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The Influenza pandemic of 1918

One cannot forget the first and the worst pandemic of influenza, the 'Spanish' flu, says Dr KK Aggarwal.

india Updated: Mar 28, 2006 18:55 IST

Influenza epidemics come after every ten years. Most of them are contained by the medical help. But one cannot forget the first and the worst pandemic of influenza in the year 1918-19.

The pandemics of 'Asian' flu in 1957, 'Hong Kong' flu in 1968 and 'Beijing' flu in 1997 all derived from avian (bird) illnesses, whereas it is thought that the 'Spanish' flu of 1918 was derived from a swine disease.

One has to know it as in the few years from now one is again envisaging another pandemic this time from bird flu which looks inevitable as of now. Knowing the nature of influenza virus with its uniqueness of changing genes, acquiring virulent forms over months one can only say that the worst is coming.

Most epidemics shows a dual phase of infection the first one with a milder flu illness followed within few months with a deadly virulent form. India and the world today is facing bird flu infection with a milder form. The virulent human form is yet to appear.

The influenza pandemic of 1918-1919 killed more people than the World War I (WWI). In the ten months between September 1918 and June 1919, 675,000 Americans died of influenza and pneumonia.

The Spanish Flu Pandemic, a global disaster, also known as La Grippe, or La Pesadilla, was an unusually severe and deadly strain of avian influenza, a viral infectious disease, that killed some 50 million to 100 million people worldwide over about a year in 1918 and 1919.

It is thought to have been one of the most deadly pandemics so far in human history. It was caused by the H1N1 type of influenza virus, which is similar to bird flu of today, mainly H5N1 and H5N2.

It was cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351.

The Spanish flu might have contributed to the end of World War I. More people (20-40 million on both sides) died from the Spanish flu during World War I than were killed in the conflict.

The epidemic erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza, which is usually a killer of the elderly and young children. It infected 28 per cent of all Americans.

An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the US soldiers who died in Europe, half of them fell to the influenza virus. 1918 would go down as unforgettable year of suffering and death and yet of peace, said the Journal of the American Medical Association final edition of 1918:

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5 per cent compared to the previous influenza epidemics, which were less than 0.1 per cent.

The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years. People were struck with illness on the street and died rapid deaths.

The influenza pandemic circled the globe. Most of humanity felt the effects of this strain of the influenza virus. It spread following the path of its human carriers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific. In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people.

A study attempted to reason why the disease had been so devastating in certain localised regions, looking at the climate, the weather and the racial composition of cities. They found humidity to be linked with more severe epidemics as it "fosters the dissemination of the bacteria.

The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918).

However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. The second wave in August was the main disaster.

The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness.

Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War.

Dr. Aggarwal is Sr. Consultant, Moolchand Medcity; President, Delhi Medical Association; President, Heart Care Foundation of India; and Member, Delhi Medical Council.