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'A Plague in Your Houses' - Swine Flu and other Epidemics

02-06-2009

The recent threat of swine flu has raised awareness of some deep-seated issues for us humans. The first is the fine line between population “health” and a significant threat to same, from nature. The second is the rapidity with which viruses can mutate to a form which can find a home in humans (having previously only infected in other species).

Human mobility makes for interesting vacations. You are no-one if you haven’t tasted at least a dozen foreign cultures, (The more exotic the better!). Rapid transmission of infectious diseases is also improved by international air travel. Think about all those nasties in the air conditioning of a plane containing 400 odd people.

This is offset to some degree by improvements in communication. These provide earlier warnings about impending epidemics and also the rapid exchange of information about ways of containing them.

In five years from 1347, 25 million people (1/3 of the population) died in Europe of Bubonic Plague. It was referred to later as “the black death”. This gave some indication of the sinister and fearsome nature of this illness. People were buried 6 deep and the survivors were said to be “numb”. Every major epidemic since then has served as a reminder of our vulnerability to attack by similar invisible forces.

The invisible force in the black plague was a bacillus known as Yersinia Pestis. It was carried to humans by fleas which infected rats. This caused a skin infection which rapidly overcame the immune system and usually killed people within 5-6 days (about 60% of those effected). Even worse was the associated lung infection, which could then spread from one human to another human being without needing the flea as a vector. People usually died of the pneumonic form of the illness in 2 or 3 days.

Interestingly, successful human adaptation had contributed to this situation. Improved farming techniques and an increase in global temperatures from 1000AD improved the supply of food and therefore nutrition. As a result, human populations increased dramatically, especially worldwide. Urban areas became densely populated and thrived. Ship building and improved navigation facilitated international trade.

However, soon after 1300 a period of particularly frigid weather and devastating storms hit northern Europe, damaging crops. Population health and hence immunity suffered.

Meanwhile in Asia during the 1340’s, China had been waging a long war with the Mongols. Great areas of land were laid waste so that the rat population headed for towns in search of food. In this context Bubonic Plague got a foothold in China before any other part of the world. Approximately 35 million people lost their lives in China (History’s Greatest Hits, J Cummins). This is where the epidemic started. It then spread along the overland trade routes to Eastern Europe. It also went by sea in ships from the Black Sea to Italy, and to the Middle East. Infection rates tended to subside in winter, only to increase again in the warmer months. It had effectively petered out by 1352, although further smaller outbreaks continued until the 1600’s. The plague found ideal victims amongst the poorly-nourished ie. the susceptible population. Although it still occurs, it is readily treatable.

The influenza epidemic (so called “Spanish Flu”) of 1918-19, again hit a world made vulnerable, this time by 4 years of world war. Estimates of mortality from the influenza epidemic are that 20-40 million people died worldwide. It effected not only the very old and the very young. Death usually followed viral pneumonia. There were obvious similarities with the Black Plague.

Recent epidemics have raised the alarms, somehow as a reminder of our potential vulnerability, especially to viral illness. The HIV situation in Africa will have long-term effects on that population. In 2007, 22.5 million adults and children were living with HIV. There had been 1.6 million deaths and that year there were 1.7 million new HIV infections (The Body, HIV Resources).

So the main threat to humans as a species remains from other life forms which are invisible. These can be devastating, especially where humans are more susceptible to infections generally. This threat is difficult to predict, unless studies of the DNA of viruses (in samples taken from people with symptoms, worldwide) are undertaken. The technology of DNA study is as yet relatively early in this development and is still expensive. Given time, this will change. However, most of the recent epidemics have begun in countries least likely to have this technology ie. third world countries. If this genetic surveillance were available, it has the potential to predict more virulent threats as well as create more effective vaccines (which, at present, are the most effective anti-viral measure).

A recent article I wrote about developments in medical technology addressed internet driven information sharing as well as genomics and various other technical “tricks”. The internet presents a very efficient monitoring system for outbreaks of infectious illnesses. This may well be a major priority. The other priority (if history tells us much) is to at least look at what makes some populations more vulnerable to infections that others.

Research from the Centres for Disease Control in USA (The Economist, May 30 2009) shows up some interesting features of the virus causing the current epidemic. The first is that it did originate in the swine population. Next, its DNA contains “pieces” from avian and human as well as porcine flu. The thought is that swine might be “natural” hosts which allow various forms of the viruses to mutate (change in genetic make-up). This virus effects a younger population than usually with influenza epidemics (2/3rds of those effected are between 5 and 24 years). Only 1% of those effected is over 65. Maybe these older folk have been exposed to a similar virus many years ago, rendering them less susceptible.

The recent events around the “Swine Flu Epidemic” suggests that some awareness of the plague of the 14th century and its young cousins, still lurks in the depths of our psyche.

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