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home : health : health October 21, 2018

1/23/2018 2:02:00 PM
The deadliest flu outbreak
The Spanish Flu ward at Walter Reed Hospital, 1918. photo public domain
+ click to enlarge
The Spanish Flu ward at Walter Reed Hospital, 1918. photo public domain

By Jim Cornelius
News Editor

I had a little bird

Its name was Enza

I opened the window

And influenza

- Children's rope-skipping rhyme, early 20th century

Flu season has been especially severe across the nation. Here in Central Oregon, flu cases have strained the capacity at St. Charles Medical Center. Some who have had the misfortune to be hit with it say it's the nastiest bug they've ever grappled with.

Influenza A - H3N2 - is the prevalent strain this year, according to the Centers for Disease Control. CDC reports that H3 viruses often lead to more widespread and more serious cases of the flu, especially in young children and elderly adults.

Bad as it is, this flu season cannot compare to one that occurred exactly 100 years ago - a pandemic that has been called the greatest medical catastrophe in human history.

What was then known as the Spanish Flu hit Europe and the United States in a lethal storm in early 1918, as the world limped into what would be the fourth and final year of the First World War. Illness had started cropping up late in 1917, but mutations and rapid spread due to wartime conditions pushed the accelerator to the floor in early 1918. The influenza came in two waves, the second wave deadlier than the first. In the wake of the global pandemic, some 675,000 Americans had died. Globally, the pandemic took the lives of as many as 50 to 100 million people. Strangely, many of them were otherwise healthy young adults.

s s s

The origin of the flu remains mysterious and controversial. Some researchers believe it originated in Asia and was brought to Europe among some 96,000 Chinese laborers mobilized for the Western Front in France. A strain of upper respiratory virus loose in northern China in 1917 was thought to be identical to the Spanish Flu. Chinese researchers, not surprisingly, dispute that research and argue that the flu was circulating in Europe well before the pandemic outbreak.

Why "Spanish" flu? Wartime censorship suppressed the extent and severity of the outbreak on the Western Front in France and Belgium - which was affecting all armies. But news from neutral Spain, where censorship did not reign, revealed the fearful toll. King Alphonso of Spain nearly died of it. With all of the news about the flu coming out of Spain, the media and the public hung the moniker Spanish Flu on the deadly virus.

And deadly it was - so deadly that some victims were fine in the morning and dead by nightfall. The youth and vigor of many of its victims posed a horrific puzzle for doctors.

The war crowded thousands of people together and moved them in unprecedented masses across continents, which doubtless contributed to rapid spread. War-related malnourishment, especially in Germany, which was feeling the severe pinch of an Allied naval blockade, may have reduced resistance. But no one factor readily accounts for the extreme lethality of the 1918 outbreak.

Modern researchers surmise that the special virulence of the Spanish flu, and the profile of its victims, point to the flu triggering a "cytokine storm," a hyperactive immune response that overwhelms the body. Counterintuitively, in such cases a strong immune system - as in a young, vigorous man or woman - was a liability.

Deaths spiked in the second wave of the pandemic in October 1918, but then flu cases dropped off significantly. Public health measures to prevent spread, better treatment of the pneumonia that took off many victims, and/or a mutation to a less-lethal strain may account for the dissipation of the pandemic - but no one really know for sure.

Despite having killed more people by far than the Great War itself, the flu pandemic of 1918 is little remembered today. The war ended, the flu dissipated, the '20s roared. Then the world fell into the twin catastrophes of the Great Depression and the Second World War, which overshadowed the earlier crisis and pushed it into the shadows of historical memory.

But every time influenza strikes hard - as it did most recently in the 2009 Swine Flu pandemic - the specter of 1918 rises to haunt us. For pathologists and public health officials know that someday a pandemic on the scale of 1918 WILL come again.

This, miserable as it is, is not that year.

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