they are convinced the hazard is a greater pain than the solution. And of course it may never happen.

    • Tiny ==> Who would have thought that ferrets would be lab animals for research, yet it is true. Ferrets turned out to be very good at getting the flu, human strains of the flu. They were rather nasty to work with though, according to contemporary reports, all those sharp little teeth.

    • When syphilis first showed up in Europe, in the late 1490s, it was much more virulent than currently. It was probably too effective. It seems to have become less virulent, even becoming dormant for years before killing the host.

  29. About 20 years ago I had a flu. Could barely stand up.
    I lived, but at the time I wasn’t sure about it. Haven’t missed the shot since.
    About then we went to a clinic. They scheduled a morning and there were lines.
    About 5 years ago, most of the vaccine was going to pharmacies and clinics did not have much.

    If someone thinks they might have a reaction, I’d suggest going to a clinic. Then sit in the lobby and wait a half hour. I don’t even get a sore spot. My wife, on blood thinner, does. No big deal.
    But get the shot. You really do not want flu.

    • John. Just this morning recovered from the most serious flu illness I have ever experienced. At one point I was beginning to think I may not make it. A couple of days into the illness I was thinking maybe I should have got the flu vaccine like my wife does. About that time she got the flu too. Her son got the vaccine and the flu too. He is living with us now. I was forced to get a flu shot for ten years while a member of the USAF. The shot always made me ill for a couple of days. We were always given the shot before a three day weekend. I have not taken the shot since 1980. My wife and her son conditions were no better than mine. So now I’m still no sure about the vaccine.

      • James Francisco ==> “The CDC says: “…flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.”

        So, it improves one’s chances not getting the flu — if vaccinated, you’ve got a coin tosses chance of not getting it. If you also get the pneumonia booster, then you chance of getting mortally ill from this year’s flu is reduced by a lot more.

        If you can get FREE flu shots (health insurance pays) then your cost/benefit ratio looks pretty good — especially when, like me, one is older and the downside can be death.

        • Kip …. and all u other people …. if you want to maximize your resistance to the flu … 1) get a flu shot (number needed to treat NNT = 40), …. 2) take 4-5000 units Vit D (NNT =33; actually better than the flu shot); …. 3) take Elderberry Extract when in crowds and immediately if you feel you’ve been exposed to the flu (proven to antagonize flu binding to cells, thus preventing infection).

          You do those three things …. you won’t get the flu.

      • James F.,
        I sense at least two issues.
        The flu vaccine can cause symptoms , but cannot cause the flu.
        If you get ill “always” there is no reason, other than bad luck, that others should respond in the same manner (maybe twins?).
        If the three of you got the flu, the batch of vaccine in your area may have been poor — don’t suspect that’s possible.
        One of you picked this up. What happened next? Nursing homes and the like would have been in “lock-down” and visitors restricted. Those on site would use hand sanitizer quickly and often, and wear masks of high quality (say, N-95). Living in the same house and not doing such things would assure you of passing the virus around.
        Anyway, the two of us have had the shot for 20 years and have been flu-free.
        Better luck in 2019.

        • We suspect we picked up the virus in a local bar. All three of us were there a couple of days before. A friend playing for the band that night became very ill too. He said several people there became ill too. We drank two small pitchers of beer. My three cousins setting across our table didn’t have any problems. I guess I will get the shot from now on. Thanks John.

      • James, how long before you showed symptoms of the flu did your wife and her son get the vaccination? There is an incubation period before the symptoms appear, plus a lag time after the vaccination before it reaches any degree of effectiveness. It could very easily be that you were both exposed to the illness before the vaccinations.

      • The flu vaccine doesn’t immunize against all strains of flu, just the strains that they believe will be the most likely to appear.

      • James, the think to remember is that the flu vaccine is a bit of a guessing game. They have no way of knowing in advance which strains of flu will be going around. They look overseas to see what strain have been active there in guessing as to which ones are likely to be active here. Each vaccine is formulated to target three or four of the “most likely to circulate” strains each year, but there are many more stains out there. Unfortunately, it seem that your family happened to catch one of the ones that the vaccine didn’t target this year.

  30. I find the first graph comparing 1918 and 2018 mortality by age group quite astonishing. It appears that for those aged 65 and up, the chance of dying is today is the same as it would have been in 1918, and this despite the availability of a flu vaccine said to be more effective than usual.

    You might find it interesting to learn that the government of Quebec, which in prior years provided the flu vaccine gratis for those 65 and older, decided this year to deny it to those under 75, unless they have certain qualifying chronic illnesses . It would be most interesting to learn whether this turns out to be a cost-cutting measure in more ways than one.

    • otropogo ==> The first graph, with the “W” shape for 1918 compares 1918 with the ten previous years – 1911-1917 — not the present.

      The characteristic shape of the death by age remains the same, 100 years later — very young, very old, and the weak. 2009 was an exception again — men and women, strong and healthy, in their 20s once again were taken, but the numbers of dead were smaller than normal.

  31. Kip – My Grandmother nursed the sick in the 1918 Black or Spanish flu epidemic with its thrice-weekly “Dead Trains ” to mass graves outside Auckland City, NZ. My books inform me the last German offensive before the British broke through to open country past Cambrai in 1918, were accompanied by high rates of Flu in the ranks. We remember later epidemics like the Asian one after WW2, ’50-s-60s.
    In Dec. 1998 I got the Sydney A Strain and came within an ace of dying. My heart was badly damaged, lost 55% of pumping function, widespread damage. Studying Aplied Plant Science and Pathology at the time: I looked into this and found that it was the cytokine storm, virally-induced, that does the real damage. “A” or Wild Strains are indeed worst at killing, but the disease stops there, so weaker “B” strains that evolve are better vectors. Sure do not miss a flu shot now, but they weren’t available in December for my one. Nor would I have had one, having forgotten the lesson of history, as we do….. Cheers and Thanks, from Brett

    • Brett Keane ==> Thanks for sharing your flu story. Glad you’re still with us and able to give good advice — get your flu shots!

      I didn’t realize the 1918 flu hit New Zealand so hard. Those wanting more details on the New Zealand 1918 Pandemic can see it here.

  32. Epilogue:

    This essay had a two-fold purpose. The first being to remind us of the 1918 Influenza Pandemic, to which many of our grandparents and great-grandparents were witnesses and victims. Last year’s mortality numbers for the United States should give us pause — 79,000 deaths despite all the advances in medical technologies. Should a 1918-like Pandemic recur our hospitals will quickly be swamped and medical resources overwhelmed. Knowledge of this helps government health agencies prepare for such events. The good news is that medical researchers continue to learn more about how viruses work and how to fight them.

    The second purpose was to use the 1976 Flu Pandemic and the story of the US government’s response to it as an example of the difficulties of Decision Making under Deep Uncertainty. In 1976, President Ford as pushed by health experts to take massive, drastic action to prevent a possible disaster — and the actions turned out to be unnecessary and had adverse effects outweighing the good.

    The fight surrounding Climate Change response looks a lot like the 1976 Flu situation. One one hand, there are those who demand immediate drastic, potentially disasterous, action now to avoid an uncertain problem in the future. On the other hand, cooler heads encourage a combination of “Let’s wait and see” and “only no regrets” action in the present.

    Complicating the situation is the fact that the major players can not even agree about the magnitude of the uncertainty.

    Thanks for participating and…

    Thanks for reading.

    # # # # #

  33. As I understand it many of the deaths were caused by overdosing with aspirin:

    The high case-fatality rate—especially among young adults—during the 1918–1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely “wet,” sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.

    https://academic.oup.com/cid/article/49/9/1405/301441

    • Rexx ==> The paper you link only makes a case for the plausibility that aspirin treatment lead to some of the 1918 flu deaths and concludes:
      “To determine the proportion of virus-induced pathology, subsequent bacterial infection, and overall 1918 pandemic mortality attributable to salicylate, experimental models and analysis of primary consecutive individual treatment and pathology records are needed. Prospectively, aspirin should be investigated in countries where aspirin is used for influenza.”

      The idea may be sound, but the paper itself notes that aspirin treatment was not the norm, but rather was new and not common. Further, the 1918 strain of influenza was massively mortal everywhere — in tiny Alaskan outposts, major American cities, the wilds of New Zealand, the depths of Siberia — places where new (and at the time exotic) drugs were unknown and therefore unused.

      It might be possible to test the idea — the Army possibly kept treatment records for soldiers in its hospitals. But people dropping dead on the streets of America in 1918 were very unlikely to have taken too much aspirin — or even to know what it was.

      The interesting thing is that research goes on even 100 years later.

  34. Thanks for the fascinating read on a topic that deserves more discussion, both the 1918 flu and decision making conundrums. My grandparents’ generation was devastated by the flu. Both my grandfathers lost sisters, a great uncle lost his fiancée and had to marry someone else, friends died… all were in their 20s. Too many people today don’t realize the devastation that diseases caused just a couple generations ago. People lost children to whooping cough and diphtheria and Scarlett fever, people contracted polio. My aunt, now 91, contracted polio as a young woman.

    Nothing is certain, and diseases have a way of fighting back, but vaccines are a blessing. It dumbfounds me that people don’t vaccinate their children.

    • Janelle Allemandi ==> Thanks for sharing your family’s story — your experience is common but often simply not talked about. And you are so right about the diseases of yesteryear not being in the public’s consciousness….and the silliness for refusal to have children vaccinated.

  35. I was 20 in 1976 when everyone was encouraged tjo get the swine flu vaccine. Years later, my father recalled getting the vaccine at a local high school . Patients stood in line and waited their turn. He insisted he recalled the reusing needles to administer it. That was also the year AIDs began to spread widely.

    • Reggie ==> Your father is probably remember the Jet Injector — which was used in 1976 during the mass vaccination program against smallpox. The actually don’t have a needle but shoot a high pressure jet of the vaccination liquid into the skin of the patient.

  36. According to a story I read an autopsy on the remains of one of the victims of the 1918 pandemic which was preserved by the Greenland/Iceland permafrost showed that it was bird flue!

    • Ross ==> A man named Johan Hultin went to Alaska to dig up 1918 flu victim corpses, which had been buried and remained in permafrost, to get samples of their lung tissue in 1951. The 1918 flue was an H1N1 virus, and so are some bird flu and some swine flu.

  37. Question: Is it not possible that overly focusing on the 1918 Flu strain distracts from the issue of why that certain Flu strain took people who normally didn’t succumb to the Flu in general? Isn’t it as likely that so many healthy people died because during their lifetime that NO significant Flu occurred previously while they were “young” to prep their immune systems on an annual basis?

    The native Americans were decimated by Small Pox and other diseases brought by the Europeans. These diseases were not a part of the historical experience of Western Hemisphere up to that time and therefore there was no immunity developed by the native Americans. In other words, the surviving Europeans were carriers that reintroduced diseases to re-create immunity in the next generation by their very infectious presence. Hence, the very young would experience a high mortality rate due to a lack of personal historical exposure and very old would be killed off due to the state of general poor health (worn out body defenses) by the time they got old.

    Like everything else we experience in life, it is the constant assault, the struggle that preps us for success/survival. Use it or lose it.

    • dscott ==> The answer to the question is “Yes, it is reasonable’ but that was not the cause of the high mortality — virologists know now exactly what flu strain caused the 1918 Pandemic — they obtained samples, in 1951, from the frozen lungs of victims in the Arctic buried in permafrost– and they pray that it does not recur.

      The viruses that cause flu mutate very rapidly and present the medical world with new strains almost every year — there are a lot of strains out in the worlds floating around, hiding in animal populations and in human populations.

      In 2009, the new flu strain that popped up had WHO and other public health bodies very worried, as it was an H1N1 type, it struck middle aged people hardest — it just looked so much like the 1918 strain — but it fizzled.

      In the 1918 Pandemic in the US, there were two waves in the general population. Those who had been sick but survived the first wave were immune when the second wave hit.

  38. The portion of the article about modern prevention does not address promoting a high-level of immune function, something you need whether you go the vaccine route or not. Those of us who follow these topics closely address immune system health by promoting optimal vitamin D levels, ideally through brief exposure to mid-day high-angle sun, or by supplementation along with D’s co-factors, Vitamin A, K2 and magnesium, high-doses of Vitamin C, adding liposomal C as symptoms are coming on, and ensuring optimal digestive (micro-biome) health, as well as more exotic things.

    Regarding vaccine injuries, I am not a parent so I haven’t studied this topic closely, however from what I know of it, I think your portrayal is very unfair. My understanding of vaccine injuries is that they involve catastrophic (often permanent) loss of function and are not things that could be easily confused with something else. It would be interesting to know if such events ever happen in un-vaccinated children, but I am not aware of any studies looking at this, and vaccine injuries are apparently not reported in a well-organized, reliable way, so the answer seem to be that we really don’t know. It’s not a risk I would take except to vaccinate against a deadly and likely threat.

    Regarding vaccination overall, if someone is aware of good long-term studies (long-term being 10-15 years) that compare maximally vaccinated, minimally vaccinated and un-vaccinated equivalent populations against all health parameters, especially auto-immune issues, I would love to hear about it. That is what it would take to begin to establish safety and generate a proper risk/reward profile. The potential for long-term auto-immune issues seems, from my understanding, to far outweigh the marginal -at-best benefit from the flu vaccination, especially when the immune-strengthening items I mentioned above are added (something the CDC’s statistics are not corrected for.)

    Those interested in this topic should seek out the recent book or podcasts by Dr. Thomas Cowen on the topic of how the immune system, herd immunity, and vaccinations actually work, and the potential long-term risks involved.

  39. 1976 was the last time I had a flu shot. It must have worked well cause I’m still alive. The flu vaccines are a fraud because they will never know long enough in advance to actually manufacture and distribute the vaccines in time to prevent an outbreak. Faith in government sponsored solutions is a mistake. The next outbreak will most likely be genetically engineered to sail through the herd immunity.

    • Fred, they’re not a fraud, they’re an educated guess. They look at what strains are going around elsewhere in the world and, based on that information, make their best guess as to which ones will be active over here when flu season hits. Sometimes they get it spot on, other times not so much.

  40. Looking at the 2009-2010 flu graph, I would love to see a line where broad immunization program was underway. Without immunizations, would that early slope have continued its rapid climb?

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