Hi, and welcome to this podcast Will Kill You. I'm Erin and I'm also Erin. Thanks for joining us.
Thanks for tuning in. This is our very first episode. Why are we here, Erin, Well, we just really like talking about infectious diseases and we decided to start this podcast as an outlet to talk about them more.
And we are graduate students currently studying disease ecology and epidemiology.
We're not posing as experts, that's for sure.
But we really like learning about this stuff and figure that other people might like learning about infectious diseases too.
So every episode we'll focus on one particular infectious disease.
We're going to start with some basic definitions, then talk about the biology of the pathogen, hit you with some history, then round it off with what the status of the disease is today.
And we'll end each episode by letting you know just how scared you need to be.
Welcome to episode one.
Today we're talking about influenza.
What is considered America's greatest pandemic.
Possibly the greatest pandemic of all time.
Depending on your metric. Right, we'll get into that.
We'll get into it, So pull up a chap pull yourself a drink, and let's get started bringing it back to nineteen eighteen. What are you drinking over there, Aaron?
What are you drinking? Oh?
I'm drinking a quarantiney.
Oh my gosh, so am I What kind of quarantine are you drinking? Today?
We're drinking the h one drink one inspired by the classic cocktail from the eighteen hundreds called Corpse Reviver.
Corpse Reviver, this is actually a Corpse Reviver two. Your multiple variants.
So if you'd like to follow along and drink or should I say, if you'd like to drink along and you can make your very own by mixing what is it? Equal parts gin lemon juice, quantrout and Lillet, which is a weird sounding French liquor. You can find it at the liquor store, mix.
And serve over ice.
It's really delicious, surprisingly great for something named corpse Revivor.
Actually this is a little bit of pre trivia. Oh, this was a popular drink in the nineteen during the nineteen eighteen pandemic.
Oh my god. Yeah, that's amazing.
Yeah. So every week we're going to be drinking quarantinies named with our own special names inspired by classic drinks or ones that we make up on our own, and we'll post the recipes and if you want to drink along with us, please do so.
We would love that. So let's define some of the words that people might not know that we're probably gonna use a lot, both in this episode and going forward.
Let's start off with epidemic.
So, an epidemic is an outbreak of a disease that is greater than what we would normally see in that particular population.
Okay, and so I often hear the word pandemic. Can you tell me what that is?
Right, So, a pandemic is essentially just an epidemic that has spread to be in many countries and or usually the entire globe.
What about pathogen.
A pathogen is a bacteria, a virus, or even a parasite such as a worm, that causes disease. Let's jump right in. I'm going to take you back all the way back to nineteen eighteen. That was the year in case you didn't know, that's the year of the Great Influenza pandemic. So we're going to start with some first hand account ounce So just to really get you in the mood of what life was like during this pandemic.
Are you ready, I'm ready, Okay. I'll read you a few first hand accounts from people I guess most of whom survived since they were able to write their account.
After Oh there are some of that didn't.
There are some that didn't. This is a story from Josie Mabel Brown. These are from the documentary which you can find on YouTube called The American Experience Influenza nineteen eighteen or something similar to that. So this is Josie Mabel Brown's story. She was a nurse at the Great Lakes Naval Station during the nineteen eighteen pandemic, and this
story was told by her niece. Her niece said, as she walked into the ward, not only were the forty two beds full, but there were boys that were laying on the floors and on the stretchers waiting for that boy in the bed to die. They were having raging fevers and delirium and profume snowsebleeds, and their lungs would collapse and it would go into this horrid, bloody pneumonia.
That sounds more like it's from a movie script right than it does real life. And that was real life in nighttore that was ninety nine years ago, this time of year.
Yeah, it's terrifying. We've got another one. This is doctor Victor Vaughan, who, Yeah, I don't know right, it's exciting. He was at a base near Boston called Camp Devns. He said, this is his actual words, He said, I saw hundreds of young stalwart men, which I assume that means like a strapping young man, stalwart young men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in their faces, wore a
bluish cast, a cough brought up blood stained, spewedum. Sixty three men died the day he arrived at Camp Devans. That's at one camp alone on one day. Remarkable, remarkable, It's incredible. And I think I have one more story that I'd like to tell just because it's well, I've got a grave digger story. But like, who doesn't have a grave digger story?
So this is I want to hear the grave story.
Okay, Uh. The grave Digger story is from Arthur Dory Davis and this is not from that same documentary. This is actually you can find these on the CDC, which is the Centers for Disease Control website. They have this very fascinating storyboard all about the nineteen eighteen flu with tons of survivor and also not survivor sufferer stories told from either first person perspective or from their immediate family, and it's absolutely fascinating. So here's one of those stories.
This man, Arthur Jerry Davis, was worked at like a logging camp and his family was in Tennessee during the flu, and so this is one story that he told his son. One morning, at six am, I was set to work digging three graves for a family of six that lived down the road from my home. Around nine am, the doctor sent word to dig yet another grave. Then around lunchtime I got word to dig yet another grave, and by four pm I was instructed to dig the final grave for that entire family. Oh my god, I know
it's depressing. Starting with a down.
I can't even imagine what it would be like. I mean one of us. I mean think about.
You're a teacher, kind of sure will you teach a class? Yeah?
Think about going to class one day and realizing what proportion of those kids, because we're they're all the ripe ages. We'll find out right, would not be coming to class a month from now because they'd be dead of influenza.
That's absolutely terrifying.
I mean it would be insane. Plus not to mention the fact that college classrooms are kind of a perfect place to breed this.
Oh they're filthy, filthy, disgusting human scholar student. Yes we are, okay, so maybe well we'll leave it at that. Was that depressing enough to sort of start us off with influenza?
I think so. I think I think it gave us a sense of time and place. So zooming out from those stories, let's talk a little bit about the history of influenza itself. Now, all of us, I'm sure know have or I've heard about seasonal flu. Get your flu shot, blah blah blah. Oh I can't come in. I have the flu. I have stomach flu. Not really, that's flu.
That's probably for a different day that we'll talk about that. But the stomach flu, guys, it's not flu.
It's not influenza. So influenza is a viral infection and it has been around for millennia. We don't know exactly how long because the symptoms of flu are so general, vomiting, nausea, fever, listlessness, listlessness. That it's a really hard line that it's It's unclear whether a lot of the epidemics that have been written about in history are flu or it could have been
some other respiratory ailment, could have been mnemonic plague. But it does seem clear that there are some in Europe in the twelfth century, in the fifteenth century, in the sixteenth century that can be pretty conclusively tied to influenza.
Wow, that's fascinating that it goes that far back.
Well, oh, it goes even farther back. So the first what research what historians call reliable description of influenza was done by Hippocrates himself, oh my god, the father of Western medicine. What we do know for certain is that the influenza virus was the causative agent for the huge pandemic in nineteen eighteen that killed wait for it, fifty to one hundred million people worldwide.
Fifty to one hundred million people.
So before we were diving into the pandemic itself, I want to bring you up to data bit about sort of the context, the historical context surrounding this huge pandemic. So let's talk about Western medicine at the time, so Western medicine was in its infancy, really bacteriology. So throughout the eighteen hundreds, early to mid eighteen hundreds, bacteriology really got up and running. We had Pasture discovering a lot
of bacterial posative agents of diseases. There were some innoculations going on vaccines, Edward Jenner with his smallpox hit in the late seventeen hundreds. Epidemiology began as a science in eighteen fifty four.
Fascinating and we'll talk all about that in a future episode, won't we.
Yes, we will thank you John snow not from Game of Thrones, different John snow So. But despite all of the advances of medical research, medical practice was really lagging far behind. And this was due to a multiple factors, one being that germ theory was still kind of debated, so germ theory was not widely accepted.
Can you explain a little bit what germ theory.
Got to ask you to do? Aaron, Can you tell us what germ theory is.
I'd love to. Germ theory is essentially just the idea that many diseases, most normally we think of infectious diseases are actually caused by micro organisms rather than just say the air or the water, which is what was very commonly thought before we realize that there are organisms that are so small that you can't actually see them with the human eye, and that's what actually is causing many infectious diseases.
Thank you, excellent explanation. So yes, so germ theory was not widely accepted among doctors, and even if it wasn't widely accepted, a lot of physicians practicing physicians were never given a class in this medical school was totally achievable for any human being who had enough money. Oh dear, you could spend a couple of years in US medical schools up through like the early nineteen hundreds prior to
the nineteen eighteen flu. You could spend a couple of years in medical school taking some courses, never actually see or interact with a patient, and graduate with a medical degree.
Oh my god.
As a result, there was a lot of mistrust among doctors.
Doctors, completely understandable.
Of course, doctors back then didn't have the respect that they do today in terms of oh this stop, I'm going to go to the doctor and I know that they will fix my ailment. So consider the time nineteen eighteen, even though there was a lot of work being done on bacteria, there was still no antibiotics, right, so you could there were inoculations, so you could to some degree could be protected against some diseases, but a lot of ones there was nothing that you could do. In nineteen
eighteen during the flu pandemic, alcohol was prescribed. I mean, Mike, I mean, I can get be behind that, but that's not going to help you.
No, it's really it's it's going to make you feel a little bit better because you forget how much pain you're in, but it's certainly not going to cure any of your ailments.
So the other thing, besides the complete lack of adequate medical training going on in nineteen eighteen, there was also a war going on.
Oh yeah, there wasn't there. It was kind of like, I don't know, the First World War.
The war to end all wars, not if only that were the case. What this meant war means guess what large scale transport of young men throughout the entire world, and.
Crowding very very much and also very unsanitary conditions.
Very unsanitary they were, I mean.
Like digging pits and things and just hundreds of people all slumped together, and you know, probably poopin and holes and things, probably pupinin holes, probably pupinin holes. It was.
It was basically it set the stage for perfect conditions for transmission of influenza. So let's get to the pandemic itself. Ooh, let's we'll head to Haskell, Kansas, early nineteen eighteen.
Wow, Kansas of all places. Yeas, let's go Kansas. I'm there here we are.
A doctor named Loring Minor began to see cases of influenza that were a lot more severe than he had previously encountered. So he and this was also notable because A, like I said, it was a lot more severe. But b it was also impacting young, strapping men otherwise the people who are least susceptible to influenza.
Right because generally it's what old people and tiny little babies that actually get sort of severely sick from something like influenza, right.
Right exactly. He made a note of this, and he sent off some letters and some notes medical journals to public health officials saying, hey, can you help me? Can you send some things like this is a problem, And he got no response, Oh.
My god, just a man trying to be proactive.
Just trying to be proactive. And so by this these cases started popping up January February, but by mid March the epidemic had burned itself out. Basically good news, good news, right, Yeah, it didn't burn out before a couple of soldiers returned from Haskell back to their back to Camp Funston.
Funston.
Yeah, not very fun I don't think. Where is Camp Funston, also in Kansas, oh Okay, where a super cold winter meant that they had to put a bunch of soldiers together in barracks much more crowded than they would ever have allowed before, which led to rapid spread of this virus throughout the entire camp. Within a few days, people like hundreds of soldiers were sick. And it didn't remain,
of course, isolated at Funston. Because of the war, soldiers were being sent to other places in the US, other camps in the US, over to France, over to England, and thus began the first wave of the pandemic.
Oh my gosh, way to go Kansas, Way to go Kansas.
More on that it might not be actually Kansas in this first in what historians called the first wave of the pandemic. Tens of thousands of soldiers were hospitalized, but very few died, which is interesting. Yeah, during this first wave is where Spanish influenza picked up its name.
Oh, let's talk about its name, because a lot of people think, if it's called the Spanish flu, it must have come from Spain, right.
Not so?
Oh fascinating.
Actually, so, there are a number of theories as to where Spanish flu actual began, but none of them are Spain. The likeliest scenario by according to a lot of historians, is Kansas Haskell Kansas, France is another contender where birds waterbirds, and pigs domestic pigs mix.
I'll talk a lot about birds in just a minute.
And so, but the reason that it got the name Spanish flu is because Spain was neutral during World War One, whereas countries like the US, England, France, Germany, all of whom were very hard hit by this first wave, censored their news.
Oh my god, the US censored their news.
Shocking, shocking. So a lot of this came off of I thought this was really fascinating. It came off of Woodrow Wilson, who was president at this time. Passed what is called the Sedition Act of nineteen eighteen, and it prohibited the use of quote disloyal, profane, scurrilous, or abusive language about the US government It's flag.
Oh god, aren't we doing that again too?
M or its armed forces, or that caused others to view the American government or its institutions with contempt.
Oh my god, my jaw is on the floor.
So this meant that a lot of news about the flu was kept under wraps because it would have made the US look weak, right and bad. And it also so yeah, they're just there's so much I could keep talking about that. Yeah, Oh, I mean this there could be an entire someone should I'm sure there is one a podcast episode on this Edition Act. Because it is dirty. They used it to say, like if you were walking down the street and you said this war sucks, you could be put in prison. Wow, it was that kind.
Of that's absolute insanity.
M hmm. It's up there with some of the.
Bady hopefully not what we're about to get into current. Where's that drink?
I don't you go? During the first wave, the flu raged globally from around March to June through August wow. Between for instance, between June first and August first, over two hundred thousand British soldiers who were stationed in France were hit hard enough that they could not report for duty. So this is two hundred thousand out of two million, wow, which is ten percent.
That's ten percent of the soldiers were sick enough that they couldn't even get up and stand at their bunks or whatever you have to do when you're a soldier.
Yeah, exactly, it was. It was really bad. But then August came around and it was gone.
Wo.
So it's good news, wonderful. Episode over, episode over. Not so fast, not so fast, the second wave began. So the second wave was the more lethal wave, and it first took hold on us soil by many accounts, at Camp Devns outside Boston. Oh, we already heard a little bit about Camp Camp Devans.
I sure did.
And this started in mid September. Up to twenty percent of soldiers were sick at one time, and descriptions of the progression of the disease ooh, were horrifying.
Tell me them. I want to hear that.
Okay. Oh, I have a big section on this later.
Oh good, good, good.
Within actually we'll just do all the symptoms right now, within a couple of hours of admission with standard flu symptoms.
Okay, so we're talking like aches, chills, fever, et cetera.
Mm hmm. Patients were turning blue because their lungs could no longer transfer oxygen into the blood.
Oh my god.
So let's hear some more symptoms of the nineteen eighteen flu Let's extreme pain, body pain, so much so that physicians at the time were not sure whether it was actually Dungey fever also known as breakbone fever, because it is so extraordinarily painful. Wow, cyanosis, which is what I just mentioned right.
That's turning blue, like your actual skin is blue like a smurf.
Bleeding from mucous membranes, so your nose. Sometimes doctors reported blood spurting out, oh the nose.
Blood spurting out of your nose.
To a couple of feet away, Holy cow, dribbling from your mouth, your eyes ears.
And if you're a woman, your vagina, well doesn't that happen anyways, you know.
That's why it took so long to be noted as AI.
It's just your woman problems. Don't worry, go home. Tend the children.
Yeah, well they couldn't because pregnant women face the highest mortality rates of all. All internal organs were affected, so you would have necrotic adrenal glands, dry brain tissues, which indicated Yet.
Your brain dried out. Bro, If you didn't know this, your brain is literally sitting in a pool of fluid. Is not supposed to be dry.
The folds got all weird, and the brains, yeah, brains dried out. Torn or degenerated muscles associated with coughing.
You cough so hard that you rip your muscles of your diaphragm and stuff.
Eh, and lungs that looked so bad upon autopsy. Doctors compare their condition to pneumonic plague, which is the second most lethal form of bubat of your Cinnia Pesta's plague, which causes death in ninety percent of its victims.
Don't worry, We're gonna have a two part episode dedicated to the plague.
Yeah we are. Or toxic gas. Wow, it destroyed the lungs. I mean they would fall apart. It was. It's horrifying, Wow, horrifying. Oh my god. Here's another very unique symptom of the nineteen eighteen flu accumulation of pockets of air just beneath the skin, so that when a patient was turned over to maybe change the bedding there's, their bodies would crackle like One Navy nurse compared the sound to rice crispies.
I was gonna say, like rice crispies.
She said she could never eat the cereal again.
Oh my god, I don't know if I can, except let's be really, I can definitely eat.
They get way too soggy.
Waste of time, That's all I'm saying.
So it was horrifying. I mean it was so it was would some people would come in within a few hours be dead. It was unheard of for flu.
I mean still to this day, that's absolutely insane. Well yeah, kind of, we'll see, is it really? I don't know.
So what happened? So this this was not this incidant was not isolated at Devons, the extreme mortality. It spread globally. And but but if it was this the same virus that caused the first wave, and if so, how did it pick up pathogen or how did it pick up it? Right? One hypothesis is antigenic shift. Oh, erin, can you tell me a bit more about antigenic shift.
Yeah, you know, let's let's let's do that. Let's talk about the flu virus. There's a couple of words that I want to define so that then we can sort of talk about the flu virus in general. So one of them you already mentioned, which is virulence, and the
other word is infectivity. So I'm just gonna really quickly. Infectivity, for anyone who doesn't know, is essentially the percentage of people that are exposed to a disease that actually get infected, So it tells you how well infectious and infectious disease actually is. So let's say I'm sick with the flu and I cough on you, maybe you'll get the flu and maybe you won't. And infectivity determines how many people that I cough on will get the flu. Right.
Do different flu strains have different levels of infectivity?
Absolutely? Yeah, absolutely So clearly the nineteen eighteen flu was a particularly infectious strain. It was able to sort of travel the globe, and in general, flu viruses are very infectious compared to something that, say, like sexually transmitted such as HIV. Okay, and then virulence, which is essentially if you do get infected how likely is it that you're going to get very, very sick and or die. So that's what your virulence is. So this nineteen eighteen strain
was both very infectious and extremely virulent. It was killing a ton of people. Flu viruses, the influenza virus for I don't know, I guess how many people are listening to this that don't know what a virus is. Let's let's just define it difine virus. Let's define it. We're starting from day zero. So viruses are essentially just little bundles of genetic material surrounded by protein. Right, Viruses have proteins on their surface that our cells are immune cells
used to recognize them. These proteins are called antigens, and we make antibodies to fight them.
Makes sense, makes sense.
So flu happens to have two of these antigens, H and N. So if you've heard of H one, N one or whatever, yeah I have. Okay, yeah, So that's what that actually means, is the proteins that are on the outside of the actual flu virus itself. It just so happens that there are sixteen of those H proteins and nine different versions of that N protein.
That's a lot of combinations exactly.
So, the flu virus is what's called a retrovirus, which is a type of RNA virus. That means that the genetic material that makes up the flu is RNA. In humans, it's DNA.
Gotcha, gotcha.
RNA viruses and retroviruses especially have a really high mutation rate. They're so retro get it because they're retro viruses. It's like nineteen eighteen.
Do retro people have higher mutations?
It's just like a funny joke play on word.
Can we get a cricket sound please? Cricket? Thank you?
So what that means a high mutationary means that every time an influenza virus replicates, it might make a few mistakes that could result in small changes to those H and N proteins that make it harder for our body to recognize it. And this process, if you care about vocabulary, is called antigenic drift.
Gotcha.
Now, the other way that flu viruses can change, which is even more dramatic, is what's called antigenic shift. Basically, the flu virus isn't just a single strand of RNA. It's a bunch of short strands. So if for example, as often happens, an unlucky pig or an unfortunate bird is infected with not one, but two different strains of flu.
Like H one N one and H three N three.
Exactly, those can inside of the bird or pig mix and match and recombine to make like H one and three or H three and one. And this is what makes it really hard for our immune system to actually respond.
And so that is shift. That's a major change, exactly, and drift is small changes which are less scary exactly. And so antigenic shift, then is what is theorized to have happened in the nineteen eighteen second wave pandemic. One of the reasons that they think that this is the case that it was an antigenic shift rather than a completely new virus, okay, is that a lot of the people who were infected during the first wave showed immunity or partial immunity to the second wave.
Yeah, so that makes sense.
So that makes sense. So now we've got this horrifying, the virulent virus right that is wreaking havoc in the military in the US, just raging in France and England and Germany, and it doesn't stop there. It spills over into the public and there it's even worse in some places. So a lot of the anecdotes that I'll be mentioning in terms of the pandemic spread take place in the US. And that's just because one of the books that I read concentrated on this pandemic in the US.
Right, it doesn't mean that these weren't also happening all over the world global.
The globe was affected by this, and a lot of areas were hit harder than the US. So from Camp Devons, the virus more deadly this time exploded across the US. And so one of the places I'll talk about is Philadelphia. So Philadelphia was hit extremely hard, partly because the lead public health official at the time refused to cancel parades to say saying that public morale was more important than and he was like, oh no, the flu is not a problem. The flu's not a problem.
Oh no, yeah. And what's important is that for the flu virus, you become infectious, that is, you start shedding virus out of you, like coughing, sneezing, whatever, before you actually show any symptoms.
So that means that you could be a happy go lucky, seemingly healthy twenty five year old woman at this parade waving a banner meanwhile coughing, really not even coughing, but just breathing, hugging people and giving kissing people, kissing people with.
The mouth, and just spreading flu virus. And so that's really really important. It's a really important aspect of the flu is that you are infectious before you ever show symptoms. And that's why it's very, very easy to spread because you have these people, like you said, at a parade, that seem to be perfectly healthy, so you're not afraid of them like you might be of someone who's coughing.
You might avoid a person who's coughing because you think, I don't want to get sick, but you don't avoid people that seem healthy, because why would you.
Right, And so at this massive parade in Philadelphia, which was not shut down against the advice of virtually every other public health official and physician, within two to three days after it, the number of flu cases exploded in Philadelphia to be in the thousands.
Oh my god.
On one October day in Philadelphia, seven hundred and fifty nine people died of influenza.
One day, in one day, in one city.
In one city that's prior to this outbreak of influenza, all deaths in the city averaged four hundred and eighty five per week, all deaths for all causes.
All causes. Oh my god.
So it was extra raordinarily bad.
Yeah sounds.
The other terrifying thing about the influenza pandemic tell me is that the people that were hit the hardest were not the people who are usually hit by influenza. So usually the influenza mortality curve, so where you would have on the Y axis, on the vertical axis the number of deaths, and on the X axis, the horizontal axis,
you would have age in years. So with zero at the far left end and let's say one hundred at the far right end, normal influenza, seasonal influenza, you see a U shaped graph where you see high mortality mortality peaking in infants and in the elderly, well people and babes, old people and babes. With the nineteen eighteen pandemic that you was turned upside downce it was actually inverted where
you see the highest mortality rates among people. The highest was in the group between the ages of twenty five and twenty nine. Wow, followed by thirty to thirty four and then twenty to twenty four. So it hit hardest the groups of people that are normally completely resilient, healthy, young, robust.
So how did this happen? Was this all just because it was a new virus? I mean?
So there are a couple different ideas. Okay, One is that the elderly were protected because they had been exposed to a similar virus in their youth. Okay, it doesn't match up to some of the other previous epidemics, but that still could be the case. Another theory is that young people had also very healthy immune systems, so that by the time the virus had invaded all of their lungs, the immune response that their bodies mounted was so severe that it was that that actually killed the people.
I am shook.
So does that make sense?
Yeah, you're saying that because they had such a great immune system. Essentially that all of the stuff that your immune system, which we're not going to get into because it's too technical, but all of the stuff that is released during that immune response essentially is what actually killed them and not.
The virus itself, right, exactly.
Wow, we're like penalized for being good at stuff, I know, typical young people.
So it was I mean it was devastating and bizarre. Yeah, and it caused a lot of panic. It caused a lot of laws to be enacted, such as anti spitting laws.
Okay, that's probably a good law of is I.
Mean, yeah, you're who like you shouldn't spit on people anyway.
But but so if your city has an anti spitting law, it's probably because of the nineteen eighteen flu.
It probably is.
That's awesome.
Somebody was killed because of because they spat.
Wait, like somebody got infected because they were spat on.
No, no, I'm sorry, somebody a policeman. I need to I need to fact check this. Oh, but let's just say that it's fact. Okay, a policeman killed an individual or spitting in the streets in San Francisco.
Oh my god.
It was taken very seriously. Wow, I you could not go outside without without face masks. But at the same time, the public health advice was very influenced by the fact that the US was at war, so it was keep morale up. The ways to avoid the flu were to not talk about the flu. Oh, no, yep. So this was the genius idea of the same guy who decided to go on with all the parades in Philadelphia, Oh God, and don't talk about the flu. Drink alcohol probably probably,
and cheer for your country. With this devastation going on in the youngest and healthiest populations, the race was on to try to find a cure and the causative agent. For a really long time, the causative agent of influence was not known, and the biggest contender was this bacterium called Hemophilus influenzae, which was found in a lot of flu patients. Right, But it wasn't actually.
That obviously because we know now that it's But how did we figure that out? I mean, nineteen eighteen, we didn't have a lot of technology, right, right.
No, it took a really long time, and so it wasn't actually until a few years ago, within the past ten to fifteen years, was it conclusively shown that the nineteen eighteen flu was actually an influenza virus.
How'd they do that?
Well, I'll tell you, a bunch of scientists went up to Alaska.
Probably put their glasses on because scientists all wear glasses, and.
Labco stereotype PPE personal protective equipment.
That's not a stereotype. That's important, that's really important.
Got our ethics training. So a bunch of scientists went up to Alaska where they where there were graves in the permafrost from the nineteen eighteen flu victims, and the fact that it was in permafrost means that the conditions were such that the bodies could be preserved a lot longer, and so the RNA and the viruses didn't degrade as much. Right, that's so cool, super cool. So then they actually dug
up some bodies. Hope they got permissions, I should have said, got permission to dig up some bodies and took out lung tissue in some of the victims, and from that isolated the RNA virus, the influenza virus that caused the nineteen eighteen flu. They sequenced it and they recreated it. Are you serious? So in a lab they recreated the nineteen eighteen strain of flu virus that killed fifty to one hundred million people. Wait wait for it. They infected
monkeys with it and the monkeys died of this. This in very similar way that the victims, the young victims of the nineteen eighteen flu virus did, which was their immune system just going crazy at the flu virus. Poor little monkey, Poor little monkeys. But this also brings to mind the ethical dilemma. Yeah, of such work, right, So, and I'm not talking about testing animals. That's for another.
Episode, separate ethical dilemma.
Right, But we're talking about the bioterrorism impact. Yeah, So when you have this viral genome sequenced, you can publish it. It's basically a recipe.
You actually you have to publish it. You do have to publish it, like there are requirements that when you I don't know if this is boring for people, but if you sequence something novel, you have to publish it in a publicly available database. So yeah, in theory, anybody with enough knowledge and access to laboratory equipment could make it and then disseminate it. And it's been long enough since nineteen eighteen that most of us probably aren't immune to that.
Right, except unless you got your flu shot. So every year the flu shot includes a number of different flu strains, right we talked about Yeah, and in two thousand and nine, actually they included H one N one variant of nineteen eighteen.
Right, oh of nineteen eighteen. Yeah, Oh shoot, I don't know if I got my flu shot in two thousand and nine.
I don't think i'd but I mean it probably is worn off by now.
That anyway, Tue, that's true. But that's really Interesting't that interesting? That? I love it? Because it was an H one N one flu that caused that swine flu outbreak in two thousand and nine that people were very worried about that that. I mean, it turned out not to be as bad as it could have been. But wow, how interesting.
Yeah, by the end of the pandemic, which was pretty much over by Armistice November eleventh, I mean it came through, it swept through the globe and left devastation in its path. Fifty like I said, fifty to one hundred million people killed worldwide, some of the areas I just wanted. There's some yeah, interesting statistics.
Yeah, hit me with them.
In the US, about twenty eight percent of people were infected. Wow, six hundred and seventy five thousand people died today that is estimated. That would be over one million, seven hundred and fifty thousand people.
Oh wow, it would be devastating.
Oh my God, but the US escaped the mortality that a lot of other places saw.
So other places had it even worse than six hundred and seventy five thousand people.
Yes, there were entire villages in Alaska that were killed. Oh my god, entirely everyone dead. I ran between eight and twenty one point seven percent of the population died.
If you could see my face right now, it's just like a shocked, totally shocked.
The worst affected was German Samoa, which is now the Independent Republic of s with ninety percent of the population infected. Why thirty percent of adult males, twenty percent of adult females, and ten percent of children.
Dead Islands Man Islands. It's just so easy to just spread through an entire island.
Like that, especially if it hasn't been exposed, especially if the population hadn't been exposed to a similar influenza mass. So it was truly, it was truly devastating, and so one of the questions though, because it had such devastation, it caused such high mortality, but why didn't it leave its mark in American culture or literature or music or behavior. And the answer is it probably did, But overall, I mean, it didn't leave its mark the way some of the
other pandemics have left as as obvious a mark. Some historians argue that the pandemic accelerated the end of World War One. The Central Powers were hit harder and earlier, or were hit earlier harder by the flu virus, and so that weakened their forces, and so then they tried to negotiate peace talks earlier on than they had anticipated because the Allies were hit later on.
Oh wow, so we actually only won because.
We got sick later, because we got sick later. Wow. There was and there was there was one in one of the books that I read. Some historians have theorized that Woodrow Wilson came down with the flu and it changed him his mental state, which was shown in some other cases anecdotally in terms of being more aggressive or more just a personality, like a permanent change, like a permanent change. Whoa, And he was way more withdrawn and way more argumentative, and way more stubborn, and so he
the peace treaty, the armistice that was eventually negotiating. The peace treaties that were signed were much more severe towards Germany that Central powers than they originally had planned on and so that could have contributed to the animosity which then built up events leading to World War two.
Wow, which is interesting, that's insane.
So yeah, so this, this nineteen eighteen pandemic was enormous in scope, enormous in death toll. Yeah, and we haven't seen anything like it since. In twenty four weeks, the flu virus killed more people worldwide than HIV has killed in twenty four years.
Seriously, seriously, that's a that's seriously wow.
So I should fact check that because that statistic is from two thousand and four.
Oh yeah, we should definitely back check that then. But that's still a pretty shocking statistic.
Shocking, it's a I mean, it's terrifying to read about because this was only ninety nine years ago. We don't have treatments for viral infections that are as effective as we do for bacterial infections.
Right, Viruses are still much trickier, little beastis and a lot of that has to do with what we were saying before about just how sneaky these viruses are and how mutable they are.
Right. So, then the question ill posed to you is how worried do we have to be? About another nineteen eighteen pandemic.
It's a really great pandemic. So let me say, can I just say you should be worried? Like I mean, I could leave it at that, but I'll elaborate.
But tell me why.
Okay. So the flu virus being such a sneaky beastie is something that obviously sort of circulates all the time. Right, there are seasonal flu strains, and you probably every time that you go to your doctor between the month of September two January says word, your lecture got a flu shot? You should have you had your flu shot? Yet?
Do you go to a doctor that in the nineteen twenties.
Yeah, that's us how my doctor voices?
Does see work at a speakeasy here?
Oh, good trial tonic. I'm all flu shot. But the vast majority of those flu cases for anyone who doesn't get the flu shot, are pretty mild. Right, You're maybe miserable for a week, but you recover. You don't die unless you're a very old person or a very young person, or an immuno compromised person. But there is quite a lot of concern that a similar thing could happen. As to what likely happened in nineteen eighteen. That is a new strain that we have never previously seen, we being
the human race, has never seen before. And if that were to happen, yeah, we really could see something similar to what we saw in nineteen eighteen. If you were to ask most people who work and study infectious disease epidemics what they're most afraid of, I would put good money on bedding that they would say.
H five and one H five and one H five and one. Sorry, I said end one A five and one H H five N one.
Right, So H five and one is avian flu bird flu? Have you heard of that?
Of course?
Right, most people have heard of it. If you haven't, you're hearing about it now, so you'll be ahead of the curve. The avian flu is a particular strain of virus that circulates in wild like waterbirds, ducks, geese, et cetera, many of which are migratory, and it can also circulate in domestic foul so chickens and domestic ducks. And the reason that it is so scary is that it has been spilling over to humans.
What does that mean exactly? Spilling over?
So spillover is the term that we use when a infectious disease that normally circulates only in animals begins to infect humans.
Could that be something like ebola.
Absolutely, we'll talk about that in a future episode. Don't worry, but yeah, absolutely. Ebola is a very good example of a disease that is usually caused by spillover from animal populations into humans. And same thing with H five N one. So this is a virus that usually circulates in wild birds, often spills over into domestic birds, and from those domestic birds, it's very easy for it to then spill over one more time into the human population, and it has done
this a number of times. The very first time that this happened was in nineteen ninety six or nineteen ninety seven. Nineteen ninety seven was the first human case. It happened in Hong Kong. It was a little boy and he died, and he became the first known human case of H five N one. There were a number of other people, seventeen other people in fact, that became infected around that exact same time in Hong Kong, and five of those people died.
But those are very small numbers that you're telling me. So does this mean why? Why wasn't there a pandemic. Why wasn't this larger?
Well, okay, so I can hit you with some slightly scarier numbers hit me. So that was nineteen ninety seven. We're now in twenty seventeen. That's twenty years later. This bird flew H five N one has spilled over from domestic animals into humans in sixteen different countries. It has infected eight hundred and fifty nine people, according to the most recent estimates by the World Health Organization, And of those eight hundred and fifty nine cases, four hundred and fifty three of them died.
Holy moley, that's a fifty.
Two percent mortality rate. Fifty two percent. That's why this virus is so terrifying. So it's true that most of these are what you might want to call like isolated cases.
Maybe maybe were humans the dead end host? No, Well, was there human? Was there human to human transmission?
Right? So that's the big question. And in many of these outbreaks we do see evidence of human to human transmission, and this is something that for a long time. There's been a lot of politics around this, and for a long time, various governments were refusing to recognize that human to human transmission was actually happening. But in many of these cases, human to human transmission is definitely happening, it is at much lower levels than what we normally see with a human flu virus.
So the infectivity is lower exactly. And so the issue with the government is that because when H five N one was found in a bird population, they would call the entire.
Well yes and no. So that's sort of common practice, and that started because of that initial outbreak that happened in Hong Kong. Hong Kong actually called millions of bird birds and they have since kept infections very much at bay on the island of Hong Kong. Other countries have
tried to do the same. But the issue is that in many of the countries where these spillovers are happening, it's small farmers who have these bird flocks, and so you're basically destroying their livelihood by coming in and culling all of these infected birds. So farmers don't want to cooperate and the government doesn't want panic, which tends to happen when you say something like fifty two percent of people are dying from a pathogen that we don't have control over.
So I understand that the government doesn't want panic, but we kind of saw how that panned out in the nineteen eighteen flew.
Yeah, isn't it amazing how humans just never learn our lesson?
But then there was the Ebola scare. I think that it's a it's a combination of not wanting to panic people, which is understandable because then people might do crazy things, but then also a lack of scientific understanding about transmission. So whereas the Ebola scare, it was not warranted for people in the US, but this is warranted in some cases.
Yeah, So there hasn't been extensive human to human transmission yet, extensive meaning you know, we haven't seen a pandemic yet, but there certainly has been limited human to human transmission. So maybe one person going home and infecting his entire family, for example, but maybe not infecting an entire village or
an entire town or something like that. But that is sort of the biggest fear is that this virus has spilled over so many times that eventually it's going to break that last barrier and it's going to be able to be transmitted freely between humans, in which case we could absolutely see a global pandemic.
So, but one difference between now and nineteen eighteen is technology for a vaccine creation. Absolutely how does that plan this?
So every year they're all, I guess it's virologists. They try to predict what is going to be the most common circulating strains of flu, right, and they put those They do a lot of models to figure out what strains those are, and then they make a vaccine for it.
And that's the seasonal flu vaccine that you get. This virus we can't quite make a vaccine for yet because it doesn't quite exist yet in a form that would be passing human to human, So we wouldn't be able to make a vaccine for it until it's it already is circulating, if that makes sense. So we don't have
a vaccine for H five N one for humans. We do have a vaccine for domestic birds, and so a lot of places are trying to vaccinate all domestic birds so that we don't have that initial spillover event happening in the first place. But that's sort of an imperfect system as well. So another big difference between nineteen eighteen and today is that today you can get on a plane in Chicago and be in Hong Kong tonight, get on a plane there and be in Australia the next day.
So our mobility is insanely huge. So the chances that if something like this were to happen that it could spread worldwide extremely quickly are very very high, which is something that concerns a lot of people who study this.
So to answer your initial question, which is how scared do you you need to be about this kind of thing happening today, go ahead and get your seasonal flu shot at wash your hands, and just, I don't know, be a little bit afraid, I guess, be a little afraid, not too afraid, like, but you know, don't hang around birds. That would be a good piece of advice I have for you. Don't hang around birds.
Be aware of the symptoms of flu and educate yourself.
Don't be afraid to go to the doctor. Don't be afraid to go to the doctor because that happens a lot and then you can end up infecting family members or friends.
If you're feeling sick, don't go to work, oh my gosh.
And don't come to class.
Oh god, please don't come to class. Don't go to the library, don't cough on me on the bus.
Don't touch all the door knobs.
Cough into your elbow. I think we're being too preachy.
We're definitely being here.
We can cut all of this, Yeah, we can. Well, I don't think I have anything that I want to add.
How do we close this out?
We say?
Oh, thanks for listening, Thanks so much. Make sure that you rate, review, and subscribe.
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If you want to learn more, we have a number of books and articles that we're going to hit you with right now.
Yeah, we encourage you to read.
Some of the books that we focused on were The Great Influenza by John Berry, which is super interesting. It's really well researched, great book.
All about the nineteen eighteen flu, specifically.
Right, and it focuses mostly on the effects in the United States. Flu by Ginocolata is more focused on the discovery of the actual flu strain that caused the nineteen eighteen flu, so how it was isolated and then sequenced and so on. Pale Writer by Laura Spinney is another nonfiction book about the nineteen eighteen flu, and this deals more with personal histories and accounts, and this has a much more global feel to it.
Okay. And then if you're interested in learning more about the Avian influenza and you want to be scared shirtless, like seriously, you can read Fatal Strain Colon on the Trail of Avian Flu and the Coming pandemic, and that's by Alan Cyprus. It's a really really interesting book. Thank you to Bloodmobile for the music and to Miles for all of your help with our logo.
Thanks for listening.
Bye,