Coronavirus pandemic is forcing the whole world to go 100 years back to reopen the pages of the world’s deadliest pandemic “Spanish Flu.” The memories of the 1918 Spanish Flu again refreshed that claimed between 50 and 100 million lives globally during World War 1.
Introduction:
This is not the first time that the world is facing any virus pandemic such as Coronavirus (COVID19) pandemic. The 1918 pandemic is the deadliest pandemic in the history of the world. During the time period of World War 1, in year 1918, a new influenza virus emerged. It was caused by an H1N1 virus with genes of avian origin. It is estimated that about 500 million people i.e. one-third of the world’s population became infected with this virus. The influenza pandemic of 1918-1919, killed more people than both World Wars put together, with death toll at probably 50 million and possibly as high as 100 million, with about 6,75,000 occurring in the United States. Around 12-17 million people died in India from this 1918 influenza pandemic. The only remedy to the virulent virus was only quarantine, social distancing and proper hygiene. In history of US and Europe this was the time they never wanted to see it again. But the Coronavirus pandemic is reminding the whole world about the deadly history of “1918 influenza pandemic”. Let’s discuss in detail about 1918 pandemic which is also known as Spanish flu.
Spanish Flu:
During World War 1, outbreaks of flu-like illness are first detected in the United States. The first official cases of the 1918 Spanish flu pandemic were recorded at the U.S. Army’s Camp Funston, Kansas, in March 1918. More than 100 soldiers at Camp Funston in Fort Riley, Kansas become ill with flu. Within a week the number of flu cases quintuples.
The influenza pandemic circled the globe.It spread by 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 (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people. The Great War, with its mass movement, of men in armies and aboard ships, probably aided in its rapid diffusion and attack.
This flu killed more people in 24 weeks than HIV/AIDS takes time to kill in 24 years. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351.
Deadly Effect of Spanish Flu Pandemic:
The pandemic affected everyone. The effect of the influenza epidemic was so severe that the average lifespan in the US was depressed by 10 years. 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.
Bodies piled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers. As noted in the Journal of the American Medical Association final edition of 1918:
"The 1918 has gone: a year momentous as the termination of the most cruel war in annals of the human race; a year which marked the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).
Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales; funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News).
Mortality All Around Globe:
The disease killed in many parts of the world. The pandemic is believed to have infected a third of the world's population and claimed between 50 and 100 million lives. Some 12-17 million people died in India, about 5% of the population.
In Japan, 23 million people were affected, with at least 3,90,000 reported deaths.
In Iran, the mortality was very high: according to an estimate, between 9,02,400 and 2,431,000, or 8% to 22% of the total population died.
In Brazil, 3,00,000 died, including president Rodrigues Alves.
In Britain, as many as 250,000 people died and in France, more than 4,00,000 people died.
In the U.S., about 28% of the population of 105 million became infected, and 5,00,000 to 6,75,000 died (0.48 to 0.64 percent of the population). Native American tribes were particularly hard hit.
In the Dutch East Indies (now Indonesia), 1.5 million were assumed to have died among 30 million inhabitants. In Ghana, the influenza epidemic killed at least 1,00,000 people.
Spanish Flu Impact in India:
A ship of returning soldiers that harbored in Mumbai in June 1918 was the prime carrier of deadly Spanish flu which ransacked India. A second wave of the epidemic began in September in southern India and spread along the coastline. India lost its 6 percentage of people in the Spanish Flu. By early July in 1918, 230 people were dying of the disease every day, up nearly three times from the end of June. As per the sources Mahatma Gandhi and his associates were also suffered from “Spanish Flu” in year 1918 but lucky to recover.
The prime symptoms are high temperature and pains in the back and the complaint lasts three days. More Indian adults and children were infected than resident Europeans. To avoid an attack, the newspapers advised people at home, to stay at home and not to go outside. They suggested people to restrain from all places where there is overcrowding and consequent risk of infection such as fairs, festivals, theaters, schools, public lecture halls, cinemas, entertainment parties, crowded railway carriages etc. People were reminded the disease spread "mainly through human contact by means of infected secretions from the nose and mouths.
Unique Feature of Spanish Flu:
Spanish flu pandemic resulted in a higher than expected mortality rate for young adults. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. Influenza is typically most deadly to weak individuals, such as infants under age two, adults over age 70, and the immunocompromised people. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. But the pandemic mostly killed young adults. 20 to 40 years old. It was an astonishing factor for most of the scientific researchers.
Modern analysis has shown the virus to be particularly deadly because it triggers a cytokine storm (overreaction of the body's immune system), which damages the stronger immune system of young adults. One group of researchers recovered the virus from the bodies of frozen victims and transfected animals with it. The animals suffered rapidly progressive respiratory failure and death through a cytokine storm. The strong immune reactions of young adults were postulated to have ravaged the body, whereas the weaker immune reactions of children and middle-aged adults resulted in fewer deaths among those groups.
With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
Three Waves of Spanish Flu:
There were 3 different waves of illness during the pandemic, starting in March 1918 and subsiding by summer of 1919.
First Wave (Spring 1918):
The first outbreak of flu-like illnesses was detected in the U.S. in March, with more than 100 cases reported at Camp Funston in Fort Riley, Kansas. As engaged in War, Hundreds and thousands of U.S. soldiers traveled across the Atlantic to deploy for war. The mass troop movement contributed to the global spread of flu.
Second Wave (Fall 1918):
Between September and November, a second wave of flu peaks in the United States. This second wave is highly fatal, and responsible for most of the deaths attributed to the pandemic. The second wave of flu emerges at Camp Devens, a United States Army training camp just outside of Boston, and at a naval facility in Boston.
By the end of September, more than 14,000 flu cases are reported at Camp Devens—equaling about one-quarter of the total camp, resulting in 757 deaths. In fall of 1918 the United States experiences severe shortages of professional nurses, because of the deployment of large numbers of nurses to military camps in the United States and abroad.
October 1918 was the deadliest month of the whole pandemic. The virus had mutated to a much deadlier form.The 1918 flu pandemic virus kills an estimated 1,95,000 Americans during October alone.
Philadelphia is hit hard with the pandemic flu viruses—more than 500 corpses await burial, some for more than a week. Cold-storage plants are used as temporary morgues; a manufacturer of trolley cars donates 200 packing crates for use as coffins. Chicago, along with many other cities across the United States, closes theaters, movie houses and night schools and prohibits public gatherings.
The end of World War I in November 1918 enables a resurgence of influenza as people celebrate Armistice Day and soldiers begin to demobilize. Salt Lake City officials place quarantine signs on front and rear doors of 2,000 homes where occupants have been struck with flu.
From December 1918 Public health officials begin education programs and publicity about dangers of coughing and sneezing; careless disposal of “nasal discharges. ”Committee of the American Public Health Association encourages stores and factories to stagger opening and closing hours and for people to walk to work when possible instead of using public transport to prevent overcrowding.
Third Wave (Winter 1918):
A third wave of influenza occurs in the winter and springs of 1919, killing many more. Seven-hundred and six cases of influenza and 67 deaths are reported in New York City, triggering fear of a recurrence of severe flu activity.
Third wave subsides in the summer. Influenza appears to be nearly eradicated in New Orleans as number of reported cases drops around Feb 1919.
Symptoms of Spanish Flu:
The Spanish flu strain killed its victims with such a rapid speed never seen before. In the United States stories abounded of people waking up sick and dying on their way to work. One anecdote shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza . Others told stories of people on their way to work suddenly developing the flu and dying within hours. The symptoms were terrifying:
Sufferers would develop a fever and become short of breath.
Lack of oxygen meant their faces appeared tinged with blue.
Hemorrhages filled the lungs with blood and caused catastrophic vomiting and nosebleeds, with victims drowning in their own fluids.
Unlike so many strains of influenza before it, Spanish flu attacked not only the very young and the very old, but also healthy adults between the ages of 20 and 40.
One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth (Starr, 1976)."
Origin of Spanish Flu:
The origins of the deadly flu disease were unknown but widely speculated upon. Some of the allies thought of the epidemic as a biological warfare tool of the Germans. Many thought it was a result of the trench warfare, the use of mustard gases and the generated "smoke and fumes" of the war. While some researchers have pointed to a military camp in Kansas or the front-line trenches in France as the breeding ground for the disease. Researchers have speculated the below three major sources of 1918 influenza pandemic.
ALDERSHOT, U.K., ETAPLES, FRANCE:
The major UK troop staging and hospital camp in Étaples in France has been theorized by researchers as being at the center of the Spanish flu. The research was published in 1999 by a British team, led by virologist John Oxford. In late 1917, military pathologists reported the onset of a new disease with high mortality that they later recognized as the flu. The overcrowded camp and hospital was an ideal site for the spreading of a respiratory virus. The hospital treated thousands of victims of chemical attacks, and other casualties of war, and 1,00,000 soldiers passed through the camp every day. It also was home to a piggery, and poultry was regularly brought in for food supplies from surrounding villages. Oxford and his team postulated that a significant precursor virus, harbored in birds, mutated and then migrated to pigs kept near the front.
US (Kansas):
There have been statements that the epidemic originated in the United States. Historian Alfred W. Crosby stated in 2003 that the flu originated in Kansas. A 2018 study of tissue slides and medical reports led by evolutionary biology professor Michael Worobey found evidence against the disease originating from Kansas as those cases were milder and had fewer deaths compared to the situation in New York City in the same time period. The study did find evidence through phylogenetic analyses that the virus likely had a North American origin, though it was not conclusive. In addition, other studies suggest that the reassortment of the H1N1 virus likely occurred in or around 1915.
China (Shanxi Province):
According to a new article published in the January 2014 issue of the journal War in History, historian Mark Humphries of Canada’s Memorial University of Newfoundland points to newly unearthed records to make the case that the lethal influenza pandemic first appeared in China in 1917 and then exploded across the globe “as previously isolated populations came into contact with one another on the battlefields of Europe.”
Humphries, author of “The Last Plague: Spanish Influenza and the Politics of Public Health in Canada,” writes that victims of a mysterious respiratory disease that broke out in northern China in November 1917 suffered many of the same symptoms as those of the “Spanish flu.” Doctors reported that patients turned blue from a lack of oxygen, coughed up blood and suffered from fevers, headaches, pneumonia and shortness of breath. The highly contagious and deadly disease was particularly unusual in that it killed otherwise healthy adults between the ages of 18 and 40 by seemingly turning their strong immune systems against them. However, with no solid scientific evidence of the outbreak’s cause, local Chinese health officials labeled it “winter sickness” and chose not to quarantine citizens or enact travel restrictions.
In 2014, historian Mark Humphries argued that the mobilization of 96,000 Chinese laborers to work behind the British and French lines might have been the source of the pandemic. Humphries, of the Memorial University of Newfoundland in St. John's, based his conclusions on newly unearthed records. He found archival evidence that a respiratory illness that struck northern China in November 1917 was identified a year later by Chinese health officials as identical to the Spanish flu. In 1993, Claude Hannoun, the leading expert on the 1918 flu for the Pasteur Institute, asserted the former virus was likely to have come from China. It then mutated in the United States near Boston and from there spread to Brest, France, Europe's battlefields, Europe, and the world with Allied soldiers and sailors as the main disseminators.
Multiple studies have documented that there were relatively few deaths from the flu in China compared to other regions of the world. The relatively mild flu season and lower rates of flu mortality in China in 1918 may be explained due to the fact that the Chinese population had already possessed acquired immunity to the flu virus. This has led to speculation that the 1918 flu pandemic originated in China.
Why it is named as Spanish Flu?
The Outbreak was named as “Spanish Flu”, not because it originated there but Spain was the first country to report this disease publicly. Papers were free to report the epidemic's effects in neutral Spain, such as the grave illness of King Alfonso XIII because the country was free from wartime newspaper censors such as those in the United States, France and the United Kingdom who minimized reports of the influenza outbreak in order to prevent potential panic. But when the deadly virus exploded across the world and became known as “Spanish influenza,” Spain protested that its people were being falsely stigmatized.
End of Pandemic:
The pandemic subsides around year 1920, but virus (H1N1) continues to circulate seasonally for 38 years. One explanation for the rapid decline in the lethality of the disease is that doctors became more effective in prevention and treatment of the pneumonia that developed after the victims had contracted the virus. However, John Barry stated in his 2004 book The Great Influenza: the Epic Story of the Deadliest Plague in History that researchers have found no evidence to support this position. Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out.
Global Outcome of this 1918 Pandemic:
The pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments compared with other birth cohorts. A 2018 study found that the pandemic reduced educational attainment in populations. This pandemic introduced women in the field of nursing due to their success of their patient care and did not associate the spread of the disease with their work.
Conclusion:
100 years after again the history is refolding the pandemic with a new name i.e. “Coronavirus Pandemic”. With such technological and medical advancement in the 21st digital century, we are once again helpless against “Pandemic”. Today the developed countries like US, Italy, Spain and France are speechless against “Coronavirus Pandemic”. With the great medical facilities they are not able to fight the rapid communal transmission and death toll arise of the Coronavirus infection disease (COVID-19). The reason may be the natural reassortment of a novel coronavirus or may be the biological warfare but still the whole world has no depth of solution for a pandemic than “Social Distancing” and “Proper hygienic”. This is the time that the whole world needs more research on these epidemic outbreaks and then how it is affecting the whole world and becoming a pandemic. When an epidemic will be inspected properly with its global guidelines then its chance of conversion to pandemic can be greatly reduced.
Prevention is better than cure. Whole world should seriously consider the epidemic before it turns into pandemic.
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