Why the second wave of the 1918 Spanish flu was so deadly

https://www.history.com/news/spanish-flu-second-wave-resurgence

258 188 6 years ago

"The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims"

"Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged that had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection."

I knew this, but its still utterly terrifying to see it expressed so bluntly.

As the article says, rapid population movement was a key factor in its spread and mutation. We can't take the world back to a time when international travel was rare, so when we're done with the immediate effects of the Covid-19 pandemic, we (as a species) need to get better at rapid vaccine creation. Like an order of magnitude better. Otherwise the next one could be one that takes us down.

avip3• 6 years ago

Can we not? Why can't Australia for example close all borders and call it the day?

saagarjha• 6 years ago

Because Australia already has a number of cases?

mikekchar• 6 years ago

For one thing, most countries are not self sufficient in basic necessities (not even food!). You could do it for a very short time, but not sustain it. Also, the economy of the country depends on international trade. Modern economies actually don't have a lot of slack. If you shut down trade, quite a few companies will just go under. You would have to back that up with huge subsidies. It would be a massive undertaking.

andyjohnson06• 6 years ago

In addition to the reasons others have given (self-sufficiency, and it being too late this time), closed boarders as a general and ongoing solution is very brittle. All it takes is one infected person to get across the border and you have no defence-in-depth. As a short-term measure in combination with other public health efforts, it might have some merit, but thats all really.

ailideex7• 6 years ago

need to get better at rapid vaccine creation.

What is stopping you from making a vaccine for COVID-19? I can promise you nobody will be upset with you if you do it, you don't need anyone's permission either.

khafra• 6 years ago

I don't think he's saying vaccine creation is easy, I think he's saying it's a hard problem that needs a concerted effort at developing shortcuts.

Also, this is technically true, but vacuous:

What is stopping you from making a vaccine for COVID-19? I can promise you nobody will be upset with you if you do it, you don't need anyone's permission either.

Even if by some herculean effort and unbelievable luck, I brewed up a Covid-19 vaccine in my garage, I would be unable to help people at scale with it unless it passed millions of dollars worth of testing for regulatory approval.

flarg2• 6 years ago

Do you think a vaccine is the right answer? Surely development and stockpiling of anti virals is the key, Tamiflu or similar. The lead time for vaccines will also be far too long and the protection against flu like illnesses is variable over time. What do you think?

andyjohnson06• 6 years ago

Surely development and stockpiling of anti virals is the key, Tamiflu or similar.

Tamiflu doesn't have any effect on Covid-19. There might be antivirals that are effective, and testing is happening now. I'd argue we should be trying to find ways to speed that process up for next time.

The lead time for vaccines will also be far too long and the protection against flu like illnesses is variable over time.

Thats what I was saying: can we (humans) get better/faster at doing this?

46Bit• 6 years ago

The protection of antivirals is variable too. The value of Tamiflu itself still seems controversial.

wbl2• 6 years ago

Tamiflu blocks neuramidase from releasing the viral particles. Coronavirus does not bind to salic acid so neuramidase is irrelevant.

hef198989• 6 years ago

International travel, especially between Europe and the US, was very much a thing back in 1918. Even more so for the younger, male population who tended to be packed in ships for the journey.

andyjohnson06• 6 years ago

I'm not saying there was no international travel in the early 20th century, just that the numbers are massively higher now.

raphaelj• 6 years ago

The article does not answer the question, except for "it mutated"

gambiting7• 6 years ago

Does it not? It clearly says that countries like the UK knew full well that the best way to combat the illness was to isolate and quarantine people and cities, but decided not to do it to avoid harming the war effort - resulting in a lot more deaths. How is that not an answer to this question?

Spare_account• 6 years ago

I'm watching the UK government decide not to implement 'delay' measures today, ostensibly to protect the economy. It seems there is always a reason not to do the right thing.

I hope they change their mind very soon.

fnord123• 6 years ago

I think GP was wondering why the flu was so deadly per person rather than how it racked up a huge body count. The article explains the body count but not why any particular person would die at a higher rate than another strain of flu.

sschueller2• 6 years ago

All interesting but you just can't compare a Flu in 1918 with today.

The list is endless of what we didn't have in 1918, from computers to do DNA sequencing to even testing the way we do today.

poooogles• 6 years ago

The list is endless of what we didn't have in 1918, from computers to do DNA sequencing to even testing the way we do today.

And the vast majority is useless to people when you've got 100x more patients than you can deal with.

sschueller2• 6 years ago

China was able to build a 645,000-square-foot medical facility in 10 days with 30 ICU units and 1000 beds. Coordinating such a feat in such a short time would not have been possible in 1918.

ethbro2• 6 years ago

Genetic sequencing and RT-PCR are still pretty useful.

You're essentially making the claim that having electricity is worthless, if there isn't enough for everyone to run a heater. Apples and oranges.

dsun180• 6 years ago

Also we have some disadvantages we didn't had 1918. Like most people living in dense cities. Or it is harder to force people into quarantine.

falcor84• 6 years ago

harder to force people into quarantine

I don't think that's true, case in point being the (eventual) Chinese response in Wuhan, which appears to be extremely effective (if you trust their figures). It's all about government determination, which is mostly missing now, just as it was then, based on the article.

usrusr2• 6 years ago

And supply chains! There are many things that a 1918 city could manufacture in an emergency that a 2020 city can't.

dsfyu404ed• 6 years ago

I think there's a quantity/quality difference between the cities of 1918 and today. Even if we have more people in cities today cities in 1918 had much, much worse health and cleanliness practices and allowed much more opportunity for disease to spread.

gimboland• 6 years ago

Or it is harder to force people into quarantine.

From the article:

Harris believes that the rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime.

jbay808• 6 years ago

Probably our biggest disadvantage compared with 1918 is widespread air travel.

moosey• 6 years ago

Enormous quantities of elderly people who will need to be hospitalized, and without will get added to the death toll.

avip3• 6 years ago

What make the diff is sanitation and effective communication, not DNA sequencing.

DSingularity• 6 years ago

As the article notes, most the deaths of the Spanish flu were due to the bacterial infections which subsequently emerged in the patients. These would be prevented by modern antibiotics.

jeltz• 6 years ago

Not all of them. People die in the west even today from bacterial pneumonia caused by the flu.

Fragoel2• 6 years ago

I think this article sums up quite effectively the differences between now and then: https://www.theguardian.com/world/2020/mar/07/coronavirus-re...

everybodyknows• 6 years ago

This article was amended on 7 March 2020. An earlier version wrongly stated that “a solution of ethanol, hydrogen peroxide and bleach will disinfect surfaces"

Hydrogen peroxide and ethanol, when sprayed into a combustion chamber, make a dandy rocket propellant. Mix 4:1, H2O2:ethanol. Theoretical specific impulse of 245 seconds. Source: table from poster published by Rocketdyne division of North American Aviation Inc, early '60s (gift from Dad)

Reader confidence in the author's scientific chops somewhat diminished.

HlessClaudesman• 6 years ago

Yes, but we are now more populous and densely packed, somewhat negating out technological progress.

heavenlyblue• 6 years ago

It was World War I raging at the time, how more densely packed can you be than a bunch of soldiers sitting in a mudded trench?

bluGill3• 6 years ago

While we are more populous, because of smaller families and urban sprawl we are less densely packed.

The above applies to the US, and to a lesser extent Europe. In Asia is probably isn't true for various reasons.

DyslexicAtheist• 6 years ago

counterpoint: what percentage of the world population has access to that?

matwood• 6 years ago

Just basic hygiene is much better than in 1918. I think it's instructive to look at the Spanish Flu, but I agree that too many people are using it to draw direct comparisons. With respect to viral spread, many things are greatly improved today as you mention, but some are worse (such as the ease of global travel).

coldtea2• 6 years ago

When you die from a disease it doesn't really matter what gadgetry is available in your era though...

COGlory• 6 years ago

Not to mention influenza has a segmented genome that makes it exceptionally good at mutating, whereas Corona viruses have much more stable genomes, comparatively.

notacoward• 6 years ago

Yes, you can compare. There are differences - there are always differences - but there are also similarities. Any reasonably smart person can pick out some signal from the noise, if they just try. Meanwhile, those who do not learn the lessons of history, etc. And contrarians (using the polite term) are gonna do their thing too, no matter how injurious, because its fun for them.

koheripbal2• 6 years ago

This thread is too vague to be meaningful.

nogabebop23• 6 years ago

It was also far easier to prevent global travel, specifically individuals, like we have today. The changes cut both ways...

fxj2• 6 years ago

There is a very good post from univ oxford on this topic:

https://ourworldindata.org/spanish-flu-largest-influenza-pan...

which provides more scientific background and real numbers and compares it with other flu pandemics and the ongoing covid pandemia.

fxj2• 6 years ago

Differences in health systems and infrastructure also matter. The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perhaps most, were not caused by the influenza virus itself, but by secondary bacterial infections. Morens et al (2008) found that during the Spanish flu “the majority of deaths … likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria.

Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.

OJFord• 6 years ago

Haven't many of the COVID-19 deaths also been due to pneumonia?

rimliu• 6 years ago

Yes, but this time its viral pneumonia.

malandrew• 6 years ago

I'm also curious about how many were due to a cytokine storm and multiple organ failure.

onetimemanytime2• 6 years ago

can the system dispense as many as needed antibiotics in time? Or, I guess, they just drop them via helicopter...even if it means that some will be taken for no reason

dragontamer• 6 years ago

The Spanish flu hit the world in the days before antibiotics were invented;

IIRC: Antibiotics and germ theory were invented. But the scientific community and the medical community weren't fully on board yet.

eloff• 6 years ago

Germ theory goes back a lot longer. It was well accepted by 1918.

btilly3• 6 years ago

You are confusing two things. AntiSEPTICS and germ theory were both well established by the Spanish Flu. AntiBIOTICS were not. In other words we knew how to prevent surgical infection but not how to treat a bacteria that had already settled into someone's body.

Louis Pasteur came up with and proved the germ theory in the 1860s. Joseph Lister proved in 1865 that carbolic acid would prevent infection in surgery. Adoption took many years, but by the 1880s antiseptic surgery was widely adopted and Lister was made a baronet in recognition.

The Spanish flu was 1918, decades after the widespread adoption of antiseptics.

The first antibiotic, penicillin, was discovered in 1928. But it did not enter medical use until 1942. This was not a result of doctors resisting a good idea though. Penicillin is created by a bacteria. How do you produce useful quantities of a substance that in concentration kills the very thing that produces it?

branko_d• 6 years ago

According to Wikipedia (https://en.wikipedia.org/wiki/Penicillin#Discovery):

"The effects of penicillium mould were finally isolated in 1928 by Scottish scientist Alexander Fleming"

koheripbal2• 6 years ago

...kind of like how today we have anti-virals, even for covid-19, which aren't being widely distributed.

wusher• 6 years ago

Continuing with that thought, the correct dosages of drugs like aspirin were still being worked out. Aspirin was common treatment for the Spanish Flu, but an overdose of aspirin causes a build up of fluid in the lungs making pneumonia worse.

https://www.sciencedaily.com/releases/2009/10/091002132346.h...

all_blue_chucks• 6 years ago

We can now treat bacterial pneumonia, but COVID-19 causes pneumonia directly, unfortunately.

cletus• 6 years ago

There's a surprising amount of well-intentioned but misinformed speculation in this thread.

"We don't know" is the best answer to a lot of the questions about Spanish flu. What we do know is that it disproportionally killed young, healthy people who could go from no symptoms to dear in 24 hours. There's a lot of speculation as to why. I've seen medical experts theorize this is likely due too a cytokine response, meaning basically that a healthy immune system goes nuts. Apparently there are other diseases that have fit this pattern.

The mortality rate is estimated at about 3%. Influenza is 0.1%. Coronavirus is somewhere between those.

Best guess of why the second wave was so deadly was due to a mutation that likely happened in Europe.

It's true we have things we didn't in 1918 but we still have surprisingly few tools to combat viruses. Fun fact: only one virus has had a cure developed and that was Hepatitis-C in recent years. To be clear, vaccines != cures.

We also have problems we didn't have in 1918, specifically mobility of people. It's that mobility combined with people being highly contagious while being asymptomatic that makes this particular diseases such a challenge.

TheCondor• 6 years ago

Thanks for this, I was going to say that we have had to infer most of the details about it or earlier pandemics.

kakwa_2• 6 years ago

The mortality rate of Covid-19 seems higher than that.

The around 3% mortality rate is what you get by dividing the number of deaths by the number of infection (past and present) (as of today: 5359 / 140875 = 3.8%).

But this is incorrect as the number of currently infected people is quite high (half the total number of infections) and unfortunately, a few will die in the near future.

If you divide the number of deaths by (recovered + deaths), the mortality is much higher (as of today: 5359 / (70174 + 5359) = 7.1%).

Which seems actually about as high as the Spanish Flue right in between the low and high estimate (20M/500M, 50M/500M). And it's source for worries since our medical systems are 1) much more developed than in 1918, and 2) they are not yet completely overloaded. If it were to spread rapidly and overload our health systems, the mortality rate could rise even more, let's hope it doesn't reach that level.

dntbnmpls• 6 years ago

The mortality rate of Covid-19 seems higher than that.

Sure if you intentionally mislead people by cherrypicking data.

The around 3% mortality rate is what you get by dividing the number of deaths by the number of infection (past and present) (as of today: 5359 / 140875 = 3.8%).

140875 is the number of confirmed and tested infections. The number of actual infections is certainly much higher. So the mortality rate is most likely much lower than 3.8%. After all, most coronavirus infections are mild for the vast majority of people.

If you divide the number of deaths by (recovered + deaths), the mortality is much higher (as of today: 5359 / (70174 + 5359) = 7.1%).

Sure if you ignore the hundreds of thousands of infected who "recovered" from mild symptoms.

If it were to spread rapidly and overload our health systems, the mortality rate could rise even more, let's hope it doesn't reach that level.

The standard pattern. Try to fearmonger with intentionally misleading stats and then try to come off as a good samaritan. Why do all the coronavirus fearmongering comments all follow the same template?

andrewseanryan• 6 years ago

Good article, but this one from Smithsonian is much more detailed. https://www.smithsonianmag.com/history/journal-plague-year-1...

ipnon• 6 years ago

Useful given history.com responded to my request with an empty document

known• 6 years ago

https://en.wikipedia.org/wiki/Information_asymmetry

sebastianconcpt• 6 years ago

Harris believes that the rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime. In Britain, for example, a government official named Arthur Newsholme knew full well that a strict civilian lockdown was the best way to fight the spread of the highly contagious disease. But he wouldn’t risk crippling the war effort by keeping munitions factory workers and other civilians home.

dhosek• 6 years ago

Or in 2020: must keep the stock market up.

yters• 6 years ago

Once the quarantine is lifted we will have a bunch of non inoculated people, and the corona will spread all over again.

Agenttin• 6 years ago

The goal isn't to stop those people from being infected, it's to delay their infection. A massive spike of infections would overwhelm the hospitals. The same number of patients, slower, is doable.

andrekandre• 6 years ago

in case you don’t read the article, there is an interesting historical anecdote: why it’s called “spanish flu”

Interestingly, it was during this time that the Spanish flu earned its misnomer. Spain was neutral during World War I and unlike its European neighbors, it didn’t impose wartime censorship on its press. In France, England and the United States, newspapers weren’t allowed to report on anything that could harm the war effort, including news that a crippling virus was sweeping through troops. Since Spanish journalists were some of the only ones reporting on a widespread flu outbreak in the spring of 1918, the pandemic became known as the “Spanish flu.”

Why the second wave of the 1918 Spanish flu was so deadly

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