The 1918 flu pandemic (January 1918 - December 1920), also known as Spanish flu , is a deadly influenza pandemic extraordinary, the first of two pandemics involving the H1N1 influenza virus. It infects 500 million people worldwide, including people on remote Pacific islands and in the Arctic, and resulting in deaths of 50 to 100 million (three to five percent of the world's population), making it one of the world's deadliest natural disasters. human history.
Illness has greatly limited life expectancy in the early 20th century. In the first year of the pandemic, life expectancy in the United States declined by about 12 years. Most influenza outbreaks disproportionately kill teenagers, elderly, or already weak patients; on the contrary, the pandemic of 1918 primarily killed previously healthy young adults.
There are several possible explanations for the high mortality rate of the 1918 influenza pandemic. Several studies have shown that specific variants of the virus have tremendously aggressive properties. One group of researchers found the virus from the frozen body of the victim, and found that transfection in animals led to rapid progressive respiratory failure and death through cytokine storms (excessive reactions of the immune system). It then postulates that a strong immune reaction from young adults damages the body, whereas the weaker, weaker immune systems of children and middle-aged adults result in fewer deaths among the groups.
Recent investigations, primarily based on the original medical report of the pandemic period, found that the viral infection itself was no more aggressive than previous influenza, but that special circumstances (malnutrition, overcrowded medical camps and hospitals, poor hygiene) promoted infectious bacterial superinfection most victims are usually after a long death bed.
Historical and epidemiological data are inadequate to identify the geographic origin of the pandemic. It was involved in the outbreak of lethargica encephalitis in the 1920s.
To safeguard morals, wartime censors minimize early reports of illness and death in Germany, Britain, France and the United States. Papers are free to report on the effects of epidemics in neutral Spain (such as the serious illness of King Alfonso XIII). This creates a false impression of Spain as deeply battered, giving rise to the pandemic nickname, "Spanish Flu".
Video 1918 flu pandemic
History
Hypothesis about source
Historian Alfred W. Crosby notes that flu originated in the US state of Kansas, and popular writer John Barry echoed Crosby in describing Haskell County, as the point of origin even though it was at the end of 1917 there had been a first wave in at least 14 US. military camp.
The investigation worked in 1999 by the British team led by the virology of John Oxford of St. Bartholomew's Hospital and Royal London Hospital identified staging of large troops and hospital camps in ÃÆ'â € ° taples, France, as the center of the 1918 flu pandemic. By the end of 1917 , a military pathologist reported the onset of a new illness with high mortality which they later came to know as the flu. Crowded camps and hospitals - which treat thousands of victims of chemical assaults and other war victims - are the ideal sites for the spread of respiratory viruses; 100,000 troops transit each day. It is also home to live pigs, and poultry is regularly brought from the surrounding villages. Oxford and his team postulated that significant precursor viruses, buried birds, mutated so that they could migrate to pigs stored near the front.
The initial hypothesis of the origin of the epidemic has varied. Some flu hypotheses are from East Asia. Claude Hannoun, the leading flu expert of 1918 for the Pasteur Institute, confirmed that the former virus probably originated in China, mutating in the United States near Boston and spreading to Brest, France, the battlefields of Europe, Europe and the world using Allied Soldiers and sailors as the main spreaders. He considered several other origin hypotheses, such as Spanish, Kansas, and Brest, as possible, but impossible.
Political scientist Andrew Price-Smith published data from Austrian archives showing that influenza originated from the beginning, beginning in Austria in early 1917.
In 2014, the historian Mark Humphries of the Memorial University of Newfoundland at St. John's stated that the newly excavated record confirms that one of the side stories of the war, the mobilization of 96,000 Chinese workers to work behind British and French lines in World War I western front, might be a source of a pandemic. In his report, Humphries found archive evidence that a respiratory illness that invaded northern China in November 1917 was identified a year later by Chinese health officials as synonymous with the "Spanish" flu. A report published in 2016 in the Journal of the Chinese Medical Association found no evidence that the 1918 virus was imported into Europe through the armies and workers of China and Southeast Asia. Found evidence that the virus had circulated in the European army for months and probably years before the 1918 pandemic.
Spread
When an infected person sneezes or coughs, more than half a million virus particles can spread to those who are nearby. The close proximity and massive troop movements of World War I accelerated the pandemic, and may both increase additional transmission and mutation; war can also increase virus death. Some speculate that the immune system of the soldiers is weakened due to malnutrition, as well as pressure from combat and chemical attacks, increasing their vulnerability.
A major factor in flu incidence worldwide is an increase in travel. The modern transportation system makes it easy for soldiers, sailors, and civilian tourists to spread the disease.
In the United States, the disease was first observed in Haskell County, Kansas, in January 1918, prompting local Loring Miner doctors to alert the academic journals of the US Department of Health. On March 4, 1918, company chef Albert Gitchell reported ill at Fort Riley, an American military facility that at the time trained American troops during World War I, making him the first recorded victim of the flu. Within days, 522 people in the camp had reported illness. On March 11, 1918, the virus had reached Queens, New York. Failure to take precautions in March/April is then criticized.
In August 1918, more vicious tensions arose simultaneously in Brest, France; in Freetown, Sierra Leone; and in the US in Boston, Massachusetts. Spanish flu also spread through Ireland, brought there by returning the Irish army. Allied World War I came to call it Spanish flu, especially since the pandemic received greater press attention after moving from France to Spain in November 1918. Spain was not involved in war and did not apply wartime censorship.
Maps 1918 flu pandemic
Mortality
Worldwide
The global mortality rate from the 1918/1919 pandemic is unknown, but it is estimated that 10% to 20% of those infected die. With about a third of the world's population infected, this case-fatality ratio means 3% to 6% of the world's total population dies. Influenza may have killed as many as 25 million people in the first 25 weeks. The older estimate says it killed 40-50 million people, while current estimates say 50-100 million people worldwide are killed.
This pandemic has been described as "the largest medical massacre in history" and may have killed more people than Black Death. It is said that this flu killed more people in 24 weeks than AIDS killed in 24 years, and more in a year than Black Death was killed within a century. However, a 2016 article in The Atlantic states that the Black Death, during the 1340s decade, killed more than 10% of the world's population while the 1918 flu pandemic killed less than half of this percentage.
It kills in every corner of the world. A total of 17 million people died in India, about 5% of the population. The death toll in Britain-controlled districts of India alone is 13.88 million.
In Japan, out of the 23 million people affected, 390,000 died. In the Indies (now Indonesia), 1.5 million were assumed to have died among the 30 million inhabitants. In Tahiti 13% of the population died within just one month. Similarly, in Samoa 22% of the 38,000 population died within two months.
In Iran, the impact is very large and according to estimates, between 902,400 and 2,431,000 or 8.0% and 21.7% of the total population dies.
In the US, about 28% of the population becomes infected, and 500,000 to 675,000 people die. Native American tribes are devastated. In the Four Corners area alone, 3,293 deaths are registered among Native Americans. The whole village community was killed in Alaska. In Canada 50,000 died. In Brazil, 300,000 people died, including president Rodrigues Alves. In the UK, as many as 250,000 people died; in France, more than 400,000. In West Africa, an influenza epidemic has killed at least 100,000 people in Ghana. Tafari Makonnen (future of Haile Selassie, Emperor of Ethiopia) was one of the first Ethiopians infected with influenza but survived, although many of his family subjects were not; estimates for fatalities in the capital, Addis Ababa, range from 5,000 to 10,000, or higher. In Somaliland, an official estimates that 7% of the indigenous population died.
This enormous casualty is caused by a very high infection rate of up to 50% and the severity of extreme symptoms, thought to be caused by cytokine storms. Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue fever, cholera, or typhoid. An observer writes, "One of the most striking of the complications is bleeding from the mucous membranes, especially from the nose, stomach, and intestines.Bleeding from the ears and petechal bleeding in the skin also occurs." The majority of deaths come from bacterial pneumonia, a common secondary infection associated with influenza, but the virus also kills people directly, by causing massive bleeding and edema in the lungs.
Severe illness kills up to 20% of those infected, compared with a normal flu epidemic death rate of 0.1%.
Pattern of death
Most pandemics kill young adults. In 1918-1919, 99% of pandemic influenza deaths in the US occurred in people under 65 years, and nearly half of those in young adults aged 20 to 40 years. By 1920, the mortality rate among people under 65 had dropped sixfold to half the death rate of people over 65, but still 92% of deaths occurred in people under 65. This is unusual, as influenza is usually the most lethal for individuals who weak, such as infants (under the age of two), who are very old (over the age of 70), and who are immunocompromised. In 1918, older adults may have partial protection caused by exposure to the 1889-1890 flu pandemic, known as the Russian flu. According to historian John M. Barry, the most vulnerable of all - "those most likely, the most likely", to die - are pregnant women. He reported that in thirteen female studies admitted to hospital in a pandemic, the mortality rate ranged from 23% to 71%. Of pregnant women who survived labor, more than a quarter (26%) lost children.
Another oddity is that the epidemic extends in the summer and autumn (in the northern hemisphere); influenza is usually worse in winter.
Modern analysis has shown the virus to be extremely lethal because it triggers a cytokine storm, which destroys a stronger immune system than young adults.
In fast-growing cases, death is primarily caused by pneumonia, by viral-induced pulmonary consolidation. A slower case develops secondary bacterial pneumonia, and there may be nerve involvement that causes mental disorders in some cases. Some deaths are caused by malnutrition.
A study conducted by He et al. - using a mechanistic modeling approach to study the three waves of the 1918 pandemic influenza. They try to study the factors underlying variability in temporal patterns, and patterns of mortality and morbidity. Their analysis shows that temporal variation in the transmission rate provides the best explanation and variation in the transmission required to produce these three waves in biologically reasonable values.
Another study by He et al. using a simple epidemic model to combine three factors including school opening and closing, temperature changes during outbreaks, and changes in human behavior in response to outbreaks to infer the cause of three influenza pandemic waves of 1918. Their modeling results show that all three factors are important but behavioral responses humans show the greatest effect.
The deadly second wave
The second wave of the 1918 pandemic was far more deadly than the first. The first wave resembles an ordinary flu epidemic; those most at risk are the sick and the elderly, while the younger, healthy people recover easily. But in August, when the second wave started in France, Sierra Leone and the United States, the virus had mutated to a much more deadly form. As the 1918 American Influenza Experience, October 1918, was the deadliest month of the whole pandemic.
This increased severity has been linked to the state of the First World War. In civil life, natural selection prefers a mild stretch. The severely ill live at home, and the sickly continue their lives, gladly spreading light tension. Inside the trench, natural selection is reversed. Soldiers with mild strain stay where they are, while the severely ill are sent by crowded rail to a crowded field hospital, spreading deadly viruses. The second wave started and the flu quickly spread throughout the world again. As a result, as long as the modern pandemic health official notices when the virus reaches a place with social upheaval (searching for a deadly viral strain).
The fact that most of those who recover from a first wave infection are now invulnerable suggests that it must be the same flu strain. This was most dramatically described in Copenhagen, which escaped with a combined mortality rate of only 0.29% (0.02% in the first wave and 0.27% in the second wave) due to a less lethal first wave exposure. Throughout the population, it is now far more deadly; the most vulnerable are those who are like soldiers in the trenches - previously healthy adults.
The destroyed community
Even in areas where mortality is low, so many are paralyzed so much of daily life is hampered. Some communities close all stores or ask customers to leave an order outside. There are reports that health workers can not care for the sick or grave diggers do not bury the dead because they are also sick. Mass graves are dug up with steam shovels and corpses buried without coffins in many places.
Some areas of the Pacific island are devastated. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent the ships carrying the flu from leaving its ports. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9,000 people).
The worst affected is the German Samoa, today the independent state of Samoa, which New Zealand has occupied in 1914. 90% of its population is infected; 30% of adult men, 22% of adult women, and 10% of children die. Instead, the flu was kept out of American Samoa when Governor John Martin Poyer imposed a blockade. In New Zealand alone, 8,573 deaths were attributed to the 1918 pandemic influenza, which resulted in a total population mortality rate of 0.74%. In Ireland, Spanish flu contributed 10% of total deaths in 1918.
Data analysis revealed 6,520 deaths recorded in Savannah-Chatham County, Georgia (population = 83,252) for a three-year period from January 1, 1917, to December 31, 1919. Of these deaths, influenza was specifically listed as the cause of death in 316 cases, representing 4 , 85 percent of all causes of death for a total time period.
Unaffected area
In Japan, 257,363 deaths were caused by influenza in July 1919, giving an estimated death rate of 0.425%, much lower than almost all other Asian countries whose data are available. The Japanese government severely limits maritime travel to and from the islands of origin when the pandemic struck.
In the Pacific, American Samoa and the French colony of New Caledonia also managed to prevent even single deaths from influenza through effective quarantine. In Australia, nearly 12,000 people were killed.
At the end of the pandemic, the remote MarajÃÆ'³ island, in the Brazilian Amazon River Delta did not report the outbreak.
Saint Helena also reported no casualties.
Aspirin poisoning
In a 2009 paper published in the journal Clinical Infectious Diseases, Karen Starko proposed that aspirin toxicity contribute substantially to the death toll. He based this on symptoms reported to those who died from the flu, as reported in the post mortem report is still available, and also the time of a major "death spurt" in October 1918 that occurred just after the Surgeon General of the United States Army, and > Journal of the American Medical Association both recommend a very large dose of 8 to 31 grams of aspirin per day. This level will result in hyperventilation in 33% of patients, as well as pulmonary edema in 3% of patients. Starko also points out that many early deaths show "wet," occasionally hemorrhagic lung, whereas late mortality indicates bacterial pneumonia. He suggested that the wave of aspirin poisoning was due to "the perfect storm" of events: Bayer's patent on aspirin ended, so many companies rushed to profit and greatly increased supply; this coincides with a flu pandemic; and symptoms of aspirin poisoning were not known at the time.
As an explanation for the universally high mortality rate, this hypothesis is questioned in a letter to a journal published in April 2010 by Andrew Noymer and Daisy Carreon of the University of California, Irvine, and Niall Johnson of the Australian Commission for Safety and Quality in Health. They questioned this universal application given the high mortality rates in countries such as India, where there was little or no access to aspirin at the time compared to the rate at which aspirin was abundant. They conclude that "the hypothesis of salicylate poisoning [aspirin] is difficult to maintain as a primary explanation for the unusual virulence of the 1918-1919 influenza pandemic." In response, Starko pointed to anecdotal evidence of aspirin use in India and argued that although over-prescription aspirin did not contribute to India's high mortality rate, it could still be another high-level factor in areas where other exacerbation factors were present. in India is not playing a role.
End of pandemic
After a deadly second wave struck at the end of 1918, a new case crashed suddenly - almost nothing after the peak in the second wave. In Philadelphia, for example, 4,597 people died in the week ending October 16, but on November 11, influenza almost disappeared from the city. One explanation for the rapid decline of this deadly disease is that doctors are better at preventing and treating the pneumonia that develops after the victims are infected with the virus, although John Barry states in his book that researchers have found no evidence to support this.
Another theory suggests that the 1918 virus mutates very quickly into less lethal strains. This is a common occurrence with influenza virus: there is a tendency for pathogenic virus to be less lethal with time, as the host of the more dangerous strains tends to die (see also "Deadly Second Wave", above).
Long-term impact
A 2006 study in the Journal of Political Economy found that "cohorts in the uterus during the displayed pandemic reduced educational attainment, increased physical disability, lower incomes, lower socioeconomic status, and transfer payments that higher than in other groups of births. "
Legacy
Academic Andrew Price-Smith has made the argument that the virus helped to reverse the balance of power in the last days of the war towards the cause of the Allies. He provided data that virus waves hit the Central Block before they attacked the Allied forces, and that both morbidity and mortality in Germany and Austria were much higher than in Britain and France.
In the United States, Britain and other countries, despite the relatively high levels of morbidity and mortality resulting from the epidemic in 1918-1919, Spanish flu began to fade from public awareness for decades until the arrival of news about bird flu and others. pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu as a "forgotten pandemic".
Various theories about why the Spanish flu "is forgotten" include a rapid pandemic, which killed most of its victims in the United States, for example, in less than nine months, resulting in limited media coverage. The general population is familiar with the pattern of pandemic diseases in the late 19th and early 20th centuries: typhus, yellow fever, diphtheria, and cholera all occurred at about the same time. This epidemic may reduce the significance of an influenza pandemic to the public. In some areas, flu is not reported, the only one mentioned is advertising for drugs that claim to cure it.
In addition, the plague coincided with the death and media focus of the First World War. Another explanation involves the age group affected by the disease. The majority of casualties, both from war and epidemics, were among young adults. Fluid-induced deaths may have been neglected due to the number of deaths of young men in war or as a result of injuries. When people read obituaries, they see postwar wars or deaths and deaths from influenza side by side. Particularly in Europe, where the victims of war are so high, the flu may not have major psychological effects, apart, or it may appear to be just an extension of the tragedy of war.
The length of the pandemic and the war can also play a role. The disease usually affects only one specific area for a month before leaving, while the war, which was initially expected to end quickly, has been going on for four years at a time when the pandemic struck. This leaves little time for the disease to have a significant impact on the economy.
Regarding the impact of the global economy, many businesses in the entertainment and service industries suffer losses in earnings, while the health care industry reports profit gains.
Historian Nancy Bristow argues that a pandemic, when combined with the increasing number of women attending college, contributes to the success of women in the field of nursing. This is due in part to the failure of medical doctors, who are predominantly male, to resist and prevent disease. Nurse staff, who are mostly women, feel more likely to celebrate the success of their patient care and less likely to identify the spread of the disease with their own work.
In Spain, sources from that time explicitly connected the Spanish flu with the Don Juan cultural figures. The nickname for flu, "Naples Soldier", was adopted from Federico Romero and operas Guillermo FernÃÆ'¡ndez Shaw, The Song of Forgetting ( La canciÃÆ'³n del olvido ), the protagonist representing type of Don Juan stock. Federico Romero, one of the librettists, insinuated that the most popular musical number in the drama, Naples Soldier, was as interesting as the flu. Davis argues that flu-Don Juan Spain's connections serve cognitive function, allowing the Spaniards to understand their epidemic experience by interpreting it through a well-known template, the Don Juan story.
Spanish Spanish flu research
The origin of the Spanish flu pandemic, and the relationship between an epidemic almost simultaneously with humans and pigs, has become controversial. One hypothesis is that the viral strain originated in Fort Riley, Kansas, in viruses in poultry and pigs raised for food; the soldiers were then sent from Fort Riley to the world, where they spread the disease. The similarities between the reconstruction of viruses and the avian virus, combined with human pandemics before the first reports of influenza in pigs, led researchers to conclude influenza virus jumps directly from bird to man, and pigs catch the disease from humans.
Others disagree, and more recent research suggests that the strain may come from non-human species, mammals. Estimated dates for his appearance in mammalian hosts were laid in the period 1882-1913. This ancestral virus deviates from about 1913-1915 into two clades (or biological groups), which gives rise to the classic pig breeds and descendants of H1N1 humans. The same last human ancestor occurred between February 1917 and April 1918. Because pigs are more easily infected with the avian influenza virus than humans, they were advocated as recipients of the original virus, transmitting the virus to humans between 1913 and 1918.
Efforts to re-create the 1918 flu strain (subtype of the avian strain H1N1) is a collaboration between the Armed Forces Pathology Institute, the USDA ARS Fisheries Research Laboratory, and Mount Sinai School of Medicine in New York City. The effort resulted in the announcement (on October 5, 2005) that the group had succeeded in determining the genetic sequence of the virus, using a sample of historic tissue found by pathologist Johan Hultin from female flu victims buried in Alaska's permafrost and samples preserved from American troops.
On January 18, 2007, Kobasa et al. (2007) reported that monkeys (Macaca fascicularis) infected with a flu strain that was created showed the classic symptoms of the 1918 pandemic, and died of a storm of cytokines - an overreaction of the immune system. This may explain why the 1918 flu has a surprising effect on younger and healthier people, as people with stronger immune systems will potentially have a stronger overreaction.
On September 16, 2008, the body of British politician and diplomat Sir Mark Sykes was excavated to study the RNA flu virus in an effort to understand the genetic structure of the modern H5N1 bird flu. Sykes was buried in 1919 in a coffin that scientists hoped would help preserve the virus. The coffin was found parted by the weight of the soil above it, and the corpse was rotting. Nonetheless, the lung and brain tissue samples are drawn through the split, with the remaining casket in situ in the cemetery during this process.
In December 2008, research by Yoshihiro Kawaoka of the University of Wisconsin linked the existence of three specific genes (called PA, PB1, and PB2) and nucleoproteins originating from a flu 1918 sample with flu virus ability to attack the lungs and cause pneumonia. This combination triggers similar symptoms in animal testing.
In June 2010, a team at Mount Sinai School of Medicine reported a 2009 flu pandemic vaccine providing cross protection against the 1918 flu pandemic strain.
One of the few things known for certain about influenza in 1918 and for the next few years is that it, outside the laboratory, is exclusively a human disease.
In 2013, the AIR Worldwide Research and Modeling Group marked the 1918 pandemic and estimates the impact of a similar pandemic happening today using the AIR Flu Pandemic Model. In the model, the "modern day" Spanish flu "event will result in additional life insurance losses between USD 15.3-27.8 billion in the United States alone", with 188,000-337,000 deaths in the United States.
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