Flu: The Story Of The Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It [Paperback]

 

 

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Gina Kolata's telling of the story of the 1918 influenza pandemic reveals how modern medicine, basking in the success that the new germ theory of disease had brought, was utterly unprepared for, and therefore completely helpless in the face of, the pandemic that ravaged the world. This flu was unlike any flu encountered before: it was 25 times more lethal than ordinary influenzas, killing 2.5 percent of its victims, in contrast to the normally observed 0.1 percent mortality. Worldwide, possibly 50 million people died. That the pandemic was caused by a virus was discovered in the 1930's; yet scientists remained troubled by their lack of understanding of the virus, where it came from, and what made it so lethal. They realized the only way they would solve the mystery was to somehow obtain the actual 1918 influenza virus itself.

Enter Johan Hultin, in 1951 a 26-year-old Swedish postgraduate student studying in the United States. In 1936 scientists had learned how to grow influenza viruses in fertilized hen's eggs, and Hultin decided to attempt to retrieve the 1918 flu virus from victims who had been buried up north in permafrost and whose bodies were therefore well preserved. By growing it up scientists would be able to study it, perhaps learn what made it so deadly, and make a vaccine so that there would never be a repeat of 1918. He was able to obtain some specimens from a burial site in a tiny Alaskan village called Brevig, but he was unable to grow it. It seemed that, for the time being, he was at a dead end.

The 1976 swine flu episode in the United States demonstrated how the long shadow of 1918 could still influence the objectivity of scientists, how despite the huge gains made in virology in the intervening years, the lack of hard data about the Spanish Flu virus would allow fear to tip the balance in the question of a nation-wide vaccination program. Though in hindsight we know it turned into an expensive fiasco and a nightmare of litigation, Kolata is reserved in her criticism: "For even now, more than two decades later, it is not clear that the scientists had much choice in their decisions or that, if they had to do it over again, they would make radically different decisions." Indeed, the argument for vaccination was persuasive: first, there was evidence of a new flu strain with man-to-man transmission; second, always before when a new strain was found there was a subsequent pandemic.

Possibly, in retrospect, better judgment would have prevailed if an answer to a simple question would have been required of the scientific advisors: what information might make the group change its mind about the need to prepare to immunize the nation against swine flu? Would it be evidence that every swine flu case was mild? Or that no one but the Fort Dix soldiers (where the only fatality occurred) got the swine flu? Because in the end, the decision was made to vaccinate everyone for a disease that no one could prove to even exist. It was, then, the metaphor of 1918, the "vivid images rooted in folk history", rather than hard science, that drove the decision. So the lesson from 1976 was that if a new virus appears, you shouldn't jump the gun and assume a pandemic is happening.

More recently science has made headway in tackling some of the biggest questions remaining from 1918, including why the age group usually best able to resist serious infection, people aged 20 to 40, in this case suffered the highest rates of mortality (along with the very young and very old). One theory is that a viral strain similar to, but less lethal than, the 1918 strain, circulated the world in the late 1800's so that those above 40 years old would have had some immunity to the 1918 strain, but those below 40 would have been completed blindsided by the new virus. Another theory is that the virus killed by inducing something called a "cytokine storm" which is a potentially fatal over-reaction by the immune system. Those most susceptible to cytokine storm would be those with the most vigorous immune systems, namely adults between 20 and 40.

Johan Hultin's part in the story was by no means over in 1951. He went on to a successful career as a pathologist, but never forgot about his burning desire to be a part of solving the Spanish flu mystery. As the years passed he observed the development of molecular biology techniques, and with the advent of PCR, he knew that the time had come for a repeat visit to Brevig. After obtaining the cooperation of a molecular biologist, Dr. Jeffrey Taubenberger, in 1997 he returned to Brevig, a self-funded, solitary trip done in utter secrecy. He was successful in finding specimens from one more well-preserved body. In addition to this specimen, Taubenberger's team had located in a medical storage warehouse, lung specimens from two soldiers who had died from the 1918 flu. Using PCR, they were able initially to sequence the hemagglutinin gene from each of the three, and by 2005, the whole genome of the virus. We can now say that the Spanish Flu was caused by an avian strain of H1N1.

However, despite all the increases in knowledge since 1918, the scientific community is divided as to our capacity to handle a similar outbreak today. Some are confident that because of the surveillance we now have, combined with new antiviral drugs like Tamiflu, and the potential for vaccines, we will never have a repeat of 1918. But others are far less optimistic, suggesting that even a best-case scenario would have 20 million deaths worldwide, while a worst-case scenario would have a death toll exceeding that of 1918. As the 2009 "Swine Flu" pandemic continues on through the summer and the autumn flu season approaches, this admitted uncertainty gives little confidence to observers such as myself.

If you're looking for a highly detailed and relatively technical discussion you might find this book a little light. However, if you, like me, have just the general exposure to the subject of epidemics, their causes and consequences, you are likely to have a good read here.

A couple times Ms. Kolata's prose and approach get a little dramatic but it doesn't get in her way as far as telling the story and a little honest feeling for the subject is hardly a bad thing.

Comparisons to 'The Hot Zone' are inevitable but not quite accurate. 'The Hot Zone' deals with diseases still very much a threat and almost supernaturally spooky in their virulence and mystery. 'Flu' is more a forensic look at a disease that is familiar and whose flirtation with serious mortality has, so far, been a one-time thing.

Say 'Ebola' to someone and they react: where is it? how bad is it? is this the time it will get loose? Say 'flu' and most people shrug. We've all been there, done that. Influenza is a familiar, if unwelcome, guest every year. Reading Ms. Kolata's book won't exactly have you hiding under your bed come next flu season, but you might not be quite so inclined to cavalierly skip the innoculation campaign either.

First, whoever designed the cover and spine of this book should be fired. While sitting on your bookshelf the neon green spine jumps out and the lettering makes it look like some cheesy sci-fi tripe. Which is unfortunate, because it's a very informative book and full of excellent research. It's odd that the great flu epidemic got relegated to an historical footnote, because it's scale was devastating and frightening. It's also likely that sometime in the future a similar outbreak will jump from animal to man in south China or somewhere similar. And the results today would dwarf the original flu epidemic and make SARS seem like a mild fever. This book makes for fascinating reading on these counts and it's very interesting to follow how the scientists went back to uncover the flu's origins.
Like many psuedo-historical books of this nature, however, the author is much less skilled as a writer than she is as a researcher. She tries too hard to inject the book with drama when the subject matter itself is sufficiently dramatic. Thus reading it becomes irritating at times because the prose and bad melodrama gets to you, but you nonetheless don't want to stop reading and not get all of the information.

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5.0 out of 5 stars Frightening but an excellent read
Highly readable though this book I'm sure was not written to make you an expert on the subject. If you know nothing about the Flu epidemic of 1918 nor other quasi flu epidemics... Read more

Published on Mar 19 2004 by P. Vitale

5.0 out of 5 stars Science Thriller
From cover to cover, I found this book absolutely riveting. Reads more like a piece of investigative journalism than a typical science book. Read more

Published on Feb 15 2004 by William F. Stasior

5.0 out of 5 stars Important History
I could not put this book down. Gina Kolata does a fantastic job of telling the history of the flu. She presented stories within the story of the flu. Read more

Published on Jun 9 2003 by Pam

2.0 out of 5 stars Like a bad high school research paper...
This book actually contains some information on the flu epidemic, but it is precious hard to sort out from all the totally irrelevant stuff. Read more

Published on Mar 24 2003 by methylethel

2.0 out of 5 stars Meandering
This book reads like an over long movie. The plot is good, the characters interesting, but of the 306 pages in this book, a good 150 to 200 could have been excised. Read more

Published on Mar 2 2003

4.0 out of 5 stars A fascinating Story
Good historical information, many interesting biographical sketches, and stories about the flu of 1918. The worst epidemic in world history. (and the least talked about. Read more

Published on Feb 13 2003 by R. Speizer

4.0 out of 5 stars Informative read and a couple of adventure stories too
First off, this book is some things and is not some things. It is very informative and was well researched, there are lots of footnotes at the end. Read more

Published on Jan 18 2003 by Michael Bird

4.0 out of 5 stars Influenza
Flu by Gina Kolata is about the Great Influenza Pandemic of 1918 and how it greatly effected the world when World War I was taking place. Read more

Published on Jan 10 2003 by Johnny

2.0 out of 5 stars A sickly imitation of THE HOT ZONE
Gina Kolata seems frustrated that Richard Preston had such a big hit with THE HOT ZONE. She refers to that book, and the Ebola virus a few times in FLU as if to say, "If you... Read more

Published on Dec 14 2002 by John B. Maggiore

5.0 out of 5 stars Very Interesting, well told
Some of the other reviews point out the fact that the middle chapters of the book move away from the 1918 flu to discuss things like the Hong Kong flu and the 1976 Swine Flu. Read more

Published on Nov 26 2002 by jhd1013

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