Day 4: Pandemic Prescription—Generational Conflict

I hate to sound like one of those flu debunkers, but so far most of the cases arising here in New York are false alarms. This is hay fever season, so the prospect that a sneeze could kill has driven thousands to the emergency room. The pictures of corridors and sidewalk tents crammed with anxious people, paper masks askew, are reminiscent of 1918. (Sick people sure dressed better then.)

Many cases are undoubtedly influenza-Like Illness, which accounts for most symptoms in most years. (There are hints that catching the common cold might help fight flu.)

Most of these people are fine. Those who are genuinely ill will get less care because hysterical allergy cases are disrupting the system. That helps H5N1 circulate.

GLOBALLY AEROSOLIZED MICROBES! (David)So do toilets: Flushing infected waste aerosolizes microbes, churning them into a fine mist. Short people and children in particular ought to close toilet lids before they unleash clouds of nasty virions. (Don’t even think about airplane lavatories—those cramped and smelly plastic enclosures, brimming with germs so violently and constantly stirred….)

Stores are emptying. Pharmacies are arming guards. People are bashing pigeons in the streets. (Not the best idea if the birds are sick—peasants in Southeast Asia long ago learned what H5N1 can do to people who slaughter infected chickens and ducks.)

Before we succumb to pointless anxiety—as opposed to the kind that might make us prepare—I’d like to point out that Americans of differing ages face different risk levels.

Influenza is tricky. It works much of its harm indirectly. Even though seasonal flu concentrates on the very old, half of the elderly wind up succumbing to unrelated, opportunistic infections, mainly pneumonia. The flu virus weakens them and pneumonia bacteria swoop in for the kill.

Though seasonal flu can harm the very young, whose immune systems aren’t yet up to speed, it is easily repelled by teenagers and young adults, whose immune systems reject opportunistic infections, too.

Shelter From the Cytokine Storm

Pandemic flu brutalizes youth. It provokes a ferocious immune response that can run out of control—scorching a victim’s lungs beyond repair and flooding them with white gunk. People can turn blue for want of oxygen. Scientists disagree as to whether this is caused by the much-discussed cytokine storm, by which “the violent and uncontrolled immediate response of the immune system … destroys lung tissue by runaway inflammation.” (Sure sounds like what happened to that bus driver; here’s a charming video account of how a Deadwood, S.D., bordello madam saved the narrator’s upright grandparents from a cytokine storm during the Great Pandemic.)

The elderly are not a prime target of pandemic flu. They’ve survived so much that their immune systems are tired—too relaxed to kill them. In 1918, people over 65 accounted for only 1% of excess deaths. The rate at which folks over 75 were killed by influenza and pneumonia fell that year.

Among H5N1 victims, 90% have been under 40. Half were under 18, and most of those were 10 or older. Younger kids tend to survive nearly as well as people from 50 to 70, probably because their immune systems are too immature to put up a suicidal defense. Those aged 10 to 40 have the most to fear.

The elderly face a different peril: They stand to lose things they already rely on to stay alive. Our health system won’t offer much support or medication for such conditions as cancer, diabetes, or heart or lung disorders. A century ago there were numerous extra deaths during the pandemic from tuberculosis, whooping cough, and premature births.

Scientists have added obesity to the list of known flu risk factors that include asthma, pregnancy, and diabetes. That’s progress for you: In Flu: A Social History of Influenza, Tom Quinn quotes a doctor’s observation during the influenza pandemic of 1831 that “stout young men” and pregnant women were likelier to catch pneumonia.

For years, flu debunkers have proclaimed that our advanced civilization—our antiseptic society—could easily withstand an avian flu pandemic. I say sophistication cuts both ways: People didn’t depend on kidney dialysis systems in 1918. There weren’t millions living with cancer. This makes us more vulnerable to disruption, not less.

How will elderly Americans deal with traditionally fatal, chronic illnesses? Who will tend them? With what? In keeping with our just-in-time inventory system, the only stockpiles of medicine and ventilators are maintained by the Feds. I don’t know where the stuff is located, but it can‘t possibly suffice. Heck, I hear fuel is already running out. Coffins and body bags will be scarce. The only products that seem plentiful are bogus flu remedies featured in spam emails, texts, NFC, and calls.

The elderly feel vulnerable and they vote. The young are vulnerable to this flu and they do not. Expect resources to be misdirected.

A final note: I’m receiving a lot of email for a blog that’s only three days old. Some ask why I don’t let readers post responses. Good question.

I don’t want to have to monitor the site for abuse. Nor will I host debates about what politician would make a worse president, or which movie star or pop singer is doing more to fight bird flu, (Listen to the chorus of Smells Like Teen Spirit—lyrics & music about entertaining contagion here.)

I welcome email if you want to talk back. I'll respond to interesting points. Just don't expect me to publish them verbatim.