Students and faculty members are disappearing. Locked in bedrooms, mouths covered in surgical masks, suspected victims of H1N1, better known as swine flu, can spend as long as a week hidden from the rest of the Yale community.
Swine flu may be the only epidemic our generation of college students will experience first-hand. But Yale, in its 308-year history, has seen far greater pandemics. For the first time, though, the course of the disease is far out of Yale’s hands — not because of any lack of scientific advances — but due to a limited supply of vaccines and a reliance on self-isolation to contain the spread of the flu.
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College kids are at great risk for acquiring H1N1. This is not only because undergraduates live in close proximity to one another but also because of their lack of antibodies capable of defending against the H1N1 virus, according to the Centers for Disease Control. Many of our grandparents, however, developed these antibodies when strains of H1N1 were still present in seasonal influenza.
Since Sept. 1, more than 661 cases of H1N1 influenza have been reported at Yale, of which close to 90 percent are Yale students, Director of University Health Services Paul Genecin said in a phone interview. But the number of cases may be much higher, since many students choose not to report incidents of influenza, sometimes due to fear of isolation or quarantine, according to several undergraduates interviewed.
“It is reasonable that healthy people who get swine flu may get on a respirator and die, but the overwhelming majority do not,” Genecin said.
Today, YUHS prepares to handle any emergency, be it weather- or disease-related, according to Genecin. But what did Yale do when faced with incurable infectious diseases before an organized center for student health services existed?
It all begins with smallpox.
The first nationally reported case of smallpox at Yale occurred in 1895. On Wednesday, March 10 of that year, Yale Medical School lecturer Dr. J.P.C. Foster ordered that all Yale students be vaccinated “at once” because of three smallpox cases among students, as stated in a March 9, 1895 New York Times article. One of those students was Philip H. Bailey, who had contracted smallpox more than two weeks before the vaccination order. The former brother of Alpha Delta Phi fraternity later volunteered as a second lieutenant in the U.S. Army when the government increased the size of its army with the Army Reorganization Act of 1899.
Smallpox, a contagious disease that causes a spotted skin rash, can also lead to backache, delirium, diarrhea, excessive bleeding, fatigue, high fever, severe headaches and vomiting. Diagnosed patients are typically isolated immediately and receive vaccines to shorten the duration of the disease. Complications can lead to arthritis, encephalitis, eye infections, pneumonia, scarring, more bleeding, skin infections and even death, according to Google Health.
Only five years after the mass vaccination, G.W. Perkins, a freshman at the Sheffield Scientific School (which used to be the science wing of Yale College) was found to have smallpox. In an article from March 4, 1900, The New York Times reported Perkins had contracted the disease while visiting New York in February of that year, popping the Yale bubble with big city disease. Prevention measures taken by the University to treat the student and exposed students helped to contain a potential major outbreak, as illustrated by a lack of reported on-campus cases of smallpox.
The potency of the smallpox vaccine helped to contain the disease throughout the 20th century. The disease only reappeared in the public consciousness after 9/11, when some surmised that the virus could be harnessed as a biological weapon.
School of Management Professor Edward H. Kaplan was involved in creating a model to evaluate alternative responses policies to smallpox after 9/11.
“The worry is purely one of an intentional outbreak — if a terrorist could get a hold of the virus and weaponize it. People were worried about that possibility not because it’s particularly likely, [but] because the consequences can be so severe,” Kaplan said.
Kaplan’s model proved that the most effective way to combat a potential biological threat would be a mass vaccination program.
However, sometimes a vaccination program cannot contain the severity and spread of an outbreak. This was best illustrated by the international Spanish influenza pandemic of 1918.
Yale History of Science & Medicine Chair Frank Snowden said older people had gained immunity to Spanish influenza by surviving the prior flu epidemic in 1889. Though college students would seem to be the prime targets for this virus, Yale managed to emerge virtually unscathed by the worldwide pandemic.
The virus, like swine flu, causes the immune system to go into overdrive, otherwise known as the “cytokine storm.” This hyper-response, most common in people with active, vigorous immune systems, caused the most fatalities among people between teenage and middle-age age groups.
“You have a clearly disciplined and highly controlled population,” Snowden said of Yale. “It was possible to isolate them more or less entirely from the city of New Haven.”
The Yale bubble to the rescue.
Unlike the single, great outbreak of Spanish influenza, polio has recurred multiple times throughout American history. Also viral in nature, poliomyelitis damages the nervous system and can cause paralysis. There is no cure for polio.
Yale had some of the most distinguished polio researchers in the country beginning in the interwar period. Within the Yale School of Epidemiology and Public Health, Dr. John Paul and Dr. James Trask organized the Yale Poliomyelitis Study Unit in 1931 in response to epidemics in Middletown, Conn., in 1930 and New Haven in 1931. The doctor duo isolated the virus by visiting polio patients, taking physical examinations and collecting throat washings. They found that the virus was present in the intestinal tract, sewage and flies feeding on feces. Following the success of Paul and Trask, Yale School of Medicine received the first March of Dimes grant to combat polio in 1936. Dr. Dorothy M. Horstmann joined the Unit in 1943 and found that the polio virus reaches the nervous system via blood, which allowed polio vaccines to be possible.
These advances in clinical treatment made on Yale’s campus helped to prevent the college and national populations from greater suffering as a result of polio.
As part of a commemorative project celebrating the 175th anniversary of Yale-New Haven Hospital in 2001, Aileen Meyer, a nursing student doing rounds at Grace-New Haven Hospital from 1947–1952, wrote about her experience treating polio patients: “Our weapons during this war [on polio] consisted of a single row of wringer washing machines standing out the doors of patients’ rooms, filled with hot packs,” Meyer said. “The night shift had the responsibility of preparing these soldiers of war for the day shift by seeing that the tubs were filled and heated to a certain temperature before the packs could be applied to the patients’ afflicted areas.”
Polio first occurred in America in 1894, affecting thousands of people for nearly 70 years. But by 1964, the disease was diminished by the Salk and Sabin polio vaccines.
Snowden described polio as a “little noticed” disease before the late 19th century. Advances in sanitation and health led to the polio outbreaks during the first half of the 20th century, since they reduced early exposure to the disease, preventing toddlers from gaining natural immunity while the polio virus persisted. Thus, polio often hit Americans late in life, as adolescents or adults, due to a “buildup of susceptible people,” Snowden said.
Also incurable, but more easily preventable, AIDS hit the national radar less than two decades after polio phased out in America.
AIDS was first named and recognized to be an auto-immune disease in the early 1980s. At the time it was most often associated with homosexuals, as expressed by writer David Leavitt ’83, a Yale student during the ’80s AIDS epidemic in the United States:
“I can trace back the presence of AIDS in my consciousness to 1981, when I was 19 and in my second year at Yale. I was standing near the newsstand at the Oakland airport, waiting for the plane that would take me back to school from Christmas vacation, when I noticed a newspaper headline — something about ‘gay cancer,’” Leavitt wrote in an article from July 9, 1989 for The New York Times. “I put the headline out of my mind, but somehow the moment lodged itself in my memory. During the next several years, I was always able to recall it exactly, the way that people of my parents’ generation could remember exactly what they were doing the moment they heard Kennedy had been shot.”
Groups on Yale’s campus held Gay and Lesbian Awareness Days (GLAD) with rallies, dances, lectures, workshops, with participants wearing pink triangles in solidarity.
In Leavitt’s article, “The Way I Live Now,” he wrote that, “In the protected fishbowl of Yale in 1982, we certainly hadn’t experienced [AIDS], and probably didn’t imagine it could have anything to do with us. AIDS, I thought then, was something that happened only to the kind of people who populated Larry Kramer’s novel ‘Faggots’ — men older than me who summered on Fire Island, went to the bathhouses and had sex with strangers.”
Part of this sense of invincibility is justified because there was never really an outbreak of AIDS among Yale students, according to Kaplan. (The SOM Professor studied the needle exchange program in New Haven during the height of the AIDS crisis in the late ’80s and early ’90s.)
“From the time I got here, which was back in 1987, there’s always been a very high awareness of HIV and AIDS on campus,” Kaplan said. “Whether individual students or faculty were affected, that’s quite confidential information. What’s absolutely clear is that it was never the sort of thing where you would have large numbers. There’s no outbreak here. That’s the wrong way to think about it.”
Yet Kaplan contrasted the Yale AIDS experience with the New Haven one.
“In New Haven, there was very much an epidemic going on in the drug injectors of the community,” he added. “It’s transmissible only if you take the risks that lead to transmission. Being aware of what the risks are means you don’t have to take them.”
Diseases at Yale have come and gone. But, for now, the swine flu is at the forefront of students’ minds.
Unfortunately for those wishing to evade the present H1N1 outbreak, needles and unprotected sex are easier to avoid than a coughing roommate.
YUHS has been fighting swine flu since experiencing its first case in April, right before Commencement.
Genecin said he believes Yale is at the end of its first wave since the number of cases per day has declined from last week’s peak of approximately 30 new cases a day.
But the worst may be waiting to burst through Phelps Gate.
“We haven’t yet seen widespread illness in school children. Once school children start to infect one another, they also infect their siblings and their parents, who tend to be young adults,” Genecin said.
Complicating this situation is the limited supply of vaccines — both for H1N1 and the seasonal flu. Genecin said he does not yet know the amount of H1N1 vaccine doses Yale will receive from the state.
Current seasonal flu vaccines, which increase protection against several main strains of flu, do not protect against H1N1. As a result, vaccine producers stopped making Trivalent seasonal influenza vaccine in order to incorporate the new H1N1 vaccine, Genecin explained. He said YUHS currently has only 8,000 doses of Trivalent. This amount could not vaccinate the entire Yale population of students, faculty and staff. Thus, if there were a major outbreak of seasonal flu right now, without vaccine reinforcements, the Yale campus could become a breeding ground for both strains of flu virus.
“The best thing is to immunize as many people as you can, understanding there will be a limit for people willing to be immunized,” Genecin said. “You try to get herd immunity in the population, even if you can’t blanket everyone.”
YUHS has a far greater capacity for emergency measures than has been currently employed, Genecin maintained. He added that measures such as a Universitywide quarantine or the set-up of triage tents have not been warranted by the limited severity of H1N1 cases, and that one of the final stages of an emergency plan would be the closure of the school.
“Most of the cases in the United States have been a fairly mild event,” Snowden said. Yet, he added, “It is worth remembering that people have died and people have been seriously ill. We won’t know exactly what the final impact is until later on.”
Snowden even suggested the next incarnation of H1N1 may be more harmful.
“That was true about the 1918–1919 flu. The second wave was much more virulent than the first,” Snowden said.
But, looking to avoid slow YUHS urgent care and underwhelming clinicians, some students said they have chosen to diagnose and treat themselves for swine flu.
Nick Garver ’10 contracted H1N1 the first weekend after classes started. When he went to YUHS, Garver found a full waiting room with patients already outfitted in surgical masks.
“[YUHS] took my temperature. They gave me a flu kit, but I didn’t take any Advil because I wanted to see my temperature change without masking it,” Garver said.
Though a mass vaccination campaign on the scale of the Universitywide smallpox program in 1895 has not been needed for the containment of H1N1, fear not, sick Bulldogs. Yale’s history of evading nationwide pandemics leaves hope that even the swiniest flu will soon be diminished — if only to reemerge in a newer form in time for our kids.