Without a doubt, Stephen King is one of the most recognized names in literature and he has become the focus of both academic courses and even graduate theses. His books are almost guaranteed to make the bestseller list but only a few have become legendary, sticking in the memories of those who have read his fictionalized passages and the curiosity of those who have yet to read his tomes.
His books also have a striking similarity to strains of the flu and how they affect public health.
Each year, the influenzavirus circles around the globe, infecting between five and 15% of the global population, causing millions to suffer from the classical symptoms of respiratory problems, fever, chills and aches.
Sadly, between 250,000 and 500,000 individuals die. These viruses, which usually take the names H1N1 or H3N2 are known as seasonal strains. They have a bestseller -- or best infecter -- status as they occupy our worries and the headlines for a short period of time, usually around the fall and winter months but then with the coming of summer, disappear from the public mindset.
Occasionally, a new strain emerges with an unexpected ferocity leading to unspeakable consequences. These iconic strains, more appropriately coined best killers, can lead to fear and even panic amongst the masses. The most renowned of these is the 1918 strain of influenza, the Spanish flu. This version of the virus led to between 20-50 million deaths and sent the entire world into a panic not seen since the days of the Black Plague, which was killing at a rate of 200 people per day. The effect on humanity was immense and was akin to turning the fiction of one of King's greatest works, The Stand, into reality.
More recently, the pandemic of 2009, caused by the ignobly named Swine Flu also took the world by storm although its effect was significantly less dramatic. While this strain kept the public worry high for over a year, when all the analysis was completed, it had done little more than a best-infecter. As such, it has all but disappeared from the public discussion while 1918 continues to spark engaging conversation -- at least amongst microbiologists.
Now a new set of flu strains have emerged, revolutionizing the way we look at these viruses. Rather than being one-time bestsellers or gaining that ever elusive legendary status, these strains have relatively little impact on public health yet somehow manage to sustain their prevalence in the public eye; they are best persisters. Like King's Carrie, which seems to pop up every decade and maintain its status as a book to be read and remembered, these particular strains become household names though they not as striking as their seasonal or pandemic counterparts.
The benchmark was H5N1, which appeared in Hong Kong in 1997 and led to 18 infections and 6 deaths. The virus was not only new, it was unexpected and caught the world by surprise. Thankfully, the virus could not be spread from person to person, making the likelihood of a killer pandemic unlikely.
Over the last 16 years, however, H5N1 has made sporadic appearances worldwide, killing only a handful of people at any given time. Yet each appearance brings back the media and the worry. While there is no reason for panic, the concern remains at a steady level as we wait to see whether this persister will eventually become a killer.
Now another new strain of influenza has emerged, H7N9, which at the moment is proving to be a potential best killer. The epidemic, which is centred in the eastern areas of China is continuing with dozens of confirmed cases, and about 20% perishing. The numbers are expected to rise as is the general panic in the public.
But this reaction may be far too premature and H7N9 may have a different fate. There are few indications that this strain will lead to a pandemic highlighted by the fact that there are no confirmed cases of human to human transmission, much like H5N1. Without this ability, there can be no pandemic. As we are seeing right now, there exists an opportunity for officials to work together to stop the tide before the situation gets worse. And it is exactly what they are doing with relative success. Within a month, the H7N9 epidemic may be a thing of the past.
However, that doesn't mean that H7N9 is gone for good. This virus also has all the markings of a best persister. Much like H5N1, infections appear to be linked to migratory birds . If this is the case, then the virus will most likely spread to Hong Kong and eventually to other countries including Vietnam, Indonesia and Egypt. The cases will most likely be sporadic and not lead to a large number of infections or deaths but because of its potential, it will occupy the headlines and citizen concern for years and maybe decades to come.
Much like any new offering from Stephen King, which requires time to determine its place in his legacy, the new H7N9 flu requires more than just a few weeks to determine its place in the historical records of infectious disease.
While at this time, the trend appears to be that of a best persister, things could change quite rapidly and we could be facing a new best-killer. However, one thing is certain: much like the New York Times Best Sellers list, which tracks and lists the literary hits of our time, we can always turn to the World Health Organization to help us better understand the impact of H7N9 or any other infectious disease breakout so that we are not only aware but also prepared for whatever possible horror novelty may come our way.