WE HEARD THE BELLS: The Influenza of 1918 (DOCUMENTARY)

IN 19 AND 18, I LIVED
IN SEQUOIA COUNTY. IN 1918, MY FAMILY WAS LIVING
IN SOUTH PHILADELPHIA. IN 1918, WE WERE LIVING
IN EL PASO, TEXAS. I WAS BORN AND RAISED
IN BALTIMORE. Narrator: IN BUSTLING CITIES
AND REMOTE VILLAGES, IN THE UNITED STATES
AND AROUND THE WORLD, ORPHANED CHILDREN CRIED
FOR THEIR PARENTS IN 1918. PEOPLE OF ALL CULTURES STRUGGLED WITH
THE SAME TERRIBLE THREAT, AND WITHIN A MATTER OF MONTHS, AS MANY AS 50 MILLION
WOULD BE DEAD. IN THE UNITED STATES, THE DEATH TOLL
REACHED 675,000, 5 TIMES THE NUMBER
OF U.S. SOLDIERS KILLED IN WORLD WAR I. WHAT WAS THAT DEADLY THREAT? [BELL TOLLING] THERE WAS SO MANY, MANY PEOPLE
THAT I HEARD DIED.

WE HAD JUST COME FROM–
A FEW YEARS BEFORE– FROM MEXICO,
WHERE WE WERE LIVING, ON ACCOUNT OF THE REVOLUTION,
THE MEXICAN REVOLUTION. I WAS ABOUT 10 YEARS OLD. I WAS THE OLDEST AND MY 4 BROTHERS AND SISTERS. OUT OF THE FAMILY,
ONLY MY DAD AND MY SISTER, MY SMALLER SISTER,
DID NOT GET IT. MY 2 BROTHERS WERE
IN ONE ROOM SICK. I WAS SICK IN THE OTHER BEDROOM
WITH MY MOTHER. MY POOR DAD AND SISTER
HAD TO BE OUR ATTENDANTS AND SEE WHAT THEY COULD DO
FOR US. INFLUENZA GAVE YOU
SUCH HIGH FEVER. MOTHER TOLD ME THAT I THOUGHT
HER BLACK HAIR WAS A CAT, AND I WAS AFRAID OF IT WITH THE DELIRIUM
FROM THE HIGH FEVER.

PEOPLE WERE LEFT
VERY WEAK WITH IT, ON ACCOUNT OF THAT HIGH FEVER, AND ALL THE SCHOOLS
AND ALL PUBLIC PLACES AND EVERY PLACE WAS CLOSED, I GUESS, NEARLY
2 OR 3 WEEKS. I WAS 8 YEARS OLD. WE LIVED NEAR
MY DAD'S MOTHER, AND SHE AND HER DAUGHTER
AND 2 GRANDCHILDREN WERE LIVING CLOSE TO US, AND WHEN THEY GOT THE FLU
AND GOT SICK, MY PARENTS–WE JUST MOVED IN
WITH THEM TO WHERE MY MOTHER
COULD NURSE THEM, ALL THE PATIENTS,
AND TAKE CARE OF THEM. AT THAT TIME, MY MOTHER
WAS 25 YEARS OLD, AND SHE HAD 3 CHILDREN. AND SHE WAS EXPECTING
ANOTHER BABY IN MAY, AND THIS WAS IN FEBRUARY, AND SHE'D TAKEN CARE OF
8 PATIENTS AT ONE TIME, VERY SICK PATIENTS
WITH THE FLU, WITH NO CONVENIENCE, NO MODERN FACILITIES
WHATSOEVER.

AND MOTHER HAD TO GET THE WOOD
TO KEEP HEAT IN THE HOUSE, TO KEEP ALL THOSE FIRES GOING, PLUS DO THE NURSING CARE
WITH 8 PATIENTS. MY FATHER'S NAME
IS TELESFORE REYNA, BUT HE ALWAYS WENT BY
"TELL US GOOD MORNING." "GOOD MORNING"
WAS HIS INDIAN NAME. AT THAT TIME, HE WAS WORKING IN TENNESSEE
FOR DUPONT COMPANY. EVERY TIME ANYBODY WAS SICK, HE WOULD ALWAYS
BRING UP THE STORY ABOUT HOW HE GOT SICK
WHILE HE WAS IN TENNESSEE, AND HOW A LOT OF PEOPLE
FROM THE VILLAGE THAT HAD GONE
WERE BROUGHT BACK SICK. THEY WERE BROUGHT BACK
IN A TRAIN, HE SAID. SOME OF THEM
HAD PASSED AWAY
IN TENNESSEE. IN 1918, MY MOTHER WAS, LIKE,
JUST 11 YEARS OLD, BUT SHE REMEMBERS THEY LIVED ON THE SOUTH SIDE
OF THE VILLAGE. SHE REMEMBERS THE CHURCH BELL
WOULD RING EVERY DAY, THAT THERE'S A CERTAIN BELL
FOR A NOTICE FOR THE DEATH.

AND SHE SAID SHE REMEMBERS
AS A LITTLE GIRL HOW AWFUL IT SOUNDED. [CHIMES] IN 1918, AS NOW, MOST PEOPLE DIDN'T THINK
OF INFLUENZA AS A DISEASE
THAT COULD LEAD TO DEATH. WE SUFFER THROUGH
THE FLU SEASON EVERY WINTER. IN THE U.S., THE FLU SEASON
USUALLY PEAKS BETWEEN JANUARY
AND THE END OF MARCH. THE SYMPTOMS OF A COLD
ARE USUALLY A RUNNY NOSE,
SOMETIMES LOW-GRADE FEVER, AND JUST FEELING
A LITTLE WIPED OUT. INFLUENZA,
ON THE OTHER HAND, IS MUCH, MUCH MORE
PRONOUNCED THAN THAT. PEOPLE WILL GENERALLY HAVE
A HIGH-GRADE FEVER, ABSOLUTELY NO ENERGY
WHATSOEVER, MUSCLE ACHES, HEADACHES,
A FAIRLY DRY COUGH. WITH A COMMON COLD,
YOU MAY FEEL BAD
FOR A COUPLE OF DAYS, BUT AFTER 4 TO 5 DAYS,
YOU'RE STARTING TO FEEL
YOURSELF AGAIN. WITH INFLUENZA,
IT'S SOMETIMES
2 WEEKS OR MORE.

IF REALLY SEVERE,
IT CAN GO ON
TO CAUSE PNEUMONIA. COMPLICATIONS FROM THE FLU CAUSE AN AVERAGE OF MORE THAN
200,000 HOSPITALIZATIONS EVERY YEAR IN THE U.S., AND AN AVERAGE 36,000 PEOPLE
DIE FROM THOSE COMPLICATIONS. DURING SEASONAL
INFLUENZA EPIDEMICS
IN THE UNITED STATES, THERE ARE CERTAIN GROUPS THAT ARE HIGHER RISK
FOR COMPLICATIONS. YOUNG CHILDREN IN PARTICULAR,
THOSE LESS THAN 2 YEARS OF AGE, ELDERLY PEOPLE, PARTICULARLY
PEOPLE 65 YEARS AND OLDER, PERSONS OF ANY AGE
WHO MAY HAVE CERTAIN UNDERLYING
CHRONIC CONDITIONS. FOR EXAMPLE, ASTHMA,
CHRONIC LUNG DISEASE, CHRONIC
CARDIOVASCULAR DISEASE. AND IN ADDITION, PREGNANT WOMEN
ARE AT HIGHER RISK FOR COMPLICATIONS
FROM SEASONAL INFLUENZA. WHILE SEASONAL INFLUENZA
IS A SERIOUS HEALTH THREAT FOR PEOPLE AT RISK
OF COMPLICATIONS, THE OUTBREAK OF INFLUENZA THAT SWEPT THE NATION
IN 1918 AND EARLY 1919 KILLED OVER HALF A MILLION
PEOPLE IN THE U.S. WHEN THE POPULATION WAS ONLY
A THIRD OF WHAT IT IS TODAY.

I WAS 4 YEARS OLD
AT THAT TIME. I WAS LIVING
AT THE TRUJILLO RANCH IN MIMBRES,
FAYWOOD, NEW MEXICO. MY MOTHER WAS THE MIDWIFE,
AND SHE TENDED TO THE PEOPLE, DELIVERY OF BABIES
AND ALL THAT KIND OF THING. SHE USED TO TAKE ME WITH HER
TO GO AND VISIT THE NEW MOTHERS, AND I LOVED TO GO SEE
THE NEW BABIES, AND I CRIED,
BECAUSE AT THAT TIME, SHE DIDN'T WANT TO TAKE ME
WITH HER BECAUSE SHE WAS TENDING
TO THE SICK AND THE DYING.

BUT THE MIRACLE ABOUT IT
IS THAT SHE DIDN'T GET IT. AND ACCORDING TO HER, NONE OF US
AT HOME GOT IT, EITHER. SHE WOULD TELL ME
ABOUT HOW PEOPLE WOULD DIE, SOMETIMES 2 IN THE SAME BED, AND THEY HAD NO FUNERAL SERVICES
OR ANYTHING LIKE THAT. THEY WOULD JUST CARRY THEM OFF
TO BURY THEM. IT WAS VERY HARD FOR THEM
TO KEEP UP BURYING THE DEAD BECAUSE THEY WERE DYING
SO FAST. ONE THING
THAT STAYED IN MY MIND BECAUSE I USED TO
HEAR IT EVEN LATER WAS THE POUNDING OF
THE NAILING OF BOARDS TOGETHER, MAKING, I CALLED THEM BOXES,
COFFINS FOR THE PEOPLE. [BELL TOLLS] WHETHER PEOPLE
CALLED IT INFLUENZA, THE GRIPPE,
OR THE SPANISH FLU, IT WAS CLEAR THIS WAS NOT
THE FLU THAT COMES EVERY WINTER. TODAY, WE KNOW THAT INFLUENZA
IS CAUSED BY A VIRUS, THE INFLUENZA VIRUS. WE KNOW THAT THE VIRUS SPREADS
FROM ONE PERSON TO ANOTHER THROUGH DROPLETS WHEN PEOPLE
COUGH AND SNEEZE, OR THROUGH CONTACT
WITH THE VIRUS ON SOMEONE'S HAND OR A CONTAMINATED SURFACE. IN 1918, NO ONE KNEW
WHAT CAUSED IT, WHERE IT STARTED,
OR HOW TO STOP IT.

THEY WERE SCARED
BECAUSE IT HAPPENED
SO RAPIDLY. THEY DIDN'T KNOW
WHAT WAS GOING ON, WHAT WAS HAPPENING,
WHY. THERE WERE FEW COMMUNITIES
IN THE U.S. SO SMALL OR ISOLATED THAT THEY WERE SHELTERED
FROM THE WAVES OF DEADLY DISEASE THAT SWEPT AROUND THE WORLD. THE INFLUENZA OF 1918 EVEN TOUCHED REMOTE
INUIT VILLAGES IN ALASKA, SOMETIMES KILLING
EVERY MAN, WOMAN, AND CHILD OR KILLING THE ADULTS AND LEAVING THE CHILDREN
WITH NO ONE TO CARE FOR THEM. THE 1918 INFLUENZA STRUCK SOME NATIVE PEOPLES
IN THE SOUTHWEST VERY HARD, TOO. I DON'T THINK THE DOCTOR
RESIDED HERE, BUT HE CAME FROM ALBUQUERQUE. A LOT OF OUR PEOPLE,
OLDER PEOPLE, DIDN'T SPEAK
THE ENGLISH LANGUAGE, SO MY DAD
WOULD INTERPRET FOR HIM WHAT HE WAS ASKING THEM TO DO,
HOW TO TAKE CARE OF THEMSELVES. THEY WOULD WORK
FROM EARLY MORNING
TILL LATE NIGHT TRYING TO VISIT EVERY HOME
IN THE PUEBLO. IN THE MORNING, WHEN THEY GOT
TO SOME OF THE HOMES, THEY WOULD FIND MAYBE
2 OR 3 PEOPLE IN THE FAMILY THAT HAD PASSED AWAY
DURING THE NIGHT.

EVERY DAY,
THEY WERE BURYING PEOPLE. THE CHURCH BELL WOULD BE TOLLING
FROM MORNING TO EVENING BECAUSE OF SO MANY DEATHS. [BELL TOLLING] THE BUREAU OF INDIAN AFFAIRS SENT DR. D.A. RICHARDSON
TO INVESTIGATE THE SITUATION IN THE PUEBLOS
NEAR ALBUQUERQUE, NEW MEXICO. HE WROTE, "THE STRENGTH
OF THE PUEBLOS "WAS NOT TAKEN WITH THE AGED
OR MARKEDLY WITH THE INFANTS, BUT FROM THE YOUNG ADULT LIFE
OF THE TRIBE." AND THIS WAS TRUE
AROUND THE WORLD. WITH THE INFLUENZA THAT HITS US
EVERY FALL AND WINTER, MOST HEALTHY ADULTS ARE SICK
FOR A WEEK OR 2 AND RECOVER. WHEN PEOPLE DIE OF THE FLU, IT'S ALMOST ALWAYS
THE VERY YOUNG AND THE VERY OLD. BUT THE INFLUENZA OF 1918 WAS NOT ONLY MUCH MORE LETHAL
THAN SEASONAL FLU, THE DEATH RATE WAS VERY HIGH
AMONG YOUNG ADULTS, STRONG YOUNG MEN AND WOMEN WORKING TO SUPPORT
AND CARE FOR THEIR FAMILIES. MY PARENTS CAME TO THIS COUNTRY
FROM ROMANIA–BESSARABIA. IN 1918, MY FAMILY WAS LIVING
IN SOUTH PHILADELPHIA.

I THINK IT WAS A NEIGHBORHOOD
MOSTLY OF IMMIGRANTS. IT WAS A HARD LIFE,
IT WAS A ROUGH LIFE. MY MOTHER AND FATHER
AND MY 2 SISTERS
ALL HAD THE FLU. IT WAS A VERY SAD PERIOD. THERE WAS LIKE A SADNESS
OVER THE CITY. WHEN YOU LOOKED OUT,
YOU SAW HARDLY ANYBODY
WALKING AROUND. PEOPLE STAYED IN THEIR HOUSES
BECAUSE THEY WERE AFRAID. AND THEY SAID
THAT IT SEEMS THAT IF IT KILLED YOU,
IT DID IT FAST, BECAUSE I REMEMBER THEM
TELLING ME THAT A YOUNG NEIGHBOR,
THEY SAW HIM COMING HOME. THEY WATCHED FROM THE WINDOW,
COMING FROM WORK. AND THE NEXT AFTERNOON,
THEY SAW HIM CARRIED OUT. HE DIED. OF ALL THE CITIES
IN THE U.S., PHILADELPHIA HAD ONE
OF THE HIGHEST RATES
OF SICKNESS AND DEATH AND THE MOST DISRUPTION. THE CITY RESISTED
PUTTING MEASURES IN PLACE THAT MIGHT HAVE LIMITED
THE SPREAD OF THE FLU, MEASURES SUCH AS PROHIBITING
PUBLIC GATHERINGS WHERE THE FLU
COULD SPREAD EASILY.

THE CITY ALLOWED
A LARGE PARADE TO TAKE PLACE TO RAISE MONEY
FOR THE TROOPS FIGHTING WWI. ALTHOUGH THE MARCHERS
AND CROWD WORE GAUZE MASKS, MANY PEOPLE CAUGHT THE FLU FROM THOSE WHO WERE
ALREADY INFECTED. BALTIMORE FARED
ALMOST AS BADLY AS PHILADELPHIA. SOLDIERS AT CAMP MEADE,
SOUTH OF THE CITY, BECAME SICK IN MID-SEPTEMBER,
AND BY EARLY OCTOBER, THERE WERE 2,000 CASES
IN BALTIMORE. OFFICIALS HESITATED TO CLOSE
SCHOOLS AND OTHER MEETING PLACES WHICH WOULD HAVE REDUCED CONTACT
BETWEEN THE SICK AND THE WELL. HOSPITALS AND FUNERAL HOMES
WERE OVERWHELMED, AND THE WORKERS
WHO KEPT THE CITY
AND ITS BUSINESSES RUNNING WERE TOO SICK
TO GET OUT OF BED. BETHLEHEM STEEL
WENT AROUND AND GOT ALL THESE MEN
FROM DOWN SOUTH
TO OPERATE THE MILLS. AND THERE WERE
JUST THOUSANDS OF MEN COMING OFF FROM THE MILLS. MY FATHER WORKED FOR
THE BETHLEHEM STEEL COMPANY'S
BAKERY. THE ONLY BLACK BAKER
THEY EVER HAD WAS MY FATHER–
HENRY LINDSEY. THE PEOPLE WERE VERY KIND
TO ONE ANOTHER, AND IT WAS
A PLACE WHERE EVERYBODY
LOOKED AFTER ONE ANOTHER. IN THE BARRACKS,
NOBODY LIVED IN THERE BUT THE MEN WHO WORKED
FOR THE BETHLEHEM STEEL.

THEY DIED, AND THE MEN
WHO WERE AROUND THEM DIDN'T EVEN KNOW
THEY WERE DEAD. COME HOME IN THERE,
AND THE MAN DEAD. DON'T KNOW
HOW LONG HE'D BEEN DEAD
BECAUSE THEY WENT TO WORK. COULD LEAVE HIM THERE
IN THE MORNING, COME BACK,
HE'S DEAD IN THE EVENING. MY MOTHER WAS SICK
AND EVERYTHING, AND THEY QUARANTINED US. WE DIDN'T VISIT NOBODY,
AND NOBODY VISITED US
EXCEPT THIS LADY. THIS MRS. KISSY THORNTON– SHE WENT 'ROUND
HELPING EVERYBODY
WHO WAS SICK, AND I DECLARE THAT LADY
NEVER GOT SICK OR ANYTHING. BACK IN 1918, I WAS BETWEEN 10
AND 12 YEARS OLD,
I WOULD SAY, AND I GOT THE FLU,
AND IT WAS JUST
MY MOTHER AND I. 2 OF MY FRIENDS, WE WENT TO
ELEMENTARY SCHOOL TOGETHER, AND BOTH OF THEM
WERE STRICKEN WITH THE FLU, AND I WOULD GO OUT
TO THEN BAYVIEW HOSPITAL
TO GO VISIT HER. AND THEY'D PUT HER
OUT ON A PORCH
IN THE COLD WINTERTIME. AND THEY HAD BLANKETS,
BLANKETS AND A HOOD ON HER,
BUT SHE DIED, BOTH OF THEM DIED
AT THAT YOUNG AGE.

PEOPLE DIDN'T UNDERSTAND,
AND THERE WAS NO VACCINE. BUT YOUR PARENTS
DID THE BEST THEY COULD
FOR YOU. THE INFLUENZA OF 1918-1919
WAS A PANDEMIC, AN OUTBREAK OF DISEASE
AROUND THE WORLD WHICH CAUSED
SERIOUS ILLNESS AND DEATH. WHY WAS THE INFLUENZA OF 1918
SO MUCH MORE DEADLY THAN THE SEASONAL FLU
WE EXPERIENCE EVERY WINTER? WHAT WAS DIFFERENT ABOUT
THE INFLUENZA VIRUS IN 1918? THE SEASONAL
INFLUENZA VIRUSES THAT CAUSE ANNUAL OUTBREAKS,
EPIDEMICS, IN THE UNITED STATES
DURING OUR FALL, WINTER,
AND EARLY SPRING– THOSE ARE INFLUENZA VIRUSES THAT ARE CIRCULATING
AMONG PEOPLE WORLDWIDE, AND THEY ARE EVOLVING,
THEY'RE CHANGING
JUST A LITTLE BIT. BUT THEY'RE HUMAN VIRUSES, AND SO SOME PERCENTAGE
OF THE U.S. POPULATION AND THE WORLD'S POPULATION
GETS INFECTED EVERY YEAR. SOME BECOME ILL. SOME PERCENT RECOVER FROM
A SELF-LIMITED ILLNESS. ALL THESE PEOPLE WHO SURVIVE
WILL HAVE SOME IMMUNITY. OTHER PEOPLE GET VACCINATED, AND WE RECEIVE SOME IMMUNITY
THROUGH THAT VACCINE. SO THERE ARE 2 WAYS
TO ACQUIRE IMMUNE PROTECTION. ONE IS THROUGH
NATURAL INFECTION, IN WHICH YOU RECOVER,
YOU SURVIVE,
THEN YOU HAVE IMMUNITY.

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THE OTHER
IS THROUGH VACCINATION, AND VACCINATION STIMULATES
OUR BODY'S IMMUNE SYSTEM TO PRODUCE ANTIBODIES
AGAINST THE SPECIFIC
VIRUS STRAINS THAT ARE CONTAINED
IN THE VACCINE. AN INFLUENZA PANDEMIC
IS DIFFERENT. AN INFLUENZA PANDEMIC IS THE EMERGENCE
OF A VERY NEW
INFLUENZA "A" VIRUS TO WHICH MOST OF THE POPULATION
HAS NOT PREVIOUSLY BEEN EXPOSED AND DOES NOT HAVE ANY IMMUNITY,
NO IMMUNE PROTECTION. AND SO WHAT YOU SEE
IS VERY HIGH NUMBERS, VERY HIGH PERCENTAGE OF PEOPLE
BECOMING SICK WORLDWIDE. IN THE LAST 100 YEARS,
NEW INFLUENZA VIRUSES HAVE CAUSED 4 PANDEMICS
IN 1918, 1957, 1968, AND 2009. ULTIMATELY,
THEY COME FROM BIRDS– WILD WATERFOWL, DUCKS AND GEESE
AND VARIOUS OTHER BIRDS. THEY CAN GET INTO
DOMESTIC POULTRY, CHICKENS. THEY CAN ALSO, AS WE KNOW,
GET INTO HUMAN BEINGS DIRECTLY, PIGS,
VARIOUS AQUATIC MAMMALS. THEY CAN GET INTO HORSES.
THEY CAN GET INTO DOGS
AND CATS. SO THEY CAN TAKE
ANY OF THESE PATHS, AND IN THEORY, THEY COULD
END UP GETTING INTO PEOPLE BY EITHER COMING DIRECTLY
FROM A BIRD OR GOING THROUGH
A CIRCUITOUS ROUTE
IN ANOTHER ANIMAL. BY A VARIETY OF MUTATIONS THAT OCCUR
FOR A NUMBER OF REASONS, THESE TYPES OF VIRUSES CAN, UNDER CERTAIN CIRCUMSTANCES, ADAPT THEMSELVES
TO OTHER SPECIES.

AND THEN AS THEY
PROPAGATE THEMSELVES
IN THESE OTHER SPECIES, THEY ADAPT THEMSELVES BETTER
TO SPREAD FROM PIG TO PIG OR FROM BIRD TO BIRD
OR FROM PERSON TO PERSON. AND THE HOST WE WORRY ABOUT
THE MOST, OBVIOUSLY, FROM A HUMAN HEALTH STANDPOINT,
IS THE HUMAN SPECIES. Thurber:
ONE OF MY DAD'S SISTERS
LIVED PRETTY CLOSE TO US, AND SHE HAD A FAMILY
OF 4 CHILDREN AND HER HUSBAND, AND SHE WAS EXPECTING. AND SHE'D TAKEN THE FLU, AND OF COURSE, SHE PASSED AWAY
JUST–SHE WAS VERY SICK. SHE PASSED AWAY. THE LADIES THAT TAKEN THE FLU
THAT WERE PREGNANT, ALL WE EVER KNEW DIED,
AND MY MOTHER DIDN'T GET IT. WE DON'T KNOW
WHY PREGNANT WOMEN DIE
OF INFLUENZA AT A HIGH RATE, BUT IT'S BEEN DOCUMENTED
FOR WELL OVER 500 YEARS. ONE OF THE BIGGEST
RISK FACTORS FOR A FATAL OUTCOME
FROM INFLUENZA IS PREGNANCY. WHATEVER THE REASON,
IT'S PRETTY CLEAR THAT PREGNANT WOMEN IN 1918
WERE AT VERY HIGH RISK. PREGNANT WOMEN, OF COURSE,
ARE GOING TO BE IN
THE YOUNGER AGE RANGES, BUT NON-PREGNANT WOMEN
AND MEN IN THAT AGE RANGE WERE ALSO AT MUCH HIGHER RISK
OF DYING.

WHY THIS HAPPENED,
WE DON'T KNOW. IN ANY FLU PANDEMIC,
PEOPLE DIE FROM PNEUMONIA, SOME PERCENTAGE
WILL ALWAYS DIE, BUT IT TENDS TO BE
THE OLDER FOLKS, PEOPLE
WHO HAVE CHRONIC CONDITIONS
LIKE HEART AND LUNG DISEASE, PREGNANT WOMEN,
INFANTS AND SO ON. THIS TIME, IN 1918, SOMETHING
VERY DIFFERENT HAPPENED. OTHERWISE HEALTHY YOUNG ADULTS
DIED AT A VERY HIGH RATE AND CONSTITUTED
A FAIRLY LARGE PERCENTAGE
OF THE TOTAL DEATHS, SOMETHING THAT'S
NEVER BEEN SEEN BEFORE. WHY THAT HAPPENED
IS A MYSTERY. BREVIG MISSION
IS NORTHWEST OF NOME, ALASKA, ON THE BERING SEA. THE FACT THAT BREVIG
EXISTS TODAY IS REMARKABLE, SINCE OF THE 80 RESIDENTS
IN 1918, ONLY 5 ADULTS AND 3 CHILDREN
SURVIVED THE FLU PANDEMIC. OVER 50 YEARS AGO, A YOUNG MAN
WITH AN INTEREST IN VIRUSES FOUND HIS WAY
TO THE VILLAGE. I WAS A MEDICAL STUDENT
IN SWEDEN, AND I DECIDED TO TRAVEL
TO THE UNITED STATES AND GET A MASTER'S DEGREE
IN VIROLOGY.

AND THEN ONE THING
LED TO THE NEXT
AND TO THE NEXT, AND I DECIDED THAT
I WOULD GO FOR MY Ph.D., AND ONE DAY, WE HAD A VISITOR,
A VERY PROMINENT VIROLOGIST. AND I REMEMBER HIS TALKING ABOUT
EVERYTHING THAT HAD BEEN DONE TO FIND OUT WHAT WAS IT
THAT CAUSED THE 1918 FLU. AND THEN HE–LIKE,
A 15-SECOND COMMENT
AT THE END OF HIS TALK. HE SAID SOMEBODY OUGHT TO GO
TO THE NORTHERN PART
OF THE WORLD AND TRY TO FIND A VICTIM OF THE 1918
SPANISH FLU PANDEMIC BURIED IN THE PERMAFROST. AND THAT VICTIM IS LIKELY TO HAVE BEEN
REMAINED FROZEN FOR– SINCE 1918, AT THAT TIME, IT WAS SOMETHING
LIKE 35 YEARS OR 40 YEARS, AND TRY TO RECOVER THE VIRUS. AND THEN AS IF HE WENT
TO SOMETHING ELSE. AND THAT 15 SECONDS,
I HAPPENED TO BE
THAT I HEARD IT. I IMMEDIATELY WENT
TO MY FACULTY ADVISOR
TO ASK HIM, "COULD THAT BE A SUBJECT
FOR MY Ph.D.?" "OH, YEAH. WHY DON'T YOU
GO AHEAD?" I HAPPENED TO HAVE WORKED
DURING THE SUMMER OF 1949 FOR A PALEONTOLOGIST
IN ALASKA.

THE PALEONTOLOGIST,
OTTO GEIST, HAD WORKED
ON THE BREVIG PENINSULA AND KNEW THE MISSIONARIES
IN THE VILLAGES THERE. WITH GEIST'S HELP, HULTIN WAS ABLE TO REVIEW COPIES
OF MISSION RECORDS FROM THE FALL OF 1918. HE FOUND THAT THE MILITARY
HAD VERY GOOD RECORDS SHOWING THE LOCATION
AND THICKNESS OF THE PERMAFROST
IN ALASKA. ON THE BASIS OF THAT, I CAME–
DECIDED ON 3-3 VILLAGES. I SHOWED UP IN JUNE,
AND I WENT TO THE FIRST VILLAGE. IT'S CALLED NOME.
IT'S A RATHER LARGE CITY,
ACTUALLY, NOME. I WENT INTO THE MASS GRAVE
AT THE CEMETERY AND DISCOVERED THAT THE RIVER
THAT NORMALLY HAD FLOWED ON THE SIDE OF THE VILLAGE
AT SOME DISTANCE AWAY, IT HAD CHANGED COURSE
SINCE 1918 AND HAD COME INTO THE VILLAGE
AND MELTED THIS PERMAFROST. I COULD JUST SEE IT. AND THEN I ENGAGED
A BUSH PILOT TO FLY ME TO ANOTHER VILLAGE CALLED WALES
AT THE BERING STRAIT.

I FOUND WHERE
THE MASS GRAVE WAS CLEARLY MARKED
WITH A LARGE CROSS, AND THE BLUFF HAD FALLEN
ONTO THE BEACH AND ALMOST EXCAVATED
OR INVADED THE MASS GRAVE. SO I FIGURED
THERE IS NO PERMAFROST HERE. SO THE BUSH PILOT FLEW ME
TO WHAT TODAY IS BREVIG, BUT THERE WAS NO WAY
TO LAND THERE. I HAD TO LAND ON THE BEACH
AT SOME DISTANCE AWAY
IN ANOTHER VILLAGE. AND THEN I HAD TO CROSS
SOME WATER WITH A WHALEBOAT. GOT ACROSS
THIS REALLY SIZABLE WATER. AND THEN I HAD TO WALK
ABOUT 6 MILES IN SOGGY TUNDRA THAT WAS JUST BEGINNING TO MELT,
THEN ON TO BREVIG. THEY HAD A VILLAGE COUNCIL,
THE COUNCIL OF THE ELDERS. AND IT'S A MATRIARCHAL SOCIETY. SO THE ELDEST WOMAN
OF THE LARGEST FAMILY
MAKES DECISIONS OR HEAVILY INFLUENCES
DECISIONS. AND LITTLE DID I KNOW THAT THAT WAS GOING TO BE
VERY IMPORTANT LATER ON. FORTUNATELY FOR ME, THERE WERE 3 SURVIVORS
OF THE 1918 PANDEMIC
STILL ALIVE. SO I ASKED THEM TO PLEASE TELL
THE OTHER MEMBERS, THE ELDER COUNCIL, WHAT IT WAS LIKE
IN THAT NOVEMBER WEEK WHEN 90% OF THE VILLAGE DIED. THEN I SAID, "IF YOU ALLOW ME
TO ENTER THE GRAVE, "AND IF I'M FORTUNATE ENOUGH "TO FIND THE RIGHT SPECIMENS, "I WILL TAKE IT BACK, "THE SPECIMEN
BACK TO MY LABORATORY, "AND IF EVERYTHING
WORKS OUT WELL, "IT WILL BE POSSIBLE FOR US
TO DEVELOP A VACCINE.

"SO IN THE NEXT PANDEMIC COMING,
THREATENING YOU, WE WILL HAVE A VACCINE
TO IMMUNIZE YOU, PROTECT YOU." THEY UNDERSTOOD
WHAT VACCINE WAS BECAUSE THEY HAD BEEN IMMUNIZED
AGAINST SMALLPOX. THE MATRIARCH, JENNY OLANNA, WAS IN FAVOR OF THAT. SO THAT INFLUENCED
THE DECISION. SO THEY ALLOWED ME
TO OPEN THE GRAVE. SO I WENT OUT ON THE GRAVESITE
AND STARTED TO DIG, AND ABOUT A FOOT DOWN,
I CAME ONTO PERMAFROST, A VERY HARD FROZEN GROUND. I STARTED A FIRE, GOT DRIFTWOOD FROM THE BEACH
AND CLIMBED UP ON THE BLUFF, AND THERE
WHERE THE MASS GRAVE AND STARTED TO MELT
THE PERMAFROST.

AND ON THE END
OF THE SECOND DAY, I CAME DOWN ABOUT 4 FEET, AND THERE I FOUND
THE FIRST VICTIM,
YOUNG CHILD, A GIRL I ESTIMATED
12 YEARS OF AGE. BUT THE CONDITION
OF HER BODY AT 4 FEET FROM THE SURFACE
WAS SO GOOD THAT I WAS CONFIDENT
THAT DOWN DEEPER, THERE WILL BE– EVEN BE BETTER-BETTER-PRESERVED
ADULTS AND SO ON. 72 BODIES IN THAT GRAVE. NOW, I DIDN'T COME ALONE
TO ALASKA. I HAD MY FACULTY ADVISOR,
INFLUENZA VIROLOGIST. I HAD A PATHOLOGIST, ONE OF THE PROFESSORS
IN THE DEPARTMENT IN IOWA, TO PERFORM
THE POST-MORTEM EXAMINATIONS, AND THEN OTTO GEIST.
SO THERE WERE 4. I WAS OUT THERE AHEAD OF THEM TO SCOUT THE GRAVE,
TO SCOUT THE TEST DIG. A DAY LATER,
THEY CAME TO THE SAME BEACH
WHERE I HAD LANDED EARLIER, AND WE TRAVELED THE SAME WAY
BACK TO BREVIG. NOW THERE WERE 4 OF US DIGGING,
SO WE COULD DO IT VERY RAPIDLY. ABOUT 3 DAYS LATER,
WE WERE DOWN 6 FEET. AND THEN WE FOUND
3 PERFECTLY PRESERVED BODIES, AND THE PATHOLOGIST PERFORMED
POST-MORTEMS ON THEM, AND THE LUNGS
WERE PERFECTLY PRESERVED.

THEN WE LEFT,
THANKED THE VILLAGERS,
CLOSED THE GRAVE. AND I TOOK SOME PICTURES,
OF COURSE, ALL THE TIME. SO, EVENTUALLY
WE GOT TO IOWA WITH THIS, AND I STARTED TO TRY
TO GROW THE VIRUS, TRYING TO FIND
AN ALIVE INFLUENZA VIRUS. WEEK AFTER WEEK
AFTER WEEK AFTER WEEK, I GOT MORE AND MORE
DISCOURAGED. AND EVENTUALLY,
I HAD NO MORE SPECIMEN. AND THE VIRUS WAS DEAD. AND THERE WENT MY Ph.D.

I COULD SEE IT FLY OFF
THROUGH THE WINDOW IN THE
NON-AIR CONDITIONED OFFICE, BY THE WAY, THE LAB I HAD. I DECIDED TO GO BACK
TO SWEDEN TO CONTINUE
MY MEDICAL EDUCATION, AND I WAS EXCEEDING–
EXTREMELY FORTUNATE. I WAS OFFERED TO CONTINUE
MEDICAL SCHOOL AT IOWA. THEN I GOT MY M.D. THERE,
BECAME A PATHOLOGIST. BUT BACK IN MY MIND, I HAD THIS MEMORY
OF NOT GETTING MY Ph.D. AND ALL THE EFFORT
WENT INTO THAT, AND IT WAS JUST–
KIND OF COLLAPSED. MOLECULAR PATHOLOGY IS
A SPECIALTY OF MEDICINE, WHERE PATHOLOGISTS
USE THE TOOLS OF MOLECULAR BIOLOGY
AND MOLECULAR GENETICS TO MAKE DIAGNOSES AND PROVIDE INSIGHT
INTO PATIENT CARE DECISIONS. YOU CAN MAKE DIAGNOSES
OF INFECTIOUS DISEASES BY LOOKING
FOR THE GENETIC MATERIAL
OF THE INFECTIOUS ORGANISM, THE VIRUS OR THE BACTERIA,
FOR EXAMPLE. I WAS IN THE NATIONAL CANCER
INSTITUTE AS A PATHOLOGIST
IN THE '80s, AND IN 1993 I MOVED
TO THE ARMED FORCES
INSTITUTE OF PATHOLOGY TO SET UP A NEW GROUP DEVOTED
TO MOLECULAR PATHOLOGY, BOTH FOR CLINICAL
MOLECULAR PATHOLOGY
AS WELL AS RESEARCH, AND ONE OF THE THINGS
WE HAD TO DO FOR BOTH SIDES OF THAT IS
TO WORK OUT WAYS TO RECOVER GENETIC MATERIAL
FROM TYPICAL BIOPSY MATERIAL.

THE TISSUE REPOSITORY
AT THE AFIP GOES BACK
TO THE CIVIL WAR, SO THEY HAVE A HUGE COLLECTION
OF MILLIONS OF TISSUE SAMPLES REFLECTING ALL ASPECTS
OF CLINICAL DISEASE, TUMORS
AND INFECTIOUS DISEASE, INCLUDING AUTOPSIES OF SOLDIERS
WHO DIED OF FLU IN 1918. I WANTED TO THINK OF A PROJECT
THAT WOULD HIGHLIGHT THE UTILITY OF HAVING
SUCH AN OLD TISSUE ARCHIVE AS WELL AS
OUR NEW MOLECULAR TECHNIQUES
IN WHICH WE COULD DO ANALYSES, AND THE WAY THOSE 2 THINGS
CAME TOGETHER IN MY MIND WAS TO GO AFTER THE 1918 FLU.

WE THOUGHT
THAT IT MIGHT BE POSSIBLE TO RECOVER FRAGMENTS
OF THE GENETIC MATERIAL
OF THE VIRUS STILL PRESERVED
IN AUTOPSY TISSUES OF PEOPLE WHO DIED
IN 1918. WHEN WE STARTED THE PROJECT, THERE WERE REALLY 2
FUNDAMENTAL QUESTIONS
THAT WE WANTED TO ANSWER. THAT IS, ONE,
WHY WAS THIS VIRUS
SO PARTICULARLY VIRULENT? WHY DID IT KILL
SO MANY PEOPLE, ESPECIALLY YOUNG,
HEALTHY ADULTS? AND SECONDLY,
WHERE DID THIS VIRUS
COME FROM? WE WERE HOPING TO LEARN
FROM WHAT WE SEE IN 1918 TO APPLY IT TO THE FUTURE, THAT WE COULD UNDERSTAND
HOW PANDEMICS FORM AND WHY PARTICULAR FLU VIRUSES
CAUSE MORE DISEASE THAN OTHERS.

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THESE TISSUES
WERE EXTREMELY OLD,
AND IT WAS NOT CLEAR THAT WE COULD ACTUALLY RECOVER
ANY GENETIC MATERIAL AT ALL
FROM THESE SAMPLES. WE HAD TO WORK OUT TECHNIQUES AND CONTINUE
TO REFINE THE TECHNIQUES TO EXTRACT NUCLEIC ACIDS, DNA AND RNA,
FROM THESE SAMPLES. WE HAD STARTED THIS PROJECT
IN 1995, AND IT TOOK OVER A YEAR
TO FIND A FIRST POSITIVE CASE, TO WORK OUT OUR TECHNIQUES TO MAKE SURE THAT WE ACTUALLY
COULD FIND INFLUENZA. ONCE WE HAD FOUND
A FIRST POSITIVE CASE AND WE STARTED
TO GENERATE SEQUENCE AND COMPARE IT
TO KNOWN INFLUENZA VIRUSES, WE WERE CONVINCED THAT WE HAD
REALLY FOUND THE 1918 VIRUS. BUT WE WERE REALLY CONCERNED
THAT THERE WOULD BE INADEQUATE AMOUNTS
OF MATERIAL AVAILABLE TO US TO SEQUENCE THE WHOLE VIRUS
FROM THAT MATERIAL.

pexels photo 6097703

IN MARCH OF 1997
IN SCIENCE NEWS, THERE IT WAS–
"1918 PANDEMIC VIRUS FOUND." A SMALL SEQUENCE
HAD BEEN DISCOVERED
BY JEFFERY TAUBENBERGER. I WROTE A LETTER SAYING, "IF YOU NEED MORE SPECIMEN,
LET ME KNOW, "AND I WILL GO BACK TO ALASKA. I'VE BEEN THERE BEFORE.
I KNOW WHERE IT IS.
I CAN GO BACK." AND I DIDN'T HEAR ANYTHING,
I DIDN'T HEAR ANYTHING. AND I THOUGHT, "WELL, HE KNOWS.
HE THINKS I'M A NUT." AND IT WAS JUST SORT OF BAD. HE HAPPENED TO BE ON VACATION,
SO HE DIDN'T GET HIS MAIL.

WE WERE EXTREMELY EXCITED
ABOUT THE POSSIBILITY. WE HAD HOPED THAT IF
WE COULD RECOVER MATERIAL FROM A FROZEN VICTIM THAT THE QUALITY
OF GENETIC MATERIAL
OF THE VIRUS MIGHT BE IMPROVED
OVER WHAT WE HAD IN THESE
FORMALIN-FIXED BLOCKS. AND HE CALLED ME HERE. AND HE ASKED,
"WHEN CAN YOU GO?" I SAID, "I CAN'T GO THIS WEEK,
BUT I CAN GO NEXT WEEK." AND I CALLED UP TO BREVIG. NOW THIS TIME WHEN I COME,
THE SECOND VISIT IN 1997, IT SO HAPPENED IT WAS IN AUGUST, AND THAT IS A MUCH BETTER TIME
TO DIG IN THE PERMAFROST. I WENT TO SEE THE MISSIONARY.
IT'S ANOTHER ONE NOW. PASTOR BRIAN CROCKETT
IS HIS NAME. HE'S STILL THERE. AND HE KNEW OF THE EXCAVATION
THAT I HAD CARRIED OUT IN 1951, AND HE ALSO KNEW
THAT I HAD TO GET PERMISSION TO DO IT AGAIN.

SO HE SAID IT WAS VERY–
IT WAS DIFFICULT. "YOU MAY NOT BE ABLE
TO GET A PERMISSION THIS TIME, "BUT I WILL– I WILL INTRODUCE YOU
TO RITA OLANNA." SHE WAS THE MATRIARCH IN 1997. AND LITTLE DID I KNOW
THAT HER GRANDMOTHER
WAS JENNY OLANNA. THAT WAS IT. IT WOULD NEVER HAVE HAPPENED
OTHERWISE. EVERYTHING DOESN'T GO WRONG
ALL THE TIME.

IT JUST LOOKS LIKE THAT,
BUT IT DIDN'T. HERE IT IS–CRUCIAL. DR. HULTIN PRESENTED HIS CASE
TO THE BREVIG VILLAGE COUNCIL, INCLUDING RITA OLANNA. HE MADE SURE THEY UNDERSTOOD
THAT THE VIRUS WAS DEAD AND COULD NOT CAUSE DISEASE. I ALSO TOLD THEM
HOW IMPORTANT IT IS, BECAUSE– "YOUR PARTICIPATION,
THIS IS WHERE IT BEGINS. "AND YOU'RE PART OF THE TEAM
NOW, THE VILLAGERS OF BREVIG, "AND I'M THE SPECIMEN COLLECTOR, "AND THEN
DR. TAUBENBERGER "IN THE ARMED FORCES INSTITUTE
OF PATHOLOGY. THESE ARE THE 3.
BUT IT BEGINS WITH YOU." AND I GOT THE PERMISSION TO GO. I FIGURED NO ONE WANTS
TO GO IN A GRAVE AND DIG
WITH BODIES, SO I WAS ALL SET
TO DO IT MYSELF.

AND SO ONE
OF THE MEMBERS SAID, "WOULD YOU LIKE
TO HAVE SOME HELP?" 4 YOUNG MEN, ESKIMOS, ASSIGNED
BY THE VILLAGE COUNCIL, ASSIGNED TO HELP ME. BECAUSE I HAD THE PHOTOGRAPH
WITH ME, I KNEW WHERE THE GRAVE WAS,
SO I MARKED IT OFF. THE END OF THE FIRST DAY,
WE WERE DOWN ABOUT 4 FEET, AND I DIDN'T SEE
ANYTHING AT ALL, AND 5 FEET THE FOLLOWING DAY. I NOTICED THERE WERE
SOME BODIES AT 7 FEET. FOUND A SKELETON, AND THEN NEXT TO THE SKELETON
WAS A WOMAN, AND PERFECTLY PRESERVED WITH– CLOTHING HAD FALLEN OFF,
ROTTED AWAY, BUT I COULD SEE THE SKIN,
AND IT WAS OF AN OBESE WOMAN.

I STARTED
TO DO THE POST-MORTEM. AND THEN I TOOK THE RIB CAGE OFF
AND THERE EXPOSED THE LUNGS, AND THEY WERE
THE TEXTBOOK PICTURE OF A PERSON WHO HAD DIED
FROM ACUTE VIRAL PNEUMONITIS, EXACTLY WHAT I NEEDED. THE SUBCUTANEOUS FATTY LAYER
OF LUCY–AND FAT INSIDE,
OF COURSE, ALSO– THAT HAD PROTECTED THE LUNGS
FROM THE OCCASIONAL THAWS
OF THE PERMAFROST THAT HAD REACHED 7 FEET DOWN. THE ESKIMOS ARE NOT OBESE– THERE'S NOT THAT MUCH FOOD
AROUND– AND THEY WERE ACTIVE
AND HARDWORKING, PARTICULARLY IN 1918. TO FIND ONE
WHO HAD EXTRA CALORIES,
STORAGE CALORIES, THAT WAS JUST REMARKABLE. AND HERE WAS A WOMAN
WHO HAD AMPLE FOOD, HAD A GOOD HUSBAND,
GOOD SEAL HUNTER,
WALRUS HUNTER, BROUGHT ALL THIS FOOD
FOR HER. CAN YOU IMAGINE HOW FORTUNATE? THEN I DECIDED BEFORE I LEAVE,
I'VE GOT TO MAKE NEW CROSSES TO SHOW MY GRATITUDE
TO THE VILLAGE. I HAD PHOTOGRAPHS
OF THE ORIGINAL CROSSES. I KNEW HOW TALL THEY WERE,
THE WIDTHS, EVERYTHING. I FINISHED MY WORK
WITH THE CROSSES AT 1:00, AND BY 8:00 THE NEXT MORNING,
THE HIGH SCHOOL KIDS CAME, AND THEY HELPED ME
PUT THE CROSSES IN. AND ABOUT AN HOUR LATER
THE BUSH PILOT LANDED, AND I GOT ALL MY SPECIMEN
ON BOARD, AND THEN I SHIPPED THEM
TO JEFFERY TAUBENBERGER.

THE ADVANTAGE THAT WE HAD
WAS THAT THE FORMALIN-FIXED
AUTOPSY TISSUE SAMPLES WERE EXTREMELY TINY,
JUST THE SIZE OF A FINGERNAIL, AND SO WERE VERY LIMITING, WHERE HE WAS ABLE
TO PROVIDE US LARGE SECTIONS
OF AN ENTIRE LUNG, SO THAT EVEN THOUGH THE QUALITY
OF RNA WAS LOWER, WE HAD SO MUCH MORE MATERIAL
TO WORK WITH. IT BECAME ABSOLUTELY CLEAR THAT WE WOULD BE ABLE
TO SEQUENCE THE REST
OF THE VIRUS FROM THAT MATERIAL. I FIGURED IT WOULD TAKE
WEEKS AND WEEKS BEFORE HE HAD ANY INKLING
THAT THE SPECIMENS WERE GOOD. LIKE, 10 DAYS LATER HE CALLED, AND HE SAID,
"JOHAN, WE HAVE IT. "THE SPECIMEN IS GOOD. "WE HAVE LOTS OF SPECIMEN,
GREAT MATERIAL, AND THIS IS GOING TO BE
WONDERFUL." IT WAS A GREAT DAY FOR ME,
BECAUSE STARTED IN 1951, AND FINALLY IN '97, HERE IT IS. MADE IT. BUT, AGAIN,
WITHOUT THE ESKIMOS IN BREVIG, NOTHING WOULD HAVE COME. THE EFFORT TO SEQUENCE THE ENTIRE GENOME
OF THE 1918 VIRUS FROM BEGINNING TO END
TOOK 10 YEARS. IT WAS A VERY LABORIOUS
PROCESS. MORE THAN 13,000 PIECES
OF GENETIC INFORMATION THAT HAD TO BE PUT TOGETHER
AS A TOTAL, SO IF HE GETS A SEQUENCE OR A…

A STRETCH OF A GENE, A LITTLE PIECE, SO HE HAS IT,
LOOKING AT IT HERE, AND HER GENE IS THIS LONG
WHEN IT'S FULLY BUILT, AND THIS PIECE,
WHERE DOES IT FIT IN? HERE? FIT IN HERE? OR IS IT IN THIS END, HERE?
OR IS IT THIS WAY? WHAT COMES TO THE LEFT
AND THE RIGHT? AND DAY AFTER DAY,
MONTH AFTER MONTH, PUTTING THESE THINGS TOGETHER
YEAR AFTER YEAR. SO, 13,000 PIECES PLUS PIECES
HAD TO FIND ITS PROPER PLACE, AND IT'S INCREDIBLE. IT'S CLEARLY A VIRUS
THAT WAS HUMAN ADAPTED, BUT GENETICALLY
IT'S VERY BIRD-LIKE
IN ITS SEQUENCE. IT'S VERY AVIAN-LIKE. AND SO WHAT WE THINK
IS THAT IT IS AN ENTIRELY AVIAN-LIKE
INFLUENZA VIRUS THAT SOMEHOW ADAPTED
TO HUMANS. WE NOW KNOW THAT THERE ARE
A NUMBER OF MUTATIONS IN SEVERAL OF THE GENES THAT ARE ABSOLUTELY CRUCIAL
IN THE ADAPTATION TO HUMANS.

AND SO YOU COULD IMAGINE
USING THESE MUTATIONS
AS A SCREENING TOOL TO ASSESS THE SIGNIFICANCE
OF A BIRD STRAIN AS TO WHETHER IT WAS
ACTUALLY MOVING ALONG THE PATH THAT WOULD MAKE IT ADAPT
TO HUMANS. IF WE IDENTIFY CHANGES
THAT WERE CRUCIAL TO ALLOW A BIRD VIRUS
TO REPLICATE IN HUMANS, YOU COULD PARTICULARLY
DESIGN DRUGS THAT MIGHT BLOCK OR BIND
TO THAT PARTICULAR CHANGE TO PREVENT A BIRD VIRUS FROM
ACTUALLY FUNCTIONING IN HUMANS.

THE 1918 FLU HAD
AS ITS MOST UNIQUE FEATURE THE FACT THAT IT HAD
A HIGH PROPENSITY TO KILL YOUNG ADULTS
AGES 15 TO 40. EVEN HAVING THE ENTIRE SEQUENCE
OF THE VIRUS IN FRONT OF US, WE DO NOT YET UNDERSTAND
WHY IT BEHAVED IN THAT MANNER. I FAVOR THE IDEA THAT PEOPLE
IN THAT PARTICULAR AGE GROUP MIGHT HAVE HAD THE WRONG SORT
OF IMMUNITY TO THE 1918 VIRUS, SOME KIND OF IMMUNE RESPONSE THAT ACTUALLY MADE THEM
MORE SUSCEPTIBLE TO DIE. IN PEOPLE OLDER THAN
ABOUT AGE 45 OR 50 IN 1918, THERE MIGHT HAVE BEEN
PREEXISTING IMMUNITY TO VIRUSES SIMILAR
TO THE 1918 VIRUS. WE'RE TRYING TO IDENTIFY
INFLUENZA VIRUS-POSITIVE AUTOPSY TISSUE SAMPLES
FROM BEFORE 1918 TO TRY TO HELP US
FIGURE OUT THIS PROBLEM. JEFFERY TAUBENBERGER'S
RIGHT-HAND WOMAN, ANN REID–
VERY ACCOMPLISHED– SHE WAS SENT UP
WITH A PLAQUE FROM THE AFIP TO PRESENT IT
TO THE VILLAGE COUNCIL. IF THIS TAUBENBERGER'S WORK BRINGS ANTIVIRAL DRUGS
AND GOOD VACCINES AND THE SAVINGS OF HUNDREDS
OF MILLIONS OF LIVES, IT BEGAN WITH RITA OLANNA AND JENNY OLANNA. ANOTHER QUESTION
ABOUT THE DEATH TOLL
IN THE 1918 FLU PANDEMIC WAS HOW PEOPLE DIED AFTER
THEY BECAME ILL WITH THE FLU.

DR. TAUBENBERGER
AND DR. MORENS EXAMINED NOT ONLY THE AUTOPSY TISSUES
IN THE AFIP COLLECTION BUT ALSO AUTOPSY REPORTS
FROM ALL OVER THE WORLD OF PEOPLE WHO HAD DIED
OF PANDEMIC INFLUENZA. WE FIND THAT THE VAST MAJORITY
OF PEOPLE DYING DIED BECAUSE OF SECONDARY
BACTERIAL PNEUMONIA. WHAT WE THINK HAPPENED IS THAT
A VERY VIRULENT INFLUENZA VIRUS CAUSED SUCH AN EXTENSIVE
INFLAMMATORY RESPONSE
IN THE LUNGS AND CAUSED SUCH TISSUE DAMAGE, THAT BACTERIA LIKE STREP
OR PNEUMOCOCCUS THAT ARE VERY COMMONLY
CARRIED IN THE THROAT
OF NORMAL INDIVIDUALS COULD SPREAD DOWN INTO THE LUNG
AND CAUSE A DISEASE THAT WOULD ULTIMATELY
ACTUALLY KILL THE PERSON.

THE EVIDENCE
OF THE BACTERIAL PNEUMONIAS I THINK HELPS EXPLAIN WHY
YOU HAD SUCH HIGH MORTALITY IN MILITARY CAMPS
PARTICULARLY. WHILE THIS IS VERY IMPORTANT IN TRYING TO UNDERSTAND
WHAT HAPPENED IN 1918, IT ALSO HAS
SIGNIFICANT IMPLICATIONS FOR PANDEMIC PLANNING
IN THE FUTURE. WE'VE REALLY SEEN AN EXPLOSION
IN INFORMATION ABOUT INFLUENZA IN THE LAST 10 OR SO YEARS, BECAUSE PRIMARILY,
I THINK, OF SEQUENCING
OF THE 1918 VIRUS, BUT ALSO THE UNUSUAL EVENTS
ASSOCIATED WITH THE H5N1 VIRUS,
THE BIRD FLU VIRUS. WE'VE BEEN WATCHING THIS PARTICULAR
AVIAN INFLUENZA VIRUS FOR OVER 10 YEARS NOW. THESE VIRUSES
ARE HIGHLY TRANSMISSIBLE FROM BIRD TO BIRD, AND THEY CAN DESTROY
A FLOCK OF BIRDS. BUT THE MOST IMPORTANT THING
FROM THE PUBLIC HEALTH
PERSPECTIVE IS THAT HUMANS WHO HAVE VERY CLOSE CONTACT
WITH THE INFECTED BIRDS OCCASIONALLY
CAN BECOME INFECTED BY THIS VIRUS.

OVER 60% OF THOSE WHO HAVE
BECOME INFECTED HAVE DIED. MANY MORE PEOPLE
HAVE BEEN EXPOSED TO THE VIRUS THAN HAVE BECOME INFECTED. IN ORDER FOR THIS
AVIAN INFLUENZA VIRUS
TO CAUSE A PANDEMIC, WE WOULD HAVE TO SEE
A NUMBER OF CHANGES THAT WOULD OCCUR
IN THE VIRUS SO THAT THE VIRUS
COULD BE TRANSMITTED EASILY FROM HUMAN TO HUMAN TO HUMAN. THE FACT THAT
THE AVIAN INFLUENZA VIRUSES THAT WE'RE MONITORING
SO CLOSELY HAVE BEEN CIRCULATING
FOR 10 YEARS AND STILL HAVEN'T CAUSED
A PANDEMIC DOESN'T MEAN THAT THESE VIRUSES
WILL NOT CAUSE A PANDEMIC. WE DON'T KNOW
FOR PAST PANDEMICS HOW LONG THOSE VIRUSES
ACTUALLY CIRCULATED, CAUSED INFECTIONS IN HUMANS, AND THEN GAINED THAT ABILITY
TO BE TRANSMITTED EFFICIENTLY. SO WE DON'T KNOW ENOUGH
ABOUT PAST HISTORY TO PREDICT THE FUTURE. I THINK THE BIGGEST LESSON IS THAT WE CAN'T PREDICT
WHAT INFLUENZA WILL DO.

AS SCIENTISTS CONTINUE
TO LOOK FOR ANSWERS IN THE 1918 FLU VIRUS, WE CAN ALSO LEARN
FROM THE MEN AND WOMEN WHO RESPONDED
TO THE HEALTH CRISIS BY TAKING IT UPON THEMSELVES
TO CARE FOR THEIR RELATIVES, THEIR NEIGHBORS,
AND THEIR COMMUNITIES. DR. JOHN TAPPAN WAS A PHYSICIAN WITH THE PUBLIC HEALTH SERVICE
IN EL PASO, TEXAS. HE WROTE TO A COLLEAGUE SERVING AT AN ARMY FIELD HOSPITAL
IN FRANCE. Tappan: "WE HAVE ALL BEEN
AWFULLY BUSY WITH THE "FLU." "I MADE ON AN AVERAGE
OF 30 CALLS A DAY
FOR ABOUT A MONTH, "AND EVERYONE ELSE DID
AS MUCH OR MORE.

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"THE PUBLIC HEALTH SERVICE
AND THE RED CROSS "OPENED A HOSPITAL
IN THE OLD AOY SCHOOL, "WHERE WE TREATED
THE MEXICAN PART OF TOWN. "THE EPIDEMIC HERE
WAS FIERCE. "WE HAD ABOUT 10,000 CASES
IN EL PASO, "AND THE MEXICANS DIED
LIKE SHEEP. "WHOLE FAMILIES
WERE EXTERMINATED. "THE WHITE POPULATION FARED
ALMOST AS BADLY. "I WAS 3 DAYS BEHIND
IN MY CALLS. THE OTHER DOCTORS ALL HAD
THE SAME EXPERIENCE, OF COURSE." Narrator:
WHEN THE PEOPLE LIVING IN
OTHER PARTS OF EL PASO LEARNED OF THE MANY DEATHS
IN THE SOUTHERN PART OF THE CITY NEAR THE BORDER WITH JUAREZ, MANY VOLUNTEERED
TO USE THEIR CARS AS AMBULANCES, PICKING UP THE SICK
AND DELIVERING THEM TO HOSPITALS IN OTHER PARTS OF TOWN.

WHEN THE AOY SCHOOL
IN THE CHIHUAHUITA NEIGHBORHOOD WAS TURNED INTO A HOSPITAL
FOR FLU PATIENTS, EL PASOANS FROM
ALL OVER THE CITY VOLUNTEERED AS NURSES, DRIVERS, AND CLERKS. Tappan: "SO YOU SEE,
WE HAVE BEEN SERVING OUR COUNTRY RIGHT HERE AT HOME."/ THAT EPIDEMIC HELPED
THE COMMUNITY TO GET TOGETHER, BECAUSE EVERYBODY HELPED
THAT COULD, GAVE THEIR HOUSES
OR THEIR HELP OR WHATEVER THEY HAD
PEOPLE NEEDED– THAT NEEDED IT. SO THAT HELPED THE COMMUNITY,
BOTH JUAREZ AND HERE. THERE WAS A SHORTAGE
OF DOCTORS AND NURSES DURING THE 1918
INFLUENZA PANDEMIC BECAUSE SO MANY
OF THE PHYSICIANS AND NURSES WERE SERVING
IN THE WAR EFFORT. SO YOU HAD A MIXTURE OF BOTH
TRAINED MEDICAL PERSONNEL AND THOSE WITH SOME TRAINING, AND THOSE WHO BASICALLY
WERE VERY CIVICALLY MINDED
INDIVIDUALS WHO WANTED TO PARTICIPATE
IN TENDING TO THE ILL. THE WOMEN WHO VOLUNTEERED DURING
THE 1918 INFLUENZA PANDEMIC WERE LITERALLY PUTTING
THEIR LIVES ON THE LINE.

THEY WERE STEPPING
INTO A DEADLY PANDEMIC BECAUSE THEY BELIEVED
THAT IT WAS THEIR CALLING, AND THEY WANTED TO DO
WHAT THEY BELIEVED
WAS THEIR DUTY. I WOULD SAY
THAT THE ACTIVITIES
OF VOLUNTEERS, AND PARTICULARLY
WOMEN VOLUNTEERS WHO ROSE TO THE CHALLENGE, WAS ABSOLUTELY CRUCIAL. THIS IS A STORY
OF UNSUNG HEROES,
OF FORGOTTEN PEOPLE WHO REALLY ROSE TO THE GRAVITY
OF THE MOMENT. Morens: IN VILLAGES
IN ALASKA, FOR EXAMPLE, THE WHOLE VILLAGE
WOULD BECOME SICK AT ONCE. THERE WOULD BE NOBODY
TO PROVIDE FOOD, NOBODY TO PROVIDE SHELTER. THESE THINGS
CAN A MAKE A DIFFERENCE. AND EVEN IN WEALTHY NATIONS
LIKE THE UNITED STATES, THE CONCLUSION
AT THE END OF 1918 AND 1919 WAS THAT THE SINGLE
MOST IMPORTANT THING THAT COULD SAVE YOUR LIFE
FROM FLU WAS GOOD NURSING CARE. NOT MEDICINES, NOT DOCTORS,
NOT HOSPITALS, BUT GOOD NURSING CARE. WHEN YOU FIRST READ THOSE
THINGS, YOU'RE LIKELY TO SAY, "THAT CAN'T BE TRUE.
WHAT COULD THEY DO
IN THOSE DAYS?" YOU KNOW, WHAT'S CHICKEN SOUP
GONNA DO? WHAT'S A BLANKET
GONNA DO? I BELIEVE THE DATA.
THEY'RE STRONG.

AND SOME OF THE BEST
AND SMARTEST PHYSICIANS,
NURSES, AND OTHER OBSERVERS SAID IT AGAIN AND AGAIN–
"GOOD NURSING CARE." EVEN THOUGH NO ONE KNEW
WHAT CAUSED INFLUENZA IN 1918, SOME COMMUNITIES TOOK STEPS TO PREVENT THE SPREAD
OF THE DISEASE. Markel:
IN OUR GROUP AT THE CENTER
FOR THE HISTORY OF MEDICINE, WE HAVE BEEN LOOKING
AT 43 AMERICAN CITIES
DURING THAT PANDEMIC TO SEE EXACTLY WHAT THEY DID
TO STAVE OFF THE EPIDEMIC, OR WHAT THEY DIDN'T DO,
FOR THAT MATTER. WHAT WORKED, WHAT DIDN'T WORK.
AND WHAT WERE THEIR RECORDS? AND WHAT WE FIND IS THAT THOSE
THAT ACTED VERY EARLY WITH A SUITE OF CLASSICAL
PUBLIC HEALTH INTERVENTIONS– THINGS LIKE QUARANTINE,
CLOSURE OF SCHOOLS,
BANNING PUBLIC GATHERINGS– IF THEY ACTED VERY EARLY, BEFORE THE EPIDEMIC HAD A CHANCE
TO SPREAD TO A LOT OF PEOPLE, KEPT THESE MEASURES ON
FOR A LONG TIME AND USED MORE THAN ONE
OF THESE MEASURES
AT THE SAME TIME, THOSE CITIES
HAD A MUCH BETTER RECORD
IN TERMS OF CASES AND DEATHS THAN THOSE CITIES THAT DID NOT.

I THINK THERE'S A MOUNTAIN
OF STUFF THAT WE'RE LEARNING FROM THE 1918 PANDEMIC THAT APPLIES TO PEOPLE TODAY OR IN THE NEAR
AND DISTANT FUTURE. WE HAVE LEARNED
FROM THE EXPERIENCES
OF THE 1918-1919 PANDEMIC. BUT THAT'S ONLY ONE
OF THE FACTORS THAT MAKES US BETTER PREPARED
TO DEAL WITH INFLUENZA PANDEMICS THAN THE WORLD WAS IN 1918. THERE ARE
EXTRAORDINARY ADVANTAGES. SOME OF THEM ARE PRETTY SIMPLE, LIKE EXPERIENCE OF WHAT SEEMED
TO WORK IN SOME CITIES, LIKE SOCIAL DISTANCING
AND AVOIDING CROWDED PLACES– THINGS THAT WERE NOT NECESSARILY
FULLY APPRECIATED. SOME CITIES DID IT
AND DID WELL. BUT MOST IMPORTANTLY WE HAVE
BIOMEDICAL AND HEALTH CARE AND TECHNICAL ADVANCES
THAT WE DIDN'T HAVE. WE HAVE VACCINES. WE DIDN'T HAVE VACCINES THEN
FOR FLU. WE DIDN'T EVEN KNOW
WHAT THE MICROBE WAS. WHEN THEY WERE DEALING
WITH IT, MANY PEOPLE THOUGHT IT WAS
SOME STRANGE FORM OF A BACTERIA AND NOT NECESSARILY A VIRUS. NUMBER 2,
WE HAVE ANTIVIRAL DRUGS– FOR EXAMPLE, TAMIFLU
AND RELENZA AND OTHERS.

WE DIDN'T HAVE IT THEN. WE HAVE ANTIBIOTICS TO TREAT
THE SECONDARY COMPLICATIONS, THE BACTERIAL COMPLICATIONS
OF INFLUENZA. WE HAVE MUCH BETTER TECHNOLOGIES TO TREAT ACUTELY
AND SERIOUSLY ILL INDIVIDUALS LIKE EFFICIENT,
GOOD RESPIRATORS,
INTENSIVE CARE UNITS, PEOPLE WHO HAVE EXPERTISE
IN MEDICINE THAT'S ACUTE CARE MEDICINE. ALL OF THESE THINGS
WE DID NOT HAVE BACK THEN. WE HAVE THEM NOW. OUR PARENTS AND GRANDPARENTS HAD LITTLE WARNING
OR CHANCE TO PREPARE, BUT WE KNOW NOW THAT INFLUENZA
HAS CAUSED PANDEMICS
AT INTERVALS FOR AT LEAST
THE LAST 500 YEARS. PUBLIC HEALTH OFFICIALS
HAVE BEEN PREPARING FOR THE NEXT FLU PANDEMIC, KNOWING THAT IT COULD BE
A MILD PANDEMIC, AS IN 1968, OR AS SEVERE AS IN 1918. THE WORLD IS WATCHING
A NEW PANDEMIC FLU VIRUS- THE NOVEL H1N1 FLU VIRUS– WHICH EMERGED
IN THE SPRING OF 2009. WE KNOW THAT
THE NEW 2009 H1N1 VIRUS IS IN ALMOST EVERY COUNTRY
OF THE WORLD ALREADY.

FORTUNATELY SO FAR, THE 2009 H1N1 VIRUS
DOESN'T APPEAR TO HAVE THAT LEVEL OF SEVERITY
THAT THE 1918 ONE HAD. THE 2009 H1N1 VIRUS
IS AFFECTING PEOPLE DIFFERENTLY THAN SEASONAL FLU STRAINS. THE ILLNESS IS MOST COMMON
IN YOUNG PEOPLE– CHILDREN AND YOUNG ADULTS– BUT WE'RE ALSO SEEING
HOSPITALIZATIONS AND DEATHS IN PARTICULAR IN PEOPLE
WHO HAVE CONDITIONS THAT INCREASE THEIR RISK
OF COMPLICATIONS. PREGNANT WOMEN HAVE REALLY
BEEN HEAVILY HIT BY THIS VIRUS. IN THE UNITED STATES,
AND REPORTS AROUND THE WORLD, SUGGEST THAT NATIVE POPULATIONS
MAY HAVE A HIGHER RISK OF SEVERE ILLNESS CAUSED
BY THE 2009 H1N1 STRAIN. WE WANT TO BE READY AND WE WANT TO MAKE SURE
THAT THESE POPULATIONS
ARE SERVED AND THAT THEY HAVE
GOOD ACCESS TO HEALTH CARE
AND TO THE VACCINATION. EVERYONE HAS THE EXPERIENCE
THROUGHOUT THE WORLD THAT THE BEST WAY
TO CONTAIN INFLUENZA IS BY GETTING A VERY EFFICIENT
AND SAFE VACCINE. VACCINES, GIVEN
THE CURRENT TECHNOLOGY AND EVEN IN MORE MODERN
TECHNOLOGY, YOU DON'T MAKE A VACCINE
OVERNIGHT. YOU HAVE TO FIRST FIND OUT WHAT THE VIRUS IS
YOU'RE DEALING WITH, AND THEN YOU GO
THROUGH A MULTI-STEP PROCESS IN ORDER TO GET ENOUGH VACCINE TO PROTECT THE POPULATION.

THAT MULTI-STEP PROCESS
GENERALLY TAKES SEVERAL MONTHS, USUALLY ALONG THE LINE
OF 6 OR MORE MONTHS. VACCINATION IS
A REALLY IMPORTANT PART OF OUR RESPONSE
TO THE 2009 H1N1 VIRUS, BUT IT'S IMPORTANT TO SAY
IT'S NOT THE ONLY PART OF IT. WE HAVE A WHOLE SERIES
OF MITIGATION EFFORTS AND A WHOLE SERIES
OF COMMUNICATION EFFORTS. PUBLIC HEALTH OFFICIALS ARE
FIGHTING THE SPREAD OF INFLUENZA WITH THE HEALTH HYGIENE
WE LEARNED AS CHILDREN– STAY HOME WHEN YOU'RE SICK, WASH YOUR HANDS FREQUENTLY
WITH WARM WATER AND SOAP
FOR 20 SECONDS, PRACTICE COUGH
AND SNEEZE ETIQUETTE, AND AVOID TOUCHING YOUR EYES,
NOSE, OR MOUTH. AT THE START OF A PANDEMIC, THAT'S THE MOST EFFICIENT TOOL
WE'LL HAVE IN ADDITION
TO OBVIOUSLY SOCIAL DISTANCING, LIKE STAYING HOME
WHEN YOU'RE SICK AND SO ON.

BUT WE ARE A COMMUNITY
THAT HUGS, THAT SHAKES, THAT HAVE ELEVATORS
THAT YOU NEED TO RIDE ON TO GO TO DIFFERENT PARTS
OF A BUILDING. WE GO GROCERY SHOPPING,
AND WE NEED TO PUSH OUR CARTS. EVERYTHING YOU DO,
BASICALLY YOU NEED
TO TOUCH SOMETHING THAT OTHER PEOPLE TOUCH, AND SO THAT HAND-WASHING BIT
WOULD BE VERY CRITICAL. THESE GOOD HABITS
AND VACCINATION ALSO PREVENT THE SPREAD
OF SEASONAL FLU. AN ANNUAL IMMUNIZATION
FOR THE SEASONAL FLU HELPS PEOPLE STAY HEALTHY
AND HELPS HEALTH WORKERS PREPARE TO VACCINATE THE POPULATION
DURING A PANDEMIC. THESE IMMUNIZATIONS
ARE WIDELY AVAILABLE
EVERY YEAR. IT'S VERY IMPORTANT
FOR PEOPLE, PARTICULARLY PEOPLE
WHO ARE 65 AND OVER, TO TAKE THE INFLUENZA
IMMUNIZATIONS. IT'S IMPORTANT
TO HAVE THE VACCINE EVERY YEAR, AND THE VACCINE
IS A COVERED MEDICARE BENEFIT. THERE'S ABSOLUTELY NO WAY
YOU WILL GET THE FLU
FROM THE FLU SHOT. BASED ON WHAT I KNOW AND WHAT I HAVE BEEN OBSERVING
WITH THIS 2009 H1N1 VIRUS, AND BASED ON WHAT I KNOW
ABOUT INFLUENZA VACCINES, THE RISK
OF GETTING INFLUENZA OR HAVING A COMPLICATION
FROM INFLUENZA IS MUCH HIGHER
THAN ANY THEORETICAL RISK
FROM THE VACCINES.

IT'S IMPORTANT
FOR PEOPLE TO KNOW THAT NOT GETTING VACCINATED
ALSO PUTS YOU AT RISK. A HUNDRED MILLION PEOPLE
GET INFLUENZA VACCINE EVERY YEAR
IN THE UNITED STATES. THEY HAVE A STRONG
SAFETY TRACK RECORD, AND THE 2009 H1N1
INFLUENZA VACCINES ARE BEING MADE
EXACTLY THE SAME WAY THAT THE SEASONAL FLU VACCINES
ARE MADE. A LONG-TERM GOAL FOR SCIENTISTS
WORKING ON FLU VACCINE IS TO DEVELOP A VACCINE
THAT WOULD PROTECT AGAINST ALL SEASONAL
AND PANDEMIC INFLUENZA. WE GENERALLY REFER TO THAT AS
A UNIVERSAL INFLUENZA VACCINE, AND I THINK THERE'S
A REAL POSSIBILITY TO THAT. I DON'T THINK
IT'S GONNA BE EASY TO DO. WHAT WE'RE WORKING ON– WHEN I SAY "WE," I MEAN
THE SCIENTISTS IN THE FIELD– IS TO IDENTIFY THE COMPONENTS OF ALL INFLUENZA VIRUSES
THAT DON'T CHANGE AS THE VIRUS DRIFTS
OR EVEN SHIFTS.

AND THEN YOU'VE GOT TO
PUT THAT IN WHAT WE CALL
AN IMMUNOGENIC FORM, NAMELY A FORM THAT WHEN
YOU INJECT IT INTO A PERSON OR YOU SPRAY IT
INTO THE NOSE OF A PERSON, THAT THAT PERSON WILL MAKE
AN IMMUNE RESPONSE THAT'S VERY ROBUST. THERE ARE A LOT OF PEOPLE
WORKING ON IT. IT'S A HIGH-PRIORITY PROJECT. EVERY YEAR
WE HAVE FEWER ELDERS TO REMIND US
OF THE TERRIBLE TIME THEY, THEIR FAMILIES
AND THEIR COMMUNITIES ENDURED IN 1918 AND 1919, BUT WE NEED TO KEEP
THOSE MEMORIES ALIVE. THERE'S A LOT OF THINGS
TO BE LEARNED FROM CONTINUING
TO STUDY THE 1918 FLU. I THINK THE IMPORTANT LESSON IS THAT PANDEMICS
CAN BE VERY SERIOUS BUT ALSO, PANDEMICS
CAN BE WIDESPREAD
BUT NOT THAT SERIOUS. THERE'S A GRADATION
OF SEVERITY OF PANDEMICS.

YOU ALWAYS MUST PREPARE
FOR THE WORST-CASE SCENARIO EVEN THOUGH YOU MIGHT HAVE
A MILD PANDEMIC, LIKE OCCURRED IN 1968, OR AN INTERMEDIATE PANDEMIC
THAT OCCURRED IN 1957. Frieden:
THE CURRENT PANDEMIC
IS MUCH LESS SEVERE SO FAR THAN THE PLANNING SCENARIOS
THAT MOST OF US HAD HAD. IT COULD BE
THAT IT BECOMES LESS SEVERE AND DOESN'T AFFECT
A LOT OF PEOPLE. IT COULD BE
THAT IT BECOMES MORE SEVERE AND MUTATES
TO A DEADLIER VIRUS, WHICH WOULD BE TERRIBLE
AND VERY DIFFICULT TO MANAGE. IT COULD BE THAT IT CONTINUES
ALONG THE WAY IT'S BEEN SO FAR. ONLY TIME WILL TELL. WE HAVE TO BE READY TO PIVOT
AND RESPOND DIFFERENTLY IF THE VIRUS CHANGES. THE ONE THING YOU CAN PREDICT
ABOUT INFLUENZA IS THAT IT'S UNPREDICTABLE. WE STILL KNOW MUCH LESS
THAN WE'D LIKE ABOUT INFLUENZA, BUT THE EXPERIENCES
OF THE INDIVIDUALS WHO ENDURED THE PANDEMIC
OF 1918 AND THE RESEARCH
INTO THAT PANDEMIC CONTINUE TO CONTRIBUTE TO OUR UNDERSTANDING
OF THE DISEASE. WE ARE INFINITELY
BETTER PREPARED NOW THAN WE WERE 100 YEARS AGO, BACK IN THE BEGINNING
OF THE 20th CENTURY.

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