A Conversation with Three Pandemic Viruses

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Conversation One. The Asian Flu

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The first virus with whom I had a conversation was the Asian flu of 1957. He was called the Asian flu because he was first discovered in Hong Kong. He came from a long line of influenza A viruses whose well established family name was Orthomyxoviridae. The family had the reputation of producing progeny that caused annual influenza virus epidemics, though not pandemics of any great magnitude. But there were exceptions. The 1957 pandemic was the first major influenza pandemic since the Spanish flu in 1918. What’s interesting about the Asian flu is that today, most people have forgotten how much damage he produced —some 120,000 deaths in the US and millions worldwide. He went into hiding after a vaccine was rapidly introduced just as he was getting started. He plans to tell us more about this during his presentation. Incidentally, he prefers to be called by his shortened and more neutral name of H2N2 to avoid any unnecessary political controversy as a result of using the name Asian flu.

What the Asian Flu (H2N2) Had to Say

Thank you for this unique and long overdue opportunity. I’m a bit apprehensive about what I should and should not say, especially with so many of you humans reading this, let alone COVID-19 and HIV with their own critical analysis. I have not had an opportunity to directly explain to humans who I am, what I do, and how I got around the world. I might add that along with you humans, I too am eager to hear the stories from COVID-19 and HIV. There is nothing like learning from others and applying what you’ve learned to something that might work better in the future. As you may know, I have been accused of being dormant – not so. What I learn I may be able to incorporate into my next attempt to reenter humankind and cause a major pandemic. Don’t be surprised if that happens soon.

It is probably not the best of approaches, but I do need to begin with a criticism. What took you so long to set up these presentations? It is about time someone asked at least a few of us viruses to tell our side of the story. Our opinion counts too, especially since we probably know more about why we do what we do and how we go about doing it. Many of the so-called experts in this current pandemic just want to sound off but don’t know what they are talking about. That’s why it’s essential to go directly to sources like us to get the facts. 

First, I would like to set something straight — we viruses are not stupid and we certainly are not sitting around creating random mutations to use with our genes without a master plan. I will speak for myself, but I will be interested in hearing the opinions of HIV and COVID-19 in their stories. For my part, ever since the 1918 so-called Spanish flu, I was waiting for the right time to appear, all the while rearranging my mutations and perfecting my genetic makeup. That moment happened when I escaped from my duck hosts. As I left them, I thanked them profusely for their hospitality for so many decades, and they in turn thanked me for keeping my promise not to make them sick. Next, I began my journey, full of confidence, using the first human I infected. I fantasized about making my grand entry into the US. As it turned out, I had to spend a little bit more time in Hong Kong perfecting my assault.

Timing was critical. Since the Spanish flu in 1918 there hadn’t been any major influenza pandemics. You humans had become pretty complacent. You thought that I would be just another ordinary influenza epidemic that came and went every year. No big deal, as you like to say. The mid-nineteen fifties seemed just about the right time to act. I was quite excited when I finally said farewell to my Hong Kong progeny. All that I needed next to begin my expansion was a single human to get a foothold in America. Most humans think that epidemics begin with hundreds or even thousands of invaders, but that’s a military concept. We viruses rely on exponential growth that begins with one individual. Just think what HIV was able to accomplish by infecting just one human in a remote region of Africa. I think you’ll find HIV’s story fascinating.

I had other reasons for thinking that 1957 would be a good year to make my move. For instance, the state of scientific knowledge. There were some really bright scientists working on vaccines in the nineteen fifties. However, I felt they didn’t really understand how vaccines worked and what kind of immune response was needed to protect individuals from bad actors like me. If I waited too long, scientists would become so sophisticated that they would pinpoint just what was needed for a vaccine and public health officials would jump at the chance to keep me at bay. If that happened, I would lose my only opportunity to start the pandemic that I had envisioned ever since I was a young viral particle centuries ago.

At this point I must admit that I made a mistake. I’m not shy about admitting I underestimated the capabilities of an individual who, in 1957, was a little-known scientist. We viruses accept the responsibility for our own mistakes. We don’t try to shift the blame onto others as I gather is quite common among humans. So, here’s what I didn’t count on — a human who was relatively unknown to the scientific community but had the insight to realize what I was about to do. This guy was working in some sort of facility called the Walter Reed Army Institute of Research. He was a PhD microbiologist with a small lab and no fancy research equipment, but he was familiar with making vaccines, fairly crude ones at that. Most of today’s scientists would snub their noses at what he and his fellow researchers did. He wasn’t popular either. He rubbed a lot of people the wrong way, especially with his impatience and his bypassing any regulatory roadblocks that would slow down vaccine development and getting it to the public. 

One day, this relatively unknown PhD person was sitting in his office reading about me in the New York Times. The article said that I had started an epidemic of influenza in Hong Kong. By the time the article came out I had already infected a couple hundred thousand individuals. He nearly fell out of his chair as he realized that this might be the beginning of a major influenza pandemic that would hit the US very soon. He immediately cabled a US Army lab in Japan and found a medical officer who identified a Navy serviceman who was sick with the flu. The serviceman was instructed to gargle with salt water and spit into a cup. Two weeks later the sample arrived in his laboratory. It took his small team of researchers only 14 days to culture me. Of course, he had to bypass a lot of regulatory government agencies and other bureaucracies, but in four months six small vaccine companies had manufactured 40 million doses of a vaccine that he thought would work. No fancy biomolecular studies and no studies of thousands of individuals to prove it worked. He realized it was an emergency if he was going to stop me from creating the first pandemic in almost 40 years. By September, 1957, 40 million doses of the vaccine were administered, putting an end to my vision of surpassing the devastation of the Spanish flu pandemic. My only consolation was that I was still able to kill 120,000 humans in the US. Not bad but not great either.

I hate people like that microbiologist, and in the future, I will avoid anyone like him. This may seem crazy to you humans but the scientists that I favor now are the ones with fancy and expensive equipment and really big laboratories. They spend their time trying to figure out the minute molecular details of me and other viruses which often increase their chances of failure as they target the wrong part of us. Maybe they do that because they want to claim everything as their own private intellectual property. But, in the process, it also increases the time that it takes to develop a vaccine along with the chances of failure. All of us viruses who are interested in creating pandemics cheer them on as we take advantage of the delays they create to firmly establish new versions of ourselves.

COVID-19 will probably tell you that she was smarter than I was by waiting longer before she made her entry into humans until the right mutation had occurred. But COVID-19 and I are really different viruses and she had a distinct advantage, as she will probably boast about. COVID-19 may also tell you that I’m lazy and have just gone to sleep for six decades. That’s not true. I have been welcomed back with open wings into my duck hosts, getting myself reacquainted with them, and establishing a mutually beneficial relationship. I am making as many mutations as I can, sorting them out, and just waiting for the right one before I return. I may try my hand at a recombination. That’s when I take some of my genes and some of the genes from another virus and, when we are both in the same cell, create a new virus. I’ve got some great ideas of what to do after talking to COVID-19 and HIV and sharing some secrets with them. I’m not going to make the same mistake I made in 1957 by entering humans too soon to create a sustained epidemic. 

Arthur Ammann: Reflection on What H2N2 Told Me

We have read an incredible story from one of three viruses that I have had the privilege of speaking to.  We have received some insight as to why and how one of them created a global pandemic that plagued mankind in 1957. It is sobering to realize how deliberate influenza viruses can be. Let us take them seriously. Had H2N2 waited to make his appearance until this century, he would have taken full advantage of what mankind has created to transform epidemics into pandemics — overpopulation, urbanization, political interference, global travel, a global economic system that increases the gap between the rich and the poor, and an ever-increasing loss of humanity.

Above all, let us protect ourselves against ignorance, misinformation, dogmatism, and those who put their own interests above what can be done to protect mankind from these plagues. Personally, I will not dissuade myself from the realization that these plagues can be used for political aggrandizement, scientific advancement at the price of public good, and commercialization for the sake of profits. Therefore, I will always seek the facts, question authority, and diligently pursue the truth.

Click here to read Conversation Two. COVID-19 »

Have a question for H2N2? Type it in the comment form below.
I might be able to get hold of him and get your question answered.

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Comments

  • Marlene Cowan Monday, 21 September 2020

    Your later personifications of COVID-19 and HIV/AIDS will strike home with all who take time to read them. Actually, all who do read them will better understand the dilemmas we must live with. Thank you, Dr. Ammann.

  • Ron Bachman Sunday, 06 September 2020

    Art - Those were the good times. I was a first year pediatric resident (well, actually an intern) It was Phil Nader, Dick Stiem, Jack LaFave By Almond, and of course yourself who I learned my basic Pediatrics. You all were my most favorite teachers in my whole career and that even include my time at the NIH. ron

  • John Payne - Medical Ambassadors International Saturday, 05 September 2020

    I appreciate your insight into how human motivations facilitate pandemics. I have little virology expertise compared to you, Art. However, it makes me sad to see how pride, fear, selfishness and greed play into both blocking viral control, promoting viral mutation in huge populations of intermediate host animals. I look forward to future articles.

  • Shirley Witt Saturday, 05 September 2020

    Art, I am fascinated by your clever portrayal of this “tridemic”, but not surprised. Thank you for sharing your creativity. Next?

  • Stuart Kleeman Saturday, 05 September 2020

    Dear Art,
    I got the opportunity to read this after Rick Oken forwarded it to me. Some of the most poignant memories of my residency at UC, was watching your intial efforts to deal with the hereditary immunodeficiencies. The education and, hopefully,understanding of the virtually infinite variations in human immunity have continued to be a cornerstone of my conceptualization of human disease. Watching at a distance as you, Diane Wara,
    Gwen Scott and others that you inspired, deal with the burgeoning HIV/AIDS epidemic beginning in the eighties, was truly inspirational. I, too, can not wait for the next two installments

  • Kerry Gough Friday, 04 September 2020

    I marvel at your ability, Art, to persuade these killers to talk to you. What promises to them did you make? I find their stories intriguing but how can I be sure H2N2, HIV and Covid have not invaded you and lying in wait until an opportune time to become symptomatic? During the interviews were you wearing a mask? At six feet? I look forward to reading the next episode but I shall defer from scheduling coffee with you even in an outdoor cafe at separate tables. I still regard you as a good friend, but take issue with your decision to befriend those three notorious killers


    Covid

    MD

  • All I remember about viruses in the 1950s was their total dependence on entering a cell in order to reproduce . Looking forward to the next interview. your next interview. Thursday, 03 September 2020

    Alice Kagi

  • Nancy Jessen Wednesday, 02 September 2020

    Thanks for including me in your list, Art. So well done, creative and informative. I look forward to the next conversation.

  • Pascal Mailu - Nairobi, Kenya Tuesday, 01 September 2020

    Thanks Art for quite an insightful piece; of course, I look forward to the conversations with HIV and Covid-19. I am particularly interested in hearing from Covid-19 why her mortality rate in most of Africa is significantly low as compared to other continents. Keep up the great work!

  • Girish N. Vyas, PhD, FRCPath. (girish.vyas@ucsf.edu) Tuesday, 01 September 2020

    Art, thank you for the fascinating story of H2N2. Anticipating more interesting stories from HIV-1 and SARS-CoV-2. In 1957, I was a graduate student in Medical Microbiology in Bombay (now Mumbai), but assigned to work on serology and genetics of newly discovered Bombay blood (OhOh). I did not know if H2N2 simply sailed from Hong Kong to New York or San Francisco, but it apparently bypassed Bombay. During my postdoc period in Cleveland and San Francisco, I worked on Ig-allotypes, discovered Anti-IgA causing rare anaphylactic reactions and defined the first genetic marker of IgA2. Since I became Director of the Blood Bank at the UCSF Medical Center, George Brecher asked me to work on viral hepatitis as a major risk of blood transfusion. Thanks to Australia antigen, my academic career was devoted to blood-borne viruses (HBV/HIV/HCV) The principle of passive-active immunization to prevent mother to child transmission of HBV became my mantra (Stevens CE, et al, Biologicals, 2017). While I am devoted to implementing the same principle to immune prevention of HIV-1, Covid-19 has become a compelliong digression for all of us working unsuccessfully on HIV-1. Look forward to hearing from HIV-1 and SARS-CoV-2.

  • Mary Ann Wight Tuesday, 01 September 2020

    Dear H2N2, How invincible are you? If you have been detected back in your duck flock, plotting your next lethal collaboration, is there any measure - short of mass extermination of millions of ducks - that you fear could eliminate you from your reservoir? What are your favorite mutation loci?

  • Rick Oken, UCSF Class of 1971 Monday, 31 August 2020

    Art,
    You continue to educate me, even though both of us are on Medicare - from SLE to COVID. Isn't the solution- Prevention ? Treatment is an academic challenge, but prevention is where the money ( and answer) reside. Thank you for your sobering insight .

  • Al and Jan Wade Monday, 31 August 2020

    Art, our commendations for your clarity in identifying the major issues. As non-scientists, it helps our understanding. We look forward to the next two conversations.

    How to persuade people to perceive reality rather than latch onto rumors from unknown and unreliable sources, so amplified with the internet? Not only the politics. For example, the resistance or refusal by some to be vaccinated for measles, small pox, flu, polio et al. Not simply a problem for the 3rd world, but also a problem in the developed world including the US.

  • Nadine Watts Monday, 31 August 2020

    As always, Art, you amaze me with how you can present such a complicated subject in quite an innovative & understandable, not to mention entertaining, way.

  • Jonathan Levine (formerly of Wild4Life) Monday, 31 August 2020

    Art, absolutely brilliant! I'm especially looking forward to the story of HIV, which you (and I more recently in Zimbabwe) have worked so hard to defeat. In your H2N2 reflections, you acknowledged the "political aggrandizement, scientific advancement at the price of public good, and commercialization for the sake of profits" involved in humanity's dealing with these viruses. Covid-19 might demur, but when you interview her, I'd love to hear her analysis of these factors in our current environment. She's no doubt ecstatic!

  • J.W. Gregg Meister, Interlink Media LLC Monday, 31 August 2020

    You have no reason to recall, Dr. Ammann, that I had the privilege of videotaping you about ten years ago when you were in the Dominican Republic, at the invitation of your colleague Dr. Ken Culver, founder of the Foundation For Peace. Your doctor-patient skills were impressive. Taping you in remote settings respectfully ministering to some of the poorest people in our hemisphere, while simultaneously teaching and training local health care workers, made a lasting impression of me. I'm certain you made a much greater and more significant impression on those you touched, treated and taught. Thank you for keeping me on your email list with your informative and imaginative approach to our current crisis. Blessings, Gregg Meister

  • Daniel Robbins, MD Monday, 31 August 2020

    What a wonderful perspective; I cannot wait to hear what Covid 19 and HIV have to say....new perspectives lead to new ideas and new questions. Thank you!

  • Barbara Schofield Suleiman MD FAAP B. Pharm ( hons) Monday, 31 August 2020

    Many thanks for this unique approach to describing a virus
    How does one convey the information to the sceptical and ignorant enablers of this artful creature?

  • Lily M. Sanvee Monday, 31 August 2020

    Dr. Ammann, you have made my day through this interesting and educative conversation with H2N2. It was easy to read and understand. I can not wait to read the conversation with HIV and
    Covid-19.

  • Robin Weiss Monday, 31 August 2020

    Thanks Art, it's a beautifully crafted story from H2N2.
    I'll be specially interested in what my old pal HIV has to say.
    I give a course for the University of the 3rd Age in London (retirees teaching each other) on "Pandemics: The Germ's Eye View" so I'm used to this inverted thinking, albeit with a Darwinian perspective rather than Arisotle's sense of purpose.

  • Sally Hughes Monday, 31 August 2020

    Your approach as the virus is decidedly more catchy than an oral history, Art. A great way to convey scientific information. Heaven knows, we need it at this historical moment. Warm wishes.

  • Ted Ruel Monday, 31 August 2020

    What a wonderful and effective way to tell this story. Reminds me of the Screwtape Letters. I look forward to the next...

  • Georgene Usher Monday, 31 August 2020

    Brilliant..entertaining and very informative .
    Looks like you’ve put your quarantine time out to excellent use and we all benefit.
    Thank you Art ..can’t wait for the next installment

  • Rich Aunger raunger19@gmail.com Monday, 31 August 2020

    Thank you Art for this and all the work you have done. Waiting for the rest of the story.

  • Ri Monday, 31 August 2020

    Thank you Art for this and all the work you have done. Waiting for the rest of the story.

  • Nancy Edmondson Monday, 31 August 2020

    So great to hear from the Asian flu! I was in elementary school at the time. I don’t remember any grownup talk about it. Looking forward to the next viral interview.

  • Bob and Elane UCSF class of 1967 Sunday, 30 August 2020

    Thanks, Art, for this vital info and for the entertaining style of presentation. Looking forward to the next chapter.

  • Phil VanderWilt Sunday, 30 August 2020

    Can't wait to read the next two conversations. I remember a chance meeting with you, Art, probably 25 years ago, as we sat next to each other on an airplane bound for, I don't remember. Thank you very much for these conversations. Good health and God Bless.

  • Ann Petru, MD - Oakland Sunday, 30 August 2020

    Delightful and incite fun perspective, as always, Art! I look forward to later chapters! I wish people out there knew what to believe, whom to trust, and how to respond responsibly and with a focus on optimizing safety as we move SLOWLY towards reopening our society. Stay well and keep safe!

  • Herb Krantman Sunday, 30 August 2020

    Old immunologists never die, they become profoundly insightful. Dick Stiehm, yourself ,Dick Hong, and Becky Buckly were such tremendous role models for me in the seventies and eighties.
    I wish I could have followed in your footsteps.

  • albinaduboisrouvray Sunday, 30 August 2020

    thank you very much
    what is it was the name of the obscure microbiologist?

  • Nancy Keyes NP Sunday, 30 August 2020

    Thank you Dr Amman for your dedicated work as a researcher and humanitarian.

  • Nancy Keyes NP Sunday, 30 August 2020

    Thought provoking and intelligent. Look forward to reading the next conversation with SARS COVID 19.
    Thanks for your unrelenting work DR Amman .

  • Rick Boxer: rboxer@mednet.ucla.edu and richard.boxer1@gmail.com Sunday, 30 August 2020

    Thanks, Art. You have made my day through education and entertainment. You are and always have been one of my heroes...along with Dick Hong

  • Gordon Gaddy Sunday, 30 August 2020

    Is there anything that prevents two or more of these deadly infectious viruses from occurring at the same time in the same place?
    President Trump has been very aggressive in mobilizing and pressuring multiple drug companies to aggressively work at developing vaccines and therapies to control the impact of Covid 19. This includes pressure on the FDA and other health agencies to act much more aggressively and timely in getting these drugs approved and out to the population. Should this process be used for other serious illnesses that affect a large number of people?

  • Sue Gaddy Sunday, 30 August 2020

    In response to the closing comments from H2N2, how do we humans protect ourselves from believing erroneous information?
    Also, what/how is the origin of a virus?

  • Karl Weiler kweiler@weilerabrasives.com Sunday, 30 August 2020

    Dr Ammann,

    What has Covid told you about how we human beings should have reacted differntly than we have?

    BTW Peter Maier is a close freind and neighbor her in Buck Hill Falls Pa.

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