Science still isn't good at prevention of diseases

Nowadays, it is mainly memes and tweets that go viral. But sometimes diseases do, too. Ebola has lately been in the news, but variants of influenza — avian, swine and so on — often account for the biggest panics, possibly because we all know how easily flu can be passed on.

In the past 100 years, though, nothing quite as deadly as the so-called Spanish flu has struck the planet. This can partly be ascribed to the leaps and bounds by which medical science has advanced during the preceding century. Antibiotics, for instance, were unavailable in 1918, and aspirin overdoses are believed to have contributed to the death toll of up to 50 million by some accounts, and possibly 100m according to others.

Even at the lower level, that’s far more lives than were consumed by the industrial-level slaughter known as World War I. The level of fatalities is not so much contested as uncertain, because in many cases detailed records either did not exist or did not survive. I have failed, for instance, to ascertain what proportion of the deaths blamed on the Russian civil war, exacerbated by Western intervention, that followed the Bolshevik revolution, can be laid at the door of the then novel H1N1 virus.

The Poles called it the Bolshevik disease, but it certainly did not originate in Russia — who knows, it might have been transported there by the interventionists — any more than it did in Spain. It became known as the Spanish flu because at one point the nation’s entire Cabinet, as well as its king, were laid low by the virus. Besides, given Spain’s neutrality in the ensuing European conflict, its press was considerably less constrained in discussing the outbreak than its counterparts in other countries.

Investigations in recent decades have led many specialists to conclude that the virus originated in the US, possibly in a Kansas barracks or in New York. Others believe the outbreak can be traced back to China. In either case, it wasn’t intentionally spread, although initial ignorance about its seriousness undoubtedly contributed to insufficient quarantining and other preventive measures. Its appearance on the battlefields of Europe is attributed in large part to America’s entry into the World War I.

At least a third of troops on the Western Front are believed to have been infected — and some of the survivors owe their lives to the flu, having been bedridden while their companies were wiped out on the battlefield. Troop movements, on the other hand, are believed to have played a leading role in facilitating the international spread of the disease, including to islands where around a quarter of the population was wiped out.

The largest devastation of any country was experienced in India, where the flu is believed to have initially spread from the main port at Bombay to Karachi and Madras — and then everywhere else. As in other parts of the world, a relatively small proportion of those infected succumbed to the disease, although the levels were universally higher in the colonies than in the “developed” world. In India this meant an estimated 16 million deaths. Any of today’s Indians, Bangladeshis and Pakistanis exploring their family are likely to come across casualties, and probably fatalities, among their ancestors. Among the latter were my maternal grandfather’s first wife and two of her siblings. There may well have been others I know not of.

Intriguingly, family lore also includes the tale of a family retainer who, lying unattended in the open air, requested a passerby to break her some fruit from a nearby bush. She sucked on it, and survived.

That story may well be apocryphal, or at least have been embellished in retrospect. What’s scientifically accepted, though, is that one of the respects in which H1N1 differed from familiar variants of influenza, which proved deadliest in the case of the very young and the very old, was that it struck people in the prime of life with an unprecedented vengeance. Some specialists attribute this to the likelihood that the healthiest victims’ immune systems overreacted to the infection.

The scourge struck in three phases from early 1918 to mid-1919 (even US president Woodrow Wilson fell ill while attending the post-First World War peace conference at Versailles), and then waned without any obvious explanation. Medical science still struggles to keep up with viral mutations, and many experts fear that a pandemic on a comparable scale is only a matter of time. It could take months to come up with an antidote, and it is estimated that a recurrence today could claim 300m lives.

There is obviously little to be gained from panicking at the prospect. We are far better equipped to deal with pandemics than our ancestors were 100 years ago. But our capacity for pre-empting catastrophes remains a work in progress.

By arrangement with Dawn