How scary is the avian flu?
I get frequent emails from Mother Nomad regarding various viruses and bacteria that are out there ready to destroy mankind. I even posted an early article on the bird flu last Feburary here. Before the bird flu, Mother Nomad would send me SARS stories and so on.

While I do find these stories unsettling, I've been reluctant to get carried away with the fear. My thinking is that, maybe things are just different enough today to make another 1918 flu pandemic an entirely different event. Things I ponder include:

--how many of the deaths in 1918 were directly due to the flu, and how many were due to secondary bacterial infections? If bacterial infections played a prominent role in the mortality, then the discovery of antibiotics will greatly mitigate this aspect in a future outbreak.

--how has medical protocol changed since 1918 that might also have a positive impact. I remember reading somewhere that cholera used to be a terrible threat in much of the Third World, because medical treatment didn't focus on simple hydration therapy to combat it. Millions died of dehydration, brought on by cholera, when providing simple fluids would have saved many of them. Are there corresponding changes in the treatment of common viruses that will have similar mitigating effects?

--what role, if any, will over-the-counter anti-inflammatories and anti-fever drugs play in reducing mortality. Do the effects of these drugs help to mitigate the effects of the illness beyond merely reducing the tangible symptoms?

--will better standards of living, improved sanitation, and better general health in the population mean a higher survival rate?

-- will a better understanding of infectious diseases, and corresponding steps by medical professionals to reduce spread in places like hospitals help to stifle an outbreak, once it starts?

Viruses are scary. They can and do kill. But, I'm skeptical about whether human beings (at least in the West) are as vulnerable as we were 90 years ago.

This bit on Instapundit is what made me want to put my thoughts down:

IS AVIAN FLU BEING OVERHYPED?-

Excerpt:

As a medical researcher, I want to make a gentle but sincere plea to the blogosphere to calm down this flu hysteria just a bit. The main way that flu kills is by predisposing its victims to "superinfection" by bacterial illnesses - in 1918, we had no antibiotics for these superimposed infections, but now we have plenty. Such superinfections, and the transmittal of flu itself, were aided tremendously by the crowded conditions and poor sanitation of the early 20th century - these are currently vastly improved as well. Flu hits the elderly the hardest, but the "elderly" today are healthier, stronger, and better nourished than ever before. Our medical infrastructure is vastly better off, ranging from simple things like oxygen and sterile i.v. fluids, not readily available in 1918, to complex technologies such as respirators and dialysis. Should we be concerned? Sure, better safe than sorry, and concerns about publishing the sequence are worth discussing. Should we panic? No - my apologies to the fearmongers, but we will never see another 1918.

Patrick Cunningham M.D.
Assistant Professor of Medicine
Section of Nephrology
University of Chicago - served up by Nomad @ 7:11 PM