In early April of 2005, after a particularly rainy spring, an influenza epidemic (epi: upon, demic: people) exploded through the maximum-security hospital for the criminally insane where I have worked for the last ten years. It was not the pandemic (pan: all, demic: people) we all fear, just an epidemic. The world is waiting and governments are preparing for the next pandemic. A severe influenza pandemic will kill many more Americans than died in the World Trade Centers, the Iraq war, the Vietnam War, and Hurricane Katrina combined, perhaps a million people in the USA alone. Such a disaster would tear the fabric of American society. Our entire country might resemble the Superdome or Bourbon Street after Hurricane Katrina.
It’s only a question of when a pandemic will come, not if it will come. Influenza A pandemics come every 30 years or so, severe ones every hundred years or so. The last pandemic, the Hong Kong flu, occurred in 1968 – killing 34,000 Americans. In 1918, the Great Flu Epidemic killed more than 500,000 Americans. So many millions died in other countries, they couldn’t bury the bodies. Young healthy adults, in the prime of their lives in the morning, drowning in their own inflammation by noon, grossly discolored by sunset, were dead at midnight. Their body’s own broad-spectrum natural antibiotics, called antimicrobial peptides, seemed nowhere to be found. An overwhelming immune response to the influenza virus – white blood cells releasing large amounts of inflammatory agents called cytokines and chemokines into the lungs of the doomed – resulted in millions of deaths in 1918.
As I am now a psychiatrist, and no longer a general practitioner, I was not directly involved in fighting the influenza epidemic in our hospital. However, our internal medicine specialists worked overtime as they diagnosed and treated a rapidly increasing number of stricken patients. Our Chief Medical Officer quarantined one ward after another as more and more patients were gripped with the chills, fever, cough, and severe body aches that typifies the clinical presentation of influenza A.
Epidemic influenza kills a million people in the world every year by causing pneumonia, “the captain of the men of death.” These epidemics are often explosive; the word influenza comes from Italian (Medieval Latin ?nfluentia) or influence, because of the belief that the sudden and abrupt epidemics were due to the influence of some extraterrestrial force. One seventeenth century observer described it well when he wrote, “suddenly a Distemper arose, as if sent by some blast from the stars, which laid hold on very many together: that in some towns, in the space of a week, above a thousand people fell sick together.”
I guess our hospital was under luckier stars as only about 12% of our patients were infected and no one died. However, as the epidemic progressed, I noticed something unusual. First, the ward below mine was infected, and then the ward on my right, left, and across the hall – but no patients on my ward became ill. My patients had intermingled with patients from infected wards before the quarantines. The nurses on my unit cross-covered on infected wards. Surely, my patients were exposed to the influenza A virus. How did my patients escape infection from what some think is the most infectious of all the respiratory viruses?