—

The bad news is that mainstream media got the pandemic flu story wrong; though A/H1N1-Avian flu did not morph into the dreaded march of viral death echoing the 1918 killer flu that erased some 50 million souls off this earth in nine months, the viral disease that seems to have originated in San Diego County last March is still around, still killing here and there, still hovering just off the collective radar, and perhaps giving humanity one last quiet breath before evolving into a new plague. That dramatic sentence notwithstanding, many health and medical experts have unceasingly called for vigilance in the face of almost certain mass contagion that is expected to recur once the high temperatures of summer abate below the 92 degrees fahrenheit that flu virus needs to transmit itself. Its already transmitting itself just fine in most other places on earth, in spite of warm summer temperatures; so far, San Diego seems to be spared since our summer temperatures retard transmission at present. This will change, of course, and when it does, this city will experience new and evolving forms of a virus that is particularly good at adapting to---and killing---man. This essay is an attempt to better prepare our readers to survive any coming flu epidemic and is entirely advisory.

What worries health officials is a combination of swine and avian flu. A/H1N1 is named for a combination of flu virus originating in swine and fowl. Earlier worries that either virus would attack people on a large scale ended when the virus strains combined into something more dangerous than either one alone. Flu has a remarkable ability to change itself into strains that are more readily adaptable to their host, and they show their particular fitness to conquer their host by the speed with which the virus overwhelms its host to replicate more virus cells---and killing its subservient victim. Flu is a kind of critical evolution and its human victims are prey or perhaps just a convenient source of cells for the virus' taking.

Influenza is an RNA virus; its cells encode their genes in ribonucleic acid to form a simple and unstable molecule that is similar, in essence, to a kind of software. One or more of the eight genes that make up the virus along with its genome, tell the cell what to do after a cell has been infiltrated by the curious virus. That occurs when spike-shaped nodes of the virus, called hemagglutinin, attach and bind to a healthy host cell. Once entered, the host cell is used up as the virus endlessly copies itself within; when the infected cell can take no more, it bursts, releasing many more copies of the virus that go on to infect other cells. Another protruberance on the RNA virus called Nueraminidase, prevents the immune system from immediately targeting the newly hatched virus erupting from the shattered host cell. The combination of the grappling iron-like hemagglutinin and the blower fan-like action of the neuraminidase ensures that influenza can do maximum damage in minimum time.

Besides that, influenza can change its clothes, making it virtually impossible for the immune system to fight it. Hemagglutinin occurs in fifteen known shapes, neuraminidase in nine; there are various subtypes as well and these, when known by researchers, yield the name of the ever-changing strain of virus at hand. H1N1 Hemagglutinin 1, Neuraminidase 1, was the name belatedly bestowed on the killer virus of 1918. It is a combination of an H3N2 that has circulated in people for perhaps a dozen years along with an H5N1 found in birds and several types that infect swine. Because flu has a segmented genome---its genes do not lie along a continuous strand of its nucleic acid---"reassortment" of genes becomes very likely. Reassortment is like shuffling two or more decks of cards and making up new decks from the mix, in the case of flu virus making new, hybrid strains that can more easily jump from animal to man or from man to man. The recombinant result of these virus is something verging on the old death of '18. At present, no one seems to know quite why it isn't spreading like wild fire the way it did then. Health officials are more than a little concerned that its odd reluctance to infect may be replaced by a sudden surge of infectivity for which there would be little immunity. Should that scenario play out, the numbers of cases---and deaths---could be grim and great, though unlike 1918, medical science has a few tools available that may blunt a new epidemic if enough people know what---and what not to do---in time.

What works against medicine where flu is concerned is the ability of the virus to mutate in unpredictable ways. Every individual combination of a new strain with existing strain can produce something completely different and as a better adapted strain passes through more victims, its infectivity becomes greater. Where perhaps hundreds of billions of cells might have been needed to cause symptoms in an individual, with time's passage perhaps only tens of millions may sicken new victims later. The finer the fit of the virus to man, the deadlier the virus becomes. In 1918, the virus killed people in a matter of hours, even before some knew they were sick. It did this by swarming so rapidly that victims died of shock or sudden respiratory or heart failure. They were the lucky ones; those who lingered often bled copiously from the nose, mouth, eyes and ears before turning dark blue and suffering from brain hemorrhages. The fever was crippling; some who recovered were never the same mentally since the virus seemed to attack the brain; particularly the blood vessels. Katherine Ann Porter described its effects in Pale Horse, Pale Rider. It was not a pretty tale.

Any flu pandemic arising from this mix of virus would spread much faster than ever before---certainly faster than in 1918---because of air travel. Millions fly worldwide daily and if a plane full of infected people who are hours away from showing any symptoms of disease land in a foreign environment, they would spread disease long before they could be spotted, isolated and treated. If birds and swine are infected as well that would mean that the world transportation and food industries would need to be treated to stop the contagion. Flu virus usually sicken between 15 and 40 percent of an exposed population and fatality rates can run from nearly zero to almost 90 percent. In 1918, the fatality rate for the US in the latter half of that year was well over 60 percent and in some cities essential services and functions nearly stopped. In a country full of high rise buildings, elevators, public transit, forced ventilation and central heating----all of which are useful in spreading airborne disease like flu, the infectivity rate could be vast. So could the death rate.

Quarantines might be effective if they were draconian enough and imposed soon enough, but that isn't likely to happen. It does little good to close borders, schools, theatres or churches if people need to go to work in office buildings, ride a trolley, go to grocery stores or have their cars parked in lots by attendants who may have flu but not show symptoms-and who sneeze or cough in the vehicles that sit in the sun, incubating airborne virus later breathed by a driver and passengers at day's end for the commute home. For quarantines to be effective, they must mimic what the disease does to the society it infects---society must slow the transmission of the disease and break the likely flow of available victims the virus needs to spread. It does this in two ways: it stops all but unnecessary interaction and it impedes infectivity by increasing cleanliness and filtration.

PROTECTING YOURSELF

Though the flu can kill more people quicker than World War I did, you don't have to be on the hit list. There are steps you can take to lessen your chances of catching it. First, it's important to limit your contact with environments that harbor the soon-to-be-ill. Contact with Elevators, buses, public restrooms and places with poor ventilation should be avoided if possible. When it isn't, make a concentrated effort to avoid touching your face and perhaps bringing virus from your hands to your eyes or nose. Gloves might be useful in a time of pandemic if only as a reminder to keep your hands off your face. The 3M brand surgical mask m95 is what most first responders will wear if and when the time comes. These offer a fair deal of protection when fitted properly against the face and used at all times. They can be found in home repair, gardening and medical supply stores. The masks are useless on a man's stubbly face however; close shaving may make a world of difference to men. There are various respirators that painters and others who work in dusty environments use; depending on the make and model they may offer some degree of protection if fitted with new filtres and kept in good order, at least, while they're worn.

Sharing food and meals can become a vector for infection; if possible, it may be wise to keep one's food separate from others and cook and eat away from the sick and the worried well. Copious hand washing and sanitizing everything one is likely to touch can slow the spread of the virus, too and this is an important thing to do. The flu virus can live on inert objects for at least several hours if not longer and it makes sense to cleanse your hands with soap and water at every opportunity---and even to spray alcohol on surfaces, doorknobs and other items that are commonly used at work and elsewhere from hand held spritz bottles. Though it seems strange, this kind of action can at least slow down the spread of any pandemic, breaking the cycle of infectivity and hastening the end of the time when the virus mutates back toward a less deadly form-and maybe prevent you from catching a dose of it, too.

If you do feel sick, there are a few quick steps to take. If you become ill, get to a hospital or clinic ASAP. If for no other reason, this may prevent your family members and others from getting sick. The good news is that unlike 1918, supportive care can make all the difference you need; oxygen, heart stimulants, antibiotics to control secondary respiratory infections and simple nursing care can save your life. If a vaccine for a pandemic flu strain is available in time, get it, and make sure everyone you care about gets it, too. Even after you and yours are inoculated, take steps to slow the spread of the virus; you'll do others a favor and lessen the severity of any virus that finds you. Some drugs may have some use against flu. Amantadine is one that can lessen the severity of an attack and buy you enough time to recover. Know your options, know where to get help and know how to get there if and when necessary.

Albert Camus wrote, "What's true of all evils in the world is true of plague as well. It helps men rise above themselves." Many victims of disease are those who die for lack of even simple assistance. No one got them to a hospital in time; no one brought them food or gave them water. No matter what we may face someday and no matter if our own number comes up, we need to attempt to keep civilization going if we hope to have help ourselves when we need it. No matter the danger or the grim chances we may face, for any of us to come through alive and with a clean conscience we should accept the challenge to rise above ourselves if neccessary.

Be well.