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History of the Spanish Flu Pandemic

The 1918 Spanish Flu Pandemic, and the Emerging Swine Flu Pandemic

Mankind's most devastating recorded global epidemic, and its latest close call

By Leonard Craneauthor of Ninth Day Of Creation


As their lungs filled … the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business.

--Isaac Starr, 3rd year medical student, University of Pennsylvania, 1918.

By the fall of 1918 a strain of influenza seemingly no different from that of previous years suddenly turned so deadly, and engendered such a state of panic and chaos in communities across the globe, that many people believed the world was coming to an end. It would later be characterized as a human-to-human transmissible case of swine flu.

The virus struck with amazing speed, often killing its victims within just hours of the first signs of infection. So fast did the 1918 strain overwhelm the body's natural defenses, that the usual cause of death in influenza patients---a secondary infection of lethal pneumonia---oftentimes never had a chance to establish itself. Instead, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients would drown in their own body fluids.

micrograph of influenza A

Micrograph of flu
virus. Surface
proteins visible
on periphery

Not only was the Spanish Flu (as it came to be known) strikingly virulent, but it displayed an unusual preference in its choice of victims---tending to select young healthy adults over those with weakened immune systems, as in the very young, the very old, and the infirm. The normal age distribution for flu mortality was completely reversed, and had the effect of gouging from society's infrastructure the bulk of those responsible for its day to day maintenance. No wonder people thought the social order was breaking down. It very nearly did.

But at the close of the First World War, when Spanish Flu appeared, the world was a very different place. Since then, outstanding advances in our knowledge of the germ world have been made, adding dramatically to our repertoire of medical wizardry. Surely what happened back then couldn't happen again.

Or could it?

During the 1918-1919 fall period the number of Americans who died from influenza is estimated at 675,000. Of those, almost 200,000 deaths were recorded in the month of October 1918 alone. Worldwide, the mortality figure for the full pandemic is believed to stand somewhere between 30 to 40 million. So, with the world population today having more than tripled in the intervening years, what is to stop a modern flu pandemic from claiming upwards of 100 million lives? The answer, it seems, is nothing at all.
the H5N1 variety of influenza responsible for the bird flu pandemic

H5N1 variety of influenza responsible for the bird flu pandemic

Today, of course, we have vaccines and antiviral drugs. But in the Third World, at least, these combatants are in very short supply. In India, where the Spanish Flu is thought to have culled more than 10 million from the population, public health care is still notoriously deficient. In China, with a population one third larger again, the situation is not much better. Even for developed countries, where vaccines are readily available, the fraction of the population that routinely subjects itself to inoculation generally hovers around 10 percent. In the event that the public were to receive adequate warnings of an impending pandemic, it's likely of course that this number could be significantly increased. But even then, it may not matter. By their nature pandemics tend to take us by surprise. The next influenza strain that ravages the human population will probably not be the one we were planning to encounter.

If all this seems a little alarmist in nature, consider for a moment the initial bird flu controversy that Robert Webster, chairman of the Department of Virology and Molecular Biology at Saint Jude Children's Research Hospital in Memphis, Tennessee, has called The Hong Kong Incident.

In 1997 epidemiologists and public health officials from around the world got their first glimpse¹ of an entirely new variety of human influenza. Known as subtype H5N1 for the surface proteins which the virus carries, the new strain had only ever previously been observed in birds. Ominously, the effect of H5N1 on poultry had earned it the evocative title of "Chicken Ebola." And when it surfaced in the human population of Hong Kong in 1997 it proved to be almost as deadly.
public takes precautions against the bird flu pandemic

Public attempts to stem threat of human-to-human bird flu transmission

How deadly? Even with the advantages of intensive-care treatment, fully one third of the first 18 confirmed cases never recovered. They died. In the latest bird flu pandemic of 2005, that fraction has increased to one half. For perspective, that's almost as deadly as being shot point blank in the chest. These latest numbers are suggestive of the death tolls suffered by immunologically-isolated Alaskan villages in 1918, where, in some cases, half the population was lost to the disease. In Hong Kong, and in the latest incident, bird-to-human contact was the established transmission route. Fearing a public health crisis, city officials in December of 1997 ordered the slaughter of Hong Kong's entire poultry population (a precaution that has been repeated many places across the globe since). All ducks, geese, and chickens in the city were killed. Fortunately it appears the H5N1 subtype so far lacks the ability to transmit itself through the air from one human host to the next potential victim.

On the surface, HK97 shows the hallmarks of what might be described as a "near miss" for our species. In other words, a biological catastrophe. Or it could be a false alarm. It's too early to say, although the scientific community grows more concerned every year. Either way, it's hard to argue that we didn't just receive a wake-up call of sorts. Maybe what happened in 1918 has today merely the substance of a tenuous memory, but it also marks a lesson that clearly would be dangerous to forget. On the scale of a human life span, pandemic influenza is a rarity, but no-one seriously doubts that it will be back.
influenza expert Dr. Robert Webster

Influenza expert
Dr. Robert Webster¹

As Webster reminds² us, "All the genes of all influenza viruses in the world are being maintained in aquatic birds, and periodically they transmit to other species... The 1918 viruses are still being maintained in the bird reservoir. So even though these viruses are very ancient, they still have the capacity to evolve, to acquire new genes, new hosts. The potential is still there for the catastrophe of 1918 to happen again."

Note: More information on the topic of bird flu pandemic can be found in the accompanying essay entitled Bird Flu is a Real Pandemic Threat to Humans.

Follow up:

When this essay was first published in 1998, work had already begun on the reconstruction of the 1918 Spanish Flu virus by Dr. Jeffery Taubenberger and his team at the Armed Forces Institute of Pathology. In October of 2005 it was reported that the virus had been finally reconstructed after 10 years of work. When I interviewed him I had forseen the day when this would happen. You can read about the announcement in the PBS article entitled 1918 Spanish Flu Offers Clues About Pandemic Viruses.

Note on 2009 Swine Flu Alarm:

As the outbreak of a new strain of swine flu in 2009 demonstrates, the nature of influenza pandemics is entirely unpredictable. This new strain, an H1N1 variety appears to be very similar to the virus that struck in 1918. To reduce the amount of confusion that you are likely to encounter when looking for information about swine flu online, you can assume that most of the material written in the last few years about bird flu pandemics applies equally to the swine flu scenario. The source of the virus in either case is likely initially avian, and the effect it has on human hosts is likely to be much the same.

Related Links and Ebooks:

A number of ebooks have surfaced on the topic of the emerging bird flu pandemic, and you may assume that the information contained in them about bird flu applies equally well to swine flu. I have not read these books because I prefer to do my own research. However, I am listing a few of them for your consideration. They may or may not prove useful:

Bird Flu Pandemic Ebook Australian biologist Stephen Jones has prepared a book entitled Bird Flu - The Complete Survival Guide. On his web site Jones says: "It has taken months to find the information that I needed to know to protect my family. Later, I realised that the government was doing little to assist people to prepare themselves if a severe pandemic occurs. Thousands of lives could be lost needlessly simply because the public is not being adequately informed. All fears dissolve to cautious awareness when preparations are complete." This is short, inexpensive, and likely to be to the point.

Bird Flu Pandemic Ebook
Another of these books is simply entitled Bird Flu. Written by Richard Stooker, this title epouses a "7-Perimeter Immune Defense System" to protect yourself against bird flu. Stooker paints a bleak picture of life inside a real bird flu pandemic--overrun hospitals, soldiers on the streets with shoot-to-kill orders for panicking civilians causing unrest. Unfortunely, that picture may turn out to be quite accurate for many parts of the world. Stooker examines natural flu fighting remedies--alternatives to short-stocked Tamiflu--that appear to have been overlooked by pharmaceutical companies.
Bird Flu Pandemic Ebook If you are seeking more information about the emerging bird flu pandemic, check out this Avian Flu Ebooks page. According to the blurb from the website: "This eBook will guide you though all of the conventional, natural and alternative treatments that are 'known' to help with the 'regular' flu virus and the H5N1 virus to include deadly interactions with other medications. This eBook has dosage charts and even an elixir that Dr. Pavel Nyvlt has found helpful for the flu virus. A Pandemic may or may not happen any time soon but if it does, have peace of mind that you are going to do what you can do to survive." I can't vouch for the likelihood of "alternative treatments", since I'd tend to stick with the recommendations of the World Health Organization and the CDC when it comes to anti-virals, namely Tamiflu and Relenza.

Cover of Ninth Day Of Creation For an entirely fictional story that examines how influenza might be incorporated into a bioweapons scenario, click on the cover here to the left. Ninth Day of Creation is an account of one company's brazen attempt to resurrect the 1918 Spanish Flu for commercial purposes. They almost get away with it. But things don't go quite as planned. If you've been waiting to read a good science thriller, then this could be the book for you. Find out what prompted Publishers Weekly to declare that, "Crane spins a gripping tale with all the complexity of a Tom Clancy novel".

Interview with Dr. Jeffery Taubenberger, sequencer of the Spanish Flu virus Want the real deal? To check out an article about the current effort by Dr. Jeffery Taubenberger, of the Armed Forces Institute of Pathology, to sequence the genome of the 1918 strain, click on the image of Taubenberger at work.


¹ "The Flu Hunters," Erik Larson. An account of the Hong Kong Incident. Time, February 23, 1998.

² The Invisible Invaders, Peter Radetsky. Little, Brown and Company, 1994. Page 246.

Introduction to Ninth Day of CreationSynopsis for Ninth Day of CreationTaubenberger, sequencer of the 1918 Spanish Flu virusReview of Ninth Day of CreationAuthor's BioSelling Points for Ninth Day of CreationBird Flu
The 1918 Spanish Flu Pandemic, and the Emerging Bird Flu PandemicAuthor's ViewpointPrologue for Ninth Day of CreationChapter One of Ninth Day of CreationChapter Two of Ninth Day of CreationHomepage for Ninth Day of Creation
Content and Copyright © by Leonard Crane, 1998-2006.
All rights reserved.