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SPANISH FLU 1918
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- Influenza (flu) is a virus that attacks the human respiratory system. The virus is highly contagious - when an infected person coughs, sneezes or talks, respiratory droplets are generated and transmitted into the air, and can then can be inhaled by anyone nearby. A person who touches something with the virus on it and then touches his or her mouth, eyes or nose can become infected.
- The flu pandemic first noted in 1918 was the worst catastrophe of the 20th century. The virus that caused it infected 500 million people, more than a quarter of human population, and killed between 50m and 100m.
- By 1921, when the pandemic receded, it had reduced humanity by between 2.5% and 5%. In comparison, the first world war killed roughly 17m people, and the second around 60m people.
- In 1918, there were no effective drugs or vaccines to treat this killer flu strain. Citizens were ordered to wear masks, schools, theaters and businesses were closed and dead bodies piled up in makeshift morgues before the virus ended its deadly global march.
- The influenza outbreak of 1918-19, known (unfairly to Spaniards) as the “Spanish” flu, proved particularly harmful to those aged between 20 and 40, and thus apparently in their prime. So the young died more than the old.
- One explanation is that those older than 40 tended to survive because they had acquired protective immunity from an earlier round of influenza to which younger generations had not been exposed. A second is that the more potent immune systems of the young overreacted to the 1918 virus for some reason, and that this triggered in them a cataclysmic, frequently fatal, immune response known as a cytokine storm.
- Scientists have struggled for a century to find why it was so lethal, because the 1918 flu is an anomaly in the annals of flu pandemics too. There have been 15 such outbreaks in the past 500 years, but the numbers of sick and dead were not collected systematically until the late 19th century.
- Of the five flu pandemics that have been recorded since 1889, none besides the 1918 episode killed more than 2 million
- In an average flu pandemic, 0.1% of those who fall sick go on to die, essentially of severe respiratory distress. In 1918, that number was 5-10%. Strange!
- Scientists disagree on where the virus first appeared. A crowded British army camp in France, a farm in Kansas and a bird-migration route in China are all plausible suggestions. However, in order to maintain morale, wartime censors refused newspapers permission to report on the disease and its severity. In order to keep war production for the army as high as possible, few preventative measures were taken.
- Newspapers in Spain, which was neutral in the war, were allowed to cover the disease there freely. Their articles were republished around the world. And so the disease unfairly gained an almost certainly inaccurate nickname: “Spanish flu”.
- Spain was hit hard by the disease and was not subject to the wartime news blackouts that affected other European countries. Even Spain's king, Alfonso XIII, reportedly contracted the flu.
- Two broad schools of thought on "lethality":
- The first is that the virus was inherently potent. The genome of the 1918 flu virus was sequenced in 2005, after a preserved specimen was extracted from victims buried in Alaskan graves. It was then brought back to life. Using this, it was seen that in the imperfect process of copying its genetic material or RNA, the 1918 flu virus (like the dangerous H5N1 avian-flu virus that is circulating in birds and can also infect humans) produces significantly more RNA fragments, or mini RNAs, than mild seasonal flu viruses. These mini RNAs bind to a human receptor known as RIG-I that triggers an immune response. The more mini RNAs, the stronger that response, and the more marked the resulting inflammation. Both the 1918 virus and H5N1 are known to produce massively inflamed lungs. Indeed there is debate as to whether it was the virus itself or the immune response it provoked that caused so many deaths in 1918.
- The second approach considers factors extrinsic to the virus, such as the state of the world into which it erupted. It is no coincidence that the most lethal flu pandemic on record coincided with a world war. In evolutionary terms, the optimal strategy for a virus transmitted directly between people, such as the flu, is to moderate its virulence, thereby keeping its host alive long enough to infect as many new hosts as possible. The war may have interfered with that process, though. On the Western Front, life in the trenches effectively immobilised large numbers of young men for days and weeks on end. In those circumstances, the pressure on the virus to reduce its virulence was relieved.
- A lesson that can usefully be learned from 1918 would be that sometimes the worst consequences of war are unforeseen, and might come in the form of lethal, globe-encompassing disease.
- Until Covid-19 rekindled interest in the history of pandemics, the Spanish flu had been widely forgotten in public memory and was even ignored in some history books. That process was helped by both press censorship and the decision by governments to bury the human toll of the disease in the collective memory of the first world war.
- British war memorials often state that the “Great War” lasted from “1914 to 1919” because they also included the names of troops who died of Spanish flu after the armistice.
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