Influenza
What was the Spanish Flu Pandemic?
By Wikipedia
Oct 6, 2005 - 11:23:00 PM

The Spanish Flu Pandemic, also known as the Great Influenza Pandemic, the 1918 Flu Epidemic, and La Grippe, was an unusually severe and deadly strain of influenza, a viral infectious disease, that killed some 25 million to 50 million people worldwide in 1918 and 1919. It is thought to have been one of the most deadly pandemics so far in human history.

The nations of the Allied side of World War I frequently called it the "Spanish Flu." This was mainly because the pandemic received greater press attention in Spain than in the rest of the world, because Spain was not involved in the war and there was no wartime censorship. In Spain it was called "The French Flu". Spain did have one of the worst early outbreaks of the disease, with some 8 million people infected in May 1918. It was also known as "only the flu" or "the grippe" by public health officials seeking to prevent panic.

Many infections with similar but milder symptoms were recorded in the spring of 1918, with sore throat, headaches, dizziness, and loss of appetite. It has been proposed that the earliest known cases were in Haskell County, Kansas, in January 1918. Several local men were inducted into the army at Fort Riley, Kansas, where on March 4, 1918, company cook Albert Gitchell reported to the infirmary with a temperature of 103 F (39.5 C). He was soon followed by Corporal Lee Drake and Sergeant Adolph Hurby. Within two days 522 men at the camp had reported sick. In the summer, infections became much more severe. In August 1918 the more deadly version broke out simultaneously in three disparate locations � Brest, Boston, Massachusetts, and Freetown. Many of the worst outbreaks of the "Flu" were among soldiers, both at the front lines and in camps far away which soon spread into civilian populations. Severe outbreaks often required hospitalization and even with the best of care often killed one third of those infected. The strain was unusual in commonly killing many young and healthy victims, as opposed to more common influenzas which caused the bulk of their mortality among newborns and the old and infirm. People without symptoms could be struck suddenly and be rendered too feeble to walk within hours; many would die the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs.

Mortality in the fast-progressing cases was primarily from pneumonia, by virus-induced consolidation. Slower progressing cases featured secondary bacterial pneumonias while some suspect neural involvement led to psychiatric disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.

Global mortality rate from the influenza was estimated at 2.5%�5% of the population, with some 20% of the world population suffering from the disease to some extent. The disease spread across the world killing twenty-five million in the course of six months; some estimates put the total of those killed worldwide at over twice that number, possibly as high as 100 million. An estimated 17 million died in India alone, with a mortality rate of about 5% of the population. In the Indian Army, almost 22% of troops who caught the disease died of it. About 28% of the population of the U.S. suffered from the disease, and some 500,000�675,000 died from it. Some 200,000 were killed in Britain and more than 400,000 in France. The death rate was especially high in indigenous peoples where some entire villages perished in Alaska and southern Africa. Fourteen percent of the population of the Fiji Islands died in a period of only two weeks while 22% of the population of Western Samoa died. By July of 1919, 257,363 deaths in Japan were attributed to influenza, giving an estimated Japanese mortality rate of 0.425%, much lower than nearly all other Asian countries for which data are available.

While it usually only infected less than one-third of the population in most places and killed only a fraction of those infected, there were a number of towns in several countries where the entire population was wiped out. The only sizeable inhabited place with no documented outbreak of the flu in 1918�1919 was the island of Marajo at the mouth of the Amazon River in Brazil.

Many cities, states, and countries enforced restrictions on public gatherings and travel to try to stay the epidemic. In many places theaters, dance halls, churches and other public gathering places were shut down for over a year. Quarantines were enforced with little success. Some communities placed armed guards at the borders and turned back or quarantined any travellers. One U.S. town even outlawed shaking hands.

Even in areas where morbidity 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 to not enter the store but place their orders outside the store for filling. There were many reports of places with no healthy health care workers to tend the sick and no able bodied grave diggers to inter the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places.

The social effects were intense due to the speed of the epidemic. AIDS killed 25 million in its first 25 years, but the Spanish flu may have killed as many in only 25 weeks beginning in September 1918.

The Spanish Flu vanished within eighteen months, and the actual cause was not determined at the time. It appears to have been an H1 virus type. (The outbreaks of bird flu in Hong Kong in 1997 and other parts of Asia since then are an H5 type.) The influenza virus was not understood by medical science at the time, and most contemporary effort was spent in an unsuccessful quest to find a vaccine to the supposed bacterial cause of the disease, Bacillus influenza, which was in fact only one of several causes of secondary pneumonia associated with the epidemic. Two much milder influenza pandemics followed the Spanish Flu: the Asian Flu in 1957, and the Hong Kong Flu in 1968.

It has been suggested that the stresses of combat, possibly combined with the effects of chemical warfare, may have weakened soldiers' immune systems thereby increasing their vulnerability to the disease and accelerating its spread. Certainly the close quarters and mass movement of troops accelerated the process.

In September 2000, Noymer and Garenne published a study that poses an �tiological theory explaining the unusual W-shaped mortality age profile of the virus. This profile is characterized by a mode in the 25�34-year age group. Usually, influenza has a U-shaped profile, being most deadly to the young and the old. Additionally, after the pandemic the difference in life expectancy between men and women decreased (women had a historically longer life expectancy). Noymer and Garenne have causally linked these two anomalies with the predominantly-male mortality of tuberculosis.

In October 2002, the Armed Forces Institute of Pathology teamed up with a microbiologist from the Mount Sinai School of Medicine in New York. Together, they started to reconstruct the Spanish Flu. In an experiment, published in October 2002, they were successful in creating a virus with two 1918 genes. This virus was much more deadly to mice than other constructs containing genes from contemporary influenza virus. The experiments were conducted under high biosafety conditions at a laboratory of the US Department of Agriculture in Athens, Georgia.

In the February 6, 2004, edition of Science magazine it was reported that two teams of researchers, one led by Sir John Skehel, director of the National Institute for Medical Research in London and another by Professor Ian Wilson of the Scripps Research Institute in San Diego had managed to synthesize the hemagglutinin protein responsible for the 1918 outbreak of Spanish Flu by piecing together DNA procured from a lung sample taken from the body of an Inuit woman buried in the Alaskan tundra and a number of preserved samples taken from American soldiers of the First World War. The two teams had analyzed the structure of the gene and discovered how subtle alterations to the shape of a protein molecule had allowed it to move from birds to humans with such devastating effects.

A highly realistic but fictionalized cautionary tale of the reconstruction of the 1918 strain of influenza by a private biotechnology company in San Diego, and its application to 21st-century germ warfare, is captured in the science thriller Ninth Day of Creation, published June 2000.

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