Flu: Always Trying to Avoid Partying like It's 1918

That a 57 year old man died from influenza should come as no surprise, even if that man is named Prince. While it is not confirmed that Prince actually succumbed to true influenza—people use the word “flu” for a variety of conditions--his tragic loss should serve as a reminder that influenza is not a benign illness but a major infectious disease killer responsible for the deaths of thousands of Americans yearly.  Just hours before Prince’s death was announced to the world, a friend of mine was baffled over the death of a young police officer in my own county from influenza.

People die from influenza when it progresses to severe pneumonia blocking the ability of the lungs to deliver oxygen to the bloodstream. This phenomenon can occur with primary viral pneumonia caused by influenza or via a secondary bacterial pneumonia. Also, those with severe illness who are hospitalized are at risk for downstream complications of that hospitalization such as kidney failure or pulmonary embolism, for example.

As of this writing it is unclear what the circumstances of Prince’s death were and the nature of his illness, but it is said he was battling flu for weeks leading me to speculate he may have had a secondary complication of some sort.

While this year’s flu season has been late-peaking and relatively benign (thanks, in part, to a well-matched flu vaccine), there have been many severe cases around the nation. In its latest weekly report (covering through April 9) on flu the CDC relates that 7.5% of deaths reported in the 122 Cities Mortality Reporting System were due to pneumonia/influenza – above the threshold value expected for this time of year. Additionally, 10 pediatric deaths were reported for that same week.

This is what it sounds like when flu kills.

Zika and Causality: A Crucial Threshold Crossed

Today a major milestone was achieved with Zika virus: the establishment of a causal relationship between the virus and fetal abnormalities such as microcephaly. By now the world has been acting, appropriately, as if this was the case based on highly suggestive data. However, seeing the fidelity to causality in making the definitive case was heartening.

As philosopher Leonard Peikoff writes: 

“The explicit identification of causality (by the Greeks) was an enormous intellectual achievement; it represented the beginning of a scientific outlook on existence, as against the prescientific view of the world as a realm of miracles or of chance.”

Causality is the hallmark of science--no appeals to correlations, suggestions, faith, "optics", or notion can supplant the need for causality. The CDC's New England Journal paper announcing the linkage does so with absolute deference to causality as exemplified by Shephard's Criteria.

Shephard's Criteria delineate what is required to establish the teratogenicity -- fetal malformation causation -- of a substance and Zika now unequivocally meets that threshold. With this development, the greenest light possible has been given to scientists to determine how to combat the virus.

Seeing such fealty paid to causality in an era when, unfortunately, logic is regarded as superfluous is remarkable.

Pneumococcus: An Infectious Disease Tornado

There is something majestic and sublime about watching a ferocious infectious disease at work, the elegance of a microscopic creature ravaging something incalculably larger than itself. I recently witnessed a cause of overwhelming post-splenectomy infection due to pneumococcus. For those who have witnessed this infection, it is truly jaw-dropping in its ferocity.

Sometimes being the equivalent of a tornado-chaser with infectious diseases, causes me to reflect on the host-microbe interaction and how the precarious balance can be tipped allowing a microbe to damage the host.

The spleen is a crucial organ of the immune system and its absence places one at a severe disadvantage when it comes to fighting off infections. The big three of post-splenectomy infections are the encapsulated Hemophilus influenzae (type B), pneumococus (Streptococcus pneumoniae), and meningococcus (Neisseria meningitidis), all of which are targeted via vaccination before splenectomy is performed (if planned) or shortly after (if unplanned). Vaccine immunity is not absolute and can wane, leading to enhanced vulnerability.

In many of these cases mortality rates remains very high even in the face of antibiotics and state of the art critical care, highlighting the evolutionary and survival value of a fully functioning immune system.

Be thankful mammals evolved spleens, yours probably saved your life more times than you can count.

Infectious Disease & Colonial Politics: A Review of The Fever of 1721

I often wonder how people living before the germ theory of disease was discovered, before the causes of illnesses were known, and before any effective treatments were available coped with infectious disease outbreaks. How did they go about their lives, continue their businesses, and plan for the future. 

A new book, gaining some attention, shows how one community coped with such an outbreak. In The Fever of 1721: The Epidemic that Revolutionized Medicine and American Politics Stephen Coss provides just such a glimpse. The etiology of this particular fever, that occurred in colonial Boston, was smallpox, the scourge of humanity that was thankfully vanquished by the bifurcated needle wielded by DA Henderson. 

What makes the smallpox outbreak notable was that it was one of the first in which people were not helpless and could, borrowing the title from another important book on smallpox, defy Providence via inoculation. As I've written before, inoculation -- as opposed to vaccination -- was a procedure long-practiced in Africa and Asia,  that involved taking the material of smallpox and scratching it into someone's skin. The mild case of smallpox that followed was protective against the sometimes fatal naturally-acquired smallpox.

In 1721, as the story goes, a fire-and-brimstone preacher named Cotton Mather -- someone who was involved (on the wrong side) in the Salem Witch Trials -- came across reports of inoculation in a scientific journal after he had also learned of it through one particular slave. This prompted a largely unsuccessful crusade to have Boston physicians adopt the practice--Dr. Zabdiel Boylston being the heroic exception. It is a mystery to me how someone could be so compartmentalized intectually that they could participate in the Salem Witch Trials also support the cutting-edge science and exemplar of rationality that was inoculation.

What was peculiar about this situation--and this is one of the underlying themes of the book--is that Mather was very caught up in the politics of the colony and drew the ire of a particular newspaper, the New-England Courant, run by James Franklin assisted by his apprentice and younger brother Benjamin Franklin. The newspaper ran diatribes against inoculation and parodies of it (labeling it was a way to spread smallpox amongst Indians) but also general political commentary that was biting, incisive, and challenging to authority. It was even associated with Satanism! 

The tension was so high in the city that Mather's house was firebombed -- something I hope the anti-vaccine movement doesn't emulate. James Franklin wasn't anti-inoculation per se, but surely published anti-inoculation material. However, after seeing the benefits of inoculation during the Boston outbreak Benjamin Franklin became the "country's foremost inoculation evangelist." 

Inoculation, based on the results in Boston and in England, became an important component of smallpox control and was embraced by many, including John Adams (a relative of Boylston) and George Washington. In fact, pre-emptive inoculation of the Revolutionary Army is considered one of Washington's most important strategic actions.

The distinct value of this book is how it expertly weaves the narrative of the outbreak and the controversies surrounding inoculation with the burgeoning of a distinctly American political conscience--the newspaper published Cato's Letters.

For those who want to understand how politics interacting with infectious disease in colonial America, there is, to my mind, no better book.