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fredag den 8. maj 2009
tirsdag den 5. maj 2009
The Influenza Pandemic of 1918.
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The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I ( WWI) , at somewhere between 20 and 40 million people.
It has been cited as the most devastating epidemic in recorded world history.
More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351.
Known as "Spanish Flu"or "La Grippe" the influenza of 1918-1919 was a global disaster.
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mandag den 4. maj 2009
The 1918 Spanish Influenza.
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1918 flu pandemic.
The 1918 flu pandemic (commonly referred to by the misnomer Spanish flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly Influenza A virus strain of subtype H1N1. Historical and epidemiological data are inadequate to identify the geographic origin of the virus.
Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. According to historians, we have discovered that many of the patients were young, but the most deaths were elderly. The pandemic lasted from March 1918 to June 1920, spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 70 to 100 million people were killed worldwide, or the approximate equivalent of one third of the population of Europe, more than double the number killed in World War I. This extraordinary toll resulted from the extremely high illness rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.
The pandemic is estimated to have affected up to one billion people: more than half the world's population at the time.
Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.
Mortality
The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).
Three pandemic waves: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919.
The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. Note this does not mean that 2.5-5% of the human population died; with 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% ( ≈50 million) of the whole population died.
Influenza may have killed as many as 25 million in its first 25 weeks. Older estimates say it killed 40–50 million people while current estimates say 50 million to 100 million people worldwide were killed.
This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.
As many as 17 million died in India, about 5% of India's population at the time. In Japan, 23 million persons were affected, and 390,000 died. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa.[which?] Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived, although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher, while in British Somaliland one official there estimated that 7% of the native population died from influenza. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%.
This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid.
One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."
The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.
The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%. [clarification needed]
Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.
This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.
Origins of name:
Although the first cases of the disease were registered in the continental US and the rest of Europe long before getting to Spain, the 1918 Flu received its nickname "Spanish Flu" because Spain, a neutral country in WWI, had no special censorship for news against the disease and its consequences. Hence the most reliable news came from Spain, giving the false impression that Spain was the most -if not the only- affected zone.
History:
While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic, and increased transmission augmented mutation and may have increased the lethality of the virus. Some researchers speculate that the soldiers' immune systems were weakened by malnourishment, and the stresses of combat and chemical attacks, increasing their susceptibility to the disease. Price-Smith has made the controversial argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. Specifically, he provides data that the viral waves hit the Central Powers before they hit the Allied powers, and that both morbidity and mortality in Germany and Austria were considerably higher than in Britain and France.
A large factor of worldwide flu occurrence was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide.
Geographic sources
Progression of the 1917-1919 pandemic.
Some scholars have theorized that the flu probably originated in the Far East. Dr. C. Hannoun, leading expert of the 1918 flu for the Institut Pasteur noticed that the former virus was likely to have come from China, mutated in the USA near Boston, and spread to Brest (France), Europe's battlefields, Europe, and the world using Allied soldiers and sailors as main spreaders. C. Hannoun also notice several other theories, such Spain, Kansas, Brest, but as being possible but not likely.
Historian Alfred W. Crosby observed that the flu seems to have originated in Kansas, the political scientist Andrew Price-Smith has published data from the Austrian archives suggesting that the influenza had earlier origins, beginning in Austria during the Spring of 1917. Popular writer John Barry echoed Crosby in proposing that Haskell County, Kansas was the location of the first outbreak of flu. In the United States the disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918, and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.
Patterns of fatality:
The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly weak individuals, such as infants (aged 0–2 years), the elderly, and the immunocompromised; older adults may have had some immunity from the earlier Russian flu pandemic of 1889. Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months.
In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced pulmonary consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.
Devastated communities
Chart of deaths in major cities
Even in areas where mortality 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 not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places.
Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which belatedly implemented measures to prevent ships carrying the flu from leaving its ports. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9000 people). Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed.
By contrast, the flu was kept from from American Samoa by a commander who imposed a blockade. The mortality rate in New Zealand itself was 5%.
Less affected areas:
In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck.
In the Pacific, American Samoa and the French colony of New Caledonia also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.
US Government response:
The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from World War I was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza.
On September 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations.
While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, which affected both sides alike.
Cultural impact:
In the United States, Great Britain and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918–1919, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a “forgotten pandemic.”
Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. Also, in 1935 John O'Hara wrote a long short story, "The Doctor's Son," about the experience of his fictional alter ego during the flu epidemic in a Pennsylvania coal mining town. However, in 1937 William Keepers Maxwell, Jr., the American novelist, wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, also wrote about her parents' deaths in Memories of a Catholic Girlhood. In 1992 Bodie and Brock Thoene's "Shiloh Legacy Series" leads off with an account of the Spanish Flu in New York and Arkansas in their fictional novel, "In My Father's House." More recently (2006), author Thomas Mullen wrote a novel called The Last Town on Earth, about the impact of the Spanish flu on a fictional mill town in Washington and author Myla Goldberg wrote a novel called Wickett's Remedy that is set in Boston during the pandemic.
Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years. These include the rapid pace of the pandemic (it killed most of its victims in the United States, for example, within a period of less than nine months); previous familiarity with pandemic disease in the late 19th and early 20th centuries; and the distraction of the First World War.
Another explanation involves the age group affected by the disease. The majority of fatalities, in both World War I and in the Spanish Flu epidemic, were young adults. The deaths caused by the flu may have been overlooked due to the large numbers of deaths of young men in the war or as a result of injuries.
When people read the obituaries of the era, they saw the war or post-war deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was extremely high, the flu may not have had a great, separate, psychological impact, or may have seemed a mere "extension" of the war's tragedies.
The duration of the pandemic and the war could also play a role: the disease would usually only affect a certain area for a month before leaving, while the war, which most believed for a quick end, had been lingering for more than three years by the time the pandemic struck. This left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.
...
1918 flu pandemic.
The 1918 flu pandemic (commonly referred to by the misnomer Spanish flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly Influenza A virus strain of subtype H1N1. Historical and epidemiological data are inadequate to identify the geographic origin of the virus.
Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. According to historians, we have discovered that many of the patients were young, but the most deaths were elderly. The pandemic lasted from March 1918 to June 1920, spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 70 to 100 million people were killed worldwide, or the approximate equivalent of one third of the population of Europe, more than double the number killed in World War I. This extraordinary toll resulted from the extremely high illness rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.
The pandemic is estimated to have affected up to one billion people: more than half the world's population at the time.
Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.
Mortality
The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).
Three pandemic waves: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919.
The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of those who were infected died. Note this does not mean that 2.5-5% of the human population died; with 20% or more of the world population suffering from the disease to some extent, a case-fatality ratio this high would mean that about 0.5-1% ( ≈50 million) of the whole population died.
Influenza may have killed as many as 25 million in its first 25 weeks. Older estimates say it killed 40–50 million people while current estimates say 50 million to 100 million people worldwide were killed.
This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.
As many as 17 million died in India, about 5% of India's population at the time. In Japan, 23 million persons were affected, and 390,000 died. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa.[which?] Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived, although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher, while in British Somaliland one official there estimated that 7% of the native population died from influenza. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%.
This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid.
One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."
The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.
The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%. [clarification needed]
Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.
This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.
Origins of name:
Although the first cases of the disease were registered in the continental US and the rest of Europe long before getting to Spain, the 1918 Flu received its nickname "Spanish Flu" because Spain, a neutral country in WWI, had no special censorship for news against the disease and its consequences. Hence the most reliable news came from Spain, giving the false impression that Spain was the most -if not the only- affected zone.
History:
While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic, and increased transmission augmented mutation and may have increased the lethality of the virus. Some researchers speculate that the soldiers' immune systems were weakened by malnourishment, and the stresses of combat and chemical attacks, increasing their susceptibility to the disease. Price-Smith has made the controversial argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. Specifically, he provides data that the viral waves hit the Central Powers before they hit the Allied powers, and that both morbidity and mortality in Germany and Austria were considerably higher than in Britain and France.
A large factor of worldwide flu occurrence was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide.
Geographic sources
Progression of the 1917-1919 pandemic.
Some scholars have theorized that the flu probably originated in the Far East. Dr. C. Hannoun, leading expert of the 1918 flu for the Institut Pasteur noticed that the former virus was likely to have come from China, mutated in the USA near Boston, and spread to Brest (France), Europe's battlefields, Europe, and the world using Allied soldiers and sailors as main spreaders. C. Hannoun also notice several other theories, such Spain, Kansas, Brest, but as being possible but not likely.
Historian Alfred W. Crosby observed that the flu seems to have originated in Kansas, the political scientist Andrew Price-Smith has published data from the Austrian archives suggesting that the influenza had earlier origins, beginning in Austria during the Spring of 1917. Popular writer John Barry echoed Crosby in proposing that Haskell County, Kansas was the location of the first outbreak of flu. In the United States the disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918, and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.
Patterns of fatality:
The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly weak individuals, such as infants (aged 0–2 years), the elderly, and the immunocompromised; older adults may have had some immunity from the earlier Russian flu pandemic of 1889. Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months.
In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced pulmonary consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.
Devastated communities
Chart of deaths in major cities
Even in areas where mortality 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 not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places.
Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which belatedly implemented measures to prevent ships carrying the flu from leaving its ports. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9000 people). Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed.
By contrast, the flu was kept from from American Samoa by a commander who imposed a blockade. The mortality rate in New Zealand itself was 5%.
Less affected areas:
In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck.
In the Pacific, American Samoa and the French colony of New Caledonia also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.
US Government response:
The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from World War I was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza.
On September 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations.
While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, which affected both sides alike.
Cultural impact:
In the United States, Great Britain and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918–1919, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a “forgotten pandemic.”
Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. Also, in 1935 John O'Hara wrote a long short story, "The Doctor's Son," about the experience of his fictional alter ego during the flu epidemic in a Pennsylvania coal mining town. However, in 1937 William Keepers Maxwell, Jr., the American novelist, wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, also wrote about her parents' deaths in Memories of a Catholic Girlhood. In 1992 Bodie and Brock Thoene's "Shiloh Legacy Series" leads off with an account of the Spanish Flu in New York and Arkansas in their fictional novel, "In My Father's House." More recently (2006), author Thomas Mullen wrote a novel called The Last Town on Earth, about the impact of the Spanish flu on a fictional mill town in Washington and author Myla Goldberg wrote a novel called Wickett's Remedy that is set in Boston during the pandemic.
Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years. These include the rapid pace of the pandemic (it killed most of its victims in the United States, for example, within a period of less than nine months); previous familiarity with pandemic disease in the late 19th and early 20th centuries; and the distraction of the First World War.
Another explanation involves the age group affected by the disease. The majority of fatalities, in both World War I and in the Spanish Flu epidemic, were young adults. The deaths caused by the flu may have been overlooked due to the large numbers of deaths of young men in the war or as a result of injuries.
When people read the obituaries of the era, they saw the war or post-war deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was extremely high, the flu may not have had a great, separate, psychological impact, or may have seemed a mere "extension" of the war's tragedies.
The duration of the pandemic and the war could also play a role: the disease would usually only affect a certain area for a month before leaving, while the war, which most believed for a quick end, had been lingering for more than three years by the time the pandemic struck. This left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.
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