Arthur J Ammann MD
Founder Global Strategies. Clinical Professor Pediatrics
Global Health Sciences Affiliate Faculty Member
University of California San Francisco Medical Center

Preface

It might seem strange to post a series of imaginary conversations with plague viruses on an ethics blog site, but the COVID-19 pandemic has uncovered issues that are central to how we value one another — fundamental issues of justice and equity.

Certainly, viruses themselves do not make moral judgments but the suffering and pain that they elicit force us to examine how we, as individuals and a society, react to catastrophes. The plagues that are elicit may indeed be an allegory of human destiny.

A focus on ethical issues that occur during times of plague is not new. Albert Camus in his novel, The Plague , utilized the black plague to cast individuals in various situations expressing the tension between good and evil, forgiveness and blame, action and inaction, hope and hopelessness. After his book was published many believed that it was an allegory of the German occupation of France warning against ignoring the rise of power and the consequences of indifference to humanity.

I begin this series of interviews with a question. Are the activities of these viruses random, or do viruses have the capability of planning their destructive behaviors to match our human weaknesses? After reading what they have to say, can we gain insight into what might be next for us, even as in this moment we are unable to control the newest of the pandemics? Read what follows carefully and determine whether the truth shall make us free or warn us of coming plagues that will enslave us all. Reflect on whether the tragedies precipitated by these plagues might be a means to force us to examine when and how we may have compromised our moral principles.

This series of conversations begins with the 1967 influenza virus (H2N2) pandemic. In contrast to the current COVID-19 epidemic it ended with 70,000 deaths compared to the current 550,000 deaths from COVID-19. Its containment was attributed to the rapid identification of the virus, a robust public health response and the production and distribution of 50 million doses of a vaccine within a four-month period. What accounts for the difference between the 1957 influenza virus pandemic and the current COVID-19 pandemic? Will the devastation caused by new pandemics viruses continue to escalate?

Part One – A Conversation With H2N2

Prologue

After reading The Plague by Albert Camus in High School, I was intrigued with the devastation that microbes could force onto mankind. My first encounter with a living influenza virus was not until my last year of college. In 1957 I left Brooklyn, New York, making my way by Greyhound bus to Wheaton College in Illinois for my senior year. I was looking forward to my graduation in the spring of 1958.

I arrived on campus in early September along with my fellow classmates, all eager to complete our studies and obtain a degree. By the end of September, we were already in full swing. During the first week of October, our rather serious college president stood before us in the early morning chapel service and announced, “I have just been informed by the Student Health Services that the influenza virus epidemic is progressing and we will not be meeting in large groups including the chapel, the library, and student buildings. We will also have to curtail some of the college activities. You will still be attending class, some of which will be held outdoors under the elm trees.” No one that I know of left school. It would have required traveling by train or automobile or Greyhound bus. Air travel was limited and expensive.

Because of H2N2, chapel was held outdoors.
Weaton College, October, 1957

I don’t remember much about the week when the influenza epidemic hit the college campus. While that pandemic killed 70,0000 individuals in the US, only a few students got very sick and no one that I knew of died. We got down to the business of studying after restrictions were lifted and focused on getting good grades, completing coursework, and graduating in the spring of 1958. Our yearbook described the influenza virus pandemic in only three sentences, referring to the outdoor meetings as somewhat of a unique adventure. When I recently questioned several classmates at a 60th reunion, few even recalled the episode.

That 1957 influenza pandemic triggered my interest in biology and medicine. Following graduation from college, I applied to medical school, was accepted, graduated, and then went on to train in pediatrics and immunology. After accepting a position as Professor of Pediatrics and Immunology at the University of California in 1971, I journeyed to San Francisco. Things were quite predictable during the next decade until 1981 when everything changed. As an immunologist, I was catapulted into the beginning of the AIDS epidemic. Early on it had all of the indications of becoming a highly destructive pandemic, but most people didn’t believe us researchers. Even other scientists were skeptical. For me, the COVID-19 pandemic that we are now struggling through is a déjà vu of the AIDS pandemic – skepticism, denial, misinformation, political interference, pontification, and bureaucratic delays. Perhaps the only thing that is different now is the constant barrage of tweets emanating from nonexperts who don’t contribute anything except confusion. I won’t say anything more about the AIDS pandemic now. I’ll let HIV tell other parts of his story later.

So here we are in the middle of a “novel” virus pandemic that seems to be overwhelming almost everything and everyone – our healthcare delivery system, our scientists, our capitalistic economy and, of course, any ability of our national political and public health systems to coordinate an effective counter attack on what is killing hundreds of thousands of people worldwide. Getting the correct information is difficult. In the past I’ve always relied on the scientific and medical literature, but now we have been overtaken by Twitter, Facebook, blogs, You Tube, Instagram, and other forms of social media. Mainstream media is no better, having succumbed to premature announcements that lack credible documentation before being released to the public. No wonder this is creating such a skeptical population of people. So, I thought, maybe it’s time to hear from the viruses themselves. They haven’t had an opportunity to tell humans their side of the story. I’m not trying to defend these viruses, or give them undue prominence, or make them into “good guys.” I just believe in equal time and going directly to the source for first-hand information. And, it might be informative for us all to at least read what they have to say.

The first virus with whom I had a conversation was the 1957 influenza virus (H2N2) pandemic. 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 H2N2 influenza pandemic is that today, most people have forgotten how much damage he produced – some 70,0000 deaths in the US and millions worldwide. He went into hiding after a vaccine was rapidly introduced just as he was getting started.

What the H2N2 Pandemic Virus 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 70,0000 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, and commercialization for the sake of profit — all at the expense of public good. Therefore, I will always seek the facts, question authority, and diligently pursue the truth.