White Coat Underground

Influenza invades the military

Influenza is a fascinating virus. When it undergoes antigenic shift, as the novel H1N1 (“swine”) flu did, it efficiently evades most people’s immune systems. Non-novel flu strains are bad enough, but antigenically novel strains can have a ridiculously high attack rate. i-4e06c04e89550439e2fe7fbdf72f53ab-flubook.jpg John Barry’s book, The Great Influenza, is a (usually*) terrific read, and describes very clearly what can happen when a novel influenza virus encounters a naive population. In the case of the 1918 pandemic, the circulating virus had not only a very high attack rate, but was also violently virulent, killing a large percentage of those infected (at least after the first wave).

So far, the new flu has had the attack rate, but not the virulence. That isn’t to say it’s the equivalent of the common cold; it’s not. Influenza is a potentially serious disease, so the more people it afflicts, the more (in raw numbers) will become seriously ill or die. Still, we’ve been lucky so far.

But our we lucky or good? So far, I vote for luck. Our luck is due mostly to the virus’s lack of virulence, not to medical or public health breakthroughs. The pandemic has not been contained. Influenza likes crowds, and military bases and summer camps are crowded. The Air Force is now reporting that a large number of cadets at their Academy have H1N1 flu, a number likely to grow larger. But at least it’s a containable environment, right? Military recruits have to follow orders, after all. During World War I, containment and control of the epidemic failed at least in part to military orders, or lack of them. In the frenzy to fight, our military and government allowed soldiers who were ill or at risk to travel the world, leading to events such as the Death Train from Camp Grant in Illinois, which, while en route to another camp in Georgia, spread the flu from town to town, and arrived at its destination with up to ten percent of it’s passengers dead or soon to be dead. But we’ve learned from our experiences, right?

[An academy spokesman] said it was nearly impossible to determine the source of the outbreak because some cadets had fanned out across the world for various Air Force-related programs.

We’ve been very lucky so far, in that H1N1 is not more virulent than other influenza viruses. This luck may or may not continue. If we continue a “business as usual” approach to containment, we will be lucky if all we have to deal with is some mild suffering and days lost at work. I don’t like to contemplate what will happen if our luck runs out. But someone had better.

*His style is more than occasionally repetitive; the book might have been a bit better if the editor had been a bit less merciful, but I still strongly recommend it.


  1. #1 Shay
    July 15, 2009

    “But at least it’s a containable environment, right? Military recruits have to follow orders, after all.”

    Would a lock-down of the Academy work? There are so many people in contact with the USAF Academy who are not cadets (instructors, support staff, contractors, civil service workers, family members, visitors).

  2. #2 Donna B.
    July 15, 2009

    How is the AF Academy any different from other colleges/universities?

    Health care is provided to the cadets in a more controlled and centralized location providing better records. Trends there will be spotted more quickly than at other less controlled institutions.

    How are West Point and Annapolis faring?

  3. #3 PalMD
    July 15, 2009

    college dorms and military barracks are very similar environments, but one is a bit more controlable, and regularly sends people in crowded conditions to all ends of the earth.

  4. #4 Kathy
    July 15, 2009

    Through the precious letters he left behind our family learned the sad story of my grandmother’s uncle, who left Chicago a fit and healthy 22-year-old and contracted the TB in basic training at Ft. Benning, Georgia. (It ended up killing him a few years later.) In his letters he mentions often how “half the camp is sick with some thing or other” and despite his own serious illness, he was actually shipped off to France for a few months in 1918 (he spent the whole time in a hospital, too ill to fight). Doesn’t sound like a whole lot of screening, surveillance or treatment went on in the military back then…I shudder to think it’s no better now.

  5. #5 khan
    July 15, 2009

    Back in Nov. ’68 I woke up at college with the Hong Kong Flu on the day I had to take a 3 hour bus trip from campus to parents’ house.

    Spread it to my family and everyone else.

  6. #6 PalMD
    July 15, 2009


  7. #7 military wife
    July 16, 2009

    The article didn’t mean that USAFA was going to send these cadets all over the place, but that they couldn’t identify the original source of the flu outbreak because the kids came from all over the place to start their “fun” basic training experience before their freshman year. Have any of you heard of any civilian companies telling employees that they can’t spend the weekend out shopping/traveling/dining because 5% of their colleagues have symptoms of ILI? The military is doing a much better job of testing for and tracking H1N1 cases than the civilian world, and is definitely serious about educating folks about reducing transmission as well.

    My husband graduated from USAFA, btw. I just hope they don’t rush the kids back into “camp” before they really feel up to the physical exertion.

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