Public health officials have been warning for years about the constant threat of a worldwide pandemic like the “Spanish flu” of 1918. About 100 million people died, or 5% of the world’s population.

The U.S. Public Health Service ignored the alarm of an unusually lethal outbreak, sounded by a family physician in Kansas. The federal government suppressed any bad news that might impede the war effort, or prevent attendance at mass Liberty Bond rallies. Some called the epidemic “Wilson’s flu” as a result (see The Great Influenza: the Epic Story of the Deadliest Plague in History by John M. Barry).

In 1976, the government made the opposite type of error. The predicted swine flu pandemic never materialized. More people probably died from the vaccine that was rushed into mass production. According to a Nov 4, 1979, program on 60 Minutes, 46 million Americans obediently took the vaccine, and 4,000 filed a damage claim with the government, mostly for paralysis attributed to the shot. The consent form made no mention of potential neurologic complications, although the government was allegedly aware of them. Moreover, while the CDC’s consent forms stated that the vaccine had been tested, a different, allegedly nontested vaccine was actually given to most of the 46 million.

Congressman Ron Paul, M.D., has warned against overreaction.

The World Health Organization (WHO) has raised the threat level to a five out of six, having determined that human-to-human transmission is possible. The CDC is issuing daily guidance, see http://www.cdc.gov/h1n1flu/. A 33-year-old Texas schoolteacher, with unspecified other medical conditions, has been reported as the first U.S. fatality. The CDC has released an H1N1 PCR (polymerase chain reaction) test kit. The CDC is using Twitter to follow case reports and to send updates http://twitter.com/CDCemergency.

The rapid influenza test kits used in physicians’ offices detect influenza A or influenza B nucleoprotein antigen in respiratory secretions. Most of the positive tests in Tucson, Arizona, according to persons participating in a forum at Carondelet St. Joseph’s Hospital, are for influenza B. The “novel H1N1” virus is a type of influenza A. Neither the sensitivity nor the specificity of the rapid test for H1N1 is known. The CDC has received reports of both false positives and false negatives.

For detection of seasonal influenza, the sensitivity of rapid tests is 50% to 70% compared with viral culture. Specificity is 90% to 95%. A positive test, according to the CDC, could mean that the patient has (1) novel H1N1 influenza, (2) seasonal influenza A, or (3) a false positive test.

Conflicting advice circulates. Some say that if you have symptoms you should get to a doctor immediately, “before it’s too late.” A Tucson emergency facility has stationed a physician assistant at triage to send people home immediately if symptoms suggest influenza. Oseltamavir (Tamiflu) or zanamavir (Relenza) are recommended—or not—for prophylaxis, for early treatment, or for treatment only of the sickest. The effect is said to be to shorten duration of illness by 0.5 to 1.5 days, and it is hoped that it might prevent more serious complications.

In Japan, two teen suicides and 64 psychological disorders were linked to Tamiflu in 2005. These included panic attacks, delusions, delirium, and convulsions in otherwise normal persons. The FDA added a warning to the label (PsychCentral.com, Nov 17, 2006). This potential does not appear to be widely known among U.S. physicians, who may think that psychological reactions are restricted to amantadine, or that they are more likely to be a manifestation of the influenza itself.

Vitamin D deficiency may play a crucial role in susceptibility to influenza. In an April 2005 epidemic in a hospital for the criminally insane, patients on a ward where they were receiving a supplement of 2,000 units of vitamin D daily were spared (Medical News Today 9/15/06). A decreased incidence of colds and influenza was an incidental finding in a study of vitamin D supplementation and postmenopausal bone loss, one of many benefits reviewed by Joel M. Kauffman in the forthcoming summer 2009 issue of the Journal of American Physicians and Surgeons. Toxicity is rare, Kauffman writes. Increased dose recommendations are lagging trial results. Doses of 1,000 IU/d to 2,000 IU/d are now considered routine, and doses up to 50,000 IU/d for rapid repletion are considered safe.

According to a 2006 review, vitamin D suppresses excessive expression of inflammatory cytokines, likely the cause of death in young persons in the 1918 pandemic, as well as increasing the expression of antimicrobial peptides (Cannell JJ et al., Epidemiol Infect 2006).

While a severe influenza pandemic remains a possibility, use of the threat as a pretext for mandatory vaccination and monumental expansion of governmental power is also a danger.

Additional information:

• “Tamiflu May Be Linked to Risk of Self-injury and Delirium; Vitamin D Suggested for Influenza,” AAPS News of the Day 12/6/06.
• “Influenza Vaccine: Review of Effectiveness of the U.S. Immunization Program, and Policy Considerations,” by David A. Geier, Paul G. King, and Mark R. Geier, J Am Phys Surg 2006;11:69-74.
• “American Scientists Resurrect 1918 Pandemic Influenza Virus, Plan to Send It in the Mail,” AAPS News of the Day 11/15/05.