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Spanish flu
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The 1918 flu pandemic (commonly referred to as the Spanish flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. Historical and epidemiologic data are inadequate to identify the geographic origin of the virus. Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients.
The pandemic lasted from March 1918 to June 1920, spreading even to the Arctic and remote Pacific islands.
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The 1918 flu pandemic (commonly referred to as the Spanish flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. Historical and epidemiologic data are inadequate to identify the geographic origin of the virus. Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients.
The pandemic lasted from March 1918 to June 1920, spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 20 to 100 million people were killed worldwide, or the approximate equivalent of one third of the population of Europe, more than double the number killed in World War I. This extraordinary toll resulted from the extremely high illness rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.
The disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918, and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.
Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm, which explains its unusually severe nature and the unusual age profile of its victims (the virus caused an overreaction of the body's immune system—the strong immune systems of young adults ravaged the body, while the weaker immune systems of children and middle-aged adults caused fewer deaths).
Mortality
The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25 million in its first 25 weeks (in contrast, AIDS killed 25 million in its first 25 years). Older estimates say it killed 40–50 million people while current estimates say 50 million to 100 million people worldwide were killed. This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.
An estimated 7 million died in India, about 2.78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it . In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa. Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived, although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher, while in British Somaliland one official there estimated that 7% of the native population died from influenza. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%.
This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred." The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.
The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%. Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old. This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.
History
While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic. Some researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease.
A large factor of worldwide flu occurrence was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide.
Two poems, dedicated to the Spanish flu, were popular in those days:
I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza.
-American Skipping Rhyme circa 1918
Obey the laws
And wear the gauze.
Protect your jaws
From septic paws.
Patterns of fatality
The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims – typical influenzas kill mostly infants (aged 0-2 years), the elderly, and the immunocompromised. Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months.
People without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids (pneumonia). In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and blood loss.
In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.
Devastated communities
While in most places less than one-third of the population was infected, only a small percentage of whom died, in a number of towns in several countries entire populations were wiped out.
Even in areas where mortality was low, those incapacitated by the illness were often so numerous as to bring much of everyday life to a stop. Some communities closed all stores or required customers not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places.
Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which belatedly implemented measures to prevent 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%, 9000 people). Worst affected was Western Samoa, a territory then-under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed. By contrast, "[t]he flu was excluded from American Samoa by a commander who imposed a blockade". The mortality rate in New Zealand itself was 5%.
Unaffected locales
In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck.
In the Pacific, American Samoa
and the French colony of New Caledonia
also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.
Government response
The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from WWI was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza. On Sept. 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations. While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, which affected both sides alike.
Cultural impact
In the United States, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918-1919, the Spanish flu remained a relatively obscure event until the rise in public awareness of bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a “forgotten pandemic.” Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. However, in 1937 William Keepers Maxwell, Jr., the American novelist, wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, also wrote about her parents' deaths in Memories of a Catholic Girlhood. More recently (2006), author Thomas Mullen wrote a novel called The Last Town on Earth, about the impact of the Spanish flu on a fictional mill town in Washington and author Myra Goldberg wrote a novel called Wickett's Remedy that is set in Boston during the pandemic.
Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years, including the rapid pace of the pandemic (it killed most of its victims in the United States in a period of less than nine months), Americans' familiarity with pandemic disease in the late 19th and early 20th centuries, and the distraction of the First World War. Another explanation is shown when observing the age group affected by the disease. The majority of fatalities, in both World War One and by the Spanish Flu, were young adults. The deaths caused by the flu were overlooked due to the deaths from the war. When people would read the obituaries they would see the deaths from war and the deaths from the influenza side by side. Seeing the figures right next to each other may have lessened the impact the influenza had on individual people. The fact that the disease would usually only affect a certain area for a month before leaving, left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.
Spanish flu research
One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms – genetic drift and antigenic shift – in viruses in poultry and swine which the fort bred for local consumption, but evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine. The soldiers were then sent from Fort Riley to different places around the world, where they spread the disease.
An effort to recreate the 1918 flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in New York; the effort resulted in the announcement (on October 5, 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered from a female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers.
On January 18, 2007, Kobasa et al. reported that monkeys (Macaca fascicularis) infected with the recreated strain exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm – an overreaction of the immune system. This may explain why the 1918 flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.
On September 16, 2008, the body of Yorkshire landowner Sir Mark Sykes was exhumed to study the RNA of the Spanish flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hope will have helped preserve the virus.
In December, 2008 research by Yoshihiro Kawaoka of University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from 1918 flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.
Victims
Notable fatalities
- "Admiral Dot" (1864-1918), circus performer under P. T. Barnum
- Amadeo de Souza Cardoso, Portuguese painter, († October 25, 1918)
- Francisco de Paula Rodrigues Alves, Brazilian elected president, (†January 16, 1919)
- Guillaume Apollinaire, French poet († November 9, 1918)
- Felix Arndt, American pianist († October 16, 1918)
- Louis Botha, first Prime Minister of the Union of South Africa, († August 27, 1919)
- Randolph Bourne, American progressive writer and public intellectual, († December 22, 1918)
- Larry Chappell, American baseball player, († November 8, 1918)
- Angus Douglas, Scottish international footballer, († December 14, 1918)
- Harry Elionsky, American champion long-distance swimmer
- George Freeth, father of modern surfing and lifeguard († April 7, 1919)
- Sophie Halberstadt-Freud, daughter of Austrian psychoanalyst Sigmund Freud, († 1920)
- Irmy Cody Garlow, daughter of Buffalo Bill Cody
- Harold Gilman, British painter († February 12, 1919)
- Henry G. Ginaca, American engineer, inventor of the Ginaca machine († October 19, 1918)
- Myrtle Gonzalez, American film actress († October 22, 1918)
- Charles Tomlinson Griffes, American composer († April 8, 1920)
- Joe Hall, Montreal Canadiens defenceman, a member of the Hockey Hall of Fame († April 6, 1919)
- Phoebe Hearst, mother of William Randolph Hearst, († April 13, 1919)
- Hans E. Lau, Danish astronomer, (†October 16, 1918)
- Harold Lockwood, American silent film star, († October 19, 1918)
- Meri Te Tai Mangakahia, New Zealand suffragist († October 10, 1920)
- Francisco Marto, Fátima child († April 4, 1919)
- Jacinta Marto, Fátima child († February 20, 1920)
- Alan Arnett McLeod, Victoria Cross winner, († 6 November, 1918)
- William Francis Murray, Postmaster of Boston and former U.S. Representative († September 21), 1918)
- Sir Hubert Parry, British composer, († October 7, 1918)
- John Reed, American journalist, poet, and communist activist, († October 19 1920)
- William Leefe Robinson, Victoria Cross winner, († December 31, 1918)
- Edmond Rostand, French dramatist, best known for his play Cyrano de Bergerac, († December 2, 1918)
- Egon Schiele, Austrian painter († October 31, 1918). His wife Edith, who was six months pregnant, succumbed to the disease only three days before
- Reggie Schwarz, South African cricketer and rugby player (†November 18, 1918)
- Yakov Sverdlov, Bolshevik party leader and official of pre-USSR Russia († March 16 1919)
- Mark Sykes, British politician and diplomat - body exhumed 2008 for research († February 16, 1919)
- Frederick Trump, Grandfather of businessman Donald Trump, († March 30, 1918)
- Max Weber, German political economist and sociologist († June 14, 1920)
- Prince Erik, Duke of Västmanland (Erik Gustav Ludvig Albert Bernadotte), Prince of Sweden, Duke of Västmanland († September 20, 1918)
- Vera Kholodnaya, Russian actress († February 16, 1919)
- Dark Cloud (actor), aka Elijah Tahamont, American Indian actor, in Los Angeles (1918).
- Franz Karl Salvator (1893-1918), son of Archduchess Marie Valerie of Austria and Archduke Franz Salvator, grandson of Empress Elisabeth of Bavaria and Emperor Franz Joseph I of Austria, died unmarried and childless.
- Anaseini Takipo, Queen of Tonga from 1909, consort of King George Tupou II of Tonga, survived by one daughter, († November 26, 1918)
- King Watzke, American violinist and bandleader, († 1920)
- Bill Yawkey, Major League Baseball executive and owner of the Detroit Tigers, in Augusta, Georgia († March 5, 1919)
- Dan McMichael, manager of Scottish association football club Hibernian († 1919)
Notable survivors
- Mary Pickford (1892 – 1979), early motion picture star.
- John J. Pershing (1860 – 1948) American general.
- Franklin D. Roosevelt (1882 – 1945), American president
- Woodrow Wilson (1856 - 1924) American president.
- Prince Maximilian of Baden (1867 – 1929), Chancellor of Germany during the armistice.
- Walt Disney (1901 – 1966), cartoonist.
- Wilhelm II, German Emperor (1859 - 1941)
- Joseph Joffre (1852 - 1931), French World War I general, victor of the Marne.
- Alexandrine of Mecklenburg-Schwerin (1879 – 1952), Queen of Denmark
- David Lloyd George (1863 – 1945), British prime minister.
- Peter Fraser (1884 - 1950), longest serving New Zealand prime minister.
- Leo Szilard (1898 – 1964), nuclear physicist, inventor of the nuclear chain reaction.
- Haile Selassie (1892 – 1975), Emperor of Ethiopia.
Fictional
- Hazel Forrest Bellamy, a fictional character in the television series "Upstairs, Downstairs" (played by Meg Wynn Owen)
- William Krichinsky, a fictional character in the film "Avalon", directed by Barry Levinson
- Fanny and Jemma Macgregor in "If I Die Before I Wake" by Jean Little
- Elizabeth Masen and Edward Masen Sr., fictional characters in the Twilight series by Stephenie Meyer. Main character Edward Cullen was saved from death by Spanish flu by being turned into a vampire.
See also
Further reading
. A popular history.
External links
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- Article: The Deadliest Fall
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- Annotated links to articles, books and scientific research on the 1918 influenza pandemic
- U.S. Dept. of HHS
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- , by the National Archives and Records Administration (see actual pictures and records of the time).
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- - The New York Times
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- , Cosmos magazine, September 2006
- , 1918 newspaper account on impact of flu on Minneapolis
- BBC News, January 2007
- University of Wisconsin - Madison, January 17, 2007
- Journal of Translational Medicine, January 20, 2004
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- - Exposure to virus generates life-long immune response.
- Database of influenza genomic sequences and related information.
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