“Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History” is a fascinating book that examines the deadly 1918 flu pandemic, what we learned from it, and how that knowledge has been used and misused over the next century. Author and physician Jeremy Brown was raised and studied medicine in London but has worked in the U.S. ever since his residency in emergency medicine in Boston. He is currently director of the Office of Emergency Care Research at the National Institutes of Health.
Brown begins with a brief history of some of the appalling but once prevalent practices of treating illness, including bloodletting, laxatives, and worthless or even deadly administration of drugs whose action was poorly understood.
The 1918 flu epidemic was a truly epic medical disaster, even more so since it arrived worldwide in the waning months of World War I. There still is much we do not know about it, including where it started. It might have been Haskell County, Kansas, an Allied camp in northern France, or possibly in China. Also, unlike most pandemics that disproportionately strike the sick and the very young and very old, this epidemic also struck healthy young adults in large numbers. We still don’t know why.
We do know now that a virus that somehow, somewhere made the jump from some animal species to humans caused the flu. Thanks to some genetic and DNA work on exhumed well-preserved flu victims in the Arctic in the 1990s, we now also know the virus’ precise genome.
Influenza has always been a difficult disease to fight, in part because every year it returns in a slightly different form, depending on the combinations of various strains of viruses that are most prevalent at that time. Given that vaccines have to be manufactured months in advance, sometimes the resulting “shot” does not very accurately target the then-prevalent strains of the virus. Even the “best guess” years such as 2013-14 seldom yield more than 50% effectiveness. Much lower effectiveness rates are common, such as 19-20% in 2014-15 and 2017-18. Although Brown does not say don’t bother to get a flu shot, he does note that in his native U.K., it is only officially recommended for the very young, very old and others with chronic compromised health conditions.
Another complexity of influenza is that a lot of the people who die from the flu actually die from later complications such as pneumonia, which opportunistically attacks the flu-weakened body. Some of these subsequent conditions are bacterial, unlike the viral flu, and can be treated with antibiotics, which are useless for the flu itself. Not surprisingly, this has led to some confusion about treatments in the minds of much of the public.
One interesting chapter looks at the seasonal patterns of flu. Although most people know that “flu season” peaks in the winter and early spring, that may not be entirely due to people spending more time inside and in closer proximity to each other. Brown explores some other possible contributing factors, including sunspot flare-up and seasonally differential sunlight stimulating vitamin D production in the body.
Brown discusses later flu epidemics, none nearly as catastrophic as the 1918 event. Later flu epidemics, such as the swine flu scare of the 1970s, were mishandled due to public fear and the medical establishment’s desire to “do something,” even if ill-advised. The political cost of underreacting to the threat is real but so is the cost of overreacting. There have also been numerous expensive but not very successful attempts, some by Google, to use big data to predict the flu virus’ behavior.
Brown is quite critical of the practice of stockpiling antiviral medications such as Tamiflu. His careful review of research on such drugs shows that they, at best, shorten the time one is ill by a day or so, and that only if taken shortly after the first appearance of flu symptoms. One interesting chapter, “The Business of Flu,” explains just how much money is involved in corporations developing vaccines and treatments for flu. Brown makes clear that research and public policy regarding flu treatment always occurs in a matrix of understandable but sometimes irrational public fears and potentially huge commercial incentives.
Jeremy Brown is a gifted writer who makes this complex medical topic accessible to the public. As such, this book is a fine contribution to efforts to raise the information level of the general public. For the more research-oriented reader, there are extensive notes and bibliography following the text.
Richard Harris is a professor emeritus of psychological sciences at K-State.