THE GREAT FLU also known as the SPANISH FLU 1918, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. This virus was broke out at the very end of the World War 1 and lasted for nearly two years, from March 1918 to December 1920. About 500 million people were infected across the world, which had at the time a population of 1.80 billion people. It killed 50 million to 100 million people. This was 3%-5% of the world's population at that time. It was one of the greatest natural disasters in human history.
NAMING OF THE FLU:
This pandemic was known by many names by place, time and context. Clinical indications in common with the 1918 pandemic included rapid symptom progression to a "dusky" heliotrope cyanosis of the face. This characteristic blue-violet cyanosis in expiring patients led to the name 'Purple Death'.
* Besides this two names The Great Flue and Purple Death, in the spring of 1918, British soldiers called it 'Flanders flu',
* German soldiers used 'FlandernFieber' (Flemish fever).
* In Senegal it was named 'Brazilian flu' In Brazil, 'German flu'.
* In Spain it was also known as the 'French flu' or the 'Naples Soldier'.
* French military doctors originally called it 'disease 11'.
* German doctors called it 'pseudo influenza',
• In Africa, it was called as 'influenza vera'.
A children's song from the 1889–90 flu pandemic was shortened and adapted into a skipping-rope rhyme popular in 1918. It is a metaphor for the transmissibility of 'Influenza', where that name was clipped to the apheresis 'Enza':
“I had a little bird
And its name was Enza
I opened the window
And in-flew-Enza’’
The propaganda behind the naming of this flue as “Spanish Flue”
During World War I, the warring nations (including the United States, the United Kingdom, France, and Germany) imposed strict censorship on the press to maintain morale and prevent any news that could be seen as detrimental to their war efforts. For this reason reports of the influenza outbreak were suppressed or downplayed in these countries. But in case of Spain which was not involved in the war, did not impose the same level of censorship on its press. As a result, when the flu began to spread and cause significant illness and death, Spanish newspapers openly reported on the epidemic. King Alfonso XIII of Spain was also reported to have contracted the flu, further bringing attention to the outbreak in Spain. Because Spain was one of the first countries to report extensively on the outbreak, the perception arose that Spain was the epicenter or origin of the pandemic. This led to the misnomer "Spanish Flu," even though there is no evidence that the virus originated in Spain.
TIMELINE:
This pandemic 1918-1919 occurred in three primary waves:
1. First Wave
2. Second Wave
3. Third Wave
First Wave (Spring 1918):
The pandemic is conventionally marked as having begun on 4 March 1918 at Camp Funston in Kansas, United States. This initial wave appeared in the spring of 1918. It was relatively mild compared to the later waves. Symptoms were typical of seasonal flu, and the mortality rate was not unusually high. In the United States 75,000 flu-related deaths were reported in the first six months of 1918. In Madrid, Spain, fewer than 1,000 people died from influenza between May and June 1918.
Second Wave (Autumn 1918):
The second wave of the 1918 pandemic was much more deadly than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. October 1918 was the month with the highest fatality rate of the whole pandemic. In the United States, 292,000 deaths were reported between September–December 1918. The Netherlands reported over 40,000 deaths from influenza and acute respiratory disease. Bombay reported 15,000 deaths in a population of 1.1 million. The 1918 flu pandemic in India was especially deadly, with an estimated 12.5–20 million deaths in the last quarter of 1918 alone.
Third Wave (Winter 1918 - Spring 1919):
The third wave occurred during the winter of 1918-1919 and into the spring of 1919. It was less severe than the second wave but still more lethal than the first. The third wave caused significant illness and death, particularly in Europe and North America.
SIGNS & SYMPTOMS:
The majority of the infected experienced only the typical flu symptoms of-
* sore throat,
* headache, and
* fever, especially during the first wave.
However, during the second wave, the disease was much more serious, often complicated by bacterial pneumonia, which was often the cause of death. This more serious type would cause heliotrope cyanosis to develop, whereby the skin would first develop two mahogany spots over the cheekbones which would then over a few hours spread to color the entire face blue, followed by black coloration first in the extremities and then further spreading to the limbs and the torso. After this, death would follow within hours or days due to the lungs being filled with fluids.
Other signs and symptoms reported included:
* spontaneous mouth and nosebleeds,
* miscarriages for pregnant women,
* a peculiar smell,
* teeth and hair falling out,
* delirium,
* dizziness,
* insomnia,
* loss of hearing or smell, and
* impaired vision.
The majority of deaths were from bacterial pneumonia. This pneumonia was itself caused by common upper respiratorytract bacteria, which were able to get into the lungs via the damaged bronchial tubes of the victims. The virus also killed people directly by causing massive hemorrhages and edema in the lungs. Modern analysis has shown the virus to be particularly deadly because it triggers a cytokine storm (overreaction of the body's immune system).
CAUSALITIES:
Due to World War I, many countries engaged in wartime censorship, and suppressed reporting of the pandemic. For this the accurate number of death and infected could not be record. Many survey by different countries and journals proposed that about 500 million people globally were infected by this flu. This amounted to about 33% of the world’s population at the time. In addition, the Spanish flu killed about 50 million people. Here is a general overview of death tolls by country based on historical research:
* India was hit particularly hard, where between 12 and 17 million people died. This represented approximately 5% of the population.
* In Finland, approximately 210,000 people were infected, and about 20,000 people died.
* In Sweden, approximately 34,000 people died.
* In Japan, approximately 23 million people were infected with the Spanish flu, and approximately 390,000 people died.
* Similarly, in Western Samoa 22% of the population of 38,000 died within two months.
* In Brazil, approximately 300,000 people died, including the president Rodrigues Alves at the time.
* In the Dutch East Indies (now Indonesia), 1.5 million were assumed to have died among 30 million inhabitants.
* In Istanbul, capital of the Ottoman Empire, 6,403 to 10,000 died, giving the city a mortality rate of at least 0.56%.
* In New Zealand, the flu killed an estimated 6,400 Pākehā and 2,500 indigenous Māori in six weeks.
* In Australia, the flu killed around 12,000 to 20,000 people.
* In the UK, as many as 250,000 died; in France, more than 400,000.
* In Ghana, the influenza epidemic killed at least 100,000 people.
* 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".
FIGHTING WITH THE FLU:
When the 1918 flu hit, doctors and scientists were unsure what caused it or how to treat it. Unlike today, there were no effective vaccines or antivirals, drugs that treat the flu. Complicating matters was the fact that World War I had left parts of America with a shortage of physicians and other health workers. And of the available medical personnel in the U.S., many came down with the flu themselves.
Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students. Officials in some communities imposed quarantines, ordered citizens to wear masks and shut down public places, including schools, churches and theaters. People were advised to avoid shaking hands and to stay indoors, libraries put a halt on lending books and regulations were passed banning spitting.
END OF THE FLU:
By the summer of 1919, the flu pandemic came to an end. As the virus spread rapidly, many people were infected, and those who survived developed immunity. Over time, a significant portion of the population became immune, reducing the virus's ability to spread effectively.
This article is taken from the Galen Gazette, July 2024, Issue No. 03. The author, Sakib Hasan, is a fifth-semester pharmacy student at Comilla University.
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