For many reasons the Influenza Pandemic of 1918-1920 (an H1N1 strain), known colloquially as the Spanish Flu, is a remarkably fascinating disease for many reasons. I will touch only a few of them, which offer similarities to GDD:
1. One of the most remarkable unique aspects of this flu in relation to other flus is its propensity to infect and kill young adults. Most flus tend to kill the very young and very old, but many of the deaths of the Spanish Flu were young adults in their 20s-40s. Part of the explanation is that this flu strain had a particular propensity to result in a cytokine storm, and the healthy immune system of young adults allows for this robust response. Most cases of GDD arise in individuals in this age group, and my opinion is it is for similar reasons: the level of full maturation of the immune system, without diminution from later age, allows for a strong cytokine response, that the young and old cannot mount.
2. The role of co-pathogenic infectious organisms resulting in a one-two punch. The relatively unique ability of the meningococcus bacteria to result in fatal pneumonia, superimposed on the Spanish Flu. This has been termed the co-pathogenic association of this influenza N1H1 strain and a variety of bacteria, resulting from the combined effect of both infections to attack the immune system. Co-pathogenic disease may also be quite common with GDD. The association with chronic infections such as Lyme disease is one such example. If we expand co-pathogenic beyond exogenous invaders (Gd and an infective organism) to Gd and an auto-immune condition, or Gd and recent administration of potent antibiotics, then the percentage of co-pathogenic states is probably in the 20-30% range.
3. The Spanish flu may be the deadliest disease event in all of human history with an estimated 50-100 million deaths. Despite this it is relatively under-recognized and under-appreciated. How to explain this? I suspect in part it because flu is common and somehow pedestrian and not sufficiently exotic to elicit interest. Not liker Ebola, which is exotic, or deaths from combat in the first World War (10-20 million) which are explosive - in all uses of the word. GDD is not so dramatic or exotic - just a bunch of young to middle aged adults who are in pain and confused. No blood frothing from the mouth or explosive projectile Exorcist-type vomiting, and few exotic deaths. Just sick folks who can be brushed off as malingerers and complainers.
4. None the less, a considerable number of serious scientists and physicians have studied the Spanish Flu, and yet many answers are still not known and only postulated; examples being the first 2 points above. There are with essentially every disease some very important aspects that remain unknown, and treatments imperfect. This is a subject of enormous frustration (understandably so) amongst GDD sufferers, and also the substrate for dubiousness by disease-detractors. Many things are unknown about essentially every disease, and most treatments are only partially successful for most diseases. With that in mind, with GDD, even at this early stage of knowledge and discovery, we are doing comparatively quite well: and there hasn't been a century of study by tens of thousands of scientists studying the disease as there has been with the Spanish Flu.
Richard Semelka MD Consulting
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