Talk:Spanish flu

Incubation Period

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If someone hasn't done this, will you please include something about the incubation period of the virus, AKA: in many victims there was a very long incubation period (6 or more months through the spring and summer) after initial symptoms subsided. Then, the darned thing picked back up in these same people in the fall and they all fell victim to the more severe symptoms.

Got this from that 1918 Flu book by ??; but I think its very important in sight of the probability of another outbreak of what they are begining to term as a "mutation" of the Swine Flu down in Mexico last month.

66.134.110.154 (talk) 00:04, 28 April 2009 (UTC)

Jaka mon (talk) 08:02, 29 April 2009 (UTC) RE Incubation Period: In some cases it would kill within 12 hours of exposure: "Uniquely, it produced a deep cyanosis (blue skin) that affected the face, lips and lungs. Somehow, the virus penetrated the deepest parts of the lung for unknown reasons. It was known to kill some people in as little as 12 hours after contracting the virus." Also: "Death itself could come so fast. Charles-Edward Winslow, a prominent epidemiologist and professor at Yale noted, 'We have had a number of cases where people were perfectly healthy and died within 12 hours.' the Journal of American Medical Association carried reports of death within hours: 'One robust person showed the first symptom at 4:00pm and died by 10:00am.'

Earlier of Spanish Flu's three waves may have helped immunize New York and Chicago

While a cursory reading of history have suggested that quarantine and the closing of schools explain the milder death rates in cities like New York and Chicago, the assumed facts underlying that conclusion may not bear careful historical analysis, such as that provided in http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/nov2707barry.html COMMENTARY Little evidence for New York City quarantine in 1918 pandemic Nov 27, 2007 (CIDRAP News)

In this article, a noted historian rejects the presumed existence of timely quarantine, and looks instead to the happy happenstance of herd immunity gained by exposure to the mild initial pandemic wave:

Is there another explanation for the relatively benign experiences in New York and Chicago? Possibly. Both cities experienced quite definite spring waves of influenza, which may have immunized some of the population.

2 or 3 waves in the Spanish Flu -- second wave was the deadly one

http://www.nytimes.com/2009/04/26/world/americas/26flu.html?em -- another source about the waves.

Important, because cities that caught the first, milder wave were protected when the later deadly wave came. —Preceding unsigned comment added by 69.3.11.131 (talk) 03:33, 26 April 2009 (UTC)

U.S. HHS headlines three waves in lead paragraph on its Spanish Flu page

HHS has a compelling condensed history of the Spanish Flu, complete with tabs and multi-media, published at

http://1918.pandemicflu.gov/

Citation to this work (and especially to the key feature of the three-wave structure) has been overlooked (regrettably) in the current article.

New Scientist on earlier wave in Sweden, notes two vital policy implications of an earlier milder wave

1918 flu pandemic had a trial run

• 30 January 2008
• NewScientist.com news service

...

Scandinavian health statistics record an unseasonable outbreak of flu in the summer of 1918. People who caught it were only a tenth as likely to die as those stricken in the autumn, but those who did catch it were mainly young adults - a hallmark of the autumn outbreak and a strong indication that the summer virus was closely related to it

...

the Scandinavian figures suggest that the autumn virus spread slowly because the summer virus had already immunised many people. The team also found that the summer virus spread too fast for social distancing to work, but that the immunity it caused may have saved lives. Not every city got the summer flu and those that did may have had up to 40 times fewer deaths in the autumn.

...

If a pandemic behaved the same way now, this suggests we shouldn't try to avoid the first wave. Watching out for it could also give us time to make vaccine before the bad wave hits.

From issue 2640 of New Scientist magazine, 30 January 2008, page 19

http://www.newscientist.com/channel/health/bird-flu/mg19726404.900-1918-flu-pandemic-had-a-trial-run.html —Preceding unsigned comment added by 66.167.164.207 (talk) 23:32, 8 April 2008 (UTC)

100 million ?

The Stanford page says 20 to 40 million.

"The influenza epidemic that swept the world in 1918 killed an estimated 50 million people." National Archives 68.183.223.35 (talk) 21:16, 10 May 2008 (UTC)

At least one pair of recent, serious researchers admits to the possibility of the 100M figure being the top estimate: www.ncbi.nlm.nih.gov. NCBI. PubMed. Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic. (2002). They say that their best guess of 50M deaths could be as much as double that, given the poor state of records they were able to find.

The authors of the paper above give 50M as their estimated minimum mortality. They especulate that it could have been as high as 100M although the reliable estimate remains as "over 50M". 79.78.50.235 (talk) 21:51, 11 October 2008 (UTC)

I think we're both reading and comprehending the same article and the same conclusions. Over 50M, possibly as high as 100M. Binksternet (talk) 10:50, 12 October 2008 (UTC)

Here's a table of the various country and region death toll estimates that I was able to find online:

Country/Region	Deaths: low estimate	Source for low estimate	Deaths: high estimate	Source for high estimate
United States	500k	[1]	675k	[2]
Canada	30k	[3]	50k	[4]
Germany	686k	[5]	686k	[6]
Norway	15k	[7]	15k	[8]
UK	225k	[9]	250k	[10]
India	5M	[11]	17M	[12]
China	1M	[13]	9.5M	[14]
Sub-Saharan Africa	1.5M	[15]	2M	[16]
Australia	12k	[17]	12k	[18]
France	400k	[19]	400k	[20]
Spain	8M	[21]	8M	[22]
Japan	257k		257k
Western Samoa	7.5k	[23]	7.5k	[24]
Russia/USSR	?		?
Philippines	90k	[25]	90k	[26]
Union of South Africa	139k	[27]	139k	[28]
Madagascar	114k	[29]	114k	[30]
Caribbean	100k	[31]	100k	[32]
New Zealand	8k	[33]	8k	[34]
Sweden	38k	[35]	38k	[36]
Finland	25k	[37]	25k	[38]

Russia's data isn't known. Low estimate shown here is less than 20M. High estimate is about 40M. Note that a lot of countries and regions aren't represented. For instance, Java/Dutch East Indies has been cited as suffering 1M infections but I have no death toll or death rate data. Also note that the references here aren't very tightly vetted; they're just quick search results with only the obvious POV sites ignored.

The biggest unknowns in this chart are China, India and Imperial Russia/emerging Soviet Union. Some researchers argue that China had a low rate of death in the interior because of a poor network of roads and rail. Others put quite a high death estimate on China, extrapolating coastal port city death rates into total population. People are just guessing! Russia was in combat all over the map both with outsiders and internal revolutionaries, but was also plagued with influenza and encephalitis during 1918-19, the latter peaking in 1924-25. It's impossible to know for certain how many people specifically died of the flu. In India, certain region's deaths were charted in detail while others were not. There's a very wide gap between estimates. Binksternet (talk) 01:46, 11 May 2008 (UTC)

Russian flu 1889-90 immunity

I believe that "The Plague of the Spanish Lady - The Influenza Pandemic of 1918-19" (isbn=0-8371-8376-6) mentions that exposure to the Russian 'flu pandemic conferred a degree of immunity against Spanish 'flu, but I'm not sure. Can some one confirm this? --Michael C. Price ^talk 17:19, 20 August 2008 (UTC)

Flu worldwide progression

In yellow are show some famous but highly improbable source of the pandemic.

As of current research it is not clear whether the Spanish flu originated in North America, Europe or Asia. There are several opposing views on the topic. The picture on the progression of the disease worldwide looked quite authoritative, when I find it quite speculative. The picture was also referring to unknown unpublished, personal research. It would be better to replace this picture with a set of three pictures depicting the different hypothesis on the propagation of the pandemic during 1918-19 and according to the different possible origins. Proper citations for the figure would also be needed. 79.78.50.235 (talk) 22:26, 6 October 2008 (UTC)

I agree that the image assumes too much certainty. Binksternet (talk) 01:01, 7 October 2008 (UTC)

The uploader of this image keeps putting it back in, but the progression it shows is not certain, not agreed-upon by all experts. Binksternet (talk) 14:07, 4 May 2009 (UTC)

Please use appropriate references

In the sake of the article's quality, we should make sure that we use appropriate references from reliable sources whenever possible. For example, using PowerPoint presentations as authoritative references is out of order. Also, the latest, most authoritative account of Spanish Flu's mortality comes from Jonhson and Muller's "Updating the accounts" paper. Using Science Daily as a reference for the number of deaths is not appropriate either. It is clear that 50M is currently the minimun number of deaths, with perhaps up to 100M, so the article would be better reading "over 50M people died". —Preceding unsigned comment added by 79.78.104.70 (talk) 22:18, 17 October 2008 (UTC)

Lethality patterns suggest the summer wave of the Spanish Influenza may have protected against the lethal fall wave.

Lethality patterns suggest the summer wave of the Spanish Influenza may have protected against the lethal fall wave.

"The summer wave may have provided partial protection against the lethal fall wave."

Viggo Andreasen, Cécile Viboud, and Lone Simonsen Epidemiologic Characterization of the 1918 Influenza Pandemic Summer Wave in Copenhagen: Implications for Pandemic Control Strategies MAJOR ARTICLE The Journal of Infectious Diseases 2008;197:270–278 © 2007 by the Infectious Diseases Society of America. All rights reserved. http://www.journals.uchicago.edu/doi/abs/10.1086/524065 0022-1899/2008/19702-0015$15.00 DOI: 10.1086/524065 —Preceding unsigned comment added by 69.3.11.30 (talk) 19:27, 20 October 2008 (UTC)

Listify list of victims

Unsure why survivors are really notable?

• Oh Jolly Good you didn't die.

Yes, insensitivity aside...

Notable casulties might be better placed in quarrantine at List of notable 1918 influenza pandemic casulties. Insert whatever the title of the article actually becomes to replace "1918 influenza pandemic". Would also think "notable" is optional (it must be notable {and reliably sourced} to be included in wikipedia).

Fictional casulties should not go in such a list. Instead a section on #In popular culture should detail significant representations of the pandemic in literature, music and film (including notable fictional figures who died because of 1918 pandemic-related causes).

The present #victims section might better provide further information on demographics of casulties. (oh wait that is probably in #Mortality section - merge and cut down a section, hooray!).

Discuss--ZayZayEM (talk) 06:14, 23 October 2008 (UTC)

imo, survivors are NOT notable and should be removed IceDragon64 (talk) 19:48, 29 April 2009 (UTC)

Proposed 2008 WHO pandemic guidelines include waves

CIDRAP on WHO's new pandemic-phase guidance

Via CIDRAP: WHO's draft pandemic flu guidance revises phases. Excerpt:

The World Health Organization (WHO) has drafted a revised pandemic influenza preparedness plan that updates the definitions of pandemic phases and puts more emphasis on the social and economic effects of a global epidemic, among other changes.

The plan, intended to replace the existing one published in 2005, aims to present "simpler and more precise definitions" of the six pandemic phases and groups them to emphasize planning and preparedness considerations. The draft also defines "post-peak" and "possible new wave" phases.

Recent Australian study seeks reasons 2nd and 3rd waves were more deadly

(The most obvious hypothesis, of course, is that the virus had evolved into a more deadly form.)

This article suggests that some may have been inoculated by earlier exposure to common flu. If so, this a seasonal live-virus vaccine like Flumist or the Russian seasonal live vaccine might provide some pandemic protection.

=

1918 Spanish flu records could hold the key to solving future pandemics http://curevents.org/showthread.php?s=fb82b05d9451aecf7aba69e85e4d3b22&t=4776

Ninety years after Australian scientists began their race to stop the spread of Spanish flu in Australia, University of Melbourne researchers are hoping records from the 1918 epidemic may hold the key to preventing future deadly pandemic outbreaks.

This month marks the 90th anniversary of the return of Australian WWI troops from Europe, sparking Australian scientists' race to try and contain a local outbreak of the pandemic, which killed 50 million people worldwide.

Researchers from the University of Melbourne's Melbourne School of Population Health, supported by a National Health and Medical Research Council grant, are analysing UK data from the three waves of the pandemic in 1918 and 1919.

They hope that modern high-speed computing and mathematical modeling techniques will help them solve some of the questions about the pandemic which have puzzled scientists for close to a century.

Professorial Fellow John Mathews and colleagues are analysing the records of 24,000 people collected from 12 locations in the UK during the Spanish flu outbreak including Cambridge University, public boarding schools and elementary schools.

He says gaining a better understanding of how and why the virus spread will help health authorities make decisions about how to tackle future pandemics.

"In the 1918/19 pandemic, mortality was greatest among previously healthy young adults, when normally you would expect that elderly people would be the most likely to die, Professor Mathews says "We don't really understand why children and older adults were at lesser risk.

"One explanation may be that children were protected by innate immunity while older people may have been exposed to a similar virus in the decades before 1890 which gave them partial but long-lasting protection.

"Those born after 1890 were young adults in 1918. They did not have the innate immunity of children and as they weren't exposed to the pre-1890 virus they had little or no immunity against the 1918 virus. We can't prove it but it is a plausible explanation."

Another striking feature is that the pandemic appeared in three waves, in the summer and autumn of 1918 and then the following winter.

One theory being examined to explain why some people were only affected in the second or third wave is that because of recent exposure to seasonal influenza virus they had short-lived protection against the new pandemic virus.

"The attack rates in the big cities weren't as high and this is probably because many people had been exposed to ordinary flu viruses, giving short-lived immunity, he says.

"In the English boarding schools, where there was social demarcation, children were probably less exposed to seasonal influenza viruses in earlier years; without that protection, pandemic attack rates were much higher than in ordinary government elementary schools.

"If we can provide a detailed time course of epidemics and the attack rates at different times, that information can be extremely useful in determining how a future pandemic might progress, says Professor Mathews.

He says initial findings point strongly to the value of short-lived immunity to provide protection or partial protection against the early waves of a virus.

This is particularly important when considering the stockpiling of drugs and vaccines to protect the community against a virus.

"The early implications of our study are that there may be benefit in providing short-lived immunity that is broadly based rather than specific, he says.

"If another flu pandemic were to come along and you have a vaccine, it may be better to use it even if it is against a different sub-type of the virus."

Source: University of Melbourne http://www.physorg.com/news145530214.html

EXAMPLES

In which BSL 3 Labs are today Examples of H1N1 ? —Preceding unsigned comment added by 125.60.241.211 (talk) 11:03, 15 November 2008 (UTC)

Anecdotal observations

Talking with older family members bring recollections of who died and what they had in common. Apparently the folks who got sick, went to bed, received good care and continued to take it easy during a prolonged recovery, did better than their active counterparts. The ones who recovered and promptly got up to work or take care of others often had a relapse and died. While this is obviously third hand and anecdotal, the family members born in 1917 and 1920 remember their parents talking about this. This actually seems to tie in with the people 20 to 65 being the highest mortality. They were the ones who would be expected to be active and to get back to work as soon as possible. Socsci69 (talk) 21:54, 15 November 2008 (UTC)Socsci69

Move Proposal: 1918 Influenza

Could I suggest moving this article to:

1. Influenza pandemic of 1918
2. 1918 influenza pandemic
3. 1918 influenza

   or at the very least:

4. Spanish influenza pandemic
5. 1918 Spanish influenza pandemic
6. Spanish influenza pandemic of 1918?

For various reasons I am trying to keep "flu" out of influenza article titles. This is a slang term, while in perfectly common usage (and med, and med historian usage), it contains ambiguatity and is regularly used to refer to non-influenza disease (such as gastro, colds and non-influenza virals). Hopeful that part of my suggestion is non-controversial.

The article title should conatin the word "pandemic". This article is not about a form of influenza (a disease), it is not even about a strain of influenza virus (that would be H5N1). This article is about a historic event, a pandemic. the article title should accurately and correctly convey its contents and subject matter.

I would also suggest that removing "Spanish" may be overtly innacurate despite common usage. The plague has been suggested to originate from other spheres (Nth America, China). I do not see that it actually had greater impact to Spain. The only reason for such naming is that it " received greater press attention" in Spain because of lack of governmental censorship. I can see this as being controversial, and am not stuck to this being necessary criteria for the article. However contemporary and modern sources do significantly use date to identify the pandemic, and merely refer to "spanish" as a more commonfolk person's identifier.--ZayZayEM (talk) 06:07, 23 October 2008 (UTC)

I agree : "Spanish" is misleading.

I'm the former author of the French articles fr:Grippe de 1918 and fr:Pandémie de la grippe de 1918, copy of a personnal work done in 1999. By that time, I had read paper from the Institut Pasteur, especially from Dr. HANNOUN, the local expert for this issue in France. About the Spanish source theory, his paper stated that France newspaper being censored for war reasons, they were only allowed to talk about the flu in Spain, but not what she did in France. Same for all Europa. Accordingly, people of Europa misleadingly said they catched the "spanish flu". This is misleading, and should be remove from the title name to become a synonyme only. Yug (talk) 06:22, 9 January 2009 (UTC)

I make the move.

The article itself state since long time ago "The 1918 flu pandemic (commonly referred to as the Spanish flu)" in its introduction, the 'Spanish flu' title being misleading, and several user having express across time their support to a move, all encourage to do it. Yug (talk) 11:19, 12 January 2009 (UTC)

My vote's for "1918 influenza pandemic". You're right, "flu" is a slang term, and I was surprised to see it as the article title. Kevin (talk) 23:03, 11 February 2009 (UTC)

My vote, too. If you don't move it to "1918 influenza pandemic" in the next few days then I will. Not a very controversial decision, IMO. Binksternet (talk) 00:48, 12 February 2009 (UTC)

I think the first option, "Influenza pandemic of 1918" is more grammatically correct. SamEV (talk) 01:26, 12 February 2009 (UTC)

GA Reassessment

This discussion is transcluded from Talk:1918 flu pandemic/GA1. The edit link for this section can be used to add comments to the reassessment.

This article, listed as GA in April 2006, failed GA Reassessment for the following reasons:

• The article fails 2 (b) in that it fails to provide in-line citations from reliable sources for direct quotations, statistics, published opinion, counter-intuitive or controversial statements that are challenged or likely to be challenged. The article contains numerous {{citation needed}} tags throughout. Further, there is a long list of "Notable fatalities" that is largely uncited.
• The article fails 3 (broad in its coverage) in that there is a {{globalize}} tag under the "Cultural impact" section.
• Additionally, the article has a {{Cleanup-restructure|date=October 2008}} that has not been addressed of this date. The talk page reflects some disagreement over content, naming, and the accuracy of figures give.
• Therefore the article will be delisted as GA if problems are not remedied.

—Mattisse (Talk) 18:47, 14 February 2009 (UTC)

Agree this should not at this point be a GA.--Doc James (talk · contribs · email) 22:21, 8 April 2009 (UTC)

Agree it should be delisted - entire paragraphs are unreferenced, and reference formatting is inconsistent. Parrot of Doom (talk) 22:18, 27 April 2009 (UTC)

There are no {{citation needed}} tags any more. It looks like a good article to me. Shreevatsa (talk) 04:20, 12 May 2009 (UTC)

• The article is much improved. However, there is still a {{clarifyme}} tag and a request for a more {{global}} point of view for the cultural impact section, which seems important since this flu was a global pandemic. Also the list of "Notable fatalities" and "Notable survivors" is unavoidable arbitrary and should be removed. Also, the references need to be checked. For example, http://www.avian-bird-flu.info/spanishfluepidemic1918.html goes to a flu vacine sales sites. And http://www.dmacdigest.com/flu1918.html (used repeadedly) list the Spanish wikipedia as one of its sources. These are not reliable sources. Regards, —Mattisse (Talk) 20:49, 12 May 2009 (UTC)

• I will close this as undecided so Keep and open a community GAR regarding the the list of "Notable fatalities" and "Notable survivors". Regards, —Mattisse (Talk) 23:55, 13 May 2009 (UTC)

• Actually, this article would be a Keep with no GAR if you remedy the following complaint. The article with the improved references is fine except for the lists of "Notable fatalities" and "Notable survivors". I believe the lists should be removed because they are an arbitrary selection from worldwide cases, the two lists are too long, some names on the list are not referenced, and some names are redlinked so they are not notable enough to have articles. Would you consider removing the lists? Regards, —Mattisse (Talk) 14:36, 14 May 2009 (UTC)

Myrtle Gonzalez

Her article gives (referenced) her cause of death as heart disease, and possibly indirectly from a fall from a horse. It doesn't say anything about flu. Who's right? 81.159.57.7 (talk) 20:39, 25 April 2009 (UTC)

All comments in the article to notable deaths and cases in real and fictional people should be deleted. WAS 4.250 (talk) 21:18, 25 April 2009 (UTC)

Obscure event?

In the United States, Great Britain and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918-1919, the Spanish flu remained a relatively obscure event until the rise in public awareness of bird flu and other pandemics in the 1990s and 2000s.

(See beginning of cultural impact ). Citation or no citation, I think this statement is horseshit. I think a lot of people were aware of 1918 before 1990 in the UK. —Preceding unsigned comment added by 82.10.238.89 (talk) 00:09, 26 April 2009 (UTC)

To be fair though, back at the time it simply known as the Great Flu Epidemic, 'a lot of people' today probably assume that the 'pandemic' is an entirely different event, at least those that aren't up to date with modern hyperbole may. 86.5.0.241 (talk) 12:44, 27 April 2009 (UTC)

Origins of the 1918 Pandemic: The Case for France

NPR provides: Origins of the 1918 Pandemic: The Case for France at http://www.npr.org/templates/story/story.php?storyId=5222069 ...

John Oxford, a professor of virology at Queen Mary's School of Medicine in London, holds to a different theory: the British Empire nurtured the disease.

The British army had an enormous training camp set up in Etaples, France. On any given day, 100,000 soldiers were milling around. Many were on their way to World War I's Western Front; others, wounded, sick, and often prisoners, were on their way back. The camp had 24 hospitals alone and a team of fearful — but curious — pathologists. They recorded post mortems on everything that came their way. "They were worried, even at that stage, in 1916, about the possibility of infectious disease decimating the British army, as had happened in the past with typhus and cholera," says Oxford.

Then, just after the Battle of the Somme in the winter of 1916-1917, dozens of soldiers at the camp fell ill, complaining of aches, pains, cough and shortness of breath. Mortality was high at 40 percent, and some also had what later became known as a telltale sign of the killer flu: Their faces were tinged a peculiar lavender color, a condition known as heliotrope cyanosis.

Two months later, says Oxford, a similar outbreak was reported near London at Aldershot, site of one the biggest barracks in the army. Aldershot pathologists eventually published studies in The Lancet medical journal pinpointing the origin of the 1918 pandemic to Etaples and Aldershot.

... —Preceding unsigned comment added by 69.3.11.131 (talk) 03:38, 26 April 2009 (UTC)

An article from American History magazine details part of the 1918 flu's effects in America. Some newspapers even used it to whip up anti-German sentiment, blaming the Huns for the plague. 1918 Spanish Influenza Outbreak: The Enemy Within —Preceding unsigned comment added by Historychaser (talk • contribs) 17:14, 28 April 2009 (UTC)

Other resources

US Government archive documents & photos: [39]

--VelcroWarrior (talk) 22:29, 28 April 2009 (UTC)

† dead?

In the 'Victims' 'Notable fatalities' section I think the use of "†" to signify the date of death for the victim is not very politically correct considering that many victims were not Christian. Why not use simply 'd' instead?--Xania ^talk 22:29, 28 April 2009 (UTC)

It looks a lot like an outdated execution tool, one used as a symbol for a major world religion, but it's really a Dagger (typography). ;^)

As such, it's politically acceptable. Binksternet (talk) 00:24, 29 April 2009 (UTC)

Contradiction?

What is the contradiction refered to in the message stuck on the page? Is the the fact that one part of the page quotes that the Central Powers suffered more than the Allies, whereas another confidently states that both sides suffered equally? IceDragon64 (talk) 19:59, 29 April 2009 (UTC)

Secondary Infections

If you look at some of the most recent research from the CDC, the Spanish Flue deaths were mostly caused by secondary bacterial infections. This article should have a section about this and a reference to the CDC article. Here is the link: http://www.cdc.gov/eid/content/14/8/1193.htm —Preceding unsigned comment added by Timbo79 (talk • contribs) 03:10, 30 April 2009 (UTC)

Waves

This article appears to say nothing about the multiple waves of varying severity and different seasons. —Centrx→talk • 03:40, 30 April 2009 (UTC)

Graphic of the three waves, plotted against stock market

http://bespokeinvest.typepad.com/.a/6a00d8349edae969e201156f63219b970c-popup

from

http://bespokeinvest.typepad.com/bespoke/2009/04/1918-spanish-flu-and-the-market.html —Preceding unsigned comment added by 69.3.11.188 (talk) 14:27, 30 April 2009 (UTC)

Earlier mild wave in summer 1918 helped immunize Copenhagen

Brundage JF, Shanks GD.

Deaths from bacterial pneumonia during 1918–19 influenza pandemic.

Emerg Infect Dis [serial on the Internet]. 2008 Aug [date cited]. Available from http://www.cdc.gov/EID/content/14/8/1193.htm

DOI: 10.3201/eid1408.071313

The Journal of Infectious Diseases 2008;197:270–278 © 2007 by the Infectious Diseases Society of America. All rights reserved.

DOI: 10.1086/524065 MAJOR ARTICLE

Epidemiologic Characterization of the 1918 Influenza Pandemic Summer Wave in Copenhagen: Implications for Pandemic Control Strategies

Viggo Andreasen,1

Cécile Viboud,2 and

Lone Simonsen3,a

1Department of Sciences, Roskilde University, Roskilde, Denmark; 2Fogarty International Center and 3National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Background.

The 1918–1919 A/H1N1 influenza pandemic killed 50 million people worldwide. Historical records suggest that an early pandemic wave struck Europe during the summer of 1918.

Methods. We obtained surveillance data that were compiled weekly, during 1910–1919, in Copenhagen, Denmark; the records included medically treated influenza‐like illnesses (ILIs), hospitalizations, and deaths by age. We used a Serfling seasonal regression model to quantify excess morbidity and mortality, and we estimated the reproductive number (R) for the summer, fall, and winter pandemic waves.

Results.

A large epidemic occurred in Copenhagen during the summer of 1918; the age distribution of deaths was characteristic of the 1918–1919 A/H1N1 pandemic overall. That summer wave accounted for 29%–34% of all excess ILIs and hospitalizations during 1918, whereas the case‐fatality rate (0.3%) was many‐fold lower than that of the fall wave (2.3%). Similar patterns were observed in 3 other Scandinavian cities. R was substantially higher in summer (2.0–5.4) than in fall (1.2–1.6) in all cities.

Conclusions.

The Copenhagen summer wave may have been caused by a precursor A/H1N1 pandemic virus that transmitted efficiently but lacked extreme virulence. The R measured in the summer wave is likely a better approximation of transmissibility in a fully susceptible population and is substantially higher than that found in previous US studies. The summer wave may have provided partial protection against the lethal fall wave.

Received 13 April 2007; accepted 5 July 2007; electronically published 10 January 2008. Reprints or correspondence: Viggo Andreasen, Dept. of Sciences, Roskilde University, DK‐4000 Roskilde, Denmark

Cited by ... —Preceding unsigned comment added by 69.3.11.188 (talk) 15:20, 30 April 2009 (UTC)

Delayed CNS damage

I remember a science show on TV that mentioned central nervous system damage thought to have come from the 1918 flu pandemic. The symptoms included sufferers unable to move their limbs consciously, i.e. a doctor could lift their arms up 45 degrees and they would just stay there and not fall back. Also, they looked like they were in a coma but 'wide awake', if that makes any sense. There were meant to be 10s if not 100s of thousands of sufferers worldwide, all of whom survived the pandemic unscathed. The symptoms started about 2 or 3 years after 1918 and have never been seen since. I think it was on Horizon; they had contemporary film footage of the sufferers and their doctors. Can anyone else remember this? Does the condition have a name? Has there been any proven link to the 1918 pandemic? If so, should it get a mention in the article?--ML5 (talk) 11:56, 1 May 2009 (UTC)

Move?

The following is a closed discussion of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

The result of the proposal was No consensus Parsecboy (talk) 10:34, 9 May 2009 (UTC)

• Move need: 1918 flu pandemic → 1918 influenza pandemic — Reason: flu is a slang term, influenza is more correct. '1918 influenza pandemic' is currently a redirect to '1918 flu pandemic'. Yug (talk) 13:29, 1 May 2009 (UTC)

• Oppose. Flu is the most commonly used term, even in the press and other reliable sources. It's a stretch to call it slang. --Born2cycle (talk) 22:18, 1 May 2009 (UTC)

• Oppose use Spanish Flu instead. 76.66.202.139 (talk) 04:24, 2 May 2009 (UTC)

'Spanish flu' is exclude, this name is misleading, that's why experts avoid it. Wikipedia is an encyclopedia, accuracy is more important than popular believes, which an encyclopedia have to destroy. Yug (talk) 12:55, 2 May 2009 (UTC)

WP:COMMONNAME use common name instead of obscure professional name. 76.66.202.139 (talk) 04:54, 3 May 2009 (UTC)

Ah, but see also Wikipedia:Naming conventions (precision). "Spanish flu" is woefully ambiguous. Sceptre ^(talk) 08:39, 3 May 2009 (UTC)

WP:PRIMARYTOPIC Not in common usage it isn't. Otherwise every article page would be disambiguated, and nothing would exist at primary names. 76.66.202.139 (talk) 14:33, 3 May 2009 (UTC)

How is it ambiguous? Is there an example of another large scale outbreak that was normally titled the "Spanish flu". I'm not asking about other outbreaks of the flu in Spain, but can you give an example of another outbreak that was, and remains, widely called the "Spanish flu" (without qualification). For instance, is there a notable book with "Spanish flu" in the title, that didn't talk about the 1918 event. If I'm wrong about this, and "Spanish flu" is an ambiguous term, then we should create a disambiguation page, with links to all the notable flu pandemics that were known simply as "Spanish flu". --Rob (talk) 05:33, 5 May 2009 (UTC)

• Oppose use Spanish Flu instead, since this is the most notable usage. --Michael C. Price ^talk 15:31, 2 May 2009 (UTC)
• Support per swine flu → swine influenza and avian flu → avian influenza precedent. Sceptre ^(talk) 20:21, 2 May 2009 (UTC)
• Support We can have a redirect, but the main article should have the full name. --McSly (talk) 20:25, 2 May 2009 (UTC)
• Oppose, and use Spanish Flu instead.. Regardless of what we name it, all references in the article should be updated to be consitent. Notice how the exact text "1918 flu pandemic" exists only once in the entire prose of the article. The exact text "flu pandemic" exists in the prose, but only as part of "Russian flu pandemic". So, not only is "1918 flu pandemic" not a standard/common name outside Wikipedia (which is what really counts), but it's not even common here. The world knows what the "Spanish flu" is. There are lots of terms in the English language that are used, but shouldn't be taken literally. We're supposed to figure what the common English term is, and not decide what it should have been. I notice Spanish Wikipedians have it right with es:Gripe española. As long as we make clear, right at the start, that the "Spanish flu" didn't come from Spain, and isn't literally Spanish, then there's no misinformation. --Rob (talk) 15:27, 4 May 2009 (UTC)

  Then it shouldn't really be at "Spanish flu" then. Sceptre ^(talk) 22:55, 4 May 2009 (UTC)

• Support, no need to use a slang term when both titles are perfectly understandable to our readers. Tim Vickers (talk) 23:23, 4 May 2009 (UTC)
• Support. We can use any number of redirects to accommodate casual usage. The article should have a tightly-defined name. Binksternet (talk) 00:32, 5 May 2009 (UTC)

I Support a move, but Oppose this one. Specifically, as SamEV mentioned above, moving it to "Influenza Pandemic of 1918" is more grammatically appropriate. Thoughts? ~ Amory (talk) 00:40, 5 May 2009 (UTC)

The above discussion is preserved as an archive of the proposal. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

Initial wave in 1918 outbreak began as a mild form of influenza

Researchers can't agree on severity of swine flu outbreak By TONY PUGH McClatchy Newspapers

http://www.kansascity.com/444/story/1174048.html

...

Lee Harrison, a professor of epidemiology and medicine at the University of Pittsburgh, agreed that preliminary data suggests the outbreak won't become a world pandemic, but he cautioned that the 1918 outbreak began as a mild form of influenza.

"It wasn't until it came back the following flu season that you really saw a real devastating pandemic in terms of death," Harrison said of the 1918 influenza. The second and third waves of the 1918 outbreak killed about 50 million people worldwide..

Harrison said it would take more work and time to determine the mortality rate from the current outbreak, but that "it does appear to be low and it doesn't appear to be in range with the 1918 pandemic. But again, it's a rapidly evolving situation and in 1918, it was the second wave that was particularly nasty."

... —Preceding unsigned comment added by 69.3.11.51 (talk) 03:56, 2 May 2009 (UTC)

What I had always read about the 1918 epidemic is that the first wave was mild, but it mutated into a deadly form when it hit the trenches of WWI. There, the evolutionary pressures began to favor a deadly strain rather than a mild case. The new strain went around the world a second time, but anyone who caught it the first time was immune. I'm surprised this information is missing from the article, especially since it's relevant to the current outbreak. I read this in a long New Yorker article about the epidemic many years ago, but I don't have a reference right now. —MiguelMunoz (talk) 07:11, 4 May 2009 (UTC)

Okay, I found the reference and put it in. —MiguelMunoz (talk) 05:30, 5 May 2009 (UTC)

Recognition of the second wave of 1918, 1957, and 1968 most salient to predicting possible paths of swine flu.

The fact that pandemics come in waves is fundamental to predicting the possible paths whenever a new and mild pandemic strain, like the swine flu, emerges.

In fact, multi-waves seems the rule, not the exception.

... Andrew Pekosz, associate professor of immunology and microbiology at Johns Hopkins University Bloomberg School of Public Health, says it's important to keep in mind that the 2009 H1N1 virus is new, which means no one has immunity to it. He points out that the three outbreaks in the last century that were caused by new viruses -- in 1918, 1957 and 1968 -- started with a mild wave followed by more severe waves months later. Scientists dig for lessons from past pandemics http://www.cnn.com/2009/HEALTH/04/30/swine.flu.1918.lessons/index.html

http://www.cnn.com/2009/HEALTH/05/07/swine.flu.future/ —Preceding unsigned comment added by 66.167.95.139 (talk) 17:21, 7 May 2009 (UTC)

The CNN article proceeds to the obvious implications for predicting the possible future course of the Swine Flu hybrid:

4. In the fall, could we have a pandemic like we had in 1918?

At a press briefing last week, World Health Organization spokesman Gregory Hartl brought up the specter of the 1918 pandemic, which killed more than half a million people in the United States. "In 1918, that pandemic started out as a very mild case of disease in the spring of 1918. ... Cases of the disease almost completely disappeared over the summer, only to reappear in the autumn of 1918 with the vengeance which we all know," he said. "So even though we might be only seeing mild cases now, we cannot say what will happen in the future." Learn more about the swine flu »

But many experts believe it's highly unlikely there would be an outbreak anything like 1918. First of all, scientists have a much better understanding of infectious diseases, and health care has improved greatly since 1918. Secondly, the 2009 H1N1 lacks a gene that is present in highly virulent flu viruses, such as the one in 1918.

http://www.cnn.com/2009/HEALTH/05/07/swine.flu.future/index.html?section=cnn_latest

Although the swine flu does not yet include a lethality gene, such genes are already present in H5N1, which is endemic in poultry and pigs all along the Pacific Rim. In Indonesia a variant of H5N1 better adapted to pigs has already been found, and that variant is still deadly in mice and ferrets. The possibility of a pig catching both the contagious swine flu and the lethal H5N1 bird flu and mixing them are obvious. The offspring virus could be a second wave that is both human-contagious and deadly. This mixing is by no means certain, and may even be unlikely, but underlies the caution with which public health authorities approach the possible future course of swine flu.

In each of the four major pandemics since 1889 (1889, 1918, 1957, 1968) a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease

http://www.cnn.com/2009/HEALTH/04/30/swine.flu.1918.lessons/index.html

Scientists dig for lessons from past pandemics By Caleb Hellerman CNN Senior Medical Producer Decrease font Decrease font Enlarge font Enlarge font

(CNN) -- If there's a blessing in the current swine flu epidemic, it's how benign the illness seems to be outside the central disease cluster in Mexico. But history offers a dark warning to anyone ready to write off the 2009 H1N1 virus.

In each of the four major pandemics since 1889, a spring wave of relatively mild illness was followed by a second wave, a few months later, of a much more virulent disease. This was true in 1889, 1957, 1968 and in the catastrophic flu outbreak of 1918, which sickened an estimated third of the world's population and killed, conservatively, 50 million people. [emphasis added]

...

—Preceding unsigned comment added by 66.167.95.139 (talk) 17:31, 7 May 2009 (UTC)

And from http://www.usatoday.com/news/health/2009-05-09-swine-winter_N.htm :

Swine flu likely to return to U.S. next winter ...

"If you draw parallels to previous flu pandemics, the pattern has always been a mild epidemic in the early summer or late spring, then you see a larger epidemic in the winter," said Dr. Luis Z. Ostrosky, an associate professor of medicine and epidemiology in the division of infectious diseases at the University of Texas Medical School in Houston. "If this were to follow the pattern of previous outbreaks, we would see it again in the winter."

Ostrosky was referring to 1918 (Spanish flu pandemic), 1957 (Asian flu) and 1968 (Hong Kong flu).

This pattern of an initial "herald wave" followed by a second wave is common in the flu world.

"Sometimes we will see a little spike of flu towards the end of the season with that turning up next year. Maybe that's what this is. That would be very typical," said Dr. John Treanor, a professor of medicine and of microbiology and immunology at the University of Rochester Medical Center. "My guess would be that if this virus does not end up causing significant disease in the northern hemisphere over the summer, it will certainly do so in the fall."

So far, some of the most affected nations have been in North America and Europe, but the flu is spread more easily in the winter, and it's already fall in the Southern hemisphere. Experts fear public health systems could be overwhelmed if swine flu and regular flu collide in major urban populations, according to the Associated Press.

"You have this risk of an additional virus that could essentially cause two outbreaks at once," Dr. Jon Andrus, of the Pan American Health Organization's headquarters in Washington, D.C., told the wire service.

Two separate flu strains could also mutate into a new strain that is more contagious and dangerous. "We have a concern there might be some sort of reassortment, and that's something we'll be paying special attention to," World Health Organization spokesman Dick Thompson told AP.

In North America, the summer should slow down the spread of swine flu; neither viruses nor bacteria survive well at temperatures above 70 degrees Fahrenheit, explained C. Ed Hsu, an associate professor of public health informatics at the University of Texas School of Health Information Sciences at Houston and associate director of health informatics at the Center for Biosecurity and Public Health Preparedness at the University of Texas School of Public Health.

How and when the flu spreads is dependent on other factors as well: the fitness and efficiency of the virus itself along with its innate ability to replicate; the susceptibility of the host; and the environment, which includes not only the weather, but also human behavior (for example, groups of people confined together inside, making it easier for the virus to jump from person to person).

If a particular virus is especially robust, the weather and other environmental factors may play a lesser role.

"It may not care what the environment is like, because it doesn't need that assistance, or it may depend on environmental factors. It could go either way," Treanor said.

And while influenza virus needs a warm human body to replicate, it seems to sustain itself better in airborne respiratory droplets when it's cold, Horovitz said. Hence, the sneeze heard around the world.

"But, if it does go away, it will come back, he added. "I would be pretty sure of that."

A fall/winter resurgence may or may not be more virulent, said Ostrosky.

"We've been very lucky so far that it's appearing to be mild, at least in the U.S., as far as virulence and susceptibility to antivirals is concerned," he said. "It could change. That's one of the concerns."

"The severity depends on whether [and how] the genotype of the virus reassorts itself," Horovitz added. The reassortment may be so minimal as to make no clinical difference, or it could assert itself in entirely new ways."

But a vaccine will likely be ready by the time a second wave hits, Ostrosky noted, and the world is prepared in other ways as well.

"We have completely sequenced the genome of the virus, and it shows low virulence at this point. We know about it. We can prepare," he said. "If nothing else, this has been an extraordinary exercise in preparation."

Since being unlocked, this article is greatly improved

I would hope that an article of this importance would not lightly be denied the input of those with possibly pertinent information.

The genius of Wikipedia is unleashed only when there is contribution, correction and revision, not when there is censorship. —Preceding unsigned comment added by 66.167.95.139 (talk) 00:29, 8 May 2009 (UTC)

50–100 million again

Another good source says "Total deaths were estimated at ≈50 million and were arguably as high as 100 million." The source is:

• Centers for Disease Control and Prevention. Jeffery K. Taubenberger and David M. Morens. 1918 Influenza: the Mother of All Pandemics, January, 2006.
  • Centers for Disease Control and Prevention. Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic., 2002 Spring.

Just putting that out there for all the editors who would prefer an estimate of ~50 million. Binksternet (talk) 04:00, 9 May 2009 (UTC)

Contradiction?

In one part of the article it states that: "Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths."

But in this part of the article it states that: "Some researchers speculate that the soldiers' immune systems were weakened by malnourishment, and the stresses of combat and chemical attacks, increasing their susceptibility to the disease."

Is this a contradiction or not? If both is true than that would mean that weaker people would easier catch the flu, but would survive and that stronger healthier people wouldn't catch the flu as easily but if they did they would have a much higher risk of death. —Preceding unsigned comment added by 85.226.156.198 (talk) 16:40, 10 May 2009 (UTC)

Notable Victims

A number of people on that list were not victims of the Spanish Flu. Read some of their profiles. UStars (talk) 04:08, 11 May 2009 (UTC)

Like who? Examples would be useful. (Just in case: note that the "Victims" section consists of two lists, "Notable fatalities" and "Notable survivors".) Shreevatsa (talk) 04:23, 11 May 2009 (UTC)

Well Louis Botha, Myrtle Gonzalez, and Francisco de Paula Rodrigues Alves are all listed as fatalities of the Spanish Flu. And read their profiles. Not one of them three died from the illness. UStars (talk) 04:35, 11 May 2009 (UTC)

Yeah, seems there's something to be sorted out for the first two, because we have sources on this page (available online) that claim these died of the flu and sources on the other page (not available online) which claim heart disease. As for the third, it does say he died of Spanish flu, but you've just added a contradictory line saying he died of a heart attack :P Shreevatsa (talk) 04:51, 11 May 2009 (UTC)

Is that necessarily contradictory? 'flu places a strain on the heart and respiratory system.--Michael C. Price ^talk 07:30, 11 May 2009 (UTC)

Looking at Botha's bio I see it says "While other speculative theories of his death may exist they remain speculative and entirely unsubstantiated. " So there exists some doubt that he did die of "just" a heart attack. --Michael C. Price ^talk 07:36, 11 May 2009 (UTC)

In The Plague of the Spanish Lady by Collier (1974), Botha is listed as dead from Spanish Flu if that's any help. --talk

World War II casualty comparison

I removed the statement that the 1918 flu killed "more than double the number killed in World War II." The number of people killed by WWII is estimated 50-72 million. 96.10.251.86 (talk) 17:29, 12 May 2009 (UTC)