Spanish Flu of 1918: A Case Study of a Devastating Pandemic and its Socio-Economic Impact on the World

Spanish Flu
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The Spanish influenza, also known as the 1918 flu pandemic, was a rare form of H1N1 virus. It lasted from February 1918 to April 1920, infecting 500 million people – about a third of the world’s population at that time – in four consecutive waves. The death toll is estimated to be between 20 million and 50 million, though it is estimated to be between 17 million hard-core to 100 million, making it one of the deadliest diseases in human history.

The first observations of illness and death were recorded in the United States (Kansas) in March 1918 and in April in France, Germany, and the United Kingdom. To maintain morality, World War I inspectors reduced these initial reports. Newspapers were free to report the effects of the epidemic in neutral Spain, such as the tragic death of King Alfonso XIII, and the news gave a bleak picture of Spain as a major offensive. This coined the term “Spanish flu”. Historical details and diseases are insufficient to pinpoint the origin of the epidemic, with varying degrees of geographical location.

Most flu outbreaks occur evenly  very young and very old, with a high survival rate among those in the middle, but the Spanish flu epidemic has led to higher mortality rates than expected in adults. Scientists provide several explanations for the high death toll of the 1918 flu, including the harsh six-year climate that disrupted the spread of infectious diseases and increased the risk of waterborne disease. Some studies have shown that the virus is especially deadly because it creates a cytokine storm, which destroys strong immune systems in adults. In contrast, a 2007 analysis of medical journals from the epidemic found that the virus was no longer more aggressive than previous strains of the flu. Instead, malnutrition, overcrowded medical camps and hospitals, and poor hygiene, all exacerbated by the recent war, encouraged the spread of viruses. This defeat of the disease killed many of the victims, often after a long deathbed.

The Spanish influenza of 1918 was the first of three viruses caused by the H1N1 virus; the most recent was the 2009 swine flu epidemic. The Russian flu of 1977 was also caused by the H1N1 virus, but it mainly affected young people.

First wave, beginning of 1918

The epidemic was marked as the one that began on March 4, 1918 with the recording of the trial of Albert Gitchell, a military cook at Camp Funston in Kansas, United States, although there had been cases before him. The disease was detected in Haskell County in January 1918, prompting local physician Loring Miner to warn the US Public Health Service journal.  Within a few days, 522 men in the camp reported being ill. By March 11, 1918, the virus had reached Queens, New York. Failure to take security measures in March / April was later criticized.

First wave of Flu
credit: https://cdc.gov

As the United States entered World War I, the disease spread rapidly from Camp Funston, a major military training base in the American Expeditionary Forces, to other US Army and European camps, becoming a pandemic in the Midwest, East Coast, and French ports in April 1918, and we reach the Western Front in the middle of the month. It soon spread throughout France, Great Britain, Italy, and Spain and in May reached Breslau and Odessa. Following the signing of the Treaty of Brest-Litovsk (March 1918), Germany began liberating Russian prisoners of war, who then brought the disease to their country. It arrived in North Africa, India and Japan in May, and soon thereafter may have traveled to the rest of the world as there were recorded cases in Southeast Asia in April. In June a disease was reported in China. After arriving in Australia in July, the tide began to recede.

The first flu pandemic broke out in the first quarter of 1918 and was minimal. The mortality rate was not above the normal range; In the United States ~ 75,000 people died of flu in the first six months of 1918, compared with ~ 63,000 deaths in the same period in 1915. In Madrid, Spain, less than a thousand people died from the flu between May and June 1918. There was no isolated isolation in the first quarter of 1918. The first wave, however, caused significant disruption to World War I military operations, with three-quarters of French soldiers, half British troops, and more than 900,000 German soldiers sick.

Dangerous Second Wave, August 1918

Deaths in Second Wave
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The second wave began in the second half of August, probably spreading to Boston and Freetown, Sierra Leone, by ships from Brest, where it was likely brought by American or French troops trained in navy. From the Boston Navy Yard and Camp Devens (later renamed Fort Devens), some 30 miles [30 km] west of Boston, other U.S. military bases. They were soon harassed, and soldiers were sent to Europe. Assisted by military action, it spread over the next two months to all of North America, then to Central and South America, and even to Brazil and the Caribbean by ship. In July 1918, the Turkish Government recognized its first cases against other soldiers. From Freetown, the epidemic continued to spread across West Africa along the coast, rivers, and colonial railways, and from railways to remote communities, while South Africa acquired it in September on ships bringing back members of the South African Native Labor Corps returning from France. From there it spread to southern Africa and beyond the Zambezi, reaching Ethiopia in November. On September 15, New York City witnessed its first death from the flu. The Philadelphia Liberty Loans Parade, held in Philadelphia, Pennsylvania, on September 28, 1918 to promote World War I government commitments, resulted in the death of 12,000 people after a massive outbreak of the disease spread to visitors to the exhibition.

From Europe, the second wave passed through southwest Russia – previously northeast, and was brought to Arkhangelsk by the intervention of North Russia, then spread throughout Asia following the Russian Civil War and the Trans-Siberian railway, reaching Iran (where it spread) in the holy city of Mashhad), and later in India in September, as well as in China and Japan in October. The Armistice celebrations of November 11, 1918 also caused riots in Lima and Nairobi, but by December the tide had subsided considerably.

The second wave of catastrophic floods of 1918 was more deadly than the first. The first wave was similar to the common cold; those most at risk were the sick and the elderly, while the younger, healthier people were more likely to recover. October 1918 was a month of high mortality throughout the epidemic. In the United States, ~ 292,000 deaths were reported between September-December 1918, compared to ~ 26,000 in the same period in 1915. The Netherlands reported 40,000+ deaths from flu and respiratory infections. Bombay reported that 15,000 people out of 1.1 million people had died. ​​The 1918 flu epidemic in India was catastrophic, with an estimated 12.5-20 million deaths in the last half of 1918 alone.

Why second wave was so hazardous?

The horrific scale of the 1918 flu epidemic – known as the “Spanish flu” – is difficult to understand. The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims – more than all soldiers and civilians killed during World War I.

While the global epidemic lasted for two years, a large number of deaths were reported in the worst three months, especially in the fall of 1918. Historians now believe that the deadly effects of the “second wave” of the Spanish flu were due to a virus that was transmitted by the military. When the Spanish flu first appeared in early March 1918, it had all the symptoms of the flu season, even though it was a highly contagious and powerful flu. One of the first registered cases was Albert Gitchell, a U.S. military chef at Camp Funston in Kansas, who was hospitalized with a 104-degree fever. The virus quickly spread through the deployment of troops, home to 54,000 soldiers. By the end of the month, 1,100 soldiers had been hospitalized and 38 had died of pneumonia.

Third wave in 1919

In January 1919, a third wave of the Spanish flu swept across Australia, killing 12,000 people following the removal of prisons, and then rapidly spreading to Europe and the United States, where they remained in the spring until June 1919. It greatly affected Spain, Serbia, Mexico and Great Britain, resulting in the death of hundreds of thousands of people. It was much heavier than the second wave but still more deadly than the first wave. In the United States, remote outbreaks occurred in other cities including Los Angeles, New York City, Memphis, Nashville, San Francisco and St. Louis. Louis. The total American death toll was tens of thousands in the first six months of 1919.

Fourth Wave

In the spring of 1920, a fourth wave erupted in isolated areas, including New York City, Switzerland, Scandinavia and other islands in South America. New York City alone reported 6,374 deaths between December 1919 and April 1920, almost double the number of first wave in the spring of 1918. Other US cities include Detroit, Milwaukee, Kansas City, Minneapolis and St. Louis. Peru experienced a wave of floods in the late 1920’s, and Japan had another one from late 1919 to 1920, the last of which came in March. In Europe, five countries (Spain, Denmark, Finland, Germany and Switzerland) recorded the highest number between January and April 1920.

The main origins of Spanish Flu

China

In 1993, Claude Hannoun, a leading Spanish flu specialist at the Pasteur Institute, argued that the original virus may have originated in China and then spread to the United States near Boston and spread to Brest, France, European stadiums, Europe, and the rest of the world, with soldiers. Allied and sailors as major distributors. Hannoun views various options, such as Spain, Kansas, and Brest, as possible, but not impossible. In 2014, historian Mark Humphries argued that the recruitment of 96,000 Chinese workers to work behind the British and French lines could be the source of the epidemic. Humphries, of Memorial University of Newfoundland in St. John’s, holds his conclusions on the newly obtained records. He found the archaeological evidence that a respiratory illness that struck northern China (where workers had left off) in November 1917 was identified the following year by Chinese health officials such as the Spanish flu. However, no tissue samples survived by today’s comparison. However, there were reports of respiratory illnesses in parts of the route that workers had taken to Europe, which also passed through North America.

The Spanish Flu
credit: https://historyextra.com

One of the few regions of the world that seems to be less affected by the Spanish flu pandemic is China, where a number of studies have shown that the flu season in 1918 was mild. Although this is challenged due to lack of data during the Warlord Period, see Worldwide. This has led to speculation that the Spanish flu epidemic has emerged in China, The prevalence of influenza can be explained by the number of Chinese people who have previously received the flu vaccine.

A report published in 2016 in the Journal of the Chinese Medical Association found no evidence that the 1918 virus was introduced to Europe by Chinese and Southeast Asian soldiers and personnel and instead found evidence of its spread in Europe prior to the epidemic. A 2016 study suggested that the low prevalence of the flu (estimated at one in a thousand) among Chinese and Southeast Asian workers in Europe means that the deadly flu pandemic of 1918 would not have occurred in those workers. Another evidence that the disease is still being transmitted by Chinese workers is that workers entered Europe via other routes with no visible spread, making it possible that they were the first managers.

Europe

The UK’s largest military base and hospital camp in aptaples in France have been named by virologist John Oxford as the epicenter of the Spanish flu. His research found that in late 1916 the aptaples camp was hit by the onset of a new high mortality-causing disease that caused flu-like symptoms.  According to Oxford, a similar outbreak occurred in March 1917 in the Aldershot military camp,  and later epidemics saw this outbreak as the same as the Spanish flu. The overcrowded camp and hospital in Etaples was an ideal place for the spread of respiratory infections. The hospital treated thousands of victims of gas poisoning, other war victims, and 100,000 soldiers passing through the camp every day. And there was a pig house, and chickens were often brought from nearby villages to feed the camp. Oxford and his team wrote that the previous parasite, with birds, mutated and migrated to pre-housed pigs.

A report published in 2016 in the Journal of the Chinese Medical Association found evidence that the 1918 virus had been circulating in European wars for months and possibly years before the 1918 epidemic. Political scientist Andrew Price-Smith has published data from Austrian archives that suggest the flu began in Austria in early 1917.

A 2009 study of Influenza and Other Respiratory Viruses found that Spanish flu deaths simultaneously occurred between the two months of October and November 1918 in all fourteen European countries analyzed, which did not match the pattern that researchers would expect if the virus appeared anywhere in Europe and spread. without.

Symptoms

Spanish Flu Symptoms
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Most infected people only get the usual symptoms of a sore throat, headache, and fever, especially during the first wave. However, during the second wave the disease was more severe, often exacerbated by bacterial pneumonia, which was often the leading cause of death. This serious condition can lead to heliotrope cyanosis development, in which the skin may begin to develop two spots of mahogany on the bones of the grain and then over a few hours spread to a green surface, followed by black at the edges and then spreads to the feet and body. After this, death would follow within hours or days due to fluid-filled lungs. Other reported signs and symptoms include spontaneous mouth and nose, miscarriage in pregnant women, special odor, teeth, and fallen hair, confusion, dizziness, insomnia, loss of hearing or smell, blurred vision, and color vision. One commentator wrote, “One of the most common problems was bleeding from parts of the mouth, especially the nose, stomach, and intestines. Bleeding from the ears and minor bleeding on the skin also occurred. Most of the symptoms are believed to be caused by cytokine storms.

Most deaths were caused by bacterial pneumonia, the most common common cold-related infection. The pneumonia itself was caused by normal respiratory bacteria, which were able to enter the lungs through the damaged bronchial tubes of the victims. The virus also kills people directly by causing severe bleeding and edema in the lungs. Modern studies have shown that the virus is especially deadly because it causes a cytokine storm (an overdose of the immune system). One team of researchers identified the virus in the bodies of cold victims and infected animals. The animals experienced progressive respiratory failure and death by a cytokine storm. A strong immune response in adolescents was thought to be detrimental, and weakened immune systems in children and middle-aged adults led to fewer deaths in those groups.

Mutation Variants

The basic number of viral rebirths was between 2 and 3. The settlements adjacent to the large-scale movement of World War I accelerated the epidemic, and perhaps both increased transfers and shift additions. War may also reduce resistance to the virus. Some think that the immune system is weakened by malnutrition, as well as by the aggression of chemical agents, which in turn increases its tendency. A major factor in the global flu epidemic is increased mobility. Modern transportation systems make it easier for soldiers, sailors, and public travelers to spread the disease. Another was the lies and denials of the government, leaving people unprepared to deal with the outbreak.

Tranmission and Mutation of Flu
credit: https://marketwatch.com

The difficulty of the second wave was due to the conditions of World War I. In public life, natural selection prefers a smaller species. Those who are seriously ill live at home, while those who are less ill move on with their lives, preferring to spread the lesser type. In the trenches, natural selection was reversed. Soldiers with less difficulty stay where they are, while black patients are sent to overcrowded trains of hospitals filled with fields, spreading the deadly virus. The second wave began, and the flu spread quickly throughout the world. As a result, during the epidemic of modern diseases, health authorities are searching for species that kill the virus when it reaches unstable areas in the community. The fact that most of those who received first-line treatment were no longer physically fit indicates that it should have been the same type of flu. This was demonstrated in a very significant way in Copenhagen, with a combined mortality rate of only 0.29% (0.02% in the first wave and 0.27% in the second wave) as a result of exposure to the first less lethal wave. Of all humans, the second wave was the most lethal; the most vulnerable people are those who are like soldiers in the trenches – older people who were younger and fitter.

After the second wave of floods in late 1918, new cases suddenly dropped. In Philadelphia, for example, 4,5997 people died last week on October 16, but by November 11, the flu had almost completely disappeared from the city. Another explanation for the rapid decline in the prevalence of the disease is that physicians are effective in preventing and treating pneumonia that develops after the victims become infected. However, John Barry, in his 2004 book The Great Influenza: The Epic Story of the Deadliest Plague In History, stated that researchers had found no evidence to support the claim. One theory states that the 1918 virus evolved rapidly into a less lethal form. Such flu-like mutations are commonplace: there is a tendency for pathogenic bacteria to become harmless over time, as many of the most dangerous species tend to disappear. Other murder cases continued in March 1919, killing one player in the 1919 Finals in the Stanley Cup.

Impact of Spanish Flu, Economically and Socially

An estimated 40 million people, or 2.1 percent of the world’s population, died from the Great Flu of 1918-20. If a similar epidemic occurs today, it will result in the deaths of 150 million people worldwide. In The Coronavirus and the Great Influenza Pandemic: Studies from the “Spanish Flu” of Coronavirus’s Potential Effects on Mortality and Economic Activity (NBER Working Paper 26866), Robert J. Barro, José F. Ursúa, and Joanna Weng study the cross – global variability in the number of deaths associated with the outbreak, and the associated economic impacts.

The flu spread through three waves: the first in the spring of 1918, the second and the deadliest from September 1918 to January 1919, and the third from February 1919 to the end of the year. The first two waves were strengthened by the last years of World War I; the authors work to distinguish the effect of the flu on the level of death from the effect of war. The flu kills mostly older people in the absence of pre-existing conditions, which has had a significant impact on the economy compared to the disease that affects young and very old.

Researchers analyzed mortality data in more than 40 countries, accounting for 92 percent of the world’s population in 1918 and even the largest share of its GDP. The mortality rate varied from 0.3 percent in Australia, which set the target in 1918, to 5.8% in Kenya and 5.2 percent in India, which lost 16.7 million people in the three years of the epidemic. The flu killed 550,000 people in the United States, or 0.5 percent of the population. In Spain, 300,000 deaths are 1.4 percent, on average. There is no consensus as to where the flu came from; met with Spain because the media there was the first to report it.

There is little reliable information on how many people are infected. The most common estimates, one-third of the population, are based on a 1919 survey of 11 US cities; it may not represent the people of the US, let alone the international community.

How COVID-19(2020) & Spanish Flu(1919) affected Indian Economy?

Economic growth and development are often shocking, which may be due to changes in society, the political economy, the environment, etc. This shock has an impact on access to any economy (Brainerd and Seigler 2003 Karlsson 2014). Epidemics are also a major threat to the economy as these affect not only public health but also economic health. History provides a record of epidemics, epidemics and diseases that have occurred in the past, resulting in a lasting impact on people’s lives and economic activities (Boxmeyer 2006; Killingray 2003). Various nations and India were affected by the same disease in 1918, when the flu epidemic hit the world (García – Sastre and Whitley 2006; Gottfredsson et al. 2008; Karesh and Cook 2005).

The 1918 flu pandemic was a deadly virus caused by the H1N1 virus. It was one of the most widespread and deadly bombs ever seen by the world economy, which not only threatens people’s lives, but also society and trade-related activities. (Fargey 2019; Karlsson et al. 2014). Data from the World Economic Forum (WEF) indicates that about 500 million people contracted the flu – a third of the world’s population at that time. The plague broke out in four consecutive waves between February 1918 and April 1920. The mortality rate was estimated at 2 percent of the world’s population and 5.2 percent of the population of India (World Economic Report 2020). Although the 1918 flu epidemic coincided with the First World War, Figure 1 shows the death toll in India.

Compare COVID-19 & Influenza 1918-19

First, the number of patient varies. While the 1918 flu killed an unprecedented number of 25-40 year olds whereas COVID-19 mainly affects those over the age of 65, especially those with comorbidities. Particularly the death toll from the flu has risen to 8 % -10% for young people compared to 2.5% mortality and the mortality rate for people aged 25 to 40 years is only 0.2% compared to a total mortality rate of 2.4%. Those aged 25-40 years accounted for 40% of deaths due to the flu of 1918, while those aged 18-44 accounted for only 3.9% of deaths from COVID-19. Many countries survived in the 1918 epidemic and only the small Pacific Islands (Soloman and Vanuata Islands) remain COVID-19 free of charge. The mortality rate for pregnant women with Spanish influenza was 23% -37% and 26% for those who survived but lost their babies and the mortality rate of four pregnant women COVID-19 is unknown. The Spanish flu has led to massive illness by 25% -3 0% of the world’s population, with over 50 million deaths, and COVID-19 has infected nearly a million people 55 to date with 2 million deaths in the USA alone. COVID-19 cases are more than 11 million as of November 16, 2020, an increase of about 40% k is from last month. 

Comparison between COVID 19 and Influenza
credit: https://marketwatch.com

Secondly, these two diseases  in different ways. While those with the flu died of secondary bacterial pneumonia those with COVID-19 died from an overdose that led to many failures. 2 8 Acute respiratory illness (ARDS) can develop in both cases. As a complication from the flu, ARDS had a 100% mortality rate compared to a 53.4% ​​mortality rate as a complication from COVID-19. The estimated economic impact of COVID-19 on the US economy is a decrease of $ 5.76- $ 6.17 trillion on gross domestic product (GDP), based on Fitch Ratings and US GDP according to the World Bank. Economic data during the 1918 epidemic is scarce, but it was noted that Mexico lost $ 9 billion.

Things to learn from Spanish Flu Pandemic to deal with the current COVID 19 Pandemic

As we accomplish an unparalleled record of one million cases in 10 days, it is time to pause, reflect, analyze, and most importantly, acknowledge, that all one effort to combat the dreaded coronavirus attack has been in vain. While epidemiologists and world leaders were trying to do their best, there were historical reports from the Spanish Flu that warned of a second wave of infectious disease. Standing at the arrival of the second COVID-19 wave in India, it is fair to say that while the first Spanish influenza wave killed an estimated 5,000 people in India, the second wave of September 1918 struck western India, and the estimated number of deaths is in any one million million Indians. -12 to 18.

The current number of recorded deaths is close to 1,70,000, most of us just a figure. To put it bluntly, the total number of Indian soldiers martyred in the 1962 war with China, and the three wars against Pakistan in 1965, 1971 and 1999 (Kargil), were less than 10,000. With the onset of ‘epidemic fatigue’, 1 deaths, 1 70,000 due to COVID-19 does not produce a consistent response as did the deaths of our soldiers. Part of our peace is due to man’s tendency to pay more attention to the death of others than to others. Perhaps survivors are reluctant to talk about an experience that seems impossible to hold or cure.

As we hear the news of the shortage of vaccines, and the crowds at vaccination centers, let’s try and understand the difference between making a vaccine, and vaccinating more than 100 million people (about 75 percent of the population) to achieve any herd size. To understand the magnitude of the challenge, this number would be equal to the number of children collected for the polio vaccine in five years in India. Each year nearly 2.3 million applicants under the direction of 1,55,000 directors visit 209 million homes to provide Polio Vaccine to children under the age of 20 (200 million) under the age of five, cross country. With the nuances of individual COVID-19 vaccines, temperature issues, and dietary differences between injecting OPV drops compared to injectable potion, it is possible to look back to 2022 before life returns to the “normal pre-Covid” under the umbrella for protection against infection. It makes a lot of sense to minimize the celebration of the introduction of the vaccine, to extend safety measures such as social isolation, masking, and active immunization.

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