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It is not just the flu virus that kills. Death also can be triggered by our own body’s over-reaction to the presence of certain strains of flu virus. When our bodies detect these deadly viruses, T-Cells are dispatched to our lungs, which are the sites of the infection. As more and more T-Cells accumulate in the lungs, they inflame tissue, cause swelling and can ultimately suffocate us.

This over-reaction of the body to a viral infection is called hypercytokinemia, or cytokine storm, and is the primary cause of death from more virulent forms of influenza infections. The Spanish Flu of 1918 produced this cytokine storm effect in patients and it is thought that this is the reason the mortality was unusually high in younger, previously healthy people. Even bronchitis, other varieties of influenza, pneumonia, and possibly rheumatoid arthritis can trigger cytokine storm.

Following are the five primary defenses currently available to combat a flu surge. Each of them has serious flaws.

Vaccines - Vaccines work well when they are available. Each year a newly formulated batch of vaccine must be created and manufactured to meet a changing flu threat.  There is no universal influenza vaccine. Flu vaccine must be modified to meet the differing characteristics of each flu strain. It takes up to six or eight months to create enough vaccine to meet a new flu threat. The technology now used for flu vaccine production is close to 60 years-old. It uses eggs to germinate the disease from which the vaccine will be made. There may not be sufficient manufacturing capacity to produce pandemic vaccine without delaying seasonal flu vaccine production, and seasonal flu kills, on average, 36,000 people in the U.S. every year.  Further, the new "cell-based" vaccine technology that will speed the manufacturing process has been under development for a number of years, but is advancing slowly.

Antivirals - Recent reports by the World Health Organization and the U.S. Health and Human Services indicate that osaltimivir phosphate (Tamiflu) has been shown to be ineffective against the H1N1 strain of influenza in Denmark, Hong Kong and London.  Millions of doses of Tamiflu and Zanamivir (Relenza) have been stockpiled by nations around the world.  Additionally neurological side effects of Tamiflu could be fatal and the manufacturing process is complex, limiting production capacity.  These factors combine to make the current generation of antivirals a marginally effective treatment against flu.

Social Distancing - This practice calls for avoiding crowds and limiting large gatherings of people. But it is vulnerable. One sick person in a crowd would threaten to infect anyone nearby. In the event of a threat, where voluntary social distancing was imposed, public transportation would be curtailed, schools would be closed and public events canceled. This is an extremely disruptive and expensive intervention. When schools close, parents must stay home to take care of children. Parents of toddlers will miss work because day care will be closed along with the schools. Public libraries, movies and other places where people gather could be closed. Airlines, trains, subways, sporting events and plays will suffer economically. But people will need to go to public places to buy food, seek medical care, or escape the tedium and monotony of days confined at home.

Quarantine and/or Isolation - This intervention requires you to stay home if you are sick. If someone in your family were sick, that person would be required to stay home and you would too. Maintaining quarantine will require tremendous logistical support. People will soon run out of food and medicine. How and by whom they will be resupplied has not been addressed. National Guard units, the historic resource for states during domestic emergencies, are either depleted or deployed. Prisons, nursing homes and other group living facilities will be in dire straits very quickly, and if infection enters one of those institutions, it will run through it like wildfire.

Personal Hygiene - This intervention calls for washing your hands, covering your mouth when you cough or sneeze and keeping well rested. It includes the use of personal protection devices, such as masks, gowns, gloves and goggles. This intervention is very difficult to universally enforce and universal adherence is necessary to have an impact.