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10 misconceptions about the 1918 flu, the 'greatest pandemic in history'

The influenza pandemic of 1918

It is often referred to incorrectly as the “Spanish flu.” Between 50 and 100 million people are thought to have died, representing as much as 5% of the world’s population. Half a billion people were infected.
Misconceptions about it may be fueling unfounded fears about the new virus.

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10 misconceptions about the 1918 flu, the 'greatest pandemic in history'

10 misconceptions about the 1918 flu, the 'greatest pandemic in history'

http://theconversation.com/10-misconceptions-about-the-1918-flu-the-greatest-pandemic-in-history-133994

theconversation.com

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Key Ideas

The influenza pandemic of 1918

It is often referred to incorrectly as the “Spanish flu.” Between 50 and 100 million people are thought to have died, representing as much as 5% of the world’s population. Half a billion people were infected.
Misconceptions about it may be fueling unfounded fears about the new virus.

The origins of the "Spanish" flu

The so-called Spanish flu did not originate in Spain. The geographic origin of the flu is debated to this day, though hypotheses have suggested East Asia, Europe, and even Kansas.
The influenza pandemic from 1918 got this name most likely because of the WWI context: The major countries involved in the war 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 U.S. By contrast, 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 end of mankind

The 1918 flu spread rapidly, killing 25 million people in just the first six months. This led some to fear the end of mankind and that the whole thing was caused by a form of super-virus.
Recent studies show that the high death rate can be attributed to crowding in military camps and urban environments, as well as poor nutrition and sanitation, which suffered during wartime.

The first wave of the pandemic

There is the misconception that the first wave of the so-called Spanish flu was more lethal than the ones to follow. But in reality, the second (October-December 1918) out of the 3 waves had the highest rate of deaths.
During the second wave, those with severe cases were often crowded together in hospitals and camps, increasing the transmission of a more lethal form of the virus.

Mortality rates

The virus that caused the 1918 influenza did not kill most of the people who were infected with it.
The vast majority of the people who contracted the 1918 flu survived. National death rates among the infected generally did not exceed 20%(death rates that exceed the typical flu, which kills less than 1% of those infected.) However, death rates varied among different groups

Therapies of the day

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, rather than cure them.

The day’s news

The severity of the so-called Spanish flu was underplayed by the authorities of the day and that resulted in less coverage in the press.
But officials took a few measures: at the height of the pandemic, quarantines were instituted in many cities.

The pandemic and WWI

It’s unlikely that the flu changed the outcome of World War I because combatants on both sides of the battlefield were relatively equally affected.
However, it's clear the fact that the war profoundly influenced the course of the pandemic.

Widespread immunization

This concept was not popular nor practiced in 1918, so it did not have any effect on the ending the pandemic.
Exposure to prior strains of the flu may have offered some protection. In addition, the rapidly mutating virus likely evolved over time into less lethal strains.

The genes of the virus

In 2005, researchers made public the fact that they had successfully determined the gene sequence of the 1918 influenza virus.
Scientists now believe that an immune system overreaction contributed to high death rates among otherwise healthy young adults in 1918.

Being better prepared

We know today more about how to isolate and handle large numbers of ill and dying patients, and doctors can prescribe antibiotics, not available in 1918, to combat secondary bacterial infections.
To the common-sense practices of social distancing and hand-washing, contemporary medicine can add the creation of vaccinations and anti-viral drugs.

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The disease, suspected to have been typhoid fever, weakened the Athenians significantly and played a big role in their defeat by the Spartans.

165 A.D.: The Antonine Plague

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Typhus fever in World War 1 (1945)

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2009: The H1N1pdm09 virus

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The 2009 H1N1 outbreak in numbers

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Epidemic vs. pandemic

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Disease Event Classification

Epidemiology is the branch of medicine that handles the following:

  • Incidence: the occurrence of a disease over a specified period.
  • Prevalence: how many people are affected within a population.
  • Control of diseases: an appropriate public health response.

Two measurable factors mostly define the level of disease occurrence:

  • The pattern and speed by which a disease moves.
  • The size of the susceptible population.
The terms an epidemiologist use
  • Sporadic refers to a disease that occurs infrequently or irregularly.
  • Cluster refers to a disease that occurs in larger numbers even though the actual number or cause may be uncertain.
  • Endemic refers to the constant presence and/or general prevalence of a disease in a geographic population.
  • Hyperendemic refers to persistent, high levels of disease well above what is seen in other populations.
  • Epidemic refers to a sudden increase in the number of cases of a disease above what is normally expected.
  • Outbreak is the same as an epidemic but is often used to describe a more limited geographic event.
  • Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.

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A History Of Pandemics
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Quarantined
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  • Vaccination, if available, and herd immunity can curb the spread of disease.
  • Big cities, with exploding population and traffic, can lead to the rapid spread of any infectious disease.
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The situation is improving in China

For several weeks now, the number of cases diagnosed daily is dropping.

From a very detailed epidemiological follow-up in other countries, we know outbreaks are very specific to areas and can be controlled easier.

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The pandemic

According to the World Health Organization, a pandemic is declared when a new disease for which people do not have immunity spreads around the world beyond expectations.

Declaring a pandemic

When declaring a pandemic, the World Health Organization has the last word. There is no threshold, such as a certain number of deaths or infections, or a number of countries affected, that needs to be met.
And once a pandemic is declared, it becomes more likely that community spread will eventually happen, and governments and health systems need to ensure they are prepared for that.

Dealing with the current pandemic

Although a pandemic has been declared, there is no need for global panic. Panic would defeat the purpose of trying to raise awareness.
It is still urging countries to detect, test, treat, isolate, trace and mobilize their people.

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A new playbook

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The false choice

“Save the economy or save lives” is a false choice.
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  • Early and aggressive interventions saved lives and triggered a faster rebound, such as job growth and banking assets.
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The hope is for a deep, short recession, to show that people have shut the economy down to limit the spread of disease.

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During this time, the U.S. is expanding unemployment benefits and are also delaying tax filing. In northern-European countries, the government is directly paying businesses to maintain their payrolls to avoid mass layoffs and furloughs.

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The mask

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Surgical masks

Doctors started wearing the first surgical masks in 1897. The masks were not designed to prevent airborne disease - that is still not the case today - but to prevent doctors from coughing or sneezing droplets onto wounds during surgery.

The first modern respirator

During 1920, a plague broke out between a shared jurisdiction of China and Russia. The Chinese Imperial Court brought in a young doctor named Lien-teh Wu that determined that the plague was not spread by fleas but through the air. He expanded upon the surgery masks he'd seen in the West, and made it from gauze and cotton and added several layers of cloth to filter inhalations.

When the Spanish flu arrived in 1918, the mask was well-known among scientists and the public.

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The new virus

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The symptoms

Common symptoms: coughing, fever, and shortness of breath. Non-respiratory symptoms (feeling nauseous, vomiting having diarrhea) were also reported.
The virus is more violent with the elderly, the very young and with individuals that have a weak immune system. The majority of those infected however recover after a few days.

Spreading the virus

Coughs or sneezes from an infected person are the most likely to spread the virus. So it's essential to follow basic hygiene rules:

  • Wash your hand often during the day.
  • Cover coughs and sneezes with your inner elbow or a napkin.
  • Don't touch your eyes, nose, or mouth with your hands.
  • Stay inside if you have any of the symptoms and avoid interacting with people that show signs of the infection as well.

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