“You always liked Nathaniel more than you liked me, Dad.” said Michael, whining like an unhappy pre-teen. “Just because I didn’t like to dissect frogs or pickled pigs. It wasn’t fair. That’s why I went into the stand-up comic business instead of the autopsy business. I’m crushed, Dad. My own father doesn’t love me.”
“Enough, Michael. More than enough. You’re not on the stage. I love you both, you and Nat,” Dan said. “And you and Nat are both pushing fifty, Michael. You can handle your strengths and what I politely refer to as your lesser strengths, without whining. You are not boys; you are men – and aging ones, at that. Wait – ‘maturing’ is the adjective I like to use about myself – it sounds less bad than ‘aging’. Nat, let me start with the initial impression I have, from having read some of the homework you suggested. There are – and there have been for many hundreds of years – thousands of years, actually – lots of pandemics. The underlying bugs – the viruses, the microbes – can get inside a bird or an animal or a human, and multiply. The creature the bugs infect has an immune system, which often can destroy the invading bugs. Or the human can ingest a medicine, or a vaccine, that will kill or isolate the bugs – so the human ends up with something like a bad cold that goes away. And normally the invading bugs aren’t readily transmitted in the air – for instance, from a sick bird to a human. How’m I doing so far?”
“Just about right,” Nat said. “Not at all like an M.D. Unlike an M.D., most of your words are in English, not in what purports to be Greek.”
Dan kept chugging. “But the attacking microbes in many cases can adapt themselves in ways that make them resistant to the immune system. And if that’s the case, the microbes can disregard the humans’ immune defenses, and can make the birds or the pigs or the people very sick, or dead. That’s even more likely if the bug is a virus.”
“You’re brilliant, Dad.” Michael said. “Not since Joseph Lister came up with Listerine, or since big farmers figured out how to put the dung in dungarees. You’re my hero.”
Dan pressed on. “I’m no scientist, but I learned to read, and Nat helped steer me to what I should read. You might be able to do that, too, Michael, if you put your mind to it. What happened towards the end of World War I, in 1918 and 1919, was an outbreak of a kind of flu called Type A or H1N1 flu, that spread easily from bird to people and from one human to another, and that – unlike the usual flu – didn’t spare young adults. The result was that in a year or two, over 50 million people – some experts estimate as many as 100 million – were killed by flu. In numbers of people killed, that was, as John Barry put it on the uncheery cover of his book, ‘The Deadliest Pandemic in History.’ There may well have been other plagues that resulted in deaths that were fewer than 50 million, but were a higher percentage of the total population at the time of those plagues than the percentage killed in 1918-1919. That seems to have been the case of Black Death in the 1300s, which killed about a quarter of the people in Europe – killed at times when there were far fewer people around than there are now, or than there were after all the killings in World War I. Nat, what caused the huge number of deaths in the 1918-1919 flu?
“I don’t think that anyone knows for sure to this day. There’s a theory that the flu virus antigens – the things that the human immune system reacts to and tries to defend against – infected the patient’s lung tissue, triggering the immune system to attack the lungs, with the result that the patient had more and more trouble breathing, until the patient died. The sickness from the flu was repulsive. There would be an outpouring of blood from the noses of many patients. Other patients couldn’t get oxygen into their lungs, and turned blue, often dark blue, before dying. I believe the big dark blotches are what caused the disease to be known as the Black Death. And the 1918-1919 disease was spread through Europe and Asia.”
“Yech,” Michael said. “I just finished dinner, Nat. I’d like to keep down the food I ate, but it feels like it wants out. And I don’t want to feel blue or be blue – deep dark blue – and then drop dead.”
Dan kept talking to Nat, disregarding Michael. “I’ve read that the 1918 flu was an H1N1 flu. What’s that mean? What’s the H and the N?”
“H is for hemagglutinin, Nat said. N is for neuraminidase.”
“Thanks a whole hell of a lot, Nat,” Dan said. “Was what you just said a cheerleading chant? If so, it’s not a very catchy one. But it does sound like the kind of things doctors say.”
“Doctors do like long words, Dad. Patients often don’t have the heart to challenge unintelligible words or phrases. The H thing and the N thing are both names for antigens that stick out of the surface of a virus and that can mutate into different shapes. Virologists give different names to the H and N antigens, depending on the shapes the antigens take. What was scary about the 1918 virus, the H1N1 virus, was that there was a major shift to new forms of H and of N – forms of antigen that didn’t cause the death of the virus, but that were sufficiently different that the patient’s immune system couldn’t recognize the virus and protect against it. The result was the H1N1 virus – the 1918 virus – could multiply with great speed, attacking patients’ lungs, often resulting in the death of those infected. In the 1918-1919 outbreak, in Camp Devens, Massachusetts, alone, about 100 soldiers were dying every day – getting pneumonia, turning dark blue, and dying. In Philadelphia, over 600 died of the flu every day. According to John Barry, 33,000 people died from influenza in New York City. Welcome to the Big City!”
“How about vaccines? Did the doctors back in 1918 or 1919, in America or in Europe, come up with a new vaccine that stifled the viral attack?”
“Not so far as I know,” Nat said. “No one knows just why the flu went away. Most people think the flu became milder because nature took its course. Maybe the influenza cells that provoked a strong immune attack on the lungs, by killing patients, made it harder for the flu cells to multiply into huge swarms and to spread by coughing or touching to other people. Dead patients couldn’t cough out flu cells. Or maybe humans with fewer immune attacks on lungs were more likely to survive, and to develop at least partial immunity to the H1N1 virus. But the short answer is that within a year the flu had somehow been modified to become much less lethal.”
“What about nowadays? Could the 1918 virus, the World War 1 virus, come back again to attack us now?” Dan asked.
“Maybe so. Maybe it could. As I said, the influenza virus changes frequently, to be able to multiply without being killed by an immune system. Not too many years ago, there was a form of H1N1 virus that started with pigs, so it was known as swine flu. People were worried it would kill millions of humans, but it didn’t do so. Swine flu virus wasn’t the same as the World War 1 virus; it didn’t spread easily to people. But maybe someone could find in a freezer somewhere – maybe carefully preserved in a virologist’s icebox – some of the 1918 H1N1 virus – for which no effective vaccine was ever developed. A murderous plague could break out if that virus infected someone now. That’s because, to the best of my knowledge, no one ever developed an effective vaccine for the 1918 virus; instead, by trial and error, vaccine attacks may have built up people’s immunity to H1N1. Moreover, most of the people alive today were born quite a while after the 1918 H1N1 virus had mutated away from its lethal form, so very few of today’s people were ever exposed to the lethal form of H1N1 virus. As a result, they would never have developed immune system defenses to it – so that if they did get exposed to that virus today, they’d be much more likely to die than people who had wrestled with the virus and managed to live through it. Sustained exposure to virus by humans can help to build their immunity to the virus. Growing older can be helpful. There is, for example, an article in Scientific American that explains that the reason the life expectancy of humans is so much longer than the lives of other animals (the average life expectancy of chimpanzees is only 13 years, for example) is because humans, by their prolonged ex
posure to diseases, are likely to increase their immunity to viruses and other diseases.”
Michael chimed in. “Lots of things are good for you, Nat. Many doctors these days – probably many of your doctor colleagues, Nat – are telling us that if we want to live long strong lives, we should eat the excrement of others. The theory is that by becoming exposed to the thousands of different germs that lurk in the bowels of others, the shit-munchers will develop much broader gauge kinds of immunity, capable of withstanding many more kinds of disease.”
Dan and Nat paid no attention to Michael. “If I’m hearing you right, Nat,” Dan said, “what you’re telling me is that the slaughter in 1918 from H1N1 virus is like why many of the Indians in America dropped dead soon after being exposed to European settlers carrying diseases like smallpox – diseases to which many of the Indians had not yet built up any immunity. I’ve read somewhere that 56 million Indians in North America died from smallpox after being exposed to European settlers. That number is too precise to be credible to me – but there seems to be broad agreement that a lot of Native Americans died as a result of contact with the Europeans.”
“You got it, Dad,” Nat said. “When the Pequot in the 1630s encountered smallpox from contact with Dutch and English traders, close to 80% of the Pequot died of smallpox within a decade. The same kind of high mortality, a little later on, hit the Blackfeet and many of the other tribes. They hadn’t wrestled with smallpox before, and as a result they had not developed any way of fighting it. And in the 1918-19 influenza pandemic, several villages of Inuits in Alaska, who had never before been exposed to lethal flu, were entirely wiped out when they encountered it.”
Michael broke into song: “‘Youuu … light up my wiiiife.’ What do you think, fellows? Pretty good? Better than listening to Nathaniel on the likelihood of worldwide wipe-out, anyhow. I can’t say you two are bringing joy to the world, even though the Christmas season is drawing nigh.”
“We may bring in some legitimate concerns,” Dan said. “Nat, are the concerns limited to influenza?”
“You’ve looked at plenty of books on plague, Dad – from Gilgamesh until now. And I have to tell you that human knowledge of plague probably goes a lot earlier than Gilgamesh’s couple of thousand years B.C. Europeans for years viewed Neanderthals as brawny idiots, but recent studies of the bones of Neanderthal sites – for example, skeletons in the Shanidar cave in Iraqi Kurdistan, and more recent indications of Neanderthal diseases and genes being borne by other humans as a result of intermarriage with Neanderthals – have suggested that there were Neanderthal deaths by fighting and perhaps by exposure to diseases, and that some Neanderthals may also have developed immune genomes that defended against some diseases – immune genomes that may have gone back in some cases as far as 35,000 to 65,000 years ago.
“I don’t purport to be an expert on Neanderthal skeletons or genomes, but those topics have become hot in recent years. Most of the experts seem to say that the Neanderthals were a completely different breed of hominid – and, if so, the experts seem to see little chance that Neanderthal genomes guarded other hominids against pandemics. The simple fact is that plagues of different sorts surface or resurface from time to time, and have done so for millennia. Black Death, polio, Ebola, Marburg, Lassa, tuberculosis, AIDS, the coronavirus that leads to SARS (Severe Acute Respiratory Syndrome), smallpox, malaria, some kinds of influenza, yellow fever – you name it. It’s just a question of time before there’s another pandemic.”
“Lassa” Michael said. “There are Lassa lethal bugs, I guess. That’s not Lassa laughs. Damn, but I’m good. I also know that some of the earliest hominids wandered around a lot, and so were known as Meanderthals. There’s another Wowser from my lips!” Michael then sang “Plenty of sunshine coming my way,” before saying “I’m hanging up on this call because I have an important meeting with a large bottle of Scotch, which may well settle my stomach, or at least will render me senseless. I am flying the coop, leaving you two to coop the flu.”
Wherefore, as by one man sin entered into the world, and death by sin; and so death passed upon all men, for that all have sinned. (Romans 5:12)
5
The End of Grace
After the conference call with his sons, Dan kept on reading about plagues and their recurrences and changes. He started by reading the most recent CDC reports on influenza and vaccinations. The reports were not always easy to follow – or heartening. They included the possibility of exposure to one or more kinds of influenza virus that had not been included in that year’s flu vaccine. They also noted that some people, even if they had been vaccinated, could become infected with an influenza virus the current flu vaccine was designed to guard against. In addition, they noted that the flu vaccine worked best among young healthy adults and older children, and that older people (for example, Dan thought, people like him) tended to develop less immunity after vaccination than younger people did. CDC had also received reports of people who had been vaccinated, had become immune, and nevertheless had thereafter tested positive for influenza. Dan read materials that discussed the risk that efforts by Dutch researchers to develop a stronger form of bird flu (H5N1) for research purposes increased the likelihood that the modified bird flu would create a strain that was highly transmissible to and between humans. That would be, as one epidemiologist put it, “disastrous if it ever escaped the lab,” because most people had no immunity to H5N1. The possibilities of large numbers of deaths from human-transmissible H5N1 were real. The 1918 flu (an H1N1 flu), in killing between 50 and 100 million people worldwide, killed only about 3% to 5% of those who contracted the disease – while H5N1 flu killed almost 60% of those who became infected with that illness. The world’s population had soared between 1918 and the 21st century – from 3.5 billion to more than 7 billion. If 2 billion people contracted H1N1 in 1918, but only 100 million died, that number of deaths would look small compared to the number of deaths in the 21st century that could result if H5N1 became transmissible to people. In today’s world, if 3.5 billion contracted H5N1, and 60% of those who had the disease died of it, then 2.1 billion would have died from the flu. The numbers could be far worse if a new form of flu was more effective than most kinds of flu in acting as an avian flu, spreading flu from sick birds to people – an explosion of the sort that had been threatened by avian flu in China on several occasions in recent years.
By the time Dan had puzzled his way through these issues, it was mid-November. Dan celebrated Thanksgiving at home. His only companions in that celebration were two tasty bottles of Châteauneuf-du-Pape. Early on the morning after Thanksgiving, Dan biked, as he did on most mornings, to pick up the newspaper from Jimmy Madeiros’s news store, Rockinam’s center for news – both true and otherwise. As he entered the store at 5:30 A.M., when Madeiros opened the newsstand, Dan saw that Madeiros had cut out and posted on the glass center of the door of his store two excerpts from the local newspaper, the Rockinam Sentinel. That door window was where Madeiros normally posted obituaries, cut out from the newspaper, of recently deceased local men or women. In the feeble gray light of early winter morning, Dan squinted at the newspaper clippings on Madeiros’s door. One of the clippings was an obituary containing a picture of a large shapeless older woman. The obit, using conventional phrases typical of the local funeral homes, said the deceased, named Grace Stout, aged 69, was a widow who had “passed into everlasting life” after “a long hard fight with flu.” Dan recognized that the woman in the picture was the woman named Grace – the woman who had sneezed mucus on him at church in late October – the woman whose last name had not come to Dan’s mind. The name Stout, which leapt out from the newspaper obituary page, struck Dan as an apt but unfortunate name for a large heavy woman. According to the obit, Ms. Stout’s maiden last name had been Kennedy. Grace Kennedy was a name that sounded nice, and that might even have been well connected. Ms. Stout must have loved Mr. Stout, for her to take his nam
e in replacement of the Kennedy name, as part of his marriage to her.
The other obit posted in the Madeiros store window had a picture of a young man wearing a dark tee shirt. Dan recognized the man as the young father he had seen he had seen near St. James Church in late October – the young man whose black tee shirt had borne on its back a skull and cross-bones and the logo “We All Gotta Die Sometime.” The obit picture, a frontal view of the young man, did not show any skull, cross-bones, or logo. The text of the obit identified the man as Kurt Starkherz, who died aged only 28. The obit said he was an intern in the Rockinam hospital who was the son of Dr. Konrad Starkherz, a doctor in New York City. The cause of death was described as “complications from influenza.” The obit said that Kurt Starkherz had been predeceased earlier that year by his mother, Emily Starkherz, and had been survived by his wife, Georgia Starkherz, and their two year old son Hans Starkherz. Kurt Starkherz had also been survived by his father Dr. Konrad Starkherz and by his grandfather Dr. Klaus Starkherz.
Dan picked up a copy of the Sentinel in the just-opened news store. He had time to reread the two obituaries and to talk with Madeiros. “What are these two deaths about, Jimmy?” Dan asked. “I’ve heard of people in Rockinam getting fevers and coughing from flu – but they didn’t die from it, unless maybe they did so back in 1918 or 1919, when a lethal new virus was raging – but that was decades before even I, old as I am, was born.”
“I don’t have a clue,” Madeiros said. “Mrs. Stout wasn’t that all old. She may have been bulky – she surely was bulky – but she was reasonably fit. She didn’t drive much; she walked or biked all over town. Kurt Starkherz was still a kid. He wasn’t much over 25. And you would think he must have known a lot about medicine, being an intern at the Rockinam hospital, and having a New York doctor for his dad. Maybe Kurt died from a heart attack?”
Sometime- the Plague World Page 4
