Many questions raised about Swine Flu
07 Oct 1976
Last week I talked about the worldwide influenza epidemic of 1918. It killed 21 million people in 11 months, more than twice as many as died in years of war. The problem is will it happen again? Even if it does, there are many questions to answer. Will it be as lethal a disease with the availability of present day antibiotics? Will it be the swine flu virus that causes the influenza? Could the vaccine be worse than the disease for some people? In essence, should Canadians run for the woods or roll up their sleeves for the shot?
The current fear of Swine Flu stems from a happening at Fort Dix in New Jersey in January 1976. Several healthy recruits developed influenza. One of them died from viral pneumonia. Laboratory studies showed it was the swine flu virus that was believed to be responsible for the 1918 pandemic. The virus, known to reside in swine, appeared to be again travelling from person to person.
Doctors cannot be certain that the virus now present in pigs is the one that produced 21 million deaths in 1918. The evidence is only circumstantial. But people who lived in 1918 do have antibodies in their blood most likely caused by the swine flu virus.
The optiists say that a virus that has remained in swine for 58 years may be quite different from the 1918 one. Most likely it has grown weaker. There is some evidence for this theory. For example, soldiers who contacted the Victoria flu virus were just as ill as the ones with the Swine flu. Moreover the Swine flu did not spread outside the camp. Yet you can’t escape the fact that a healthy soldier died.
Some experts say that an entirely new virus will cause the next epidemic. The Swine flu is simply an old hat virus so why get vaccinated for it? After all, it was the Asian flu in 1957 that infected 45 million people and killed 70,000. Then the Hong Kong flu in 1968 carried off 33,000 people. Why shouldn’t it be a different virus this time. Viruses have a reputation for being quick change artists. It’s also because of this trait that they are able to cause so much trouble.
The optimists drive home another point. The World Health Organization has 85 laboratories in 55 countries that constantly monitor influenza. They use 4,000 fertilized eggs every week to grow viruses. A worldwide alert for the Swine flu has not found any new cases. Normally a number of small outbreaks occur which “seeds” the population prior to a major epidemic. For this reason several top experts say the Canadian and U.S: governments are wasting more than $150 million.
What do the other experts say? One writing in the prestigious New England Journal of Medicine was less optimistic. He said there was a possibility the present Swine flu virus had caused the 1918 pandemic. It could cause the next one.
The pessimists also warn not to count on antibiotics. They agree that many people died from bacterial pneumonia that could be prevented by current drugs. Yet you could also stub your toe thinking this way. Many people in 1918 died from viral pneumonia which would be untouched by antibiotics.
There’s another important point to consider. Epidemic influenza can be a dramatically short disease. Whole families can be wiped out within 24 hours. By the time patients saw a doctor and obtained the antibiotics they would be too late to be effective. And tens of thousands of people in 1918 were never able to get to a doctor.
Besides, not all the victims of influenza die of pneumonia. Many are killed by myocarditis and encephalitis, and for these infections of the heart and brain there are no effective remedies.
What about the doctors who say they will wait and see what happens in other parts of the world? This is also a risky stance. The epidemic could begin in the U.S. or Canada. More important, this approach doesn’t leave sufficient time for action. For instance, in 1918 cases were first seen in Boston and Bombay, India, on the same day. At this point it’s too late to get organized. It’s hard enough to carry out a mass immunization program when you have ample time. It’s an impossible task when doctors and other health personnel are fighting an epidemic. So you make your move now or not at all.
Many patients have wrong ideas about the safety of the vaccine. Some think it may give them the flu. It’s a needless worry since patients are given a killed virus. This in turn stimulates the body to produce antibodies which protect against the virus. Public Health officials say it will work for about 80 per cent of the people who take it.
What about reactions from the shot? Approximately one person in every 100 will run a mild temperature for a day or two. And about 30 per cent will notice a slight swelling, redness and tenderness in the inoculated arm, which disappears in 24 hours. Severe reactions are very rare. Luckily the Ped-O-Jet apparatus gives a painless injection.
People who are allergic to eggs should stay clear of the injection. This is because the vaccine is grown in fertilized eggs and could cause a severe sensitivity reaction. Other people who have a fever should side-step the injection until it sub-sides. And it’s wise not to take the flu shot if other vaccines such as tetanus or measles have recently been given.
In assessing the pros and cons of the vaccine keep this in mind: in the middle-ages people didn’t have a choice during an epidemic. They only treatment was to paint a red cross on the stricken home with the words “God have pity on us.” In the 1918 pandemic doctors still had nothing of value in their black bags.
But suppose a vaccine had been available? I’d bet the 21 million victims would have been down on their hands and knees begging for it.
In preparing these two articles I’ve talked to numerous experts on the subject. In my opinion there are two basic points to remember. First, the potential benefits of the vaccine far outweigh the risk. Second, none of the experts can assure me an epidemic won’t happen. It’s for these reasons I’m rolling up my sleeve for the vaccine.
Gifford-Jones is the pseudonym for a practising physician. He expresses opinions and in general terms not be considered advice to anyone who may have a medical problem.
Vintage articles by W. Gifford-Jones, MD are posted for the purposes of sharing the historical record of the writings of one of Canada’s longest-serving and well respected medical journalists. Information may be out-of-date and readers are reminded to always consult with their doctors on any matters pertaining to their own personal health.
