Where does that leave scientists? Still largely uncertain about the details of the Spanish flu—and fairly anxious about it. John Oxford, who led the team that exhumed Sykes, hoped to study the disease in order to prevent a similar flu pandemic—which he thinks is just around the corner. Ideally, the better we understand previous pandemics, the better able we’ll be to treat and prevent future ones. That’s the goal of Jeffrey K. Taubenberger, chief of viral pathogenesis and evolution at the National Institutes of Health’s Laboratory of Infectious Diseases. Taubenberger, who led the research team that recovered the Inuit victim’s lung tissue, speculates that humans have been facing influenza pandemics for longer than most realize, probably millennia. He’s uncovered annals from monasteries in England and Italy in 1070 that describe maladies with identical respiratory symptoms—probably the flu by another name. And Taubenberger has traced about 14 discrete pandemics since the 1500s, the most recent being the swine flu outbreak of 2009.
But Spanish flu was a pandemic of a different magnitude compared to swine flu, bird flu, or any other recent outbreaks. And perhaps because of its worldwide prevalence, it became the foundational flu of modern times. Before 1918, another influenza virus was surely being passed from human to human. When Spanish flu emerged, it out-competed this virus, mutating with greater celerity and spreading with ease. And though it has since mutated further, Spanish flu remains the basic strain of influenza being spread today. If you had swine flu, or even a standard-grade seasonal flu, you almost certainly contracted a mutation of Spanish flu.
It might sound pretty horrifying to know you’ve had Spanish influenza, but it could be worse. As long as we’re dealing with the same basic virus, Taubenberger says, it’s fairly easy to study the flu and develop vaccines, building upon a sturdy foundation of research and resources already in place. The problem comes along when a completely new influenza virus emerges, one that knocks Spanish flu off its throne. Such fears have thus far been fodder for horror movies and science fiction, but we may be closer to flu doomsday than we realize.
“You can say with almost complete certainty that humans will face future pandemics of influenza,” Taubenberger said. “And at the moment, we can’t predict them in advance.” That could change eventually: Taubenberger dreams of a day when scientists are able to spot a newly developing pandemic in its earliest stages and even develop a universal vaccine for all future mutations of the influenza virus. Right now, though, “the virus mutates so fast that it’s impossible to make a vaccine with broad universality.” In other words, the flu is out-evolving us.
In the meantime, Taubenberger and his team will keep studying the old virus in an attempt to uncover a pattern in its genetic structure that might explain its particular virulence. As for its animal origin? “It’s possible we’ll never actually know,” Taubenberger conceded. “We don’t have these missing links. There’s no surveillance [of flu-prone animals] going on before 1918. We don’t have any animal samples” to trace the development of the virus.
What they may have, however, are human samples. The Armed Forces Institute of Pathology, which served as the largest pathology institute in the world before it was disbanded in 2011, has preserved tissue samples going back to the Civil War. If Taubenberger can get his hands on a few flu-infected pieces of lung from before 1918, he might be able to sequence the pre-1918 influenza virus. A comparison of the two viruses could reveal how Spanish flu mutated its way to the top, giving us a greater understanding of influenza in general—and possibly even paving the way for the development of the mythical universal vaccine.
For now, the flu will keep adapting year after year, usually as a seasonal annoyance, occasionally as a 2009-level menace. Scientists like Taubenberger will continue to sequence both fresh and old influenza viruses, while the international community remains vigilant against the next pandemic. Perhaps when it comes, we’ll have gleaned the secrets of the Spanish flu and be prepared to fight against influenza’s endless mutations. If we aren’t—well, we’ll have a whole new set of human samples to study before the next flu comes around.