Flu epidemic poised to make an ugly return

Wednesday, June 23, 1999

A deadly strain killed millions in 1918; experts say another is due.

By Ron Sylvester
News-Leader

Marjorie McCune vividly recalls when the killer flu knocked at the door of her childhood home in Peculiar early in the winter of 1918.

“Everybody in our community was sick,” said McCune, now 96 and living in Springfield. “My father came home from seeing my sister in Kansas City, and he said, `She’s gone! She’s gone!’ The flu had taken her.”

About 30 million people around the world died of influenza that year – more than in all the wars of the 20th century.
And it will likely happen again as strains of the virus find ways, just as bacteria do, to fight medical treatments. In the case of influenza, resistance develops to vaccines.

A local task force on drug-resistant diseases will be devising plans in the coming months to prepare Springfield for outbreaks that could ravage health care, emergency services, public safety and the economy.

Both the Centers for Disease Control and Prevention and the World Health Organization say another worldwide spread of deadly flu is inevitable.

The flu’s last scourge happened so long ago, however, that most communities are ill prepared – though CDC recommendations aren’t vastly different from the response of 81 years ago.

“But so few people remember just how big a deal it was,” said Jeanie Carver, virus specialist with Cox Health Systems.

Deaths from the flu in Missouri alone jumped from 390 the previous year to 9,677 in 1918.

In October that year, Springfield mayor J.J. Gideon ordered an emergency rule to prohibit all public meetings. All churches and schools were closed for the month.

The CDC said communities should again prepare for widespread public closings as the agency looks ahead to a widespread flu epidemic that could kill as many as 227,000 Americans, with an economic impact approaching $166 billion.

New strains of the flu emerge almost every year.

Forms of the virus shift easily, and even jump among species. Animals such as birds and swine carry influenza that can be passed to humans.

Carver said she won’t soon forget receiving a sample in 1998 from a patient at a local clinic.
The virologist identified it as a form of influenza A.

Can’t be, the clinic nurse said: The woman was vaccinated against type A.

“The hair on my arms just stood up,” Carver said. “And that was just the beginning. We had case after case after case of people who had influenza A and had been vaccinated.”

Carver said the 1998 strain arrived in Miami on a cruise ship from Australia and was not one covered by that year’s vaccine. More than two-thirds of flu cases in the United States that year came off that cruise ship.

“You can make a vaccine for a particular virus, but by the next season it may have changed enough that the vaccine may no longer be effective,” Carver said. “The flu vaccine is basically a guess. They’re prognosticating which flu viruses are going to be prevalent … based on which viruses were prevalent in prior seasons.”

Although viruses don’t respond to antibiotics, they mutate like bacteria.

“They’re two different phenomenons but follow similar trends in genetic shifts and drifts,” said Harold Bengsch, director of the Springfield-Greene County Health Department.

The CDC reports that it takes long enough to develop a vaccine to combat a novel flu bug that only one in 10 people will receive it.
Any local plans, the agency said, should include specific guidelines defining priorities in dispensing vaccines.

Most flu deaths these days strike those who are already sick and the elderly. People usually die of complications that accompany the flu, such as pneumonia-causing bacteria.

The 1918 version killed otherwise healthy people in their teens and mid-20s.

The CDC said in another such flu crisis, the hardest hit would be health-care and emergency medical providers, impeding efforts to treat the sick.

Community contingencies, therefore, should include plans to supplement essential services due to employee absences.

The 1918 flu forced Springfield’s Red Cross to open an emergency ward in the basement of South Street Christian Church.

“Physicians are so overrun with work that some have been continuously active for 48 hours without rest,” the Springfield Leader reported on Oct. 5, 1918. “In many households entire families are stricken with the disease and no outside help is available.”

Waiting for the help is what McCune remembers most about 1918.

“My mother was so sick, she was delirious,” McCune said. “I remember thinking, `I wish that darned old doctor would come.’ But he had everybody in the community to take care of.”

The flu’s next grip

Federal health officials say a widespread illness from a novel strain of the flu is inevitable and will hurt communities for weeks and months. The United States alone can expect:

OTHER LIKELY IMPACT

Source: Centers for Disease Control and Prevention