Dr. Bob Lutz: The forgotten pandemic

As is evidenced by an emerging theme in several of Jim Kershner’s recent “100 years ago in Spokane” features, one century ago was both a celebratory and yet dark time in our county’s history – while America was celebrating Armistice Day, a global influenza pandemic was starting to hit home. The Spanish flu of 1918 globally accounted for an estimated 500 million infections and more than 50 to 100 million lives lost, significantly more than died during World War I, the “war to end all wars.” Spokane was not spared of this devastation – over 11,000 residents fell ill between October 1918 and February 1919, representing nearly 11 percent of the city’s population, with some 562 people dying of complications.

Any present-day visit to a 1920s-era graveyard is impressive of both the pandemic’s magnitude as well its lack of discretion in who it took. My own exploration to a small northern California town and its aged cemetery many years ago was heartbreaking – decaying headstones and faint engravings of the names of infants and children, “our lost angels,” who succumbed in the span of a few days to weeks.

2009’s H1N1 pandemic, which claimed 12,469 American lives, was not near the scale of the Spanish flu, but still serves as a critical reminder that we’re not absolved from global outbreaks that can infect people easily and spread efficiently from person to person. Experts believe we’re increasingly susceptible to yet another influenza pandemic for a number of reasons. These include globalization and ease of travel, and the ever-changing nature of the virus itself, which makes it challenging to develop a “universal” vaccine.

Beyond influenza, more recent infectious disease outbreaks, such as Ebola in 2014, found international public health systems challenged. These events of a global nature require coordinated efforts across multiple national jurisdictions that are not always easy, whether because of politics, conflict, culture or mistrust of governmental interventions. Lack of dedicated resources and funding further affect efforts.

Over the next ten years, Congress plans to cut $1.35 billion from the national Prevention and Public Health Fund, to include a 12 percent decrease to CDC’s budget. This would impact its prevention efforts around emerging infections in hot spots like Asia and Africa. As Dr. Thomas Frieden, former director of the CDC, argued, epidemic diseases are “like terrorism … you’ve got to fight [them] where they emerge … [not] just within our borders.”

Going forward, efforts to address future epidemics will continue to rely on public health approaches to decrease risks to the public. These include surveillance, determination of individual- and population-level risk factors and vaccinations where and when available. Collaboration with both the public and private sectors around community mitigation strategies will also be needed. Coordination with health care organizations, such as those already occurring through Spokane Regional Health District’s timely provider alerts, ensure physicians and other providers are in-the-know about these situations as they occur and evolve. These behind-the-scenes public health efforts should provide assurance to our community that while we may not be able to prevent an epidemic from occurring, we can lessen its impact.

Dr. Lutz is a board-certified family medicine physician who is currently the health officer for Spokane Regional Health District and Asotin County Public Health.