As winter wraps up in Australia, it’s become quite clear that – barring a very unusual late burst of activity – the 2018 influenza (flu) season has passed Australia by with little impact. My experiences this flu season have reminded me of the question: if we’d had a slightly different efficiently spreading flu virus, would we have been able to avoid a pandemic?

If I think hard about it, my family was hit by more than the usual number of sniffles this autumn and winter. None of them was a serious health threat but all of them were annoying and uncomfortable experiences. Each had slightly different signs and symptoms, and we didn’t see a lot of symptom overlap among us, even if we were sick at the same time. But that’s not unusual. Our dances with viruses this year were best defined as ‘common colds’ and not ‘the flu’. We should write each of these down so we can look back and see whether one year was different from another. I say this every year.

Then we got sick

All of a sudden though, as the temperatures began to rise, we all came down together with a decent cold and flu-like illness. It wasn’t long after that school outbreak. It may have even been close to our Ekka visit. This bout was the type of thing that starts with a sore throat and triggers some sneezing and copious amounts of snot (we should have counted and weighed our wet tissues as a measure of severity). I could imagine each of us covered in a film of viruses.

Stingy eyes and some mildly stiff muscles/joints reminded the parents they weren’t getting any younger. Sinuses became blocked, headaches abounded, some got a sore ear, sleep was affected, everyone became tired and grumpy, mistakes started happening, groaning echoed throughout the house, used tissues were left on tables and benches (I swear that’s all the kids) and later we started to cough.

Then we went to the Doctor

Of course we didn’t! It’s just a cold. Or maybe a mild flu.

We’d already been vaccinated but that’s not a guarantee of preventing flu – plus it’s the only respiratory virus-driven disease we can vaccinate against.

Nothing can be done to stop any other of the 200+ respiratory viruses from using our cells as staging areas for an assault on those around us. And therein lays a major reason not to bother going to a Doctor.

Also, we often don’t routinely test for the most likely cause of acute respiratory illness; rhinoviruses.

The kids had a day off from school but couldn’t take more because there were assignments being handed out, and notices, and things due, and favourite classes to attend, and friends to see. Dad took a day off from work (he is lucky enough to have that option; many can’t do that). Only one day because – as all grown-ups know – life goes on. It’s just a cold. Or maybe a mild flu.

But let’s be real. Most of the time these invasions are not that bad. They usually aren’t life-threatening illnesses to us or most of those around us. We’ve built this routine of managing mild and moderate annoying-but-not-life-threatening illness. We don’t usually consider virus transmission. And being us, we usually don’t think about the health of others, just our health. But sometimes respiratory viruses are dangerous. Sometimes they make people – whether old or young, sick or healthy – very sick. They more often make particular groups in our community sicker than others. Sometimes they can kill.

We probably aren’t clear enough about how long to stay away when sick

Ideally, we need our schools and workplaces to be very specific about what to do to prevent the spread of these viruses. Don’t come in if you’re are shedding virus? Sure. Stay away while you’re sick? Will do. But what defines these things in the public’s collective consciousness? How long should I stay away? How sick to I have to be? It’s highly likely we’re going to need some new research to answer this.

We send our kids to school, after all, the entire system assumes consistent attendance. Schools have curricula to cover; they can’t stop and it’s very hard to catch each child up individually when they absent at different times. If our kids stayed away while obviously infectious (showing signs of illness) they’d likely miss a week per virus event! And that wouldn’t capture early transmission that occurs before obvious signs of illness appear, as happens for some respiratory viruses. And how would working parents manage that? I can’t see this working to interrupt virus transmission.

We also go to work…if we’re not at home to care for sick kids; remembering that children get ill due to respiratory virus infection more often than adults. Adults have a lifetime of immunity to moderate their illnesses (the infections still happen). Plus – and only if they’re lucky – they may accrue 10 days of sick leave per year, which wouldn’t cover a few colds.

Habits maketh the epidemic but vaccine preventeth it

The community contract is that we expect to get sick and equally, we assume we’ll just push on through it, going out and about, doing our chores amongst others in the community, merrily infecting people as we go. A sneeze here, surface contamination there and you’ve done your bit to keep the transmission chain alive. The viruses go on.

These are the sorts of habits that mean we just won’t ever stop a pandemic unless we have a preventative medicine. Those medicines are called vaccines.

Treatments are fine for managing a disease, but not for preventing one. Once a virus is in us, it’s too late to stop transmission. Unless a drug works unrealistically quickly. But do you go to your Doctor at your first sneeze? No, it might be days later. Treatments aren’t going to stop the spread of a human-friendly respiratory virus. 

So let’s stop being surprised by outbreaks, whether in schools, offices or at epidemic scale. 

Without good vaccines to prevent illness and reduce the high levels of virus we shed while sick, we just can’t stop outbreaks, epidemics and pandemics of respiratory viruses. In fact, they will probably become more likely in our world of increasing population density and of routine around-the-world travel. We need more respiratory virus vaccines, but especially universal flu vaccines. Viruses kill. Virus epidemics kill more.

Oh, hey! I’ve stopped sneezing. Time to head back to work. I’ve only got that cough now. It was probably just a cold. Or maybe a mild flu.

 

With thanks to Dr Katherine Arden for editing, help and ideas.