By Leonard J. Silberstein

 

       WASHINGTON, D.C. -  Plague.  The word brings up images of ancient times, of crowded cities with poor sanitation, of people who knew nothing about how germs spread disease.  They thought spirits brought   sickness or that they being punished for impure acts that offended Heaven… or the stars      themselves lined up badly and the forces of illness were unleashed on the world.

       Bubonic Plague - The Black Death – caused populations in some areas to drop from 25 to 30 percent; nobody knew where it came from and the only   defense against it was to run. 

       Plagues such as smallpox, typhoid, cholera… each of these caused uncounted deaths and it was only within the past century that some kind of control was established against them. Times have changed, though, and vaccinations, sanitation and better hygiene have made these outbreaks a thing of the dark, distant past.

Have they?

 

       Almost a century ago – between 1918 and 1919 – a new disease ran around the world, killing approximately fifty million people, before it disappeared almost as quickly as it arrived. 

       It was called the “Spanish influenza” or “Spanish Lady Flu”  and it overran the cities and the  countryside, cutting a swath of death.    

       US scientists have managed to re-create the virus that caused this epidemic… and have discovered something disturbing, something out of history that may have chilling  implications for today’s doctors.  

       A team from the US Armed Forces Institute of Pathology began working with samples of lung tissues from victims of the 1918 epidemic. Using modern techniques of genetic analysis and   engineering the researchers were able to re-assemble the virus, re-creating its  entire genetic sequence first in a computer, then in mice. 

       Studying the raised-from-the-dead virus revealed that the final three pieces of its genetic code have strong similarities to modern-day viruses found only in birds, such as the H5N1 strain which is making headlines in Southeast Asia as “Avian Flu”.

       So far sixty-five deaths have been attributed to H5N1… and many scientists believe that it is only a matter of time until this strain might combine with a human strain of influenza, causing it to spread in humans even more quickly.

       Differences between the two strains show that 1918 virus had mutations that may have caused it to reproduce more rapidly and have more intense and virulent effects. 

       Scientists also believe that other major influenza epidemics by viruses (1957 and 1968) which had acquired two or three genes from avian influenza strains…. but that the 1918 strain was probably entirely a bird virus that adapted to humans.

       “By unmasking the 1918 virus we are revealing some of the secrets that will help us predict and prepare for the next pandemic,” said Julie Gerberding, the director of the US Centers for Disease Control. 

       Similarly, Dr Jeffery Taubenberger, lead researcher for a study done in Nature magazine, said: “Determining whether pandemic influenza virus strains can emerge via different pathways will affect the scope and focus of surveillance and prevention efforts.”

       Professor John Oxford, an expert in virology at Queen Mary College, London, said “This study gives us an extra warning that H5N1 needs to be taken even more seriously than it has been up to now.” suggesting that the  virus had the potential to jump between humans without first combining with a human virus… making it even more of a threat.

Why re-create the past?

 

       What reason is there for bringing back the 1918 strain?  Dr.    Terrence Tumpey, of the US Center for Disease Control (CDC), said “We felt we had to recreate the virus and run these experiments to understand the biological properties that made the 1918 virus so exceptionally deadly. 

       “We wanted to identify the  specific genes responsible for its virulence, with the hope of designing antivirals or other interventions that would work against virulent pandemic or epidemic influenza viruses."

       Meanwhile, actions are being taken in the USA in preparation for the possibility that the Spanish Lady – or one of her younger cousins – might come back to pay a visit.  The government has agreed to stockpile vaccines, $100-million worth of a still-experimental drug; at the United Nations in New York both the head of the World Health Organization and President Bush issued warnings.

       “We must also remain on the offensive against new threats to public health, such as the avian influenza," Bush said. "If left unchallenged, the virus could become the first pandemic of the 21st century.”

       Officials in London are looking for extra morgue space for the bodies of H5N1.  “Right now in human beings, it kills 55 percent of the people it infects,” says Laurie Garrett, a senior fellow on global health policy at the Council on Foreign Relations. “That makes it the most lethal flu we know of that has ever been on planet Earth affecting human beings.

       “Each year different flus come, but your immune system says, ‘Ah, I've seen that guy before. No problem. Crank out some antibodies, and I might not feel great for a couple of days, but I'll recover,’” Garrett says. “Now what's scaring us is that this constellation of H number 5 and N number 1, to our knowledge, has never in history been in our species. So absolutely nobody  watching this has any natural immunity to this form of flu.”

       Dr William Karesh, lead veterinarian for the Wildlife              Conservation Society, explains how  viruses spread from wild birds to domestic fowl to humans.  “We start at a market somewhere in Guangdong Province in China,” he said. “And it's packed with cages, and you'll have  chickens, and you'll have ducks. You might have some other animals — cats, dogs, turtles, snakes — and they're all stacked in cages, and they're all     spreading their germs to each other.”

       Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University's Mailman School of Public Health, furthers the explanation.  “The tipping point, the place where it becomes something of an immediate concern, is where that virus changes, we call it mutates, to something that is able to go from human to human,” he said. 

       “Once that virus is capable of not needing the birds to infect humans, then we have the beginnings of what can turn out to be this worldwide epidemic problem that the experts call “pandemics’.”

       This is what happened in 1918.  “The Spanish flu was killing people in two or three days once they got sick,” said Dr Karesh.

       “In 1918, my now-quite-elderly uncle was a young boy, living in Baltimore, Maryland,” says Laurie Garrett. “And the flu came through, and his family insisted that he could not go outside for any reason until the whole epidemic was over. He spent afternoons looking out the window and counting  the hearses going up and down the neighborhood and trying to guess which of his schoolmates had died.”

       And this was before airplanes moved people – and diseases – around the world as they do now.

       Dr Redlener sees unpleasant possibilities.  “The city (New York) would look like a science fiction movie,” according to him. “It's extremely possible we'd have to quarantine        hospitals. We'd have to quarantine sections of the city.”

       “I could imagine that you could look at Grand Central Station and not see much of anybody wandering around at all,” Garrett agrees. “People would be afraid to take the subways, because who wants to be in an enclosed air space with a whole lot of strangers, never knowing which ones are carrying the flu?”

       Dealing with the disease would be difficult, to say the least.  “There wouldn't be equipment and personnel    to staff them adequately that you could really call them a hospital,” Garrett    predicts. “You might more or less call them warehouses for the ailing.”