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SPANISH FLU OF 1918
Influenza, frequently known as Flu, is a viral respiratory disease that attacks the respiratory system, including lungs, nose, and throat caused by A and B viruses of influenza. It occurs across the globe, which significantly causes mortality and morbidity every year. The Human flu A and B illnesses cause recurrent flu epidemics nearly every single winter in the U.S. Influenza A viral infection are the primary influenza infections that cause influenza or flu pandemics, which is the global flu epidemics disease. A pandemic occurs when different, and new flu viruses emerge, contagious to human beings, and affect many people in the continents and across the globe.
Influenza A virus infection is categorized into two types based on the number of proteins on the virus’s superficial layer. They include neuraminidase and Hemagglutinin. The Hemagglutinin has 18 different subtypes, and neuraminidase has 11 different subtypes. With more than 198 different potential influenzas A subtype groupings, only 131 subtypes have been noticed in natural surroundings. The common types of flu viruses that are highly infectious and regularly circulate in human being include A(H3N2) and A(H1N1). Influenza A types are further classified in diverse hereditary clades and sub-clades. Influenza B infections are categorized into two lineages, which include B/Victoria and B/Yamagata. Both influenza A and B viruses subtypes are classified into particular groups and sub-groups commonly referred to as clades and sub-clades.
Human seasonal influenza virus. Source: CDC, 2019.
The influenza infection is complicated and continually keeps changing. The influenza virus physical arrangement makes it particularly susceptible to minor surface variations in antigens throughout replication, thus making the virus to equivocate the host’s defense mechanism. These make the influenza virus infect and re-infect individuals in the consequent years due to weak body immunity.
Due to variations of the influenza virus, people’s immunity to Flu is short-term, making large parts of the population vulnerable to influenza in the ensuing year. Influenza is a recurrent infection in moderate weather. Influenza A virus contaminates many different animals, including humans, other mammals, pigs, aquatic birds, and horses, while the influenza B virus infects only humans. Influenza A virus is a zoonotic disease, and from time to time, viruses in birds and animals jump and infect humans being.
The 1918 Spanish influenza virus was one of the severe pandemics in recent history. The pandemic influenza virus originated from pigs, while the 1957 and 1968 pandemics were said to have come into being from contact with avian species. The habitant regions of the proximity of pigs, birds, and human being played a crucial role in establishing a conducive environment for antigenic drifts and shifts. It is imperative to have an exceptional reconnaissance in such regions.
The Spanish Flu presented different signs and symptoms, including fever, which is higher in children, cough, chills, runny nose, sore throat, muscle ache, headache, and frequently extreme weakness. The virus is contagious, spread mainly through aerosols(airborne), and overcrowding in enclosed spaces. Most people who get infected with the influenza virus recover fully within 1-2 weeks. Nevertheless, severe virus complications can occur, predominantly in older people, children, and other susceptible groups with low immunity due to underlying diseases. The most common possible fatal complication of the influenza virus is bacterial pneumonia, and the other influenza complication is virus-related pneumonia, which is rare but has more severe effects.
The primary method of preventing influenza is by vaccination. Though, due to the continually varying flu viruses composition, the modification of the influenza vaccine each year is a must to match current viruses. These involve getting detailed circulating strains knowledge of different types of influenza viruses—the WHO created an International surveillance network of influenza in 1948 and became in charge of its administration. The administration system comprises of 82 countries which have 110 influenza state centers, and other four Cooperating Midpoints for WHO Research and Reference on Influenza situated in London, UK, Atlanta, USA, London, UK, Tokyo, Japan, and Melbourne, Australia.
This network assists in monitoring influenza trends globe and ensuring that the information is shared with all WHO were collaborating. The centers’ virus is isolated for research and reference for instant identification of any new strain. Selected collaborating centers are mandated to deal with specimens of animals. Influenza results from the influenza network are analyzed every February and September, and approval for the antigenic composition for the subsequent year’s vaccine of influenza is prepared by WHO and handed on to the vaccine manufacturers. The review and recommendations of February and September relate to the composition of the vaccine predictable for the northern hemisphere and Southern hemisphere in winter, respectively.
ORIGINS OF SPANISH FLU
The 1918 influenza pandemic, which is commonly known as Spanish Flu, was the deadliest in the history of Flu. The Spanish Flu was highly contagious and surged in a few months. The influenza pandemic was caused by the influenza A virus of H1N1. The duration of the Flu was from the beginning of 1918 to mid-1920, which infected over half a billion people, which was a time the world’s third population. The pandemic happened in four consecutive waves. People estimated 17-50 million lost their lives to this deadliest influenza virus in the history of all human pandemics.
In early 1918, the cause and the spread of human Flu, commonly known as influenza A virus of Spanish Flu and its associations with swine flu and birds to avian, were mysterious. Despite epidemiologic and clinical resemblances to flu pandemics of 1847, 1889, and even past, many questioned if the fatal disease could be influenza. The question resolved the 1930s when similar viruses, known as H1N1 and related to influenza, were isolated from pigs and later from a human being. Later, studies that were done for seroepidemiologic were linked to the 1918 pandemic of both viruses. Consequent research shows that the 1918 virus descendants continue in pigs enzootically.
They constantly circulated in human being, undertaking steady antigenic shift and drift, thus causing the 1950s epidemics. The emergent of Asian Flu (H2N2) in 1957 was directly linked with H1N1 virus-related descendants pandemic strain of 1918, which extincted in people circulation, though the lineage related enzootically in pigs. The H1N1 human virus re-emerged abruptly from a freezer in a laboratory. They endure to move and infect people epidemically and endemically.
In early 2006, there were two lineage descendant H1N1 virus of 1918, which persisted naturally, a human endemic/epidemic H1N1 lineage, classic swine flu(enzootic H1N1 lineage), and the human lineage H3N2 virus, which lead to porcine H3N2 lineage. The H3N2 and H1N1 lineages have been linked with lesser deaths and illnesses than the 1918 virus. However, the H3N2 lineage has been associated with higher deaths than H1N1.
Earlier and later, 1918, most influenza viruses emerged in Asia and spread across the globe. The influenza virus spread in different waves in Asia, North America, and in Europe. The first wave was described in March 1918 in the United States. There is no epidemiologic and historical data to classify the virus’s geographical source with the recent genetic analysis of the 1918 virus genome, which does not place the influenza virus in any environmental context.
The 1918 influenza virus A was not reported supposed to be for all reportable diseases, and diagnostic standards for pneumonia and influenza were ambiguous. This lead to the sharp rise of pneumonia and influenza virus-related death in the United States in 1915 and 1916 as the major of a primary lung disease widespread in December 1915. Death rates curved to some extent in 1917.
The 1918 virus pandemic had a sole characteristic, the concurrent contagion of swine and humans. The 1918 influenza A virus pandemic expressed an antigenically new subcategory, to which almost all humans being and swine were naïve immunologically in 1918. Newly written and printed phylogenetic and sequence analyses put forward that the encoding of genes neuraminidase and hemagglutinin superficial layer proteins of the 1918 infection resulted from birds like the influenza virus before the start of the epidemic. The precursor diseases had not spread to swine and humans in a few years before. In the latest gene segments, analyses of the virus support this assumption. The human and swine flu sequences regression of gene analysis acquired from 1930 to date place the preliminary transmission of the 1918 precursor infection in humans at nearly 1915–1918. As a result, the precursor was most likely not spreading widely to people until in a while before 1918. nor did the virus appear from any avian species, and its origin remains puzzling.
The 1918 influenza pandemic killed many people than World War I, which was previously known as the Great War. The flu virus pandemic was devastating documented in modern Global history. Many people succumbed to influenza in one year than Black Death Bubonic disease of four years from 1347 to 1351.
The genesis of the influenza virus is not well known, though the virus comes from China. It is thought to have originated in China in a sporadic genetic drift and shift of the flu virus. The recombination of the virus superficial layer of a protein created a new virus, which leads to the loss of people herd immunity. Lately, reconstruction of the virus from dead soldier tissue is currently being characterized genetically. The name of the influenza virus, commonly known as Spanish Flu, came from Spain after massive deaths and the early illness on 10/19/1918. There was no acknowledgment or response to the Spanish flu epidemics in military camps in March and April of 1918. It was unluckily because no single steps or strategies were applied to prepare for the surge and recrudescence of the infectious influenza virus strain in the winter. Due to lack of virus research, Incorrect application of control methods of the virus used and later criticized because the pandemic could not be overlooked in the time of winter in 1918. The military soldiers in the camps were trained on epidemics in 1918.
The viral sequence data recommend that the 1918 virus was new to people, and it was not produced from the existing or old strains of many or one genetics like those which caused pandemics of 1957 or 1968. It is conflicting because the 1918 virus looks like the bird flu/influenza from toto, a mysterious source because its segments of the genome are noticeably diverse from the genes of avian influenza. The collected specimens of wild birds show that approximately in 1918 influenza A virus DNA segment structures show a slight difference from today’s avian viruses. These indicate that there are anti genetic variations of avian viruses over extended time in their host.
Viruses which were found in the forest birds had similar gene sequence of 1918 nucleoprotein and the levels of amino acid, but different levels of nucleotide which depicts current nucleoprotein and 1918 nucleoprotein evolution of strains of the wild birds. The evolution of genes distance can be compared by ratios of identical or non-identical nucleotide substitutions. An identical substitution signifies a silent alteration of a nucleotide modification in a codon that does not replace amino acid. Commonly, a viral genetic factor exposed to an immunologic drift force displays a more significant percentage of non-identical alterations, whereas a virus on slight pressure accrues identical changes. With little or no assorted pressure is applied to identical changes, they reflect the distance of evolution.
With more identical changes of genes segment of the 1918 influenza virus sequence, it was linked with strains of wild birds though they are not likely to have emerged from the influenza virus of birds, which were similar to the sequenced today. It is noted that the 1918 virus sequences have few proteins different from avian strains, which spend a long time adapting in swine or human as the only intermediate host. The influenza virus reservoir has been acquired from rare gene segments that have not been sampled or identified. The genetic material and gene segments of all 1957 and 1968 and 1918 pandemic viruses depicts that the viruses originated from avian viruses of the Eurasian. This lead to the rise of human viruses strain, which was earlier transmitting infection as the H1N1 strain. Analysis of virus gene sequence alone does not substantiate the 1918 virus pathogenicity. Different experiments have been done to give the animal and in vitro model virulence containing 1918 genetic factors using viral constructs by reverse genetics.
Different theories are explaining the origin of the Spanish Flu. There is one which explains how the pandemic flu started in Kansas, the United States, and infected human beings from birds. The first case was reported on March 4, 1918, where Army mess cook Albert Gitchell was the first patient. During that time, the Fort Riley camp of U.S. soldiers was preparing for World War 1 in the Western Front. The Flu was endemic a month later in America Midwest, where they disembarked in the French ports and embarked on eastern seaboard cities.
The other theory explains the rare 1918 flu pandemic virulence by outlining its first outbreak was in Europe’s trenches. The virus later declines due to the lack of a host, which made it surge. The 1918 flu could not surge because it erupted in trenches occupied by soldiers who were not traveling. The virus was not virulence due to a lack of evolutionary pressure because it stayed in the trenches for days, weeks, and months. Later, the virus spread and surged in Spain and in Germany soldiers. With the censorship of flu news by war censorship regimes in many countries and Spain thinking that they were the only country enduring the flu outbreak, they got the “Spanish flu” name. The soldiers who were prisoners of war in Russia returned to Germany and spread the disease in the Soviet Union, which was newly created. Other countries in Africa, Japan, India, and China had the outbreak by May and June in 1918.
Military hospital with influenza patients in Soldiers in trenches during World War I
Switzerland, December 1918. Source: Fox media, 2020.
Source: Fox media, 2020.
HOW THE 1918 FLU CURVE WAS FLATTENED
The flattening of the 1918 flu pandemic was done by creating awareness for people to observe physical distancing, which saved many Americans. The first case of the deadly influenza virus in Philadephia was diagnosed on September 17, 1918, fast spreading. A campaign against coughing, sneezing, and spitting in public was launched by city officials to curb the spread of the deadliest virus. Due to the surge of flu cases, all public gatherings, churches, schools, and theatres were shut down. People who had signs and symptoms of influenza virus were in 1918 quarantined their homes. An increase in population, globalization, and urbanization has made it challenging to contain pandemics. These facilitate fast spread within hours across continents because of similar tools of response. Public Health strategies are applied as the only first line of defense against any pandemic without any vaccine. Different measures that are applied to reduce the spread of any pandemic include country lockdown, closing shops, restaurants, and schools, transportation restrictions, physical distancing, and banning all gatherings in public.
Getting people to comply with public health restrictions to limit the spread of pandemics is not easy. Police are used to enforce all laws established by public health, including beautiful to all those who are found not adhering to the set protocols and guidelines. These helped to cut the infection rate by 30-50%. Some cities, including New York City, closed its borders earlier after the announcement of the Influenza virus. The application of different measures such as allocation of business hours and mandatory quarantine lowered the deaths across the Eastern seaboard.
The Spanish Flu is frightening because it demonstrates that a pandemic killing tens of millions of people is very plausible in reasonably modern society. But that “reasonably modern” society was still much more primitive when it came to medicine and public health than the world of today.
People were not aware that the virus caused the 1918 influenza. Some people said bacteria caused it until researchers proved that the virus caused it in 1933. Antibiotics were discovered ten years later for treating influenza-related pneumonia. Antibiotics capable of treating flu-related pneumonia transmission and the first antiviral medications were developed in 1963—the WHO had not been formed to facilitate tracking and surveillance of severe disease outbreak. Because of war censorship by regimes, most countries across Europe lacked information about the flu outbreak.
The New York state health Commissioner ordered the closure of all entertainment places and saloons to stop the spread of influenza, which was spreading at an alarming rate. In the previous history of epidemics, no drastic actions and strategies were put in place. The deadly influenza virus spread fast across the United States with mysterious characteristics. Similar simultaneous virus emergence was documented in many navies and army camps. There was speculation that the virus could have been introduced by their enemies, where the secret service was considering without any doubt. The army said that, all people who get access and enter the camps were freeze and which was also under strict surveillance and guarded.
The virus or any other disease can be averted by bursting in the sun and outdoor air. Diseases or germs are contagious to people working in closed stores, workshops, and railroad trains due to bad air. Hundreds of people attend meeting in a poorly ventilated room except door opening when someone gets in or out. This drastically makes the virus to spread when one coughs or sneezes in the room. Some people fail to open window due to the mentality that, my neighbour will see what is inside my room thus making them desist. Prevailing of grip makes employers production handicap. People working in the workshop should take charge to make sure they are supplied with fresh air. They should wear clothes which are warm to withstand few drafts. Girls who wear mosquito nets in their waist should substitute during fall weather with something appropriate. Keeping ourselves healthy and physical fit will save fatal illness and other conditions which will help the country running.
People were advised by doctors to avoid other people or crowded places because they were in hard place and a rock with no vaccine for the Flu. Others remedies which were also suggested included drinking wine and eating cinnamon which had no scientific evidence of eliminating the virus. Doctors insisted that, people should wear masks to cover their nose and mouth while at public places. Masks could limit the spread of the deadly virus because while talking one could not spit saliva aerosol which contain flu virus which was airborne. By then, Asprin could be used to cure the infection though it was blamed for causing pandemic.
Some companies took advantage of the virus and advertised Formamints linking it with symptoms of the Flu in British papers on June, 1918 and people noticed it was vitamin tablets. Many companies made fake advertisement promising cure of the Flu, thus making a lot of money. United States citizens were offered advice of avoiding getting infected. They were highlighted to avoid shaking hands, touching library books, and shaking hands. Theatres and schools were closed, and spitting was made illegal by Health Department of New York. There was shortage of doctors as a result of World War I in some areas, and many physicians left contracted the virus and became ill. Most medical colleges, makeshift hospitals, and medical students took the place of doctors who were sick.
Despite the advance in medicine and The public health, all measures which were put in place to curb the spread of the deadly influenza virus in 1918 are still instituted today. Different kind of measure which were applied then and are used today to manage diseases such as coronavirus include: quarantine, wearing of masks, thorough hand washing for a minimum of 20 seconds, isolation of patients, physical/social distancing, avoiding overcrowding, and locking up of countries, counties or regions with surge of pandemic to limit spreading in other regions. These are ancient techniques which are also applied today and people now understands health and sick people have to be separated.
People poorly wearing mask in 1918. People properly wearing mask in 1918.
Source: Fox Media, 2019. Source: CDC, 2019
OVERVIEW OF SPANISH FLU
The Spanish Flu commonly known as strain of influenza of 1918 caused deadly global pandemic, killing people indiscriminately and killing people quickly. All those who were infected by the Spanish Flu including the healthy, old and young, and those with underlying health problems had a 10% death rate.
The virus killed almost 50 million people which was a third of the world population in 1918 making it the worst pandemic ever documented. The pandemic gained the name Spanish flu though it was questionable if it originated from Spain. It emerged in 1918 few months to the end of World War 1. The virus surged and spread very fast because of conflict which was responsible for the spread of the virus. The soldiers who were living in dirty and damp, and cramped conditions in the Western Front became ill. As a result of malnourishment, their immunity become weak. They had highly infectious illnesses which affected all ranks known as “la grippe” After three days of infection, soldiers felt better though they succumbed because of the virus. As the troops begun to return home or leave during 1918 summer, they spread the virus because they were asymptomatic and later became ill. This lead to the spread of the virus in the soldiers village, cities and towns in their home countries. Those who were infected both civilian and soldiers did not recover quickly. The virus spread fast in young adults between 20 to 30 who were formerly healthy.
There were some theories on the spread of the virus in 2014 suggesting that the virus originated in China. There were records undiscovered which explained how the virus was spread from Chinese Labour Corps across the Canada in 1918. The Chinese laborers where from rural areas who were farmers. They were sealed and transported in train containers in the country for six days and later heading to France. More than 90.000 workers in Western Front were mobilized to dig trenches, lay tracks, build roads, unload trains and repair damaged tanks.
More than 25,000 laborers from Chinese, only 3,000 ended their journey to Canadia in medical quarantine in 1918. Due to fallacies stereotypes of race, they blamed Chinese laziness for the illness and workers symptoms were not taken seriously by Canadian doctors. Laborer’s who arrived in North France had virus symptoms and many were dying in early 1918.
WHY INFLUENZA VIRUS WAS NAMED THE SPANISH FLU?
The influenza virus epidemic was first identified in Spain as a result of censorship during time of war. The nation of Spain was neutral during the time of war and strict censorship on the press was not enforced which resulted to the publish of the virus illness information freely. This lead to people deceptively believing that, the influenza virus/flu was specific to Spain hence been named “Spanish flu”. During the spring time in 1918, Spain news service send message to London, in the U.K. notifying them that, they have diagnosed new epidemic disease which had strange characteristics in the capital city, Madrid. No people had died in the time of reporting however, after two weeks, almost 100,000 contracted the Flu.
The deadly virus struck so harder and infected leading politicians and Alfonso XIII who was the king of Spain. Almost 40% of all people who were living and working in confined areas including schools, government buildings, and barracks contracted the virus. Services of telegraph were disturbed and reduction of track drivers business because many people were sick and they could not work. Hospitals were overwhelmed and could not keep the demand of people medical supplies. The Spanish influenza was embraced in Britain and British media accused Spanish weather due to the surge of the Flu by communicating that the Spanish windy spring which was dry, unhealthy season and unpleasant which facilitated faster spread. It was noted that, due to dusty winds which spread across Spain with microbe-laden, it was stopped by wet climate of Britain thus lowered cases of the Flu.
ANALYSIS OF THE SPANISH FLU
The influenza virus pandemic of 1918 killed between 20-50 million people across the globe including adults and healthy young. The Armed Forces Pathologist from Institute of Pathology extracted RNA which was viral in autopsy specimen and viral genes were sequenced from victim. Experts in different professions said that, the flu pandemic originated from birds to human being due to sequence of virus in human. In relation to the 1957 and 1968 influenza virus, viruses involved from human and avian viral sequence. The deadliest flu pandemic of 1918 had changes of amino acid which are highly pathogenic in H5N1 bird virus which succumbed a lot of people in the past eight years.
The CDC collected data from Army Forces Institute of Pathology(AFIP) and tested the pathogenicity of mice by recreating the 1918 influenza virus. In comparison of human influenza virus, the deadly 1918 pandemic virus had 40,000 times higher particles of virus in the lung tissue. It had diverse symptoms including, pulmonary edema, inflammation of bronchitis and alveoli and alveolar of haemorrhage similar to 1918 human lungs. The team substantiated that, the virus changed specific genes by creating viruses which are different with Hemagglutinin being crucial for virulence and polymerase genes being part of it. The protein of Hemagglutinin was important in pathogenesis, occurring by new ways. With the explanation of both the 1918 flu virus and the H5N1 bird virus, a novel virus with similar signs and symptoms has been witnessed, which is Coronavirus(COVID-19- with over 18 million cases in August, 2020 Worldwide and the United States leading with almost 5 million cases and over 158,000 deaths) and there are possibility of other similar flu virus which will impact negatively to both health and economy across the globe.
Transfusion of similar viruses can be used to cure people with avian flu pandemic and the development of current vaccines and treatment. A recovered patient from avian flu pandemic can donate significant plasma to treat a large number of H5N1 influenza patients. According to a study done by World Health Organization(WHO), avian flu pandemic can emerge and re-emerge, as it is was reported in 2006 with 141 cases and succumbing to H5N1. The WHO have stated that, birds plays critical role in widespread of H5N1 virus, precisely poultry which are main sources of Asian infections. High prevalence of virus in birds surges the probability of bird to people virus transmission. At point when the virus becomes contagious between human being, leads to epidemic flu. If the virus is infectious, it will move faster, and without antiviral tablets or vaccine, it will surge worldwide.
Many researchers come together to work as a team to identify the heritages and structure of the Spanish flu virus. It took years for them and other virologists to succeed. In mid-1990, Dr. Jeffrey Taubenberger and his team carried out phylogenetic and sequence analysis of 1918 flu genes and recognized that, the H1N1 which caused the Spanish Flu originated from birds. Dr. Terrence Tumpey was working to identify virus gene source in BSL3 improved laboratory situations. It included use of suit, double gloves, powered air purifying respirator(PAPR) and working inside Class II biosafety cabinet (BSC).
Dr. Jeffery Taubenberger and Dr. Ann Reid Dr. Terrence Tumpey working in BSL3
reviewing a genetic sequence from the 1918 enhance laboratory conditions. Source:
virus. Source: CDC, 1998. James Gathany, 2019.
At the same time, this new knowledge, and the ability to test the pathogenicity of different experimentally created viral mutants, which has help us identify targets for treatment and vaccination.
CAUSES OF SPANISH FLU
This devastating disease wiped out about 3.3% of the world population in addition to infecting over 30% of humanity. It was caused by a novel pathogen, H1N1, which is a viral agent with genes derived from birds. The disease spread throughout the world like wildfire between 1918 t0 1919. The causative virus, H1N1, was unique in the sense that it caused high mortality of healthy individuals aged between 15 to 34 years, reducing life expectancy in the USA by over 12 years. Its protein coat made of Hemagglutinin (H.A.) coded by the H.A. gene is essential in the entry and infection of the virus in healthy cells. Antibodies of the immune system also recognize and target the H.A. of the virus. Upon sequencing the virus, it became clear that the ancestors of the virus-infected the human race from 1900 to 1915. By 1918 the virus had gone through several adaptations to become more human and swine-like in terms of its phylogenetic development and diversity. Notably, the virus had been mutating in mammalian hosts before attaining the ability to cause a pandemic. Some alterations in influenza virus genes take place constantly as the virus replicates in a process referred to as antigenic drift, which explains the recurrence of flu seasons annually. Antigenic drift also explains why individuals catch the Flu many times in their lifetime. Despite lacking cleavage sites present in modern strains of virulent influenza strains, the Spanish flu virus was highly virulent, a feature associated with many genetic factors. One of the factors is its Neuraminidase (N.A.) gene, which codes for its Neuraminidase coat proteins. It has a major contribution to the spread of the infection by facilitating its exit from infected cells and attacking healthy cells.
Even if scholars agree that the virus causing the pandemic originated from the aves family naturally, the precise pathway from its origin until it attained its pandemic nature is largely elusive. Further, specific genetic factors that can be associated with its extraordinary virulence have not been forthcoming despite several years of intensive research. One school of thought proposes that the pandemic might have begun in Etaples within a British military base in the Northern part of France during the First World War. This key military base housed 100, 000 soldiers in an area of 12km2 characterized by sea marshes occupied by several migratory birds. Nearby multiple farms existed having geese, ducks as well as pigs utilized as the soldiers’ food, with horses utilized for transport. It is believed that the interaction of congested troops, various animals with 24different mutagenic war gases, may have sparked the outbreak of the first epidemic beginning December 1916 to March 1917.
However, other scholars believe that the pandemic may have originated from china—the transportation of Chinese laborers during World War 1 in Canada in sealed trains. Medical records revealed that over 3000 out of the 25000 Chinese laborers on transit in Canada on their way to Europe were later put on quarantine after developing flu-like symptoms. Many Chinese laborers working behind British and French soldiers in the war front are thought to have been the pandemic’s source. The significantly low death rates in China served as evidence of the proposal since it indicated greater levels of immunity possibly activated by prior contact with the pandemic virus, H1N1. Besides, historical evidence of a respiratory illness reported in the northern part of china in 1917 was found to be significantly similar to Spanish Flu. However, since the influenza virus exists in numerous forms which keep mutating from time to time, it later became extremely challenging to trace its origins. Speculations that the virus that caused the pandemic was manufactured in the lab for use as a biological weapon has also made efforts to trace its origin a daunting venture. A general consensus is that an enormous reservoir of similar viruses exists in domestic as well as wild animals with the potential to transform pandemic type pathogens through a natural reassortment process of its genetic material or human influence.
THREE WAVES OF SPANISH FLU
The pandemic which took the world as a storm spread in a wave-like manner with three main peaks characterized enormous death rates. The need to establish processes and mechanisms responsible for the multiple waves of pandemics cannot be ignored. Researchers have proposed viral evolution with effects on transmission or escape form immune responses or both environmental variation and behavioral alterations, among other possible causes of the waves. The Spanish flu pandemic occurred in three different waves, with the last one causing mortality even in 1920.
The pandemic’s initial wave struck in 1918 spring. Health officials in Kansas USA first reported the illness in a military facility. The military camp was housing the First World War troops. When the American troops entered Europe, shortly afterwards, Spain reported individuals with the disease symptoms in the middle of the month of May. Since Spain maintained neutrality during the war, its press reported the spread of the infection without any restriction resulting in the name Spanish flu. During this phase, one of the main regions of spread included Madrid, mainly due to the San Isidro festive activities occurring at the time. Many people got infected during this wave, including King Alfonso XIII. To contain its spread, the government put stringent confinement measures in place, including stopping of postal services among other services. The wave persisted for sixty days with a mortality rate of about 0.65 per thousand globally except Australia and South America, which remained free from the pandemic.
The next wave of Spanish Flu took place during the autumn season of 2018, with much worse effects compared to the first wave. A number of views have been proposed on how it spread. One of the views is that the returning home of soldiers from the war in the summertime was behind the spread; others are of the view that the Portuguese people going back home by train were the cause of the spread, while other believe a mutation of the causative virus was to blame. During the second wave, mortality rates soared, summer festivals were stopped, and religious groups were required to stop activities that could make people realize how few they were. In the city of Zamora, the mortality rate was threefold that of the rest of Spain, mainly due to church activities, which increased its spread. The wave more doctors were infected compared to the initial wave, with the spread and severity getting worse globally. Many proposals exist regarding where this phase began with thoughts revolving around f Liberia, Boston city, and Brest’s port, among other possible epicenters. Australia became one of the most hit countries despite being unaffected during the first phase, reporting over 80000 deaths, mainly due to soldiers returning from the war-front in Europe.
Year
The third wave struck in the early days of the year 1919 and was not as devastating as the second wave because most individuals in the population had gained immunity against the virus. This phase lasted for a longer period with some countries like Japan reporting cases in 1920. Over eight million individuals had passed away by the time the pandemic ended in Spain. Kids aged 1-3 years old and young adults aged between 21 and 30 were the most affected group of individuals. Even though the place of origin of the virus has never been confirmed, three cities were proposed, including Shanxi in China, Etaples in France, and Haskell in the United States of America. The tendency of this virus type to spread in wave-like spikes has made it necessary for healthcare staff to consider pathogens causing similar infections as frequently emergent diseases. In the same century, at least three related pandemics have occurred including H1N1 in 1918, H2N2 in 1957 and H3N2 of 1968.
EFFECTS ON MAJOR AMERICAN CITIES AND ITS DEVASTATION
Towards the end of summer in 1918, the second phase of the Spanish Flu had far-reaching effects on many major American cities. The spike was mainly attributed to returning soldiers from the war Europe. The pandemic initially hit Boston, then New York and Philadelphia before spreading westwards to St. Louis and San Francisco. At the end of the pandemic, about 675000 Americans had died. American cities reported varied levels of the devastation caused by the pandemic with cities executing timely and well-organized responses managing to flatten infection as well as mortality curves. Cities with slow or poorly coordinated responses bore the brunt of the pandemic. On September 28, a Liberty Loan parade in Philadelphia attended by thousands of people resulted in an unprecedented spike of the pandemic, which led to the filling to the capacity of all the 31 health facilities in the state within 72 hours and 2600 deaths after one week. Due to the magnitude of the devastation caused by pandemic, massive resources have been allocated to fund research meant to investigate how pandemics arise and practical techniques of mitigating their effects.
An example of a city that responded in a timely and organized manner to flatten the infection curve in St. Louis. Before reporting the first case of the pandemic, the city’s health commissioner directed health workers to be on high alert and publicized the importance of keeping off from crowded places. When the Flu spread from a military camp into the general population, the commissioner did not hesitate to close schools, pool halls, movie theatres, and outlaw public assemblies. These and other measures ensured that the peak death rate in St. Louis was merely an eighth of cases reported in Philadelphia. On the other hand, San Francisco enforced the wearing of masks with the hope that it will help flatten the infection curve the regulation eventually became law with anyone found in public with no mask on or wearing it wrongly was charged $5. However, it later became apparent that the gauze masks that were thought to be 99 per cent effective in offering protection against the virus were not effective. Never the less the city recorded relatively low infection rates attributed to the closure of learning institutions, the prohibition of public gatherings as well as the closure of entertainment joints. San Francisco was worst hit in the third wave of the pandemic in January 1919 when the public who largely believed it was wearing masks that protected them rebelled against social gathering regulations leading to one of the highest mortality rates at the time.
The USA is one of the countries that experienced some of the worst effects of this pandemic. It caused devastating effects so adverse that they are evident even today. Currently, research is still ongoing to unravel the intricacies of the causative pathogen. Burial activities significantly spiked during the fall season, with one family of 12 residing in Pleasant Unity losing eight members in just one week. The deaths caused by the pandemic affected those left behind in psychological, economic, social ways. Children who lost their parents or guardians to the pandemic were left with no option but to fend for themselves. Moreover, the pandemic seemed to perpetuate disparities in conditions underlying various sections of society, such as health conditions, cultural disparities, war, slavery, crowding, and poverty. The subtle balance between the H1N1 virus and the host dynamics and social factors have been significantly influential in focusing transmission patterns, mechanisms of spreading, and the pandemic’s health effects. The pandemic further offered valuable lessons o strategies of handling future pandemics through community, government, and family response measures meant to flatten infection curves, especially of the Covid 19. Containing pandemics depends on the timely, well organized, and collective efforts by all those involved. Any efforts to safeguard personal, business or religious interest would only result in the spiking of infections and subsequent devastating effects on the family, health systems, government services as well as economic prospects of the whole society.
CONSEQUENCES OF THE SPANISH FLU
- Deaths
It is estimated that Spanish Flu murdered 2.7% of people globally. High mortality rate happened between the 20-40 years as shown in graph 1. The lower the age the higher the mortality rate. The epidemic took place in three sessions; initial took place in the summer period of 1918, succeeding during the end of 1918, and the final during the initial months of 1919. Second period from October to December 1918 recorded high rate of mortality rate as compared to first session of Spanish flue from July to September 1918. Third session of Spanish flue was moderately small. The statistics that took place in some cities of England, United States and Norway (Vaughan 1921; Great Britain Ministry of Health 1920; Hanssen 1923; Collins 1931; Britten 1932) shows a clear picture on how Spanish flue affected individuals based on age-sex. The research shows that the influenza impacted negatively on individuals during the summer session.
Source: Commonwealth Bureau of Census and Statistics,1920.
High mortality rates was seen in countries such as India which had large number of population. Research shows that high mortality rate was seen in weighted countries than those countries with less weighted.
- Mental and health disorders
Individuals who survived the epidemic were observed to have disorders such as, depressions, dizziness, low blood pressure, sleeping, heart problems, ear illness, hepatitis, deafness, blindness, baldness, and lung tuberculosis. Furthermore, people who survived Spanish flue developed sleeping sickness disorder (encephalitis lethargica). The sleeping sickness was common among youths (10-30 years), and the case is more prone in men than in women. In addition, approximately one million individuals of world population were infected by Spain flue and it was reported that half of the people died of the sleeping sickness in the bout 1919-1928. In the case of Norway, 268 cases and 52 deaths were announced. However, the figure of Norway (1.0) tend to be low per 1000 as compared to Sweden (3.0) and Denmark (5.9). It was reported that Spanish influenza survivors developed coronary heart disease (CHD) in their later life. After 1920, men recorded high number individuals who had infected with coronary heart disease as compared to women. Correspondingly, Spanish influenza increased cases of alcohol consumption and suicides and this resulted from increased psychological health disorders. Major causes of suicides was social isolation that resulted from closure of schools, churches, theatres and so on. Furthermore, loss of relatives and couples from Spanish influenza took part in many suicides.
- Shortage and rationing
During Spanish influenza epidemic, some foods were rationed due to scarcity and inflation. Youths were greatly affected due to malnutrition and weight loss in the year 1918. The session of rationing resulted to loss of lives among youths which directly affected future generation.
- Mass emigration and selection
Migration of men 1920s built a selection mechanism as women were left behind. For instance, Norway, male and female who were born in 1865-85 were decreased by 30 and 20 percent because of emigration.
- Deterioration of economy.
In the months of October 1918 in United States, there was a decrease in 40- 70 percent in sales departmental stores and merchants. Similarly, there was a decrease in Gross Domestic Product per capita by about 6 per cent in classic countries in a session of 19187-1921. Spanish Flu reduced the manufacturing productivity of United States by 18%. Many industry sectors declined due to scarcity of labor caused by high mortality rates that left less individuals to provide man power.
- Loss of Employment
In Australia, 25- 40 per cent of retailers collapsed due to Spanish flu epidemic. This caused unemployment as most businesses relocated in areas which was unaffected. In addition, some businesses reduced employees due to reduced orders.
- Social isolation
Typical countries had quarantine response in order to prevent high spread of the influenza. Isolation of individuals made their family members to feel like they have been isolated.
TREATMENT OF SPANISH FLU
During 1918 epidemic, physicians did not have any idea about Spanish flue treatment. Medical physicians took the flue to be caused by Baccilus influnzae. They separated the types of bacteria under a microscope which they called very small agents. In 18th century vaccine for small agents had been discovered. The process of discovery took another step in 1931 where Richard Shope conducted a study on a pig that had swine flu by applying same procedures used earlier on discovering causes of yellow fever.
In the year 1936, Richard discovered that people who associate with pig gardens had closeness with swine disease. Moreover, complicated innovations went at Vanderbit University. Scientists were in a position to identify two common flu viruses, namely A and B. After identification of viruses, researchers started to discover new vaccines in 1930s to treat the Flu. The use vaccine influenza started working on soldiers in United States in 1944 and went on to civilians in 1945. After the research on the vaccine, results showed that immunity of one virus counteracted the immunity of the other.
Epidemiological studies indicated the importance of wearing facemasks which prevented Spanish Flu from spreading from host to unaffected one. Influenza A can be treated on its own by having some rest. In some cases, medical physician may instruct individuals to use Zanamivir, oseltamivir and peramivir. Fortunately, prescriptions prevent Virus A from spreading within cells. However, they causes vomiting and nausea. It is advisable for one to visit a doctor if the situation persists. There is an invented medicine known as baloxavir marboxil (Xofluza) from Japanese pharmaceutical company. The medicine was accredited in United States 2018 under Food and Drug Administration (FDA). Anal vaccination tend to be the best method of preventing the influenza. The spread of disease may also be prevented through washing your hands regularly, avoiding large crowds, specifically during a flu outbreak, covering your mouth and nose during sneezing, staying home after being affected by fever and 24 hours after recovery. Virus A is most dangerous infection that may cause death if not well treated.
San Francisco residents wearing masks, which Philadelphia Hospital with Spanish Flu
Protected the surge of the virus. Patients. Source: Fox media, 2020.
Source: Fox media, 2020.
– Causes,
– The Three Waves of Spanish Flu,
– How the Flu Affected Major American Cities & Devastation it Caused
– Consequences of Virus,
– Spanish Flu Treatments,
– Lessons from History.
Inserting statistics (some graphs are welcome).
Welcome advice from the author.
Excellent English is recommended.
Commercial book for United States publication.
Thank you!