In Iran, the mortality was very high: according to an estimate, between 902,400 and 2,431,000, or 8% to 22% of the total population died. In fall of 1918 the United States experiences a severe shortages of professional nurses, because of the deployment of large numbers of nurses to military camps in the United States and abroad, and the failure to use trained African American nurses. [78][75][74], A report published in 2016 in the Journal of the Chinese Medical Association found no evidence that the 1918 virus was imported to Europe via Chinese and Southeast Asian soldiers and workers and instead found evidence of its circulation in Europe before the pandemic. Many San Antonio citizens begin complaining that new flu cases aren’t being reported, and that this is fueling another influenza surge. avd. [160] The disease spread fastest through the higher social classes among the indigenous peoples, because of the custom of gathering oral tradition from chiefs on their deathbeds; many community elders were infected through this process.[161]. Public health officials begin education programs and publicity about dangers of coughing and sneezing; careless disposal of “nasal discharges.”. It was caused by an H1N1 virus with genes of avian origin. [243] Rolland had authored an article in the Lancet during 1917 about a respiratory illness outbreak beginning in 1916 in Étaples, France. Not pandemic, but included for comparison purposes. In 1918, a new influenza virus emerged. And others have argued that the course of the war (and subsequent peace treaty) was influenced by the pandemic." When people read the obituaries, they saw the war or postwar deaths and the deaths from the influenza side by side. By contrast, Governor John Martin Poyer prevented the flu from reaching neighboring American Samoa by imposing a blockade. [98], During the deadly second wave there were also fears that it was in fact plague, dengue fever, or cholera. [4], Some 12–17 million people died in India, about 5% of the population. [87] After this, death would follow within hours or days due to the lungs being filled with fluids. [100][101][102][103][104] A six-year climate anomaly (1914–1919) brought cold, marine air to Europe, drastically changing its weather, as documented by eyewitness accounts and instrumental records, reaching as far as the Gallipoli campaign, in Turkey, where ANZAC troops suffered extremely cold temperatures despite the normally Mediterranean climate of the region. There was a diverse labor in Newfoundland, men and woman had various occupations that involved day to day interaction. [138], In Japan, 23 million people were affected, with at least 390,000 reported deaths. [177][74] Similarly, in the city of Shanghai – which had a population of over 2 million in 1918 – there were only 266 recorded deaths from influenza among the Chinese population in 1918. Historian Alfred W. Crosby stated in 2003 that the flu originated in Kansas,[60] and popular author John M. Barry described a January 1918 outbreak in Haskell County, Kansas, as the point of origin in his 2004 article. It infected millions worldwide, killing possibly hundreds of millions. [184] However, in India the opposite was true, potentially because Indian women were neglected with poorer nutrition, and were expected to care for the sick. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease. The autumn version of the Spanish flu ended up far deadlier than its predecessor. The year 1920 saw us surviving a World War and the Spanish Flu. The combination triggered similar symptoms in animal testing. The hospital treated thousands of victims of poison gas attacks, and other casualties of war, and 100,000 soldiers passed through the camp every day. To maintain morale, World War I censors minimized these early reports. [8], 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 infections in New York City in the same period. [53] Other US cities including Detroit, Milwaukee, Kansas City, Minneapolis and St. Louis were hit particularly hard, with death rates higher than all of 1918. Centers for Disease Control and Prevention. In Ireland there was a belief that noxious gases were rising from the mass graves of Flanders Fields and being "blown all over the world by winds". [142], In New Zealand, the flu killed an estimated 6,400 Pakeha and 2,500 indigenous Maori in six weeks, with Māori dying at eight times the rate of Pakeha. [43] The Philadelphia Liberty Loans Parade, held in Philadelphia, Pennsylvania, on 28 September 1918 to promote government bonds for World War I, resulted in 12,000 deaths after a major outbreak of the illness spread among people who had attended the parade. The flu … [67] A 2006 Lancet study corroborates higher excess mortality rates in Germany (0.76%) and Austria (1.61%) compared to Britain (0.34%) and France (0.75%). [54] Overall American mortality rates were in the tens of thousands during the first six months of 1919. These outbreaks probably lessened the significance of the influenza pandemic for the public. In Ireland, during the worst 12 months, the Spanish flu accounted for one-third of all deaths. The effort resulted in the announcement (on 5 October 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered by pathologist Johan Hultin from an Inuit female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers[232] Roscoe Vaughan and James Downs. [85] For the rest of the population, the second wave was far more deadly; the most vulnerable people were those like the soldiers in the trenches – adults who were young and fit.[86]. [117], As there were no antiviral drugs to treat the virus, and no antibiotics to treat the secondary bacterial infections, doctors would rely on a random assortment of medicines with varying degrees of effectiveness, such as aspirin, quinine, arsenics, digitalis, strychnine, epsom salts, castor oil, and iodine. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%), and Fiji (5%, 9,000 people). Overall, the Spanish flu was present in England from June 1918 to April 1920 in three different waves, meaning it was in the country for just under two years. The majority of men were working along the coast during the summer and it was typical for entire families to move to Newfoundland and work. The spread of the pandemic is known to have began in spring of 1918, but Newfoundland didn't see the deadly wave until June or July, which aligns with the high demand for employment in fishery. An effort to recreate the Spanish flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, the USDA ARS Southeast Poultry Research Laboratory, and Mount Sinai School of Medicine in New York City. [105][106][107] The climate anomaly has been associated with an anthropogenic increase in atmospheric dust, due to the incessant bombardment; increased nucleation due to dust particles (cloud condensation nuclei) contributed to increased precipitation. The 2009 pandemic was caused by … [182], There were also geographic patterns to the disease's fatality. [136], Kenneth Kahn at Oxford University Computing Services writes that "Many researchers have suggested that the conditions of the war significantly aided the spread of the disease. [89] A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%). [190], A 2020 study found that US cities that implemented early and extensive non-medical measures (quarantine, etc.) These countries suppressed public reports of the viral infection and the death of soldiers. [108][109][110], While systems for alerting public health authorities of infectious spread did exist in 1918, they did not generally include influenza, leading to a delayed response. 1923. [66] The 2016 study suggested that the low flu mortality rate (an estimated one in a thousand) found among the Chinese and Southeast Asian workers in Europe meant that the deadly 1918 influenza pandemic could not have originated from those workers. [163][164], In South Africa it is estimated that about 300,000 people amounting to 6% of the population died within six weeks. A third wave of influenza occurs in the winter and spring of 1919, killing many more. [113] Nevertheless, actions were taken. suffered no additional adverse economic effects due to implementing those measures,[191] when compared with cities that implemented measures late or not at all. [60], There are various theories of why the Spanish flu was "forgotten". (By … [40] From there it spread around southern Africa and beyond the Zambezi, reaching Ethiopia in November. Bg. Maritime quarantines were declared on islands such as Iceland, Australia, and American Samoa, saving many lives. [183] There was also great variation within continents, with three times higher mortality in Hungary and Spain compared to Denmark, two to three times higher chance of death in Sub-Saharan Africa compared to North Africa, and possibly up to ten times higher rates between the extremes of Asia. The disease wasn’t Spanish at all but a misnomer of the times. [17][18] Newspapers were therefore free to report the epidemic's effects, such as the grave illness of King Alfonso XIII, and these widely-spread stories created a false impression of Spain as especially hard hit. A draft is established to increase the number of soldiers; Army begins training recruits at 32 large camps, each housing 25,000 to 55,000 soldiers. Their modeling results showed that all three factors are important, but human behavioral responses showed the most significant effects. Australia also managed to avoid the first two waves with a quarantine. Another factor is the higher mortality rate of men compared with women. [157], Although medical records from China's interior are lacking, extensive medical data was recorded in Chinese port cities, such as then British-controlled Hong Kong, Canton, Peking, Harbin and Shanghai. ", "Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature", "Transmissibility and geographic spread of the 1889 influenza pandemic", "1918 Influenza: the mother of all pandemics", "Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009", "Why the coronavirus outbreak isn't likely to be a repeat of the 1918 Spanish flu", "Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study", "First Global Estimates of 2009 H1N1 Pandemic Mortality Released by CDC-Led Collaboration", "The age-specific cumulative incidence of infection with pandemic influenza H1N1 2009 was similar in various countries prior to vaccination", "Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study", "Case fatality risk of influenza A (H1N1pdm09): a systematic review", "Seasonal Incidence of Symptomatic Influenza in the United States", "H1N1 fatality rates comparable to seasonal flu", "Open Collections Program: Contagion, Spanish Influenza in North America, 1918–1919", "Researchers reconstruct 1918 pandemic influenza virus; effort designed to advance preparedness", "Closing In On a Killer: Scientists Unlock Clues to the Spanish Influenz Virus", "Scientists Uncover Clues To Flu Epidemic of 1918", "Research on monkeys finds resurrected 1918 flu killed by turning the body against itself", "A shot-in-the-dark e-mail leads to a century-old family treasure – and hope of cracking a deadly flu's secret", "Purulent bronchitis: A study of cases occurring amongst the British troops at a base in France", "Brief communication: Rethinking the impact of the 1918 influenza pandemic on sex differentials in mortality", "The 1918 Influenza Epidemic's Effects on Sex Differentials in Mortality in the United States", "Sex‐ and age‐based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland", "The first wave of the 1918 influenza pandemic among soldiers of the Canadian expeditionary force: First Wave of 1918 FLU in Soldiers of the CEF", "Compromised constitutions: the Iranian experience with the 1918 influenza pandemic", "Using non-homogeneous models of nucleotide substitution to identify host shift events: application to the origin of the 1918 'Spanish' influenza pandemic virus", "Researchers unlock secrets of 1918 flu pandemic", "Swine flu shot protects against 1918 flu: study", "Inferring the causes of the three waves of the 1918 influenza pandemic in England and Wales", "Modeling a Modern Day Spanish Flu Pandemic", "Questioning the salicylates and influenza pandemic mortality hypothesis in 1918-1919", "The Spanish Influenza Pandemic of 1918–1919: Perspectives from the Iberian Peninsula and the Americas", "Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence", "Integrating historical, clinical and molecular genetic data in order to explain the origin and virulence of the 1918 Spanish influenza virus", "Children and encephalitis lethargica: a historical review", "Out in the Cold and Back: New-Found Interest in the Great Flu", "What the 1918 Flu Pandemic Can Teach Today's Insurers", "The 1918 influenza epidemic's effects on sex differentials in mortality in the United States", "The re-appearing shadow of 1918: trends in the historiography of the 1918–19 influenza pandemic", "Existing antivirals are effective against influenza viruses with genes from the 1918 pandemic virus", We Heard the Bells: The Influenza of 1918, Presentation by Nancy Bristow on the Influenza Pandemic and World War I, November 1, 2019, The American Influenza Epidemic of 1918–1919: A Digital Encyclopedia, Spanish Flu: The History Channel WebSite (26 March 2020), Armistice between Russia and the Central Powers, https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid=1002130013, Wikipedia indefinitely semi-protected pages, Short description is different from Wikidata, Wikipedia articles needing page number citations from November 2020, Articles with unsourced statements from July 2020, Pages using multiple image with auto scaled images, Articles with unsourced statements from April 2020, Articles with unsourced statements from May 2020, CS1 maint: DOI inactive as of January 2021, Wikipedia articles with SUDOC identifiers, Creative Commons Attribution-ShareAlike License, Chandra, Siddharth, Julia Christensen, and Shimon Likhtman. [27] Within days, 522 men at the camp had reported sick. The 2009 flu pandemic was the second H1N1 pandemic the world had seen — the first being the 1918 Spanish flu, still the most deadly pandemic in history. [11][12], The 1918 Spanish flu was the first of two pandemics caused by H1N1 influenza A virus; the second was the 2009 swine flu pandemic. In addition, the haemagglutinin glycoproteins of the virus suggest that it originated long before 1918, and other studies suggest that the reassortment of the H1N1 virus likely occurred in or around 1915. By 11 March 1918, the virus had reached Queens, New York. [249], 1918–1920 pandemic of H1N1 influenza A virus. Nursing staff, who were mainly women, celebrated the success of their patient care and did not associate the spread of the disease with their work. Spanish influenza - which did not originate in Spain - appeared in 1918 at the end of World War I and took more lives than any pandemic other than the 14th-century Black Death plague. ", Phillips, Howard. "Connectivity and seasonality: the 1918 influenza and COVID-19 pandemics in global perspective. Life expectancy dropped in males during the pandemic but then increased two years after the pandemic [247], One major cause of the spread of influenza was social behavior. [48] The 1918 flu pandemic in India was especially deadly, with an estimated 12.5–20 million deaths in the last quarter of 1918 alone. The Asian flu pandemic lasted from 1956-57 and the Hong Kong flu followed a … One hypothesis is that the virus strain originated at Fort Riley, Kansas, in viruses in poultry and swine which the fort bred for food; the soldiers were then sent from Fort Riley around the world, where they spread the disease. [79] The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. Their analysis suggests that temporal variations in transmission rate provide the best explanation, and the variation in transmission required to generate these three waves is within biologically plausible values. 90% of the population was infected; 30% of adult men, 22% of adult women, and 10% of children died. The virus became associated with Spain as a result. [156], The death toll in Russia has been estimated at 450,000, though the epidemiologists who suggested this number called it a "shot in the dark". [26] It then quickly spread to the rest of France, Great Britain, Italy, and Spain and in May reached Breslau and Odessa. Particularly in Europe, where the war's toll was high, the flu may not have had a tremendous psychological impact or may have seemed an extension of the war's tragedies. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus. Vaccines were also developed, but as these were based on bacteria and not the actual virus, they could only help with secondary infections. The 1918 influenza pandemic and human capital development", https://www.marketwatch.com/story/another-warning-from-1918-spanish-flu-for-covid-19-survival-does-not-mean-that-individuals-fully-recovered-2020-08-18, "Downton Abbey, Season Two, Episode Six Recap: Nobody Expects the Spanish Influenza! [36] The Netherlands reported 40,000+ deaths from influenza and acute respiratory disease. Any soldier that was ill and could not depart was added to the population of Halifax, which increased the case rate of influenza among men during the war. In the Four Corners area, there were 3,293 registered deaths among Native Americans. Despite its name, historical and epidemiological data cannot identify the geographic origin of the Spanish flu. The death toll is typically estimated to have been somewhere between 20 million and 50 million, although estimates range from a conservative 17 million to a possible high of 100 million, making it one of the deadliest pandemics in human history. [14][49][50][46] It primarily affected Spain, Serbia, Mexico and Great Britain, resulting in hundreds of thousands of deaths. Illinois passes a bill to create a one-year course to become a “practical nurse,” an effort to address the nursing shortage the pandemic had exposed. This affected especially WWI troops exposed to incessant rains and lower-than-average temperatures for the duration of the conflict, and especially during the second wave of the pandemic. Influenza pandemic among Canadian soldiers. [167] This huge death toll resulted from an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. During the three waves of the Spanish Influenza pandemic between spring 1918 and spring 1919, about 200 of every 1000 people contracted influenza (about 20.6 million). He reported that in thirteen studies of hospitalized women in the pandemic, the death rate ranged from 23% to 71%. Below is a historical timeline of major events that took place during this time period. Some parts of Asia had 30 times higher death rates than some parts of Europe, and generally, Africa and Asia had higher rates, while Europe, and North America had lower ones. Kahn has developed a model that can be used on home computers to test these theories. In September 1918, the Red Cross recommended two-layer gauze masks to halt the spread of "plague". [87] However, during the second wave the disease was much more serious, often complicated by bacterial pneumonia, which was often the cause of death. The pandemic is conventionally marked as having begun on 4 March 1918 with the recording of the case of Albert Gitchell, an army cook at Camp Funston in Kansas, United States, despite there likely having been cases before him. The rapid pace of the pandemic, which, for example, killed most of its victims in the United States within less than nine months, resulted in limited media coverage. [citation needed] Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks. 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. [118] Treatments of traditional medicine, such as bloodletting, ayurveda, and kampo were also applied. 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. [165] Almost a quarter of the working population of Kimberley, consisting of workers in the diamond mines, died. [57] New York City alone reported 6,374 deaths between December 1919 and April 1920, almost twice the number of the first wave in spring 1918. Worobey extracted tissue from the slides to potentially reveal more about the origin of the pathogen. [126][127] An early estimate from 1927 put global mortality at 21.6 million. [8] One group of researchers recovered the virus from the bodies of frozen victims and transfected animals with it. [242], In 2018, Michael Worobey, an evolutionary biology professor at the University of Arizona who is examining the history of the 1918 pandemic, revealed that he obtained tissue slides created by William Rolland, a physician who reported on a respiratory illness likely to be the virus while a pathologist in the British military during World War One. [183] Cities were affected worse than rural areas. Studies show a much higher mortality rates in males compared with females. During the 1918 influenza pandemic, there were no known cures or vaccinations for the virus. [180] Of the pregnant women who survived childbirth, over one-quarter (26%) lost the child. However, in Spain, which was neutral during the war, the media was able to widely report the high incidence of death from the illness. [38] From the Boston Navy Yard and Camp Devens (later renamed Fort Devens), about 30 miles west of Boston, other U.S. military sites were soon afflicted, as were troops being transported to Europe. “The 1918 flu killed more Americans than all of our country’s wars in the 20th century combined," according to the Tampa Bay Times archives. [162] The country was going through the Persian famine of 1917–1919 concurrently. This pneumonia was itself caused by common upper respiratory-tract bacteria, which were able to get into the lungs via the damaged bronchial tubes of the victims. [3][4][5], The first observations of illness and mortality were documented in the United States (in Kansas) in March 1918 and then in April in France, Germany and the United Kingdom. [113] By the end of the pandemic, the isolated island of Marajó, in Brazil's Amazon River Delta had not reported an outbreak. [70][71] However, no tissue samples have survived for modern comparison. [89], The majority of deaths were from bacterial pneumonia,[90][91][92] a common secondary infection associated with influenza. This represents a mortality rate of about 1.1% of the European population (c. 250 million in 1918), considerably higher than the mortality rate in the US, which the authors hypothesize is likely due to the severe effects of the war in Europe. In order to determine the cause of the death during the pandemic, war scientists used the Commonwealth War Graves Commission (CWGC), which reported under 2 million men and women died during the wars, with record of those who died from 1917 to 1918. The 1918 flu pandemic virus kills an estimated 195,000 Americans during October alone. [69] Hannoun considered several alternative hypotheses of origin, such as Spain, Kansas, and Brest, as being possible, but not likely. And m illions of Americans were among its victims. Similarly, in Western Samoa 22% of the population of 38,000 died within two months. Within a week the number of flu cases quintuples. [29] Failure to take preventive measures in March/April was later criticized. Several explanations have been proposed for this, including the fact that lower temperatures and increased precipitation provided ideal conditions for virus replication and transmission, while also negatively affecting the immune systems of soldiers and other people exposed to the inclement weather, a factor proven to increase likelihood of infection by both viruses and pneumococcal co-morbid infections documented to have affected a large percentage of pandemic victims (one fifth of them, with a 36% mortality rate). The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). The climate anomaly likely influenced the migration of H1N1 avian vectors which contaminate bodies of water with their droppings, reaching 60% infection rates in autumn. [198] In some areas, the flu was not reported on, the only mention being that of advertisements for medicines claiming to cure it. In late 1917 and throughout 1918, thousands of male troops gathered at the Halifax port before heading to Europe. Men had more social variation and were mobile more than women due to their work. The Spanish flu, also known as the 1918 flu pandemic, was an unusually deadly influenza pandemic caused by the H1N1 influenza A virus. [239], In June 2010, a team at the Mount Sinai School of Medicine reported the 2009 flu pandemic vaccine provided some cross-protection against the Spanish flu pandemic strain. [187], Academic Andrew Price-Smith has made the argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. [8] Some fatal cases did continue into March 1919, killing one player in the 1919 Stanley Cup Finals. (2011) used a mechanistic modeling approach to study the three waves of the 1918 influenza pandemic. [2] Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the deadliest pandemics in history. While origin theories about the 1918 virus still abound, it was assigned a country specific name: the Spanish Flu. Between September and November, a second wave of flu peaks in the United States. [177] If extrapolated from the extensive data recorded from Chinese cities, the suggested mortality rate from influenza in China as a whole in 1918 was likely lower than 1% – much lower than the world average (which was around 3–5%). Historical and epidemiological data are inadequate to identify with certainty the pandemic's geographic origin, with varying views as to its location. [194] The flu has also been linked to the outbreak of encephalitis lethargica in the 1920s. [231] This ancestor virus diverged about 1913–1915 into two clades (or biological groups), which gave rise to the classical swine and human H1N1 influenza lineages. [153] Tafari Makonnen (the future Haile Selassie, Emperor of Ethiopia) was one of the first Ethiopians who contracted influenza but survived. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old. [177], The pandemic mostly killed young adults. "’17, ’18, ’19: religion and science in three pandemics, 1817, 1918, and 2019. [44], From Europe, the second wave swept through Russia in a southwest–northeast diagonal front, as well as being brought to Arkhangelsk by the North Russia intervention, and then spread throughout Asia following the Russian Civil War and the Trans-Siberian railway, reaching Iran (where it spread through the holy city of Mashhad), and then later India in September, as well as China and Japan in October. [28] By 11 March 1918, the virus had reached Queens, New York. Encyclopedia Britannica and the Center for Disease Control indicate that the pandemic occurred in three waves. [72] Nevertheless, there were some reports of respiratory illness on parts of the path the laborers took to get to Europe, which also passed through North America. Show a much higher mortality rates were particular high in those aged 20–35 male... Hospitalized women in the midst of World War I may and June 1918 at least reported... Worobey extracted tissue from the Austrian archives suggesting the influenza pandemic for the virus had reached Queens, New.! Of researchers recovered the virus ' genetic makeup allowed it to kill the,. Both are estimated to have died among 30 million inhabitants Brazil, 300,000 died, including president Rodrigues.... 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