“Those who cannot learn from history are doomed to repeat it.”
– George Santayana

Why is there such a big push for the H1N1 vaccine right now? Why did the United-States declare a state of Emergency for the H1N1 virus? Why has the WHO (World Health Organization) been so public about escalating the H1N1 virus to a “pandemic”?

It’s because we’re learning from our past. Well hopefully we’re learning. Back in 1918 people were too slow to react to the biggest Pandemic in recorded history. And when they did react, it was either too late or too slow. The time to react is not once we’re in the midst of a full virulent pandemic storm. Rather the time to react is before it becomes virulent. Even with today’s modern medicine we still can’t cure the Influenza (Tamiflu isn’t really a cure). All we can do is prevent it and treat the symptoms.

Back in 1918, before it really struck at full force, people just kept saying it was “only just the flu”. Nothing to worry about. It’s just another cold. Yes, initially it was, but that quickly changed. And even then, many people still kept saying it was only just a flu. It wasn’t until people started dying, and even then it wasn’t for some time, that the population really started to react.

If you don’t know the history of the 1918 Influenza Pandemic, I strongly recommend the book The Great Influenza – The Story of the Deadliest Pandemic in History by John M. Barry. It’s an amazing read! The information and knowledge in the book is priceless! Not only does he follow you through the history of the pandemic, Barry also explains how influenza works and why we still need to be just as vigilant today.

The 1918 pandemic is chillingly similar to today’s pandemic. Firstly, the 1918 Influenza was an H1N1 Influenza virus, unlike the Avian Flu’s H5N1 makeup. If you’re not familiar, Influenza can come in a number of forms, H1N1 being one, H5N1 being another, and so on. Each form is different enough that if you have immunity to one it doesn’t give you immunity to another (so for example being immune to H1N1 doesn’t give you immunity to H5N1). This is why there are seasonal vaccines, there are just too many possible forms. As well, to make things more complicated, the Influenza virus can be different enough within one form to only offer partial immunity to that form (and in some cases none at all). It’s almost like variations within forms!

But getting back to the 1918 pandemic, it too started with an initial mild first wave. It’s the second wave that brought death and carnage to the world. The second wave was of the same form but much more virulent. So virulent in fact that in the most severe cases it killed within hours of when people showed the first signs of symptoms much like the death this week of the 13 year boy in Toronto who died of H1N1 with 48 hours of showing symptoms. Statistically, the 1918 flu killed anywhere from 2-20% of those infected as opposed to the normal rate of 0.1%! The good news is that in most cases it just made you really sick, but please don’t confuse that with how many people it killed. It killed complete families. It devastated whole communities. Governments in the US collapsed. Cities collapsed (Philadelphia, etc.). Booming cities became ghost towns. In terms of scale, it’s estimated to have killed over 100 million people. In today’s numbers that would be over half a billion people!

This is also incidentally why the WHO, and governments around the world, are pushing so hard for everyone to get vaccinated as soon as possible. We want to stop it dead it in it’s tracks, to prevent it from mutating into a much more virulent form. We don’t want to give it that chance. Not only that, we know that the H1N1 has the potential for being a real killer!

The similarities don’t just stop there, the H1N1 from 1918 was much more virulent to the healthy young people than to the young and elderly. Sadly, hundreds of thousands of children were left without parents after the virus had finished it’s run. Not something you normally see from the seasonal flu.

The reason it can be so deadly in young healthy people is because they are so healthy. It’s not actually the virus that kills them in many cases, it’s their own body. Rather than just sending in special soldiers and snipers from your immune system to attack the virus, it has to send in it’s full arsenal. Now in many cases, it’s not a big issue, but if the virus fights is strong, your body reacts accordingly (not exactly but close enough). So what happens is that you get your own personal World War 3 waged in your body. In most cases your body will win, but have you ever seen a battlefield after a big war? There’s not much of it left. In this case, the battlefield IS your body, specifically your lungs, so there’s not much left. This is called a Cytokine Storm.

This is often what causes you to die. And you’re lucky enough to survive the onslaught of the battle, your lungs are so beat up that they get secondary infections such as pneumonia, bronchitis, etc. In 1918 they didn’t know what to call this. Today we call it ARDS (Acute Respitory Distress Syndrome). If you get ARDS, your chances of survival are low. In 1918 you had a 10% chance of surviving. Today I believe it’s now up to a 50% chance of surviving. Better but not great. Incidentally, this is why SARS was so scary.

Just how fast can it happen? Here’s a story from the book The Great Influenza: “In Cape Town, South Africa, Charles Lewis boarded a streetcar for a three-mile trip home when the conductor collapsed, dead. In the next three miles six people aboard the streetcar died including the driver. Lewis stepped off the streetcar and walked home”.

Yes today we have better treatment for secondary infections such as antibiotics, but we definitely don’t have enough supply for a major pandemic. It’s believed that the world supply of antibiotics would be depleted early on in a significant pandemic, and manufacturers wouldn’t be able to keep up with demand. That’s part of the cost/benefit of our society’s “Just in Time” inventory. It helps reduce costs and wastage, but we don’t have much backlog. Again, we still have no cure for Influenza itself, all we have is medicine (antibiotics) to treat secondary infections.

Which is why we need to get the people who will be most sick (or most likely to pass it to others) vaccinated first. Not just because they’re more likely to suffer and die, but also because we want to be careful not to overwhelm our already over stretched medical system. In most places in North America, the medical system is already running at more than 100% capacity. That’s right, more than 100% capacity!

If you compare the medical system today to the 1918 medical system, they may have been better prepared. The hospitals back then were running well below 100%. In 1918 the bed per capita (ie number of beds for a given number of people) was much much better than it today. Even with this extra supply of bed and staff, you hear many stories from survivors who while in the hospital never saw a doctor. In some places people couldn’t get beds, even with bribes. People would lie on the floors waiting for others to die so that they could take their beds. It wasn’t pretty. And that’s with a bigger padding than today. It’s not about the quality of care, or what treatments are available, but just about being able to see a doctor!

It’s believed that our current medical system can’t even handle the extra surge from a mild pandemic! Never mind a virulent one. We just don’t have the resources for the surge in capacity. It looks like our hypothesis is about to be tested, and it’s already proving to be accurate. We are ONLY in a MILD Pandemic right now. Hopefully that’s all it will be.

The good news is that we have much better communications today. The fact that Barack Obama has already declared a state of emergency for the United States is phenomenal!! In 1918 it was hushed for as long as possible. Declaring a state of emergency early means we’re already starting to allocate resources before it’s a massive problem. It means we’re trying to prevent it rather than react. Not only that, but making people aware is a good thing. There may be some fear and panic right now, but compared to what happened in 1918, it’s way better.

In 1918 because they tried to hide the spread of the virus (it was during World War 1 and they were trying hard to boost morale – an Influenza pandemic killing millions doesn’t exactly boost morale), they created even more fear and panic. People had no idea what was going on. People didn’t trust anyone. Would you? It was a mess. Actually the cities that fared best, such as San Francisco, did so because they publicly shared truthful information. People were informed. Information was the key. And because they knew what was happening, what to expect, they dealt with it much better. The unknown is scarier than anything else. When you watch a scary movie, the anticipation up to the moment is the scariest. Once you see the bad guy, you’re no longer scared. The unknown is what’s scarier.  So I only have praise for Barack Obama because he’s already started to allocate resources ahead of time. Great job!!

In terms of prevention, learning from 1918 (and other pandemics), it’s almost impossible to stop Influenza. This is why in the spring the WHO basically suggested there’s no point in stopping air travel. It was too late. With the Avian flu they still had a chance, but with H1N1 it was too late. It had already spread.

To give you an idea how far and wide it can spread, almost no one was safe in the world in 1918, before they had commercial travel like we have today. Even remote locations up in the North Pole got hit. Researchers were recently able to resurrect live samples of the 1918 Influenza from Alaska. The only communities that were able to save themselves from the 1918 Pandemic enforced very strict quarantines, almost to the point of being extreme. No ONE, and I mean NO ONE was allowed in once the quarantines were setup. Even something as innocent as a delivery of mail could devastate a community. Most communities failed, even with strict quarantines.

Yet still some were able to enforce quarantines where no one died. Communities such the town of Gunnison, Colorado. In October of 1918, in advance of the pandemic, they shut down the town for about 2 months. No public gatherings. Lawmen blocked all the roads. Train passengers weren’t allowed to get off the train to stretch their legs, not even outside. There’s even a record of a couple trying to drive through the town who got thrown in prison and quarantined. Basically they took very drastic measures but it worked. The neighboring town, Sargeant, esperienced 6 deaths of out 130 in one day. The quarantine worked. If you’re interested, you can find a list of newspaper clippings from 1918 with dates as the events unfolded here – it’s very informative.

Of course in our global world, it’s already too late. There’s no way to quarantine yourself. What you can do however is stay away if you’re sick. Please, STAY HOME IF YOU’RE SICK! This is how the virus passes. In our modern society, we’ve grown up to tough it out, throw some dirt on our wounds, and go to work. That’s the exact behaviors that cause the virus to spread. We need to change our way of thinking. If you’re sick, don’t go to work. Stay home. Don’t go out to public places. If you don’t need to go to the doctors then don’t. And especially, if you don’t need to go to the hospital then please don’t.

Even if you’ve been vaccinated, remember it’s not 100% effective. It’s 85% effective. You still have a chance of getting H1N1. However if you do get it, odds are that it will be much milder. As well, be aware that the vaccine is NOT immediate. It takes time for the vaccine to take effect. Your body has to build an immunity to it. It takes days, even weeks (I’ve read as much as 3 weeks with H1N1). In that interim, you CAN STILL CATCH the H1N1 flu. Each day you’re less likely, but you still can.

And please, please, please, if you already have the flu, don’t go get vaccinated while you have it. Firstly, it’s too late. Secondly, it won’t help, you’ve already gotten it. It’s not a cure but a prevention method! And this is why a lot of people think the vaccine is sometimes ineffective. If you were already infected but hadn’t yet shown signs (even more so if you show symptoms), it won’t do anything for you. It’s totally useless in that case.  Again, it takes some time for vaccine to take effect, so you should get it sooner than later. The longer into the pandemic you wait, the less effect it will have.

For example, today in the news I read “Desrochers said she is anxious to be vaccinated because her grandson is sick with flu symptoms.” Are you serious? If you already have the flu, the vaccine is not going to help. It’s not going to make your grandson better. If anything, all you’re going to end up doing is infecting other people. It means you’re going to nullify the vaccine for everyone you come into contact with. It’s just wrong. But people are misinformed, and unfortunately the message being communicated is completely inconsistent.

I’ll give you another example. I was talking to someone locally who had just seen her doctor, and they informed her not to get the vaccine. The reason given was that it was a live virus and could be potentially dangerous because you needed a strong immune system to fight it. She is one of those high at risk. Her doctor couldn’t be more wrong. The vaccine available to her includes the dead virus, not the live virus. Secondly, she is exactly the high risk person that needs to get the vaccine. Why did it happen? Because the information traveling around is inconsistent. In marketing terms, there is no consistent message. That is to say, unless you educate yourself and your smart about what sources you refer to, etc., there’s all kinds of conflicting information. No one is stepping up and what’s happening is it’s creating misinformation, and hence fear and paranoia. We’re, sadly, repeating history in this case.

While I’m ranting, the other thing I don’t understand is why we aren’t delivering the vaccine faster. As far as I can tell here locally, it’s not the lack of vaccines that’s stopping us. What’s happening is that the vaccination clinics are only open for a few hours at a time before they decide to close down for the day so that they can close at their expected times. Don’t they understand, this is a race. It’s a race between getting the majority of the population immunized before the virus has the time to take hold, and in the worse case mutate to a virulent form. We’re not running out of vaccines right now. My local station giving the vaccine is only open between 2:30pm and 8pm. Within an hour the lineups are so bad that they have to close to let all the personnel go home by 8pm. At this rate, they’re vaccinating 4200 people in my city per day. Within a month, that’s approximately 100,000 people. In a city of about a million, that’s 10% of the population in a month, way less than majority needed. At that rate it would take until midway through next year just to hit 50%. Now I do understand that they are scaling up each day, but with doses available now, there’s no reason to close the vaccination clinics so early. If it’s a staffing issue, I’m sure there’s a solution to be found.

Since I’m on the topic of vaccinations, right now we spend more researching the West Nile virus than we do on Influenza, yet Influenza kills more people per year than the West Nile virus has killed since it was discovered. Why is that? With one pandemic, Influenza can kill more people than AIDS in several decades (the 1918 pandemic killed more people from Influenza in 6 months than AIDS has in 25 years). And not to downplay AIDS, but Influenza is much more transmittable than AIDS.

Not only that, but if you look at the economic costs of Influenza each year, just in terms of sick days, it’s very significant. It’s not a cheap virus. Why aren’t we developing a vaccine against all type A Influenzas, which would encompass all the different forms including H1N1. Because there’s not enough political interest, and hence not enough funding. If we could just invest 1%, or even 0.1% of what’s spent in Iraq (an accounting rounding error), I’m sure we’d make amazing strides forward. And the ROI (Return on Investment) would be significant. Imagine if we could wipe it out!

Alright, one last comment on vaccinations for now, if the vaccination effort is a success and the virus doesn’t have a chance to mutate to a virulent form, that is very few people die or get sick, what do you think will happen? People will start to complain that it was for nothing. That it was over-hyped. That it was a waste of time and money. That we scared ourselves for nothing. But did we? That’s success!!! Success IS that nothing happened.

If you think back to Y2K, did anything happen? No, because we invested millions, if not billions to prevent it. Unfortunately if nothing happens, people assume it was for nothing. Nothing happened on Jan 1, 2000. But you know what, a LOT of systems would have failed had we not put in such a big effort beforehand! Thankfully because of that big effort nothing happened. It was a success! Yet today people think it was over-hyped and not a big deal.

What about the Avian flu? Was that over-hyped? What happened? Nothing! Again, millions and millions of birds were slaughtered to prevent it from spreading. Every outbreak was quickly addressed. Thankfully the virus wasn’t too contagious and they were able to prevent a pandemic. A lot happened to prevent a pandemic. There’s a reason nothing happened. It was a success!

The same is true with 9/11. Before and after 9/11 many terrorists attempts were prevented. Of course we never think of that. All we think of is the one failure. Until something breaks down, it really wasn’t needed. It’s over-hyped. It didn’t do anything. That’s prevention. We need to be aware of why prevention is so important. An ounce of prevention is worth a pound of cure.

What are you waiting for, go get yourself vaccinated as soon as possible. Be a part of the solution, not the problem. Now’s the time to do something!

In the next little bit I plan to write about the vaccine, such as is it safe, what about this or that. If you want to make sure you won’t miss, you may want to subscribe here to get it by email as soon as it’s available.

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