Sunday Favorites: The Influenza Pandemic of 1918

The 1918 influenza pandemic was the deadliest outbreak of the 20th Century. It became a public health crisis when it spread worldwide during WWI. It is estimated that about 500 million people or one-third of the world's population became infected with this virus. The number of deaths was at least 50 million worldwide with about 675,000 occurring in the United States, according to the Center of Disease Control (CDC).

Although there is not universal consensus regarding where the virus originated, it was first identified in U.S. military personnel in spring 1918. In fact, more U.S. soldiers died from influenza than did in WWI.

To maintain morale, World War I censors minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States. However, in neutral Spain, newspapers were free to report the epidemic's effects such as the grave illness of King Alfonso XIII. The articles created a false impression that the pandemic was primarily in Spain. Because of this inaccurate perception, the pandemic's nickname became "Spanish flu."

The outbreak was a public health crisis for a variety of reasons. For one, the crowded barracks housing soldiers were a perfect breeding grounds for disease. There was a shortage of medical staff in the U.S. since many had gone to help with war efforts overseas. With no vaccine to protect against the infection and no antibiotics to treat secondary bacterial infections that can be associated with it, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

Mortality was high in people younger than 5 years old, and 65 years and older. However, it was the high mortality in healthy people in the 20-40 year age group, which was perplexing to medical experts. While the 1918 H1N1 virus has been researched, the properties that made it so devastating are not well understood.

A 2007 analysis of medical journals from the period of the pandemic found that the viral infection was no more aggressive than previous influenza strains. Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene promoted bacterial superinfection. This superinfection killed most of the victims, typically after a somewhat prolonged death bed.

Let's hope that the current pandemic isn't as deadly and stick to our new routines of self-quarantine as best we can to contain and defeat it in its tracks.