Month: February 2022

World War I and H1N1: The Dynamic Duo

mac7800 on

Today the flu virus is nothing more than a seasonal stressor for those who aren’t of vulnerable populations. However, the flu virus of today was not the same flu virus of the 1918 Spanish Flu Pandemic.

The 1918 Spanish Flu was an epidemic of H1N1 flu, a subtype of influenza A. This subtype was particularly infectious and lethal because of a rare combination of 8 genes which made an exceptionally unique natural-born killer. Unusually, the H1N1 flu had a characteristically high death rate amongst healthy adults, ages 15-34 years old. The high death toll was due to the efficiency of viral infection. Once the virus infected the lungs, it would overstimulate the immune system, causing a cytokine storm which encouraged the extensive migration of white blood cells to the lungs.

H1N1 influenza virus.jpg
H1N1 influenza A virus

While this may seem good thing, such an extreme immune reaction resulted in the destruction of lung cells and secretion of blood and mucus into the airway, causing difficulty breathing and suffocation. By the end of the pandemic in April 1920, nearly 500 million people worldwide had been infected and an estimated 17-50 million people died of the virus. The H1N1 flu virus alone lowered the United States life expectancy by more than 12 years. Accordingly, it is considered one of the deadliest pandemics in human history(1).

Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston
Soldiers sick with H1N1 flu in Camp Fuston’s hospital ward at Fort Riley, Kansas

Yet beyond the virulence of the H1N1 flu strain, the spread of the pandemic was largely due to World War I. Such an unprecedented large-scale war led to the drafting of millions of soldiers from countries across the world. Bringing together such a vast population in such unsanitary wartime conditions simply aided the virus’s spread.

Furthermore, the lack of abidance by a strict quarantine procedure within militaries did nothing to mitigate the spread of the virus. In the United States, when Camp Funston in Kansas was experiencing a rapid increase in H1N1 flu deaths, military officials transferred countless soldiers seeking refugee from the virus’s scourge(2). Instead, these soldiers simply brought the H1N1 flu virus with them to the military base they were transferred to. Additionally, soldiers from these infected military bases were being shipped across the Atlantic to fight on the warfront. In doing so, they continued to expose and spread the virus throughout the US military’s ranks and throughout the international militaries(3). However, the virus wasn’t limited to the militaries as the H1N1 flu quickly spread from the military bases to the surrounding citizenry.

Egon Schiele (1880–1918), Die Familie (The Family), painted a few days before his death, just after that of his wife Edith.

Though the greater context of World War I  is largely blamed for the H1N1 flu pandemic’s devastation, it was truly the ignorance and disregard of basic epidemiology principles which created the perfect storm that was the 1918 Spanish Flu.

 

 

SARS Insanity: Doing the Same Thing, Expecting Different Results

mac7800 on

Since 2020, the news is inundated with information on the continuing SARS-COV-2, or COVID-19 outbreak. A similar occurrence occurred in early 2003 with the original SARS-COV outbreak.

Pourquoi le SARS-Cov-2 est-il plus infectieux que le SARS ...
The spike protein trimers of SARS-COV and SARS-COV-2.

As the acronym indicates, SARS-COV originated as a strain in the coronavirus family, which is also home to the common cold viruses. The initial transmission of this strain was a zoonotic spillover from the bat population of the Guangdong province in southeast China (1). From there, SARS spread to Beijing, which at the time, had a population of nearly 13.8 million people. From Beijing, it quickly spread internationally, resulting in 8096 cases and 782 fatalities (2).

A SARS-COV molecule

The difficulty in tracking SARS was largely linked to its generic symptom profile nearly identical to the flu-fever, cough, chills, muscle aches, headache, and occasional diarrhea. The cause of SARS fatalities is it’s eventual progression to pneumonia (3).

The rapid spread of SARS internationally is accredited to superspreading: the transmission of a virus to at least eight contacts. Due to the initial lack of information on this deemed “atypical pneumonia” which spread through respiratory droplets that contaminated the air and surfaces, superspreading was most common amongst healthcare workers (4). One of the most notable being 64-year-old Dr. Liu Jianlun who, after checking into a Hong Kong Hotel for one night, infected seven people. Although he had less than eight contacts, one of the contacts was with a Canadian tourist who brought the virus with her back to Toronto where it infected 60 more people. Another three of his contacts brought the virus to Singapore, where it spread to more than 195 people. It’s estimated that nearly half of the world’s SARS cases could be traced back to Dr. Jianlun. Whilst it’s easy to simply blame poor public health initiatives and hospital safety protocols, healthcare workers wouldn’t have to contend with novel viruses without zoonotic spillovers (5).

SARS is largely believed to have spilled over from bats to humans in the Guangdong wet market. Wet markets are open-air markets which, in addition to selling domestic livestock, also sell wildlife. Although wet markets in larger cities are more hygienic, those of the smaller communities are known internationally for their unsanitary conditions. A recent analysis of 1725 game animals from wet markets across China found 71 mammalian viruses, including 18 potentially dangerous to humans (6). Wet markets aren’t unique to China as they’re also prominent in several other Asian, African, and Latin American countries(7).

UN: Live animal markets shouldn't be closed despite virus ...
An image taken at a Chinese wet market.

And just like the bushmeat trade of Africa, much of the Chinese population depends on the more than $73 billion wildlife industry(8). Furthermore, wet markets are historically engrained in Chinese culture. Chinese wildlife trade began in the 1970s after tens of millions of Chinese citizens died of starvation under Mao Zedong’s communist rule(9). Additionally, many of the goods sold are used in traditional Chinese medicine.

However, the further danger is the Chinese government’s seeming disinterest in creating long-term policy changes. Due to the SARS outbreak, wet markets were banned between 2002-2004(10). After everything settled down, they reopened until the ban following the avian influenza outbreak in 2014(11). Wet markets were once again banned in 2020 for the COVID-19 outbreak(12). Zoonotic viruses don’t disappear from wild populations during these temporary bans. Once the bans are lifted, the danger of zoonotic spillovers return. Furthermore, these bans likely diminish the potential immunity of the countless venders and marketers frequently exposed to these viruses. The continuous cultural significance of wet markets and the government’s lacking initiative to properly handle this complex public health issue create a fantastic breeding-ground for future zoonotic spillovers and novel outbreaks.