1918 Influenza: The Mother of All Pandemics

[Avalux]

The 1918 pandemic occurred in three waves. A spring wave (started in March 1918) a fall wave and a third wave in the winter. Each one more lethal than the other. The genetic material we have is from the second wave, so we really don't know where/how it all started or the original strain's make-up. Still a lot of unanswered questions.

There are similarities between what's happening now and the pandemic of 1918 which is precisely why I think the WHO and CDC are concerned.

CDC Article:

An estimated one third of the world's population (or ≈500 million persons) were infected and had clinically apparent illnesses (1,2) during the 1918–1919 influenza pandemic. The disease was exceptionally severe. Case-fatality rates were >2.5%, compared to <0.1% in other influenza pandemics (3,4). Total deaths were estimated at ≈50 million (5–7) and were arguably as high as 100 million (7).

The impact of this pandemic was not limited to 1918–1919. All influenza A pandemics since that time, and indeed almost all cases of influenza A worldwide (excepting human infections from avian viruses such as H5N1 and H7N7), have been caused by descendants of the 1918 virus, including "drifted" H1N1 viruses and reassorted H2N2 and H3N2 viruses. The latter are composed of key genes from the 1918 virus, updated by subsequently incorporated avian influenza genes that code for novel surface proteins, making the 1918 virus indeed the "mother" of all pandemics.

In 1918, the cause of human influenza and its links to avian and swine influenza were unknown. Despite clinical and epidemiologic similarities to influenza pandemics of 1889, 1847, and even earlier, many questioned whether such an explosively fatal disease could be influenza at all. That question did not begin to be resolved until the 1930s, when closely related influenza viruses (now known to be H1N1 viruses) were isolated, first from pigs and shortly thereafter from humans. Seroepidemiologic studies soon linked both of these viruses to the 1918 pandemic (8). Subsequent research indicates that descendants of the 1918 virus still persists enzootically in pigs. They probably also circulated continuously in humans, undergoing gradual antigenic drift and causing annual epidemics, until the 1950s. With the appearance of a new H2N2 pandemic strain in 1957 ("Asian flu"), the direct H1N1 viral descendants of the 1918 pandemic strain disappeared from human circulation entirely, although the related lineage persisted enzootically in pigs. But in 1977, human H1N1 viruses suddenly "reemerged" from a laboratory freezer (9). They continue to circulate endemically and epidemically.

more...
http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm

[hedgehog]

1. Excellent article!

[aquart]

2. My family has a whole crop of bright young people

at college. I don't want to lose a one of them. So I will watch this outbreak in nervous horror, as if watching could somehow stop it.

My grandmother kept her children indoors during the 1918 pandemic, washing everything constantly. Her family lived.

[Avalux]

3. I'm a researcher - so I'm trying to figure it all out as much as I can.

Too much information a bad thing sometimes? Don't know. Your grandmother was a smart woman and if this outbreak turns pandemic, we might all be served well to follow her advice.

For right now, don't get too nervous but stay informed. :hi:

[Control-Z]

5. What is your take on

tamiflu treatment? Seems to be effective by some reports.

[FedUpWithIt All]

6. I have been hearing that Tamiflu is affective if used right away.

So far, all the cases outside of Mexico have been relatively mild.

:::crossing fingers:::

[Avalux]

9. The CDC has said the virus is sensitive to Tamiflu.

It is an antiviral and doesn't kill the virus but lessens the symptoms if taken within the first 48 hours. Over time however, the virus may become resistant to Tamiflu (as it spreads from one person to another).

[Joe the Revelator]

16. If it becomes resistant it will be because it merged with this years flu

which has been resistant from the outset.

[roguevalley]

20. my grandma told me about the 1918 pandemic, it was so awful that

she was still scared in the 1980's when she spoke of it. People just dropped dead.

there was a documentary about it and it started from what they determined in a train station crossroads in France where soldiers were coming and going.

[reggie the dog]

4. Are we better prepared, medically speaking, to treat those who become ill

this time around?

[Avalux]

10. We have Tamiflu and a couple of other antivirals that can lessen symptoms.

We also have antibiotics for secondary bacterial infections like pneumonia. In that respect, yes.

[FedUpWithIt All]

7. Thanks for this article. Pandemics often go in waves of three.

As i understand it, the second wave usually packs the greatest punch.

For example, in the 1918-1919 "Spanish flu" pandemic, there were three waves. For whatever reason, the virus in the first wave, in June - July, caused illness that appeared to be indistinguishable from seasonal influenza. In November, a far more virulent illness appeared. (The first wave provided some protection from the second - those who became ill in the first wave were less likely to get sick in the second wave

http://www.queensu.ca/pandemic/faq.html

[Avalux]

12. It's fascinating.

I expect we will see waves with this current virus; at the rate we're going, pandemic status isn't far off.

[MadMaddie]

8. You should read the book

The Great Influenza: The Epic Story of the Deadliest Plague in History
by John M. Barry

It's a facinating read.

[Avalux]

11. Thanks for recommending -

I'll be sure to get it and read it. :hi:

[Patiod]

13. NYT science reporter Gina Kolada has one too

I used to work for a company that tracks influenza

[Patiod]

14. Hiking, we came across a small, abandoned Jewish graveyard

outside Philadelphia, in Gladwynne. Probably a family plot. There were several graves with dates within a few weeks (Fall 1918) and we realized they were likely flu victims.

For a number of reasons, its something most people who were alive during that time wouldn't/won't talk about. Based on what I've read, it must have been awful.

[Avalux]

15. I realized today my grandparents were infants during the pandemic.

They survived. I don't recall anyone in my family talking about it but I'm sure people died. Might need to research it. :hi:

[marshall]

17. My grandmother's sister died in the pandemic

My grandmother was eight years old, her brother and sister who were twin 15 year old both got it. My grandmother and her other sister were kept in a separate part of the house and not allowed to be in the same room with them. She said they moaned all night for several nights, then her brother got better and the sister died. I used the story in the eulogy I spoke for my grandmother when she passed away a few years ago--it was a childhood incident that she remembered the rest of her life.

[Froward69]

18. My grand mother had just fineshed

nursing school. I remember her telling me that this flu was the cause for the end of WWI. (more casualties on each side from the flu than bullets and bombs.)

I remember reading about it college and it started killing people in Asia. it began slowly at first however once it hit training camps for doughboys in eastern Kansas. It then spread around the rest of the world on troopships very rapidly.

the ultimate death toll was horrific. something like 35million world wide. the only strains that modern science was able to "capture" was from frozen bodies in the arctic. bodies that had been frozen for 50 years and never decayed.

[bluedawg12]

19. Kick for useful info. n/t

[suffragette]

21. Avalux, You might find this article interesting

http://seattletimes.nwsource.com/pacificnw/2004/1024/cover.html

It definitely has a Seattle slant, but is a fascinating mixture of medical, societal, and social impact of the 1918 pandemic.

This is also good, though much more brief and has additional resources listed:

http://www.historylink.org/index.cfm?DisplayPage=output.cfm&File_Id=2090

[Avalux]

22. That was a terrific historical read.

And even though it was written 5 years ago with avian flu in mind, still very relevant.

Nature is nature, and the fact that pandemics happen several times a century doesn't change because us humans have more bells and whistles.

Thanks for sharing! :hi:

[suffragette]

23. Yes, and I found the information about what people did

during this, both in large ways and small, very interesting.

I think there's much to be learned from that for us.