Society’s ills: Three health catastrophies offer swine flu clues
How possible pandemic might spread, affect daily life
On Monday, the Presidential Council of Advisors on Science and Technology estimated that half the U.S. population could come down with swine flu, and 90,000 victims could end up dead.
Tuesday, the Centers for Disease Control and Prevention said no panic necessary; the numbers may be overestimates.
Bottom line: No one knows for sure if a pandemic is headed our way.
Studying past health catastrophes shows both how much has changed – and possibly how little, especially when it comes to human behavior.
“It’s important to understand what the impact is on society,” says Randi Lustig, Panhandle Health District’s program manager for epidemiology.
“For example, in the 1918 influenza epidemic, the fabric of society was torn. Essential services fell apart.
“(Epidemics) interfere with the sense of neighborhood. Families can break down. It happened in the 14th century, in 1918, and it can happen again. It doesn’t matter which germ or plague, it always has an impact on society.”
Here’s a look at three of history’s major health catastrophes.
The Bubonic Plague
Beginnings: The 14th century plague likely began in Central Asia and followed trade routes over land and sea. In October 1347, a merchant ship showed up in Sicily, dead and dying men at every oar, and from there the plague roared through Europe.
How it spread: By various means, depending on the strain, but fleas and rats were its most efficient carriers.
Symptoms: Its name comes from characteristic black swellings – in arms, armpits, legs, lungs and groin – called “buboes.” Symptoms included fever, headache, body aches, bleeding, extreme weakness and often, quick death.
In “A Distant Mirror: The Calamitous 14th Century,” Barbara Tuchman writes: “In the countryside peasants dropped dead on the roads, in the fields, in their houses. Though the death rate was higher among the anonymous poor, the known and the great died, too.”
Suspected causes: No one understood disease transmission back then, so many believed it a punishment from God; some thought the century’s prolific earthquakes were releasing deadly vapors.
The medical faculty at the University of Paris attributed it to an unusual alignment of Saturn, Jupiter and Mars. Christian zealots charged that Jews were poisoning village wells, leading to mass executions throughout Europe.
“Of the real carriers, rats and fleas, the 14th century had no suspicion, perhaps because they were so familiar,” Tuchman writes.
Treatments: Lancing the buboes, bloodletting, purging with laxatives, pills made of powdered stag’s horn.
Other name: Black Death.
Death toll: Historians estimate that the plague ultimately killed between 20 million and 30 million worldwide. By the beginning of the 15th century, Europe had lost between one-third and one-half of its population.
Societal impact: Depression and lethargy among survivors led to abandoned farms and villages and diminished crop production. But labor shortages helped peasants demand more for their labor.
Hope amid the ruins: From mystic Julian of Norwich, who lived through the plague years, “All shall be well and all shall be well and all manner of thing shall be well.”
The 1918 Influenza
Beginnings: The likely (though still disputed) origin of the lethal influenza mutation was Haskell County, Kan., in early 1918. The virus traveled across the state to Camp Funston, where an average of 56,000 men prepared for battle in World War I.
In “The Great Influenza: The Epic Story of the Deadliest Plague in History,” John M. Barry writes: “Funston fed a constant stream of men to other American bases and to Europe, men whose business was killing. They would be more proficient at it than they could imagine.”
Spread by: Contact with infected respiratory secretions.
Fatal symptoms: Mild symptoms morphed into vicious bacterial pneumonia. Victims turned blue from lack of oxygen and blood poured from their noses and mouths.
“The majority of deaths were not caused by the influenza virus acting alone,” the National Institutes of Health concluded in 2008. “The virus landed the first blow while bacteria delivered the knockout punch.”
Lethal decision: Dr. Wilmer Krusen, director of Philadelphia’s public health department, refused to cancel a huge Sept. 28, 1918 patriotic parade. Within 72 hours, the epidemic raced through Philadelphia, eventually killing most of its nurses and making orphans of hundreds of children.
Ultimately at least 500,000 Philadelphians fell sick. The city offered $10 a day to anyone willing to help dispose of corpses.
“Still the bodies piled up,” Barry writes.
Treatments: Doctors throughout the world “attempted everything” to save lives, according to Barry. This included injections with typhoid virus (thinking it would stimulate the immune system) intravenous injections of hydrogen peroxide and metallic substances, mustard plasters – and bloodletting.
Other name: Spanish influenza, primarily because the Spanish newspapers were the most open about the epidemic.
Death toll: It claimed between 21 million and 50 million people worldwide before dying out in 1920. As Barry points out, “Influenza killed more people in a year than the Black Death killed in a century.”
Societal impact: The influenza epidemic created the modern public health system and jump-started medical research that led to breakthroughs in treating viruses and pneumonia.
The local scene: Influenza struck the Spokane area in fall 1918, killing approximately 300 before it faded away in December.
“Undertakers held funerals every hour of the day,” according to a 1937 retrospective article. “Florist shops kept crews working 24 hours.”
Beginnings: The poliomyelitis virus may be as old as human beings.
“An Egyptian (artifact), dating from the period 1580-1350 BC and depicting a young man with a withered leg leaning on a long staff, suggests that polio has been endemic since ancient times,” writes Tony Gould in “A Summer Plague: Polio and its Survivors.”
Polio waxed in and out of epidemic status in the first half of the 20th century. By the early 1950s, as the baby boom population exploded, fear reached a fever pitch. Swimming pools and camps closed throughout the country.
Symptoms: Some sufferers went to bed fine and woke up paralyzed, due to the virus attacking the nerve cells of the arms, legs, trunks and lungs.
Spread by: Infected nose and mouth mucus or contact with infected feces.
Iconic symbols: Leg braces and iron lungs, which breathed for victims.
The cure: Jonas Salk’s vaccine was deemed safe and effective in 1955. In 1962, Albert Sabin’s oral vaccine gained favor. The vaccines basically eradicated polio in the United States, but efforts continue in developing nations.
Number of victims: Polio disabled more than it killed. In “Living with Polio: the Epidemic and its Survivors,” Daniel J. Wilson estimates that 1.6 million men and women survived polio in the United States. In its peak year, 1952, there were 58,000 new cases of polio.
Other names: Infantile spinal paralysis and teething paralysis, for its predilection for children.
Societal impact: The polio vaccine is one of the great medical success stories of the 20th century, but some scientists worry it has lulled people into a false belief that no virus can best human beings again.
The local scene: In September 1962, 108,000 Spokane-area residents lined up at Spokane schools to drink “Sabin punch.” According to news reports, it was the “largest mass immunization campaign undertaken in the state.”
Sad postscript: Many polio survivors, even those who fully recovered, have experienced post-polio symptoms as they age.