Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It

  • Gina Kolata
Farrar, Straus and Giroux, 256 pages, $25.00, 1999 0374157065 | ISBN: 0-374-15706-5

There is a cemetery in a small railroad town in northern Ohio where I grew up that tells a sliver of the story of the great ‘Spanish’ influenza pandemic of 1918. One section of the cemetery is full of simple, rough, limestone markers that tilt willy-nilly in the perpetually damp sod of the graveyard. These unembellished memorials mark the graves of unfortunate souls who died one week during the fall of 1918 from the flu. In other towns all over the country there are similar hastily prepared grave sites. At least 10,000 people died in the city of Philadelphia during one three-week period during the month of October, overwhelming doctors, hospitals and undertakers.

The pandemic occurred just at the moment in history when the nightmare of World War I was finally ending, and it killed far more than the Great War itself. The death toll from the flu of 1918 was more than a half-million people in the United States, and more than 20 million people worldwide. This modern day plague is the topic of a new book by Gina Kolata, a science writer for the New York Times. Although the subject of the 1918 flu pandemic is certainly compelling stuff, there is little in this new book that has not already been said better by others, most notably by Alfred Crosby in a book entitled America's Forgotten Pandemic, originally written in the 1970s but since updated. In that book the student of flu can find the primary data underlying many of Kolata's generalizations.

It is unfortunate that much of the book reads like a newspaper article written on a tight deadline. The reader often feels that only the most lurid anecdotes are mentioned, apparently precluding any in-depth description of our burgeoning understanding of the structure and function of the virus itself. The virus is, after all, the ‘mass murderer’ in this detective story. There are no thoughts here about how viruses propagate or kill or evolve. There is not a word about the molecular virology underlying the phenomena of antigenic drift (a change in surface protein, usually resulting from a base pair mutation) or antigenic shift (which for flu is usually the acquisition of a whole new segment of RNA). Any scientist or physician interested in the influenza virus itself, and all its fascinating efficiencies and complexities, will be sorely disappointed with this book.

The author does, however, vividly illustrate how the great devastation wrought by the flu pandemic continues to affect more recent history. Two chapters of ten in this new book concern the swine flu fiasco of 1976. A series of unfortunate events was started with the death of a single soldier at Fort Dix, New Jersey. The causative agent in the soldier's case was determined to be an influenza virus of a type that normally infects pigs. Because of work in the decades after the 1918 flu pandemic that suggested a link between flu in humans and flu in pigs, scientists feared that the soldier's case was only the first in a deadly pandemic that could engulf the nation and the world. Using scant evidence, and what seems in retrospect to be numerology, a small group of prominent vaccinologists convinced President Gerald Ford to immunize the entire nation. The swine flu epidemic never occurred, but 43 million Americans were vaccinated, leading to scores of lawsuits of patients who claim to have been injured after being immunized.

The most original part of the book is where the author describes recent efforts Jeffery Taubenberger and his team at the Armed Forces Institute of Pathology to sequence the 1918 influenza virus using polymerase chain reaction (PCR)-based techniques. These careful workers have successfully isolated fragments of RNA from the 1918 influenza virus. The acquisition of the tissues for these experiments, either from paraffin-embedded specimens recovered from a government warehouse or from snippets of tissue obtained from bodies buried in the permafrost, is the stuff of high drama.

Even after the latest round of PCR analysis of the flu genome, it remains a mystery why the flu virus of 1918 was so deadly. The most pressing question remains: Can such a deadly virus ever emerge again? On one hand it seems unlikely, given the rapid advances in our medical knowledge. New drugs, such as zanamivir (Relenza), can inhibit the ability of the flu virus to proliferate by blocking the activity of the neuraminidase enzyme. When the Spanish flu pandemic hit, doctors around much of the globe were still using venesection as a treatment.

On the other hand, drug-resistant variants of the flu virus could emerge. Furthermore, the flu virus of 1918 killed quickly—there are many cases of documented mortality in under 48 hours. A large-scale epidemic could overwhelm our modern, sophisticated medical system. Because our overcrowded cities are massively interconnected by commerce and travel, an emerging virus could be spread today at a rate that is orders of magnitude faster than the rate of spread eight decades ago.

So the questions remain: Can such a pandemic happen again? How will we deal with the deadly viruses that will undoubtedly emerge in the future? Greater knowledge about what happened in the 1918 flu pandemic and a deeper understanding of the virus that caused it would be useful. And although Kolata's book provides a lot of heat, it does not shed much light on the questions that really matter.