Re: How would a 1918 type flu virus affect us in 2000?

That is a good question. There are those who would speculate that 1,400,000 people would die during the acute epidemic. This would be a simple extrapolation of proportional deaths based on the percent of the population 600,000 represented in 1918 - 1919. Of course that would be a terrifying event but it also would be very unlikely because of present knowledge about influenza, epidemiology and medical treatment.

There were several coincidences in 1981 that converged on the beginnings of this epidemic that might never occur this way again.

One rare coincidence was the fact that two or more genes encoding proteins responsible for the infectivity and virulence mutated and those mutations resulted in increased infectivity and virulence. Mutations occur in these proteins but often they reduce infectivity and virulence rather than increase it. If a protein responsible for virulence is changed the change is usually only a slight shift. In the case of the 1918 Flu the two antigens known to have changed, changed so dramatically that there was little or no cross reactive immunity from other Flu infections to reduce the disease.

The other rare coincidence was that the epidemic started just as the world was involved with World War I and huge numbers of military recruits were housed in cramped quarters at training camps, aboard ships, and in trenches in the battlefield. Since influenza spreads by aerosol, which is comprised of tiny droplets of moisture containing shed viruses that can remain airborne long enough to enter the nose, throat and lungs of neighbors who breath the contaminated air. The huge outbreaks of Flu among young soldiers who then mobilized all over the country and all over Europe served as a human Trojan horse that amplified the magnitude of spread of the epidemic. The likelihood that such a massive troop mobilization would be happening at the onset of a Flu epidemic would be very small today.

Furthermore, we now monitor (The CDC Monitors) serious cases of influenza and the specific antigens are determined so that the next year's vaccine can contain antigens from the most serious or infectious cases.

The epidemic of 1918 occurred when the fields of immunology and virology were in infancy and few hospitals had the ability to do serology for influenza and few could isolate and characterize a virus. Today, molecular biology has given us tools that supplement serological diagnoses and we anticipate will revolutionize viral diagnosis as these tools become licensed for use in hospital clinical laboratories.

The news that scientists at the Armed Forces Institute of Pathology had recovered and analyzed the RNA for the 1918 Flu virus from autopsy tissues archived since 1918, and scientists collected similar specimens from human cases that had been under permafrost above the arctic circle indicates that Gene probes could be available that would enable diagnosis of a Flu infection like the 1918 Flu within moments of its testing by this experimental system. The prototype system benefits from Polymerase Chain Reaction PCR technology and other linked technologies that allow identification of the PCR product in real-time. It took days to weeks in 1918 to even determine that the infection was caused by a virus and not a bacterium. The shortening of time for diagnosis by itself could be a significant reason to suspect reduced mortality from such an epidemic.

Availability of gene sequence information about the genes encoding proteins of influenza virus that were responsible for high virulence in 1918 could enable quick development of novel anti-viral drugs that inhibit attachment, uncoating, gene activation or replication would nip this influenza in the bud. The potential to make such claims frankly did not exist in 1918.

OK, so I am an optimist. The truth is an epidemic often starts before anyone becomes aware of it. There is often a period of time when people first realize something is wrong when numerous theories about what is wrong often interferes with the systematic process of isolating the agent, collecting specimens from sick people and analyzing both to determine what it is. Often the knowledge, skill and experience to do this effectively exists in a small poorly funded laboratory in an institute or university, maybe even a place that isn't known in every household. This is why quick effective communication about infectious diseases is as important as the technology in reducing morbidity (sickness) and mortality (death).

I hope these answers were useful to you and anyone interested in the topic.

Art Anderson