Next Time, It Might Kill You

Dr. Fannin laughs — the slightly condescending laugh, it seems to me, of someone who has never called in sick to work pretending to have "the flu." "You may be on to something there," she says. And then she adds: "The one socially positive thing about influenza is it’s not a great respecter of person or position. You are not protected by being rich, you are not protected by being handsome or the reverse. It’s a great leveler."

"Unlike tuberculosis."

"Yes. It has become a very fascinating subject to me."

Where does the flu come from? And when will it go away? A street song popular in 1918 had an answer to the first question:

I had a little bird

And its name was Enza

I opened the window

And in-flu-enza.

Oddly, the words were wiser than their author could have known. Avian influenza was not recognized until 1955, and was not isolated in wild birds until 1961, but since then birds have been found to play an essential role in spreading the flu virus, particularly if they spend time in China. Dr. Larsen explains it this way:

"All flu strains are found in migratory birds, like ducks, and they seem to be the source of all new flu viruses. You and I are not going to have a lot of contact with ducks, but in China they do. It turns out that the viruses that come from ducks have trouble getting into people. We don’t have the receptors in our throats to receive those viruses, but pigs do. Pigs also have receptors to receive human viruses. In China there are millions of ducks and pigs living with people on farms. The pig picks up the duck virus, then the human virus, they mix and match, the human gets the virus from the pig, and away we go — we’ve got a new virus against which humans have no protection. That’s how we believe pandemics start."

Older explanations of the flu were more fanciful. The Italians came up with the word influenza, meaning influence, in the 14th century. The influence they were referring to came from the stars, whose constellations were believed to provoke the disease. Other names for the flu have included the "new acquaintance," the "strange fever" and, in the German trenches during World War I, "Blitzkrieg Katarrh." In 1557 an English minister dubbed it "the gentle correction," explaining to his congregation that the flu "is one of those rods, and the most common rod, wherewith it pleaseth God to brake his people for sin." In 1580, there was a flu so fierce that, according to the 19th-century English epidemiologist Charles Creighton, "In the space of six weeks it afflicted almost all the nations of Europe, of whom hardly the twentieth person was free of the disease, and anyone who was so became an object of wonder to others in the place . . . Its sudden ending after a month, as if it had been prohibited, was as marvelous as its sudden onset . . ."

That the flu was pretty much then what it is now is attested to by the historical record. No one understood how it happened (Noah Webster, the American lexicographer, suggested, "The causes most probably exist in the elements, fire, air and water, for we know of no other medium by which diseases can be communicated to whole communities of people"), but they knew what it felt like. In 1562, an English letter writer described how Mary Queen of Scots

. . . fell acquainted with a new disease that is common in this towne, called here the newe acquayntance, which passed also throughe her whole courte, neither sparinge lordes, ladies nor damoysells . . . It ys a plague in their heades that have yt, and a soreness in their stomackes, with a great coughe, that remayneth with some longer, with others shorter tyme, as yt findeth apte bodies for the nature of the disease. The queen kept her bed six days. There was no appearance of danger, nor manie that die of the disease, excepte some olde folkes.

Aside from the fact that the author of that passage didn’t know that influenza was a viral infection — the flu virus was first isolated in humans in 1933 — there isn’t much difference between his description of the flu in the 16th century and the description of flu on the CDC’s Web site in 1999 — even down to the observation that not many people die of it "excepte some olde folkes." In fact, in many ways we may not be much further advanced in our battle against the flu than we were in 1918. We have antibiotics to fight bacterial pneumonia, which is what usually finishes off seriously ailing flu victims, but antibiotics are no longer as effective as they were during the smaller pandemics of 1957 and 1968 — which, taken together, killed 104,000 Americans alone — and Streptococcus pneumoniae bacteria are far more resistant than they used to be.

"In 1957 and ’68 we saved a lot of people with antibiotics," says Dr. Larsen. "We’d have a much more grave situation on our hands now. In ’57 and ’68, none of the pneumococcal bacteria were resistant to penicillin. In certain cities in the U.S., like Atlanta, though not L.A., we now have a situation where 80 percent of pneumoccocal bacteria are resistant to penicillin, and 15 percent are resistant to almost all the antibiotics we have."