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Got Flu? Keep It to Yourself
December 16, 2001|WENDY ORENT | Wendy Orent writes frequently on infectious disease and is
currently writing a book on plague.
ATLANTA — While the five deaths and seven critical illnesses from inhalational anthrax should
not be ignored or trivialized, the fear of anthrax has given rise to widespread anxiety out of all
proportion to the actual numbers of the seriously ill. Up to now, this has produced what we can
uncharitably call the "Anthrax Follies": a business evacuated after powdered sugar from a doughnut
was found on a desk; girls in a high school hosed down by the fire department after white powder-later determined to be talcum powder--was spotted on the floor; a group of hopped-up cocaine users
arrested after they called in police because they'd decided their own stash of white powder must be
anthrax.
But more serious threats face us now unless we take action. As flu season begins, a public health
and hospital system already operating at the edge of capacity may well be overwhelmed as citizens
worry that their aching muscles, fevers and shortness of breath could be anthrax. Flu shots are
useful, but they're at best a partial solution. The vaccine is only 70% to 90% effective, and there isn't
enough for everyone. The inoculations are really intended for the more vulnerable portions of the
population: those over 60 and those with compromised immune systems.
There's another approach to flu that might work much better, but it will take a lot more than
persuading people to line up for a quick jab in the arm. It requires a kind of thoughtful selfdiscipline we don't often see. It requires a whole reorientation to how we handle health, sickness and
the requirements of daily work. And it requires an understanding of flu.
Influenza is one of the most transmissible diseases. As evolutionary biologist Paul Ewald points out
in his important book "Evolution of Infectious Disease," there tends to be an inverse relationship
between the severity of an infection and its transmissibility--how the virus or bacteria gets from one
person to another. Highly transmissible diseases (with a few exceptions like smallpox) tend to be
relatively mild, allowing their hosts to walk around coughing and sneezing on other people. In
contrast, diseases such as Ebola kill so rapidly that the moribund host has little ability to spread the
virus. These diseases tend to die out quickly in human populations. Ebola spreads in hospitals,
where doctors and nurses are exposed to the blood that pours from the victim's skin and orifices or
in households when relatives care for the sick and wash the dead. But you could sit next to an Ebola
victim on a plane, and unless you got splashed with his blood you'd likely never be infected.
Flu has an entirely different pattern. It relies on a host who is not too sick to carry the virus where it
wants to go--to another victim. Under normal circumstances, it is rarely fatal except in people with
compromised immune systems. Ewald explains the exceptional mortality of the 1918 flu as a direct
result of World War I, when sick soldiers in tightly packed mobile hospitals easily infected the well
lying near them. Ordinarily, extremely virulent strains of the flu die out, as hosts are too sick to
transmit them widely. But in the war, a supply of fresh hosts was always close at hand, allowing the
evolution of an exceptionally vicious strain that rapidly spread across the world.
Understanding the evolution of flu tells us two things: that the mildness or severity of flu can be
influenced by social conditions and by human behavior, and that there are ways in which we can use
this understanding to force the evolution of milder strains of flu each year, or even to abort flu
outbreaks altogether. If you think things through logically, you can see that many of the ways
Americans behave each flu season directly contribute both to the spread of flu and to its severity.
Here's a question: When you feel a cold or the flu coming on, what do you do? Do you dose yourself
with decongestants, aspirin, Tylenol, antihistamines, and head out the door, determined to finish that
project or attend that meeting? Or do you jump into bed, resting and drinking fluids until you can
function again?
If you are like most working people, you "haven't got time for the pain," in the words of a
particularly fatuous commercial. And so you jump right up and march into the office, coughing,
sneezing, red of eye and blurred of intellect--but doing what you think you need to do to be a good
teacher or reliable nurse or sturdy corporate soldier.
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