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PORTER And the advice was a little different back then too…. ARCHIVE CLIP



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PORTER

And the advice was a little different back then too….


ARCHIVE CLIP

Some practical precautions by a medical correspondent

Keep a stout heart, don't expect to fall sick. Eat as well as possible. Drink half a bottle of light wine or a glass of port at dinner. Take a hot bath each evening on returning from work. Smoke in moderation. If there is any tendency to sore throat consult a doctor at once.
PORTER

But it wasn't long before the threat posed by the pandemic became obvious. Ada Darwin, a Manchester schoolgirl, lost her whole family.


DARWIN

Although I'd been quite poorly the doctor advised myself and another little brother to be moved. And I was very poorly that night, I remember Auntie [indistinct word] standing by me looking down and looking worried. Mother died the next day. She was 34. Of course I knew she was ill but I never thought I wouldn't see her again. Dad died in the early hours of Monday. To have survived all the war years and so much danger. It applied to so many, they'd just landed home and then hit with the flu, it was really as great an enemy as they'd been fighting.


PORTER

Dr Colin Russell is Head of Epidemiology at the Centre of Pathogen Evolution at the University of Cambridge and I started by asking him what differentiates a virus that has the potential to cause a global pandemic, from one more likely to cause the normal seasonal epidemic.


RUSSELL

Pandemic viruses are typically associated with some animal to human transmission event, so in this case it appears that the virus has come from pigs. But the 1918 virus, though its origins aren't entirely clearly, is thought to have come from birds. So the important component of that is that humans have not been previously exposed to these viruses and so everyone in the population is at least in theory susceptible to infection. This contrasts with seasonal flu in terms of there is only a small proportion of the population is susceptible to seasonal flu at any one time. So we have people getting infected year after year after year but it's different people who get infected each year because once you've been infected with flu you're immune to those strains. However, the virus evolves to avoid our immune system and after a period of a few years, let's say you were last infected 10 years ago, then you're probably susceptible to the viruses that are circulating now. So the statistics from the WHO are that, in terms of seasonal flu, approximately 10% of the world's population gets infected each year. And if we extrapolate those statistics in the roughest possible way, that means that maybe only 10% of the world's population was susceptible that year. And so if we assume - and the real situation is much more complicated than this - but if we assume that the proportion of the population that can get infected was only 10% then that makes the overall potential for the epidemic very small, especially when we contrast that with a virus that's just come from animals which has the potential to infect everyone which can result in much larger epidemics.


PORTER

Are the strains that are responsible for the pandemics that we've seen historically, are they affected by the seasons in the way that normal outbreaks of flu are?


RUSSELL

Well there has been three pandemics in the last one hundred years - there was the pandemic in 1918, 1957 and then 1968. In 1957 and 1968 those two pandemics were both affected by the typical seasonal patterns that we see of flu, so the virus spread around the world but it really only caused outbreaks during the traditional flu seasons. Nineteen eighteen was different because it actually caused epidemics during the summer in various parts of the temperate regions.


PORTER

What is it about the flu virus that means it favours certain conditions - I mean is there something about the winter and spring that makes it easily spread?


RUSSELL

Well this is a very hot topic of research right now, so there have been a number of recent studies which suggest that the virus survives better when the temperatures are cooling and relative humidity and absolute humidity are lower as well, so this describes the winter in most of the temperate regions of the Northern and Southern hemisphere. However, flu seems to cause epidemics in the tropics, much like it does in the temperate regions, except that in the tropics there's no winter and so epidemics typically occur during the rainy season. Now this conflicts with the hypothesis about low temperatures and low humidity in the temperate regions because flu epidemics are traditionally occurring in the tropics when temperatures are high and humidity is also high. So the seasonality isn't particularly well understood.


PORTER

We worry about pandemics, they attract a lot of publicity, in the past they've been devastating but actually seasonal flu in itself, normal flu if you like, can exact a pretty significant toll on a population.


RUSSELL

It can and of course the subject of another 1918 is inherently frightening, with many millions of people dying. However, the pandemics in 1957 and 1968 were only about three to five times worse than your average year of seasonal flu. And in terms of seasonal flu, the sort of things that causes epidemics each year, approximately 500,000 people die worldwide each year associated with seasonal flu epidemics. And so if we extrapolate that number back to the last pandemic which was in 1968 we're looking at approximately 20 million deaths associated with seasonal flu over the past 40 years.


PORTER

Whenever we talk about new strains of flu, including of course the recent avian scare whether that was going to become a pandemic or not, they often have Far Eastern names, what is it about that part of the world that means it's a focus often for the mutations in these viruses?


RUSSELL

Well there's really two separate subjects there. So one is the types of bird flu viruses, the H5N1 that sort of thing, that are the subjects of pandemic scare and that seems to be associated with humans and animals living in close proximity to one another, so keeping animals and particularly birds in one's home for example. But in terms of seasonal flu, when we talk about new variance of seasonal flu, that doesn't have anything to do with the human/animal interface, it all has to do with the virus passing from human to human and mutating during that process. Now it appears that East and South East Asia is the sort of hotpot for evolution because viruses are circulating there continuously, not in any one place but by passing from country to country. By example, in the temperate regions of the Northern and Southern hemispheres, so in places like Europe and in North America and Australia, New Zealand influenza epidemics occur during the winter and even though London and Warsaw are very far apart from one another they have their epidemics right around the same time. Now this contrasts with the sort of patterns that we're seeing in Asia where you can have countries that are very close to one another, for example Bangkok and Kuala Lumpur are only about a thousand miles apart, however they have their epidemics at completely different times of year. Bangkok has its epidemic during its rainy season, which is during the Northern hemisphere summer and Kuala Lumpur has its epidemic during its rainy season which is in the Northern hemisphere winter. And so what we see in East and South East Asia is that viruses circulate continuously, all year round, by passing from epidemic to epidemic, like runners passing a baton in a relay race.



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