It has been 100 years since the great influenza pandemic of 1918, which infected over 500 million people worldwide and killed somewhere between 50 and 100 million people. (Note: The death toll is hard to estimate accurately due to difficulty in tracking deaths in some countries, like India. The most recent estimates suggest that the death toll was closer to 100 million people.) The 1918 flu dropped the life expectancy in the United States by 12 years. In addition, while most influenza deaths occur in young children, older people, and people with compromised immune systems, the 1918 flu caused high death rates in young, healthy people.
This year had a particularly nasty influenza season, you've no doubt seen it on the news. The number of pediatric deaths due to influenza is up compared to previous seasons (See CDC for current epidemiological data) and more people have been hospitalized for influenza related complications. Because of the 100 year anniversary of the 1918 pandemic, experts and planners are looking back to the past and at our current infrastructure to determine if we are prepared for the next pandemic.
We've had 100 years to figure out to do with the next "big" pandemic. (Note: there have been several pandemics since 1918, but nowhere near as devastating.) Science has sped forward and thousands of new treatments for thousands of diseases have been developed. We have a better understanding of how influenza infects, how the human body responds to infections, and how to prevent infection. But, is the US ready for another "big" pandemic?
Short Answer: NO
This year I was able to attend the ASM BioThreats 2018 meeting (American Society of Microbiology) and from experts in the fields of infectious disease, emergency preparedness, public health, and pharmaceutical (vaccine and antiviral) research, it seems as though we have not made much progress in preparedness since the 1918 influenza pandemic. There are a several reasons that are, in my opinion, indicative of our lack of preparation:
- Lack of an effective universal influenza vaccine. While I hope you all go out and get your flu shots every year, you may know by now that those vaccines take 6+ months to produce and the strains of influenza targeted by those vaccines is all based on educated guesses by scientists and epidemiologist. While these well-educated professionals do their best, their predictions can be wrong. That was the case this year - the predictions were wrong. What does this mean? It means that the vast majority of people who got the influenza vaccine are still susceptible to getting the most common strain that is causing disease. To better address this issue, many biotech companies and academic labs alike are working on developing a universal influenza vaccine, which would mean it could protect you from most strains of influenza. I am happy to go into the science behind that if you really want to know (post a comment or email me!) Predication is only one of the issues that are causing a problem with the vaccine. The length of time and method for producing the vaccines are based on technology from the 1950s and can cause major issues in people with egg allergies.
- Lack of effective antiviral treatment options. You have probably heard of Tamiflu, a medication developed to help treat the symptoms of influenza. It has okay efficacy and can shorted the duration and severity of symptoms when given early on in illness (within 48 hours of symptom onset). However, patients don't often visit their doctor within 48 hours of symptom onset, nor do they know if what they have is influenza or something else. Thus, few patients are able to receive Tamiflu early enough for it to be effective. Ideally, prevention is the best medicine (vaccination, quarantine), but more effective options for influenza treatment after a patient has become ill are needed.
- Lack of appropriate training of health-care professionals. We saw it with Ebola, even when people are supposedly trained in appropriate handling/care of infectious patients, most are not trained well enough. If they were, we would not have seen nurses or other caregivers with Ebola exposure. Now, while there is no threat, is the time for hospitals to train and exercise their staff on appropriate protocols. This may include in-class training as well as a walk through of actions needed to take care of infectious patients including donning and doffing personal protective equipment, decontamination techniques, and post-exposure prophylaxis. However, it is expensive to pay people to train and hospitals being in the health care BUSINESS are reluctant to pay staff to work without being able to bill patients for that time and effort. I will stop there because my universal healthcare rant could be its own blog post.
- Vaccinate yourself and your loved ones. It's not perfect, but it DOES help reduce the risk of getting influenza as well as reduces the severity of disease if you do get it.
- Cut it out with the hugs and handshaking. It sounds impersonal, but this close contact is how influenza spreads.
- Wash your hands and quit touching your face. If you do come in contact with someone who is sick, you will reduce your chance of getting it.
- STAY HOME. I can't stress this enough. Just. Stay. Home.
- If you insist on going out, WEAR A MASK and wash your hands frequently. If you're afraid of looking weird, tough crap, you're a walking cloud of disease like Pigpen.
|Don't be this guy (Credit: Wikipedia)|