BY DR. JOSE MA. EDUARDO P. DACUDAO
A HORSEMAN draws near.
The pale rider casts his contagious gaze upon more than a billion people. The contagion comes from various mammals and birds, mutated into strains that infect humans. Our fellow vertebrates cough or sneeze them out aerosols, viral-laden air-borne liquid droplets. We humans typically follow their lead, coughing and sneezing, ever spreading the disease. But it can also be transmitted by saliva and mucus from our nose and respiratory system, mouth and gastrointestinal tract, feces, and blood. The pathogen gets into the membranes and mucosa of potential hosts’ eyes, nasal and oral cavities, and the deadly story retells itself.
Those that imbibe of the pale rider’s aerosol stare begin coughing. Fever, malaise, headache ensue.
But it’s not mere common colds. It’s something different.
The pale rider slays up to a hundred million people.
The populations of major world cities walk the streets unrecognizable in face masks. Close friends and relatives sicken. Special wards in overcrowded hospitals overflow with patients who cough and die.
In a US army camp, a doctor stands aghast at the carnage. “One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies… we (too) have lost an outrageous number of nurses and doctors…”
COVID in the 2020s?
No. We’re in the pandemic of the Spanish flu, circa 1918 to 1920. That Influenza killed more people than all the soldiers that got killed in action in WW 1.
So die they did.
An RNA virus (family Orthomyxoviridae, Influenza A virus strain of subtype H1N1) has infected them. Their respiratory tracts are the main targets. Pneumonia sets in. Tragically and peculiarly, many of them were youthful healthy adults at the start. There are speculations that it started in an army camp in the USA, full of young able-bodied soldiers. This particular pale rider takes what he wants, even the vigorous, quite unusual even among the riders of contagious death. That’s because of the complication known as the cytokine storm. Essentially the originally healthy young adult’s strong immune system overreacts in a supreme effort to get rid of the pathogens, so that it causes pulmonary edema. The victims literally drown in pulmonary fluids. Most of the deaths however were caused by secondary bacterial infection. The resulting bacterial pneumonia also literally drowns the patients’ lungs, and also causes cytokine storms, sepsis, and septic shock.
Have I seen this happen? All the time. However it starts, whether from a virus or a traumatic injury, damaged lungs that lead to death almost always end up in the same end stage – bacterial pneumonia. In my patients’ cases, they usually start off with an injury or disease that affects the central nervous system; and so they become bedridden and unable to expectorate their secretions. The accumulating secretions attract bacterial pathogens like a smorgasbord. The patient worsens. As wheezes, rales, rhonchi abound, and impending pulmonary failure approaches, the desperate doctor gives a steroid (such as Dexamethasone) temporarily to try and control bronchoconstriction and pulmonary edema, even if steroids also lower the immune resistance. Oxygen levels in the blood plummet. The doctor secures an airway by intubation (emplacing a plastic endotracheal tube down the windpipe so that the patient can breathe). Copious secretions and mucus plugs keep blocking the tube. The doctor does a tracheostomy (making a small hole on the windpipe itself though the neck’s anterior and placing in a specially designed plastic tracheostomy tube.) The patient is hooked to a mechanical electric-powered ventilator if one is available. Antibiotics and other meds galore are injected at regular intervals (and unfortunately they’re quite high-priced). The patient is turned side to side regularly and chest tapping done to help expectorate secretions. And so on. Expenses are frightfully prohibitive for most ordinary families, and many patients will die anyway. There is almost no chance for survival for the elderly and those with other serious diseases like uncontrolled diabetes.
The Spanish flu was the worst Influenza pandemic in recorded history, but it was just one of the many recurring ones. The first historically recorded one may have happened in the 16th century, but there must have been more before and after, given the nature of Influenza. There was one just before the Spanish flu, the so-called Asiatic flu or Russian flu of 1889 – 90 that may have killed a million people. Afterward there was the Asian flu of 1957 – 58 and the Hong Kong flu of 1968 – 69, each of which may have killed up to four million people. Then they were followed by the Russian flu of 1977 – 79, and the swine flu of 2009 – 10, each of which may have killed half a million people.
And every year, we get typical seasonal Influenza pandemics that kill up to half a million people out of a world population approaching 8 billion. That’s “only” a mortality rate of less than 0.01%.
In contrast, the Spanish flu had mortality rates that may have ranged from 3 to 10 percent. The military kept the best records then. One author wrote that in the British Army in India, Indian troops suffered from a 21.9 percent mortality rate. Occasionally, mortality rates rose terrifyingly high. An area in the Fiji Islands had 14% mortality rate, in Labrador 33%, and in Alaska 33%. Imagine one-third of humans getting wiped out in local communities. (To be continued)/PN
