Posted by: Snake Oil Baron | June 13, 2009

Learning From the Flu

UPDATE: I got some more info from a doctor I know well. He told me that there were reports of flu patients going from seemingly healthy one day to seemingly very much dead the next. DIC from infective agents doesn’t happen that fast. He informed me that there are three diseases generally known to cause such sudden death: cholera, plague and meningococcal meningitis. Meningococcal meningitis is caused by Neisseria meningitidis. It is normal flora in many people’s nose and throat region but can cause devastating infections if it gets in the wrong site under the wrong circumstances. Not only does it fit the bill, I suspect, for the sudden deaths but meningococcal septicemia can produce a purplish rash – explaining the heliotrope cyanosis (along with actual cyanosis from fluid in the lungs). So DIC might not be needed to explain some of these strange symptoms though it may occur in some patients who get a different opportunistic infection due to the effects of the flu virus. The rest of the post continues as first posted.

The more I learn about this swine flu and previous flu outbreaks the more interesting the subject becomes to me.

When I had previously heard about the concept of novel flu viruses causing what is referred to as a cytokine storms, I had the impression that they were causing a massive overreaction by the immune system to the unfamiliar viral infection which (after getting the jump on the body’s defenses) provoked fluid in the lungs which helped to nurture the bacterial pneumonia that these flu patients often die from – or with, depending on your point of view. But it seems to be more subtle than that. One of these groups of cytokines, called interferons, are used to inhibit viral reproduction inside cells and helps keep them from gaining access in the first place. These interferons also have other effects like telling bacteria-eating cells such as neutrophils that the infection is viral in nature and their services are not needed or wanted.

Hey, that’s fine when the flu is in the upper respiratory tract since there are normal flora living there – helpful bacteria which can out compete potential pathogenic species which might land in the area and keep each other in check. And the tissue of the upper respiratory tract is harder for bacteria to colonize than the tiny little air sacks of the lungs. But when the virus is in the lungs, for the immune system to tell all bacteria-fighting cells to clear out is asking for trouble. Now, even some of the beneficial normal flora in the upper respiratory tract can ride down on an aerosol, a globe of phlegm or some misdirected trickle of spit and start planting its flag. “I claim these aveoli in the name of Streptococcus pneumoniae!” All the neutrophil are out of the area and the virus is raising a ruckus that leaves the region filled with blood, cell proteins and mucous. Whatever bacteria land in the environment think they have died and gone to prokaryote heaven. The immune system is making a mistake that Stalin made at the onset of WWII. He was so obsessed with threats like Japan and his own paranoia that he couldn’t imagine that the Nazis would break the non-aggression pact; to the point that he didn’t believe it even while his own forces were frantically trying to tell him that the Nazis were on the move east.

Another interesting feature of the 1918 flu is the colour it left its corpses. The term, “heliotrope cyanosis” was often used to describe victims and some of the dead had been turned black, leading some of the survivors to term it the “black flu”. I have heard of claims of similar effects on bird flu victims but I have yet to see a reference to back this up. The cyanosis was, I suspect, due to the fluid in the lungs causing the body to shunt blood away from the skin to the vital organs to maintain their oxygen but this usually causes a blue tinge. This could be pushed into the purple and even black range if the damage in the lungs was causing D.I.C. – distributed inter-vascular coagulation. Many things can cause DIC but when it happens, tiny clots form through the blood and cause microscopic strokes in the capillaries of the tissue, usually leading to organ failure and death in about 90% of DIC sufferers. The tiny clots would probably cause the blue of the cyanotic skin to become purplish and DIC also uses up coagulation factors and platelets meaning that bruising and bleeding can occur which could cause a blackening of the skin. Wikipedia states that bleeding from the mucous membrane occured in some cases which would be consistent with DIC.

The fact that some called it the “black flu” is rather appropriate. I remember someone noting that, while everyone learns that the black plague killed about a third of Europe, it did so over the course of a few decades. The 1918 flu seems to have killed a similar number of people in one year but since there were so many people on earth its proportion of fatalities is less impressive unless one realizes how short a time it took to do it. This would not be the best time to be sitting back and gloating over how worked up everyone got over a simple flu. Now would be the time to be stocking up on antibiotics to fight the bacterial pneumonia and stocking the supplies needed to monitor for early signs of DIC while working diligently to get the vaccine ready.

This might not be a “herald wave”.

No! Herald wave.

No! Herald wave.

But it is acting like one so it would be wise to plan for a deadly second wave so as to minimize the damage.

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Responses

  1. Great stuff, these posts on H1N1. I spent a couple of years on pandemic response planning, and the idea of a secondary pathogen taking advantage of primary-disease-weakened immune systems or a morphing of two viruses was always something we were warned about by public health types. Never heard it compared to Operation Barbarossa before, but the analogy is apt.

    Out of curiosity, have you read “The Great Influenza” by John Barry?

    http://www.amazon.com/Great-Influenza-Deadliest-Plague-History/dp/0670894737

    An excellent (and readable) account of the first year of that new outbreak. Well worth your time.

  2. I have not read it but sounds like it would be right up my alley.

  3. Amazing,how I ended up here,reading France and the Burka. i am not well educated,but try to be informed.Over the course of the last 2 months I have been quite ill.I just wanted to say thank you for this article and that I feel much worse already thanks. I have one thought at this moment,it ain’t over yet and now I am armed with more info for the Doctor. Answer if you would,why do some people refuse to read anything of Darwin.Could it be a fear of truth?

  4. Sorry to hear you are ill and making people feel worse is kind of a talent of mine ;-)

    Good question about Darwin. I think that, whether they are attached to a traditional religious view of “creation” such as Genesis or simply want there to be an in-built purpose to all existence that is easy to understand, people would rather ignore or manipulate the facts of the world than alter, even slightly, their comfortable world view. The models we build up of reality can become as important to us as a part of our body and change of them or challenge to them can be incredibly frightening. That must be why I often see creationists and Intelligent Design proponents using techniques of argumentation and political manipulation which they absolutely must know are wrong both rationally and morally. But they can seem to rationalize these actions as being in the service of defending their belief system which they perceive as being under attack.

    I think that, rather than fear of the truth, in many cases it is fear that their own ability to retain belief in what they think is the truth might not be strong enough. We all know how easy it is to be tricked and people who think they are on the right side of an issue might worry that a well spoken but incorrect argument might weaken their belief in their world view. Many religions have the concept of temptation and confusion provided by evil agents (people or devils) which lead people astray from “the truth”.

    I know one Christian who is resistant to the basic fundamentals of evolution yet has no problem with a non-literal approach to Genesis and such. He can even accept common descent to a point but draws the line at having no creative input from God. The concept of God as a creator is so fundamental to his view or reality that that creative aspect can not be relegated to the creation of reality. Yet he does not particularly feel that microchips need to have a divine creative input. There are also lots of anti-evolutionist people who accept the evolution of microbes and within species but feel a need to have God create the kinds of things which evolve. There is so much information to deal with on the issue of species division that convincing anyone who is skeptical of separate species arising from a common one requires both the skeptic and the evolutionist to be very patient.

    I hope you feel better soon.

  5. Try some snake oil. That’s always good for what ails one.

  6. Thank you, I shall read your response a few more times.Also,interesting to me is a film I just watched called Home by Yann-Arthus – Bertrand.Skeptic that i am i feel like i have found an open door into possibly widening my rather skeptical view of evolution. Enjoyed the article on Iran.I am better thanks have returned to work this week,greatfully.Snake Oil,Hmmm.


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