waves

Flu pandemics, like wildfires, come in waves. And like wildfires they leave out obvious targets that subsequently become the area of intense study and even more intense superstition. After major fires one can drive through neighborhoods and see perfectly intact houses in the middle of total destruction. Often one will see scribbles or large graffiti on those houses, where the occupants thank god for saving them.

One will also see scientists studying this interesting phenomenon, or even trying to model it. Another big waste of tax payer dollars.

Why bring this up? Well first, because the flu pandemic isn't over yet. Pandemics like wildfires have waves and they too leave out obvious targets. There are two lessons to be learned. One is that overly optimistic and naive interpretations of 1918-9 are likely to be wrong. Back then, some cities survived in the middle of mayhem, not because of actions taken by local governments, or any other foresights, but simply because these things are part of how large systems (pandemics, hurricanes, wildfires, etc.) behave. They skip obvious targets.

The second lesson is that a mild spring wave should not lull anyone into thinking the danger has passed. All major pandemics that we know of -that is mostly those in the 20th century- behaved this way. First there was a mini version of the pandemic, not too infectious and certainly not too virulent, that went around seeding pockets here and there. That was followed by two to four waves of much more intense disease, the first one of which was usually the worst. That is the 1918 scenario. After a mild disease in the spring, the truly deadly wave came later in the fall of that year.

Experts are eager to point out that in 1918 we did not have anti-virals or vaccines. We did not even know what caused the flu. Surely we must be better off now? Dream on.

Vaccines take months to develop and they can only prevent the flu. Once infected it is too late. It is possible that we will develop a vaccine against the H1N1 by fall. And that may help. Although the fall virus will be different (viruses "evolve" on a fast time-scale), it may remain close enough so that the vaccine confers some immunity.

As for anti-viral drugs, they must be given within the first couple of days to be effective. Now it is interesting to point out that many in 1918 were dead within 9-12 hours. And that most of those were killed not by the virus per se, but by the immune reaction it evoked. That is one of the reasons given for the high mortality among 18-34 year olds during that pandemic. Unlike seasonal flu, pandemic flu tends to favor young and healthy adults. 

If a 1918 scenario develops, it seems highly unlikely that antivirals will do much good. What may help -and what we have enough of now, but did not have back then- are steroids. Steroids and respiratory support. Only it is hard to implement such measures when emergency rooms are overwhelmed with cases.

One more thing: what played a key role in 1918 was the widespread crowding of young people in army camps. That situation created a true pool of naive (as far as infection goes) candidates. Clearly, that situation does not exist today. But what does exist is many more people, living much closer together, and traveling a whole lot more.

What WHO should do now (which they can't really do) is implement very severe travel restrictions. That seems like the logical thing to do. Only it is so incompatible with the free market and consumer society that nobody will even contemplate it.

As for you, what can you do? Get infected! Seriously, getting infected now, when the disease is mild, will give you free immunity. The best immunity you can buy. But there is one catch. If we all do it, we will instantly have the pandemic that we are so desperately trying to avoid. 

You see, there is no free lunch.