‘ Disease X’ could kill 33m in 200 days

SHOULD you meet someone who has developed a fever, become short of breath, whose face appears to be tinged with blue and is subject to vomiting and severe nose bleeds, you could wonder if the Spanish Flu has returned, one hundred years after it first appeared. Dr Jonathan Quick says we are due another visit from this terrifying disease which is said to have infected 500 million people.

Quick, chair of the Global Health Council, doesn’t mince his words: “The big one is coming: a global virus pandemic that could kill 33 million victims in its first 200 days. Within the ensuing two years, more than 300 million people could perish worldwide. At the extreme, with disrupted supply of food and medicines and without enough survivors to run computer or energy systems, the global economy would collapse. Starvation and looting could lay waste to parts of the world.” And what is this “big one”? It is the Spanish flu again. Quick says that the most likely culprit will be a new deadly mutation of the influenza virus. The conditions are right. “It could happen tomorrow.”

Quick explains that somewhere a flu virus is boiling up in the bloodstream of a bird, bat, monkey or pig, preparing to jump to a human being. When that combination from birds and beasts finds its way into a person, the resulting new human strain can kill us more easily because it is unknown to us and our bodies have zero immunity to it.

The scientist also argues that we have inadvertently developed a powerful way of helping influenza to kill us. This is our addiction to cheap chicken and pork and the factory farm industry that supplies it. Factory farms present one of the greatest potentials for catastrophic disease because they pack animals together in conditions that can be fetid incubators of disease.

The consequences of the over-crowding of troops during what was to be the final year of WWI are part of the explanations for the outbreak of Spanish flu. While there is no unanimity about the location of the first examples, one influential inquiry pinpoints a major troop staging and hospital camp in Étaples, France, as the origin of the 1918 flu pandemic.

It also was home to a live piggery; and poultry were regularly brought in from surrounding villages. A British team led by virologist John Oxford of St Bartholomew’s Hospital has argued that a significant precursor virus, harboured in birds, mutated so it could migrate to pigs kept near the front line. It was a perfect setting for the way viruses can leap between birds and beasts and human beings.

Spanish flu begins to spread when an infected person sneezes or coughs. No doubt there was a lot of sneezing in WWI armies. Moreover, these soldiers are likely to have been suffering from malnourishment, the stress of combat and chemical attacks.

However, there were some oddities about the outbreak. The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the US occurred in people under 65, and nearly half in young adults aged 20 to 40 with high death rates in pregnant women. This is in contrast to what one would expect – that the main sufferers would be the very young or the very old.

Another strange aspect was that it seemed to be at its worst in the summer and the autumn rather than in winter. I can relate to this because, no doubt like many people, I have occasionally suffered from a cold in high summer, and when it has occurred it has generally been a bad one.

But the big questions are why the death toll was so massive and why were so many countries affected? The figures are astonishing. In India, as many as 17 million people died, about 5% of the population. In Iran, the impact was enormous and according to an estimate, between 900,000 and 2.4 million people died. Then, in descending order came the US with 500,000 to 675,000 deaths. Brazil lost 300,000.

About a third of the population of the world was infected. Of these cases an estimated 10% to 20% died. In turn, this implies that some 3-6% of the global population died. Estimates say 50–100 million people lost their lives from Spanish Flu.

A third oddity might explain the size of the pandemic. There is something called a cytokine storm which turns your immune system “against you”, so a healthy immune system might actually “hurt” more than it “helps”. It was then postulated that the strong immune reactions of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults resulted in fewer deaths among those groups.

A second wave of the pandemic began to develop in August 1918. It began in France, Sierra Leone and the US. More seriously still, the virus had mutated to a much deadlier form. As a result, the 13 weeks between September and December 1918 proved to be the costliest in lives.

In civilian life, natural selection favours a mild strain. For the mildly ill continue with their lives, preferentially spreading the mild strain while those who get very ill stay home. But this pattern was reversed in the trenches. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus.

The final oddity is how the pandemic suddenly eased quite dramatically. We have the figures for Philadelphia. Some 4,597 people died in the week ending Oct 16, 1918, but by Nov 11, influenza had almost disappeared from the city. It looks as if the virus may have mutated extremely rapidly to a less lethal strain. This is, apparently, a common occurrence with influenza viruses

Now there comes another forecast of a new deadly disease, which supports the dire warnings by Quick. The World Health Organisation (WHO) has put scientists and health workers around the world on alert for a new and potentially deadly pathogen, which it has named as Disease X.

The WHO states that “Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease. History tells us that it is likely the next big outbreak will be something we have not seen before.” John-Arne Rottingen, a scientific adviser to the WHO commented that it might seem strange to be adding an “X” but the point is to make sure that we prepare and plan flexibly in terms of vaccines and diagnostic tests. Rottingen’s chief fear is that Disease X could be sparked by a disease that jumps from animals to humans – just as the Spanish Flu of a hundred years ago seems to have done.

So what conclusions should we draw? We should consider pandemics as natural disasters like hurricanes or forest fires. We cannot prevent their occurrence.

Instead we must consider how best to meet the consequences, among them sudden increase in the demand for nurses, doctors and medical specialists along with hospital facilities. If our public services can rehearse for a terror attack, as they do, they can also act out the best responses to a pandemic. – The Independent