Living Columns & Blogs

Talking sense about swine flu in the fall

Editor's note: Five drug companies are furiously making H1N1 (swine flu) vaccine for American consumption this fall. Here's the story of the last killer flu year (1918) and how that may relate to H1N1. But, as the column makes clear, plain vanilla influenza (the kind we have each winter) killed oodles more Americans last winter than did H1N1 in the spring.

PULLMAN -- In the spring of 1918, World War I was taking the lives of thousands of men from many nations around the globe.

No one paid much attention when some of them came down with influenza. After getting back on their feet, the troops were once more sent forward to be shelled and shot at.

During the summer of 1918, the flu essentially disappeared from Europe. But it likely moved to the southern hemisphere, and when it bounced back to North America in our fall, the flu had morphed into a killer.

Physicians were astounded at how quickly the influenza patients sickened and then died. And it wasn’t just the lives of the old and infirm or the very young that were generally lost. The flu added a specialty by killing healthy young adults.

Before it was over, the 1918 influenza killed more people around the world than all the battles of World War I. That’s the kind of assault on society that shapes a whole generation — even if it does so silently and by attrition rather than with bombs and machine gun fire.

Like many people coming of age at the time, my grandmother’s life in 1918 was changed by influenza. She didn’t get sick, but her high school was closed down indefinitely because of the outbreak. She was a working-class girl, so she took a job and moved on without a diploma — which she missed having for the rest of her natural life. Your family may have similar stories — or names written in the family Bible marked “died of flu” in the long school year of 1918-1919.

Most of the influenza strains that scientists fear most emerge from pig or bird hosts. That animal pathway, plus the history of the 1918 flu and lesser epidemics since then, propels scientists and medical personnel to closely follow the swine (H1N1) virus you heard about in the news earlier this year.

I chose not to write about the swine flu in this column last spring because I didn’t care to add to the media hysteria around the outbreak. But in the lull of summer, perhaps we can all regroup and look at some facts before we head into the flu season this fall.

In June, the World Health Organization assigned H1N1 its highest rating, meaning that a global pandemic of swine flu has begun. The virus is alive and well around the world — and will be for some time to come. And cases of H1N1 are being reported in most states of our national union each week, information you can track for yourself from the American Center of Disease Control (CDC).

Links from the CDC site show you the total American cases and the fatality rate for H1N1. As I type these words, the data are about 34,000 American cases and 170 deaths. That’s a death rate of about half a percent.

“Many of those deaths come about in people who also had a complicating factor like lung problems or a compromised immune system,” Dr. Phil Mixter explained to me. Mixter is an immunologist on the faculty of Washington State University.

While 170 deaths are to be regretted, Mixter also put them in context for me when he said that each year about 35,000 to 40,000 Americans die of influenza. The obvious disconnect in how the news media covers different types of influenza seems clear enough to me from those stark figures.

Still, the $64 million question for this fall is whether we will experience what the world did in 1918, with a stronger flu striking the northern hemisphere hard. If so, we’ll have the advantage compared to the old days of anti-viral medications and special flu vaccines aimed at the swine flu infection.

But even if H1N1 becomes much more common than it was this past spring, it’s also worth bearing in mind that plain-vanilla annual influenza could be our greatest adversary. Your common sense for dealing with both types of flu — staying home when ill, washing hands, eating right and getting the flu shot or shots your doc recommends — are the boring but best ways to prepare for whatever comes.

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