Deadly 1918 Epidemic Linked to Bird Flu, Scientists Say

Two teams of federal and university scientists announced today that they had resurrected the 1918 influenza virus, the cause of one of history's most deadly epidemics, and had found that unlike the viruses that caused more recent flu pandemics of 1957 and 1968, the 1918 virus was actually a bird flu that jumped directly to humans.

The work, being published in the journals Nature and Science, involved getting the complete genetic sequence of the 1918 virus, using techniques of molecular biology to synthesize it, and then using it to infect mice and human lung cells in a specially equipped, secure lab at the Centers for Disease Control and Prevention in Atlanta.

The findings, the scientists say, reveal a small number of genetic changes that may explain why the virus was so lethal. The work also confirms the legitimacy of worries about the bird flu viruses that are now emerging in Asia.

The new studies find that today's bird flu viruses share some of the crucial genetic changes that occurred in the 1918 flu. The scientists suspect that with the 1918 flu, changes in just 25 to 30 out of about 4,400 amino acids in the viral proteins turned the virus into a killer. The bird flus, known as H5N1 viruses, have a few, but not all of those changes.

In a joint statement, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr. Julie Gerberding, director of the Center for Disease Control and Prevention, said, "The new studies could have an immediate impact by helping scientist focus on detecting changes in the evolving H5N1 virus that might make widespread transmission among humans more likely."

The work also reveals that the 1918 virus is very different from ordinary human flu viruses.

From a letter written by a WWI soldier:

Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the Base Hospital for the Div. of the N. East.

This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assembleges of soldiers taboo.

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up.

There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.

The normal number of resident Drs. here is about 25 and that has been increased to over 250, all of whom (of course excepting me) have temporary orders-"Return to your proper Station on completion of work". Mine says "Permanent Duty", but I have been in the Army just long enough to learn that it doesnt always mean what it says. So I dont know what will happen to me at the end of this.

We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle.

An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows.

(from "A Short History of Nearly Everything" by Bill Bryson, published in 2003:)

"Almost 80% of American casualties in the First World War came not from enemy fire, but from flu. In some units the mortality rate was as high as 80%.

A fifth of the victims suffered only mild symptoms, but the rest became gravely ill and often died. Some succumbed within hours, others held on for a few days.

In the United States, the first deaths were recorded among sailors in Boston in late August 1918, but the epidemic quickly spread to all parts of the country. Schools closed, public entertainments were shut down, people everywhere wore masks. It did little good. Between the autumn of 1918 and the spring of the following year, 548,452 people died of the flu in America. The toll in Britain was 220,000, with similar numbers dead in France and Germany. No one knows the global toll, as records in the Third World were often poor, but it was not less than 20 million and probably more like 50 million.

In an attempt to devise a vaccine, medical authorities conducted tests on volunteers at a military prison on Deer Island in Boston Harbor. The prisoners were promised pardons if they survived a battery of tests. First the subjects were injected with infected lung tissue taken from the dead and then sprayed in the eyes, nose and mouth with infectious aerosols. If they failed to succumb, they had their throats swabbed with discharges taken from the sick and dying. If all else failed, they were required to sit open-mouthed while a gravely ill victim was helped to cough into their faces.

Out of - somewhat amazingly - three hundred men who volunteered the doctors chose sixty-two for the tests. None contracted the flu - not one. The only person who did grow ill was the ward doctor, who swiftly died. The probable explanation for this is that the epidemic had passed through the prison a few weeks earlier and the volunteers, all of whom had survived that visitation, had a natural immunity.

Much about the 1918 flu is understood poorly or not at all. One mystery is how it erupted suddenly, all over, in places separated by oceans, mountain ranges and other earthly impediments. A virus can survive for no more than a few hours outside a host body, so how could it appear in Madrid, Bombay and Philadelphia all in the same week?

The probable answer is that it was incubated and spread by people who had only slight symptoms or none at all. Even in normal outbreaks, about 10% of people have the flu but are unaware of it because they experience no ill effects. And because they remain in circulation they tend to be the great spreaders of the disease.

That would account for the 1918 outbreak's widespread distribution but it still doesn't explain how it managed to lay low for several months before erupting so explosively at more or less the same time all over. Even more mysterious is that it was primarily devastating to people in the prime of life. Flu normally is hardest on infants and the elderly, but in the 1918 outbreak deaths were overwhelmingly among people in their twenties and thirties. Older people may have benefited from resistance gained from an earlier exposure to the same strain, but why the very young were similarly spared is unknown. The greatest mystery of all is why the 1918 flu was so ferociously deadly when most flus are not. We still have no idea."

Later in the book Mr. Bryson illustrates how this planet belongs to microbes and they just let us live here. The more we learn the more we understand how truly bizarre organic life truly is.

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