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I explained in 2005 why avian flu would never become anything like the Spanish flu.
Flu season has officially ended. We had about 12,000 fatalities, a third the usual number according to Centers for Disease Control and Prevention estimates. Yet almost all infections were H1N1 swine flu. The World Health Organization (WHO) has confirmed 18,036 swine flu deaths over the past year, somewhat shy of the 250,000 to 500,000 it estimates die annually of seasonal flu. So it’s hard to imagine that a year ago top public health officials and the media were comparing swine flu to the Spanish flu of 1918-19. That pandemic killed about 50 million worldwide and 675,000 Americans, what would today be equivalent to 175 million globally and 2 million Americans.
Unless, that is, you’re aware that this is now the third "Spanish flu" has been proclaimed since 1993, the equivalent not of crying "Wolf!" but crying "Wolf pack!"
At a media briefing on April 29, 2009, with all of eight worldwide deaths reported, World Health Organization "swine flu czar" Keiji Fukuda declared: "In the 1918 Spanish Flu the patterns were similar." Yet the only similarity mentioned was that both started as mild. A week later U.N. flu coordinator David Nabarro, who four years earlier predicted as many as 150 million deaths from avian flu type H5N1, also invoked the Spanish flu at a press conference. Again he only cited the mildness of swine flu. And in between those dates WHO spokesman Gregory Hartl, at a virtual press conference, warned that while cases were ebbing, the Spanish flu also ebbed in spring, only to return in autumn "with a vengeance."
So mildness and declining cases are a portent of horrible events to come?
Others made imaginative efforts to connect the two flus. One major wire service observed that both viruses "are of the (A) H1N1 subtype," that both "appear to have originated in animals" and "researchers believe the Spanish Flu spread to people from birds." It didn’t say that an H1N1 strain has circulated as seasonal flu every year since 1977 and that wild aquatic birds are the natural reservoir and spreader of all influenza A viruses.
Laurie Garrett, author of the 1985 book The Coming Plague, used swine flu in her Newsweek cover story to preach that our environment, left unchanged, "will one day spawn a severe pandemic that will dwarf that of 1918."
Naturally public health officials now insist the swine flu would have been vastly worse but for their warnings and efforts. But virtually no vaccine was available until after the epidemic peaked in October and hand-washing campaigns probably had little effect, insofar as there’s little evidence hand hygiene prevents flu spread. So WHO Secretary-General Margaret Chan offered the ultimate excuse: We were "just plain lucky." Anger over the misspent money and misspent fear has led to the forming of a panel to investigate her agency, but don’t expect much from it—Chan appointed the members.
Forbes readers knew all along swine flu was a soggy pork chop, because that’s where I published my first piece on the "porcine panic"—two days after Fukuda’s declaration and a week before Nabarro’s. Either I’m the new Nostradamus or I’m simply not an alarmist. (Hint: I’ve never made a dime at the race track.)
The Previous "Spanish Flu" The "Spanish Flu" was avian flu H1N1. Nabarro’s top estimate of 150 million deaths was merely Spanish flu deaths extrapolated to today’s world population. Michael Osterholm, director of the federal Center for Infectious Disease Research and Policy estimated in 2005 in The New England Journal of Medicine that there would be 180-360 million deaths worldwide and 1.7 million here if bird flu became readily transmissible between humans. He restated those figures during countless national TV appearances. His source: An extrapolation to today’s population from the worst estimates of Spanish Flu fatalities.
Spanish flu killed 775,000 Americans; SARS killed no Americans. But besides that...
Garrett, in a mid-2005 award-winning article wrote "Scientists have long forecast the appearance of an influenza virus" that would kill "unimaginable numbers" and that avian flu has shown all the earmarks of becoming that disease." She added that while bird flu was commonly being compared to Spanish flu, in fact "avian flu is far more dangerous."
But bird flu has stubbornly refused to go pandemic at all, peaking at 79 deaths in 2006. None of the experts pointed out that we’ve been rubbing shoulders with it since at least 1959, when it was discovered in poultry.
And Before That... The "Spanish flu" before that was SARS (Severe Acute Respiratory Syndrome) in 2003. Donald Henderson, who headed a team of international doctors that snuffed out smallpox and is now a professor at Johns Hopkins University, compared the two diseases and expressed great worry. The Global Health Council declared SARS could kill 60 million people worldwide, about the same number Spanish Flu did. The Washington Post published an article syndicated throughout the country under such headlines as "Spanish Flu Shows How a Disease like SARS Could Sweep the Globe." It did concede there were differences—such as "SARS is deadlier."
Ultimately SARS killed just 774 people worldwide, and no Americans. Yet the myth that it was a devastating killer lives on, such that two years later a reporter for a nationally televised news program informed watchers "The toll from avian flu could dwarf SARS and [sure enough!] even the 1918 Spanish Flu." And illustrating that Spanish flu isn’t the only disease being abused in comparisons: Johns Hopkins University Press, a year after SARS disappeared, published a book titled Twenty-First Century Plague: The Story of SARS.
Yes, hindsight is 20/20, but at the beginning of both the SARS and avian flu outbreaks, not just that regarding swine flu, I proclaimed them hysterias. Again, if I knew, others knew or should have known.
So Why Did They Do It? The sole reason for invoking a horrific flu outbreak from 90 years ago rather than the far more recent and vastly milder pandemics of 1957-58 and 1968-69 is just that. Spanish Flu was the worst.
Yet the reason for that may have had a lot less to do with the genetics of the virus than its perfect storm timing.
In 1918 people were in far poorer general health than we are today and we know that’s a powerful factor in infectious disease severity. "Between 14 and 17 million people die each year due to infectious diseases—nearly all live in developing countries," according to the Global Health Council.
The world war contributed in many ways to the toll. That included malnutrition from food shortages (Germans were literally starving) and soldiers being packed together in box cars, ships and trenches. In fact, "Spanish" flu was first identified in the crowded environs of Fort Riley, Kan.
Also, since 1918 we’ve developed flu vaccines, antivirals, pneumonia vaccines and antibiotics. Those last two are vital because secondary bacterial infections cause the vast majority of flu deaths. Both Osterholm and Garrett have argued, as Garrett wrote, Spanish flu "was a direct killer" and "Had antibiotics existed, they may not have been much help." Wrong. Even at the time medical journals reported that bacteria normally administered the Spanish Flu’s coup de grace. Much recent research has confirmed it.
SARS may indeed have been a deadlier pathogen than Spanish flu. But regardless of the severity or contagiousness of a new virus, it will never again have those "wonderful" conditions of 1918-19 in which to spread and kill.
Ultimately all our health officials and media are doing is inducing complacency that could be devastating if and when a real health emergency arises. It’s time to retire the Spanish flu wolf pack. And yes, the plague one along with it.