by Pete Davies, 1999
The 1918 influenza pandemic killed more people than the first world war - the author estimates from 20 to 40 million people. It seemed to kill about 6% of its victims (the black plague killed 10%), and some of those that survived developed a sort of sleeping sickness, and some (including my grandfather I believe) Parkinson's disease. It killed many in the prime of life, and not so many old people, possibly because stronger immune reactions in the lungs led to more inflammation and effective drowning. Possibly the war helped to select it genetically for those of fighting age. It was called the Spanish flu because the king of Spain suffered from it, but it probably originated in China, where many flus do, thanks to the proximity of pigs, people and poultry, all of which share similar versions of the virus.
Flu Viruses are categorised by their outer proteins: haemagglutinin, shaped like a spike and the key to opening your cells, and neuraminidase, which helps the multiplied viruses cut their way back out again. The 1997 Hong Kong virus that killed several people was a H5N1 - almost certainly a mutation from chickens (which it turned into "Bloody Jell-O"). If it had managed to mutate and become transmissible by air (they think direct contact with chicken feces was the cause of transmission in HK) then a number of us on this list would be dead today, if we believe the experts in this book. That's why they killed every last chicken in the HK area.
H5 flu is rare in humans. What sort was the 1918 flu? Most of the book is about finding this out, which was surprisingly hard. For all their virulence, viruses are just a couple of big molecules, and they degrade rapidly. In 1993, Kirsty Duncan of Canada started an obsessive search for corpses that could preserve the virus. She settled on some sailors who died in Longyearbyen, way north of Norway. In 1998, at a total cost of something like $1 million, a team in moon suits started digging. Ground-imaging radar had shown the bodies six to nine feet under, well below the permafrost line. But digging showed them two feet under, their innards just a black tarry mess. Oops. Davies spends way too long on this story, because he was there as a reporter and developed a fine hatred for Ms Duncan.
Meanwhile in 1995, Jeffery Taubenberger of the Armed Forces Institute of Pathology found, among their 60 million glass slides and 10 million paraffin blocks with tissue samples dating back 100 years or so, a couple of samples of the 1918 flu, which he sequenced with the fairly new Polymerase Chain Reaction technique. It showed the flu to be H1N1, and took the flu research community very much by surprise. They really needed another sample to be sure. Enter Johan Hultin from Iowa, who had dug up some corpses in Alaska in 1951 as part of his PhD thesis, but hadn't been able to prove much with the samples. Now in his seventies, having climbed in the Himalayas and so on, he offered to pop up to Alaska and do it again. He spent $3000 of his own money, charmed the locals again, got some tissue and erected a memorial cross, then got some dry ice and Fedexed the stuff to Taubenberger! Hultin said he hated leaving a project unfinished. There was enough sample to complete the sequencing. The folks at Longyearbyen were very pissed, and said he had been reckless. But Hultin replied that the flu hadn't killed him in 1951, so it wasn't going to kill anyone now.
There is info on other flu epidemics in the book, like an H2N2 in 1957 that killed 70,000 in the US, and the 1976 H1N1 swine flu panic with its $100 million vaccination program that ended up killing more people than the flu, generating lawsuits totalling $3.5 billion. There's a section on the latest "plug drugs", engineered to neutralise the neuraminidase hook. You inhale them (AIDS drugs work the same way), but you need to do it right when you are getting sick, or it's too late. So drug companies are working on cheap flu diagnostics (time to invest in drug companies?). I was interested to read that some researchers at Mill Hill, two stops away on my commuter line -- how nice to know that Ebola is that close -- have vaccinated themselves several times against H5 viruses, in anticipation of the next epidemic, which will come sooner or later.
Medicine generally scares me to death, but I love books about viruses (The Hot Zone is another favorite). This book has great info, but does suffer in several places from padding with boring statistics, and lingering too long on the Longyearbyen personalities. Still a good read.