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Millal olid esimesed surmajuhtumid Hispaania gripipandeemiast?

Millal olid esimesed surmajuhtumid Hispaania gripipandeemiast?

Sellelt lingilt leidsin teavet esimeste ajaleheartiklite kohta, mis sisaldasid teavet Hispaania gripipandeemia kohta, kuid üks ajalehe tsitaatidest ütleb:

Epideemia on kerge iseloomuga; surmajuhtumeid pole teatatud”.*

See on aprillist 1918.

Mind lihtsalt huvitab, millal juhtus esimene teade haiguse surmajuhtumitest?


Seda on võimatu kindlalt väita, sest:

  1. "Hispaania" gripiviiruse täpne tee algstaadiumis on teadmata; ja
  2. Viiruse varajast surma ei tunnistatud sel ajal ja sellele ei pööratud palju tähelepanu.

Olemasolevad tõendid viitavad sellele, et Hispaania gripp "külvati" kogu maailmas mitmete lokaliseeritud haiguspuhangute alla juba ammu enne 1918. aastal toimunud massilisi surmajuhtumeid.

Registreeriti aruanded gripisurmade kohta nii laialt levinud riikides nagu Norra, Rootsi, Soome, Kanada, Hispaania, Suurbritannia, Prantsusmaa, Saksamaa, Senegal, Tansaania, Nigeeria, Ghana, Zimbabwe, Lõuna -Aafrika, India ja Indoneesia. Nende surmajuhtumite väga lai geograafiline levik nii lühikese aja jooksul, ilma lennureiside puudumiseta, viitab sellele, et haigus oli enne seda aega levinud kogu maailmas ja et oli toimunud külvamine.

Oxford, J. S. jt. "Varased kuulutaja -gripipuhangud 1916. aastal enne 1918. aasta pandeemiat." Rahvusvaheline kongressisari. Kd. 1219. Elsevier, 2001.

Soomes registreeriti 1917. aastal ebatavaliselt palju kopsupõletiku surmajuhtumeid; Suurbritannias teatas Bochumi haigekassa administratsioon 1916. aastal gripijuhtude arvu suurenemisest 40%; ja suur hingamisteede haiguste epideemia hõlmas Ameerika Ühendriike 1915. aasta lõpus.

Kuigi 1918. aastal ei olnud gripp riiklikult teatatav haigus ning gripi ja kopsupõletiku diagnostilised kriteeriumid olid ebamäärased, oli USA grippi ja kopsupõletikku suremus 1915. ja 1916. aastal järsult tõusnud, kuna 1915. aasta detsembris algas suur hingamisteede epideemia.

Taubenberger JK, Morens DM. 1918 Gripp: kõigi pandeemiate ema. Tekkivad nakkushaigused. 2006;12(1):15-22.

Seetõttu on võimalik, et esimene suurem surmajuhtumite puhang leidis aset hiljemalt detsembris 1915. Sõna otseses mõttes esimesi surmajuhtumeid alates viiruse tekkimisest on võimatu täpselt määrata, kuid need võisid tekkida siis, kui viirus esimest korda hüppas inimesi lindudest või sigadest, võimalik, et aastatel 1913–1915.


Bakteriaalne kopsupõletik põhjustas 1918. Aastal gripipandeemia

Suurem osa 1918–1919 gripipandeemia surmajuhtumitest ei olnud põhjustatud üksi toimivast gripiviirusest, teatavad riiklikest terviseinstituutidest koosneva riikliku allergia- ja nakkushaiguste instituudi (NIAID) teadlased. Selle asemel langes enamik ohvreid pärast gripiviiruse nakatumist bakteriaalsele kopsupõletikule. Kopsupõletik tekkis siis, kui bakterid, mis tavaliselt elavad ninas ja kurgus, tungisid kopsudesse mööda rada, mis tekkis siis, kui viirus hävitas bronhide ja kopsude vooderdavad rakud.

Tulevane gripipandeemia võib areneda sarnasel viisil, ütlevad NIAID autorid, kelle paber 1. oktoobri numbris Infektsioonhaiguste ajakiri on nüüd veebis saadaval. Seetõttu järeldavad autorid, et ulatuslikud pandeemiapreparaadid peaksid sisaldama mitte ainult jõupingutusi uute või täiustatud gripivaktsiinide ja viirusevastaste ravimite tootmiseks, vaid ka sätteid antibiootikumide ja bakterivaktsiinide varumiseks.

Selles järelduses on töös esitatud täiendavaid tõendeid patoloogia ja meditsiini ajaloo valdkondadest. "Tõendite kaal, mida uurisime nii 1918. aasta gripipandeemia ajaloolistest kui ka kaasaegsetest analüüsidest, soosib stsenaariumi, mille kohaselt viiruskahjustused, millele järgnes bakteriaalne kopsupõletik, põhjustasid enamiku surmajuhtumeid," ütleb kaasautor NIAIDi direktor Anthony S. Fauci "Sisuliselt sai viirus esimese löögi, samal ajal kui bakterid andsid löögi."

NIAIDi kaasautor ja patoloog Jeffery Taubenberger, MD, doktor, uuris 58 erinevatelt USA sõjaväebaasidelt aastatel 1918 ja 1919 grippi surnud sõduri kopsukoe proove. Parafiiniplokkides säilinud proovid lõigati uuesti ja värvitud, et võimaldada mikroskoopilist hindamist. Uurimine näitas mitmesuguseid koekahjustusi "alates esmasele viiruslikule kopsupõletikule iseloomulikest muutustest ja kudede parandamise tõenditest kuni tõsise, ägeda, sekundaarse bakteriaalse kopsupõletiku tõestuseni," ütleb dr Taubenberger. Enamikul juhtudel näib ta, et surma ajal oli valdav haigus bakteriaalne kopsupõletik. Samuti oli tõendeid selle kohta, et viirus hävitas bronhitorusid vooderdavad rakud, sealhulgas kaitsvate juuksetaoliste eenditega rakud või ripsmed. See kaotus muutis muud tüüpi rakud kogu hingamisteedes - sealhulgas kopsudes sügaval olevad rakud - haavatavaks bakterite rünnaku suhtes, mis rändasid äsja loodud nina ja kurgu kaudu.

Püüdes hankida kõiki teaduslikke väljaandeid, mis kajastasid gripipandeemia 1918–1919 patoloogiat ja bakterioloogiat, otsisid dr Taubenberger ja NIAIDi kaasautor David Morens, M.D., bibliograafilistest allikatest mis tahes keeles kirjutatud dokumente. Nad vaatasid läbi ka inglise, prantsuse ja saksa keeles avaldatud teaduslikke ja meditsiinilisi ajakirju ning leidsid kõik paberid, mis teatasid gripi ohvrite lahkamisest. Aastatel 1919–1929 ilmunud enam kui 2000 publikatsiooni kogumist tuvastasid teadlased 118 peamist lahkamissarja aruannet. Kokku esindas nende läbi vaadatud lahkamissari 8398 individuaalset lahkamist 15 riigis.

Avaldatud aruannetes on "selgelt ja järjekindlalt seostatud sekundaarse bakteriaalse kopsupõletikuga, mis on põhjustatud tavalisest ülemiste hingamisteede floorast enamiku gripisurmade korral", ütleb dr Morens. Ta lisab, et tolle aja patoloogid olid peaaegu üksmeelsel veendumusel, et surma ei põhjustanud otseselt toona tuvastamata gripiviirus, vaid pigem erinevate bakterite põhjustatud raske sekundaarne kopsupõletik. Tolleaegsed eksperdid uskusid, et sekundaarsete bakteriaalsete infektsioonide puudumisel oleksid paljud patsiendid ellu jäänud. Tõepoolest, antibiootikumide kättesaadavus teiste 20. sajandi gripipandeemiate ajal, täpsemalt 1957. ja 1968. aasta gripipandeemiate ajal, oli arvatavasti võtmetegur nende haiguspuhangute ajal kogu maailmas hukkunute arvu vähenemisel, märkis dr Morens.

Autorid tunnistavad, et järgmise gripipandeemia põhjust ja ajastust ei saa kindlalt ennustada, samuti ei saa öelda pandeemilise gripiviiruse tüve virulentsust. Siiski on võimalik, et - nagu 1918. aastal - võib sarnase viirusekahjustuse muster, millele järgneb bakterite invasioon, ilmneda, ütlevad autorid. Nad kirjutavad, et ettevalmistused bakteriaalse kopsupõletiku diagnoosimiseks, raviks ja ennetamiseks peaksid olema gripipandeemia planeerimise kõrgeimate prioriteetide hulgas. "Meid julgustab asjaolu, et pandeemia planeerijad juba kaaluvad ja rakendavad mõnda neist meetmetest," ütleb dr Fauci.

Külastage veebisaiti http://www.PandemicFlu.gov, et saada ühekordne juurdepääs USA valitsuse teabele linnu- ja pandeemilise gripi kohta.

NIAID viib läbi ja toetab uuringuid-NIH-s, kogu Ameerika Ühendriikides ja kogu maailmas-, et uurida nakkushaiguste ja immuunsüsteemi vahendatud haiguste põhjuseid ning töötada välja paremad vahendid nende haiguste ennetamiseks, diagnoosimiseks ja raviks. Uudisteated, teabelehed ja muud NIAIDiga seotud materjalid on saadaval NIAIDi veebisaidil aadressil http://www.niaid.nih.gov.

Teave riiklike terviseinstituutide (NIH) kohta: Riigi meditsiiniuuringute agentuur NIH hõlmab 27 instituuti ja keskust ning on USA tervise- ja inimteenuste osakonna osa. NIH on peamine föderaalne asutus, mis viib läbi ja toetab põhilisi, kliinilisi ja translatiivseid meditsiinilisi uuringuid ning uurib nii tavaliste kui ka haruldaste haiguste põhjuseid, ravi ja ravimeetodeid. Lisateavet NIH ja selle programmide kohta leiate veebisaidilt www.nih.gov.

NIH & hellipPöörates avastuse tervisesse ®

Viide

DM Morens jt. Bakteriaalse kopsupõletiku domineeriv roll surmapõhjusena gripipandeemias: mõju pandeemiliseks gripivalmidusele. Infektsioonhaiguste ajakiri DOI: 10.1086/591708 (2008).


Mis põhjustas Hispaania gripi?

Haiguspuhang algas 1918. aastal, Esimese maailmasõja viimastel kuudel, ja ajaloolased usuvad nüüd, et konflikt võis olla osaliselt viiruse leviku eest vastutav. Läänerindel haigestusid kitsastes, räpastes ja niisketes tingimustes elavad sõdurid. See oli alatoitluse tõttu nõrgenenud immuunsüsteemi otsene tulemus. Nende haigused, mida tunti kui "la grippe", olid nakkavad ja levisid auastmete vahel. Umbes kolme päeva jooksul pärast haigestumist hakkasid paljud sõdurid end paremini tundma, kuid mitte kõik ei jõua.

1918. aasta suvel, kui väed hakkasid puhkuselt koju naasma, tõid nad endaga kaasa avastamata viiruse, mis oli nad haigeks teinud. Viirus levis sõdurite kodumaade linnades, alevites ja külades. Paljud nakatunud, nii sõdurid kui ka tsiviilisikud, ei paranenud kiiresti. Viirus oli kõige raskem noortel täiskasvanutel vanuses 20–30, kes olid varem terved olnud.

2014. aastal näitas uus teooria viiruse päritolu kohta, et see ilmus esmakordselt Hiinas, teatas National Geographic. Varem avastamata andmed seostasid gripi Hiina tööliste, Hiina töökorpuse, transpordiga üle Kanada aastatel 1917 ja 1918. Mark Humphriesi raamatu "Viimane katk" kohaselt olid talgulised enamasti põllutöötajad Hiina maapiirkondade kaugetest piirkondadest. Toronto ülikooli ajakirjandus, 2013). Nad veetsid kuus päeva suletud rongikonteinerites, kuna neid transporditi üle riigi enne Prantsusmaale jätkamist. Seal nõuti neilt kaevikute kaevamist, rongide mahalaadimist, radade ladumist, teede ehitamist ja kahjustatud tankide parandamist. Kokku mobiliseeriti läänerindele üle 90 000 töötaja.

Humphries selgitab, et 1918. aastal ühe 25 000 hiina töölise arvuga lõpetas umbes 3000 Kanada reisi meditsiinilises karantiinis. Sel ajal süüdistati rassiliste stereotüüpide tõttu nende haigust "Hiina laiskuses" ja Kanada arstid ei võtnud töötajate sümptomeid tõsiselt. Selleks ajaks, kui talgulised 1918. aasta alguses Põhja -Prantsusmaale jõudsid, olid paljud haiged ja sajad surid peagi.


Mida pandeemia põhjustas

Hispaania gripp sai oma nime sõjapiirangute kummalise liitumise kaudu. Sõdivate riikide valitsused ei tahtnud, et vaenlase rahvad teaksid, et kiiresti leviv haigus nõrgendab nende vägesid, ega ka moraali halvenemist.

Hispaania oli Esimese maailmasõja ajal neutraalne ja tema ajalehti ei tsenseeritud. Nad avaldasid lugusid surmavast gripist ja nii sai "Hispaania gripist" moniker, mis jäi külge. Seda nimetati ka "lillaks surmaks", sest kannatajad muutsid mõnikord verevooludes hapnikuvaegusest hirmutava indigo varjundi. Seda nimetati ka "Hiina gripiks" ja "Vene kahjuriks".

USA -s jätsid lapsed selle riimi vahele köie: "Mul oli väike lind, selle nimi oli Enza, tegin akna lahti ja lendasin Enzas."

Maskid olid toored. Need koosnesid kangast ja marlist, ütles ajaloolane Kenneth Davis, mis oleks umbes sarnane ekraaniakna tüki näole hoidmisega ja lootusega, et see peatab bakterid.

Föderaalseid juhiseid millegi kohta polnud. "CDC -d ei olnud. Riiklikke terviseinstituute polnud. Tervise- ja inimteenuste osakonda ei olnud," ütles Davis.

Ühiskond ja pered varisesid kokku. Suurematest linnadest ja maapiirkondadest saabusid teated inimeste nälgimisest, "sest kellelgi polnud julgust neile toitu tuua, isegi teistel oma pereliikmetel," ütles autor John Barry.

Sajad tuhanded lapsed jäid orbudeks, kui nende vanemad hirmsast gripist surid.

Pered olid toona suuremad ja õed -vennad leidsid end eraldatuna ning saadeti sugulaste või lastekodude juurde. Mõni ei näeks oma vendi ja õdesid aastakümneid ega kunagi enam. Mis veelgi hullem, mõned pandi lapsendamisele ja jagati välja nagu ukseauhinnad, kusjuures keegi ei hoolitsenud nende heaolu eest, sest sotsiaalvalitsusasutusi sel ajal ei eksisteerinud.

"Nad paneksid vanemad kaotanud lapsed rongi ja läheksid lihtsalt depoost depoosse ja kõik, kes tahtsid lapse adopteerida, ilmusid lihtsalt kohale," ütles Barry, "ja kõndisid koos nendega minema."

"Niisiis, Hispaania gripi orbudest oli terve põlvkond."

Gripp möllas kolmes laines, alates 1918. aastast, viimane mõõn langes 1919. aasta suve paiku. "Esimene faas, vähemalt USA -s kõige vähem surmav, kestis märtsist kevadeni," ütles Davis. "Aga siis tuli gripihooaeg tagasi septembris, oktoobris. Taas oli liikvel rohkem sõdureid ja tõeline plahvatus. Ja see teine ​​laine oli Ameerikas kõige surmavam".

Viimane laine ulatus 1919. aasta talvest suvekuudeni, mil juhtumid hakkasid vähenema.

Sõda lõppes 11. novembril 1918. Ellujäänud ja mdash-sõdurid, lahinguvälja õed ja arstid ning mdash kõndisid või lonkisid tagasi igapäevaellu ja ennekõike tahtsid nad lihtsalt edasi minna.

Aastal 1920 "Warren G. Harding valis presidendiks kampaaniaid normaalsuse taastamise ideel ja see oli võidukas loosung," ütles Davis. "Ta tuli vabariiklaste presidendiks ja ütles:" Me naaseme normaalsesse olekusse. ""

Üks hilinenud viirusehaige oli väidetavalt Woodrow Wilson, kes viibis 1920. aastal Pariisis, et aidata läbirääkimisi Versailles 'lepingu üle. Prantsusmaa linn võitles sel ajal suure hulga gripijuhtumitega.

Wilson jäi raskelt haigeks. Ta paranes, "aga paljud inimesed, kes teda tundsid, sealhulgas Valge Maja toatüdruk, kes teda juba pikka aega tundis, ütlesid, et ta pole kunagi sama," ütles Davis.

Tema otsustusvõimet ja arutluskäiku võis see mõjutada, erinevalt koroonaviiruse põdejatest, kes kurdavad ajuudu ja kurnavaid vaimseid tagasilööke.

"Ta leppis ja möönis mõningaid väga -väga olulisi punkte," ütles Davis Wilsoni läbirääkimiste kohta, sealhulgas "Saksamaale antud karistuse palju karistavamad aspektid seoses hüvitistega, mida nad peavad maksma."

See omakorda "aitas kindlasti kaasa Hitleri ja natside tõusule", ütles ajaloolane.

Ameerikas hõlmas I maailmasõjast edasi liikumine muutusi ühiskonna kõigil tasanditel.

Hemlines tõusis ja sotsiaalsed kombed langesid. Naised said hääle 1920. aastal ning paljud suitsetasid avalikult avalikult, karvasid juukseid ja muutusid "klappideks". Ettevõtted õitsesid, nagu ka kõnepruugid, hoolimata uuest alkoholitootmise ja turustamise keelust.

"Me kipume mitte mõtlema ajaloole haiguste osas," ütles Davis. "See oli oluline osa ajaloost, mida me alati ei õpeta ega räägi."

Inimesed tahtsid lihtsalt unustada. Nad tahtsid oma elu juurde tagasi pöörduda.

"See oli tõesti midagi nii kohutavat, et keegi ei tahtnud sellest mõelda, rääkida ega kirjutada," ütles Davis.

Igas kvartalis süvenevad Inside Edition Digitali auhinnatud ajakirjanikud mõnda konkreetsesse teemasse, mis ulatub sügavamale kui igapäevased uudistetsüklid. Lisateabe saamiseks 3. numbri kohta, kus me sukeldume põlvkonnavahetusse, klõpsake siin.


HistoryLink.org

Valesti nimetatud Hispaania gripi pandeemia haripunkt oli 1918. Väikesed mutatsioonid gripiviiruses lõid erakordselt surmava variandi, mis tappis terved noored täiskasvanud sama kergesti kui haavatavamad vanuserühmad. Patogeeni päritolukoha üle vaieldakse siiani, kuid Esimese maailmasõja roll selle kiire levikus on vaieldamatu. Sellest hoolimata läks Washingtonil vaatamata suurele sõjalisele kohalolekule paremini kui ühelgi teisel liidu osariigil peale Oregoni. Kuigi osariigi rahvaarvuga linnades oli hukkunute arv kõrgeim, puudutas pandeemia peaaegu kõiki kogukondi. Katsed haiguspuhangut kontrollida olid suures osas asjatud ning 1918. aasta septembri lõpust kuni selle aasta lõpuni tappis see ligi 5000 Washingtoni elanikku. Enam kui pooled ohvrid olid 20–49 -aastased.

Iidne nuhtlus

Gripiviirused haigestasid inimesi esmakordselt tõenäoliselt 6–7000 aastat tagasi, mis vastab sigade ja veiste varasele kodustamisele. Inimeste suurenenud liikuvus hõlbustas epideemiaid ja pandeemiaid, mis võivad mõjutada suuri alasid. Kuni 1930ndate alguseni arvas enamik teadlasi, et gripp on pigem bakteriaalne kui viirushaigus. Tegelikult olid mõlemad sageli seotud gripiviiruse nõrgestatud inimestega, kes olid bakteriaalse kopsupõletiku suhtes haavatavamad. Siiski põhjustas see gripi iga -aastastel visiitidel tavaliselt ainult mõõdukat haigust. Kuid aeg -ajalt tuli midagi muud ja palju surmavamat.

Esimene registreeritud pandeemia, mille tõenäoliselt põhjustas gripiviirus, saabus aastal 1580 ja laastas ala, mis ulatus Väike -Aasiast kuni tänapäeva Hollandi põhja poole. Pärast seda esines sageli suuri haiguspuhanguid, kuid suhteliselt vähe surmajuhtumeid. Surmavam viirus tabas Euroopat ja Venemaa impeeriumi aastatel 1781–1782 ning aastatel 1889 ja 1890 suri üle miljoni inimese, kui Hiinast puhkes surmav variant, levis Venemaale ja kogu Euroopasse ning jõudis Põhja-Ameerikasse ja Ladina-Ameerikasse. Ameerika enne Jaapanis laiali puistamist. Järgmisena tuli 1918. aasta pandeemia, mis on kaugelt kõige levinum ja surmavam, sünge erinevus, mis püsib tänapäevani.

Ameerika Samoa oli planeedi ainus organiseeritud ühiskond, kes tänu varasele, rangele ja pikale karantiinile 1918. aasta pandeemiast täielikult pääses. Vaevalt 50 miili kaugusel Lääne -Samoas suri mõne kuuga 20 protsenti elanikkonnast. Gripp ümbritses maakera idast läände ja põhjapolaarjoonest põhja Tšiili lõunatippu, jättes selle tagajärjel puruks ühiskonnad ja kümned miljonid inimesed.

Täiesti erinev haigus

Enne 1918. aastat oli enamiku gripi keskmine suremus vaid umbes kümnendik 1 protsendist ehk ligikaudu üks surmajuhtum iga 1000 nakkuse kohta. 1918. aasta gripp tappis enam kui 2,5 protsenti kannatanutest, peaaegu alati mõne päeva jooksul pärast esimesi sümptomeid ja sageli mõne tunni jooksul. Mõned surid ägeda hingamispuudulikkuse (gripiviiruse otsene mõju) tõttu ja teised langesid oportunistliku bakteriaalse kopsupõletiku ohvriks. Ja erinevalt peaaegu kõigist varasematest teadaolevatest nakkushaigustest tabas see viirus eriti tugevalt täiskasvanuid vanuses 20 kuni 40 aastat.

Esimene maailmasõda oli viimastel kuudel, kui tabas pandeemia halvim. Ligi 53 500 ameeriklast kaotas lahingutes elu ja peaaegu sama palju suri Euroopas teenides grippi. Kodus viiruse tõttu hukkunud ameeriklasi, nii sõjaväelasi kui ka tsiviilisikuid, oli hinnanguliselt üle 650 000. Kõige konservatiivsem (ja võib -olla ka kõige vähem täpne) hinnang surmajuhtumite kohta maailmas on üle 20 miljoni ja surma võib olla isegi 100 miljonit (paljud valitsused pidasid vähe või üldse mitte täpseid andmeid, muutes isegi ligikaudsed hinnangud väga problemaatiliseks).

Ameerika gripp?

Pole teada, kust pandeemia alguse sai. Seda nimetati tavaliselt "Hispaania gripiks", ilmselt seetõttu, et Hispaania, kes I maailmasõjas ei osalenud, teatas vabalt haigustest ja surmajuhtumitest, mida võitlevad riigid tsenseerisid. Eelarvamuslik kahtlus, et surmavad nakkushaigused pärinevad Aasias asuvast maa-seast või Sahara-taguse Aafrika aurastest džunglitest, ei pidanud ilmselt paika 1918. aastal. Üks toetatav teooria kinnitab, et "Hispaania" gripp sai alguse Haskelli maakonnast Kansasist, kus veebruaris 1918 tabas kohalikku arsti mitmed eriti virulentse ja surmava haiguse juhtumid, erinevalt kõigest, mida ta oli näinud pikkade aastate jooksul. Haiguspuhangu ajal tuli kohalik mees sõjaväelt puhkusele ja naasis seejärel Funstoni laagrisse 300 miili kaugusel asuvas laialdases Fort Riley kompleksis. Kolme nädala jooksul viidi laagris üle 1100 sõduri grippi ja 28 ei jäänud ellu, mis on ebatavaliselt kõrge suremus.

Aprilli alguseks teatati märkimisväärsetest kergema gripi puhangutest, sealhulgas Detroitis, kus Fordi autotehase töötajad said kannatada kuni 2000 töötajat. Surmav variant tabas Hispaaniat mai lõpus. Saladus jääb tänaseni - pole kindel, kus "normaalne" gripiviirus muteerus tõhusaks tapjaks. Konkureerivad teooriad ulatuvad Kansast Norrasse ja La Manche'i väina sadamateni kuni tavalise kahtlusaluse Hiinani. On ebatõenäoline, et seda küsimust saab kunagi lõplikult lahendada, ja see on vaevalt oluline.

Üks fakt on vaieldamatu: sõda ja haigused käisid käsikäes. 1918. aasta kevadel kandsid konvoid Ameerika vägesid I maailmasõjas võitlemiseks ja naasid haavatud, haigete ja demobiliseeritud sõduritega. Kuigi konfliktil polnud ilmselt otsest seost viiruse päritoluga, oli sellel kõik seotud selle levikuga.

Vihjed saabuvale kataklüsmile

Paljud 1918.

"See juhtus Põhja -Atlandi kolmes suuremas osas peaaegu samaaegselt: Freetownis, Sierra Leones, kus kohalikud lääne -aafriklased viidi kokku Briti, Lõuna -Aafrika, Ida -Aafrika ja Austraalia sõdurite ja meremeestega Brestis, Prantsusmaal. Liitlasväed ja Boston, Massachusetts, üks Ameerika kõige aktiivsemaid sisenemissadamaid ja suur ristmik kõigi liitlaste sõjapüüdlustega seotud riikide sõjaväelastele ja tsiviilisikutele. Esimese maailmasõja ajal mängisid massilised vägede liikumised ja oluliste elanikkonnarühmade häirimine. olulist rolli haiguse ülekandmisel "(" Gripp ", Medical Ecology veebisait).

Washingtonis tundusid 1918. aasta esimesed kaheksa kuud sarnased enamiku aastatega ning osariigi ajalehed ei pannud ilmselt tähele kevadisi gripipuhanguid Detroitis ja mõnes teises Ameerika linnas. 15. aprillil teatati aga, et sõjaväe laagris Lewis Tacomast lõuna pool "on kopsupõletik nädala jooksul veidi suurenenud, enamik juhtumeid järgneb gripile, mis oli maksimaalselt kaks nädalat tagasi" ("Civil Workers Fast Being" Likvideeritud. "). Mai lõpus Seattle Times esitas lühikese juhtmearuande, milles teatas, et "salapärane epideemia" on haigestunud vähemalt 40 protsendile Hispaania elanikkonnast ja kuigi sümptomid "meenutavad grippi. Haigus . "). Nädal hiljem ütles ajaleht Hispaania puhangu kohta: "Selle leviku kiirus on võrreldav ainult 1889. aasta suure katkuga", viide ligi 30 aastat tagasi toimunud gripipandeemiale ("Kuningas külastas kummalist haigust"). Juunis oli rõõmsaid teateid vaenlase Saksa sõdurite gripiepideemiast, kuid selle kuu alguses teatas Camp Lewis vaid 39 juhtumist.

Juuli alguseks tundusid asjad kurjakuulutavamad. 9. juulil Seattle Times teatas, et Hispaanias levinud gripp on "levinud ka mujale Euroopasse" ("Mõistatuslik epideemia"). 28. juulil märkis ajaleht, et Camp Lewis'el oli 327 gripijuhtu, kuid nädal hiljem oli see arv langenud alla 100. Veel augusti keskpaigast saadi rahustavaid teateid, et armeebaasis on gripijuhtude arv jätkuvalt vähenenud. ja ei viita mingile erilisele murele. Isegi septembris valitses üldine meeleolu. Optimistlik kommentaator oli vaimustuses: "Meie arstiteaduse täiuslikkuse tõttu on ime, et sel suvel pole olnud laialt levinud epideemiat, mis oleks tõsisemat laadi kui" gripp ", nagu nimetatakse Hispaania grippi ja teisi sellega seotud palavikke." ("Tugev vihm ja muda").

Kuu möödudes hakkas mõnele kontole hiilima tagasihoidliku ärevuse toon. A Ajad 22. septembri artikkel viitas Camp Lewise "kergele epideemiale", teatati 173 uuest juhtumist ("Camp Lewise raportid."). Samal lehel mainiti kahte tõsist gripijuhtu, millest teatati Bellinghamis. Sellegipoolest tsiteeriti kaks päeva hiljem ajalehes armee meditsiinilisi allikaid, teatades mõningast rõõmsameelsust: "Camp Lewis'is võis olla gripiga hispaanlane, kuid siin pole Hispaania grippi" ("Ütle Camp Lewis."). .

See oleks võinud surnuaiast mööda vilistada, kuid tegelikult polnud kellelgi mingit arusaama ehitatavast tsunamist. Toimuv ei kuulunud kaugeltki ajastu säravamate teadlaste ja arstide teadmistesse. Grippi põhjustanud viirus oli muteerunud ja seda viisil, mis muudaks selle üheks kõige surmavamaks patogeeniks, mis on inimkonda kunagi vaevanud. Kui see tabas Ameerikat täielikult, liikus see hingematva kiirusega läbi kogu riigi, mida aitasid igal sammul sõjast mobiliseeritud sõjavägi.

Levib kulutulena

Ajavahemikus 1918. aasta septembrist kuni sõja lõpuni novembris nakatus kuni 40 protsenti Ameerika armee ja mereväe töötajatest grippi. Seos sõjaväe ja pandeemia kiire leviku vahel oli selgelt selge. Riigi tervishoiuametnikud olid ohust teadlikud. 28. septembril 1918 Spokanes toimunud tervishoiuameti koosoleku protokollis märgiti: "Osariigis gripipuhangu tõenäosust arutati põhjalikult ning kaaluti võimalusi ja vahendeid selle ennetamiseks" (Kaheteistkümnes kaheaastane aruanne, 6).

See osutuks nii etteaimamatuks kui ka sisuliselt ravimatuks. Vaid kaks päeva hiljem, 30. septembril, Washingtoni ülikooli mereväe väljaõppejaamas Seattle'i Portage'i lahes (praegune ülikooli terviseteaduste kompleksi asukoht) teatati enam kui 650 "kerge gripi" juhtumist ("Navy Camp" U '. "). Oktoobri esimesel nädalal dokumenteeriti Lewis Campis üle 100 "raske gripi" juhtumi. Juhtumeid leiti ka Bremertonis asuvast Puget Soundi laevatehasest ja 4. oktoobril teatati, et seal on hukkunud 14 mereväelast ja "200 kuni 400" tsiviiltöötajat mereväe hoovis on haigestunud ("Bremerton Hit"). . Need teated olid palju hullemaks, sest surmav viirus levis hämmastava kiirusega.

Andmete puudus

Pandeemia edenemise osariigis suure täpsusega jälgimine on mitmel põhjusel võimatu. Esiteks ei olnud gripp haigus, millest tuli teatada riigi tervishoiuasutustele, vähemalt mitte selle kõige virulentsema faasi ajal sügisel 1918. Vabatahtlik teatamine oli äärmiselt juhuslik, nagu näha. Surmad ei vajanud diagnoosi ja need registreeriti tõetruult, kuid nakatunute üldarvu tuleb pidada ligikaudseks hinnanguks, isegi kui see on muljetavaldav.

Teiseks tuli gripp 1918. aastal ja 1919. aasta alguses kolmes erinevas laines - tavaliselt kerge vorm 1918. aasta kevadel ja suvel, millele järgnes surmav tüvi selle aasta lõpukuudel ja lõppes tavaliselt (kuid mitte alati) kergem haigus 1919. aasta esimestel kuudel, täielikult taandudes alles 1920. aastal. Mitte kõigil haigestunutel ei olnud virulentset "Hispaania" grippi nakatumist, mõnel oli leebem vorm, mis võib veel väga noortele ja eakad inimesed.

Rahvatervise ametivõimude edasiseks pettumuseks tappis Hispaania gripp nii otseselt kui ka ohvrid, kes jäid bakteriaalse kopsupõletikuga sekundaarsete infektsioonide suhtes haavatavaks, mis oli sageli surmav isegi gripi puudumisel, eriti eakatel või haigetel. See segas põhjuslikkuse pildi. Kuid kuna Hispaania gripp oli osutunud nii hämmastavalt nakkavaks ja gripiohvrite lahkamisel leiti nii sageli kopsupõletikku, otsustas föderaalne loendusbüroo 1918. aasta suremuse statistikas kasutada ühte kategooriat: "surmad grippi ja kopsupõletikku (kõik vormid)". (Suremusstatistika, 1918). Nii masendav kui see on epidemioloogidele ja elukindlustusmatemaatikutele, on kõik statistilised uuringud 1918. aasta pandeemia mõju kohta täis ebakindlust ja ligikaudseid tulemusi.

Mida rekord näitab

Washington oli üks 30st "registreerimisriigist", mida USA rahvaloendusbüroo pidas 1918. aastal suhteliselt usaldusväärseks, kuid osariigi epidemioloog rõhutas jaanuaris 1919 avaldatud tervishoiuameti kaheaastase aruande käigus kuberner Ernest Listerile (1870-1919) enneolematut. pandeemia olemus ja täpse teabe kogumise raskused:

"See pandeemia ilmus Washingtonis oktoobri esimesel nädalal. Osariigi tervishoiuameti ajaloos pole ükski selline õnnetus riiki tabanud ega nii tõsist hädaolukorda pole kunagi tekkinud. Viie aasta jooksul 1913-1917, kaasa arvatud viis kõige levinumat nakkushaigust. surmajuhtumeid on olnud 1768. Ainuüksi gripi tõttu oleme pidanud tänaseks tublisti üle 2000 surmajuhtumi lõppu veel lõppema. Maksumus on tõenäoliselt kahekordne või kolmekordne 1768. aastal.

"Linna tervishoiuametnikud, välja arvatud Seattle'is, Tacomas, Spokane'is ja Yakimas, on osalise tööajaga mehed. Nende palk ei ole sageli midagi või viis dollarit kuus. Neid määravad linnapead ja nad vahetuvad sageli. Nad ei ole meie teha ei tunne, et neil oleks meie ees suur vastutus. Nende töö maksab vähe ja nende poliitika on teha nii palju, kui palk õigustab. "(Kaheteistkümnes kaheaastane aruanne, 34-35).

Aruanne koostati 1918. aasta detsembris, kui katastroofi ulatus oli teadmata. Terviseameti järgmine iga kahe aasta tagant koostatud aruanne anti välja alles jaanuaris 1921 ja see vaikis 1918. aasta pandeemiast peaaegu. Tundub, et osariikide või föderaalriikide kohta ei ole olemas nakkuste määra või surmajuhtumite kogumit maakonniti, eriti üksikute kogukondade kohta, kuigi Washingtoni kahe suurima linna Seattle'i ja Spokane'i ja Yakima kogemuste kohta on loendusandmeid. on suhteliselt hästi dokumenteeritud.

Oma Suremuse statistika 1918 USA rahvaloendusbüroo võrdles osariigi 1918. aasta gripisurma kokku 1915. aasta surmajuhtumitega, vastandades iga aasta esimest kaheksat kuud viimase nelja kuuga. Ajavahemikus jaanuarist augustini 1915 suri 1918. aasta esimese kaheksa kuu jooksul grippi ja kopsupõletikku 605 Washingtoni elanikku, 838 Washingtoni elanikku, mis on märkimisväärne, kuid mitte šokeeriv kasv.

1915. aasta viimase nelja kuu jooksul langes Washingtonis grippi vaid 381 inimest, kuid 1918. aasta viimase nelja kuu jooksul tappis pandeemia osariigis 4041 inimest, mis on 10,6 korda rohkem kui 1915. aastal. Riigi epidemioloogi pessimism lõpliku teemaksu osas osutus üsna täpseks.

Muud faktid suremustabelitest näitavad Hispaania gripi enneolematut olemust. Võib -olla kõige üllatavam oli see, et veidi enam kui pooled ehk 2461 Washingtonis 1918 kalendriaastal hukkunust grippi surnud gripist olid mehed ja naised vanuses 20–39 eluaastat. Sama jämedad proportsioonid kehtisid ka osariigi kahes suurimas linnas. Seattle'is langes sellesse vanuserühma 708 1441 gripisurma, mis registreeriti ajavahemikus 12. oktoober 1918 kuni 15. märts 1919, samas kui Spokane'is oli 428 gripisurma 252. These numbers alone illustrate just how unique this pandemic was in comparison to any other disease outbreaks for which records exist. This mystery has never been fully resolved, but the leading theory is that the 1918 virus triggered catastrophic immune reactions in young adults with robust immune systems.

Comparative numbers were not calculated for Yakima, but roughly one-third of the population, or about 6,000 people, were infected there. Of these, 120 died -- 32 percent of the city's total 1918 death toll from all causes. So contagious was the disease that Yakima's only hospital, St. Elizabeth, run by the Sisters of Providence, for a time refused to admit influenza patients.

There is only one statistic in the 1918 mortality tables from which some comfort may be taken. Of the 30 registration states relied upon by the Census Bureau, with the single exception of Oregon, Washington by a significant margin had the lowest number of influenza/pneumonia deaths per 1,000 residents. Nevertheless, 4.1 of every 1,000 Washingtonians were killed by influenza/pneumonia in 1918 (more than five times normal) and 1.9 of every 1,000 in 1919 (more than twice normal). In contrast, the state's mortality rate from those causes in each of the three preceding years was less than one per 1,000.

Doing Their Best

The health board's Twelfth Biennial Report documented both a realistic apprehension of the danger Spanish influenza presented and a recognition of the futility of efforts to prevent it. It recounted the efforts of Dr. Thomas D. Tuttle, the state's health commissioner and the report's lead author, to get advice from the federal government:

"This epidemic was very prevalent in the Eastern states during the month of September, and, realizing that in all human probability it would rapidly spread over the entire country, your commissioner of health took up with the United States Public Health Service the question of the advisability of quarantining individual cases" (Twelfth Biennial Report, 22-23).

Specifically, the board reported, Tuttle sent a telegram to U.S. Surgeon General Rupert Blue asking "Intrastate quarantine Spanish influenza under consideration. What period of quarantine if any do you recommend?" and Blue relied "Service does not recommend quarantine against influenza" (Twelfth Biennial Report, 22-23).

In the report Tuttle provided the health board's opinion on how the Spanish flu came to Washington. It is but one theory among several, but as credible as any:

"The epidemic struck our state in the early part of October. The immediate introduction of the disease was through a shipment from Pennsylvania to the United States Naval Training Station at Bremerton of about 1500 men, a large percentage of whom were afflicted with influenza when they reached their destination. From this location the disease spread widely [but] many outbreaks were not directly traceable to the infection at or near Seattle" (Twelfth Biennial Report, 23).

Tuttle's account of a Chicago meeting of state health authorities could not conceal a tone of desperation:

"The outstanding feature of the discussion of the subject at this conference was the evidence that whatever efforts were made the spread of the disease was only retarded and not prevented. As one health officer very aptly expressed the situation: 'One can avoid contracting the disease if he will go into a hole and stay there, but the question is how long he would he have to stay there? The indications are that it would be at least for a year or longer'" (Twelfth Biennial Report, 23).

Desperate Measures, Mostly Futile

Despite its early concerns, the Washington State Board of Health did not impose statewide measures to combat the pandemic until it was well under way, probably because it had very limited resources and little or no control over local health authorities. The only preventive regulation of statewide application that the board issued came on November 3, 1918, when it required that surgical masks of a specified size and thickness "entirely covering the nose and mouth" be worn in virtually all public places where people came into close contact with one another the order also required that the proprietors of stores, restaurants, and cafes "keep their doors open and their places well ventilated" and that one-third of the windows in streetcars be opened when in use by the public ("Special Order and Regulation . ").

Vancouver in Clark County was one of the first cities in the state to aggressively address the pandemic. On October 7, 1918, acting on a report from the chief health officer, the city council ordered that "all places of public gathering, such as schools, churches, dances etc." be closed (Vancouver City Council minutes). Two days later the town council of Monroe in Snohomish County approved a similar measure, as did Yakima, which later joined with Yakima County to lease a building owned by St. Michael's Parish "for the purpose of establishing same as an Isolation Hospital" (Yakima City Commission minutes, October 21). On October 31 the ban on gatherings in Yakima was widened even further to include "all places where any kind of business is transacted . with the exception of drug stores, meat markets, restaurants, eating places, hotels and fruit ware-houses," the last an apparent concession to the town's leading industry (Yakima City Commission Minutes, October 31).

Similar bans on public assembly were imposed in counties, cities, and towns across the state. A small sample would include Seattle (October 6) Spokane (October 8) Pullman (October 10) Anacortes in Skagit County (October 15) Ferry County in Northeast Washington (November 17) tiny Wilson Creek in Grant County, where all children under age 16 were ordered confined to their homes (December 7) and Chelan, although it exempted schools (December 10). No corner of the state was spared, nor did the ordeal end with the new year. The Cowlitz County Council did not even impose similar restrictions until January 16, 1919, and White Salmon to the east was at that time still under siege.

These and similar measures probably helped to limit the spread to some extent, but perhaps the most telling reason for the eventual ebbing of the pandemic was that it simply ran out of vulnerable victims. In this regard it is important to remember that most people did mitte become infected, despite nearly universal exposure, nor did it kill but a fraction of those it did infect.

What Was It? Where Did It Go?

In the 1990s researchers, using archived autopsy samples from 1918, mapped the virus's genome and determined it to be Type A, the most common, which can infect both humans and some animals. More specifically, the investigation revealed that the virus was a strain of Type A known as H1N1. The "H" represents a protein molecule on the surface of a virus that is the usual target for the immune system. When random mutations alter that molecule, the virus can become virtually invisible to the body's defenses. As researchers explained in 2006, "Recently published . analyses suggest that the genes encoding surface proteins of the 1918 virus were derived from an avianlike influenza virus shortly before the start of the pandemic and that the precursor virus had not circulated widely in humans or swine in the few decades before" (Taubenberger and Morens, 16). Because it had not circulated widely, humanity had developed no "herd immunity" to it. This explains its rapid spread but not its lethality, which remains a mystery.

As to where it went, the answer is that it went nowhere. Almost all cases of type A influenza since 1918 have been caused by less-dangerous descendants of that lethal virus. Viruses do not have intentions, only random mutations. Some mutations will enable them to sicken birds, pigs, people, or other animals. Some will make them unusually lethal, others will render them totally harmless to humans. But inevitably a strain will emerge that is as infectious and deadly as the 1918 variety. Viral mutation is ongoing, endless, and unpredictable. In any new flu pandemic the toll will likely be lower due to advances in immunology and other countermeasures, but as with death itself, the question is not whether it will come, but rather when.

Announcement closing public places during flu pandemic, The Pullman Herald, October 11, 1918

Policemen wearing gauze masks during influenza epidemic, Seattle, December 1918

Courtesy National Archives (Record No. 165-WW-269B-25)

Stewart and Holmes employees wearing masks, 3rd Avenue, Seattle, 1918

Photo by Max Loudon, Courtesy UW Special Collections (UW1538)

Front page, Seattle Times, October 5, 1918

Streetcar conductor blocking entry of unmasked man during flu pandemic, Seattle, 1918

Courtesy National Archives (Record No. 165-WW-269B-11)

Masked elevator attendant during flu pandemic, Seattle, 1918


Historical accounts detail wave of flu deaths in Oklahoma during 1918 pandemic

Those chilling first-person accounts don’t describe some modern-day disease outbreak occurring half a world away. Instead, they’re words that Oklahomans in the last century used to describe what is believed to be the deadliest epidemic in human history: the 1918 flu pandemic.

The video-taped interviews, recorded in the 1980s and included in the Oklahoma History Center archives, offer chilling descriptions of those dark days: whole towns sickened, healthy people dead within hours, mothers and children dying on the same day.

This year, with 82 fatalities reported since September, Oklahoma has recorded the largest number of annual flu deaths since the state began tracking the number in 2009. But those numbers pale in comparison to the tide of death that swept across Oklahoma and much of the world in 1918 when experts estimate as many as 100 million perished from the virus, 675,000 of them in the United States.

According to some experts, the 1918 pandemic may have gotten its start just 40 miles north of the Kansas-Oklahoma line.

“There are other theories about other sites,” said John M. Barry, a New Orleans-based author of a 2004 book on the 1918 outbreak. “I think the evidence for Haskell is probably roughly as good as it is for any other site, but we’ll probably never know.”

In January and February, 1918, an eruption of influenza in Haskell County, Kan., struck down some of the strongest, healthiest people “as if they had been shot,” Barry wrote in “The Great Influenza: The Epic Story of the Deadliest Pandemic in History.”

At a time when public health agencies had yet to begin tracking such outbreaks, the Kansas cases were severe enough to prompt a local doctor to warn national public health officials about the virulent strain.

From there, the disease is believed to have spread when Haskell County men reported to an Army camp at Fort Riley, Kansas. That spring, at least 1,100 of the fort’s 56,000 troops required hospitalization. Those soldiers then fanned out to Army posts throughout the U.S. and then to France, transporting the flu to the trenches of World War I. In Europe, the outbreak received prominent coverage from Spanish media outlets while those in Germany, France and Britain avoided such coverage, fearing reports would hurt morale, Barry said. As a result, the outbreak got a nickname: The Spanish flu.

In August 1918, the epidemic hit America’s East Coast like a bomb. At Camp Devens, in Boston, 1,543 soldiers reported ill with influenza in a single day. In a letter to a colleague, a doctor at the post described how the flu turned into the most vicious type of pneumonia he had ever seen the faces and bodies of dying victims turned blue from the lack of oxygen, sparking rumors that the Black Death, a terrifying plague from the Middle Ages, had returned. Healthy men dropped dead within a matter of hours, hundreds in a day, some of them bleeding from the eyes.

Sooner state ravaged

In Oklahoma, state officials reported the first cases of influenza in Tulsa and Clinton on Sept. 26 by Oct. 4, 1,249 cases had been reported in 24 counties. After that, the spread became so difficult to track that officials made reports in generalities, according to a history of the epidemic on the U.S. Department of Health and Human Services’ website flu.gov.

“People died like flies,” Jim W. Smith, recalled in one of the archived interviews. Smith, of Washington, OK, who would have been 22 in the fall of 1918 and going to school in Durant for his teaching certificate, said most people died when, while on the mend, they went back to work and relapsed.

Ralph Norman was 21 when he fell ill while at a military training camp. In an archived interview, the Woodward resident remembered one hospital room filled with the corpses of soldiers who had died from the flu.

Fern Behrendt recalled the flu’s beginnings in the Oklahoma panhandle. Then 19, she remembered a family who lived about six miles north of Boise City being the first to contract the virus and then watching it quickly spread.

“Quite a few people died,” Behrendt told her interviewers.

Behrendt said she helped a local family until she caught the flu. After she recovered, she continued to help area families by doing chores while they were sick.

C.L. Alley said he was the first of 600 Woodward men drafted for World War I but was sent home because he was a farmer and rancher and received a deferment. Soon after, “the whole neighborhood came down with the flu,” he reported. The only doctor’s orders, he said, were “just go to bed and rest.”

On Sunday, Oct. 13, 1918, church bells stayed silent in Oklahoma City as every house of worship canceled services “due to the city commissioners’ drastic order closing all schools, churches and other public places in an effort to stay the spread of the Spanish influenza. . ”

Seeking a cure

Newspaper ads from that period hawked quack cures, everything from whiskey to mouth gargle Vicks reported a shortage of VapoRub and those in rural areas turned to home remedies, like rock candy in whiskey and cloverleaf salve.

The flu outbreak caused a run on whiskey, which jumped to $18 a quart in Oklahoma City, according to an Oct. 15, 1918, article in The Daily Oklahoman.

But the epidemic also brought out the best in some people.

A Feb. 8, 1919, story described how a destitute 35-year-old father arrived in Enid with thinly clad and barefoot children, two boys, 8 and 6, and a 4-year-old girl. The children’s mother had died from the flu and the father had lost his job while battling his own sickness. He traveled by train from Oklahoma City to Enid in search of work. En route, passengers collected $15 for the family and local residents purchased clothes for the children and helped get the man a job.

Avoiding another pandemic

Ultimately, the Spanish flu is estimated to have killed at least 7,500 people in Oklahoma and sickened an estimated 100,000 more.

Today, public officials aren’t sitting around waiting for the next pandemic.

The World Health Organization established a formal monitoring system for flu viruses in 1948, with scientists around the world collaborating to track virus mutations and adjust each year’s vaccine.

Health experts say that in addition to getting a flu shot, two of the best ways to keep from getting or spreading the flu are to wash your hands frequently and cover your mouth with your inner elbow when you cough.

Could a pandemic like this one resurface?

“It’s inevitable,” Barry said.

“Any infectious disease expert will tell you (their) biggest nightmare is another serious influenza pandemic.”

There are other theories about other sites. I think the evidence for Haskell is probably roughly as good as it is for any other site, but we’ll probably never know.”

Author John M. Barry,

Related Photos

Patients and workers fill an emergency hospital at Camp Funston, Kan., during the 1918 influenza epidemic. PHOTO PROVIDED BY NATIONAL MUSEUM OF HEALTH AND MEDICINE COURTESY OF THE NATIONAL MUSEUM

Patients and workers fill an emergency hospital at Camp Funston, Kan., during the 1918 influenza epidemic. PHOTO PROVIDED BY NATIONAL MUSEUM OF HEALTH AND MEDICINE COURTESY OF THE NATIONAL MUSEUM

The forgotten agony - the Spanish Flu pandemic of 1918-19

The World Health Organisation has recently released a plan designed to meet ‘the greatest threat to global public health.’ The report describes the threat as neither predictable nor preventable, and not a question of if it will strike the world, but when. The Global Influenza Strategy 2019-2030 aims to enable the world to better coordinate and respond to the threat posed by a potential influenza pandemic. In our increasingly globalised and interconnected world the threats posed by such pandemics are taken extremely seriously. This is due, in part, to the experiences of a previous pandemic, when global movements saw a virus emerge that would devastate a worldwide population already scarred by the carnage of war.

Although a number of pandemics have occurred in previous decades, the most deadly was the Spanish Flu pandemic of 1918-1919. The Spanish Flu has been described by the author Laura Spinney as ‘the greatest tidal wave of death since the Black Death, perhaps in the whole of human history.’ This pandemic is estimated to have caused the deaths of between 50-100 million people and infected one-third of the human population, around 500 million people. The flu killed far more than either the First or Second World Wars, and may even have killed more than the death tolls from both conflicts combined. The flu forced fundamental changes to public heath care systems across the globe and its severity and impact is still felt today.

The flu that most people are aware of is a seasonal virus that circulates across the globe in the colder months. Although the flu virus can effect humans, it is also prevalent in birds and mammals. Sometime in late 1917 or early 1918 a strain of avian flu managed to make the transition from birds to humans. Historians still debate the exact location of ‘patient zero,’ the very first human to become infected with this deadly new strain. Some scientists such as British virologist Professor John Oxford argue that the outbreak began in a hospital camp in Etaples, France, whilst others suggest that it began in a US Army camp in Kansas.

"We are facing a health threat unlike any other in our lifetimes."

A message from @antonioguterres, Secretary-General of @UN. #CoronavirusOutbreak pic.twitter.com/Zhs8o0iLUP

— HISTORY UK (@HISTORYUK) March 16, 2020

Spain was immune from the censorship that limited the wartime nations press. When the Spanish King was struck down many newspapers were finally able to report on the outbreak that was sweeping across the world. These press reports then led to a mistaken belief that the outbreak had started in Spain.

The unusual circumstances of 1918 helped the virus to travel further and faster than in any previous event in human history. The First World War resulted in the largest global migration of humans yet seen. This enabled the virus to spread, on troopships and transports, to every corner of the globe. Furthermore, the large concentrations of people, especially in the military, enabled the virus to infect individuals with lightning speed.

Although the study of bacteria was well known, the presence of viruses had been postulated but never proven because no equipment then existed to observe something so small. This meant that when the outbreak occurred there was no way of studying the virus effectively or developing a cure.

The Spanish Flu instead appeared to target young men and women between the ages of 18-35

A further terrifying feature of the outbreak that was apparent from its onset was the main age group of its victims. Seasonal influenza normally targets children under the age of 4 or elderly grandparents over the age of 65. The Spanish Flu instead appeared to target young men and women between the ages of 18-35. This age group normally has the strongest and healthiest immune systems, able to fight off any illnesses. However the Spanish Flu turned its victims own immune systems against them. The virus would trigger a Cytokine Storm, an autoimmune response whereby the victims immune system goes into overdrive, attacking and causing significant damage to lung tissue. This damage would cause the victims to turn blue as their bodies battled for oxygen. Victims would then eventually drown as their lungs filled with fluid.

The first wave of the outbreak in early 1918 was mild by comparison, but by August a second far deadlier strain was sweeping the world.

The devastating impact of the virus is illustrated in the ways it affected local communities. The first reports of the virus hitting the town of Crewe in the North West of England occurs in June of 1918. It reportedly laid low many of its residents, especially in its large railway works which would prove the perfect breeding ground for the virus. By November the virus had claimed 60 lives in just a 10 day period and resulted in 115 internments in Crewe’s cemetery, the highest in any month since the cemetery opened. In November 1918 of the 38 men killed on active service 18 are confirmed to have died of an influenza related illness.

The influenza virus is a parasite that can only live in an infected host. The most successful strain would be the one in which the host stayed alive, enabling the virus to be passed on. If the virus killed the host its chances of being passed on become limited. This helps to explain the spikes in death rates, and why the virus came and went so quickly. The virus became a victim of its own success, its deadly nature resulted in victims failing to pass on more deadly strains, which eventually led to the virus appearing to seemingly vanish after the end of the third wave in 1919.

The virus caused worldwide devastation to communities ravaged by the effects of war. The world of 1920 wanted to forget the terrible experiences of the war years, and so the Spanish Flu was confined to memory. In the years that have followed however, scientists have studied its devastating effects, using the outbreak as a model in how to cope with future pandemics. The virus is still around today, although in a less deadly form than when ‘the Spanish Lady’ first struck one hundred years ago.


Are Covid Fatalities Comparable with the 1918 Spanish Flu?

On April 23, 2021 The New York Times published an article titled “How Covid Upended a Century of Patterns in U.S. Deaths.” The article lays out some data regarding the unprecedented uptick in the US death rate that occured in 2020.

As shown in the graph provided by the New York Times, US death rates have been steadily declining over the past century, likely due to advances in technology and living standards. Last year certainly signaled a noticeable break from this trend with a sizable increase in deaths, but not nearly the same as the 1918 Flu which is a universal benchmark for a killer influenza virus.

This graph provided by the New York Times indicates the spike in excess deaths in 2020, which is the number of deaths that have occured exceeding the predictions of standard death trends. This is of course all important information. Last year was certainly a horrific year with the outbreak of Covid-19, the lockdowns, and all the chaos that followed. It was a year of death and despair which should not be taken lightly.

Important Discussion: Deaths and Victims

It is common to invoke comparisons with the 1918 Flu Pandemic, as that was an extremely devastating virus that rocked the world. The article makes multiple references to the 1918 pandemic but there are a couple that raise interesting questions for further investigation. The first point is as follows,

“Combined with deaths in the first few months of this year, Covid-19 has now claimed more than half a million lives in the United States. The total number of Covid-19 deaths so far is on track to surpass the toll of the 1918 pandemic, which killed an estimated 675,000 nationwide.”

Comparing the death counts between the 1918 Flu and Covid-19 without adjusting for population growth is extremely misleading. In 1918 the population of the United States was roughly 103 million, while near the end of 2020 it stood at roughly 330 million. According to CDC statistics compiled by a study in JAMA Covid-19 killed 345,000 people in 2020 and now stands at around half a million as stated by the New York Times. Adjusted for the population growth of over 200 million people and holding the death rates constant, the 1918 Flu would have killed over 2 million people if it occured today, which is more than four times greater than Covid-19.

Furthermore, the two diseases are vastly different in terms of who is vulnerable. Covid-19’s severe outcomes almost exclusively affect the elderly and the immunocompromised, particularly those over the age of 65, which is also approaching the life expectancy of a human. Furthermore 94 percent of Covid deaths occurred with preexisting conditions. It poses virtually no risk to children, minimal risk to young adults, and only seems to kill more than 1 percent of victims with those over the age of 65.

On the other hand the Spanish Flu was devastating to virtually all age groups and did not discriminate between the healthy and the unwell. The CDC writes the following about the 1918 Flu:

“Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.”

It is clear that the comparison is flawed between the 1918 Flu and Covid-19, as the former was a devastating killer virus whereas the latter only poses a threat to vulnerable populations.

Too Much Statistical Noise

It is certainly worth investigating the noted increase in excess deaths in 2020 as that is obviously a problem. However, the article seems to suggest that Covid-19 was the main causal factor driving increases in death. Although that is certainly a reasonable intuition given that it is a novel virus, clearly there is far more at play.

The main issue to point out is that there were two health crises, not one. Covid-19 is certainly one but we cannot simply ignore the absolutely devastating and unprecedented use of lockdown policies that drastically upended all of society in a way that a virus could never accomplish.

The effects of lockdowns have been thoroughly studied by AIER and in a series of articles I noted just some of the damage to the economy, young people, and the normal functioning of society. All these disruptions led to adverse outcomes whether it be mental health issues, decline in living standards, or even disrupted healthcare procedures. In a press release the CDC noted that in May 2020, it recorded the highest number of drug overdoses ever recorded in a 12-month period.

A study in JAMA notes that although there was a substantial increase in overall deaths in 2020, Covid-19 was only one part of the problem, assuming all Covid deaths are directly attributable to Covid and not a comorbidity.

Some statistics of note are an increase in deaths due to heart disease, unintentional injuries, stroke, and diabetes. Although more investigation would be needed to understand how all of this comes together, it wouldn’t be absurd to believe that lockdown policies led to an increase in deaths due to their many disruptions to normal societal functions.

To cite one example of many, the Mackinac Center Legal Foundation recounts on one of its clients by writing,

“One of the affected medical practices, Grand Health Partners, operates in the Grand Rapids area. It performs endoscopies and other elective surgeries, many of which were deemed nonessential by executive order. Due to the shutdown, many of their patients were not able to receive treatment and have suffered because of it.”

Alongside exploring and cutting through the statistical noise posed by increases in death plausibly related to lockdowns, there still needs to be a discussion on quantifying the Covid-19 death count. Genevieve Briand, an economist at John Hopkins University, was subject to a massive degree of controversy for putting out a flawed but important lecture – later expanded into a research paper – that pointed out among other things that Covid-19 deaths may be inappropriately reclassified as deaths from other leading causes.

This is especially worthy of discussion given that the overwhelming majority of Covid deaths occur with comorbidities amongst eldery populations often nearing or exceeding life expectancy.

Key Takeaway

The data is clear 2020 was a horrific year full of death and despair. The New York Times’ article certainly does a great job at starting a conversation about this topic. However, its comparisons of Covid-19 and the 1918 Flu raises more questions than answers. Furthermore its presentation of data regarding increases in deaths requires more context.

Upon further investigation, it is clear that Covid-19 claimed many lives. However, it is also clear that there is a substantial presence of statistical noise from comorbidities and increases in death from other causes. This raises many questions not just about the collateral damage of our policy response, but also about whether we are even operating with the appropriate information to be making such decisions with people’s lives in the first place.


Vaccine Development Across the United States

At the Naval Hospital on League Island, Pennsylvania (the Philadelphia Naval Shipyard), physicians described their approach to a vaccine: “After the nature of a drowning person grasping at a straw, a stock influenza vaccine was used as a preventive in fifty individual cases and as a curative agent in fifty other uncomplicated cases” (Dever 1919). They made the vaccine made from B. influenzae and strains of pneumococcus, streptococcus, staphylococcus, and Micrococcus catarrhalis (nüüd Moraxella catarrhalis). Each dose contained between 100,000,000 and 200,000,000 bacteria per cubic centimeter, in a four-dose regimen. The investigators reported that no vaccinated individuals (who were hospital workers) became sick, but also noted that strict preventive measures were taken, such as the use of masks, gloves, and so on. In a group of ill patients treated therapeutically with the vaccine, none developed pneumonia but one developed pleurisy (infection of the lining of the lungs). They noted, “The course of the disease [in those treated therapeutically]…was definitely shortened, and prostration seemed less severe. The patients apparently not benefitted were those admitted from four to seven days after the onset of their illness. These were out of all proportion to the number of pneumonias that developed and the severity of the infection of the control cases. The effects were always more striking, the earlier the vaccine was administered.” Finally, they concluded that, “The number of patients treated with vaccines and the number immunized with it is entirely too small to allow of any certain deductions but so far as no untoward results accompany their use, it would seem unquestionably safe and even advisable to recommend their employment.”

Another group of investigators described the use of vaccines at the Naval Training Station in San Francisco. They relate that Spanish influenza did not reach San Francisco until October 1, 1918, and that that staff at the training station therefore had time to prepare preventive measures (Minaker 1919). Isolation was easy, due to the location of the base on Alameda Island, reachable only by boat from San Francisco and Oakland. Naval Yard personnel were required to use an antiseptic throat spray daily. Beyond these measures, the authors noted that “steps were taken to produce a prophylactic vaccine,” even though there was a “great diversity of opinion as to the exciting cause” of the pandemic. In general pneumococcus and streptococcus were seen as the cause of the most severe complications. Additionally, and amid dissent, they decided to obtain a culture of B. influenzae from a fatal case at the Rockefeller Institute to include in the vaccine. In all, the vaccine contained B. influenzae, 5 billion bacteria pneumococcus Types I and II, 3 billion each pneumococcus Type III, 1 billion and Streptococcus hemolyticus (S. pyogenes), 100 million.

Guinea pigs were first injected with the vaccine to assess toxicity, and then five lab worker volunteers were inoculated. Lab tests determined that their white cell count increased and their sera agglutinated B. influenzae (meaning that they had antibodies in their blood that reacted to the bacteria). Side effects from the injection included local swelling and pain but no abscesses. Given permission to proceed, more vaccine was prepared and 11,179 military and civilians were inoculated, including some at Mare Island (Vallejo, CA) and San Pedro as well as San Francisco civilians associated with the Naval Training station. In most experimental groups, the rate of influenza cases was lower than in the uninoculated groups (though no information is given on how the statistics for the uninoculated groups were gathered, nor is there information on how a case was defined). Moreover, people who were inoculated received the injections about three weeks after influenza appeared in California, so it’s impossible to tell whether they had already been exposed and infected. The percent of influenza cases in control groups ranged from 1.5% to 33.8% (the latter being nurses in San Francisco hospitals), whereas between 1.4% and 3.5% (the latter being hospital corpsmen on duty in an influenza ward) of those in the inoculation group became ill with influenza.

Another use of vaccine was documented in Washington State at the Puget Sound Navy Yard (Ely 1919). Investigators claim that influenza invaded the Navy Yard when a group of sailors arrived from Philadelphia (it’s unclear exactly when they arrived, but the paper states that “the period of observation was from September 17 to October 18, 1918”). In all, 4,212 people were vaccinated with a streptococcal vaccine. The investigators reported that the influenza attack rate in the vaccinated ranged from 2% to 57% and in the unvaccinated from 1.8% to 19.6%. However, they noted that no deaths occurred in the vaccinated men. They stated “We believe that the use of killed cultures as described prevented the development of the disease in many of our personnel and modified its course favorable in others.” The investigators concluded that B. influenzae played no role in the outbreak.

E. C. Rosenow (Mayo Clinic) reported on the use of a mixed bacterial vaccine in Rochester, Minnesota, where about 21,000 people received three doses of vaccine in his initial study. He concluded that “The total incidence of recognizable influenza, pneumonia, and encephalitis in the inoculated is approximately one-third as great as in the control uninoculated. The total death rate from influenza or pneumonia is only one-fourth as great in the inoculated as in the uninoculated.” He would go on to test his vaccine in nearly 100,000 people.

In an editorial entitled “Prophylactic Inoculation Against Influenza,” Journal of the American Association of Medicine editors warned that, “the data presented are simply too inadequate to permit a competent judgment” of whether the vaccines were effective. In particular, they addressed Rosenow’s paper:

“To specify only one case: The experience at a Rochester hospital—where fourteen nurses (out of how many?) developed influenza within two days (how many earlier?) prior to the first inoculation (at what period in the epidemic?), and only one case (out of how many possibilities?) developed subsequently during a period of six weeks—might be duplicated, so far as the facts given are concerned, in the experience of other observers using no vaccines whatever. In other words, unless all the cards are on the table, unless we know so far as possible all the factors that may conceivably influence the results, we cannot have a satisfactory basis for determining whether or not the results of prophylactic inoculation against influenza justify the interpretation they have received in some quarters.”


St. Louis took action early

St. Louis was the sixth-largest city in the USA with a population of about 756,000. News of the flu spreading through Boston, Philadelphia and other cities provided early warnings, and officials took notice.

"St. Louis had an energetic and visionary health official in Dr. Max Starkloff," Navarro says. The city's health commissioner "immediately started warning the public and told physicians to report influenza cases."

Starkloff, fully supported by the city's mayor, "was very quick to implement city closures," Navarro says. He closed public places such as schools, theaters, playgrounds, city courts and churches and banned gatherings of more than 20 people.

He canceled the city's Liberty Bonds parade. "They recognized that crowds were a danger," McKinsey says.

Businesses protested closings. "They were upset because they were losing revenue," McKinsey says. "It was a constant conflict between them and the city."

How many more deaths did Philadelphia have?

Estimated total deaths from influenza and pneumonia, September-December 1918:

SOURCE University Archives and Records Center, University of Pennsylvania Research Medical Center, Kansas City, Missouri

Though "Starkloff listened to business pleas to reopen, he didn't reopen the city all at once," Navarro said. "He did it in a step-wise fashion."

Starkloff reimposed restrictions as infection cases rose again in November 1918. Infections subsided, and restrictions ended in December. St. Louis fared better than other cities.

Which cities had highest peak death rates?

Estimated peak death rate per 100,000 population in 16 weeks for 1918 flu:

MÄRGE Excess pneumonia and influenza mortality rate, Sept. 14-Dec. 14, 1918, from 1913-17 baseline peak is the day with the highest number of cases SOURCE Rahvusliku Teaduste Akadeemia toimetised

Post-pandemic analyses revealed "social distancing was highly effective against virus transmission," McKinsey says.

"We also found volunteers had a great impact in dealing with the epidemic, especially the Red Cross, which did an excellent job in making masks, training nurse assistants and distributing medical information pamphlets to the public. It really made a difference," McKinsey says.

Total death rates of cities compared

Estimated overall death rate per 100,000 population for 1918 flu:

MÄRGE Excess pneumonia and influenza mortality rate, Sept. 14, 1918-May 31, 1919, from 1913-17 baseline SOURCE Rahvusliku Teaduste Akadeemia toimetised

Except for a minor fourth wave early in 1920, U.S. pandemic fatalities dwindled and virtually ended in the summer of 1919.

In the pandemic's aftermath, "we see a change in efforts for better public health," says Deanne Stephens, professor of history at the University of Southern Mississippi.

"It ranged from a greater emphasis on clean drinking water to the recognition that nursing was a critical service," Stephens says. "There was also the realization that government could take a stronger role in disease prevention."

Beyond that, Americans turned their attention elsewhere. Perhaps that was to be expected.

"There was a different mentality then," Stephens says. "The U.S. was used to epidemics. So in urban areas, there was an attitude of 'we're going to plow through this.' "

And finally, there was the shadow of World War I itself. Americans "may have thought of the flu as simply a subdivision of the war," historian Alfred Crosby wrote in "The Forgotten Pandemic."

Horror of 1918 flu faded

Subjects of stories in American periodicals after the flu (in inches of column space):

MÄRGE Prohibition was the ban on sale of alcoholic beverages in the U.S. Bolsheviks were far-left Marxist revolutionaries who killed the czar in 1917 and started a communist regime in Russia SOURCE The Readers Guide to Periodical Literature, 1919-1921, as cited in "America's Forgotten Pandemic: The Influenza of 1918" by Alfred Crosby.

SOURCES Centers for Disease Control and Prevention University of Pennsylvania, Archives and Records Center National Institutes of Health National Endowment for the Humanities Library of Congress Federal Reserve History Museum of American Finance National Bureau of Economic Research "When We Have a Few More Epidemics, the City Officials Will Awake," published master's thesis of historian Jeffery Anderson, Rutgers, 1997 "The Great Influenza: The Story of the Deadliest Pandemic in History" by John M. Barry, 2004 "Pale Rider: The Spanish Flu of 1918 and How It Changed the World" by Laura Spinney, 2017 "America's Forgotten Pandemic: The Influenza of 1918" by Alfred W. Crosby, 1989 "Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History" by Catherine Arnold, 2018 "Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History" by Dr. Jeremy Brown, 2018

USA TODAY research by George Petras illustrations and graphics by Karl Gelles