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A 33 year old school teacher has become the first US American fatality of the so-called Swine Flu. The World Health Organization announced yesterday that the latest global tally of confirmed cases of the new virus is 1,490. New infections are happening primarily among relatively young people. Aside from the teacher and a Mexican toddler visiting the US, all confirmed deaths from the flu have been in Mexico. While the spread of the H1N1 virus as it has been formally named, has slowed, there is a strong possibility that it could return with a vengeance this fall. The flu’s ability to rapidly mutate is of chief concern, bringing into question even the efficacy of producing a vaccine against it in six months. Misinformation about the flu abounds, from possible risks of eating pork, to conspiracy theories about its origins. Public reaction has ranged from panic over a possible repeat of the deadly 1918 pandemic, to nonchalance and denial that an outbreak even exists. But, examining the facts suggests that the H1N1 virus is in fact here, is potentially far more dangerous compared to the seasonal flu, and could get a lot worse, tomorrow or next year.

In his best-selling 2004 book, the Great Influenza: The Epic Story of the Deadliest Plague in History, author John Barry explores government inaction and widespread panic during the 1981 influenza pandemic.

GUEST: John Barry, award winning writer and New York Times best-selling author of The Great Influenza: The Epic Story of the Deadliest Plague in History, Distinguished Scholar at the Center for Bioenvironmental Research at Tulane and Xavier Universities.

Rough Transcript:

Sonali Kolhatkar: John Barry, I had interviewed you on Uprising years ago when your book just came out – The Great Influenza: The Epic Story of the Deadliest Plague in History – so I’m wondering if you thought in your lifetime you’d were going to be sitting down and doing a flurry of interviews about essentially this next flu that many are comparing to the 1918 flu?

John Barry: Well, first, fortunately, at this point it doesn’t look like it’s going to be anything like 1918. I won’t say that I was thinking of doing a lot of interviews but I was thinking, and anyone who understands the virus knows this, that there was certainly going to be another pandemic and another one after that and another one after that and since the longest gap between pandemics that we know about in going back several hundred years is 42 years and, you know, it’s now 39 years since the last one so I certainly expected another pandemic in my lifetime and wouldn’t be surprised if there’s more than one.

Sonali: So you don’t think that this particular virus is going to be, in its current form at least, the big one?

John: Well, depends what you mean by “the big one”. I mean we had pandemics in 1889, 1957 and 1968. Compared to 1918, they were relatively insignificant in terms of killing people. But 1918 was the worst, the highest death toll of any disease outbreak in history, so that’s not great solace. And the other, 1889 was pretty bad. 1957 would be next to that. 1968 was the mildest. But, make no mistake, even a mild pandemic like 1968 – which a lot of your listeners probably lived through and didn’t realize they were living through a pandemic – that was still severe and it actually would probably hit us harder today than the ’68 virus hit us.

Sonali: So, let’s talk about some of the reasons why there are differences. Why would a flu like the one in 1968 hit us harder today? What is it about today’s conditions?

John: Well, there are two differences. Number one – influenza usually attacks people with weak immune systems, the elderly and the very young. And, we have a lot more people walking around with weak immune systems today than we ever had before, not just demographically significantly more elderly than we did proportionately in 1968 but also cancer survivors. There weren’t many in ‘68. There are a lot now. If you had cancer you probably had either chemotherapy or radiation therapy or both. Both of them damage the immune system for years and, in some cases, forever. HIV-infected population. Obviously, we didn’t have any HIV-infected people in 1968 but they’d be more vulnerable today. There are a lot more transplant recipients walking around than people realize. They’re all taking immunosuppressant drugs and there are other people taking suppressant drugs for other disorders. So, in terms of danger to these people, it’s much greater than it was in ’68, even from a mild virus. The second thing is the economy. We are infinitely more vulnerable economically than we were back then because not only has trade internationally increased significantly but the entire economy has become much more efficient and it’s a “just in time” inventory system. No one stocks warehouses full of stuff that they’re going to need later. And what efficiency means is that there’s no slack, there’s no waste. However, if you get even a mild virus, it’s going to affect the same proportion of people as a more dangerous virus. If you get a lot of absenteeism because people are either sick or they’re staying home to take care of their kids or their spouse, then that interferes with the supply chain – truck drivers are not on the roads delivering goods; air traffic controllers don’t go to work and that interferes with air travel; all the workers in some factory are out sick so they don’t produce a key part so that creates bottlenecks in a huge production line somewhere. So, all those things make the economy far more vulnerable than it was in ‘68.

Sonali: Now, let’s compare once more to 1918 which is what your book is based on. The science today is far more advanced than in 1918. In 1918, there was a large delay in producing a vaccine because of poor understanding of the flu. Are you more optimistic about the state of science today in responding to a flu?

John: Of course, in 1918, they didn’t have any vaccines at all. They produced some but they didn’t know what caused the disease so those vaccines were…

Sonali: They thought it was a bacteria?

John: Yeah, and they were essentially useless. We can produce a vaccine in months. It will take at least 5 months to get any. And, before we have large quantities of vaccine, which is by far the most effective tool against influenza, it will be possibly a year before we really have the numbers to protect essentially the entire U.S. population, not to mention, much longer than that to protect the world population. And, in that interim, we have a problem. And even with the vaccine, against influenza, the real problem with the virus is it’s one of the fastest mutating viruses in existence. That mutation rate is why it’s capable of jumping species. All influenza viruses originate in birds but the mutation rate allows it to jump from birds to people or other mammals whether it’s pigs, horses, dogs. In fact, in 1918, the virus came first to humans and humans then gave it to pigs and other mammals. So, even if the vaccine works – I mean, a modern vaccine that has somewhere between 70% and 85% protection rate is considered a very successful influenza vaccine because the virus is always mutating away from the vaccine and the production cycle takes so long – so, even with that, that is not a magic bullet. It is an enormous help but it does not solve all problems.

Sonali: Now there’s a lot of confusion with competing interests over the fact that the virus is capable of jumping from one species to another. Some countries have gone very far in banning all pig products, pork products – Egypt just mass-slaughtered pigs – and the name Swine Flu has been changed to H1N1 virus instead of Swine Flu because of the bad associations. But, did this virus likely jump from pig to human or is it impossible to know?

Rough Transcript:

John: At this point it’s impossible to know for sure. However, this virus has not been identified in any swine. Some of the genes are swine viruses. Some of the genes come from humans and some directly from birds so we don’t really know where those viruses came from.

Sonali: Even if it did originate in pigs, you can’t get it from eating pork, correct?

John: That’s correct.

Sonali: I mean you’d have to be around a sneezing pig, a live sneezing pig.

John: That’s correct. Exactly right. So, avoiding pork is totally unnecessary. And slaughtering herds of swine is just utter wastefulness and really dumb.

Sonali: My guest is John Barry. He wrote the book The Great Influenza: The Epic Story of the Deadliest Plague in History. And interestingly enough, John, Canadian health officials announced over the weekend, I don’t know if you saw this, that they have at least one confirmed case of the H1N1 virus crossing from a human back into a herd of 200 pigs.

John: I had heard that but wasn’t sure that it was accurate. But, given what you just told me, it is accurate, I guess.

Sonali: So, also there’s a danger that some have cited that because this virus is so fast mutating, there is a danger that it could eventually combine with another virus, the human immunodeficiency virus which causes AIDS.

John: No, that’s fantasy. That’s science fiction.

Sonali: So, that’s not a danger at all.

John: No.

Sonali: So, there is so much misinformation about this particular flu and that’s why I’m having you on to talk about some of these things. Some conspiracy theories about this flu are – I mean, they sound wacky but they’re out there, that this was something created by the government, the CDC, to test on humans. Have you seen some of these conspiracy theories and what do you think?

John: I’ve heard some of them and they’re beyond science fiction. But if someone wants to be paranoid or choose to come up with one of these ideas, you know, the right says Obama created it so that he could get his health care legislation passed. Others say it’s a terrorist. They’re just nonsensical.

Sonali: There’s also the fact that Tamiflu, the antiviral medication, is something that Donald Rumsfeld has a stake in and so this could enrich him.

John: I guess I’m one of the conspiracy theories on the left. You know, nature is out there. I live in New Orleans. I’m even on the levee board here now, the post-Katrina reform levee board, not the pre-Katrina levee board. You know, we face hurricanes every season. It’s a natural event. And that’s what this is.

Sonali: So, is there a sense that nothing can be done then? That the flu is inevitable, that you can’t postpone it or prevent it, that it is just going to happen? Or is it that the lesson from 1918 is that the government really can do a lot about at least the spread, or containment of this virus?

John: The virus cannot be contained. The virus is going to find you unless you’re capable of completely removing yourself from all contact with other people for six to ten weeks when the virus arrives in your community. And that means that you can’t even accept any mail. And your food already has to be in the house. However, that does not mean there is nothing that can be done. Number one, vaccine production takes months. The longer lead time you have, the more you’re able to produce it when another wave comes around. I mean, all the pandemics we know about historically have come in waves. And, in fact, in ’57, that virus sputtered around quite a bit before it caught fire. It took about 6 months, maybe a little longer. D.A. Henderson, who is a scientist who eradicated small pox from the world for the World Health Organization, is a friend of mine and we were just talking this morning. He happened to be a young man working for the CDC in 1957. He knows a lot about that pandemic and he sees a lot of similarities there. In ’57, for example, you could have some big outbreaks at a Boy Scout camp where, he said, that 50% of the kids got sick but they went home and there was no transmission even in their families much less the larger community. That was in the initial outbreaks. But, a few months later, it was explosive around the world and it was pretty severe. I mean, it’s not 1918 but, make no mistake, it’s not something to play with.

Sonali: So, is the lesson here then that even if this particular virus, this H1N1 virus, seems to be slowing down or cases seem to be mild, that, essentially, we have a warning signal, we have 6 months, the government has 6 months to begin production of a flu vaccine because it could come back with a vengeance this Fall?

John: That’s correct. Or it could be longer than a year. Although, personally, in fact, I advanced a hypothesis in my book – I think I may possibly have located where the 1918 virus originated – I think the best evidence I think supports the idea that it entered the human population in Kansas, which is right in – a major migratory bird flyway goes up through there – and it was the first wave that was extremely mild. And then there was a second wave, nine months later, that was lethal. But, there’s actually another theory, probably the second leading theory, in my opinion. Others would say, the advocates of that theory would say that’s the first leading theory that it originated in France in early 1916 in which case it was more than 2 ½ years during which it was more or less underground circulating, learning to adapt to people before it erupted. So, you know, it could be 6 months before this comes back during the influenza season. It could be tomorrow that a virus suddenly becomes fully adapted to humans and explosive. Or it could be 2 years. Or never. You know, the virus has been transplanted into a new environment. Like any organism in a new environment, it has to adapt or die. Right now, it’s certainly capable of human to human transmission, but it is not causing the explosive number of new cases that even ordinary seasonal influenza causes. However, chances are unfortunately pretty good that the virus will learn how to be very efficient in infecting humans and come back and bite us later.

Sonali: But, John, do you think then that the panic around it was as a result of this flu happening out of season, that if this had happened during the wintertime when we expect to see these cases, these numbers of dead and infected wouldn’t have really caused much of a spark?

John: Well, if the virus were identified, then it would certainly create a lot of…let’s say we get everyone’s attention at the World Health Organization and among everybody who understands anything about influenza…

Sonali: Because of the nature of the virus and the fact that it has strains from…

John: And the fact that it’s a new virus. That’s the scary part. However, if it had occurred in the middle of the influenza season, it’s possible that there would be a lot fewer people who had been tested to see what kind of virus it is and it might have circulated for a while entirely escaping any notice for that reason. But, once it’s identified as a new virus, the alert system would go red and we would definitely know about it. How much news it got, that I don’t …

Sonali: Finally, John, what do you make of media coverage of this flu? As I said, there’s been a lot of misinformation but…

John: I can say this. I’ve actually been too busy to look at much coverage. In fact, for several days I didn’t even have a chance to look at newspapers and I get three every day normally. And I haven’t looked online for stuff. But I know that last week most of the time I was trying to tamp down concerns when I was being interviewed pointing out this is not 1918, it’s not likely to become anything like 1918, however, in the last few days I find myself saying, wait a second, wait a second, this thing’s not over yet. It’s still serious and it still needs our full attention.

Sonali: John Barry, I want to thank you very much for your time and for doing this interview.

John: You’re very welcome, my pleasure.

Sonali: John Barry is an award-winning writer and New York Times best-selling author of The Great Influenza: The Epic Story of the Deadliest Plague in History. He’s also a distinguished scholar at the Center for Bioenvironmental Research at Tulane and Xavier Universities.

Special thanks to Julie Svendsen for transcribing this interview.