How did Humans find and Fight the Flu Virus for a Century?
Fatal Flu: A Hundred Years of Treatment: Influenza has
always been one of humanity's strongest rivals, and one of the top ten deadly
diseases in the world. Although modern medicine has shown various advantages,
curing flu is still an unsolved problem.
"Fatal Flu" provides three main considerations:
Human perception of the virus, how to deal with the flu, and are we ready for the next pandemic?
The 1918 influenza pandemic was the largest global plague
with the highest number of deaths in history, killing 50 to 100 million people
and infecting more than 500 million people. In the past 100 years, humans have
had a deep understanding of the influenza virus, but there are still many
unknowns that still cannot prevent and defeat this "serial killer".
Dr Jeremy Brown explored the history of humans finding and fighting the flu
virus, examining several important issues related to the flu, such as why the
flu is difficult to cure? Powerful reporting systems and data analysis are
applied to the prediction of influenza trends.
Can they accurately predict the arrival of the next pandemic?
Dr. Jeremy Brown, a veteran medic and emergency physician,
received his Ph.D. from the University of London School of Medicine, and then
went to Boston Medical Center for an emergency medical practice.
Formerly the
research director of the Department of Emergency Medicine at the University of
Washington, during which time he led the team to set up an HIV screening
program, a new treatment for renal colic that received three licenses from the
National Institutes of Health.
He currently heads the Emergency Nursing Research
Office of the National Institutes of Health. He has published more than forty
peer-reviewed papers and four monographs, including two first aid textbooks
published by Harvard University Press.
Are we ready for the next pandemic like 1918?
Most experts believe that the next outbreak is only a matter
of time. Altum's story helps focus my thinking on the future on three things:
our knowledge of the virus, our response to the virus, and our preparations for
the next outbreak.
First of all, the greatest achievement we have achieved in
the fight against the flu is to know the cause of the flu. In 1918, when
millions of people were lying in bed and dying, we knew almost nothing about
the culprits that caused the end of the world.
It may be bacteria, it may be
the air we breathe, it may be due to a lack of sunlight, or it may be something
mysterious like the arrangement of celestial bodies.
Within a century, we
discovered the existence of viruses, classified and tracked them according to
their structure and function, learned how they spread and mutated, and even
took many photos.
In the Arctic, we dug out the corpses carrying the influenza
virus in 1918 and pieced them together in the laboratory.
We deciphered its
genetic make-up and resurrected it in a voice of controversy. However, if we
cannot eradicate the flu, the medical revolution that began in the mid-19th
century, typified by the invention of antibiotics and vaccines, will not be
completed.
Equally impressive is the way we deal with viruses. The most
important new tool in our battle reserve is also useless against viruses. These
tools include antibiotics for the treatment of possible complications after the
flu, intensive care units, ventilators that patients with lung disease must
use, and experts who understand emergency care and the ins and outs of
infectious diseases.
The 1918 flu virus destroyed many cities and nearly
paralyzed the city's economy. There were no effective treatments at the time,
and the only thing people could do was provide verbal comfort while waiting for
the patient to recover or die.
There are more and more medicines in the rivers
and lakes, and even mainstream therapies such as bloodletting are more likely
to kill patients than cure them.
Today things are quite different. But we still
lack a drug that is effective against the flu virus. People can currently only
respond with antiviral drugs.
However, for the better, the effects of these
drugs are somewhat controversial. For the worse, these drugs have no effect at
all. We urgently need to develop a safe and effective drug that can completely
destroy the virus.
For decades, people have worked hard to achieve this goal.
But we still have the heart and the power. We were able to respond to the flu,
but still lacked a response and a medicine we really needed.
In 1918, we responded. We are not ready. Today, we are better
at preventing problems before they occur. Each state has plans for a pandemic.
These plans cover all aspects, such as obtaining vaccines, coordinating
hospitals to set up auxiliary treatment facilities in school gyms and nursing
homes, and so on.
At the federal government level, the National Strategic
Reserve Centre stores millions of doses of influenza vaccines and antivirals.
The U.S. Department of Health and Human Services updated the Influenza Pandemic
Plan in 2017 with over 50 pages. "A pandemic influenza is not a
theoretical threat. To be precise, it is a recurring threat."
The
program's preface wrote, "Even so, we don't know when the next pandemic
will happen. The outbreak does not know how serious its consequences will be.
"
The annual flu vaccine is a key element in preparing people
for outbreak prevention, but its effectiveness will hardly exceed 50%. This is
despite the consensus that high-risk groups should be vaccinated.
But we still
don't have enough reasons to force the government to make other decisions, such
as whether healthy adults should receive regular vaccination.
Obtaining the
necessary evidence is costly, but the cost of hoarding vaccines and medicines
of questionable value is minimal.
Our current preparation is to assume another outbreak of a
similar scale to the 1918 pandemic. Many experts worry that the outbreak will
have a greater impact than other potential health crises.
So why haven't the tragedies of 1918 repeated in the past 100 years?
Now that modern medicine has
made great progress, is it necessary for us to worry about an extremely
unlikely situation because of the trauma of the past and anxiety about the
future?
There are two attitudes towards this problem: pessimism and
optimism. For pessimists, the next flu outbreak looks deadly and inevitable.
The news media is full of pessimists, because pessimism can easily make
headlines. From magazines to cable news to almost every book.
Regarding flu there is a clear concern: A pandemic is inevitable. Here are some of the main
reasons why pessimists can stand:
Experts warned. They understand the flu and have been working
on the flu virus. We should value the words of experts because they take flu
seriously.
The pandemic of 1918 and the flu outbreaks of 1957 and 1968
confirmed that the occurrence of the lethal flu wave did not stop theoretically.
We have every reason to assume that past outbreaks will really repeat
themselves in the future. Other epidemic diseases have recently appeared, such
as SARS, Ebola and Zika virus. These viruses give us a certain understanding of
what may happen in the future.
These diseases know no borders. Influenza has no
borders. Since 1918, the international travel industry has grown rapidly. It
used to take days to sail from sea to the United States.
Today, the same trip
takes only 6 hours by plane. We travel around the world at an alarming rate, as
do the viruses we carry.
Although we know a lot about influenza, there is still much
to be learned. For example, we don't know why the 1918 virus favored young
people, or why it was a mild illness for some of us, but a fatal illness for
others.
Without understanding these characteristics of the virus, we cannot be
fully prepared for it. The number of poultry is increasing rapidly.
Although
bird flu is more common in ducks and geese than in poultry, the vast majority
of birds we raise and consume are more likely to transmit bird flu.
Coupled
with the factors of international travel, it can have fatal consequences.
The flu spreads easily in densely populated areas. In 1918,
family members who lived together in overcrowded houses or apartments quickly
became infected with the virus.
Today, many residents of Africa, Asia and Latin
America still live in crowded housing. The United States is not immune. About 3
million Americans live in a crowded environment. In New York, nearly 9% of
households, more than 280,000 households are overcrowded.
In the United States,
even if you live in a spacious house or apartment, you may take the subway or
bus to work or school with dozens of people every morning.
These factors indicate that pandemic diseases cannot be
avoided. But before reaching this conclusion, we might as well give the
optimist a chance. We have every reason to believe that the disaster of 1918
will not repeat itself. Over time, the lethality of severe or pandemic diseases
becomes less and less.
The 2009 swine flu outbreak suggests that we may have
overestimated its severity. Regarding the severity of the disease, there will
be a lot of hype in the past and the future.
Every year, people die from the
flu, but the number of excess deaths-especially those caused by the
particularly nasty flu virus-has not increased. T
his phenomenon may not have
much to do with our own interventions, but it has nothing to do with the
evolutionary pressure of the virus itself.
The virus spreads easily. A powerful
virus can quickly kill the host or rest in bed, after which the virus is less
likely to spread. From the perspective of an influenza virus, the best strategy
for reproduction and transmission is to protect patients from serious illness.
Newly infected patients continue to deal with healthy people.
In this way, the
chances of the virus entering new hosts by coughing and sneezing are greatly
increased. In this respect, evolutionary theory is on our side. The chances of
the virus multiplying during a mild climate. Mild viruses do not cause an
outbreak of a pandemic.
The 1918 influenza pandemic is thought to be very rare, and
there is another reason that certain conditions must be completely coincident
for the virus to be lethal.
The virus must be transmitted from birds to pig
hosts and then to humans. This requires a specific set of gene exchanges and
mutations. Without these conditions, the virus would not be so lethal. The
virus must also be in good condition for transmission.
These conditions were
provided during World War I by overcrowded military camps and warships,
factories where workers worked, and low-cost apartments inhabited by the
masses.
Jeremy Brown from NIH
Today, the problem of bacterial infections that cause most
deaths has been addressed by antibiotics. After weighing the evidence, I'm not
sure which party I should join.
Am I a pessimist or an optimist?
There are
compelling reasons for all parties. To me, all parties seem to make sense. The
year when the pandemic did not break out is one reason why optimists continue
to be optimistic-but if it is a pessimist, in this case, we will feel that we
are alive by chance.
Of course, we are more likely to hear pessimistic news. The
voice of the pessimist is louder. Health officials make recommendations based
on the worst case scenario.
News reports on the Internet and cable television
always use intimidation tactics to attract our attention. Creating panic can
cause anxiety. Don't look for good predictions about the flu based on your
source. Don't be surprised if many outbreaks similar to the 2009 flu season
occur in our lives, as the severity and speed of transmission of the flu in
2009 was overstated.
Optimists also face a serious problem. Americans are
particularly optimistic. They like to read books about happiness, and away from
troubles and negative emotions of the past. But disease has its own history,
and if we don't study the past, we can easily be in danger. 1918 did qualify
for an influenza pandemic. Since then, some of these conditions have changed
radically. But it is also true that certain new and unforeseen circumstances
may lead to outbreaks of other diseases.
Pessimists always complain about the past. Optimists always
look forward to a different future; realists live in the present, they observe
the facts and make corrections in the process. When it comes to the flu, most people join
the realist camp.
People believe that we can reflect on the human pandemic
experience, use existing knowledge and take practical action to prevent it before
it happens. To do this, we need to consider a more critical issue. This issue
does not involve medicine, science or policy. Instead, it involves our
collective memory.
Why don't we do more to understand the historical evolution of influenza?
Pessimists may indulge in the past; optimists tend to forget the
past. Realists use the knowledge of the past to understand the present and the
future.
As I have been working on this research for many years, I
have come to a realistic conclusion: we have not done enough to keep the 1918
pandemic in our collective memory.
Commemorating the centennial of the 1918
influenza pandemic is a step in the right direction, but it is only a small
step.
Changing our vigilance against disease requires the entire society to understand
the impact of the disease, the consequences of the disease in the past, and the
impact it now has on us. Of course, research funding can help change this
outcome. But in the fight against disease, the most important thing is to
discuss and understand it extensively outside university laboratories and
academic seminars.
We commemorate the war, but other very destructive events
should also remain in our collective memory. I hope to build a 1918 flu
pandemic monument in the U.S. capital to commemorate our losses, reflect on
what we have achieved, and remind us that there is still much to be done. This
century is a century of disaster, natural disasters, world wars, disease and
conflict.
It is also a century of large-scale expansion, integration, global
impact, technological breakthroughs, and medical success. The pandemic illustrates
both of these issues. People's bodies are in danger, and their brains remain in
comfort zones.
This is human failure and human victory. Perhaps by the time the
1918 Influenza Pandemic Monument is completed, we are also celebrating that
humans have found a cure for the flu.
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