CBC News, Canada
http://www.cbc.ca/fifth/nextpandemic/in ... xford.html
The following is an edited excerpt from and interview with Dr. John Oxford, conducted in late 2005...
What happened in 1918?
Toward the end of the First World War 1917-1918, and infection arose, probably here in Europe, and then spread around the world, most likely with the armistice, and four million young soldiers going home. Within 18 months, 50 million people had died. It was the biggest outbreak of any infection that the world has ever seen either before or since.
Is 1918 a fairly reasonable comparison for the potential pandemic?
1918 is very relevant to todayâ€™s situation with the chicken flu in Southeast Asia. We need to ask the questions: where is this next outbreak going to come from? How long is it going to take to explode, what is the generation time, and then how is it going to spread. All those very important questions are answered to some extent by forcing ourselves back to 1918â€¦ so I think 1918 is particularly relevant and it would we very unwise to forget about that outbreak and push it behind us, as people have done, and not try and learn from it.
One thing that I think we can think about and learn from the outbreak 1918 is the early generation. What happens at the beginning of a pandemic? There is always going to be that one case. I think we tend to forget that. And that one case turns into ten, into 100, into 1,000, 10,000, and before you know it, youâ€™ve got as in 1918, 50 million deaths. So that generation, that explosion, that transmission is very important indeed.
What did the virus do to the body?
The pathologists who first began to record the outbreak towards the end of the First World War, they were recording a very unusual outbreak. They didnâ€™t call it influenza; they called it â€œepidemic bronchitis,â€ occurring mainly in the army camps.
And what they began to notice was an entirely new disease. First of all, it was attacking young soldiersâ€¦ it was giving them cough, upper respiratory problems, their temperature was shooting up, they were finding difficulty in breathing very quickly. And then, theyâ€™d either begin to get better, or they would sink into this profound pathology or this profound serious illness and then die.
I think some of the best descriptions of the early outbreak are from the British Army Medical Corp. Often they describe how the pathologists, the doctors, they donâ€™t realize how ill they are. Thatâ€™s pretty sad, to begin with. And some of them almost got a sense of euphoria and yet the medical team knew when they were going to die. They could predict they were going to die. They would start off with a cough and a temperature, quite a high temperature and quite a serious coughâ€¦ then theyâ€™d get into difficulty in breathing.
Most of them would never recover. They would go downhill. They would become slightly euphoric, they would continue coughing, they would cough up blood, and some of them died very quickly indeed.
Of all the 1918 stories that you have come across, is there any one that particularly sticks with you?
The example I like particularly, and I think it brings everything to the forefront for me, is that of Phyllis Burns, Now she was a young woman, in Edwardian England. She could drive a motorcar. That was extremely unusual. She could have sat it out in England and done nothing, but she volunteered to become a nurse, went out the Western Front, and she saw soldiers dying of the so-called Spanish influenza.
She came back to London after the armistice, as they all did. She got to Charring Cross Station and she was not feeling well. She had the aches and pains, the temperature, the flash, the difficulty in breathing â€“ she realized she had caught the influenza. And she made another decision. It was to protect her mother. She wanted to go home to see her mother, but she thought she might infect her mother and that her mother might die. So she went off and sat by herself in a small room and tried to battle it out, and she didnâ€™t succeed. She died.
To my mind, she represents the epitome of people that went through it, and made a huge sacrifice for other people. And every time there is an infection you get this.
What are the relevant comparisons between 1918 and what could happen with the current H5 virus?
I think the most single piece of information that is relevant to today is the question of how long these pandemics take to be born. Do they explode immediately? Does a virus suddenly emerge from a chicken or goose and explode into a killer virus, or is there kind of a gestation period.
I think thatâ€™s a very important question. And I think 1918 tells us quite clearly that there was quite a long gestation period; quite a long period when the virus was getting itself together. It did not explode immediately.
Thatâ€™s a reassuring thing, because 1918 tells us that it pulled its forces together before it attacked. It took a year to do that. Thatâ€™s not to say we should be complacent, but that is to say that just because this outbreak in Southeast Asia has not exploded around the world so far, does not mean we could relax our guard.
It might take a year; it might even take two years before it can get itself together.
If it â€˜gets itself together,â€™ what happens?
When the 1918 virus got itself together, it began to spread in the community. It broke out of the British Army camps, and began to spread in the community. It was aided fantastically, and perhaps uniquely, by the end of the First World War.
Suddenly, for the first time in history, you had five, six, seven million young people on the move. They were coming home from Europe, to Canada, Australia, South Africa, the world was their oyster, and the virus took advantage of that. It had a huge opportunity at that stage to spread and it took it.
Could we have another 1918?
I think we can and we must envisage a situation where a new pandemic could be worse than 1918. In spite of these new anti-viral drugs, which are pretty fantastic, in spite of new vaccines, we have immense traffic around the world.
In a day, I think 20 or 30 million people are moving. Once this new virus begins to break out, it will have opportunities, bigger than anything the 1918 virus could even have dreamt about. Thatâ€™s why we have to be so careful. Thatâ€™s why we have to be so guarded.
H5N1 is not considered a pandemic virus at this time. There have been no human cases of H5N1 reported in Canada as of January 11, 2006.
Are we prepared for an H5 breakout?
We are spending a lot of time thinking about a lethal outbreak of H5N1 that would encompass the world, one that would give us a 1918 scenario, but in reality, when I wake up in morning, I think about what have we done, about whatâ€™s in the medicine cupboard, itâ€™s pretty thin.
Science has progressed since 1918; there have been huge discoveries in anti-viral drugs for influenza. What we have not done, I would say, is press ahead and stockpile a sufficient quantity of either the anti-viral drugs, or vaccines, to give us any sense of preservation in the face of an outbreak. That is what worries me.
This pandemic virus is so threatening that we will have to throw the book at it. Everything will have to be thrown at this virus. Anti-viral drugs, vaccines, weâ€™ll put people into quarantine. Everything will have to be thrown at this virus, to stop it spreading.
Now, how would society take all that? I donâ€™t think we will. I donâ€™t think we have a society now where you can tell people â€˜Well, hang on a minute you are not going to go to a football match, you are not going to go to a cinema, you are not going anywhere for the next week because we are closing down everything.â€™
I think it will almost be like an Armageddon and people will find it very, very hard indeed to contend with that.
How close are we really, right now?
It doesnâ€™t matter how close we are. The important thing is to prepare, to stock up on the drugs and the vaccines. Then it will not matter if this outbreak begins tomorrow, or in two years time or in five years time. Because weâ€™ll have our protection stocked away.
Can we actually have stockpiles built up in time for this onslaught?
We have the scientific know how now; weâ€™ve made these anti-viral drugs. I think one now needs political will and commitment in cash to stockpile them. What we want is commitments from governments around the world, and realization that this is an important disease; this is not just something small here.
This could be the new beginning of an epoch, of a re-focus on infectious disease, a re-focus on the prevention of Mother Nature scenarios. Here is an opportunity that weâ€™ve got now to apply new science, to apply new discoveries in preventing infectious diseases, so it could be a wonderful new epoch just beginning in the 21st century.
Can you walk us through the predicted phases of a pandemic?
I think, for the first time in human history, weâ€™ve got a pandemic under a microscope. We are looking at the evolution of a pandemic. We are watching it almost on a day-to-day basis, as this virus is moving around in Southeast Asia, as itâ€™s changing, as itâ€™s moving from country to country.
Whatâ€™s it going to do next? If it is going to break out from Southeast Asia, itâ€™s going to have to have to decrease its killing power and increase its infectiousness. Once it does that, bang! Itâ€™s almost too late for any of us to do anything about it. Thatâ€™s the kind of difficult situation that we are in at the moment.
The hospitals are going to be totally overwhelmed. You can get into an airplane in Southeast Asia and nine hours later you are in London, in a population of 12 million. You will be infecting people. They will be popping up everywhere. And then you are done for, unless youâ€™ve got a plan, unless you are prepared. There will be complete and utter chaos. Thatâ€™s what youâ€™ve got to prepare for.