Flu has been flooring humans for 2,500 years. Stylist investigates why we’re unable to beat the potentially deadly bug.
It’s unusual to see a friend pull a cotton medical mask out of her sugar-pink purse. But that’s what happened last Saturday at brunch. “I wore it on the Tube ride over,” she said as my eyes widened. “We’re in the middle of a pandemic.”
‘Pandemic’ isn’t a word that often crops up over avo on toast. But it’s been a grim winter, with ‘Aussie’ flu, a severe, deadly strain of the virus, recorded all across Britain, resulting in fatalities and putting a beleaguered NHS under monumental strain (one in five hospital admissions were related to Aussie flu at the start of the year). Today, an influenza pandemic is listed by the government as one of the top four security threats in Britain (the other three are terrorism, cyber-attacks and a military crisis).
With streaming noses, red eyes and coughing fits everywhere over the past few months, the idea of walking round wearing a mouth mask doesn’t seem quite so ridiculous. “Can you get them on Amazon?” I said, frantically scanning the potentially infected cafe.
Flu has the reputation of a harmless, if annoying, bug that will leave you with your head under the duvet for three days, perhaps a week. You’re more likely to fret about whether you have the time to actually be sick than if it’s going to kill you. But kill, it does.
This winter, three times more people in the UK have died of flu than in the equivalent period last year. In the first week of this year, 5,000 people were hospitalised, and, in recent weeks, flu fatalities have hit a high. But this doesn’t count as an epidemic (a rapid and widespread occurrence of a disease within a community or geographical area) and certainly not a pandemic (the same speed of spreading, but on a global scale). This is just seasonal flu turned a bit nastier than usual.
We could be forgiven for the flu-panic, though. The memory of what the disease can – and did do – looms in history.
The Spanish flu pandemic in 1918 infected around 500 million people worldwide. An estimated 50 million died, including 228,000 people in Britain. Unusually, it disproportionately affected young, healthy adults. Hitting towards the end of the First World War, the virus spread among an already vulnerable population, weakened by food shortages and working together in close quarters. It wreaked havoc. The only part of the world not affected was an isolated part of the Amazon basin.
Although it was 100 years ago, hearing about the Spanish flu outbreak is still scary – mainly because it was no super-virus. “When we look at the 1918 strain, there is nothing standout about it,” explains virologist Professor John Oxford of Queen Mary University of London. “We’ve replicated it in mice, grown it in cells in laboratories, and nothing about it immediately jumps out as ‘this is a deadly virus’.”
One possible reason for the devastation caused, particularly in the UK, was young, ill servicemen returning home from the trenches after the First World War ended; as they travelled through train stations and commuter hot spots, the virus soon spread to the suburbs.
That an unremarkable strain can cause such devastation is one of the reasons monitoring flu is a global priority. “Right now there are 120 labs around the world on the lookout for drifting and changing strains,” says Oxford. A whole field of expertise has grown up because of the 1918 pandemic. We’ve known since then, says Oxford, that “we can’t sit around and do nothing about the threat”.
Taking the strain
Flu types usually get named for the place the epidemic first gains ground, although it’s rarely where the virus originated (Spanish flu is unlikely to have started in Spain). The top strains in circulation this year are influenza A virus subtype H3N2 (Aussie flu) and B-Yamagata (‘Japanese’ flu). They aren’t new and, given the rough time Australia had (with over 170,000 cases of flu reported – the highest in decades), scientists predicted a bad season for the UK too.
The problem is that our defence against the virus (a yearly vaccine) isn’t up to par. “The best we can ever hope for in the flu vaccine is for it to protect about 60% of the people who get it,” says Dr Helen Stokes-Lampard, chair of the Royal College of General Practitioners and partner in her own practice in Lichfield. “It’s not fool proof, but it’s considerably better than not having one.”
This year, though, research suggests the jab failed to guarantee protection from some strains of the virus – particularly Aussie and Japanese flu – and was ineffective in older people.
But no-one expected the vaccine to be bullet proof. Each year, scientists around the globe track virus patterns and try to predict what next year’s flu season will look like. This is why the vaccine changes yearly: it’s an attempt to keep up.
“It wasn’t expected that the vaccine would give optimal protection against the viruses we’ve seen,” explains Dr John McCauley, director of the Worldwide Influenza Centre at The Francis Crick Institute. “The lineages are frequently changing and we didn’t anticipate that type B would be so predominant this year.”
But influenza’s strains are constantly evolving as they mutate inside every new host. New viruses emerge as genes from several strains mix and evolve, with the spread exacerbated globally by bird migration and human travel. This makes flu prediction, as Oxford puts it, “well-informed guess work”. The virus can, and frequently does, outsmart us: flu is a ‘clever virus’ because of its in-built molecular ‘clock’ that tells it the best time to attack its host for maximum impact.
We’re much better at dealing with flu than we were in 1918. The population is generally stronger and better fed, and our understanding of medicine has evolved hugely. But we still haven’t managed to get rid of flu for good. Is it even possible?
“We’ve managed to eradicate smallpox and have almost eradicated polio, but I don’t think this could happen with flu,” says Oxford. “Unlike the others, it’s a bird virus. We’d need to kill every migrating duck, swan and goose on the planet.”
The next outbreak
Experts are also pretty certain another pandemic will happen. It’s likely to be when a strain currently circulating in birds mutates and becomes transferable to humans. This means we’d have no immunity for it and certainly no vaccine.
“It’s not if this will happen, but when,” Oxford adds. “We expect it. There are government plans in place.”
The ever-present threat of an outbreak means plenty of labs across the globe are working to find a cure. Inside Oxford University’s Jenner Institute, scientists work to solve the flu puzzle. Vaccitech is a “spin-out company” from the academic institution. Its founders are vaccine manufacturers and their goal is to build a universal vaccine to protect against any mutation of the virus – no easy feat.
But there is good news: Vaccitech gets its funding from the deep pockets of Alphabet, Google’s parent company, and is in the preliminary stages of trialling a universal vaccine. This is the furthest that research in this area has ever gone.
“A universal vaccine is what we all want,” says Oxford. “The general idea is that you’d take the unchanging, stable proteins inside the virus and put them into a vaccine. In theory this would have a blocking effect on all types of influenza.”
While he acknowledges the work is important progress, he is also quick to point out that separate labs around the world working towards the same goal is nonsensical. Instead, a global collaborative initiative is necessary.
Oxford mentions the Manhattan Project: during World War Two, scientists across the world were brought to Arizona with the purpose of producing the first nuclear weapons. “Within two years they’d done it,” he says. “While it wasn’t necessarily a good thing, it shows that when we focus on something it can be done, and this is something that needs to be taken very seriously.”
Oxford would like to call the flu project Manhattan II, but this time it would be for the good of all humanity. He’s currently writing a paper that proposes it takes place.
Another issue at the forefront of doctors’ and scientists’ minds is our ever-increasing resistance to antibiotics. Antibiotics are used to treat secondary flu-related bacterial infections, such as pneumonia, which are often the reason flu is fatal. Antibiotic resistance occurs when bacteria get used to a drug and adapt, becoming immune to it. Every expert interviewed for this piece agreed this is a huge worry for the future.
“Without them, I imagine the situation would quickly become very similar to how it was 100 years ago – hundreds of thousands of people dying from the complications of pneumonia,” explains Dr Stokes-Lampard. This is why swine flu caused so many deaths in 2009. “It’s a really big fear if we don’t use antibiotics responsibly now.”
Given that most forms of flu are viral, rather than antibacterial, antibiotics are not required as our own immune systems do all the work – and in fact, using antibiotics for viral infections can increase the risk of antibiotic resistance.
The race to create a universal vaccine before the drugs finally stop working is a terrifying thought. But take comfort from the thousands of scientists working around the world to dissect, decode and track the virus. In hospitals, labs and research libraries, people are working to keep us safe.
The flu virus might change and mutate, but their sense of purpose doesn’t. For now, wearing a cotton mask when meeting friends for brunch seems like an increasingly less panicky proposition.
But I have flu right now!
We’ll try anything to get rid of the flu. Here are the expert-approved natural remedies to alleviate the symptoms.
Garlic has strong antiviral and antibiotic properties due to its high levels of vitamin C, enzymes and minerals. It also makes your body release the antibacterial chemical allicin.
It’s probably better as a preventative measure though, if you can stand to eat it in its raw state on a regular basis.
Also sold under the name kaloba, this plant extract is a favourite of Dr Sarah Brewer of experthealthreviews.com.
“It’s derived from a South African geranium and I highly recommend it,” she says. “It has an antiviral action, antibacterial properties and stimulates the action of cilia.” Cilia are tiny hair-like structures lining your windpipe that move mucus, so active cilia means easier breathing.
The right essential oils not only have a calming effect but also work well as a decongestant. Rub some peppermint or frankincense essential oil onto your chest, breathe deeply and reap the benefits.
“This is a traditional remedy, you think of grandmothers making elderberry wine for the winter,” says Dr Brewer. Elderberries contain natural antiviral extracts that are active against both A and B strains of influenza. “It also appears to stop the virus multiplying,” says Dr Brewer. Win-win.
Images: Getty and iStock