Mother of All Pandemics: 1918 ‘Spanish Flu’ Influenza Affected One-Third of World’s Population

By  //  August 9, 2020

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Spanish Flu claimed more than 50 million lives

SOLDIERS FROM FORT RILEY, KANSAS, ill with Spanish flu at a hospital ward at Camp Funston in 1918. The flu struck while America was at war, and was transported across the Atlantic on troopships. The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation; the war may also have increased the lethality of the virus. Some speculate the soldiers’ immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility. (National Museum of Health and Medicine image)

Throughout History, Nothing Has Killed More Human Beings Than Infectious Diseases

The year 2018 marked the 100th anniversary of the 1918-1919 global “Spanish” influenza pandemic, with an estimated one-third of the world’s population (or ~ 500 million persons) were infected and claimed more than 50 million lives. Since 1918, there have been further pandemics and today influenza remains a global threat.

■ 1889: The first well-described flu pandemic was so-called Russian flu 1889-93: On the last three or four weeks of December 1889 of this epidemic in St. Petersberg, it described the systems of the three main disease types, the purely neurotic, the gastric, and the catarrhal forms. Catarrhal pneumonia caused the few deaths that had occurred, and the epidemic acquired the name “Russian catarrh”.

■ 1890 (Jan. 11): Russian flu spread across Europe and reached England. There were conflicting information about infectious cases, including about “infectious” nature of the disease, whether it seemed to “attack the well-to-do rather than the poor”. One information described the use of a sulfurous acid spray to prevent spread of the disease in a house.

■ 1918 (Sept. 7): Towards the end of World War I, a new influenza outbreak was affecting Europe. Two reports from a military hospital in Thetford, England, describing the physical signs of troops and the “peculiarities of this outbreak”. 2067 of 10,000 men were reported sick with influenza, of whom 248 were admitted to hospital.

■ 1918 (Sept. 28): In base hospital in France, people were admitted with a new form of influenza, provisionally termed “Spanish flu”. Post-mortem findings were used to diagnose 30 cases of influenza. Mode of onset was – very sudden, short, rarely relapsed, subsided by crises.

■ 1918 (Oct. 26): It had been continuing confusion of the possible new influenza differing to the 1889-1890 type. They were wondering whether they deal with a new organism or with the recognized organisms of influenza which have for some reason attained greater virulence.

■ 1918 (Nov. 2): The symptoms were septicemia, coryza, bronchitis, broncho-pneumonia, otitis media, and body pain. The incubation period was about 48 hours. It seemed there was rapid spread of epidemic influenza.

■ 1919 (Jan. 11): A correspondence drew attention to the epidemiological association between epidemics of encephalomyelitis and influenza in 1837.

■ 1919 (March 8): In the third wave of influenza in England and also in Europe, it seems highlights the still unknown epidemiology of influenza and value of preventive measures including wearing face masks and the treatment of open air and sunshine.

■ 1919 (June 7): A report from Japan detailed experiments on influenza, indicating that the disease was caused by a virus and not bacteria such as pneumococci or diplococci. The researchers took the sputum from patients infected with influenza and injected a filtrate or emulsion into the nose and throat of healthy patients. Those who had previously had influenza displayed no symptoms whereas the remaining previously healthy patients “were attacked by the disease.”

SPANISH FLU IS ESTIMATED to have killed between 50 million and 100 million people when it swept the globe in 1918-19 – more than double the number killed in the first world war. Two-thirds of its victims died in a three-month period and most were aged 18-49. (Red Cross image0

■ 1933 (July 8): The disease was transmissible serially in ferrets either by contact or by intranasal instillation of virus-containing material. The infective agent was only been recovered from the nasal passages of sick ferrets. Swine influenza virus caused a disease in ferrets which was indistinguishable from that produced by virus of human origin, and the pig and human viruses had close antigenic relationship. For the first time the isolate was identified as influenza type A virus.

■ 1957 (June 10): First report of the “Asian Flu” epidemic that began in April in Hong Kong and Singapore, spreading to Taiwan, the Philippines, China and Hawaii. Both civilians and military personnel in these areas had been affected in large numbers. The disease had been generally mild, but some deaths had been reported. Most of the influenza viruses recovered in various parts of the world during the past year had ben antigenically alike resembling. But viruses isolated in Singapore from the present outbreak appeared to be antigenically distinct from previous strains, although apparently influenza-A viruses.

■ 1957 (October 12): Research on six of 30 isolated influenza strains suggested that the viruses continually change their antigenic pattern. The 1957 isolate was so different that the science suggested it is a new A2 strain. The complete absence of antibodies to these viruses in the population explained the high contagiousness of the influenza and allowed them to expect a worldwide spread of the “Asiatic influenza”.

■ 1968 (Dec. 28): A new influenza variant had been associated with an extensive outbreak of influenza in new global flu pandemic started in Hong Kong during 1968. The key report provided the biological and antigenic characteristics of the Hong Kong influenza A2 variant, compared with other influenza A strains. Again, the Hong Kong strain differed to previous strains, showing a “continuous spectrum of antigenic variation – within the whole influenza.

■ 1969 (Nov. 15): Early prophylactic treatment with 1-adamantanamine hydrochloride (aminoadamantane, amantadine) of household contacts confirmed reduction of incidence of clinical influenza A2 significantly in the family environment.

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■ 1998 (Feb. 14): Almost 30 years since the last influenza outbreak, an article detailed the first human fatality of a potentially pandemic, influenza A H5N1 virus (so-called avian flu), “a subtype previously not detected in human begins”.

■ 2009 (Aug. 8): In April 2009, a pandemic began with another new form of influenza, H1N1. The second fatality was a pregnant woman in the U.S. Pregnant women were more susceptible to influenza outbreaks, and the most cited articles during this pandemic presented the characteristics of 34 pregnant women with probable H1N1 identified during April-May 2009.

■ 2012 (Sept. 12): It was estimated that globally there were 201,200 respiratory deaths with an additional 83,300 cardiovascular deaths associated with 2009 pandemic influenza A H1N1 – this was 15 times higher than laboratory estimated deaths. Also, 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 51% occurred in southeast Asia and Africa.

■ 2020: COVID-19 and influenza remains a threat, with seasonal outbreaks causing hundreds of thousands of excess deaths and new virus strains with pandemic potential continuing to emerge.


Dr. Arvind M. Dhople

Dr. Arvind M. Dhople graduated from the University of Bombay and then joined Johns Hopkins University School of Public Health, first as a post-doctoral fellow and then Asst. Professor. In 1980, he joined Florida Tech as a Professor and Director of their infectious diseases lab. He is a Fellow in the American Academy of Microbiology and has also served as an advisor to the World Health Organization, National Institute of Health, German Leprosy Relief Association and the Bill and Melinda Gates Foundation. Currently, he is Professor Emeritus at Florida Tech and a freelance writer.

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