This year marks the centennial of the 1918 flu pandemic, which killed some 50 million people worldwide and sickened 10 times that number. It would be comforting to think that the disease has been tamed, but how much is truly known about the flu? Why does it still claim 30,000 lives in the U.S. annually? Is the country adequately prepared for another flu pandemic?

Brown, director of the Office of Emergency Care Research at the National Institutes of Health and a former emergency physician, explains why answers have proven elusive in Influenza (Touchstone, Dec.), which PW’s review called a “no-nonsense account of medicine’s long battle against” the disease.

What sparked your interest in this subject?

I’ve treated thousands of patients with the flu, and I’ve always been puzzled by certain features of the disease. The 100th anniversary was the impetus for me to take a deeper dive.

What about the disease puzzles you?

The only time I was in the ER as a patient was with a terrible bout of flu. Interestingly, that was a year I’d had a flu vaccine. We know the vaccine is only about 50% effective, but that experience was a wake-up call. What is it about the flu vaccine that makes it different from all the other great vaccines we have, where you take it as a kid and you’re done for life? Another example: the disease strikes the elderly, the very young, and pregnant women. Why those groups? And why is it that even young, healthy people can get the disease and be dead the next day?

What’s one of the more interesting facts you uncovered about the history of the flu?

The thing that struck me the most was how, in the life of my own grandfather, the flu was treated. The chapter I have on that is called “Enemas, Whiskey, and Bloodletting.” Those were essentially the standard treatments for flu in 1918.

How much better do people understand the flu today than a century ago?

Although we’ve made remarkable strides in understanding what the virus is, we still don’t know why the disease kills some and leaves others alone. We have some ideas about why flu has a seasonality, but we’re not really sure. And, of course, the big question: can we be sure that a pandemic will not happen again? And, if it were to rear its head, are we ready to take the measures to keep it under control?

So, are we ready?

The pessimists say, “Look, we still don’t know anything about what makes the flu virus as dangerous as it is. We don’t have a vaccine that’s really useful. And air travel and commerce make it possible to spread this virus across the world in a matter of hours.” The optimists say, “Look, we’ve had a few blips, but we haven’t anything close to the 1918 outbreak. We now have antibiotics that can cure the bacterial complications of flu. We have all the pieces in place to prevent an epidemic.” Anybody who tells you they know which of the two is right is mistaken. Nobody knows.

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