IS THIS 1918?!
Flu Outbreak Spreads Across U.S. As Media Drops the Ball
Dr. Kent Sepkowitz looks at the strain of flu blanketing the country and whether a vaccine will work.
New York City and much of the U.S. are a week or two into a major influenza epidemic. Boston declared a public-health emergency Wednesday after reporting four deaths, and North Carolina is seeing its biggest number of cases in a decade. To place the problem into graphic corporate terms, the charts sent around to compare this year’s activity with other years’ have required rescaling to accommodate the scary red line going up and up.
Perhaps it’s not a surprise. After all, flu dilly-dallied last season, barely making a peep. So maybe we’re owed a compensatory wallop. But no one really knows just why this season is so bad. We try to do all the right things—we unceasingly rub our hands with waterless alcohol products, we have learned how to sneeze and cough into the crooks of our elbows, and of course, we are receiving more vaccine than ever: some states require it of their health-care workers, and the drugstore chains, with their wide reach and slippery advertising, have set about vaccinating everyone else.
So what went wrong? One alarming possibility is that this year’s vaccine against influenza is not well matched to the current disease-causing strains. This exposes a significant problem in the modus operandi of influenza-vaccine production—it’s mired in techniques and approaches developed before World War II; in fact, soldiers from that war were among the first to get this brand of vaccine. Here’s how it works: each year, around February, world experts select from a menu of dozens of just three influenza strains—two of flu A and one of flu B—to place into the coming season’s vaccine. More than three would require a shot with too large a volume and might blunt the body’s immune response. Once selected, the three viruses are grown painstakingly, on hens' eggs (what year is this?). Then, after a big-enough crop has been raised, the virus is killed, stabilized, and sent around for injections—all on the hope that the experts guessed right.
To date, the Centers for Disease Control and Prevention has found strong agreement between the vaccine strains and the current clinical strains, suggesting the vaccine ought to work just fine. But some clinicians have their doubts. This much activity, is the thinking, can only be due to extremely limited protection from vaccine. For some it feels like 2009 all over again, when the novel flu strain, so called because it had never previously been seen in people or animals, appeared. It was first recognized after spring-break revelers from Queens returned from south of the border. Because of its novelty, no vaccine was active against it (at least at the start), so we saw the unchecked spread of influenza zipping across the country in no time flat.
More testing will be done, and the circulating disease-causing strains again will be compared with the components in the vaccine. Until we know more, we should be thankful for one thing: though nasty enough, the number of fatalities is not horrific (yet). And unlike the flu of 2009, this one is not unusually severe in the pregnant or the obese. It’s just contagious—mighty, mighty contagious. So contagious that watching it play out makes you begin to understand the concept of a magic spell, so quickly does it seem to spread.
Despite all of this activity, flu, until the last day or two, hasn’t been much covered by the media, which usually love scary flu tales. I mean, this is not just an outbreak this year, but a real outbreak. Where is everybody? All right, there are a few hyperventilatory articles, including one about a “tent city” popping up outside a community hospital in Pennsylvania. Only a close read, though, reveals that the hospital had created an annex to swiftly and safely evaluate those with possible flu while keeping them apart from other patients who had not yet begun to sniffle. Those hoping to read about a “tent city” like that used in the great 1918 pandemic will surely be disappointed at the sight of the bulbous drapes raised in a lone parking lot.
It suggests that epidemics, like explosions and tsunamis, are of interest only if there is a body count to headline the story. Our all-news-all-the-time-except-real-news approach to information operates is if there were an extreme shortage of space, despite that we have hundreds of cable networks, endless radio stations, and, of course, the Internet, infinite in capacity, though with such a broad lunatic fringe encircling it that many have opted to remain within a very narrow boundary of a few dozen sites. Perhaps the lack of the crucial theatrical trinity of tragedy, death, and closure has made the current epidemic boring, giving the media the OK to duck their public-service responsibility of educating a vulnerable public.
Or perhaps they are showing deference to a CDC worried about explaining the mess. What if, after all their work to sell vaccination, it turns out that we have a mega-epidemic regardless? Looks bad, no? Actually, not. After all, we can't expect them to hit it right every year, hobbled as they are by using a 19th-century approach improved in the 20th century against this most 21st century of infections, the very wily and evasive influenza virus. This season’s hyperactivity demonstrates emphatically how critical vaccination is to control of influenza. If indeed the vaccine isn’t a good match this year, what we are seeing is, as in 2009 with novel H1N1, unchecked influenza spreading ruthlessly. In addition to the rare death, it ties hospitals into knots, forces drugstores to run out of medication, and makes work absenteeism a common event. Indeed, there can be no greater advertisement for vaccination or a louder call for better vaccines than the great influenza outbreak of 2012–13.