This Podcast Will Kill You - Ep 1 Influenza Will Kill You

Episode Date: October 31, 2017

In Episode 1 we're talking all things flu, just in time for the start of flu season! We'll dive into the 1918 influenza pandemic that killed literally millions of people, then talk about the state of influenza in the world today, and tell you everything you need to know about how the flu virus works. See omnystudio.com/listener for privacy information.

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Hi and welcome to this podcast will kill you. I'm Aaron. And I'm also Aaron. Thanks for joining us. Thanks for tuning in. This is our very first episode. Why are we here, Erin? Well, we just really like talking about infectious diseases, and we decided to start this podcast as an outlet to talk about them more. And we are graduate students currently studying disease ecology and epidemiology. We're not posing as experts, that's for sure. But we really like learning about this stuff and figure that other people might like learning about infectious diseases too.

So every episode, we'll focus on one particular infectious disease. We're going to start with some basic definitions, then talk about the biology of the pathogen, hit you with some history, then round it off with what the status of the disease is today. And we'll end each episode by letting you know just how scared you need to be. Welcome to episode one. Today we're talking about influenza. what is considered America's greatest pandemic. Possibly the greatest pandemic of all time.

Depending on your metric. Right. We'll get into that. We'll get into it. So pull up a chair, pour yourself a drink, and let's get started. Bringing it back to 1918. What are you drinking over there, Aaron? What are you drinking?

Oh, I'm drinking a quarantini. Oh my gosh. So am I. What kind of quarantini are you drinking? Today we're drinking the H1 Drink One. inspired by the classic cocktail from the 1800s called corpse Reviver. Corpse Reviver, people. This is actually Corpse Reviver 2. There are multiple variants. So if you'd like to follow along and drink, or should I say, if you'd like to drink along at home,

you can make your very own by mixing, what is it, equal parts? Gin. Lemon juice. Quantreau. Quintra. And Lilit. Which is a weird sounding thing. It's a French liqueur.

You can find it at the liquor store. Mix and serve over ice. It's really delicious. It's surprisingly great for something named corpse Reviver. Actually, this is a little bit of pre-trivia. Oh. This was a popular drink during the 1918 pandemic. Oh my God.

That's amazing. Yeah. So every week we're going to be drinking quarantinis, named with our own special names, inspired by classic drinks or ones that we make up on our own. And we'll post the recipes. And if you want to drink along with us, please do so. We would love that.

So let's define some of the words that people might not know that we're probably going to use a lot both in this episode and going forward. Let's start off with epidemic. So an epidemic is an outbreak of a disease that is greater than what we would normally see in that particular population. Okay. And so I often hear the word pandemic. Can you tell me what that is? Right. So a pandemic is essentially just an epidemic that has spread to be in many countries and or usually the entire globe.

What about pathogen? A pathogen is a bacteria, a virus, or even a parasite, such as a worm, that causes disease. Let's jump right in. I'm going to take you back, all the way back to 1918. That was the year, in case you didn't know, that's the year of the great influenza pandemic. So we're going to start with some firsthand accounts. So just to really get you in the mood of what life was like during this pandemic. Are you ready? I'm ready.

Okay. I'll read you a few firsthand accounts from people. I guess most of whom survived since they were able to write their account after. Oh, there are some that didn't. There are some that didn't. This is a story from Josie Mabel Brown. These are from the documentary, which you can find on YouTube, called the American Experience Influenza 1918, or something similar to that. So this is Josie Mabel Brown's story.

She was a nurse at the Great Lakes Naval Station during the 1918 pandemic, and the story was told by her niece. Her niece said, as she walked into the ward, not only. were the 42 beds full, but there were boys that were laying on the floors and on the stretchers waiting for that boy in the bed to die. They were having raging fevers and delirium and profuse nosebleeds and their lungs would collapse and it would go into this horrid, bloody pneumonia. That sounds more like it's from a movie script than it does real life. And that was real life in 1980. That was 99 years ago, this time of year. It's terrifying. We've got another one. This is Dr. Victor Vaughn, who, yeah, I don't know, right? It's exciting. He was at a base near Boston called Camp Devons. He said, this is his actual words. He said, I saw hundreds of young stalwart men, which I assume that means like a strapping young man, stalwart young men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. Their faces wore a bluish.

bluish cast, a cough brought up bloodstained sputum. 63 men died the day he arrived at Camp Devons. That's at one camp alone on one day. Remarkable. It's remarkable. Horrifying. It's incredible. And I think I have one more story that I'd like to tell just because it's, well, I've

got a gravedigger story, but like, who doesn't have a grave digger story? I want to hear the grave diggers story. The Grave-Digger story? Okay. The Grave-Digger story is from Arthur Dorey Davis. And this is not from that same documentary. This is actually, you can find these on the CDC, which is the Centers for Disease Control website. They have this very fascinating storyboard all about the 1918 flu with tons of survivor

and also not survivor, sufferer stories told from either first-person perspective or from their immediate family. And it's absolutely fascinating. So here's one of those stories. This man, Arthur Jerry Davis, was worked at like a logging camp, and his family was in Tennessee during the flu. And so this is one story that he told his son. One morning at 6 a.m., I was set to work digging three graves for a family of six that lived down the road from my home. Around 9 a.m., the doctor sent word to dig yet another grave. Then around lunchtime, I got word to dig yet another grave.

And by 4 p.m., I was instructed to dig the final grave for that entire family. Oh, my God. I know. It's depressing. Starting with a downer. I can't even imagine what it would be like. I mean, one of us, I mean, think about you're a teacher. Kind of, sure.

Will you teach a class? Yeah. Think about going to class one day. and realizing what proportion of those kids, because they're all the ripe age, as we'll find out, would not be coming to class a month from now because they'd be dead of influenza. That's absolutely terrifying. I mean, it would be insane. Plus, not to mention the fact that college classrooms are kind of a perfect place to breed this virus. Oh, they're filthy, disgusting humans college students.

Yes, we are. Okay, so maybe we'll leave it at that. Was that depressing enough to sort of start us off with influenza? I think so. I think it gave us a sense of time and place. So zooming out from those stories, let's talk a little bit about the history of influenza itself. Now, all of us, I'm sure, know, or I've heard about seasonal flu, get your flu shot, blah, blah, blah, oh, I can't come in, I have the flu. I have stomach flu. Not really flu. That's probably for a different day that we'll talk about that. But the stomach flu, guys, it's not flu. It's not influenza. So influenza is,

a viral infection, and it has been around for millennia. We don't know exactly how long because the symptoms of flu are so general, vomiting, nausea, fever, listlessness, listlessness. That's a hard word. Yeah, it's a really hard one. That it's unclear whether a lot of the epidemics that have been written about in history are flu or could have been some other respiratory ailment, could have been pneumonic play. But it does seem clear that there are some in Europe in the 12th century, in the 15th century, in the 16th century, that can be pretty conclusively tied to influenza.

Wow, that's fascinating that it goes that far back. Well, oh, it goes even farther back. So the first, what historians call reliable description of influenza was done by Hippocrates himself. Oh my gosh. The father of Western medicine. What we do know for certain is that the influenza virus was the causative of influenza. agent for the huge pandemic in 1918 that killed, wait for it, 50 to 100 million people worldwide. 50 to 100 million people.

So before diving into the pandemic itself, I want to bring you up to date a bit about sort of the context, the historical context surrounding this huge pandemic. So let's talk about Western medicine at the time. So Western medicine was in its Indian. infancy, really. Bacteriology, so throughout the 1800s, early to mid-1800s, bacteriology really got up and running. We had pasture discovering a lot of bacterial causative agents of diseases. There were some inoculations going on, vaccines, Edward Jenner, with his smallpox hit in the late 1700s. Epidemiology began as a science in 1854.

And that's fascinating. We'll talk all about that in a future episode, won't we? Yes, we will. Thank you, John Snow, not from Game of Thrones. Different John Snow. But despite all of the advances of medical research, medical practice was really lagging far behind. And this was due to multiple factors. One being that germ theory was still kind of debated. So germ theory was not widely accepted. Can you explain a little bit what germ theory is? I was just about to ask you to do it. Erin, can you tell us what germ theory is? I'd love to. germ theory is essentially just the idea that many diseases, most normally we think of infectious diseases, are actually caused by microorganisms rather than just say the air or the water,

which is what was very commonly thought before we realized that there are organisms that are so small that you can't actually see them with the human eye and that's what actually is causing many infectious diseases. Thank you. Welcome. Excellent explanation. So yes, so germ theory was not widely accepted among doctors. And even if it wasn't widely accepted, a lot of physicians, practicing physicians, were never given a class in this. Medical school was totally achievable for any human being who had enough money. Oh, dear. You could spend a couple of years in U.S. medical schools up through like the early 1900s prior to 1918 flu. You could spend a couple years in medical school, taking some courses, never actually see or interact with a patient,

and graduate with a medical degree. Oh my God. As a result, there was a lot of mistrust among doctors. Well, that's completely understandable. Of course. Doctors back then didn't have the respect that they do today in terms of, oh, this, I'm going to go to the doctor and I know that they will fix my ailment. So consider the time, 1918, even though there was a lot of work being done on, bacteria, there was still no antibiotics. Right. So you could, there were inoculation, so you could, to some degree, be protected against some diseases, but a lot of ones, there was nothing that you could do. In 1918, during the flu pandemic, alcohol was prescribed. I mean, Mike. I mean, I can get behind that, but that's not going to help you. No, it's really, it's going to hurt you.

It might make you feel a little bit better because you forget how much pain you're in, but it's certainly not going to cure any of your ailments. So the other thing, besides the complete lack of adequate medical training going on in 1918, there was also a war going on. Oh, yeah. There was, wasn't there. It was kind of like, I don't know, the first world war. Yep, the war to end all wars. Not quite. If only that were the case. What this meant, war means, guess what? Large scale transport of young men throughout the entire world and crowding. Very, very much. And also very unsanitary conditions. Very unsanitary. They were, I mean, like digging pits and things and just hundreds of people

all slumped together and, you know, probably pooping in holes and things. Probably pooping in holes. Probably pooping in holes. It was, it was basically it set the stage for perfect conditions for transmission of influenza. So let's get to the pandemic itself. Ooh, let's. We'll head to Haskell, Kansas, early 1918. Wow. Kansas, of all places.

Yep. Kansas. All right, let's go. Kansas. I'm there. Here we are. A doctor named Loring Minor began to see cases of influenza that were a lot more severe than he had previously encountered.

So he, and this was also. notable because A, like I said, it was a lot more severe, but B, it was also impacting young, strapping men. Otherwise, the people who are least susceptible to influenza. Right. Because generally, it's what, old people and tiny little babies that actually get sort of severely sick from something like influenza, right? Right.

Exactly. He made a note of this, and he sent off some letters and some notes to medical journals, to public health officials saying, hey, can you help me? Can you send some things? Like, this is a problem. And he got no response. Oh, my God. Just a man trying to be proactive.

Just trying to be proactive. And so by these cases started popping up January, February, but by mid-March, the epidemic had burned itself out, basically. Oh, that's good news. Good news, right? Yeah. It didn't burn out before a couple of soldiers returned from. Haskell back to their, back to Camp Funston. Funston. Yeah, not very fun, I don't think. Where is Camp Funston?

Also in Kansas. Oh, okay. Where a super cold winter meant that they had to put a bunch of soldiers together in barracks much more crowded than they would ever have allowed before. Oh my gosh. Which led to rapid spread of this virus throughout the entire camp. Within a few days, people, like hundreds of soldiers were sick and it didn't remain of course isolated at funston because of the war soldiers were being sent to other places in the u.s other camps in the u.s over to france over to england and thus began the first wave of the pandemic oh my gosh way to go kansas way to go kansas more on that this it might not be actually kansas in this first in what historians called the first wave of the pandemic, tens of thousands of soldiers were hospitalized, but very few died, which is interesting.

Yeah. During this first wave is where Spanish influenza picked up its name. Oh, let's talk about its name because a lot of people think if it's called the Spanish flu, it must have come from Spain, right? Not so. Oh, fascinating. Actually, so there are a number of theories as to where Spanish flu actually began, but none of them are Spain.

The likeliest scenario, according to a lot of historians, is Kansas, Haskell, Kansas. France is another contender. Where birds, waterbirds and pigs, domestic pigs, mixed. I'll talk a lot about birds in just

a minute. And and so, but the reason that it got the name Spanish flu is because Spain was neutral during World War I. Whereas countries like, the U.S., England, France, Germany, all of whom were very hard hit by this first wave, censored their news.

Oh, my God. The U.S. censored their news? Shocking. Shocking. So a lot of this came off of, I thought this was really fascinating. It came off of Woodrow Wilson, who was president at this time, passed what is called the Sedition Act of 1918. and it prohibited the use of, quote, disloyal, profane, scurrilous, or abusive language about the U.S. government, its flag. Oh, God, aren't we doing that again, too?

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So this meant that a lot of news about the flu was kept under wraps because it would have made the U.S. look weak and bad. And it also, so yeah, there's so much. I could keep talking about that. Yeah. I mean, this, there could be an entire, someone should, I'm sure there is one, a podcast episode on the Sedition Act because it is dirty. Yeah. They used it to say, like if you were walking down the street and you said, this war sucks, you could be put in prison.

Wow. It was that kind of. That's absolute insanity. It's up there with some of the bad. Yeah. Hopefully not what we're about to get into in our current, where's that drink? Yeah. There you go.

During the first wave, the flu raged globally From around March to June through August. Wow. For instance, between June 1st and August 1st, over 200,000 British soldiers who were stationed in France were hit hard enough that they could not report for duty. So this is 200,000 out of 2 million. Wow. Which is 10%.

That's 10% of the soldiers. were sick enough that they couldn't even get up and stand at their bunks or whatever you have to do when you're a soldier. Yeah, exactly. It was really bad. But then August came around and it was gone. Oh, so it's good news. Yeah, wonderful. Episode over.

Episode over. Not so fast. Not so fast. The second wave began. So the second wave was the more lethal wave. Oh. And it first took hold. on U.S. soil by many accounts at Camp Devons outside Boston.

Oh. We already heard a little bit about Camp Devons. We sure did. And this started in mid-September. Up to 20% of soldiers were sick at one time, and descriptions of the progression of the disease were horrifying. Tell me them. I want to hear them. Okay. Oh, I have a big section on this later on too.

Oh, good, good, good. Within, actually, we'll just do all the symptoms right now. Within a couple of hours of admission with standard flu symptoms, Okay, so we're talking like aches, chills, fever, etc. Mm-hmm. Patients were turning blue because their lungs could no longer transfer oxygen into the blood. Oh, my God. Mm-hmm.

So let's hear some more symptoms of the 1918 flu. Let's. Extreme pain. Well, yeah. Body pain. So much so that physicians at the time were not sure whether it was actually dengue fever, also known as breakbone fever. Wow. because it is so extraordinarily painful.

Wow. Cyanosis, which is what I just mentioned. Right. That's turning blue like your actual skin is blue. Like a smurf. Bleeding from mucus membranes. So your nose, sometimes doctors reported blood spurting out of the nose. Blood spurting out of your nose.

To a couple of feet away. Holy cow. Dribbling from your mouth, your eyes, ears. And if you're a woman, your vagina. Well, I mean, doesn't that happen anyways? Yeah, oh, that's why it took so long to be noted as a sign of disease. Oh, no, it's just your woman problems. Don't worry.

Go home. Tend the children. Oh, yeah. Well, they couldn't because pregnant women faced the highest mortality rates of all. Oh, poor babies. Of all ones. All internal organs were affected. So you would have necrotic adrenal glands.

Oh, my God. Dry brain tissues, which indicated, yeah. Your brain dried out? Mm-hmm. Bro, if you didn't know this, your brain is literally sitting in a pool of fluid. It's not supposed to be dry. The folds got all weird and the brains. Yeah, brains dried out.

Torn or degenerated muscles associated with coughing. You cough so hard that you rip your muscles of your diaphragm and stuff? Your ribs, yeah. And lungs that looked so bad upon autopsy, doctors compare their condition to pneumonic plague, which is the second most lethal form of, Buba, of Yersinia pestis plague, which causes death in 90% of its victims. Don't worry. We're going to have a two-part episode dedicated to the plague. Yeah, we are. Or toxic

gas. Wow. It destroyed the lungs. I mean, they would fall apart. It was, it's horrifying. Wow. Horrifying. Oh, my God. Here's another very unique symptom of the 1918 flu. Accumulation of pockets of air just beneath the skin. What? So that when a patient was turned over to baby changed the bedding, their bodies would crackle. Like one Navy nurse compared the sound to Rice Krispies. I was going to say like Rice Krispies. She said she could never eat the cereal again. Oh my God, I don't know if I can't.

Except let's be real, I can definitely eat Rice Krispies. No, they get way too soggy. Oh, but, Rice Krisp Tries. Oh, yeah, Rice Krisp Tries. That's all I'm saying. So it was horrifying. I mean, it was so, it was, would, some people would come in within a few hours. be dead. It was unheard of for flu. I mean, still to this day, that's absolutely instant.

Oh, yeah. Kind of. We'll see. Is it really? I don't know. So what happened? So this was not, this incident was not isolated at Devons. The extreme mortality. It spread globally. And, but if it was this the same virus that caused the first wave. And if so, how did it pick up pathogen, or how did it pick up virulence? Right. One hypothesis. One hypothesis. is antigenic shift. Oh. Erin, can you tell me a bit more about antigenic shifts? Yeah, you know, let's, let's do that.

Let's talk about the flu virus. There's a couple of words that I want to define so that then we can sort of talk about the flu virus in general. So one of them you already mentioned, which is virulence. And the other word is infectivity. So I'm just going to really quickly, infectivity for anyone who doesn't know, is essentially the percentage of people that are exposed to a disease that actually get infected. So it tells you how, well, infectious, an infectious disease actually is. So let's say

I'm sick with the flu and I cough on you. Maybe you'll get the flu and maybe you won't. And infectivity determines how many people that I cough on will get the flu, right? Do different flu strains have different levels of infectivity? Absolutely. Yeah, absolutely. So clearly the 1918 18 flu was a particularly infectious strain. It was able to sort of travel the globe. And in general, flu viruses are very infectious compared to something that say like sexually transmitted such as HIV. Okay. And then virulence, which is essentially if you do get infected, how likely is it that you're going to get very, very sick and or die? So that's what your virulence is. So this 1918 strain was both very infectious and extremely virulent. It was killing a ton of people.

flu viruses the influenza virus for i don't know i guess how many people are listening to this that don't know what a virus is let's let's just define it's define a virus let's define it we're starting from day zero so viruses are essentially just little bundles of genetic material surrounded by protein right viruses have proteins on their surface that our cells are immune cells used to recognize them these proteins are called antigens and we make antibodies to fight them makes sense Makes sense. So flu happens to have two of these antigens, H and N. So if you've heard of H1N1 or whatever.

Yeah, I have. Okay. Yeah. So that's what that actually means is the proteins that are on the outside of the actual flu virus itself. It just so happens that there are 16 of those H proteins and nine different versions of that N protein. That's a lot of combinations. Exactly. So the flu virus is what's called a retrovirus.

which is a type of RNA virus. That means that the genetic material that makes up the flu is RNA. In humans, it's DNA. Gotcha. Gotcha. RNA viruses and retroviruses especially have a really high mutation rate. They're so retro. Get it?

Because they're retro viruses. It's like 19, 18. Do retro people have higher mutations? It's just like a funny joke. Play on word. Can we get a cricket sound? Please. Creaket.

Thank you, Stephen. So what that means, a high mutation rate means that every time an influenza virus replicates, it might make a few mistakes that could result in small changes to those H and N proteins that make it harder for our body to recognize it. And this process, if you care about vocabulary, is called antigenic drift. Gotcha. Now, the other way that flu viruses can change, which is even more dramatic, is what's called antigenic shift. Basically, the flu virus isn't just a single strand of RNA, it's a bunch of short strands.

So if, for example, as often happens, an unlucky pig or an unfortunate bird, is infected with not one but two different strains of flu, Like H1N1 and H3N3. Exactly. Those can inside of the bird or pig mix and match and recombine to make like H1N3 or H3N1. And this is what makes it really hard for our immune system to actually respond. And so that is shift. That's a major change. Exactly.

And drift as small changes, which are less scary. Exactly. And so antigenic shift then is what is theorized to have happened in the 1918 second wave pandemic. One of the reasons that they think that this is the case that it was antigenic shift rather than a completely new virus. Okay. Is that a lot of the people who were infected during the first wave showed immunity or partial

immunity to the second wave. Yeah. So that makes sense. So that makes sense. So now we've got this horrifyingly virulent virus that is wreaking havoc in the military in the U.S. Just raging. In France and England and Germany. And it doesn't stop there.

It spills over into the public. And there it's even worse in some places. So a lot of the anecdotes that I'll be mentioning in terms of the pandemic. spread take place in the U.S. And that's just because one of the books that I read concentrated on this pandemic in the U.S. Right. It doesn't mean that these weren't also happening all over the world.

The globe was affected by this. And a lot of areas were hit harder than the U.S. So from Camp Devons, the virus more deadly this time exploded across the U.S. And so one of the places I'll talk about is Philadelphia. So Philadelphia was hit extremely hard, partly because the lead public health official at the time refused to cancel parades. Typical. Saying that public morale was more important than, and he was like, oh, no, the flu's not a problem. The flu's not a problem.

Oh, no. Yeah. And what's important is that for the flu virus, you become infectious. That is, you start shedding virus out of you, like coughing, sneezing, whatever. before you actually show any symptoms. So that means that you could be a happy go lucky, seemingly healthy, 25-year-old woman at this parade, waving a banner, meanwhile, coughing, or not even coughing, but just breathing, hugging people and giving them.

Kissing people. Kissing people. With the mouth and just spreading flu virus. And so that's really, really important. It's a really important aspect of the flu is that you all. are infectious before you ever show symptoms. And that's why it's very, very easy to spread because you have these people, like you said, at a parade

that seem to be perfectly healthy, so you're not afraid of them, like you might be of someone who's coughing. You might avoid a person who's coughing because you think I don't want to get sick, but you don't avoid people that seem healthy, because why would you? Right.

And so at this massive parade in Philadelphia, which was not shut down, Against the advice of virtually every other public health official and physician, within two to three days after it, the number of flu cases exploded in Philadelphia to be in the thousands. Oh, my God. On one October day in Philadelphia, 759 people died of influenza. One day. In one day. In one city.

In one city. That's insane. Prior to this outbreak of influenza, all deaths in the city. averaged 485 per week. All deaths for all causes. For all causes. Oh my God. So it was extraordinarily bad.

Yeah. I mean, sounds pretty terrible. It's extraordinarily deadly. The other terrifying thing about the influenza pandemic. Tell me. Tell me. Is that the people that were hit the hardest were not the people who are usually hit by influenza. So usually the influenza mortality curve,

So where you would have on the y axis, on the vertical axis, the number of deaths, and on the x axis, the horizontal axis, you would have age in years. Right. So with zero at the far left end and let's say 100 at the far right end. Normal influenza, seasonal influenza, you see a U-shaped graph. Right. Where you see high mortality, mortality peaking in infants and in the elderly. Right.

Old people and babes. Old people and babes. With the 1918 pandemic, that U was turned upside down. So it was actually inverted where you see the highest mortality rates among people. The highest was in the group between the ages of 25 and 29, followed by 30 to 34, and then 20 to 24. So it hit hardest the groups of people that are normally completely resilient, healthy, young, robust. So how did this happen? Was this all just because it was a new virus?

I mean. So there are a. couple different ideas. Okay. One is that the elderly were protected because they had been exposed to a similar virus. All right. In their youth. Okay. It doesn't match up to some of the other previous epidemics. Okay. But that still could be the case. Another theory is that young people had also very healthy immune systems. So that by the time the virus had invaded all of their lungs, the immune response that their bodies mounted was so severe that it was that that actually killed the people. I am shook.

Does that make sense? Yeah, you're saying that because they had such a great immune system, essentially, that all of the stuff that your immune system, which we're not going to get into because it's too technical, but all of the stuff that is released during that immune response essentially is what actually killed them and not the virus itself. Right, exactly. Wow, we're like, pen. finalized for being good at stuff.

I know. I know. Typical young people. So it was, I mean, it was devastating and bizarre. Yeah. And it caused a lot of panic. It caused a lot of laws to be enacted, such as anti-spitting laws. Okay, that's probably a good law, though.

I mean, yeah, you're like, you shouldn't spit on people anyway. But. But so if your city has an anti-spitting law, it's probably because of the 1918 flu. It probably is. That's awesome. Somebody was killed because of, because they, spat. Wait, like somebody got infected because they were spat on? No, no, I'm sorry. Somebody, a policeman, I need to, I need to fact check this. But let's just say that it's fact.

Okay. A policeman killed an individual for spitting in the streets in San Francisco. Oh my God. It was taken very seriously. Wow. I mean, you could not go outside without face masks. But at the same time, the public health advice was very influenced by the fact that the U.S. was at war. So it was keep morale up. The ways to avoid the flu were to not talk about the flu. Oh, no. Yep.

So this was the genius idea of the same guy who decided to go on with all the parades in Philadelphia. Oh, God. And don't talk about the flu. Drink alcohol, probably. Probably. And cheer for your country. With this devastation going on in the youngest and healthy, populations, the race was on to try to find a cure and the causative agent.

For a really long time, the causative agent of influenza was not known. And the biggest contender was this bacterium called hemophilus influenza, which was found in a lot of flu patients. Right. But it wasn't actually that. Obviously, because we know now that it's, but how did we figure that out? I mean, in 1918, we didn't have a lot of, like, technology, right? Right.

No, it took a really long time. And so it wasn't actually until a few years ago, within the past 10, 15 years. Seriously? Was it conclusively shown that the 1918 flu was actually an influenza virus? How'd they do that? Well, I'll tell you. A bunch of scientists went up to Alaska. Probably put their glasses on because scientists all wear glasses.

And lab coats. Stereotype. PPE, personal protective equipment. That's not a stereotype. That's important. That's really important. Got our ethics training. No.

So a bunch of scientists went up to Alaska where there were graves in the permafrost from the 1918 flu victims. And the fact that it was in permafrost means that the conditions were such that the bodies could be preserved a lot longer. Wow. And so the RNA and the viruses didn't degrade as much. Right. That's so cool. Super cool. So then they actually dug up some bodies. Hope they had permission from their relatives. I should have said, got permission to dig up some bodies and took out lung tissue in some of the victims.

And from that isolated the RNA virus, the influenza virus that caused the 1918 flu. They sequenced it and they recreated it. Are you serious? So in a lab, they recreated the 1918. strain of flu virus that killed 50 to 100 million people wait wait for it oh they infected monkeys with it and the monkeys died of this this in very similar way that the victims the young victims of the 1918 flu virus which was their immune system just going crazy at the flu virus poor little monkeys poor little monkeys but this also brings to mind the ethical deletion

of such work. Right. And I'm not talking about testing animals. That's for another episode. That's a separate ethical dilemma. Right. But we're talking about the bioterrorism impact. Yeah.

So when you have this viral genome sequenced, you can publish it. It's basically a recipe. You actually, you have to publish it. You do have to publish it. Like there are requirements that when you, I don't know if this is boring for people, but if you sequence something novel, you have to publish it in a publicly available database. So yeah, in theory, anybody, with enough knowledge and access to laboratory equipment could make it and then disseminate it.

And it's been long enough since 1918 that most of us probably aren't immune to that. Right. Except unless you got your flu shot. So every year the flu shot includes a number of different flu strains, as we talked about. Yeah. And in 2009, actually, they included H1N1 variant of 1918. Right. Right. Oh, of 1918. Yeah. Oh, shoot. I don't know if I got my flu shot in 2009. I don't think I'd, but I mean, it probably is worn off by now anyway. That's true. That's true. Anyone who works long hours knows the routine. Wash, sanitize, repeat. By the end of the day, your hands feel like they've been through something. That's why O'Keefe's working hands hand cream is such a relief. It's a concentrated hand cream that is specifically designed to relieve extremely dry, cracked hands caused by constant hand washing and harsh conditions. Working,

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But that's really interesting. Isn't that interesting that they... I love it. Because it was an H1N1 flu that caused that swine flu outbreak in 2009 that people were very worried about, that that, I mean, it turned out not to be as bad as it could have been. But wow, how interesting. Yeah. By the end of the pandemic, which was pretty much over by armistice, November 11th. I mean, it came through, it swept through the globe and left devastation in its path. Like I said, 50 to 100 million people killed worldwide.

Some of the areas, I just wanted. There's some interesting statistics. Yeah. Hit me with them. In the U.S., about 28% of people were infected. Wow. 675,000 people died. Oh.

Today, that is estimated that would be over 1,750,000 people. Oh, wow. It would be devastating. Oh, my God. But the U.S. escaped the mortality that a lot of other places saw. So other places had it even worse than 675,000 people? Yes, there were entire villages in Alaska that were killed. Oh my God.

Entirely. Everyone dead. Iran between 8 and 21.7% of the population died. If you could see my face right now, it's just like a... It's shocked. It's shocked. The worst affected was German Samoa, which is now the Independent Republic of Samoa, with 90% of the population infected.

What? 30% of adult males. 20% of adult females and 10% of children dead. Islands, man. Islands. It's just so easy to just spread through an entire island like that. Especially if it hasn't been exposed, especially if the population hadn't been exposed to a similar influenza virus.

So it was truly devastating. And so one of the questions, though, because it had such a lot of, devastation, it caused such high mortality, but why didn't it leave its mark in American culture or literature or music or behavior? And the answer is it probably did. But overall, I mean, it didn't leave its mark the way some of the other pandemics have left as as obvious a mark. Some historians argue that the pandemic accelerated the end of World War I. The The central powers were hit harder and earlier, or were hit earlier harder by the flu virus. And so that weakened their forces.

And so then they tried to negotiate peace talks earlier on than they had anticipated because the allies were hit later on. Oh, wow. So we actually only won because we got sick later? Because we got sick later. Wow. There was, and there was one, in one of the books. that I read, some historians have theorized that Woodrow Wilson came down with the flu, and it changed him, his mental state, which was shown in some other cases anecdotally,

in terms of being more aggressive or more, just a personality shift. Like a permanent change. Like a permanent change. Whoa. And he was way more withdrawn and way more argumentative and way more stubborn and way more stubborn and so he the peace treaty the armistice that was eventually negotiated and the peace treaties that were signed were much more severe towards Germany that central powers than they originally had planned on and so that could have contributed to the animosity which then built up events leading to

World War II. Wow. Which is interesting. That's insane. So yes so this this 1918 pandemic was enormous in scope, enormous in death toll. Yeah. And we haven't seen anything like it since. In 24 weeks, the flu virus killed more people worldwide than HIV has killed in 24 years. Seriously? Seriously? That's a, that's seriously.

Yeah. Wow. So I should fact-track that because that statistic is from. 2004. Oh yeah, we should definitely backtrack that then. But that's still a pretty shocking statistic. It's a, I mean, it's terrifying to read about because this was only 99 years ago. Right. We don't have treatments for viral infections that are as effective as we do for bacterial infections. Right. Right. Viruses are still much trickier little beasties. And a lot of that has to do with what we were saying before about just how sneaky these viruses are and how mutable they are. Right. So, then the question I'll pose to you is how worried do we have to be about another 1918 pandemic. It's a really good question.

So let me say, can I just say you should be worried? I mean, I could leave it at that, but I'll elaborate. But tell me why. Okay. So the flu virus being such a sneaky beastie is something that obviously sort of circulates all the time, right? There are seasonal flu strains, and you probably, every time that you go to your doctor, between the month of like September to January, says, would you like to get a flu shot? You should have you had your flu shot yet?

Do you go to a doctor in the 1920s? Yeah, that's how my doctor voices. Does he work at a speakeasy? He's like, I'll get your a tonic and a flu shot. But the vast majority of those flu cases, for anyone who doesn't get the flu shot, are pretty mild, right? you're maybe miserable for a week, but you recover. You don't die unless you're a very old person or a very young person or an immunocompromise person. But there is quite a lot of concern that a similar thing could happen as to what likely happened in 1918.

That is a new strain that we have never previously seen. We being the human race has never seen before. And if that were to happen, yeah, we really could see something similar to what. we saw in 1918 if you were to ask most people who work and study infectious disease epidemics what they're most afraid of i would put good money on betting that they would say h5 and 1 h 5 and 1 sorry i said end 1 8 5 and 1 8 5 and 1 8 5 and 1 8 5 and 1 right so h 5 and 1 is avian fluid Bird flu. Have you heard of that? Of course.

Right. Most people have heard of it. If you haven't, you're hearing about it now, so you'll be ahead of the curve. The avian flu is a particular strain of virus that circulates in wild, like, water birds, ducks, geese, etc., many of which are migratory. And it can also circulate in domestic fowl, so chickens and domestic ducks. And the reason that it is so scary is that it has been spilling over to humans. What does that mean exactly, spilling over? So spillover is the term that we use when a infectious disease that normally circulates only in animals begins to infect humans.

Could that be something like Ebola? Absolutely. We'll talk about that in a future episode. Don't worry. But yeah, absolutely, Ebola is a very good example of a disease that is usually caused by spillover from animal populations into humans. And same thing with H5N1. So this is a virus that usually circulates in a disease. wild birds often spills over into domestic birds and from those domestic birds it's very easy for it to then spill over one more time into the human population and it has done this a number of times the very first time that this happened was in 1996 or 1997 1997 was the first human case uh it happened in Hong Kong. It was a little boy, and he died. And he became the first known human case of H5N1. There were a number of

other people, 17 other people, in fact, that became infected around that exact same time in Hong Kong, and five of those people died. But those are very small numbers that you're telling me. So does this mean why wasn't there a pandemic? Why wasn't this larger? Well, okay, so I can hit you with some slightly scarier numbers. Hit me. So that was 1997. We're now in 2017. That's 20 years later. This bird flu, H5N1, has spilled over from domestic animals into humans in 16 different countries. It has infected 859 people, according to the most recent estimates by the World Health Organization. And of those 859 cases, 453 of them died. Holy moly. That's a 52% mortality rate.

52%. That's why this virus is so terrifying. So it's true that most of these are what you might want to call in like isolated cases. Maybe, maybe. Were humans the dead end host? No. Well. Was there human to human transmission?

Right. So that's the big question. And in many of these outbreaks, we do see evidence of human to human transmission. And this is something that for a long time, there's been a lot of politics around this. And for a long time, various governments were refusing to recognize that human-to-human transmission was actually happening. But in many of these cases, human-to-human transmission is definitely happening. It is at much lower levels than what we normally see with a human flu virus. So the infectivity is lower.

Exactly. And so the issue with the government is that because when H5N1 was found in a bird population, they would call the entire? Well, yes and no. So that's sort of common practice, and that started because of that initial outbreak that happened in Hong Kong. Hong Kong actually called millions of birds, and they have since kept infections very much at bay on the island of Hong Kong. Other countries have tried to do the same, but the issue is that in many of the countries where these spillovers are happening, it's small farmers who have these bird flocks. And so you're basically destroying their livelihood by coming in and all of these infected birds. So farmers don't want to cooperate and the government doesn't want panic, which tends to happen when you say something like 52% of people are dying from a pathogen that we don't have control over. So I understand that the government doesn't want panic, but we kind of saw how that panned out in the 1918 flu. Yeah. Isn't it amazing how humans just never learn our lesson? But then there was the Ebola scare. I think that it's a, I mean, it's a

combination of not wanting to panic people, which is understandable because then people might do crazy things, but then also a lack of scientific understanding about transmission. So whereas the Ebola scare might, it was not warranted for people in the U.S., but this is warranted. In some cases, yeah. So there hasn't been extensive human-to-human transmission yet. Extensive meaning, you know, we haven't seen a pandemic yet. But there certainly has been limited human-to-human transmission.

So maybe one person going home and infecting his entire family, for example. But maybe not infecting an entire village or an entire town or something like that. But that is sort of the biggest fear, is that this virus has spilled over so many times that eventually it's going to break that last barrier and it's going to be able to be transmitted freely between humans, in which case we could absolutely see a global pandemic. So, but one difference between now and 1918 is technology for vaccine creation. Absolutely.

How does that play into this? So every year, virul, I guess it's virologists, they try to predict what is going to be the most common circulating strains of flu, right? And they put those, they do a lot of models to figure out what strains those are, and then they make a vaccine for it, and that's the seasonal flu vaccine that you get. This virus, we can't quite make a vaccine for yet because it doesn't quite exist yet

in a form that would be passing human to human. So we wouldn't be able to make a vaccine for it until it already is circulating, if that makes sense. So we don't have a vaccine for H5N1 for humans. We do have a vaccine for domestic birds, And so a lot of places are trying to vaccinate all domestic birds so that we don't have that initial spillover event happening in the first place. But that's sort of an imperfect system as well. So another big difference between 1918 and today is that today you can get on a plane in Chicago and be in Hong Kong tonight,

get on a plane there and be in Australia the next day. So our mobility is insanely huge. So the chances that if something like this were to happen that it could spread worldwide extremely quickly are very, very high, which is something that concerns a lot of people who study this. So to answer your initial question, which is how scared do you need to be about this kind of thing happening today? Go ahead and get your seasonal flu shot, wash your hands, and just, I don't know, be a little bit afraid, I guess. Be a little afraid. No, I'm not too afraid. But, you know, don't hang around birds.

That would be a good piece of advice I have for you. Don't hang around birds. Be aware of the symptoms of flu. And educate yourself. Don't be afraid to go to the doctor. Don't be afraid to go to the doctor. Because that happens a lot. And then you can end up infecting family members or friends.

If you're feeling sick, don't go to work. Oh, my gosh. And don't come to class. Oh, God. Please don't come to class. Don't go to the library. Don't cough on me on the bus. Don't touch all the doorknobs.

Cough into your elbow. I think we're being too preaching now. We're definitely being too preaching. We can cut all of this. Yeah, we can. Well, I don't think I have anything that I want to add. How do we close this out? We say,

um... Oh, um, thanks for listening. Thanks so much. Make sure that you rate, review, and subscribe. You can find future episodes. episodes on iTunes, on Spotify, on Stitcher, Google Play, etc., etc., etc. You can follow us on Instagram. At This Podcast Will Kill You.

On Twitter. At T-P-W-K-Y. This podcast will kill you, but it's just letters because Twitter has rules. And on Facebook. At this podcast will kill you. If you want to learn more, we have a number of books and articles that we're going to hit you with right now. Yeah.

We encourage you to read. Some of the books that we focused on were the great influenza by John Barry, which is super interesting. It's really well researched. Great book. All about the 1918 flow specifically. Right. And it focuses mostly on the effects in the United States.

Flu by Gino Colada is more focused on the discovery of the actual flu strain that caused the 1918 flu, so how it was isolated and then sequenced and so on. Pale Writer by Laura Spinney is another nonfiction book about the 1918 flu, and this deals more with personal histories and accounts, and this has a much more global feel to it. And then if you're interested in learning more about the avian influenza and you want to be scared shirtless, like seriously, you can read Fatal Strain, colon, on the trail of avian flu and the coming pandemic. And that's by Alan Cyprus.

It's a really, really interesting book. Thank you to Bloodmobile for the music and to Miles for all of your help with our logo. Thanks for listening. Bye. Running my small business was like playing basketball five on one, and I was the one. Now QuickBooks gives me access to a team of AI agents

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