Bacteria were real killers in 1918 flu pandemic

New research has shown a majority of the deaths in the 1918 flu pandemic were actually due to bacteria.
Article here

They suggest governments stock up on antibiotics in preparation for the next one.

-Blast

Fascinating -- historically and practically.

Thanks for the link!

I have a book, "Desert Survival Skills" written by David Alloway. A few years ago, after reading the book, I Googled him and found a web page that said he had died of an infection contracted when a horse stepped on his foot far from medical attention. I have since then wondered whether to carry antibiotics in my first aid kit.

After further sniffing around I wondered which antibiotic I should carry. I'm a little fuzzy on the differences but there are scads of antibiotics. There are those that work on gram negative bacteria, those that work on aerobic bacteria, those that work only on some particular infections and those that work only on Tuesdays. Some also can have quite serious side-effects (see the link below for more).

My girlfriend seems to keep Cipro stashed somewhere for some eventuality. Probably because she heard the name at the peak of the anthrax scare in 2001. But what if you are trying to prepare should you get stranded somewhere and then get infected? It seems I would want to protect myself against diarrhea and also against whatever might infect a wound for example. I suppose, ultimately, I'll ask my doctor but I would like to some more knowledge so I know what to ask for (if it is indeed a good idea).

Anybody have any thoughts on this?

http://en.wikipedia.org/wiki/Antibiotic_classes

Good article. Thanks, Blast.

Can't help you, Yuccahead, but I also would be interested in knowing more about what you're asking about.

Opportunistic infections have always been a major killer, and made a roaring comeback in the early days of the AIDS epidemic. People don't die of AIDS itself, or from some other syndromes; they die from the opportunistic infections these allow to flourish.

Not so long ago, our government did maintain rapidly deployable pharmaceutical stockpiles, including antibiotics. However, there has been much political tinkering, blundering and loss of readiness of late, in federal programs designed for disaster response and mitigation, including disease outbreaks or bio-terrorism. Several years ago, the system was in pretty good shape, and I participated in an exercise ("Bioshield") to practice receiving one of the stockpiles and distributing them to hospitals, county health clinics, etc. It went very well. Today? Who knows?

As for stockpiling antibiotics individually, that's kind of iffy, in my personal opinion. You gotta match the drug wid' da' bug. If you screw up when dealing with the really nasty cooties, you might make yourself sicker in the long run. That being said, I do stockpile myself, with a doctor's Rx. But I have specific reasons for doing so. I have a history ear infections, and I get pneumonia rather easily now, thanks to "Nine One One Lung," even though I was one of the few to wear a respirator in the thick of it. I also do long distance, off-trail, solo backpacking. My doctors know me personally, know that I am a paramedic, and trust me to not do anything too terribly stupid before I check in with them. Others here can give far better, more expertly informed advice than I can. But please don't "hold back" any pills from current antibiotic Rx's, even if you're already feeling better. It is very important that you complete the entire prescribed course of treatment.

The real key here is prevention. That means good sanitation and personal and public health pratices, and maintaining as healthy of an immune system as you can.

Jeff

Interesting article Blast, thanks for posting.

In response to some of the responses that were responding to your post;

I've always been leery of the idea of individuals stocking antibiotics for an emergency, though I do understand the rationale for it, and haven't come to a personal decision on it as of yet though I'm leaning to "nay".

The pro's:

1) Peace of mind.
As often is the case, peace of mind is just a placebo.

2) May have the correct antibiotic for the specific infection during an emergency.

The con's:

1) Peace of mind.
Thinking one has something covered can increase the likelihood of letting one's guard down or delaying seeking treatment. "I don't need to go see the doctor, I got a truck-load of Cipro in the bunker out back...."

2) Inappropriate use:
Having a source of antibiotics in the house is tempting to use when one "thinks" they have a bacterial infection.

It was not uncommon for physicians to prescribe antibiotics for a patient coming to their office with a cold (virus) just to shut them up. Folks in America tend to not feel they've gotten their "money's worth" unless they walk out of the doctor's office with a prescription of some sort.

Given the rise of drug resistant bacteria, I've seen the majority of physicians clamp down on that practice, but the publics' perception is still the same in many cases.

3) Wrong tool : wrong job:
As someone pointed out there are several different groups of bacteria. Gram positive rods, gram positive cocci, gram positive cocci in clusters or chains, gram negative rods, gram negative cocci, ..... And it's not possible to know for sure which one got you and then you have to run sensitivities to see which antibiotic will work on it.

You could have Staph. aureus, or you could have Methicillin Resistant Staph aureus (MRSA)..... in which case oral antibiotics ain't going to do you a whole lotta good.

I think that putting effort and time into prevention would be a wiser course of action. Cleaning and hygiene supplies, keeping oneself as healthy as possible to stoke up one's immunity,...

The best way anyone can prevent the spread of infection is simply washing one's hands.

That is why there are people who have masters degrees and doctorates, who still refer to very heavy and thick books, who handle drugs.

As for Cipro, it was touted as a be all and end all wonder drug. It isn't worthless, if stored and used correctly, but the odds of anyone who isn't a medical making that call is just random luck. It's like atropine- does it work? Sure, if used right. But stocking whatever random antibiotics you can lay your hands on, when you don't know how or when to use them and lack the ability to determine the actual infectious agent, while not as stupid in my opinion as stocking atropine, it is on par with gas masks and geiger counters. If you have a REAL, CREDIBLE risk, and know how to use it properly, fine, otherwise, don't.

I'm convinced I could do quite well impersonating a GP.

1st visit: "It's a virus, go home, get lots of rest and drink lots of water."
2nd visit: "Ok, perhaps its bacterial, here's an antibiotic, go home, get lots of rest and drink lots of water."
3rd visit: "Let's run a few blood tests." (or x-rays, mix it up a little)
4th visit: "Hmmmmm, I think you need to see a specialist."

At any rate, that article sounds like good news, we already have all kinds of antibiotics developed, while a specific flu vaccine can't be developed until the nasty strain breaks out and is identified.

This week's (August 6, 2008) issue of The New Yorker magazine has an article by Jerome Groopman on "Superbugs," which I found helpful for getting caught up on the use of antibiotics and the rise of antibiotic resistant bacteria in recent years.

I can also recommend "Flu: The Story Of The Great Influenza Pandemic" by Gina Kolata.

Thanks for the link, Blast, to the article re: bacterial infections and the 1918 flu epidemic.

To all of you that were directing some part of your posts towards answering me, thanks. Those posts, to me, were good informative answers and viewpoints. I actually have that New Yorker around here somewhere. I'll have to read it now.

We may be living in what turns out to be a unique period in the history of public health. Most epidemic and pandemic diseases, like polio and smallpox, have been all but wiped out. We have antibiotics effective against almost all infectious bacteria and even effective vaccines and treatments for virii. Medicine is currently is enjoying the zenith of its unprecedented success in the war on disease.

But evolution is on the side of the bugs, since they can potentially change far more rapidly than medical science can come up with new drugs to treat them. We are only seeing the tip of this looming iceburg with the new superbugs like MRSA and polyresistant turbuculosis. We may be entering an age akin that our great-grandparents knew, where a small cut could take your life, parents had good reason to fear whether or not their children would survive to adulthood without being stricken down with some dreaded disease, and infectious diseases are a leading cause of death.

Jeff

Jeff

We're already there. Recently, I was talking to a lot more of the 65+ year old crowd than I normally do, asking how so-and-so was doing, and I was amazed by how many of these folks had contracted an infection during a surgical procedure (bypass, hip replacement, angioplasty, etc.) and the surgery went fine but they died from the infection because it was antibiotic-resistant. Shocked me how common it seemed just from this small group of people.

I would guess this somewhat more common with older folks because they are partaking of medical procedures in a place that is infested with germs, the hospital, or at least my heart doctor said, there are more germs in a hospital then almost anyplace else. And that they are frailer and more vulnerable to infections. Also the doctors are playing it safe and trying to not get sued so they load them up with antibiotics.


I agree antibiotics are overused.

But for a vast majority of people, were are able to fight off germs fine without them.

I recently was stupid and tried to take part of my right index finger off with a 10-inch table saw. . I cut ½ way through my finger from the top. I lost ¼ of my nail.

All I did to take care of it was to go wash it off with water from the garden hose and wrap it in a paper towel and continue to work on my project. Later that evening I put some ointment on it and a gauze pad on it. No infection and it’s slowly growing back most of the fingernail. Had I went to the hospital they would have made me sit for 2-hrs, loaded me up with antibiotics, put gauze on it and charged a few hundred dollars. It would have looked the same as it does now.

... as far as stockpiling antibiotics for (insert disaster), please read my post here:
http://forums.equipped.org/ubbthreads.ph...0640#Post124193

A question that hasn't been asked, but that came straight to mind when I read the article is, "How do I get a vaccine for bacterial pneumonia?" Does it makes sense to get one, how long does one last...

Even when not faced with a large scale disaster, pneumonia is a statistically significant risk.

IANAD, but your GF needs to Google "Cipro side effects" and read up before relying on it as a cure-all.

That story is available online here

There is a common vaccine called pneumococcal polysaccharide vaccine (PPV). You can read more about it on this CDC webpage. Commonly given to the 65+ year old crowd. Just note that the bacterial strains covered by this vaccine aren't the only bacteria that can cause secondary bacterial pneumonia, so it's not a foolproof protection against a repeat of a Spanish Flu-type pandemic.

Just ask your doctor.

In the past few years, we in the ham radio community have been working with the Medical Reserve Corps. In the event of a pandemic requiring mass antibiotic release, the MRC is preparing to open lots of "PODs" (Points of Dispensing) for the fast release of antibiotics. The initial release would come from the "SNS" or Strategic National Stockpile, which is composed of air freight containers that can be delivered anywhere in the country no longer than 12 hrs after activation. Follow on drug releases would come from slower national and state stockpiles. The PODs are in public areas other than hospitals & clinics, to take the load off those facilities.

That's not to say that all points in the US could be reached that quickly, but here in the N. Texas area, we've been drilling for it.

Most all of us carry opportunistic bacteria in our upper respiratory and upper/lower digestive tract. These bacteria can quickly become pathogens given the right circumstances - i.e. illness. Ever notice how many people develop secondary infections after a course of antibiotics? Most antibiotics given these days are broad spectrum, and end up killing most all the bacteria in our bodies, good and bad. Commensal bacteria are normal flora and actually help us prevent infection by competing for the same space and resources that the potentially bad bacteria are looking for, which is why it's important to maintain a healthy immune system to preserve that delicate balance.

Washing your hands is VERY important, but remember that it only rids your hands of transient bacteria/viruses, and does little in the way of killing bugs that are normally present. Germicidal soaps/hand cleansers - NOT antibacterial soaps mind you - actually kill the bugs. Avagard makes a nice product line of germicidal hand cleansers used by most hospitals.

So true. My dad was one of the unlucky thousands who contracted polio back before the vaccine. He's suffered his whole life because of it. He still has nightmares about row after row of children in iron lungs. He just about freaked when he heard about the new polio outbreaks in Iowa and Wisconson.

Safe people forget about real monsters.

-Blast

It is a scary thought that people aren't vaccinating their children... herd immunity only works as long as a majority of the population is being vaccinated.

Thank you, Ironraven! As one of those heavy-book toting doctors of pharmacy, I appreciate when non-professionals speak wisdom! I have hope yet!

Even if you happen to be an M.D., my dad (a splendid physician) had a good saying: A doctor who treats himself has a fool for a doctor and a fool for a patient.

I like that most of our clinic docs write prescriptions for each other. It is a nice professional nod of ethics and respect. And if they, the pros, are careful, how much more careful should we all be who AREN'T M.D.'s!

Wow. I remember in 1997 speaking with one of my microbiologist professors about the 1918 Spanish influenza pandemic. I said so many people died d/t bacterial pneumonia. He said, nope, the people died too fast for that to be the explanation. I'm glad that it appears the former was true. We have a much better antibiotic armamentarium now, and along with the bird vaccine, should be fairly well prepared for it when (not if) it hits. It will still cost this country tons of money to treat it, and deaths will still be horrid in underdeveloped countries, but when it comes, the best place will be either an island without air service or the good ole' U.S. of A.

The demographics of the dead are interesting. We'd expect either viral influenza or bacterial pneumonia to kill the young and old preferentially, but it appears that young adults [age 20-40] died at far greater rates, something like forty times greater, than can be fully explained by the component of military servicemen's being exposed under unfavorable conditions. The elderly could have enjoyed partial resistance due to exposure during some prior flu epidemic, I suppose. But that doesn't explain why children, normally far more vulnerable, faired so much better than young adults.

Jeff

Good point. I think it is still a very scary and misunderstood event. And just because it acted that way is 1918 doesn't mean it can't mutate to some other variant. If any of you studied microbiology, you'll know how many eight (it was eight, wasn't it?) different strands can intermix and mutate in the flu virus. Spooky!

Thanks for the link Blast.



In terms of keeping in personal and family inventory, you're so right Ironraven. I'm not comfortable storing antibiotics. It's natural to want to have some on hand, but which ones and how do you use them safely?

I don’t agree with this, if a person gets an infection and he happens to be a doctor, and he takes some meds he would prescribe to his patents for the same problem he’s a fool??? I don’t see how this makes a person a fool or reckless or that he’s engaging in anything even slightly dangerous.

Obviously a doctor can’t operate on himself, but if he has a minor problem that an antibiotic can fix, why not?

By itself, it's not an issue. But it is considered the first step on a vary dangerous path. You ought to see my case files re impaired and/or disciplined practitioners.

Jeff

The problem is this...how does the doctor remain objective/ emotionally detached when he's treating himself?

My father served on the PRN (Physician's Recovery Network) for docs who were addicts. In almost every single case, the doctor related that it started with him self-treating for something very minor..."just to keep sharp" and each ethical barrier fell as he progressed into harder stuff. No, not every doctor who self-treats with something minor is going to progress to worse, but why risk it?

With that being said, I know several fine docs who still write for themselves; it's their call, not mine.