Why the Flu Can Be Such a Killer

One-hundred years ago this month, the influenza epidemic of 1918 was in full swing, killing about 195,000 Americans in the month of October. The New York Times took a look back at the pandemic with a story by Perri Klass, MD, a pediatrician and medical writer. She implored readers “to pay proper respect to the influenza of 100 years ago, get this year’s flu shot and make sure your children do, too.”

Klass interviewed David M. Morens, a scientist at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, who said, “The 1918 influenza pandemic was the deadliest event in all of human history. It killed more people than any war, any pandemic, the Black Death, AIDS—you can pick your terrible event.”

It is estimated that the 1918 pandemic, which lasted for two years, killed 50 million to 100 million people worldwide. “Ever since 1918, the descendants of that virus are still killing us,” Dr. Morens said. “Every year, the flu that comes to our communities is a descendant of the 1918 virus, and it carries the history of being deadly.” People die from influenza every year, but “some flus are more deadly than other flus. It’s a big deal, and these deaths are mostly preventable,” he said.

The 2017-2018 Flu Season

The 2017-2018 flu season was the deadliest in recent memory. Nearly 80,000 Americans died of the flu and complications arising from the virus last winter, making it the deadliest flu season in at least 40 years. According to the Centers for Disease Control (CDC), in recent flu seasons, deaths from the virus have ranged from about 12,000 to 56,000. Complications that can arise from the flu and result in death include stroke, heart attack and pneumonia.

So why was last year’s flu season so deadly? According to an article from The Conversation, “one of the circulating strains of the influenza virus, A(H3N2), was particularly virulent, and vaccines targeting it are less effective than those aimed at other strains. In addition, most of the vaccine produced was mismatched to the circulating A(H3N2) subtype. These problems reflect the special biology of the influenza virus and the methods by which vaccines are produced.”

Fewer than 4 out of 10 adults in the U.S. got flu shots last winter, the lowest rate in seven seasons and was one likely reason why the 2017-2018 season was the deadliest in decades. This past week, the CDC released their most recent data about the severity of the 2017-2018 flu season:
  • 49 million people were sickened by flu.
  • 960,000 people were hospitalized in the U.S.
  • 79,000 people died.
The Outlook for This Year

And what’s the outlook for this year’s flu season? Here’s what a recent article in Business Insider had to say about this year’s vaccine. “After last year's shot performed so poorly, proving itself only 25% effective against some of the nastiest strains of the flu, infectious disease experts and drugmakers have reformulated the 2018-2019 vaccine. Although it's still early in the season, flu experts are hopeful about the new formula.”

"What we hope is that it's going to be a better match to what's circulating," said Dr. Richard Webby, an infectious disease expert at St Jude Children's Research Hospital. “It's still too early to tell exactly how well this year's vaccine will work but there are already a few promising signs that this year's season might not be as bad as the last.”

According to Business Insider, “the formulation has been changed in two key ways: the nasty H3N2 strain that sickened many people last year has been updated, and the influenza B virus targeted for protection in the vaccine has been changed, too. So far, the revamped vaccines look promising.”

"It appears that the virus is doing a little better job, if we look at what's gone on in the southern hemisphere season," Webby concluded.

The Vaccine: Fact Vs. Fiction

Each year, everyone from government health officials to primary care doctors recommend that people of all ages (the CDC recommends everyone 6 months and older) get the flu vaccine. So why is it that last year, for example, 6 out of 10 people opted NOT to get the vaccine? Many people were aware that the efficacy of last year’s flu vaccine was not optimal. A study released by the Centers for Disease Control and Prevention said the vaccine was about 36 percent effective last year, and only 25 percent effective at combatting the powerful H3N2 strain. So a lot of people figured why bother and opted not to get the vaccine.

People’s confidence in the protection that a flu shot affords can often vary. Here at Jobson, we were offered free flu shots in mid-October and while a large number of the staff opted in, some people declined. The reasons for not getting the shot varied from “I haven’t had the flu in 25 years” to “Why expose myself to the live virus if I don’t have to.”

Some Jobsonites are not alone in their lack of confidence in the flu shot. The Massachusetts Medical Society has published a top 10 list of reasons Why People Don’t Get Vaccinated (and ways to persuade them to!). Here are some of the Top Reasons:

  1. I don’t need the flu vaccine. If I do get the flu, I’ll just take the new flu medication.
    The new antiviral medications prescribed for flu do not eliminate flu symptoms. According to the medical literature, they have the ability to reduce the severity of the flu somewhat, and may shorten the duration by only about three days. They will not stop the flu dead in its tracks, like a cough suppressant relieves a cough. Moreover, patients who have taken these medications inappropriately have been known to suffer severe side effects

  2. I will get sick from the flu vaccine.
    There’s no live virus in the injectable vaccine, so you can’t get the flu from the shot. You might get a low-grade fever and muscle aches that last about a day or two. Remember, the vaccine can take up to two weeks to become completely effective, so you could still get the flu during these two weeks. If you get the flu after this period, you may experience milder symptoms than if you had not had the immunization.

  3. The flu can’t be all that bad. After all, it’s just a really bad cold.
    The flu can be very serious. On average, approximately 36,000 people die from the flu and flu-related complications in the U.S. each year. Ninety-five percent of these deaths occur in individuals age 65 and older. The flu shot protects you, and it will help keep you from spreading it to individuals in this vulnerable age category.

    Click here for a full list of the Top 10 Reasons.
The Importance of ‘Herd Immunity’

This Reuters story explained the role that the theory of herd immunity plays when it comes to stopping the spread of the flu virus. “The knowledge that getting a flu shot can help prevent flu from spreading in the community may help convince more people to get vaccinated, a U.S. study suggests.

“Even though doctors recommend that nearly everyone, starting at six months of age, get a flu vaccine each year, less than half of Americans follow this advice. Each person who skips their annual flu shot diminishes what’s known as ‘herd immunity,’ or the potential for vaccinated residents in a community to help prevent the virus from spreading to the minority of residents who can’t get vaccinated for medical reasons.”

“The more people who are vaccinated in a community, the lower the risk that influenza will be able to spread even if the vaccine does not perfectly protect against the disease,” said senior study author Nicole Basta of the University of Minnesota in Minneapolis.

“Influenza spreads by creating chains of transmission whereby one infected person infects additional people and those individuals infect others with whom they come in contact,” Basta said.

The Bottom Line

The bottom line is that the flu can be dangerous and sometimes deadly, even for young healthy people in the prime of their lives. And getting the shot is less painful than actually getting the flu. Take for example, Charlie Hinderliter, a healthy 38-year old who didn’t get the flu shot last year because he thought only young children and the elderly were at risk.

When he got the flu in January, his symptoms worsened very quickly and by the time he got to the emergency room, he had pneumonia and his organs had begun to fail. His twitter post says it all: “The flu nearly killed me. I spent 58 days in the hospital and 21 days in a skilled nursing facility (aka a nursing home). I was fortunate that I will make a full recovery. I don’t recommend my experience. Get a flu shot.”

Listen to his story on NPR above and watch his YouTube video below, encouraging everyone to get a flu shot.