1918 Spanish Flu Holds Clues to Future Pandemics
“The 1918 genetic picture suggests to us that this was a different formation, that this was an entirely bird-like virus that ultimately adapted in all of its genes to humans,“ says Dr. Jeffery Taubenberger of the Armed Forces Institute of Pathology.
He led the team that decoded the 1918 virus. His team discovered a number of mutations that were key in adapting the virus from birds to humans, traits shared by the current H5N1 strain of bird flu.
“The H5 viruses, especially some of the more recent ones, share some of those mutations, suggesting that they might be acquiring some changes that would make them more easily adapted to humans. So that’s a very worrisome situation for us,” said the doctor.
Dr. Taubenberger is a very low-key guy. Although he never discounted the possibility that H5N1 could become a pandemic, he was not particularly concerned about this happening a year ago. If he’s worried now, we should be worried.
A question that has been gnawing at me re 1918: what was the cause of the phenomenon of “fine in the morning, dead by afternoon” that characterized the flu then? Was it that the victim had been exposed days before, then at some critical point, the virus creates the cytokine storm? It just seems so horrifying, not to mention mysterious, how it could overtake someone so quickly. It appears unlike other viruses that way. I usually know when I am coming down with something.
Cytokine storm seems to happen rather rapidly.
Other things can be fast - think of getting “hives”, or, allergic reactions where people’s airways swell closed, or, how fast a sprained ankle can swell up.
http://en.wikipedia.org/wiki/H5N1
http://en.wikipedia.org/wiki/Cytokine_storm …”When the immune system is fighting pathogens, cytokines signal immune cells such as T-cells and macrophages to travel to the site of infection. In addition, cytokines activate those cells, stimulating them to produce more cytokines. Normally this feedback loop is kept in check by the body. However, in some instances, the reaction becomes uncontrolled, and too many immune cells are activated in a single place.
The precise reason for this is not entirely understood.
Cytokine storms have potential to do damage to body tissues and organs. If a cytokine storm occurs in the lungs, for example, fluids and immune cells such as macrophages may accumulate and eventually block off the air passageways.”…
This would mean people would go from well to dead without collapsing hospitals?
I think this well-to-dead in a day thing isn’t typical now, and might not be.
People don’t all respond the same way to a virus. In general, influenza symptoms have a more sudden onset than most cold viruses cause. Some people appear to die very quickly of H5N1 and others linger for months in hospitals on respirators. Check out this cluster from Viet Nam?. A 21 year old man was admitted on Feb 8 2005 was treated with Tamiflu, was put on a respirator and finally was discharged from the hospital on May 13 2005. His 14 year old sister became ill on February 23 2005, became more ill on February 27 and was discharged from the hospital on March 14. Others have been reported to die within a week of becoming ill. The outcome of an infectious disease depends not only on the virus, but also on the host and the type of treatment.
Isn’t there massive organ failure involved? Just think how fast you can get a digestive problem. I was on the Garden State last night, drank some coffee, and thought I should just pull over to the side of the road and be sick. I wasn’t aware I had a problem. Was in distress for a half hour then fine. I am in tune with my body, but both times I’ve had pnuemonia I felt fine one moment and the next, forget it, I was prostrate. I’m sure all of you have had experiences like that.
I’m counting the number of top dudes staking their positions: Osterholm, Webster, Osterhaus, Nabarro, Peiris, now Taubenberger. Niman, of course, has been there a long time ago. Anyone holding the opposite position?
Peter Palese is the only reputable scientist that I am aware of who is taking the opposite position. Unfortunately, he is the one the US government is listening to. Hence our lack of preparedness. Although to be fair, he is in favor of preparedness in a general way.
The speed of illness attacking and killing is not unheard of. I present this account by Boccaccio from 1348:
How many noble men, how many beautiful ladies, how many light-hearted youth, who were such that Galen, Hippocrates, or Asclepius would declare them the healthiest of all humans, had breakfast in the morning with their relatives, companions, or friends, and had dinner that evening in another world with their ancestors!
So there is obviously a “rapid kill” mechanism available to infectious disease under the correct circumstances.
Anon_22: In the above list of folks, I pay the closest attention to Webster. He’s always worried about Africa. When he worries, I worry. I also pay close attention to what you have to say and have found your comments to be calm, clear, and helpful. Thank you.
Hi Folks- thank God the Fluwikie is loading OK for me at last. I missed the wide ranging discussions and real characters (wise people)who impell them.
This is a paper I found by Taubenbenberger. Notice the disconnect between >2.5% case fatality rates and the estimates of death world wide in 1918.
http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm
History 1918 Influenza: the Mother of All Pandemics
Jeffery K. Taubenberger* and David M. Morens†
“An estimated one third of the world’s population (or ≈500 million persons) were infected and had clinically apparent illnesses (1,2) during the 1918–1919 influenza pandemic. The disease was exceptionally severe. Case-fatality rates were >2.5%, compared to <0.1% in other influenza pandemics (3,4). Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million (7).”
SOOOOO- If up to 500,000,000 people were infected by H1N1 and up to 100,000,000 people died then the case fatality rate could have been 20%. If less than 500 million were infected-but 100 million still died, then the case fatality rate could have been far higher than 20%. 20% case fatality could be a conservative number. Even looking the other way, With 50,000,000 deaths, the case fatality rate is 10%- Where on earth does every forecaster and her uncle keep coming up with worst case figures of 1–2%????? These are the case fatality rates for USA whites in 1918.
Instead of saying >2.5% which sounds like “about” 2.5%, why not say, <30%???
This is not complicated- this is simple mathmatics- using numbers from the USA Gov’t CDC. No computer or staistics program required
here are the refs
Clark. You’ve hit the nail on the head…isolated another crux of the issue again. Keep it up.
anon_22 on the other side, to name a few, are Arnold Monto (MI), Peter Palese (Mount Sinai), Ian Lipkin (Columbia), Paul Offit (CHOP). They’re all very well known in their field. And they all agree in prep. They just differ as to whether H5N1 is the one that’ll go pandemic. But I promise you, they’re all watching.
DemFromCT. If this is not a viral pandemic in the making then what would be? I would predict a change in many opinions in the near future.
LOL. Once a pandemic starts, I would predict even more of a change in many opinions.
Seriously, I have questioned whether a commitment to traditional reassortment (antigenic shift) drives the skeptics in any way in regard to what they ‘see’ happening, and I can’t get a straight answer there, other than that some senior virologists don’t believe much in recombination as an important mechanism for viral evolution.
I’ve never tracked a pandemic before, so i don’t know what a pandemic in the making looks like. I am very comfortable telling you I just don’t know what I’m seeing, exactly. it worries me, but I am not sure what happens next, other than worldwide spread of H5N1 in birds.
Dem, I don’t think Arnold Monto is on the other side at all. He was very pessimistic in private. Can’t say about the others.
Well, that would be a change. I heard him speak in November and he was all for prep - a big advocate - but not so sure H5N1 was the one.
Wel, I heard him in January and he was more like - don’t see how we can avoid it. Also on the subject of closing borders, he said that his guess is that BF will be in the US and probably in multiple locations by the time we start thinking about that.
Hmm.. I just registered to hear him speak on 1/24 on the webcast. it’s linked on the Main page
“Most of us believe that the probability of an H5N1 pandemic is low but real”
That’s a Monto quote from the webcast - no numbers for gs.
“and because it’s real and would have enormous consequences, active and vigorous response is necessary”.
DemFromCT: I heard Taubenberger speak last year. He was neutral about the possibility of a pandemic from H5N1. Something like, “Maybe it will, maybe it won’t”. He did not appear to be in the least bit worried. This was before they had all of the 1918 virus sequence.
I started this thread because I think the quote from him above suggests a big change in his opinion, perhaps based on comparisons between the 1918 sequence and recent isolates of H5N1 (Turkey?, Indonesia?). I think what anon_22 is suggesting is the some of the Experts are changing their estimates of H5N1 going pandemic. This is the impression I get, but its admittedly subjective.
Monotreme, “I think what anon_22 is suggesting is the some of the Experts are changing their estimates of H5N1 going pandemic.”
They are coming off the fence IMHO.
Also, Taubenberger was definitely more non-committal even 4 weeks ago. I don’t believe he was ever ‘neutral’ in his opinion, just neutral in his expressed assessments given that he didn’t have ‘proof’. In such a situation, one can express exactly the same sentiments in 2 diametrically opposite ways: first is ‘we don’t know, we don’t have the proof’ and the second is ‘the balance of our limited knowledge leads us to a significant level of anxiety’. I think he used to take the first stance, now he is switching to the second.
That’s what I’m trying to pin down; it’s an important observation, more a feel than a definite.
What about what Taubenberger said is so different that you’d move him from neutral to changing his estimate? anon_22 said Monto was more pessimistic in private when he was in London. In MI 1/24, I quoted what he said at 21:10. Not so different than what he said in November.
Lipkin was quoted in the WSJ about two weeks ago, he’s not changed.
By the way, they’re all strong preppers. They all respect H5N1’s potential. But I wonder if we’re over-reading them?
DemFromCT: “…I wonder if we’re over-reading them?”
Maybe. But my gut says no. Taubenberger is very careful about what he says. He is perfectly aware of the impact of his statements since he is so closely associated with the 1918 virus. His statement above comparing H5′s to 1918 is much stronger than anything he’s said before, including his Science and Nature papers. Also, “…a very worrisome situation…” is atypical language for him. He’s sending a signal, IMO.
Dem,
I think they are in difficult positions. As I said before, the balance of knowledge/information/intuition of H5N1 is really scary, whether you are a top-level scientist or us here. The problem for them is that science requires a very high level of proof, but real life does not make room for such luxuries as proof before action. Hence they would have such personal dilemmas as to how to express themselves.
The pure scientific argument would still today be that ‘there is no proof that H5N1 will cause the next pandemic or it will mirror 1918′. But I’m sure they are just as spooked as we are with Turkey and Africa and Europe and the mutations etc, and it would be morally insupportable to hold onto this ‘we don’t know, we can’t tell you anything because there is no proof’. It is therefore likely that they will speak in more cautious neutral ways formally but more freely express their concerns in private discussions, perhaps even knowing that such private discussions will be interpreted as now.
Nabarro is the only one who has jumped onto the other side twice recently and said things in an official capacity that is not fully supported by ‘proof’ - the 150 million dead, and then the ‘2 mutations’ episodes. Both times he got slammed pretty bad by TPTB.
I don’t think we are over-reading them, and I can tell you why. As respected scientists, they will be under-stating more often than not. Unless there is an important reason, such as their conscience kicking them into warning people.
Just my two cents.
Before other possible disasters, like the Cuban crisis or or swine flur or Y2K or many others, there were always so called experts that were also so called scientists or doctors or whatever. Since the introduction of the internet, anyone can call themselves anything. Are they the smartest people around? Perhaps not. They may think that they are, but I could claim that too. But I won’t. I could claim that I am scary Gary North or some Dr. Niman guy or Dr. Thorgawggy from the Bird Flu Comglomerate of the New World Order. Ok, just watch out for the hype masters. Just take everything with a block of salt. Prep for yourselves and your families for any eventuality. It should just be a way of life. You never know what is coming your way.
I’m not dismissing either Monotreme, or anon_22 and what’s said in person is so different than what’s written or lectured. No body language in writing, etc.
Well, this sucker changes by the week, so we’ll have to keep up to date on all of it.
Thordawggy,
I don’t understand. Are you refering to Taubenberger, Monto, Dem or us? Because this thread is a discussion of what we think of Dr Taubenberger’s statements, and it would be quite hard to not count him as a top expert on avian flu virus.
Excerpt from a late-2005 interview with Dr. Jeff Taubenberger. His language seems pretty much the same (to me) then as it does now.
How personally worried are you about the threat of a pandemic from this H5 virus?
“I am certainly concerned what is going on with the H5 virus, but I would not be a person who would say that we are definitely going to see a pandemic or that it’s imminent. I think that it’s a virus that has a number of very concerning properties: it has a very highly pathogenic virus for domestic poultry, like chickens and other bird species, and so is a major agricultural and economic importance. This virus has the ability to completely devastate the farming industry in any country that it gets into. But in addition to that, there are some other features to the H5 virus that are unique and very worrisome.”
http://www.cbc.ca/fifth/nextpandemic/interviews_taubenberger.html
It really is a matter of personal opinion and interpretation. I think there is a difference between saying the virus has features that are worrisome and saying some of the recent strains might be acquiring some changes that would make them more easily adapted to humans.
“It really is a matter of personal opinion and interpretation. I think there is a difference between saying the virus has features that are worrisome and saying some of the recent strains might be acquiring some changes that would make them more easily adapted to humans.”
Uhhh….okay.
Late 2005 would be after the 1918 sequences were obtained and after the Indonesian cases, but before the Turkish cases. I heard him speak in early 2005 and he did not appear to be worried at all at that time, even after being challenged by someone who was more worried. I’m with anon_22 on the interpretation. I think his level of concern has shifted during the course of 2005 and 2006. Maybe gs should write him and try to get his current probability estimate ;-)
I’d like to get Dr. Taubenberger’s take on which genetic acquisitions he would see as significant on the route from HPAI H5N1 to H2H PF51.
No ordering necessary, just a few bases that we should watch?
Have autopsies been performed on any of the people who have died from H5N1? Has an exact cause of death been determined? We had the misfortune of having canine influenza (H3N8) go through our kennel 2 yrs ago, resulting in the death of two dogs and 20 others severely ill. One dog that died had jumped a 5′ fence to go play in the pasture 24 hrs before he died. The disease killed very rapidly; cause of death actually being hemorrhagic pneumonia. And interestingly we found (thankfully) that penicillin was effective in treating the dogs; even though the disease began with a virus there was a bacterial component involved with the pneumonia. The virus apparently set the stage for the secondary bacterial disease. >>>A question that has been gnawing at me re 1918: what was the cause of the phenomenon of “fine in the morning, dead by afternoon” that characterized the flu then? >>>
Question gnawing at me: I had pneumovax and trivalent seasonal flu vaccine (I’m 57yo and worked in Katrina shelters - these were mandatory); what antibiotics should be kept on hand for other types of pneumonia, etc.?
> ..no numbers for gs
thanks for the attention and previous efforts. But I’m disappointed that you still think, that you are just doing this “for me”, giving some handout to a poor probabilities-moron. While I think, I’m doing this for us all and because it’s the only reasonable,logical approach. I realize, that I failed to communicate this, noone here or at cutevents etc. really wants these estimates or is seriously talking about it. Sigh.
I’m planning to ask the experts for probability estimates/expectation values now, by offering them to post their estimates anonymously to a forum. Looking for a list of the 20 top-experts (virologists) Webster,Taubenberger,Osterholm,Fedson,Oxford,Ferguson,
gs,
we can’t give you probabilities, as I told you earlier, because we have NO DATA. We can give you guesstimates, which are nothing more than opinions, but we have NO DATA. If any of the experts you like answer you, they will be giving you OPINIONS because we have NO DATA.
Actually, there’s lots of data. The problem gs has is that the data, such as it is, doesn’t support the conclusions he wants set in probabilistic terms. To get those conclusions and probabilities, given the data he’d need, he’d have a devil of a time formulating all the joint / conditional probability functions and lacing them into his preconceived master expectation.
Personally, I can think of lots of more accessible, more finite, more immediate and more useful possibilities to be concerned for. C’mon, gs; speaking specifically of your master expectation, one more time: what’s the point?
Dubina and gs -
Let’s create some sub-estimate categories like melanie mentioned. Maybe 4 categories- Estimate, Guesstimate, Guess and Opinion?
We can then use anecdotal evidence, noted as such and constrained, with our collective abilities to perhaps produce some very communicative charts for the general public?
Any ideas?
gs should keep pushing. It’s not just for him. Just because it’s not easy doesn’t mean it can’t be done.
I don’t agree that the reason why we can’t give gs estimates is because we have NO DATA. It is because we have NO PRECEDENCE. Any probability estimate where you are trying to find out what is the chance of an event Y happening if X is observed, depends on prior knowledge of how much X is necessary to produce Y. If X has never happened in any quantifiable way before, then you can’t find out the probability estimate of Y.
The evolution of a virus from being an avian virus to one causing human pandemic flu has never been tracked in real time. Even with 1918, despite some similarities, there had been no reports of massive die-outs of either poultry or wild birds prior to the pandemic.
However much data we get now, if we have no precedence to compare to, you will not be able to get a meaningful estimate. Any number that you get from anyone will at most be an educated guess. Which is OK. But it is not probability estimate.
“I’d like to get Dr. Taubenberger’s take on which genetic acquisitions he would see as significant on the route from HPAI H5N1 to H2H PF51.
No ordering necessary, just a few bases that we should watch?”
Me too NS, I’d also like to get Dr. Taubenberger’s take on Dr. Niman’s off-handed negative comments about Dr. Taubenberger’s work reconstructing the 1918 virus. He (Niman) disagrees with the conclusion that the 1918 virus was strictly an avian virus with no borrowing of viral genes from swines.
OK, I’ll mention that they may view it as an “educated guess”.
===============================================
How likely do you think will a pandemic begin in the next 12 months ?
What’s your expectation value of the number of H5N1-deaths in the next 5 years worldwide ?
just subjective,informal estimates, “educated guesses”. Please choose one of the codes below at random for verification and post it alongside with your number for the estimate anonymously to xxxxxxx
[codes} ==========================================
Not so fast, gs.
First tell us what purpose or purposes these guesses serve.
chillinDame-
We need to invite those not under ‘gag order’ Contracts to discuss seq/polymorph history, significant known nucleotide combinations, macro-pressures that we can recommend to drive any of these .
most importantly, we must build a sub-formal network of reliable observers/reporters.
gs and dubina-
call your pals, ‘ soft’ data is going to be a primary data source.
Clark, the estimated number of deaths has been steadily creeping upward for years. There was a time when it was estimated that the number of 1918 Flu deaths was 20 million. Then 25 million. 20 to 40 million was popular for a while. Now we are up to 100 million—and why not—it’s a nice round number. I fully expect that one day I will open up the newspaper and Dr. Webster will tell us that—in fact—the human race went extinct in 1918.
The take home message is that these numbers are just sloppy estimates. I wouldn’t put that much stock in any of them.
Many of the deaths from influenza were misidentified as typhoid or cholera due to the rather varied presentation. Knowledge is a cumulative thing, and methodologies have improved. Read John Barry’s book “The Great Influenza” for a good treatment of this subject. The case for the higher estimate is compelling.
Some estimate 20m in India alone.
Wooohkay. So, I am supposed to believe that in midst of a massive PANDEMIC (which I presume caught every healthcare professional’s attention) flu was nonetheless dramtically underdiagnosed? Well, color me skeptical because that sound you hear is my BS-detector going off (where’s the button on this thing).
Do we even have any clue what percentage of victims were examined by a doctor? Because I highly doubt laypeople mischaracterized flu deaths as typhoid while everyone around them is dying of flu. Perhaps doctors are just too damn smart for their own good and—knowing the difference between typhoid and flu—systematically diagnoised (one half of all!) flu deaths as typhoid…but I doubt it. If anything, given that flu was on the very forefront of everyone’s mind I would suspect that there would be some overdiagnosis of flu. Not much, but at the very least, enough to counterbalance the “underdiagnosis.”
That is not top say that I disagree with you that the case for a higher estimate is compelling. It is very compelling, but that doesn’t mean its true. It is a nice round number (and it looks great on a grant application, too!). Scientists—by their nature—are supposed to be skeptics. And I have never seen so many “renowned” scientists willing to take a leap of faith like this based on nothing but guano. At the end of the day, fear is damn good for business so they are willing to tolerate a little junk science.
A.A.- regarding “do we have any clue how many victims were examined by doctors?” The majority of the population on the planet, in 1918, were living in 3rd world, unmodern cultures. Except in US. Europe, and the main cities in Russia, China, etc., most of the rural folks filling the planet, elsewhere, did not receive a doctor’s cause of death, for the record books. So it is a big guesstimate. It’s clearest just to deal with the US rate, but it is true that even the US doctors would be inconsistent with the cause of death. Overall there was a ten fold higher death rate for 1918, 10 times is a lot!
Older thread, closing for speed purposes.
check dates