On influenza

Not much of scientific worth today. Rather, just a perspective. I guess if I have a hobby, it’s reading history. I hated history when I took it in school, because it just seemed to be a bland regurgitation of dates (it is unclear why I didn’t hate science, which was largely a bland regurgitation of facts). But I love reading it now, especially historical fiction, which provides a narrative to the reality (I highly recommend “Gates of Fire”).

Every now and again I come across a history book that touches on my professional life. “Rats, Lice, and History” is one such book, and again is highly recommended. But for sheer impact there is almost nothing to compare to Richard Collier’s “The Plague of the Spanish Lady.” Despite the vaguely racist-sounding title, this book is a remarkable compilation of historical (and for the most part, personal) accounts of the 1918 influenza pandemic. This killer flu took out a huge number of folks worldwide, and depending on the guesstimator (it’s my word, I’ll spell it how I want) may have felled up to 5% of the world’s population. A malady seemingly on the order of the Black Death or the Plague of Justinian, given that it occurred less than 100 years ago in a world that had some knowledge of advanced practices in public health and medicine.

I bring up this book because there are certain passages that stuck in my brain, and continue to resonate. If I have an interest in biodefense, it is in large measure because of this book. I will share one such passage with you, and you can see if you are now similarly inclined (pp. 37-38):

“On one factor, at least, all doctors agreed: only in cholera did the collapse come so suddenly that most victims could fix the precise moment when they fell … most often this killer-virus struck like a lightning-bolt ….

“By the Galeria Cruzeiro, in the heart of Rio de Janeiro, a man accosted Ciro Vieira Da Cunha, a young medical student: ‘Excuse me, does the tram for Praia Vermelha stop here?’ ‘Yes, it does.’ ‘I am much obliged to you.’ With this banal exchange, the man fell dead ….

“Off-duty in Cape Town, Driver Charles Lewis of the Transport Corps boarded a train for his parents’ home in Sea Point, three miles distant — but barely had the conductor signaled the start than the man collapsed on the platform, dead. It was Lewis himself who acted as starter — but within minutes a passenger had fallen dead, then another. Five times the tram was stopped to place the still-warm bodies on the pavement, for collection by municipal carts — but three-quarters of the way to Sea Point the driver, too, slumped forward and died. Absurdly glad to still be alive, Lewis walked home.”

People going about their everyday lives all across the world, perhaps with the sniffles. And then they die. That was the 1918 pandemic.

The seemingly unique nature of this flu relative to others that have arisen (and may yet arise) does raise a number of interesting questions. First, what would happen if this virus was loosed upon modern society? Would the extraordinary interconnectedness of our planet mean that the death toll and dislocation would be multiplied many times over? Or does the fact that almost every corner of the planet now has a public health infrastructure of some sort, however primitive, mean that the virus would be stopped in its tracks, as SARS was (this is making the leap that we didn’t just get lucky with SARS, which is my own estimation)? Would the spread of immunization against other influenza viruses provide enough protection against this killer that it would lack the human hosts necessary for spread and evolution?

And is the 1918 influenza actually that unique? Is it just a rare combination of alleles that remains a potentially deadly threat? If so, then there may be some justification to those who have suggested that the release of the sequence and the resynthesis of the virus were big mistakes. Certainly there is now ongoing research into the nature of the 1918 influenza that can be seen either as a means of combating deadly influenza viruses when they arise, or as a slow roll towards disaster. I tend towards the former viewpoint, but respect the latter.

But even as I respect those who fear, I do argue against them. It is a hard argument to win, in part because fear does not usually respect rationality, and in part because fear stems from unknowns, which cannot be argued away easily. Yes, the boogey man or boogey terrorist organization or boogey state can in fact make 1918 influenza with relative ease. As previously stated, any small virus can be readily synthesized, and the reverse genetics of influenza are well-known. So, now what? Do we lock away all the knowledge and technology that just might lead to the horror aptly stated within the old nursery rhyme: “they all fall down”? If so, then there are alot of barn doors that need to be closed, and alot of PhDs that need to be put behind fences of one sort or another. It would be rather like saying that transistors should be export-controlled because computer viruses might one day arise.

The alternative view is that the only way to fight bad is with good, and to assume that good is either more powerful or more populous than bad. In the words of the great sage Walt Kelly and his mouthpiece Pogo Opossum: “Good is better than evil because it’s nicer.” I tend to believe that educating an army of white hats is the best way to combat black hats. The black hats will always be there, and there will always be some very clever ones (see also Kaczynski, Ted). Our only hope is … hope. That we are better. And to that end, we should exercise hope, the hope of knowledge, the hope of research, the hope of technology for a better future. I could have stated this much better, but I think I stated it just right.


- originally posted on Sunday, October 31st, 2010