Epidemic, an outbreak of a deadly disease, it’s the plot of a multitude of post-apocalyptic science fiction movie. It’s the catalyst for the zombie apocalypse craze splashed across TV and the movies. The scenario is one of the most fearful, a microscopic, virtually invisible invader killing everyone it infects. The worst part is, there seems to be nothing capable of stopping the indiscriminate rampage across the population. But that’s all confined to the movies and the demented imagination of genre writers, right? Sure. But then along comes ebola. A hemorrhagic fever, an infection with a high fever that causes its victims to bleed from the inside out. The scourge has found its way out of the African continent spreading into Europe and the U.S. Fears spread on the news faster than the disease itself. What could be scarier than an outbreak of Ebola creeping state to state? How about influenza?
Yes, that’s right… the FLU
While the imagery of Ebola ravaging a victim’s body stirs up primal fears in any who’s seen or heard about the effects, there have only been 4 cases of the disease in the US, having killed but one person within this country’s borders, a person who carried the infection from Liberia. The flu, by comparison, infects millions annually, leaving thousands dead each year. The Spanish Flu pandemic, between the Fall of 1918 and Spring 1919, left the United States with 675,000 dead out of a total population, at the time, of 105 million. Today’s researchers estimate the global loss of life from that pandemic is between 30-50 million souls. Compare these figures to those of Ebola that has, since 1976 when it was first discovered, infected 22,100 people and resulted in approximately 8,000 deaths. This by no means trivializes the loss of life or the severity of the disease. Ebola is very infectious and with an average mortality rate of 50%, no one should dismiss the threat. The point is, while Ebola is a favorite of cable news more interested in ratings than accuracy, there are worse diseases and the one ranked high on the list is one that is, itself, trivialized.
How many times have you heard, “Oh, I just have a touch of the flu,” dismissed as something inconsequential? The truth is, most of the time, that touch is a cold. For a touch of the flu, take the typical cold symptoms of coughing, aching, headache, fatigue and ratchet them up about four notches then throw in a 100+ fever and let simmer for about a week. A touch of the flu will put the majority down for the better part of 5 days. A bout of the illness is a truly miserable experience, leaving at the end little doubt what it was that had a hold of you. Unfortunately, for the elderly, younger children and those with weak immune systems, the ordeal can be significantly worse leading to complications like pneumonia. Thousands die in the US each year from the illness itself or those complications.
Now if one were to ask the average person off the street, “Given a choice, what would you rather have, the flu or ebola?” Is there any doubt every one of those people would choose the flu? The reason most likely resides in the death rate between these two diseases. With ebola’s average chance of survival ranking in 50-50 range (technically between 30-70% depending on the quality of care), who wouldn’t choose the flu with it’s piddly 1.4 deaths per 100,000 persons. But the real concern is when the perspective is zoomed out to the population as a whole, this is where the fear of influenza takes the lead.
All comes down to how it spreads
- While Ebola is overall much nastier than even the worst bout of the flu, the way the flu spreads puts Ebola in its place. Let’s do another comparison;
- Ebola has an incubation period of 2-21 days, but it is not contagious until symptoms appear and those symptoms are severe, the person will know they are sick, and those around them will keep their distance. These symptoms come on fast making it unlikely a person would be capable of moving about all that far.
- Influenza, on the other hand, becomes contagious one day before symptoms show up (some studies suggest up to 4 days before) and remains so for 5-7 more days.
- Ebola can only spread through direct contact with bodily fluids (blood, urine, saliva, sweat, feces, vomit, breast milk, and semen) or contact with those fluids deposited on surfaces.
- Flu is an airborne, respiratory disease capable of infecting others up to 6 feet away. Imagine how many people are within 6 feet of someone who coughs or sneezes in an elevator or subway car. It can also be spread by touching surfaces like doorknobs and countertops then from hand to face.
- Additionally, symptomatic people who think they only have a bad cold will push themselves to go about their regular days’ activities spreading the flu virus even further.
It’s influenza’s ease and mode of transmission that makes that 1.4% mortality more significant. The infection rate translates to many more infected people, which in turn increases the number of high-risk people becoming infected, who are more susceptible to the dire complications that the flu brings on. This is where percentages can be deceiving. That 1.4% represents translates to thousands of people when it is part of a population of millions who are infected annually. And contrary to some speculation on cable news shows there is little, if any, the chance of Ebola becoming airborne. To date, there is no evidence of a bloodborne disease like Ebola (or HIV or hepatitis) transforming into a respiratory disease like influenza.
Now consider a pandemic influenza bug. This is a novel (or new) virus that we humans have not been exposed to before, unlike the strains of season flu seen during the Fall and Winter months. The 1918 Spanish Flu was one of these novel viruses. It ravaged people of all ages, not just the typical high-risk populations. And with the higher mortality rate (2.5%-3%) of these pandemic strains, taken along with its ease of transmission the severity of such an outbreak is not difficult to imagine. The 20th and early 21st centuries witnessed four more influenza pandemics, the most recent occurred during the 2009-2010 flu season, none of which reached the severity of the 1918 event.
What happens with a repeat of 1918?
Once a new influenza virus is confirmed and spreading, international (WHO) and national health agencies (CDC in the U.S.) will be put on alert. In the United States, these alerts and preparations will spread to the individual states and local health departments and hospitals who will activate their response plans. Vaccine and antiviral medication suppliers will be tapped for supply and production estimates.
When vaccines become available, the quantities may be relatively small. In this case, they will be prioritized for high-risk people (the elderly, young children and people with poor immune systems), those who work or live with high-risk individuals and health care workers who will be on the front lines of treating the ill. As vaccine production increases they will be made available to the general public.
Now, should the worst develop with an outbreak spreading with voracity across the country the national, state and local agencies will scale up their responses. As hospitals fill to capacity, alternate treatment centers will open, anti-viral medications will be made widely available while supplies last. Mass vaccination clinics will open (once vaccines are available), strategically placed in communities to effectively serve as many people as possible. Many local health departments use their annual flu season clinics as emergency exercises to practice for just such events. Should these efforts and supplies become overwhelmed and state resources hit capacity, requests may go out to the national government to activate the Strategic National Stockpile (SNS). The SNS, coordinated by the CDC, is a reserve of large quantities of medications and medical supplies that are quickly delivered to any state in the country, where they are needed.
Okay, that’s great but what about me?
While it’s all well and good knowing government agencies have their plans and procedures for a fast spreading, outbreak of the flu, what is the average family or individual supposed to do? The best advice is the same advice you should follow to avoid getting sick every flu season. Cover your cough and wash your hands often. Use alcohol-based hand sanitizers because few people actually wash their hands with warm water and soap for the prescribed 20 seconds. Limit contact with other people. Wear a surgical or another type of mask that covers your mouth and nose if you feel comfortable doing so. Create a family plan. This can simply be an addition to your family’s general emergency plan that should include enough food and supplies for two weeks, appropriate medical supplies to treat a sick family member (thermometers, facemasks, tissues, over-the-counter cold/flu medications, prescription meds, anti-virals, fever reducers). Coordinate these plans with your neighbors, identify someone who can care for your children if you get sick. Be aware of children’s school plans and explore work from home options with employers. And stay apprised of where vaccination clinics will be, once supplies are available.
So what’s the broad-brushed takeaway from all this? A blunt answer is, don’t get swept away by the hype. Put things into perspective, as what was hopefully done in this article. Ebola is scary as hell, yes. But diseases like influenza, which are hardly given a second thought today, are the ones we should worry about. And not just from an imminent, new pandemic strain but from the typical, seasonal virus as well. The CDC, last week officially declared influenza has reached epidemic levels this year due to the deaths of 15 children across the country and significant jumps in reported cases. Do you have family members over 65 or under 7? Do you live or work in a daycare or with the elderly? If you can answer, yes, to either of those questions, protect your family, protect yourself and get vaccinated.