Impact of Bacterial Pneumonia on Influenza Deaths

National Institute of Health Public Access,

Author Manuscript,

Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza,

Implications for Pandemic Influenza Preparedness.

Published in final edited form through the Journal of Infectious Diseases,

October 1, 2008.

Authors, Dr. David M. Morins, Dr. Jeffrey K. Taubenberger, and Dr. Anthony S. Fauci

of the National Institute of Allergy and Infectious Diseases and National Institutes of Health, Bethesda, Maryland.

Results.

The post-mortem samples we examined from people who died of influenza

during the 1918-1919 uniformly exhibited severe changes indicative of bacterial pneumonia.

Bacteriologic and histopathologic results from published autopsy series clearly and

consistently implicated secondary bacterial pneumonia caused by common upper respiratory tract bacteria in most influenza fatalities.

Conclusions.

The majority of deaths in the 1918-1919 influenza pandemic likely resulted

directly from secondary bacterial pneumonia caused by common upper respiratory tract bacteria.

Less substantial data from the subsequent 1957-1968 pandemics are consistent with these If

severe pandemic influenza is largely a problem of viral bacterial copathogenesis,

pandemic planning needs to go beyond addressing the viral cause alone,

e.g. influenza vaccines in antiviral drugs.

Prevention,

diagnosis, prophylaxis, and treatment of secondary bacterial pneumonia,

as well as stockpiling of antibiotics and bacterial vaccines,

should also be high priorities for pandemic planning.

If GRIP condemns, the secondary infection executes.

Quote by Louis Cuvier from 1919.

The two most important things about this 2008 article,

co-authored by Dr. Anthony S. Fauci, Dr. David M. Morins, and Dr. Jeffrey Taubenberger of the NIH-NIAID,

was first, they all concluded that everyone died of bacterial pneumonia and not influenza in 1918,

and our government's highest priority was to stockpile antibiotics to prevent against another pneumonia pandemic in the future,

like in 2020. This article from the New England Journal of Medicine, published March 26,

2020, published online January 29, 2020, Early Transmission Dynamics in Wuhan, China of a Novel Coronavirus Infected Pneumonia.

The earliest cases were identified through the Pneumonia of Unknown Etiology Surveillance Mechanism.

Pneumonia of Unknown Etiology is defined as an illness without a causative pathogen identified that fulfills the following criteria.

The initial working case definitions for suspected NCIP, Novel Coronavirus Infected Pneumonia,

were based on the SARS and Middle East Respiratory Syndrome, MERS,

case definitions as recommended by the World Health Organization who,

in 2003 and 2012, a suspected NCIP case was defined as a pneumonia.

We'll look at this a little bit more in depth.

On the left,

Fauci's email that he received from his chief of staff on February 6, 2020,

regarding the pneumonia outbreak in China,

compared to the 2008 article that he co-authored, Predominant Role of Bacterial Pneumonia in Cause of Death of Pandemic Influenza,

Implications of Pandemic Influenza Preparedness,

Stockpiling Antibiotics to Prevent Against Pneumonia.

The article on the left is the New England Journal of Medicine,

where it addresses the novel coronavirus-infected pneumonia,

and on the right,

it explains pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs

along a pathway created when the virus destroyed the cells that lined the bronchial tubes and lungs.

Here's an email that Dr. Anthony S. Fauci received from his chief of staff, Greg Fulkers,

from the NIH-NIAID on February 6, 2020, that article from the New England Journal of Medicine,

where it explains the novel coronavirus-infected pneumonia.

Dr. Anthony S. Fauci responds on Friday, February 7,

very interesting, with two exclamation points.

In that email,

Greg Fulkers, chief of staff,

points out for Dr. Anthony S. Fauci to look at this line specifically,

no exposure to either market or person with respiratory symptoms,

which suggests the novel coronavirus pneumonia reported in Wuhan, China, was just the seasonal community-acquired pneumonia.

Dr. Dumlao explains there are two strains of the flu,

A and B, and many people are also being diagnosed with another deadly infection.

People are coming in with what they feel like is a flu,

for example, and then when it's found, it's pneumonia.

Many people thought it was some strange form of a bacteria and not necessarily a virus.

Number two, we have antiviral drugs, for example, Tamiflu and Valenza and others.

We didn't have it then.

We have antibiotics to treat the secondary complications,

the bacterial complications of influenza.

We have antibiotics to treat the secondary complications,

the bacterial complications of influenza.

I'm not totally sure what the president was referring to,

but I believe he was referring to a report

that used both hydroxychloroquine and azithromycin, azithromycin, azithromycin

together to have some possibility of being in effect.

Many of the things that you hear out

there are what I had called anecdotal reports.

They may be true, but they're anecdotal.

They may be true, but they're anecdotal.

So the only thing that I was saying is

that if you really want to definitively know if something works,

that you've got to do the kind of trial that you get the good information.

The president is talking about hope for people,

and it's not an unreasonable thing to hope for people.

So when you have approved drugs that physicians have the option.

in a decision between the physician and the patient.

Are you gonna use a drug that someone says from an anecdotal standpoint,

not completely proven, but might have some effect?

There are those who lean to the point of giving hope

and saying, give that person the option of having access to that drug,

and saying, give that person the option of having access to that drug,

of having access to that drug, of having access to that drug,

of having access to that drug.

And then you have the other group, which is my job as a scientist,

to say my job is to ultimately prove,

without a doubt, that a drug is not only safe, but that it actually works.

Those two things are really not incompatible when you think about that,

particularly when you're in an arena where you don't have anything that's proven.

We went through the same sort of thing with a little bit

of a different twist during the HIV-AIDS epidemic until we finally developed drugs.

And I just hope that hydroxychloroquine wins,

coupled with perhaps the Z-Pak, as we call it,

dependent totally on your doctors and the doctors there,

because you know the answer to that question.

If you do have the ventilator, you know the answer to that question.

And I hate giving the answer.

So I don't want to get them there.

I don't want to get them there.

There's a possibility, a possibility, and I say it.

What do you have to lose? I'll say it again.

What do you have to lose? Take it.

I really think they should take it.

But it's their choice, and it's their doctor's choice, or the doctor's in the hospital.

But hydroxychloroquine,

try it if you'd like.

The other thing, if you have a heart condition, I understand,

probably you stay away from the Z-Pak.

But that's an antibiotic.

It can clean out the lungs.

The lungs are a point of attack for this horrible virus.

That's an antibiotic.

It can clean out the lungs.

The lungs are a point of attack for this horrible virus.

And I hope they use the hydroxychloroquine, and they can

also do it with Z-Pak, subject to your doctor's approval, and all of that.

But I hope they use it, because I'll tell you what.

What do you have to lose? In some cases, they're in bad shape.

What do you have to lose? It's been out there for a long time, and I hope they use it.