Myths of the Great Pandemic
100 years later, we still harbor misconceptions about the flu epidemic of 1918. And we still can learn a lot from it, explains RICHARD GUNDERMAN of Indiana University
This year marks the 100th anniversary of the great influenza pandemic of 1918. Between 50 million and 100 million people are thought to have died, representing as much as 5 percent of the world’s population. Half a billion people were infected.
Especially remarkable was the 1918 flu’s predilection for taking the lives of otherwise healthy young adults, as opposed to children and the elderly, who usually suffer most. Some have called it the greatest pandemic in history.
The 1918 flu pandemic has been a regular subject of speculation over the past century. Historians and scientists have advanced numerous hypotheses regarding its origin, spread and consequences. As a result, many of us harbor misconceptions about it.
By correcting these myths, we can better understand what actually happened and learn how to prevent and mitigate such disasters in the future.
1. The pandemic originated in Spain.
No one believes the socalled “Spanish flu” originated in Spain. The pandemic likely acquired this nickname because of World War I, which was in full swing. The major countries involved were keen to avoid encouraging their enemies, so reports of the extent of the flu were suppressed in Germany, Austria, France, the United Kingdom and the UnitedStates. Neutral Spain had no need to keep the flu under wraps. That created the false impression that Spain was bearing the brunt of the disease.
The geographic origin of the flu is debated to this day. Candidates include East Asia, Europe, even Kansas.
2. The 1918 flu bug was a “supervirus.”
The flu in 1918 spread rapidly, killing 25 million people in just the first six months. This led some to fear the end of mankind, and has long fueled the supposition that the strain of influenza was particularly lethal.
However, more recent study suggests that the virus itself, though more lethal than other strains, was not fundamentally different from those that caused epidemicsin other years.
Much of the high death rate can be attributed to crowding in military camps and urban environments, as well as poor nutrition and sanitation. Many of the deaths were due to the development of bacterial pneumonias in lungs weakened by influenza.
3. The first wave was the most lethal.
Actually, the initial wave of deaths from the pandemic in the first half of 1918 was relatively low. It was in the second wave, from October through December of that year, that the highest death rateswere observed.
Scientists now believe that the marked increase in deaths in the second wave was caused by conditions that favored the spread of a deadlier strain. People with mild cases stayed home, but those with severe cases were often crowded together in hospitals and camps, increasing transmission of a morelethal form of the virus.
4. The virus killed most people who were infected.
In fact, the vast majority of the people who contracted the 1918 flu survived. National death rates among the infected generally did not exceed 20 percent. However, death rates varied among groups. In the United States, deaths were especially high among Native Americans, perhaps due to lower rates of exposure to past strains of influenza.Some entire communitieswere wiped out.
Of course, even a 20 percent death rate vastly exceeds a typical flu, which kills less than 1 percent of those infected.
5. Therapies had little impact on the disease.
No specific anti-viral therapies were available during the 1918 flu. That’s still largely true today, where most medical care for the flu aims to support patients, ratherthan cure them.
One hypothesis suggests thatmany flu deaths could be attributed to aspirin poisoning. Medical authorities at the time recommended large doses of up to 30 grams per day. Today, about four grams is considered the maximum safe daily dose. Large doses of aspirin can lead to many of the pandemic’s symptoms, including bleeding. However, death rates seem to have been equally high in places in the world where aspirin was not so readily available.
6. The pandemic dominated the day’s news.
Public health officials, law enforcement officers and politicians had reasons to underplay the severity of the 1918 flu, which resulted in less coverage in the press. In addition to the fear that full disclosure might embolden enemies during wartime, they wanted to preserve publicorder and avoid panic.
However, officials did respond. At the height of the pandemic, quarantines were instituted in many cities.
7. The pandemic changed the course of World War I.
This is unlikely because combatants on both sides were relatively equally affected. However, the war profoundly influenced the course of the pandemic. Concentrating millions of troops created ideal circumstances for the breeding of aggressive strains of the virus and itsspread around the globe.
8. Widespread immunization ended the crisis.
Immunization against the flu as we know it today was not practiced in 1918 and played no role in ending the pandemic. Exposure to prior strains of the flu may have offered some protection. For example, soldiers who had served in the military for years suffered lower rates of deaththan new recruits.
In addition, the rapidly mutating virus likely evolved over time into less lethal strains. This is predicted by models of natural selection. Because highly lethal strainskill their host rapidly, they cannot spread as easily as less lethal strains.
9. The 1918 pandemic offers few lessons for 2018.
Severe influenza epidemics tend to occur every few decades. Experts believe that the next one is a question not of “if” but “when.”
While few living people can recall the great flu pandemic of 1918, we can continue to learn its lessons, which range from the commonsense value of handwashing and immunizations to the potential of antiviral drugs. Today we know more about how to isolate and handle large numbers of ill and dying patients, and we can prescribe antibiotics, not available in 1918, to combat secondary bacterial infections. Perhaps the best hope lies in improving nutrition, sanitation and standards of living, which render patients better able to resist the infection.
For the foreseeable future, flu epidemics will remain an annual feature of human life. As a society, we can only hope that we have learned the great pandemic’s lessons sufficiently well to quell another such worldwide catastrophe.