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What if a pandemic of the deadly flu virus flares up these days?

It's been a century since the Spanish fluclaimed at least 100 million lives. And it remains only a matter of time when a similar strain appears. One hundred years ago, the flu season was brewing in the most ordinary way. Most of those who fell ill in the spring recovered quickly, and mortality was no higher than usual. The newspapers wrote more news about the war than about the flu. But in the fall, everything changed. A previously unknown virus turned out to be an extremely dangerous strain, destroying populations in North America and Europe, killing its victims in a matter of hours or days. In just four months, the Spanish flu, or "Spaniard," as it is called today, has spread throughout the world and penetrated even the most isolated societies. By the time the pandemic reached next spring, between 50 and 100 million people — about 5% of the world’s population — were dead.

A century later, the 1918 pandemic seems like thisas far away as horror from us, like the bubonic plague and other deadly diseases with which we more or less coped. But the flu is still with us - and it continues to take from 250,000 to 500,000 lives annually. Each year brings a slightly different strain of seasonal flu, while a pandemic can occur depending on the assortment of influenza viruses in animals. In addition to 1918, pandemics occurred in the last century in 1957, 1968, 1977 and 2009.

Given the tendency of the virus to mutate and itsa constant presence in nature (it appears naturally in wild waterfowl), experts are convinced that it is only a matter of time before the same infectious and deadly strain appears as the Spanish flu - and maybe even worse.

"Flu pandemics are like earthquakes, hurricanesand the tsunami: they appear, some worse than others, ”says Michael Osterholm, director of the Center for Infectious Disease Research at the University of Minnesota. "To think that we will not have a second such event as in 1918 is stupid."

But when it takes place, he continues, it’s impossibleto predict: "As far as we know, everything can begin even now while we speak." It is impossible to accurately predict how they will develop when a strain similar to the “Spanish woman” reappears and begins its bloody harvest. But we can make some reasonable assumptions.

First, the exposure of the virus will depend onwhether we catch him early enough to hold him, says Robert Webster of the Infectious Diseases Unit at St. Jude Children's Research Hospital. There are many systems that are designed for this: the World Health Organization's influenza surveillance team constantly monitors the development of the virus in six key laboratories around the world, and an additional set of agriculture-oriented laboratories does the same for poultry and pigs.

“Our observation, most likely, we willtrying to conduct as well as possible, but we cannot track every bird and pig in the world - that’s impossible, ”says Webster. “We should be lucky if we want to hold back the virus.”

The reality is, he continues, that the virus is almostsure to break out. Once this happens, it will spread across the globe in a matter of weeks, given the level of mobility today. “Influenza is one of those viruses that, if it enters a vulnerable population, develops rapidly,” says Gerardo Chowell, professor of epidemiology and biostatistics at Georgia State University. “Individuals already endure it until symptoms appear.”

Since over the past hundred years the number of people has notthe planet has more than quadrupled, there are likely to be more infections and deaths compared to 1918. If 50 million people died as a result of the flu in 1918, today we could expect 200 million deaths. “This is a lot of bags for corpses - they would end very quickly.”

As history shows, mortality is probablywill be unevenly distributed among the populations of different countries. Spanish flu has manifested itself in very different ways in different countries. In India, for example, the virus claimed more than 8% of the population, but in Denmark less than 1%. Similarly, during the 2009 H1N1 pandemic, mortality in Mexico exceeded mortality in France by 10 times.

Experts suggest that these differences are affected.a variety of factors, including the preliminary impact of the population on similar strains of the flu and the genetic vulnerability of certain ethnic groups (for example, Māori in New Zealand died seven times more often after contracting the 1918 flu than people on average around the world).

Poverty-related factors such assanitation, basic health services, and overall health care, according to Chowell, also play an important role in controlling the outbreak of the flu virus. “In 2009, in Mexico, many people were hospitalized only when they became very, very ill, and often too late,” he says. Many of these victims were driven by an economic decision: going to the doctor meant losing a day of work, and therefore paying for that day. “I'm not saying that this applies to every Mexican, but to the most vulnerable parts of the population for sure,” says Chowell.

If a pandemic affects the United States or other places withoutsocialized medicine, similar socioeconomic patterns will apply to uninsured citizens. To avoid harsh medical bills, people without health insurance are likely to postpone hospital visits until the last moment - and then it may be too late. “We are already seeing this with other infectious diseases and access to medical care.”

Vaccines are the best pandemicsays Lone Simonsen, an epidemiologist for infectious diseases at Roskilde University in Denmark. But this requires the identification of the virus, the creation of a vaccine, and then its distribution around the world - easier said than done. Flu vaccines, which were not available until the 1940s, are being made very quickly today, but it still takes months. And even if we are successful in creating such a vaccine, it will be impossible to create enough doses for everyone, says Osterholm. “In six to nine months worldwide, only 1-2% of the population will have access to the vaccine,” he says. Another limitation, he adds, is that modern flu vaccines are, at best, 60% effective.

Similarly, although we have drugsto fight the flu, we do not stockpile their stocks in the event of a pandemic. “Today we do not have enough antiviral drugs even for the richest country in the world, the USA,” says Chowell. “What can we expect for India, China or Mexico?”

In addition, the available drugs are also lesseffective than comparable treatments for other diseases, primarily because “the world treats seasonal flu as a pretty trivial disease,” says Webster. “Only when serious outbreaks like HIV occur, does the scientific community begin to pay more attention to the disease.”

Given these realities, hospitals will fill up veryfast, says Osterholm; medicines and vaccines will end instantly. “We've already shocked the healthcare system here in the US with this year’s seasonal flu, and it wasn’t even a particularly difficult year,” he says. "This shows how limited our ability to respond to a significant increase in the number of cases."

As in 1918, as infections increase andmortality, cities around the world are likely to stop. Businesses and schools will close; public transportation will stop working; electricity will be cut off; corpses will begin to accumulate on the streets. Food will be sorely lacking, as well as vital medicines that support the lives of millions of people with diabetes, cardiovascular disease, immunosuppressive conditions and other vital problems.

“If a pandemic leads to a violationproduction and transportation chain of drugs, we will see the death of people in the shortest possible time, ”says Osterholm. "The cumulative damage from the 1918-style pandemic can be quite dramatic."

Even after the virus exhales itself byitself, the consequences of its appearance will be given for a long time in different parts of the world. The 1918 virus was "still terrible," says Simonsen, that 95% of those killed were not very young and not very old, as is usually the case with the flu, but quite healthy, at the peak of their working capacity. The virus destroyed part of the workforce and had a profound effect on families, leaving many children orphaned.

Almost reliably, scientists only found out about this in2005, when the Spanish flu virus was reconstructed from samples taken during the Brevig mission in a village in Alaska, in which 72 of 80 residents were killed by the disease in less than a week. The body of one victim was preserved in permafrost well enough to allow the microbiologist to restore her lungs, which still contained the virus genes.

Animal Testing Usingrestored viruses showed that the strain of 1918 proliferated exceptionally well. It triggered a natural immune response, a cytokine storm, in which the body goes into overload mode, producing chemicals designed to prevent invasion. Cytokines themselves are toxic - they are responsible for pain and malaise during the flu - and many of them can overload the body and cause a general system failure.

Because adults have stronger immunesystems than children and the elderly, scientists believe that their stronger responses to the flu can be fatal. “We finally understood why the virus was so pathogenic,” Webster says. "The body essentially killed itself."

In the coming decades after the Spanish fluScientists have developed a variety of immunomodulatory therapies that help mitigate cytokine storms. But this treatment can hardly be called ideal, and it is not available everywhere. “Today, we are dealing with cytokine storms no better than in 1918,” says Osterholm. “There are several machines that can breathe and chase blood for you, but overall the outcome is very, very grim.”

And that means that, like in 1918, we,probably see huge life losses among young people and middle-aged people. And since life expectancy today is tens of years longer than it was a century ago, their deaths will be much more significant for the economy and society.

However, among the bad news, there is onechance of salvation: a universal flu vaccine. Significant resources have been allocated to this long-held dream, and efforts to develop a breakthrough vaccine are gaining momentum. However, we can only wait and see if it arrives on time to prevent the next pandemic.

“Research is ongoing. I hope that before this hypothetical hot virus appears, we will get a universal vaccine and be well prepared, ”says Webster. “But at the moment we have nothing.”

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