In the winter of 1918, the most lethal flu virus in recorded history erupted and spread from a Kansas military army camp. By the time it had finished its horrifying run, it had killed 100 million people worldwide.
Since September of this year, when the 2012-2013 flu season began, 29.4% of tested laboratory specimens have tested positive for the flu, with the proportion of flu related deaths being declared “above the epidemic threshold” on the Center for Disease Control's (CDC) Weekly U.S. Influenza Surveillance Report, with a national total to date of 29 pediatric deaths. Adult deaths due to influenza are more difficult to track, due to the fact that flu is rarely recorded as a cause of adult deaths, and there may have been a secondary cause of death such as pneumonia. Nationally, there are more than 3,700 flu-related hospitalizations, with 46% of those being in people age 65 or older.
In Oklahoma, as of January 18, there have been eight deaths and 484 hospitalizations from the flu since September 30, 2012. Half of these deaths were in people age 65 or older, with the others being between 19 and 64 years of age. Several schools throughout the state have closed due to the flu, including Westville Public Schools, Porum Public Schools, and Chouteau-Mazie Public Schools.
While the phrase “above epidemic proportions” has been used by the CDC, we are a far cry from the 100 million killed by the flu in 1918. One reason for that is our greater understanding of germs, the necessity of good hygiene, and reduced exposure. But it can be argued that most of the credit goes to flu vaccinations.
The 1918 flu has been referred to as “the first great collision between nature and modern science.” In “The Great Influenza: The Epic Story of the Deadliest Plague in History,” by John M. Barry, Barry calls the 1918 influenza pandemic “the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds.”
The world of 1918 was surprisingly similar to the world of today, in the sense that then, just as now, there was a conflict between those who approached biological puzzles using reason, logic and empirical evidence, and those who used anecdotal evidence or relied on prayer and faith to deal with the issues of health, sickness, death and the unknown. Additionally, there was and is an underlying distrust of the medical establishment within some circles. That distrust shows itself today in an anti-vaccination movement that includes not only flu vaccines, but any other vaccines as well.
This article began as a simple “Here’s how to prevent the flu” piece. During the research process, an informal online survey asked people if they get flu shots, and if not, why. The responses were highly illuminating. There were those who passionately believe in and promote flu vaccinations. These are scientists, or people with a strong secular philosophical bent. Then there are those who passionately oppose vaccinations, while strongly advocating that a healthy lifestyle that includes high-quality nutrition, exercise and positive thinking renders vaccinations as unnecessary at best, and actually harmful at worst. These also have a scientific background that blends with a spiritual, though not religious philosophy.
Then there are those in between; the ones who decide based on their own experiences or the experiences of friends. Some of the responses looked like this:
“I don’t get a flu shot, based on my own observations. The years I received a flu shot, I ended up with the flu. The years I skipped the flu shot, I got the flu once. It could be luck, but . . .”
“I get it each year if it’s available and convenient. Some years, they say it works better than other years, but I haven’t had the flu I think, so impossible to tell how effective it is for me. Nobody has gotten the actual flu enough times to get enough data to decide whether it’s worked for them or not.”
“Never had a flu shot. I do stay very healthy and take vitamins.”
“Working in the medical field, influenza shots are mandatory, or they take us off the schedule. So I get mine every year.”
“Fear of an allergic reaction after having recently had several drugs prescribed to me.”
“I get them about once every other year. I’m afraid of needles, so I have to psyche myself up for it. My husband and daughter get one every year. They haven’t had the flu in a few years.”
“I am around a lot of people, and it seemed like I was getting the flu every February, so I started getting the shot a few years ago. It’s nice to stay healthy and to be able to keep running.”
“Never got the flu until I got the shot. Stopped the shots . . . still get flu on occasion. The virus has to be alive or your body would not try to kill it.”
“The flu shot uses a killed virus. It's absolutely IMPOSSIBLE to catch the flu from it.”
“The vaccine isn’t trying to kill it. It’s training your immune system to recognize it as a foreign substance, and eliminate it (dead or alive).”
“My kids and I have never gotten the flu shot. It has to be over five years since one of us had the flu. We maybe go to the doctor twice a year each. I figure we must have a strong immune system.”
“NEVER get the flu shot! Been a nurse in ER, ICU and home care for over 20 years. I reduce exposure, WASH MY HANDS, and keep my immune system strong. We are exposed to pathogens constantly. Getting sick is based on how healthy we are and how our body fights off the exposure. And that is completely dependent upon the strength of our immune system. The shot does NOT ensure we reduce our exposure NOR does it improve our immune system. Instead of scaring the public into thinking they will suffer without the vaccine... we should be teaching how to improve our immune function and how to reduce exposures. It’s simple and painless!”
“My whole family gets the flu shot—one year, my husband stopped his and was very sick with the flu. I was nine months pregnant with my son, and my daughter was 19 months old. We had the shot and did not catch it from my husband. So far my family of five has not had the flu, and we take our shots every year.”
“I’m four of four getting the flu after a shot.”
According to health officials, flu prevention is fairly simple and straightforward.
• Wash your hands
• Reduce your exposure
• Get vaccinated
Kaitlin Snider, spokesperson for the Tulsa Health Department, recommends that everyone “practice good hygiene all the time, but especially during the cold and flu season.”
“Frequent hand washing is one of the best ways to prevent the spread of the flu,” she says. “Be sure to wash your hands with warm water and soap before and after you eat, and after using the bathroom or changing a diaper. If you don’t have access to running water, use an alcohol-based hand sanitizer gel or wipe. It’s also important to cover your mouth, when you cough or sneeze, with a tissue or with your sleeve to prevent others around you from becoming sick. Avoid touching your eyes, nose or mouth whenever possible. Finally, stay home from work, school, errands, etc. when you are sick, and avoid close contact. This will help prevent others from becoming sick.”
Influenza is a respiratory infection that can cause serious complications, especially in young children and older adults. The CDC recommends that those sick with flu stay at home for at least 24 hours after the fever is gone, except to get medical care or for other necessities.
“We know that the single best protection we have against flu is the flu vaccine. By protecting yourself, you also protect those around you that may not be able to receive the vaccine, such as infants younger than six months of age,” Snider says.
“Vaccination is especially important for those persons at high risk from flu complications, including people 50 years of age and older, young children, persons with chronic lung disease (such as asthma and chronic obstructive pulmonary disease—COPD), diabetes (types 1 and 2), heart disease, neurologic conditions, other long-term health conditions, and pregnant women.”
But what about all those people who say that every time they get vaccinated, they get the flu?
Snider replies that “although the vaccine may not be a 100% guarantee that you won’t become sick with flu (it is typically 60-70% effective), it does offer you considerable protection should you be exposed. We know that those who have been vaccinated are likely to have a more mild case of the flu, should they become ill.”
She adds that most of the influenza viruses that have been analyzed at the CDC are like the viruses included in the 2012-2013 influenza vaccine. The vast majority of positive influenza tests in Oklahoma and around the country have been positive for influenza A, which is included in the vaccine this year.
If you do get the flu, there are prescription antivirals available. The CDC stresses that early treatment is especially important for the elderly, the very young, people with certain chronic health conditions, and pregnant women. But even though treatment is available, you should still get a flu vaccination, as antiviral drugs are not a substitute. Though not 100% effective, a flu vaccine is by far the best way to prevent influenza.
In the workplace and school:
• Find out about plans if flu outbreak occurs and whether flu vaccinations are available on-site.
• Frequently clean frequently-touched objects including doorknobs, keyboards and phones.
• Make sure your workplace or child’s school or daycare provides an adequate supply of tissues, soap, paper towels, alcohol-based hand rubs, and disposable wipes.
• Ask how sick students and staff are separated from others and who will care for them until they can go home.
Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. If you get the flu, see your doctor immediately, especially if you have any high risk conditions.
In 2004, the CDC estimated that the annual death toll in the United States from influenza now averages 36,000 in non-epidemic years. Currently, the CDC’s Weekly U.S. Influenza Surveillance Report characterizes the proportion of death from flu and pneumonia as “above the epidemic threshold.”
The 1918 influenza outbreak taught many significant lessons including the responsibility of those in authority to be open and honest about the threat and the importance of being ever-vigilant against new viruses. But most importantly, as Barry wrote, it taught that “vaccines are the most effective defense, and early warning can make an enormous difference.”
For more information about influenza and vaccines, visit www.cdc.gov.
For more information about the flu in Oklahoma, visit www.ok.gov.
For more information about the 1918 influenza outbreak, and the impact it had on modern medicine, read “The Great Influenza,” by John M. Barry.