Thinking About Pandemic – Part 2

My apologies for the delay in getting this post out. This is complicated stuff, and I’ve done a lot of research to make sure I’m getting everything right. — APB

In part 1 of this series, I outlined my thinking about pandemics, and how I’m preparing for what I consider to be an inevitable outbreak in the near future. As we enter the winter months in the Northern hemisphere, we enter flu season, so it’s a good time to think about this. Seasonal flu is generally pretty benign, but it requires proper treatment to prevent it from progressing to a state where opportunistic secondary infections can set in and cause real problems. So while part 1 dealt mainly with prevention of infection through quarantine, part 2 will deal with treatment options.

Again, please keep in mind that I’m not a doctor, and that I’m not offering medical advice here. All I’m doing is listing some of the ways I’m planning on dealing with a pandemic flu outbreak. Make sure you read my disclaimer, and remember that anything you do is your own responsibility. When in doubt, consult a physician whenever possible.

The 1918 outbreak of Spanish Flu culled 3-6% of the world’s population, which would translate into about 200-400 million dead today.

But what if getting to a doctor is not possible, or not advisable? As I said in part 1, quarantine is probably your best defense against pandemic, but taking someone to a hospital during an outbreak might be a Really Bad Idea. Think about the implications. Someone in your family is pretty sick and needs help. You’ve got nothing to help them, so you decide to take them to the local hospital. The person is too sick to go alone, and there are no ambulances available. So right off the bat, that takes two people out of the house, and not only exposes the escort to the pandemic bug, but the sick person is also exposed to other opportunistic viruses and bacteria that might result in a secondary infection. And what if the sick person is your wife or husband? Does that mean you abandon your kids at home while you take him or her to the hospital? And think about the bugs are you going to be bringing back, if either of you ever get home – chances are the escort will not be allowed to go home by the powers that be in a regional or national quarantine.

So to my way of thinking, I need to be as prepared as possible to not only prevent the flu from gaining a foothold in my household, but also to treat it as best I can without breaking our personal quarantine. The tendency among preppers when faced with a task like this is to start buying stuff, as if having enough supplies will be the answer to the problem. Supplies are certainly part of the preps, but we need to be smart about what supplies to lay in.

Antibiotics?

The knee-jerk reaction of most preppers would be to hoard antibiotics. It seems like people think of antibiotics like magic pills, and while they are, or at least were, miracle drugs that have saved countless lives, they have very definite limits. Antibiotics don’t work on viruses, like the influenza virus, although they can be useful to treat the secondary infections that often occur in flu victims, and which are the main cause of flu-related deaths. But which ones do you stock? How many do you keep on hand of each pill? What about rotating your stock? Most drug expiration dates are bogus, but some antibiotics are actually in the small group of drugs that can not only decrease in efficacy over time, but actually become toxic. And where are you going to get these drugs? You won’t likely find a doctor to write the scripts you need, so you’d have to look to the aquarium antibiotics for what you need. And even if you manage to get and keep a stock, you’ll need specialized knowledge to be able to correctly prescribe the right drug.

Another thing to keep in mind about antibiotics is this. The first modern antibiotic wasn’t commercially available until 1941. That’s within the living memory of millions of people who are alive today, like my dad. So almost every human being who ever lived did so without benefit of these miracle drugs. Yes, some of them died of infections we can treat easily now, but most didn’t, and that speaks to our ability to fight infections with our natural immune systems.

Zombies and elderberries

We’re also a pretty smart species, or at least we used to be, and when we’re paying attention and have a need, we tend to find things in our environment that can help us. For example, we figured out that white willow bark makes a tea that can reduce pain and fever at least 4000 years ago, which lead to the first commercial aspirin preparations in the late 1800s.

“Elderberries. They’re a natural flu remedy.”
— Herschel Greene, “The Walking Dead”

There are hundreds of examples of traditional remedies that have been actually shown to work under clinical testing. I learned about one of them from an unlikely place – “The Walking Dead.” This season, as if the zombie apocalypse isn’t enough, the survivors have been struck by a deadly flu infection, most likely an avian flu from the way they’re showing it. A more austere medical environment can’t be imagined, and with no medical supplies to speak of, the group’s veterinarian-turned-physician turned to his herb-lore for a remedy. He collected a basket of elderberries from outside the prison, proclaiming them a “natural flu remedy” that his wife used to brew into a tea.

I figured that was just Hollywood stuff, but when I checked into it, I was surprised to find out that not only is elderberry a well-known remedy for viral respiratory infections, it has also been studied under controlled conditions. At least 90% of influenza A or B patients given a commercial elderberry extract were symptom free within 2 days, as opposed to a minimum of six days for the placebo control group (source – note that the research was sponsored by a company that makes a commercial elderberry extract.) It appears that elderberry works by stimulating the immune system, specifically by turning up production of cytokines. Cytokines are substances the body releases to control the inflammation reactions needed to respond to an infection. Elderberry pushes up production of certain cytokines which signal the immune system to swamp the infection.

Into the storm

Fiddling with cytokines is both good and bad. As I said in part 1, my model pandemic for planning purposes is the 1918 outbreak of Spanish Flu. That event culled 3-6% of the world’s population, which would translate into about 200-400 million dead today. I discussed a little about what made the 1918 flu so nasty in part 1 – it was especially virulent because it stimulated a major overreaction in the immune systems of some victims, particularly young, otherwise healthy adults. The result was what’s called a cytokine storm. In a cytokine storm, both the up-regulators and down-regulators start getting produced without the usual controls, causing wild swings back and forth between the two factors. The cells of the immune system don’t know what to make of the mixed signals, and end up attacking pretty much any tissue they can. The end result is profuse internal bleeding, especially in the lungs, leading to respiratory distress, then multiple organ failure, and eventually death.

On the face of it, it seems like giving someone a drug that stimulates cytokines would be a bad idea with a flu that has the potential to cause a cytokine storm. I looked as hard as I could for any research into elderberry and cytokine storms, but I couldn’t find anything definitive. I found one article that mentions “dozens of controlled studies” not finding a link between elderberry and cytokine storms, and then again, I found other references that said not to give elderberry to anyone between the ages of 18 and 35.

So I’m not quite sure what to recommend with regard to elderberry in a pandemic flu. And therein lies the problem with non-pharmacological remedies for any health problem – conflicting information. I suppose that’s true to some extent about mainline drugs as well, but with the natural and folk remedies, there’s always a lot of “I’ve read that…” and “We’ve always used…” As we say in the science business, the plural of anecdote is not data. So, you take your chances.

Personally, I’m planning on getting some dried black elderberries to keep on hand. I’ve got several recipes for syrups and tinctures that I want to try. I did some quick calculations, and dried organic berries at $20 a pound should make enough syrup for hundreds of doses, way more than you’d need even to deal with flu in a large group. The dried berries should have a pretty good shelf life – better than a stock of antibiotics that cover a broad enough spectrum to be useful. And elderberries have the distinct advantage of not needing a prescription. Another big advantage is that you can grow elder easily. It’s hardy to USDA Zone 3, so most of the US should be able to grow it. It would work well in a perennial hedge system, and in a permaculture design, it would be a great choice to grow on your swales.

One final word of caution: elderberries are not some sort of magic bullet. Someone in the throes of a cytokine storm needs a physician, not an herbal syrup or tincture, and a case of pneumonia is best cured with a round of antibiotics. Where I see the value of elderberry in a pandemic flu is in reducing the length of infection if someone does come down with a case while under quarantine. By hopping on it early, there will be less chance that the flu will spread within the house, and a smaller window of opportunity for secondary infections to get in and cause pneumonia.

I’ve run this post on way too long, and I still have some more to go. I’ll end here for now, and wrap up this series with a description of what I’m planning on keeping on hand to deal with a pandemic. In addition to elderberries, of course. Look for part 3 within the next few days, or sooner if the weather keeps me from my outdoor projects. — APB

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