There was a little bird whose name was Enza, opened up the window and in flew Enza!
—Nursery Rhyme, 1918
The cover image is a pen-and-ink drawing created in 2007. It was inspired by the enormous privilege I had to work on a cooperative flu preparedness program that was a partnership between public health, agriculture, the public health laboratory, and game and parks in the state of Nebraska. Perhaps the most eye-opening part of the experience was that the human-health participants and the animal-health participants had no idea how interconnected influenza was between birds and humans. The bisection between the health of our wildlife and food and the health of ourselves became a startling reality, as the “bird flu” scare of 2006 became all the more real in light of our program.
For the first time, those of us involved with human health saw the real impact of how influenza can “jump” species and of what that could mean in terms of viral spread. Those involved in animal health understood the animal aspect but were startled by what the reality of the human situation could be. The project reflected an exceptional interdisciplinary partnership, one that was able to create an educational program that reached clinicians, public health workers, laboratorians, and veterinarians alike. It provided a platform for remarkable interdisciplinary discourse in a way I have not seen since, and reminded us that we are all part of the same ecosystem. Especially in a large, food-producing state like Nebraska, this kind of partnership will be key to battling any virulent and species-jumping virus like influenza.
It was nearly 100 years ago that the deadliest pandemic in history ravaged the world—the 1918 influenza pandemic. Making it even more deadly were the close quarters and trench warfare of World War I, enabling the virus to spread like wildfire through the troops, paying no regard to nationality, creed, or what side they were fighting on. The flu could kill them all. And it likely started at a pig farm in northern Kansas, jumping adeptly from hogs to humans as influenza is known to do. The characteristics of influenza have not changed in the last century, but our ability to fight it has, thanks to a vaccine.
Does this interconnectedness play a part in what we are teaching our students and our patients? Do we discuss with them the interdisciplinary nature of influenza and inform them that birds are often sentinels for human influenza? Are we telling them one of the best modes of prevention is vaccination, and education about vaccination? The flu is an ever-changing virus—it can shape-shift, as well as jump from one species to another. Someday, a virulent strain of the flu will master human-to-human transmission, and the world will be in trouble. Unless, of course, we have a vaccine to protect us. The biggest difference in flu prevention between 2012 and 1918 is the vaccine. Without it, we are just as vulnerable as the population in 1918. Further, the world today is a much more crowded place—we live in closer quarters, we travel much farther, and we do not stay home sick even when our doctors and health agencies recommend that we do.
This artwork reminds us of the fluent and ever-moving nature of flu. My creation of this work is dedicated to all personnel who are exposed to influenza viruses daily, and it is inspired by an interdisciplinary group of passionate and synergistic individuals working for the health of all creatures.
Kristin A. Watkins, MBA
Ms. Watkins is an administrator, Holland
Regenerative Medicine Program, University of
Nebraska Medical Center, Omaha, Nebraska;