(Note that all the quotes are referenced with clickable links at the end of this article)
How Nature Does Mass Immunization A Whole Lot Better Than Us!: Don’t Count Your Children ’til they’ve had the Pox, by A. Parent
Just to put Influenza into perspective in terms of its impact across our emerging fully modern nations, the following quote will give you an idea of the sort of numbers of deaths we are talking about. Bear in mind that the world by the early 20th Century is much more heavily populated than it was back in the Middle Ages when the Great Plague ran rampant (we’ll return to the Great Plague of old in the final chapter of this book and the fact that having the Pox of the Chicken variety may account for why we don’t hear of this great pestilence much these days).
The influenza pandemic of 1918
The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as “Spanish Flu” or “La Grippe” the influenza of 1918-1919 was a global disaster…
Bodies pil[l]ed up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers… The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages.
Billings, M. (1997)
Why this major pandemic Flu came to be known as the Spanish sort is revealed in the following along with a very interesting pattern of the different waves of Influenza and what may have fuelled its rage when it hit nearly all of the world between 1818-1819.
Limerick City and the Spanish Influenza Epidemic, 1918-19
The name ‘Spanish Influenza’came about not because it originated in Spain but because Spain was the first country to report, uncensored and unbiased, on the spread of the disease, due to its neutrality in World War I. It occurred in three waves; the first in spring 1918, the second in October/ November 1918 and the third in spring 1919…
. The demobilisation of troops in November 1918 (Armistice Day) could possibly account for the second wave of influenza which proved to be more deadly than its predecessor…
Buckley, M., (2014, 81)
Children in America even came up with a rhyme about this great pandemic as it swept across America and people could be arrested in the street if they sneezed as documented by Buckley in the following:
Limerick City and the Spanish Influenza Epidemic, 1918-19
…in Chicago, the police were instructed to arrest anybody who sneezed in public…
as the epidemic in America gathered speed, school children even came up with a rhyme about it to skip by…
I had a little bird and its name was Enza,
I opened the window and in-flew-Enza.
The situation in Ireland as recorded at the time and established from the historical accounts since reveals the impact felt across our nations as we were going through a near déjà vu of the Great Plague of the Middle Ages many centuries earlier.
Essentially, the first wave of Influenza is also described as being mostly confined to the main ports and then it appeared to become more aggressive and wider spread – impacting our entire nation by the second wave that had reached even the far reaches of the country by Christmas time (just as the Great Plague of the similar pattern for the Great Plague?). This can be seen in the following documenting the Flu’s arrival on Ireland’s shores.
Limerick City and the Spanish Influenza Epidemic, 1918-19 continued…
In Ireland, the first verifiable outbreak of the first wave can be traced to Cobh, when a US Naval ship, the USS Dixie, docked there in May 1918.
It seems that the first wave was somewhat more contained th[a]n the subsequent waves as it did not affect the entire country …
Confirmation of the onset of the second wave came from Howth during late September and this time all areas of the country were infected.
By Christmas, all counties had suffered an outbreak in both rural and urban areas…
The death toll was massive for such a small nation as Ireland. However, it was proportional to what other regions all around the world, both great and small, were feeling. Just to put this into perspective, it is estimated that hundreds of thousands had become ill from the Flu and maybe as many as 21,000 died in Ireland from the Spanish Flu of 1918-19. For such a small nation, this had a significant impact.
Review of: The Last Irish Plague: The Great Flu Epidemic in Ireland 1918-19, by Catriona Foley
…between spring 1918 and early summer 1919, resulted in the sickness of over 800,000 people on this island, and the related death of almost 21,000 of them (statistics of the Registrar General of Ireland 1918-19)…
Jones, M. (2016, Ill-Prepared)
Interestingly, the rest of the excerpted article goes on to describe how, running concurrently with this great pandemic, our scientists were frantically trying to find a solution, to what they obviously believed would keep killing relentlessly, unless we could stop it in its tracks, although, it proved unsuccessful as outlined below.
Review of: The Last Irish Plague: The Great Flu Epidemic in Ireland 1918-19, by Catriona Foley
From the early months of the Influenza Pandemic –in Ireland as elsewhere, attempts were underway in universities and laboratories in pursuit of a therapeutic vaccine for influenza.
They did not succeed: this influenza type infection was undoubtedly lethal, and they knew that it was not a bacteria; but they simply did not know, at this stage in the pandemic, precisely what order of complexity they were dealing with.
The Taming of the Flu
Now, when we assess the overall mortality for this spectacularly severe pandemic of 1918-1919, we can see that as bad as the statistics are worldwide and within our respective populations, we should bear in mind that for much of the greater proportion of those who got the Flu and fell ill, the result was not a death sentence. However, for its victims and their loved ones, it certainly would not have looked that way. The case to fatality rate is given in the following excerpt and it might surprise you just how many actually survived the Spanish Flu.
1918 Influenza: the mother of all pandemics. Could a 1918-like Pandemic Appear Again? If So, What Could We Do About It?
In its disease course and pathologic features, the 1918 pandemic was different in degree, but not in kind, from previous and subsequent pandemics.
Despite the extraordinary number of global deaths, most influenza cases in 1918 (>95% in most locales in industrialized nations) were mild and essentially indistinguishable from influenza cases today.
Taubenberger, J. K., & Morens, D. M. (2006)
Therefore, as tragic and ultimately devastating as the Spanish Flu was for so many families and communities, the vast majority survived the infection and even got off quite lightly in terms of suffering. It is hard to believe just how many survived the great Flu epidemic.
Furthermore, nobody knew that soon after, almost as suddenly as Enza flu in, this great pestilence flew out again. We know this from accounts on the ground at the time within Ireland as indicated within a newspaper article in the ‘Irish Times’ dating to the era.
November 9th, 1918: Relief as deaths from 1918 Spanish flu epidemic began to decline
IT WAS authoritatively stated yesterday that the influenza epidemic in Dublin is abating. The statement was based on the fact that there are very few fresh cases within the past few days…
On the whole, he stated, there was a decline.
Joyce. J (2009, Nov. 9th)
A clue to the disappearance of Influenza came when investigating some communities who had gotten off rather lightly as the most virulent eruptions of the Spanish Flu reached its tentacles into some of remotest parts of the world, but yet, many communities survived relatively unscathed who had no previous exposure, mild or otherwise to this viral pathogen. How?
The Places that Escaped the Spanish Flu
“These communities basically shut themselves down,” explains Howard Markel, an epidemiological historian at the University of Michigan who was one of the authors of the study. “No one came in and no one came out. Schools were closed and there were no public gatherings. We came up with the term ‘protective sequestration’, where a defined and healthy group of people are shielded from the risk of infection from outsiders.”
…When these measures were lifted in November 1918, as reports of cases in San Francisco were on the decline, the base experienced only mild cases, but at least three people did die…
But there may be some benefit to keeping the virus out for as long as is possible. American Samoa implemented a five-day quarantine for all boats that kept influenza from its shores until 1920. When it finally did arrive, the virus appears to have lost much of its sting and there were no deaths attributed to influenza in a population of more than 8,000. The main island of Samoa to the northwest, however, lost around a fifth of its population to the pandemic…
A similar story unfolded on the Australian island of Tasmania, which implemented strict quarantine measures for boats arriving on its shores that required all passengers and crew to be isolated for seven days. When the infection penetrated the island in August 1919, medical officers reported that it was a milder infection than that on the mainland. The death rate on Tasmania was one of the lowest recorded worldwide.
Gray, R., (2018, 24th October)
What happened? Quarantine should have meant that these people were just as vulnerable whether they were exposed to the pathogen at the beginning of the invasion or about a week later and had only delayed the inevitable. But, that is not what occurred. The cause of this strange, but, very reassuring anomaly of the timing and decreasing impact of the Spanish Flu pandemic becomes clearer when we look to other similar patterns as documented from epidemiological studies and observations on the ground at the time summarised next:
The Story of Influenza 1918 Revisited
One of the more interesting epidemiological findings in 1918 was that the later in the second wave someone got sick, the less likely he or she was to die, and the more mild the illness was likely to be.
This was true in terms of how late in the second wave the virus struck a given area, and, more curiously, it was also true within an area. That is, cities struck later tended to suffer less, and individuals in a given city struck later also tended to suffer less. Thus west coast American cities, hit later, had lower death rates than east coast cities, and Australia, which was not hit by the second wave until 1919, had the lowest death rate of any developed country.
Again, more curiously, someone who got sick 4 days into an outbreak in one place was more likely to develop a viral pneumonia … than someone who got sick 4 weeks into the outbreak in the same place…
The best data on this comes from the U.S. Army. Of the Army’s 20 largest cantonments, in the first five affected, roughly 20 percent of all soldiers with influenza developed pneumonia. Of those, 37.3 percent died…
In the last five camps affected—on average 3 weeks later—only 7.1 percent of influenza victims developed pneumonia. Only 17.8 percent of the soldiers who developed pneumonia died…
Inside each camp the same trend held true. Soldiers struck down early died at much higher rates than soldiers in the same camp struck down late. Cities struck later in the epidemic also usually had lower mortality rates… The same pattern held true throughout the country and the world… places hit later tended to suffer less…
Barry, J. M (2005)
As discussed in the rest of this article, it was difficult to reconcile some of the hypotheses offered for this strange phenomenon and, therefore, another explanation was required. One hypothesis that is offered by the author of the above study, albeit admittedly highly speculative, does appear to fit the evidence a whole lot better and is therefore excerpted in summary form below:
The Story of Influenza 1918 Revisited continued…
…At the peak of the pandemic, then, the virus seemed to still be mutating rapidly, virtually with each passage through humans, and it was mutating toward a less lethal form.
We do know that after a mild spring wave, after a certain number of passages through humans, a lethal virus evolved. Possibly after additional passages it became less virulent. This makes sense particularly if the virus was immature when it erupted in September, if it entered the human population only a few months before the lethal wave.
In other words, this rapid mutation to increased virulence and ultimately, a much less lethal form, may have been due to the number of pathogen passages (infections in individuals and their spread to others) through their human hosts. That doesn’t mean that this strain became genetically mutated, it just means that something may have occurred within the behaviour of the viral pathogens in the context of their human host – a dilution or filtering effect as the viruses passed through and between more and more people (hosts) during these waves.
Now to take this a little further, none of this would show up genetically, so we have to infer a plausible scenario from what we know of the behaviour of viruses within a host and some of the defences we might put up to defend ourselves against them.
For instance, we could say that the very fact that viruses require cells/hosts to begin replicating, unlike bacteria, viruses are not actually free-living independent organisms, perhaps they took a while to establish the full takeover (hijacking) of the host’s molecular machinery to get going (the first wave milder form), but once the immune system identified what they were doing (wreaking havoc in the second wave), it found a way to begin disarming these viral replicators and we find the milder impact again as the second wave was avoided for a certain amount of time.
This pattern of increasing attenuation of the different Influenza strains over the course of generations since the initial devastation of the Spanish Flu up to more modern era is also supported by the fact that the more we go forward in time, the less deadly Influenza becomes.
This commonality of a dramatic decline is further supported by the worldwide estimates of deaths recorded for each of the major Influenza pandemics that near-simultaneously swept across almost all our nations commencing with the mother of them all, the Spanish Flu of 1918 until around 1920.
Influenza Virus (Flu)
There were three influenza pandemics in the 20th century –the “Spanish” flu of 1918-19, the “Asian” flu of 1957-58, and the “Hong Kong” flu of 1968-69.
The 1918 flu, caused by a strain of H1N1, was by far the most deadly. More than 500,000 people died in the United States as a result of the Spanish flu, and up to 50 million people may have died worldwide…
The 1957 pandemic was due to a new H2N2 strain of influenza virus that caused the deaths of two million people, while the 1968 pandemic resulted from an H3N2 strain that killed one million people.
One pandemic has occurred so far in the 21st century. This was due to the novel swine-origin H1N1 virus which emerged in 2009.
Baylor College of Medicine (1998-2008)
You might notice that our world statistics in each of the major pandemics over the previous century from an estimated 50 million worldwide (Spanish Flu of 1918/19), dropping to two million worldwide during the 1957 pandemic and further declining to one million during the 1968 Influenza pandemic and this decreasing to relatively little by the first Flu pandemic of the 21st Century (the Swine Flu) as documented in the following.
And our most recent Swine Flu pandemic of 2009/10 produced worldwide statistics as low as just under 20,000 deaths as seen in the next excerpt.
Pandemic (H1N1) 2009
WHO: Weekly update
6th AUGUST 2010
– As of 1 August 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18449 deaths.
World Health Organisation (2010, update no. 12)
FIGURE. 8: Individual number of annual Deaths from Influenza in Ireland from 1864 until the mid-1990s when the cause of death was classified differently, being combined with Pneumonia in the registrar.
Notice that in Figure 8 shows the individual number of deaths recorded from Influenza alone, annually in Ireland since official records began that there were epidemic years prior to the more significant rise in deaths during the Spanish Flu pandemic of 1918-19.
You will see that the overall longer-term trend of the major spikes representing deaths from pronounced epidemics thereafter become less and less as we progress through the 20th Century. This, therefore, reflects the major worldwide estimates of each succeeding pandemic causing significantly fewer deaths as we move through time, only on another scale relevant to Ireland’s population size.
Note also that the Irish data does not record deaths from Influenza after the mid-nineteen-nineties as the official cause of death changed at that point to include Pneumonia. Furthermore, we know from the continued data recorded from other sources that deaths from Influenza after this point or even for the first pandemic of the 21st Century would hardly register on the above graph compared to what went before. It is only really since the 2009/10 (Swine Flu era) that the vaccine has been offered in Ireland to a broader range of individuals beyond the elderly and their carers.
This overall decline in deaths since the Spanish Flu era to marginal figures in our modern era is a pattern shared across our diverse nations where statistics of this kind are available. For instance, if we examine the graphs generated from statistics relating to deaths resulting from Influenza within the U.S. and compare this data directly with the Irish graph, the only difference between them is one of scale.
The proportion of deaths for a massive population in the U.S. would obviously be greater than a relatively tiny population within a country like Ireland. See Figure 1, Crude mortality per 100000 population, by influenza season (July to June of the following year), for seasons 1900–1901 to 2003–2004 (a) in, Doshi, P. (2008), Trends in Recorded Influenza Mortality: United States, 1900–2004 .
Similarly, near-identical patterns of proportional deaths from Influenza over the same essential time frame can be found in, Twentieth-century mortality trends in England and Wales, Figure 5, showing the age-standardised mortality rates for Influenza in England and Wales from 1901 to 2000 by Griffiths C and Brock A (2003) .
Indeed, the pattern of declining deaths from Influenza since the great pandemic of 1918-19 would appear to be a near-universal pattern experienced across our developing nations where an investigation into any of the relevant studies and statistics that are available recording deaths from this once deadlier contagion over a related time frame consistently demonstrates.
The Immunization Effect in Real-Time
Now to understand the importance of exposure to gain protection to Influenza, recall that there were three main waves during the Spanish Flu pandemic starting around 1918? Recall also as discussed earlier that once the virus had gotten a greater grip upon our populations as a whole that it appeared to become more aggressive after the milder first wave when it was just getting going?
However, it also looked like quarantine (even for less than a week) could make the difference between your community dying in large numbers or surviving the Flu’s worst effects as you were now facing a slightly delayed version of the most lethal second wave – and as argued above, this may relate to the attenuation (or weakening) of the pathogen as it filtered through more hosts and spread in its less lethal form.
This process of the later you were exposed to the virus, the more protected from its worst effects was a recurrent pattern seen within the same army camps, within the same cities and across entire countries and continents depending upon how delayed your exposure may be explicable due to being infected by a pathogen that had already been filtered through different hosts who had for the most part survived and therefore, their immune systems had learned rapidly how to disarm this invader and so each new host’s immune system becomes increasingly educated as it passes from individual to individual, community to community and finally, across entire continents around the world. This would have created global immunity.
Now, this attenuation process towards robust resilience to ultimately dying from any Flu strain or, conversely, explaining its high fatality in some age groups and not others – the unusual pattern of those impacted the most and those impacted the least during the Spanish Flu pandemic era.
Similar in some ways to those who protected themselves via quarantine (unwittingly saving themselves using their common sense) thus, protecting themselves from the more aggressive second wave strain when it first erupted and only had to face a much more attenuated and heavily filtered attack, it turns out that in many other cases during the Great Flu epidemic if you were lucky enough to have been immunized by the first and milder Influenza pandemic wave of 1918 or, any of its predecessors, you were also more likely to survive the deadlier second wave when it turned much nastier.
Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic
During the 1918 pandemic period, military nurses and medical officers were intensively and repeatedly exposed to the influenza A (H1N1) pandemic strain in clinics, in ambulances, and on crowded open wards. However, during the lethal second wave, nurses and medical officers of the Australian Army had influenza-related illness rates similar to, but mortality rates lower than, any other occupational group …
Similar observations were made in other groups of military and civilian health care workers … These findings suggest that the occupational group with the most intensive exposure to the pandemic strain had relatively low influenza-related pneumonia mortality rates during the second wave …
During the fall of 1918, all 40 large mobilization/training camps throughout the United States and Puerto Rico were affected by influenza epidemics…
During the camp epidemics, influenza–pneumonia mortality rates were inevitably highest among the soldiers with the least military service.
In the US Army overall, 60% of those who died of influenza-related pneumonia were soldiers with <4 months of military service …
Shank, D. & Brundage, J.F (2012)
In other words, the more previous exposure you had (preferably before the deadlier second wave but, even in the midst of it, the greater your resistance to the worst effects of these pathogens you became. And conversely, the least exposed and most naïve your immune system the more vulnerable you were in the face of the pathogen unless you were lucky enough to have quarantined yourself until the worst had passed.
However, most of these young fit and healthy men and woman with the least previous exposure would not have had the luxury of such protective measures. Indeed, this immunization or, attenuation effect may begin to fill out some of the blanks regarding the highly unusual pattern of who survived and died as a result of the Spanish Flu pandemic, an unusual conundrum which researchers have often grappled with as documented in the following.
How historical disease detectives are solving mysteries of the 1918 flu
The pattern of deaths by age was also intriguing. Young adults in their late 20s were at heightened risk. In contrast, influenza infections were frequent among teenagers, but these infections were mild. Senior adults were also less likely than young adults to die from influenza …
Why were older adults spared? One popular explanation is that well-connected populations who had seen influenza in the 19th century would be protected upon the return of a similar virus decades later. This is known as the “antigen recycling” hypothesis.
This hypothesis gained more traction during the 2009 pandemic, when older populations had higher levels of prior antibodies and therefore were less likely to die than younger populations.
…Moreover, patterns of infection and death may depend upon people’s prior immunity, imprinted by circulation of similar viruses within the last century.
The Conversation (2018, 5th March)
As indicated above, we may be looking at protection gained from previous exposure to a similar strain of Influenza in the face of another within the age group old enough to have been exposed to earlier pandemics recorded towards the late 1800s whilst growing up. And, as indicated above, we have evidence in more recent times of those who were children during the Spanish Flu pandemic having longlasting protection against the modern pandemic (Swine Flu) of the 21st Century that happened in 2009. We will return to this longterm immunity shortly.
However, as also indicated above, which is more perplexing (leaving aside the teenagers or small children not at war or away from home) is that it was some of our strongest, healthiest and fittest members of our populations who suffered the greatest fatalities during the Spanish Flu pandemic.
In other words, the highly unusual circumstances at the end of the Great World War may have given this strain of Influenza unprecedented opportunities to expand beyond their more restrictive horizons to previously unexposed fresh victims who had very little experience with any of the Flu strains.
Unlike their more seasoned counterparts who had more opportunities to become familiar with all manner of circulating Seasonal Flu strains up that point or with the bug in its milder as experienced by many during the first wave along with the children and teenagers tucked up safely at home with ample opportunity to be exposed to the milder form of the first wave as well, if not find they were infected by the much-attenuated form after it became nastier in the second wave if they were lucky enough to live on the West Coast of the United States versus the East Coast, or which part of the city you lived in or were you living remote enough (preferably inland away from incoming ships) or you found yourself in barracks hit slightly later than another barracks.
These young healthy adults apparently had, for the most part, simply missed the boat literally and metaphorically to get immunized naturally by the milder version. Essentially, even these healthy young adults who did survive were just as immune as those exposed to the very same pathogen – it was just a matter of luck whether you got infected in its milder or more deadly form.
For example, we find further clues to this phenomenon of rapid resistance built up from prior natural exposure with strong and incredibly long-lasting molecular imprinting – even in elderly people who had experienced the Spanish Flu first hand when young and who were still alive within our modern era to tell the tale as documented in the following excerpt. They probably became quickly immune to the second more lethal wave.
Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors.
Little is known about naturally occurring adaptive immunity to this virus; however, some elderly survivors are still living. We sought to determine whether survivors exhibited evidence of acquired immunity to the virus. Expression of the 1918 HA antigen allowed us to identify and characterize protective antibodies induced by natural exposure of humans to the 1918 pandemic virus.
We identified a panel of 32 subjects aged 91-101 years (i.e., aged 2 to 12 years in 1918), many of whom recalled a sick family member in the household during the pandemic, which suggested direct exposure to the virus. Of the subjects tested, 100% exhibited serum neutralizing activity against the 1918 virus .., and 94% had serologic reactivity to the 1918 HA (…), even though these samples were obtained nearly 90 years after the pandemic.
-Thus, these studies reveal that survivors of the 1918 influenza pandemic possess highly functional, virus-neutralizing antibodies to this uniquely virulent virus, and that humans can sustain circulating B memory cells to viruses for many decades after exposure – well into the tenth decade of life.
Yu, X., et al. (2008).
It certainly is beginning to look like our immune systems have been doing a fine job defending us over the generations and it may be worth being exposed to the real thing as it seems that at the very least, we are ensuring protection directly and indeed, indirectly against future strains. This becomes clearly evident when we take a closer look at our most recent pandemic – the first one of the 21st Century.
As we revisit our most recent worldwide pandemic, the 2009 Swine Flu outbreak, more research has emerged that demonstrates the possible cause of such low mortality figures across our nations may relate to the strains of Flu you were exposed to throughout your life, whether you knew it or not as indicated above and specifically from epidemiological data as indicated in the following.
This relationship between exposures to different strains over the course of the 20th Century and into the early 21st Century giving cross-protection is summarised in the following.
Your flu risk may be linked to the year you were born
Scientists stunned by own discovery
Influenza A viruses can be categorized into two groups…
As it turned out, the researchers found that people born before 1968 were more likely to be exposed to the group 1 viruses… and were less likely to suffer or die from infections with the group 1 virus H5N1 infections later in life.
In 1968, there was an influenza pandemic that had a multinational impact.
The 1968 pandemic marked the transition from an era of group 1 viruses to a group 2-dominated one, the researchers wrote in the study.
Therefore, people born after 1968 were more likely to be exposed to the group 2 virus H3N2 at a young age and were less likely to suffer or die from infections with the group 2 virus H7N9 later in life. For both groups, exposure at a young age not only lowered the risk of a severe infection with either H5N1 or H7N9, it reduced the risk of death by up to 80%, the researchers wrote in their study.
Howard, J., (2016, 10th November)
Furthermore, we can gain real-time insight into such infections from natural exposure and subsequent immunity during different Flu seasons in the following study which reveals just how quickly and robustly our immune systems adapt to all sorts of strains, including cross-protection from more familiar types to even those that have morphed rather dramatically.
Infection with influenza A H1N1: Effect of past experience on natural challenge
Following its reintroduction in 1978 influenza A HIN1 spread widely in the child population. By the autumn of 1979, 75 % of 11-year olds entering a boys’ boarding school had detectable antibody. The protective effect of previous experience could be assessed during two outbreaks in the school. In the first outbreak in 1979, 90 % of those known to have been infected in the previous year were protected against reinfection…
Previous experience conferred over 90 % protection against infection. Between the 1979 and the 1983 outbreaks there was no overt evidence of A HIN1 activity in the school although a few sporadic infections were identified in those investigated routinely or in connection with other infections…
First, with the re-emergence of A HINt in 1978, infections were virtually confined to young people. Those old enough to have had experience of strains before 1957 seemed to be immune.
Secondly, our own observations on A H3N2 in the school (Hoskins et al. 1979) suggested that natural infection gave good protection even against strains which had undergone considerable antigenic drift.
Thirdly, the 1979 outbreak showed that recent infection with A HINt gave good protection against reinfection.
Davies, J.R, Grill, E.A., & Smith, A.J (1985, Summary)
Not only did the boys survive their ordeal and were now almost all immune for life from being directly exposed to a strange attenuated mutant gone wild, but, they also showed immunity to Flu strains upon re-exposure in other Flu seasons.
Also of interest, as also noted in the above article, is that it was observed from other related studies that exposure to the A H3N2 strain (that newer tricky type which appears to have morphed considerably, what is called antigenic drift) resulted in fairly robust resistance even though these boys had no previous exposure to that particular variant before. This is what is called cross-protection from being exposed to another Flu strain that is not too dissimilar.
All in all, it would appear that we have built up quite an arsenal of immunity against all sorts of strains over the course of our life due to continual exposure, sometimes not even knowing it and the really good news is that these seasonal exposures can give you lifelong protection, but also set you up with some mighty protection against a pandemic strain that you haven’t even experienced yet as highlighted in the next excerpt.
Age-dependence of the 1918 pandemic
A growing body of epidemiological evidence indicates reduced risk of pandemic infection in those with previous seasonal exposure, and lifelong protection against viruses of different subtypes but within the same…Group
Woo, G (2018, 11)
That is fairly impressive cross-protection due to exposure to naturally circulating Flu viruses when we see that these exposures can provide protection to future pandemic strains (new mutations that impact the world) that haven’t even happened yet!
This increasing immunity to dying from all types of Flu strains, depending upon your exposure and familiarity – even to other strains you hadn’t directly experienced, is reflected in the world mortality estimates as we move through time in each recorded major pandemic from the Spanish Flu era onwards.
Immunity to Pre-1950 H1N1 Influenza Viruses Confers Cross-Protection against the Pandemic Swine-Origin 2009 A (H1N1) Influenza Virus
The 2009 H1N1 influenza virus outbreak is the first pandemic of the twenty-first century.
Epidemiological data reveal that of all the people afflicted with H1N1 virus, <5% are over 51y of age. Interestingly, in the uninfected population, 33% of those >60 y old have pre-existing neutralizing Abs against the 2009 H1N1 virus.
This finding suggests that influenza strains that circulated 50–60 y ago might provide cross-protection against the swine-origin 2009 H1N1 influenza virus.
Skountzou, I., et al. (2010)
It really does look like we have become robustly resistant, if not fairly immune, to just about all the strains that have been circulating over the last century? Perhaps that is just as well as, apparently, we haven’t been able to come up with a good alternative to natural immunity anyway, as you will see in the following article.
Are Flu Viruses Smarter than us?
Here’s why it’s so hard to make a better flu vaccine
Imagine you work in a high-security building. It uses facial recognition technology to keep out known intruders. It works well, until someone figures out how to use clever makeup, or even just grow a moustache to game the cameras. No matter how often the intruders are caught, new infiltrators find new disguises to help them get in.
That’s a little bit how the immune system works, and the flu virus is gaming that recognition technology. It sneaks past the body’s immune system to cause misery and mayhem, even as new vaccines update the biological equivalent of facial recognition software. Each year, a new influenza vaccine is formulated and distributed, and each year, viruses develop ways to evade them. Flu vaccines are never as effective as other vaccines, and the current vaccine only provides partial protection against the ongoing flu epidemic.
It’s an annual guessing game of sorts, one backed by data but also plagued with uncertainty. And when the guesses don’t exactly match the reality, as happened this past year, it can mean a dismal and deadly flu season. “We’ll do the best we can,” said Daum, a Chicago doctor who heads the Food and Drug Administration advisory committee that makes the recommendations. But “the virus is smarter than we are at this point. I don’t know of any disease that plagues us more. It’s very, very frustrating and a very inexact science. . . . We do it with varying luck, and I think the luck is mostly the virus’s whim.
Fox, M. (2018 Feb. 14th)
The reason I suppose our health officials worry so much about protecting us from Influenza is that not many of them think to look at the actual mortality statistics that paint a somewhat more reassuring, and certainly more realistic picture of what is going on from the ground up. By all accounts discussed thus far, we are almost all already fairly resistant against all strains of these pathogens.
But, you may not blame them if you realise the type of statistical estimates and projections that they follow, which are essentially built upon assumptions modelled on Spanish Flu-like proportions pandemics lurking behind every normal Flu season. These models have been criticised as being often too broad, ill-defined and frequently contradictory and vary widely from one another depending upon the systems used as discussed in some detail by, Doshi, P. (2008), in Trends in Recorded Influenza Mortality: United States, 1900–2004 .
So now you know that when you are given those really scary statistics for the amount of deaths caused by Influenza in each year – that they are wildly different modelled estimates that bear very little relation to the real mortality figures given for Flu deaths alone (not combined with Pneumonia a common complication that is itself declining in terms of mortality – it is just taking a little longer) and ever-decreasing incidence of Flu and the rarity of actual deaths caused by having the Flu.
For instance, apparently, in reality, as you will see from a recent study below, getting the actual Flu isn’t even as common as you might think and for almost all of us, it isn’t even that problematic. Just because the Flu circulates each season, doesn’t mean you’ll get it; most of us don’t and those that do, don’t even know they have the infection because it is so mild (asymptomatic) according to a long-term study as excerpted in the following:
Three-quarters of people with flu have no symptoms
“‘77% of flu infections’ have no symptoms, say experts,” reports ITV News. The news is based on a large community-based study carried out in England, which found that most people with influenza (“flu”) don’t have symptoms, and even if they do, only a small proportion go to a doctor.
The study was part of Flu Watch – a larger, ongoing study to assess the impact of flu on public health in England – and analysed five groups of people over six periods of influenza transmission, between 2006 and 2011. Participants provided blood samples before and after the influenza season, so that the amount of antibodies in the blood could be measured. They were then contacted every week so that cough, cold, sore throat, or any “flu-like illness” could be noted down. If any of these were experienced, participants were asked to complete a symptom diary and to take a nasal swab to test for the influenza virus.
Approximately 20% of people had an increase in antibodies against influenza in their blood after an influenza “season”. However, around three-quarters of infections were symptom-free, or so mild that they weren’t identified through weekly questioning. This is very much a “good news, bad news” story. It is good news in that so many people with a flu infection are spared the burden of a nasty infection. However, limiting the spread of a future pandemic could be challenging, as it would be unclear who is infected.
NHS, News (2014, 17th March)
Maybe our health officials should not be so frightened of the natural circulation of Influenza, as, after all, the actual circulation is becoming a thing of the past as statistics are also available for the actual incidence of cases of Influenza itself that would tend to suggest that we are not even catching the Flu as often these days.
For instance, a study out of the UK which followed Flu seasons spanning forty years, (just prior to the last pandemic starting in 2009) also noted that the cases of Influenza have also gradually receded as highlighted in the following with an indication that the ability of the viruses to adapt to multiple strains may, in fact, have their limit:
Lessons from 40 years’ surveillance of influenza in England and Wales
We show a gradually decreasing trend in the incidence of respiratory illness associated with influenza virus infection (influenza-like illness; ILI) over the 40 years and speculate that there are limits to how far an existing virus can drift and yet produce substantial new epidemics.
Fleming, D. M., & Elliot, A. J. (2007)
Therefore, perhaps it is a good thing that our rates of mortality and morbidity had already dwindled along with our cases of Influenza (is you even noticed you had the infection) significantly due to this highly robust cross-immunity protection well before we began to intervene with the natural immunity cycle to any great extent, as where would we be then without our exposure?
And thankfully, even if we are beginning to forget about this rather tricky viral shape-shifting pestilence, it seems that our immune systems don’t forget so easily.
Why Revive a Deadly Flu Virus?
New York Times Magazine
Flu viruses mutate very rapidly, and each season’s version is a little different. But your immune system preserves a memory of its previous encounters with a flu, which are dragged up, like old photographs from the back of a closet, every time your system responds to a new flu invasion.
Shreevejan, J. (2006, Jan. 29th)
The name of the game would appear to be, exposure and the more exposed you are, the greater your resilience and ultimate immunity, even to strains (cross-strain protection) that you may not have directly encountered as studies discussed above strongly suggest.
And certainly, this long-term memory is very encouraging indeed, as although there doesn’t appear to be any fundamental distinction between the Spanish Flu of 1918-19 and 2009 some ninety years later that would make one genetically more virulent than the other, the main difference appears to be our level of innate and generational resilience to the virus and all its variants due to familiarity. Obviously, with our health officials and scientists (immunologists) failing to keep up, or even getting the correct strain for the coming Flu season means that if we were relying solely on vaccination to keep Old Influenza at bay, our immune systems would be poorly educated at this stage.
However, having relied at a population – almost exclusively upon the Natural Immunization Cycle gives us great hope, particularly if someone released something like the Spanish type Flu upon our populations in say, a bioterrorist attack, which, is addressed in the next excerpt.
Scientists Believe They Have Explained The Great Flu Outbreak Of 1918
…The good news here is that much of the population has now been immunized against numerous strains of flu. While these might not be enough to stop people getting sick from a novel version, it should keep the death rates down if we experience something as potentially devastating as the 1918 outbreak again.
Luntz, S. (2014, 4th May)
So, essentially, nothing happened to the Spanish Flu; it never went anywhere in particular; it is just probably finding it difficult to infiltrate our mighty defences thanks to our sophisticated protein recognition system. In other words, we have been naturally immunized, now, isn’t that reassuring?
But, it gets better, as even more reassuring is the fact that overall, these Influenza viruses may have already lost a great deal of their earlier killing power by virtue of the fact that they have been circulating within us as their host over so many generations, further supporting the ideas that if Spanish Flu was genetically engineered and released out into the public, most of us may not even notice.
Thankfully, as we have already been exposed to so many strains of Influenza over each of our lifetimes, could this protection echo down through the generations?
There is also an indication that Nature has taken care of our future resilience and immunity too. For instance, recently emerging molecular evidence takes this dynamic of non-inherited transference of protection somewhat further. It is now looking quite likely that our immune systems can memorise past battles with pathogens, even well into the future, across the generations even when the threat is no longer present in an obvious way as indicated in the excerpt below.
Now, it looks very likely that we can inherit this hard-fought-for immunity, not just from our mother’s directly, but from their mother’s and perhaps generations of mothers before them as suggested by the following study – at least in pigeons.
GRANDMOTHERS CAN PASS IMMUNITY TO THEIR GRANDCHILDREN, AT LEAST IN PIGEONS
At the moment of birth, a newborn leaves behind its safe protective environment and enters a world teeming with bacteria, parasites, viruses, and infectious agents of all sorts. However, the babies do have one trump card: antibodies and immune compounds passed across the placenta from their mothers. These short-lived molecules can dip into mom’s immunological experience to protect the newborn until the immune system gets up to speed.
Now, a new study in pigeons suggests that some baby birds owe their early immunity not just [to] their mothers, but to their grandmothers as well.
Shultz. D (2015)
Obviously, it would be far more difficult to do similar studies with actual humans (we live too long for one), but, I think we can safely say that it is highly likely that us mammals do something similar. So, is it possible that not only does your Mother’s direct experience with seasonal or pandemic Flu (even if she didn’t know she had it) primed your immune system in a way that would protect you too, but your Grandmother’s experience, say, back in the days of the Spanish Flu, could somehow be protecting you living in our modern era from the same strain, or even related strain’s effects? Really, and you didn’t even need to get exposed directly at all!
RETHINKING THE ORIGIN OF CHRONIC DISEASES
Some modern-day diseases reflect the capacity of organisms to “memorize” responses to external signals and transmit them across generations …
the original causative agent may not be extant today, but “memory” of the infection has persisted.
Shoja, M.M et al, (2012)
In more recent years the number of studies investigating such immune priming (or prompting the more naive immune system to prepare in advance for what might try to attack them) protection across multiple generations (referred to as trans-generational inheritance) are advancing to show that indeed, this may be very likely, as outlined in the following excerpt:
Adaptive epigenetic inheritance
Roth et al. (2018) review recent advances in trans-generational immune priming, one of the most well-studied examples of trans-generational inheritance.
The transfer of parental immunological experience to enhance the offspring immune defence is present in both vertebrates and invertebrates, and can be inherited for multiple generations
Lind, M.I., and Spagopoulou, F. (2018)
In other words, as indicated in the excerpted studies above, adaptation and resistance to disease appear to be handed down through generations – and presumably, this also applies to humans. This, of course, goes directly against our current dogma of genetically driven adaptation, but, with so many studies emerging supporting this non-genetic inheritance, this dogma is finally changing and more studies are exploring such adaptive forms of evolution.
This gives us hope that even if a great infectious contagion of the past that once devastated our communities and loved ones, that due to natural immunity across the generations, even our children’s children may not have to face the same again; not even if they release the Spanish Flu out into our future grandchildren’s communities.
Therefore in answer to the question posed at the beginning, would we survive the Spanish Flu if it re-emerged today, I think we most certainly would and it seems our children and their offspring might actually become fully immune to it in the not too distant future and would also survive the Spanish Flu if it re-emerged even generations later – even if they didn’t even know what a Flu was.
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