I had a little bird
Its name was Enza.
I opened up the window
And in-flew-enza.1
A report in this issue of the Southwest Respiratory and Critical Care Chronicles discusses the rates of cases of COVID-19 and influenza in Texas. While more COVID-19 infections than influenza cases have occurred, the cases of influenza have resulted in more deaths.2 As cold and flu season approaches, physicians urge the public to take advantage of the vaccines offered for the new variant of COVID-19, for influenza, and for respiratory syncytial virus (RSV).
While the COVID pandemic killed millions worldwide, the rapidly developed vaccines likely saved millions of lives. In recognition, the 2023 Nobel Prize for Physiology or Medicine was awarded to Drs. Katalin Kariko and Drew Weissman “for their discoveries concerning nucleoside base modifications that enabled the development of effective mRNA vaccines against COVID-19…the laureates contributed to the unprecedented rate of vaccine development during one of the greatest threats to human health in modern times.”3
The influenza pandemic in the early twentieth century had no specific preventive vaccine, and from February 1918 to December 1920, one-third of the global population—500 million people—were infected. One hundred million people died, many more than the soldiers and civilians killed during World War I. Artists recorded the misery, focusing even on their own illness.4 Edvard Munch’s self-portrait in 1919 depicts the artist in nightclothes slumping in a wicker chair, the rumpled sheets and blankets of his sickbed behind him to the left. The viewer’s eye is caught by the opulent colors in the room and how they contrast with the artist’s pale complexion; his unshaven cheeks seem drawn in as his open mouth breathes in gasps.
Edvard Munch (1863–1944). Self-Portrait with the Spanish Flu. 1919.
National Gallery, Oslo. Wikimedia Commons. Accessed 9-20-2023.
Munch painted another self-portrait after he survived his infection. Although he is no longer confined to his bed or to a chair and is dressed in a suit, he nevertheless does not look robust. His frame no longer looks emaciated, but he still slumps while standing. His face is haggard, his gaze is unfocused, his eyes are puffy, and he looks exhausted from the ravages of influenza.
Edvard Munch (1863–1944). Self-portrait after the Spanish Flu. 1919–1920.
National Gallery, Oslo. Wikimedia Commons. Accessed 9-20-2023.
Without a preventive vaccine for influenza in 1918–1920, many people relied for relief on traditional nostrums–family “remedies”–or were victims of outright quackery. The English word quack derives from the Dutch kwakzalver, a charlatan who peddles ineffective, sometimes dangerous, medicines. The quack’s loud attention-getting yammering at crowds recalls the noisy quacking of ducks and geese, hence the label “quack.”5 Quackery was evident during the influenza pandemic, as illustrated in this 1919 political cartoon by Chas Reese.6 A large banner hangs over a wooden building that announces, “Ye Olde and Goode Germ Destroyer. Distilled and bottled for ye kindely gentlemen.” (One wonders why 50% of the population was left out.) Crowds of men in suits rush into the building to grab this wonder drug, even climbing through windows. Hats and shoes are lost in the melee. Latecomers are shown in the background quickly driving on a winding road to the germicide station. Looming over the entire landscape is an ominous black cloud labeled “Influenza.”