Disease, Death, Dread

We eat it, live it, sleep it, and dream it, to say nothing of breathing it 16 hours a day.

-a doctor assigned in

a Camp Devens, Massachusetts surgical ward during the height

of the 1918 Flu Pandemic,

in a letter dated

September 29, 1918.

In October last year alarm swept seven Catholic schools in the San Juan-Quezon City area when a large number of students-total count exceeded 2,000-experienced flu-like symptoms. Because it was only a couple of weeks since the September 11 attack on the World Trade Center and the Pentagon, people automatically suspected bioterrorist activity. The school administrators together with the Department of Health immediately looked into the matter, and concluded that the fear of terrorist activity was unfounded. The flu-like symptoms experienced by the students were caused by the flu; the speedy transmission of the virus resulted from the enclosed air-conditioned classrooms in which students spent much of their days.

    People heaved a sigh of relief; it was only the flu. Only the flu? But the flu could just be as serious as a bioterrorist attack. And just like bioterrorist activity, the flu could strike during the most innocuous situations.

Pandemic of Hysteria

    In many ways the fear of disease is more potent than disease itself. Especially in the case of highly communicable diseases-the sight of people getting sick and then dying en masse is enough to bring forth hysteria. For instance, the outbursts of the Plague throughout Europe in the Middle Ages gave rise to extreme rituals of mortification done to curry God's favor. People flogged themselves and denied themselves food and water so they and their loved ones would be delivered from disease and death, or if they still took sick and died, that they be assured a place in heaven.

    Cholera is another disease that has caused people to panic wildly. Even into the 20th century we have received reports of people falling ill with and dying of the disease. Among the most widely reported were those that intermittently troubled the Indian subcontinent in the 1950s and the 1970s.

    Although death resulting from tuberculosis is not instantaneous, the damage it has wrought is nearly as serious as that done by the Plague and cholera. In Europe, also in the 19th century, hysteria over "the white plague" took two forms: one based on fear, another on adoration. On the one hand the paleness and blood loss inherent in tuberculosis caused people to fear vampirish exsanguination; on the other hand, consumptive heroines became all the rage in many Romantic novels.

    Although these diseases still ravage many corners of the world-there are still reports of occasional outbreaks of bubonic plague and cholera in underdeveloped and developing countries, tuberculosis is still a widespread problem-the damage they inflict is no longer as calamitous as in previous centuries. Advances in medical knowledge and technology, improvements in human sanitary practices, and a rise in people's awareness of the nature of disease have all contributed to people's improved health.

    Bubonic plague, cholera, tuberculosis, not to mention the continuing spread of HIV-AIDS: all of them feared and taken seriously. But the death rate resulting from these diseases still couldn't compare to what people essentially thought of as "merely" the flu. The total number of deaths owing to all incidences of the Plague in the Middle Ages was 137 million; the flu, in a single year in history, was able to kill between 20 and 40 million people.

1918: The Spanish Flu

    Those whom war hadn't killed were killed by illness. The year was 1918, and World War I was nearing its end. Nearly ten million people had already lost their lives to the war. The United States Armed Forces were preparing their troops to go to France. One morning in March an army private entered the camp hospital in Fort Riley, Kansas. He told the hospital staff that he had high fever, sore throat, and head and muscle aches. In the afternoon 100 other soldiers made the same complaint. By weekend 500 soldiers found out they were sick as well. However, none of the people at camp paid too much attention to the disease, caught up as they were by the War; not until the disease radiated to other parts of the United States and started claiming lives did people realize immensity of the problem. Before the year ends, 12,000 deaths due to influenza would be reported in Kansas.

    Because soldiers infected with the disease were being sent to various corners of the world, the spread of the virus became easy. In April French soldiers and civilians caught the disease; a few weeks later outbreaks started to be noted in China and Japan; still a few weeks later South Americans and Africans had it.

    The pandemic lasted 18 months. In the United States, nearly a million people were killed; several Inuit villages in Alaska, as would be found out later, were practically wiped out; 20 percent of the population of Western Samoa perished from the disease and malnutrition. Of the 60,000 American soldiers that died during World War I, 60 percent died not on battlefields, but in flu wards. Only Australia was not affected by this global health problem, owing to the implementation of strict quarantine policies.

    The medical community at the time was at a loss to explain the spread of the disease. Everything would only become clear in 1997-a year shy of the pandemics 80th anniversary.

The Waves

    By no means was the 1918 influenza pandemic the only one to occur in history. The first time influenza was described was in 412 BC, by Hippocrates. In 1580 was described the first flu pandemic. From then 31 other pandemics have occurred. The 20th century was no exception-aside from the Spanish flu of 1918, there were the Asian flu of May and October 1957, and the Hong Kong flu that lasted from July 1968 through June 1969. Two other outbreaks of the flu happened in 1976 ("Russian Swine Flu") and 1997 ("Hong Kong Avian Flu").

    The Asian flu of 1957 reached the United States by train from Asia, using the Trans-Siberia route; fewer than 100,000 people were reported killed. The Hong Kong flu of 1968 radiated from Southeast China to Japan, Singapore, and the United States, and killed nearly one million people.

    There seemed to be a connection among the flu pandemics the world has experienced. Scientists saw evidence that pandemics 60 to 70 years apart were caused by the same virus strain. This prompted US health officials to conduct mass inoculation in 1976, nearly 60 years after the 1918 Spanish flu incident. No flu incident nearing pandemic levels occurred, fortunately.

1997: Hong Kong

    Experts continued to explore what caused the 1918 pandemic. Not an easy situation, to say the least, as the method doctors from the United States Armed Forces Institute of Pathology chose was to search for original genetic material dating from the incident-nearly 80 years after all the victims had turned to dust. The Institute has a vast collection of genetic material stored in a building in Maryland. This was where they found lung tissue samples from an army private who had died of flu complications in September 1918.

    The results were unveiled in March 1997 by Dr. Jeffery Taubenberger of the USAF Institute of Pathology in an article published by Science. After sifting through the available genetic material, they found traces of RNA similar to that of the flu. Their findings showed that the virus originated from pigs, and not birds, although the virus could have initially come from birds. This means, Dr. Taubenberger said, bird virus entered swine before the 1918 pandemic. Through genetic reassortment, the virus changed into something that could be lethal to humans. The mutated virus was then unleashed to the world, causing the pandemic. This was believed to be the same route followed by the 1957 and 1968 pandemics.

    Around the same time, chickens in Hong Kong farms started dying at an alarming rate. Hong Kong flu experts knew the ability of the flu virus to reassort itself; there was a possibility that the virus killing Hong Kong fowl could transform into something that would be equally lethal to people. The farms where the infection occurred then decided to exterminate all their chickens.

    In May a three-year-old boy died of severe respiratory disease resulting from influenza. The Hong Kong Department of Health examined the strain, but they didn't recognize which strain it was. Samples were then sent to the Centers for Disease Control and Prevention in Atlanta, Mill Hill Laboratory in England, and the National Institute of Health and the Environment in the Netherlands. The global flu monitoring system intensified its activities. By August, the strain was found to be avian in nature.

    A representative from the CDC arrived, and collected samples from the population. According to TIME (February 23, 1998), of the 2,000 samples collected, only nine had antibodies noting previous exposure to the strain, and none of the people who had tested positive recalled being sick. Some more experts arrived in Hong Kong to study the situation. No other cases were found, and with the chickens dead, everything appeared safe.

    But in November, another specimen arrived in the Hong Kong Department of Health laboratory, and it turned out to be the same strain that had killed the three-year-old boy. The patient, fortunately, recovered. However, 16 other people got sick; in addition to the boy that had died in March, five others followed.

    While the watch over the patients became more potent, researchers tried to find out what could possibly be the reason behind the attacks. A study of live geese, chickens, and ducks in Hong Kong's wet markets-which are practically everywhere-showed that a fifth of them harbored the virus. To significantly diminish, if not eliminate, the possibility of the virus's transfer to humans, the birds were torched to death.

    By January 1998 no other cases appeared.

War against Terror

    Post-September 11 saw the popularity of the use of the term "war against terror." Ironically, the move to rid the world of terrorists has spread its own kind of terror. With nuclear weapons available, people think, a single flick of a secret button could blow us all off the face of the earth. With germ warfare getting more sophisticated, a split second of exposure could mean millions of deaths. The tactics have become insidious.

    The flu, too, has long been insidious in its activities. Some experts have warned that another influenza pandemic could be due soon. While this is significantly less a move to terrify people than to make them aware and subsequently get ready for anything, people are alarmed. But members of the scientific community are doing everything they could to prevent this possibility from coming true and to help people prepare for any event. Everything could be won. And unlike the war against terror that would have to cause significant damage to be won, fighting disease would kill only two things-disease itself, and its attendant fear.