infectious disease

The 1918 Flu Pandemic

“Virus” by ddpavumba at freedigitalphotos.net

The 1918 influenza pandemic was the disease outbreak that took the greatest toll in the twentieth century. Globally, perhaps between fifty and a hundred million people died. There are a wealth of wonderful books on the topic. I particularly recommend both Alfred Crosby, America’s Forgotten Pandemic and John Barry, The Great Influenza. Eileen Pettigrew’s Silent Enemy is an excellent popular account of Canada’s experience of the pandemic.

Years ago I was visiting a graveyard in Portland, Oregon. There were three graves next to each other, a man, a woman, and a child, who had all died within a few days of each other in November, 1918, almost certainly from the flu. It’s hard to imagine now what that lived experience must have been like. So many families have stories of ancestors who fought in World War One and survived, only to die on their way home.

My own grandfather was traveling in the Peace River country of northern Alberta at the time. He had decided that he was bored on the farm in southern Ontario. He and a friend had set out on an adventure to travel to the Yukon. Then his friend came down with the flu that fall in 1918. Although they never did make it to the Yukon, my grandfather helped to get his friend Frank home, where -as far as I know- he had a long and happy life. Of course, this was only one insignificant moment in the global disaster that impacted families from India to Australia, and took tens of millions of lives.

There is a fascinating new podcast series on this outbreak, which is well-researched and thoughtfully presented: Going Viral: the Mother of All Pandemics. The presenters have deep historical knowledge, and have invested an immense amount of time in preparing this engaging work. I enjoyed their trip to the former battlefields of France to try to track down the pandemic’s origin with Dr. John Oxford. One would think that there wasn’t much new left to say on this topic. Yet in their search for the true origins of the pandemic they look at provocative thinking and current debates, such as Mark Osborne Humphries’ idea that perhaps the pandemic actually began in China. They are also engaging speakers; one can imagine listening to them as a student, and being captured by their lecture style. You can find the podcast on iTunes and similar venues. Given the proliferation of H7N9, the diversification of influenza clades, and the fact that we still don’t have a universal influenza vaccine, this history remains sadly relevant. Highly Recommended. If you are interested to learn about more recent debates, you can also read my own work on influenza and pre-pandemic vaccines as well as conspiracy theories. Both of these articles are publicly available for free. You can also find more freely available articles on influenza here.

Shawn Smallman, 2018.

 

Smallpox and North Korea

A patient being inoculated against smallpox in 1802, in a satirical cartoon. James Gillray [Public domain], via Wikimedia Commons
Biological weapons are both terrifying and elusive. On the one hand, the Soviet Union made long-term investments in bioweapons research during the Cold War, as Ken Alibek’s tell-all book Biohazard makes clear. On the other hand, these diseases have proved difficult to weaponize, and the problem of blowback has made them unlikely to be used by any state. Despite the allegations that Iraq was weaponizing diseases under Saddam Hussein, no large-scale biological weapons program was discovered after the U.S. and British invasion. Now there are new allegations being made about North Korea.

Given that North Korea’s leader had his own brother murdered, and is moving forward rapidly to expand the range of his nuclear weapons, it’s not difficult to imagine that he might be fascinated with biological weaponry. But is there any solid evidence for a North Korean program? Unlike nuclear weapons, biological weapons development can take place on a constrained budget and without difficult procurement or testing issues. As such, these programs are hard to detect. Nonetheless, Joby Warrick has an article in the Washing Post that points out that in 2015 the North Korean leader had his photograph taken in a facility “jammed with expensive equipment, including industrial-scale fermenters used for growing bulk quantities of live microbes, and large dryers designed to turn billions of bacterial spores into a fine powder for easy dispersal.” Perhaps even more disturbing, North Korean soldiers who have defected have allegedly had antibodies to smallpox, although these defectors mostly escaped decades ago.

Warrick’s article is worth reading in depth. How do we judge such a threat? On the one hand, were a virus such as smallpox ever released it would be truly a global catastrophe. On the other hand, to the best of my knowledge no state has used biological weapons since World War Two. Since that time, however, many Cassandras have warned that enemies were developing biological weapons. The United States has a long history of allegations against enemies that lead to war, only to be discredited afterwards, The U.S. warship Maine was quite possibly sunk by a coal fire, not the Spanish, but its explosion was used to justify the Spanish-American war. It’s unlikely that any North Vietnamese forces were even present on August 4, 1964 for the alleged second Gulf of Tonkin incident. The first incident led to a single bullet hole in a U.S. vessel. Nonetheless, these “events” were manipulated to form the basis for the Gulf of Tonkin resolution by the U.S. Congress. In turn, President Johnson then used Congress’s authorization to massively expand the U.S. war in Vietnam. As it turns out, the U.S. intelligence services had completely misread the situation in that nation. The Bush administration alleged that Saddam Hussein was creating weapons of mass destruction in Iraq, but none were found after the U.S.-British invasion. If we included smaller conflicts -such as the contra war, which was based on a myriad of allegations against Nicaragua in the 1980s- this list of false or questionable justifications for war would become lengthy. Given this background, how seriously should we fear this new potential threat?

Sadly, biological weapons programs are by their nature easy to conceal, and difficult to evaluate. As a result, this is one potential nightmare associated with North Korea that is profoundly difficult to place in a broader context. We simply don’t have sufficient information yet to know the true scale of the danger.

Shawn Smallman, 2018

Flu, Protest and Iran

While many factors are driving the current protests in Iran, Michael Coston has pointed out that a significant outbreak of avian influenza in that country has driven up the cost of poultry and eggs, which has likely contributed to peoples’ food insecurity. His blog post is an interesting attempt to tie influenza to economic factors, which in turn may be connected to politics.

Shawn Smallman, 2018

CWD, Fear and Food

“Chronic Wasting Disease in North America.” By USGS, National Wildlife Health Center [Public domain], via Wikimedia Commons
In the mid-1980s a new disease, Bovine Spongiform encephalopathy (BSE) appeared in Britain. Better known as mad-cow disease, this disorder attacked the brain of first cattle, and later a small number of people who had consumed their meat. The most likely manner in which the disease was introduced into the food chain was through processing cattle into feed for other cattle. Only by converting cattle into unwitting cannibals -in order to  to take advantage of waste products from abbatoirs- was the prion that caused the disease introduced into humans. In Britain the images of quivering, drooling, staggering cattle on television unleashed a public panic. (1)

BSE was a classic example of an iatrogenic disease, which is an illness created by humanity itself. The disease is caused by a prion, which is not a living thing. Prions are strange. It’s believed that they are malformed proteins, which can trigger other proteins to similarly mis-form. This creates a terrible cascade that impacts the brain, thereby causing neurodegeneration. They are also incredibly resistant to heat, so they do not readily break down during cooking, which would eliminate the risk of most pathogens and helminths. Once a living organism such as a person is infected, there is no known treatment for the disease. …

Pandemics and Information

Colorized transmission electron micrograph of Avian influenza A H5N1 viruses. By Photo Credit: Cynthia Goldsmith Content Providers: CDC/ Courtesy of Cynthia Goldsmith; Jacqueline Katz; Sherif R. Zaki [Public domain], via Wikimedia Commons
There have seldom been as many times over the last 100 years when the world has faced such a diversity of emerging infectious diseases. For this reason, I want to review some of the best websites and blogs for tracking pandemic threats. Michael Coston has a wonderful blog titled Avian Flu Diary, which tracks emerging infectious diseases, particularly avian influenza. I particularly recommend his March 13, 2017 post “Avian Flu’s Global Field Experiment.” In this post, he describes in detail the diversification and geographic expansion of avian influenza threats over the preceding six months. Although the blog post is written for the lay reader, its information is scientifically sound and based upon a deep knowledge of influenza.

For the dangers that we face, and what we need to do to face them, it’s worth reading two articles. The first is Dr. Sanjay Gupta’s, “The big one is coming, and it’s going to be a flu pandemic.” It’s also worth reading Crawford Kilian’s, “A War We Should All Support — But Probably Won’t,” in the Tyee.

If you are interested in tracking news related to influenza, you’ll also want to follow the Virology Down Under blog. Ian Mackay often provides the best numerical analysis available regarding outbreaks. The Bird flu report collects tweets regarding avian influenza by experts in the field. FluTrackers.com is not a visually engaging site, but it collects detailed information on avian influenza, which is organized by world region. Finally, for influenza the H5N1 blog is one of the best sources on the web. The page also has links to almost every other valuable website regarding influenza and global public health. …

The sad human toll of Zika

There was a brief flurry of media coverage regarding Zika after the discovery that it was spreading within Florida last month. Over the last couple of weeks, however, it seems to have receded from the headlines. Some recent coverage, however, really provide a sense of the human toll of Zika. Reveal is a new podcast from the Center for Investigative Reporting, which provides long-form coverage based on work in the field. Their report, “From A to Zika” documents how people in Puerto Rico are experiencing the virus, and attitudes towards the outbreak in South Florida. It also describes the scale of the challenge that officials face fighting the virus during a deep financial crisis in Puerto Rico. …

Why Congress must act on Zika

Aedes aegypti mosquito in Dar es Salaam, Tanzania, 2009. Photo by Muhammad Mahdi Karim, Wikipedia Commons
Aedes aegypti mosquito in Dar es Salaam, Tanzania, 2009. Photo by Muhammad Mahdi Karim, Wikipedia Commons

In July 2016 the CDC issued an advisory notice that warned pregnant women -or women planning to become pregnant- against traveling to 45 different countries. With the virus’s arrival in Florida, however, the public in that state is now wrestling with what this means for mothers and their partners. The issue is now becoming a topic in the election contest in Florida, as Mark Sumner described in a (not impartial) recent article in Daily Kos. In the piece he quotes Trump’s vice-chairman for Miami-Dade as saying that Zika was an “insignificant issue,” which was less important than building a wall “to keep the illegals out.” Yesterday Donald Trump himself declined to say that Congress should reconvene to vote on funding Zika research and prevention. …

Zika in the continental U.S.

Digital photo taken by Marc Averette. The downtown Miami skyline as seen from I-195 5/16/2008. Wikipedia Commons
Digital photo taken by Marc Averette. The downtown Miami skyline as seen from I-195 5/16/2008. Wikipedia Commons

Zika has already become a significant health issue in Puerto Rico, where there have been more than 5,500 infections. More than 600 of these infections have been in pregnant women. The outbreak has also set off massive public debates on the island regarding everything from insecticides to the structure of local government. It was inevitable that Zika would eventually appear in the mainland United States. Still, it couldn’t help but be surprising to see a CDC warning about travel by pregnant women to two counties (Miami-Dade and Broward) in Florida. It’s important to keep this news in perspective. So far only 14 people have been reported to have locally acquired Zika, in a very restricted geographic area in Miami. Mosquito control activities have gone into high gear in this area. One can hear an audio copy of the briefing about this news here on the CDC website. The CDC also has a dedicated webpage on Zika, which is a helpful site for information regarding the epidemic. …

Resources on Zika

By CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia Commons
Image of Zika virus from the CDC/ Cynthia Goldsmith (http://phil.cdc.gov/phil/details.asp?pid=20541) [Public domain], via Wikimedia Commons
There is still so much that we don’t know about Zika. I was recently speaking with a medical historian who wondered if people in eastern Africa and Asia might have resistance to the disease, since it originated in those areas, or whether the epidemic will spread as explosively as it did in South America? Will the rate of birth defects be lower in newly affected countries, because mothers have more information to protect themselves? Which species of mosquito will be able to transmit the virus? How rapidly will the epidemic spread? What percentage of babies born to mothers infected with Zika will have neurological issues, even when they do not have microcephaly?

There are a few useful resources that I’ve found for Zika. Vincent Racaniello is a highly respected virologist, who has a popular podcast called “This Week in Virology” or “TWIV,” and a free online virology course. His lab spent decades working on polio, but recently shifted its focus on Zika. His new blog, Zika Diaries, give a sense of what science is like in an emerging field. Nothing is easy for the lab, from obtaining the virus, to acquiring permission to do experiments with mice.

One of the first tools that I try to create when working on an article is a timeline for events. With Zika, Ben Hirschler at Reuters has already done that work, and created a detailed timeline.

For anyone interested in the early history of Zika’s discovery in Uganda, I recommend Thomas K. Grose’s piece on NPR, which discusses a researcher studying Alexander John Haddow’s records in the University of Glasgow archives. Overall, NPR has outstanding coverage of the Zika outbreak.

Lastly, the CDC website offers practical information on Zika, including those areas where the Zika virus is circulating, and how to protect yourself.

Shawn Smallman, 2016

Destroying smallpox stocks

Smallpox has killed countless people over the last 12,000 years. It is difficult now to understand the terror that smallpox evoked in a pre-vaccination era. When smallpox was introduced into new populations the death rates sometimes could even exceed 90%, as was the case with the Mandans in the 1837 Great Plains Epidemic. The virus was finally wiped out in the wild through a massive vaccination program in the 1970s. The last infection took place in 1977. Now what should be done with the remaining stocks of the virus in Russia and the United States? I recommend a video by Errol Morris on the New York Times website “The Demon in the Freezer,” which examines this issue in detail. The interview with the Russian bioweapons scientist is particularly chilling. What I liked about the video was that it showcased voices from both sides of the debate.

Shawn Smallman, 2016

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