No Epidemic but Flu Is Nothing to Sneeze At

A Santa Monica nurse calls this year’s version of the flu the Darth Vader of respiratory diseases. A hospital librarian says it made her sicker than she has been since college. An emergency room doctor in Pasadena says it’s the worst she’s seen in 13 years.

Given all the coughing and misery in Southern California in the last few weeks, it may come as a surprise, particularly to flu sufferers, that there is no epidemic of the disease in Los Angeles this year.

In fact, according to epidemiologists at the Los Angeles County Department of Health, this has been--and probably will continue to be--a rather “moderate” flu season, no worse than the last few years. Throughout the state and the nation, there has been a “lot of flu activity” and even some isolated outbreaks of epidemic proportions, but on the whole nothing out of the ordinary, according to the Centers for Disease Control in Atlanta.

Flu is not a reportable disease, like AIDS or syphilis, so estimates are often not as precise as experts would like. Nonetheless, L.A. County is widely viewed as having a more sophisticated system for evaluating the severity of flu than many parts of the country. The Los Angeles system relies on three separate measures to determine the spread of the disease: the number of actual cases identified by laboratory tests, the number of flu-like symptoms reported to 50 designated hospitals, student health centers and physicians offices, and the number of respiratory-related deaths in the county.

During an average flu season, which will run here from November through early April, about 4% of all deaths can be attributed to the flu and its complications, which is what it is now running, said Frank Sorvillo, a county epidemiologist. Before the season has ended, one out of five people can be expected to come down with flu symptoms, including fever, chills, headache, stomachache, sore throat, gut-wrenching coughs, achy joints, painful eyeballs. According to Sorvillo, the rate of infection in Los Angeles now suggests that the figures for this year will be well within that range.

“But it’s hard,” Sorvillo admitted, “to convince people who have it that we aren’t having an epidemic.”

Dr. Raymond R. Neutra, chief of epidemiological studies at the California Department of Health in Berkeley, said laughingly in a telephone interview Friday that even he assumed there was an epidemic in Los Angeles.

“You see,” Neutra said, “I am from L.A. and my aunt and uncle live in L.A. They both had the flu. And they told me their doctor’s nurse had come down with the flu, so I, of course, assumed everyone down there had it.”

Jump to Conclusions

Quite seriously, people do jump to conclusions from a very limited set of facts, said Dr. James D. Cherry, chairman of infectious disease control at UCLA’s medical school and head of pediatric infectious diseases.

“Almost every year people come up and say to me, with some alarm, ‘ What’s going around? I’ve never seen so much of this in my life.’ People have very short memories and very narrow vision. Someone misses a tennis appointment and that makes an epidemic.”

One reason so many people may be having so much trouble taking the experts seriously is the widespread misconception about what an epidemic actually is.

It is not an easy word to define. There are, for example, no set number of victims. The influenza epidemic of 1918-1919 killed at least 20 million people. It certainly was an “epidemic.” The outbreak of Legionnaire’s disease, which struck a Philadelphia hotel in 1976, took only 29 lives and it was also considered an epidemic. Yet malaria, which infects nearly 100 million people each year, is not now considered an epidemic. It is labeled “endemic” to certain regions of the world--that is, it is common to those areas.

Definition of Epidemic

Most experts agree that an epidemic is not determined by how widespread a disease is but by whether it is more widespread than expected.

But, as far as Dr. Carole Lieberman is concerned, there is more to it.

Lieberman, a UCLA psychiatrist, recognizes that there are fundamental psychological reasons why people may forget how bad last year’s flu season was. The old dictum that people do not remember pain is quite true, she said. People tend to deny how bad they felt or how afraid they were of getting sick.

Still, Lieberman believes that people are getting the flu in larger numbers than before. Her view is supported by many officials at Huntington Hospital in Pasadena and Cedars-Sinai in Los Angeles, who say they have been swamped with flu-related complications. Blood banks also report reserves are down because flu victims cannot give blood.

Similar Symptoms

Health officials say that this year’s flu is not quite as virulent as some. According to county epidemiologists, about 80% of cases identified so far this season have been influenza B, which is generally not as devastating as influenza A, although the symptoms are similar.

As expected, according to Suzanne Gaventa of the Centers for Disease Control, there have been more children contracting the flu this year, probably because children are more susceptible to influenza B than they are to influenza A, for reasons that physicians and epidemiologists do not entirely understand.

Over the years, there have been many theories about the causes of flu, although as yet no cure, only partially effective vaccines and antibiotics to fight secondary infections that often accompany the flu.

It was not until 1933 that a team of scientists discovered that flu was the result of a virus. Like other viruses, it was found to be a microscopic organism--about 4 millionths of an inch in diameter--that, by itself, is a lifeless particle incapable of reproducing itself. Inside a cell of another living thing, however, it becomes an active organism that can multiply hundreds of times and, in the process, cause disease.

Startling Fact

With the advent of sophisticated genetic studies, researchers discovered a startling fact about the flu virus, which goes a long way toward explaining its power and persistence over the centuries. Unlike most other organisms, the flu virus was found to have the ability to alter itself genetically. In essence, that means that when an organism develops an immunity to the flu, the virus simply alters itself enough so as not to be recognized by the immune system, thus rendering most, if not all, normal defenses temporarily unprepared to fight.

When the change that the flu virus makes is a minor one, it is called antigenic “drift” and results in the seasonal variants of flu that emerge each winter. When the change is major, it is called antigenic “shift” and usually results in a worldwide epidemic.

Since 1510, 31 such epidemics of respiratory disease similar to modern influenza have been described, five of which have occurred in the 20th Century.