Recommendation: Look, this isn’t amazing, but it’s a fast read
Where to read: I read this in a café, it got weird
Read with: Gin
In brief: Yet another entry into the medicine/infectious disease part of my reading list. It’s really pretty good, if a bit short. On the plus side, it’s not the interminable The Great Influenza.
This would be a far slimmer volume if the font was a sensible size (though that can be said of many books) and I do wish Brown had gone into greater detail in pretty much every respect. That said, he writes very well, has a real talent for incorporating entertaining anecdotes and details and it’s a very easy read.
The opening chapter gives a rundown of various approaches to treating the flu and the influence of the virus throughout history. Probably unsurprisingly, the Spanish Flu pandemic figures most prominently: suffice to say it is all quite disturbing, particularly the suggestion that quinine overdoses might have contributed to the high casualty rate in younger people.
Later chapters go through other flu outbreaks across the 20th century and how the they played out – serious, but not as serious as the 1918 pandemic. As Brown explains, we don’t know precisely why this is the case however this is an area of ongoing enquiry. A particular area of focus has been the effort to study the 1918 variant and, controversially, recreate it in the lab. Brown goes into the history, and indeed the ethics, of this effort at some length.
He then runs through a couple of the issues we have faced and still face in dealing with the flu today. Every flu season, there are issues in tracing the flu and testing patients, and indeed a cost-benefit analysis around that at all – at a practical level, it is probably not worth testing every patient who presents with flu-like symptoms to determine what exactly the virus is given the treatment (getting the fuck out of a crowded waiting room, doctors note in hand, and going home for fluids and rest) is going to be the same pretty much regardless. As a result, getting accurate data to map flu spread and severity is quite challenging.
Flu cures are also something of an issue – Tamiflu was a much vaunted anti-viral treatment stockpiled in national stockpiles but there is limited evidence as to its effectiveness, to put it mildly. Finding a decent vaccine has been a similarly daunting challenge, with governments relying on flu shots compiled from the best options for the predicted dominant strains for that year (and prediction is a mess in and of itself). Sometimes it’s right, sometimes it’s wrong, and sometimes it’s only minimally effective. Opinions differ on what segments of the population to vaccinate – do you vaccinate just the elderly (who are more likely to die), or everyone or just the elderly and children and caregivers? Different counties take different approaches and it is still a live question. Brown concludes with a discussion of the economics of the flu, which is obviously more applicable to the US system than elsewhere.
All in all, I think it’s a good primer but my search for a really good book on influenza pandemics remains on foot.