Прошло всего столетие с наиболее смертоносной пандемии гриппа, которая унесла жизни более 5% населения мира. Возможно ли ее повторение сегодня и научились ли мы лучше бороться с вирусом гриппа, чем 100 лет назад?

Тогда мир пережил крупнейшую за смертностью пандемию гриппа. Она началась в последние месяцы Первой мировой войны и быстро затмила ее по масштабу жертв.

За каких-то четыре месяца «испанка» распространилась по всему миру, добравшись до самых изолированных общин.

За полтора года пандемии вирус унес жизни 50-100 миллионов человек — почти 5% мирового населения.

Века назад эпидемия 1918-19 годов кажется такой же далекой, как оспа, бубонная чума и другие смертоносные заболевания, которые нам удалось искоренить полностью или почти полностью.

Впрочем, грипп никуда не исчез. Ежегодно от него умирают от 250 тыс. пол миллиона людей.

Ежегодно штаммы вируса меняются, а причиной пандемии могут стать несколько разновидностей вируса у животных-хозяев.

Кроме 1918 года в течение прошлого века в мире произошло несколько пандемий гриппа — в 1957, 1968, 1977 и 2009 годах.

Учитывая способность вируса к мутации и его постоянное присутствие в природе (носителями гриппа, к примеру, всегда являются дикие водоплавающие птицы), эксперты соглашаются, что появление такого же заразного и смертоносного штамма, как «испанка», — лишь вопрос времени.

«Пандемии гриппа, как землетрясения, ураганы и цунами, происходят всегда, некоторые — гораздо хуже других», — говорит Майкл Остерхольм, директор Центра исследований инфекционных болезней в Университете Миннесоты.

«Мнение, что масштабов пандемия 1918 года, уже никогда не случится, очень ошибочно», — считает ученый.

Окопы Первой мировой войны стали идеальным местом для быстрого размножения вируса испанского гриппа

Но предугадать, когда она может начаться снова, крайне трудно. Так же трудно предсказать, как болезнь будет развиваться.

Однако сделать несколько научных предположений — вполне возможно.

«Влияние вируса прежде всего будет зависеть от того, как быстро мы сможем его обнаружить и сдержать», — отмечает Роберт Вебстер из отделения инфекционных болезней детской исследовательской больницы Сент-Джуд.

Ученые этим постоянно занимаются. Например, отдел по надзору за гриппом Всемирной организации здравоохранения постоянно следит за развитием вируса в шести ключевых лабораториях по всему миру.

Так же ряд сельскохозяйственных лабораторий наблюдает за возможным распространением вируса среди птиц и свиней.

«Наблюдение, конечно, ведут на лучшем возможном уровне, но осмотреть каждого птицу или животное — просто невозможно», — объясняет Роберт Вебстер.

«Поэтому нам должно очень повезти, чтобы мы смогли вовремя локализовать вирус», — добавляет он.

В противном случае он распространится за считанные недели миром, ведь люди сегодня — очень мобильные.

«Грипп является такой инфекцией, которая, попав в восприимчивую популяцию, сразу загорается», — говорит Джерардо Чоуелл, профессор эпидемиологии и биостатистики из Университета штата Джорджия.

«Люди начинают распространять вирус, прежде чем у них появятся симптомы».

Очень важно — держать больных в изоляции, но сделать это в густонаселенном современном мире будет непросто

Поскольку население мира за минувшее столетие увеличилось более чем в четыре раза, современная пандемия унесет гораздо больше жизней. Если в 1918 году грипп убил 50 миллионов, сегодня он может уничтожить более 250, отмечает Остерхольм.

«Мешков для трупов точно не хватит», — добавляет он.

Как свидетельствует история, смертельные случаи будут случаться среди населения неравномерно.

Разница в количестве смертей во время пандемии испанки в разных странах достигала 30 раз.

Например, в Индии вирус унес 8% населения, а в Дании менее 1%. Так же во время пандемии H1N1 2009 года смертность в Мексике превысило количество смертей во Франции в 10 раз.

На это влияет несколько факторов, в частности, предварительные вспышки схожих вирусов или генетическая уязвимость к вирусу определенных этнических групп. Так, коренная народность Новой Зеландии, маори, имели в семь раз более высокие шансы умереть от испанского гриппа 1918 года, чем средний мировой показатель.

Среди других причин — экономические, как соблюдение санитарных норм и доступ к медицинской помощи, объясняет Чоуелл.

«В 2009 году в Мексике много людей обратились к врачу, когда уже было слишком поздно», — отмечает исследователь.

Для многих из них это было экономическим решением. Чтобы пойти к врачу, надо было взять отгул, а значит, ничего не заработать в этот день.

«Это, конечно, не про каждого мексиканца, но именно о наиболее уязвимые слои населения», — добавляет Чоуелл.

Правительствам придется потратить огромные ресурсы на то, чтобы остановить вспышку болезни

Если пандемия ударит по США или других странах, которые не имеют обязательного медицинского страхования, произойдет то же самое.

Те, у кого нет страховки, будут ждать до последнего, чтобы избежать значительных расходов на лечение.

«Мы видим такую же картину в отношении других инфекционных заболеваний и доступа к медицинской помощи», — отмечает Чоуелл.

Лучшее средство борьбы с пандемией — это, конечно, вакцины, объясняет Лоун Саймонсен, эпидемиолог из Университета Роскільда в Дании и Университета Джорджа Вашингтона.

Но для этого нужно сначала определить вирус, создать вакцину, а затем распространить ее по всему миру — проще сказать, чем сделать.

Вакцины против гриппа, которые стали доступны после 1940-х годов — разрабатывают быстрее других, но на это все равно нужны месяцы.

И даже если бы такую вакцину успели создать, сделать достаточное для всех количество доз, просто не реально, объясняет Остерхольм.

«В первые шесть-девять месяцев пандемии доступ к вакцины получили бы только 1-2% населения», — добавляет он.

Еще одно ограничение заключается в том, что эффективность нынешних вакцин против сезонного гриппа в лучшем случае составляет лишь 60%.

Если начнется смертельная пандемия, избавиться от десятков миллионов тел будет трудно

Так же, хотя у нас и есть антивирусные препараты для борьбы с гриппом, как Тамифлю, их запасов на случай пандемии не хватит.

Кроме того, препараты, которые мы имеем против гриппа, являются менее эффективными в сравнении с другими болезнями, потому что сезонный грипп обычно не воспринимают как слишком серьезное заболевание.

Итак, больницы почти сразу переполнятся, а лекарства и вакцины быстро кончатся.

«Система здравоохранения Соединенных Штатов в этом году плохо справлялась даже с сезонным гриппом, хотя ситуация была не слишком сложной», — говорит специалист.

«Это свидетельствует о том, что мы не способны реагировать на большое количество больных».

Так же, как и в 1918 году, когда число инфицированных и умерших начало быстро расти, во многих городах мира произойдет коллапс.

Предприятия и школы закрыты, общественный транспорт не будет работать, электричество может отключиться, а тела умерших будут оставаться на улицах.

Скоро начнутся перебои с едой и жизненно важными медикаментами, нужными больным на диабет, сердечные заболевания или пациентам с иммуносупрессивными состояниями и другими опасными для жизни болезнями.

«Если через пандемию производство и транспортировка этих препаратов сократится, много людей умрет за короткое время», — говорит Остерхольм.

От испанского гриппа умирали преимущественно молодежь и люди среднего возраста. Но почему, ученые узнали лишь в 2005 году

«Сопутствующие убытки пандемии могут быть огромными», — заключает он.

Последствия будут длительными и после того, как эпидемия угаснет сама по себе.

Вирус 1918 года был таким ужасным еще и потому, что он забрал жизни не детей и стариков, как обычный грипп, а здоровых взрослых людей в расцвете сил.

В результате этого не стало значительной части рабочей силы, множество детей остались без родителей, а многочисленные семьи — без кормильцев.

Почему так произошло, ученые узнали только в 2005 году, когда реконструировали вирус испанского гриппа. Они сделали это с помощью образцов, изъятых с Бревіг-Мишн, поселка на Аляске, в котором менее чем за неделю умерли 72 из 80 жителей.

Тело одной женщины сохранилось в вечной мерзлоте так хорошо, чтобы микробиологи смогли изъять ее легкие, которые все еще содержали гены вируса.

Во время тестов на животных с использованием реконструированных вирусов ученые обнаружили, что штамм 1918 года очень хорошо размножался.

Это вызвало естественную иммунный ответ организма — так называемую «цитокінову бурю», когда в легких резко увеличивается число противовоспалительных белковых веществ — цитокинов.

Цитокины являются токсичными сами по себе. Это именно из-за них во время гриппа болит голова и ломит тело. Когда же их количество сильно возрастает, некоторые органы или системы могут отказать.

Запасы еды и жизненно необходимых медикаментов могут быстро кончиться

Поскольку иммунная система взрослого человека реагирует сильнее, чем у детей или людей пожилого возраста, исследователи считают, что более количество цитокинов может оказаться смертельной.

«Мы наконец поняли, почему вирус был таким патогенным, — говорит Вебстер. — Организм фактически убивал себя сам».

Десятилетия назад исследователи разработали імуномодулювальну терапию, которая смягчает воздействие цитокінової бури.

Но этот метод не является ни идеальным, ни широко доступным.

«Мы не справляемся сегодня с цитокіновими бурями гораздо лучше, чем в 1918 году», — объясняет Остерхольм.

«Есть аппараты, которые помогают с дыханием и циркуляцией крови, но в целом результат все еще довольно неутешительный».

Это означает, что, как и в 1918 году, наибольшие потери будут среди молодежи и людей среднего возраста. А поскольку продолжительность жизни сегодня на десятилетие больше, последствия для экономики и общества станут губительными.

Пожалуй, единственным шансом на спасение является разработка универсальной вакцины против гриппа. На осуществление этой давней мечты наконец выделяют значительные ресурсы.

Но будет ли ее появление своевременным, чтобы предотвратить следующей пандемии, остается только ждать.

«Исследования продолжаются, поэтому, надеюсь, мы получим в итоге такую универсальную вакцину и будем хорошо подготовлены к возможной вспышке вируса», — отмечает Вебстер.

«Но пока это не так».

Прочитать оригинал этой статьи на английском языке можно на сайте BBC Future.

Хотите поделиться с нами своими жизненными историями? Напишите о себе на адрес questions.ukrainian@bbc.co.uk и наши журналисты с вами свяжутся.

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