Spanish Influenza of 1918-1919

Influenza patients

Scientist examines sample of cultured influenza viruses

Priya, Sindu, Nikita, Faye,

& Trisiah.

Guiding Question!

To what extent did the Spanish

Influenza epidemic influence and

impact our world in the present day?

What was the Spanish Influenza?

A devastating flu- known as “Spanish influenza”

Raged in World War I in Europe

Epidemic started in trenches during May of 1918

Referred to as a global disaster

Other Names for the Spanish Influenza: Spanish Flu, La Grippe, and Spanish Lady. The word influenza came from the Italian language meaning influence of a poison or danger.

Trenches of WWI

Causes:Not the Spanish peopleVaccinationsInfluenza A – H1N1◦ Influenza virus derived from an unknown sourceDoctors told the patients and the world that the influenza was caused by a germ- viruses weren’t known during that time period◦ They would blame germs and bacteria in case of death or any

other situationStruck right after soldiers came back from world war 1 – overseasIn 1918 it was believed the cause of the influenza was the refusal of getting the shot which prevented the disease.◦ Everyone in the towns went down with the flu, including doctors

and nurses The virus strain was caused by a cytokine storm◦ Immune systems were agitated to the maximum, resulting in the

destruction of the human body◦ Stronger the immune system, the more it was affected (young

adults)Many deaths were from a pneumonia◦ Causes were of a secondary bacterial infection from the Spanish

influenza

First Wave:

Spring of 1918

Tens of thousands had fallen ill and died

First wave was like a “prelude” of the second and third wave

Extremely contagious

Completed faster than second and third wave

Started quietly as most people were unaware of this new, mild virus

Second Wave:Fall of 1918-1919Reappeared in full force from first wave during the spring of 1918Extremely contagious, deadly, and fatal-most vicious and severe out of all three wavesCaused simultaneous outbreaks in the Northern and Southern HemispheresData suggests that people unfortunately faced with the influenza in the second wave could have been protected compared if they were infected in the third waveMore frequent complicated, severe, and fatal cases in the second wave as well as the third waveTransportation was much slower during the second waveStarted in Switzerland

Third Wave:Winter of 1918-1919

Less deadly than the second wave, but more deadly than the first wave

Third wave did spread internationally, however, did not get much attention as the first two waves because the war was over during this time and many wanted to start their lives over again

Presence of the third wave had somewhat lingered

After the new year, 1919, flu showed signs of slowing down

The world started to get back to normal, as in back to normal routines and activities, such as re-opening the schools

Theories of Origin :There is no exact known place where the influenza first occurred but it was estimated that the first cases happened near the ending of World War I, early spring of 1918. Many thought that the influenza was a result Germans using the flu as a biological warfare tool. There were claims that “Bayer Aspirin” was filled with “poisoned germs” however, this claim was disproved. Additionally, there were accusations of German spies infiltrating the Medical corps and spreading the flu through shots.

German flag during WWI

Theories of Origin in Asia:One of the main theories of Origin was that the influenza came from Asia.

The outbreak of a fatal pulmonary disease could have been the cause and mutation of the virus.

Chinese and Vietnamese labourers working in the United States spread was another theory.

Map of Asia

Theory of Origin in the U.S.A.:

Despite many origins, many historians and scientists firmly believe that the first outbreak of the Spanish Influenza was in the United States in the Military Camp Funston of Kansas.

The flu has known to originate from farm animals where the virus has mutations as it transfers between humans and domesticated animals.

In the closely populated State, this likely happened with many people raising poultry, cattle and hogs.

Patients who were some of the most healthiest and strongest people in the country suddenly fell ill and soon came down with pneumonia and died.

With almost 60,000 men in the camp, within three weeks, more than 11,000 were sick enough to require hospitalization. The influenza spread to other military camps in the States, first starting with camps in Georgia.

Spreading the Flu World Wide:

In France, the outbreak of Influenza occurred in Brest, the largest port for the in which the Americans used to arrive for the war in Europe. Soon, the flu spread across Europe.

In the unsanitary conditions of the trenches, soldiers began to fall ill. With what appeared to be a cold at first soon turned deadly.

Again, in military bases, soldiers collapsed because of very high fevers and died of severe pneumonia; there was also severe respiratory failure.

With mass movements of troops and supply ships leaving war for their home countries, the second wave of the deadly flu followed and the virus spread through North America, Europe, Brazil and the South Pacific.

Pneumonia lungs- X-Ray B, healthy lungs-X-Ray A

Due to a mutation in the virus, the second wave of the flu was not only very contagious as the first wave, but increasingly deadly as well. Few countries were spared. Spain was the first country to notice and officially recognize the flu in May 1918 when it killed nearly 8 million people. (Hence, the Spanish Influenza)Although the flu generally affects the elderly and young, the Spanish Influenza unusually and mainly targeted young and healthy men and women from the around the ages of 20 – 40It killed ferociously in South Africa, Siberia, and Samoa (humidity was a factor in spreading the disease) while, in American cities, half the population became ill.

General Symptoms:

High fever-led to dangerous changes in the victim’s mental stateHeadacheInflammation-choking pain, swelling, rednessBody or muscle acheDelirium-crazy state, where victim is not mentally able to control his or her self and mind, happens because chemical or disease (hence, Spanish Influenza) is disturbing the neurons of the cerebral cortexDiarrhea and vomiting-which led to dehydrationExtreme fatigueFoaming blood came from mouth and nose and ear; nosebleedsSome died within hours of the first symptom

Respiratory SymptomsRunny nose

Sore throat

Cough◦ So severe that people would sprain

abdominal and chest muscles◦ Produced blood-tinged sputum

Viral pneumonia-pneumonia started by a virus

Rapid breathing

Respiratory distress

Cyanosis ◦ Skin turns slightly blue from the lack of oxygen

Pulmonary haemorrhage- acute bleeding in the lungs, especially in the upper respiratory tract, which resulted in deaths

Bacterial pneumonia-pneumonia started by bacteria

Hematolgic (related to blood) Symptomes:

The H1N1 virus during the Spanish influenza pandemic had characteristics of vital hemorrhagic fever viruses

Increased bleeding tendencies

Nosebleeds

Easy bruising

Bleeding from mouth and once again, in lungs

Intestinal bleeding

Petechial hemorrhage- A petechia is a small red or purple spot on the body that is caused by a minor hemorrhage (broken capillary

blood vessels) .....

Petechial hemorrhage

Social Effects:

Killed more people than WWI

By two years, the influenza transformed to a common cold to a vast epidemic and a fifth of the world’s population was infected

Flu prominent and more deadly for those aged 20 to 40

Unusual pattern because it mostly affected the elderly and youth

Approximately 675,000 Americans died because of this flu; this is ten times as many as in the world war

US soldiers who died in Europe-most died from epidemic instead of WWI

Journal of the American Medical Association final edition of 1918 notes describes 1918 as unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings.” (12/28/1918)

Schools closed, illness also spread in family, deaths occurred

Influenza had profound impact on mortality/death rate (2.5 %) whereas other epidemics that broke out in the past were mostly 0.1 % lower.

Mortality rate for those aged 15 to 34 was 20 x higher in 1918 compared to the previous years.

People struck with illness on the street, deaths were quite rapid.

Influenza went international and most of humanity felt and was impacted by the effects of it; trade routes and shipping lines were affected, countries: North America, Europe, Asia, Africa, Brazil, and the South Pacific

India: mortality rate extremely highabout 50 deaths per 1000 people.

Influenza did affect humanity internationally, but also affect the war and the course of the war: entire fleets were ill because of the influenza and frontline men were too sick to fight and combat

Everyone affected: ¼ US affected, 1/5 world affected-so many infected: lack of health care workers and medical supplies, shortage of coffins, morticians and gravediggersPerson infected would be dead within hours of being infected by diseaseBody sheds blood, lungs fill with liquid Ways people were infected: high fevers, shivers, coughs, muscle pain, sore throat, tiredness, loss of strength ergo not able eat or drink independently, difficulty in breathing, death.New York City only33 000 deathsPres. Wilson infected by flu in Paris

working out details of Versailles TreatyDisease also placed additional strains

on society and the economy, however this was visible due to WWI as well

Economic Effects:Sharp decline in demand◦ Public areas where most economic

activities took place such as stores and restaurants were avoided

Shrinking of labour supply◦ Many workers became ill, stayed

home to prevent getting sick or were obliged take care of others who are sick

Short Term Effects There was an increase in demand for medical services◦ hospitals and clinics were

overwhelmed, hence emergency buildings

◦ Surveillance of the flu was hard to monitor

◦ Care for other health problems was limited

◦ Medical personnel had a chance to be strained as they were exposed to the flu very often

Large decrease in travel◦ Travel to areas where the disease is common drastically

decreased◦ People more likely stayed at home to quarantine

themselves at home Dramatic decline in retail trade ◦ Decreased attendance at theatres, sporting events,

museums and other entertainment Reduced gross domestic product and supply of labour Supply chains were affected◦ Restrained transportation systems Interrupted global trade

Long Term Effects

Reduction in population and labour force ◦ Depends on mortality of the outbreak (e.g. if very old

people were most affected, the effects would be relatively small compared to high mortality rates of young workers)

Increased ratio of capital to labor/decreased rate of return to capital◦ Slower pace of capital accumulation and growth of the

gross domestic product for several years

Predicted lower incomes and socioeconomic status of children who were born immediately after the pandemic

Faster per capita growth ◦ Return to previous trend growth from recession

Ethical Effects:Epidemic so dreadful that average life span in

US decreased by 10 years.

Pregnancy was affected because the around mid twenties to 34 was the age where most women expected babies and were pregnant.

Physician’s responses to their patients health conditions: patients that seemed to have the ordinary flu

or cold(influenza) would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis(change in colour to blue on skin mostly lips, tougue, fingernails and a sign the oxygen is dangerously decreased in blood system) appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979)

influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976)

Children sang this song during the epidemic:I had a little bird, Its name was Enza. I opened the window, And in-flu-enza. More soldiers killed than those that could have been killed with the weapons on both sides during WWIAlready shortage of physicians during war because of for example, battle wounds and mustard gas burns, but more shortage after because of the epidemicTo fight the influenza, Red Cross created a National Committee on Influenza and fully used nurses, volunteers, medical supplies. Committee was involved in both military and civilian sectors to assemble all forces to fight the epidemic.In US-Red Cross was forced to recruit more volunteers to help fight the epidemic

Emergency hospitals created to help patients from US and those sick overseas

Those that luckily weren’t infected still faced public health regulations to prevent spread of the epidemic.

Gauze masks distributed, no sales in stores, funerals limited to 15 minutes.

Whoever ignored flu laws was fined by officers (i.e. misuse of gauzes-poke holes in gauzes to smoke, let gauzes hang loose around necks which women did and used these masks as veils, etc.) resulted in 100 $ fine and 30 days in jail.

Emergency hospitals created

Proper way to wear a gauze mask

Political Effects:Political instability ◦ Government should already be prepared and well informed to handle

this flu pandemic◦ Government would be expected to address and find a solution (ex.

Supplies for the poor, famine, shortages) ◦ Likely loss of trust in government ◦ Potential rise in fascism ◦ Global terrorism may be influenced

Disruption in vital government services Government needed to help minimize economic impacts ◦ Ex. Encourage people, mostly the infected, to conduct business using

electronic communications at home or encourage people to shop online to help retail trade

Effective surveillance and immediate identification of pandemic strain Provide the opportunity to find a vaccine Disruption to public safety ◦ Outbreaks/public panic ◦ Lawlessness ◦ Violence

Environmental Effects:Strains of the virus could have developed from animals ◦ Ecosystems would be disturbed

There may be human interference in the environment to find a cure

Effect on Children/Infants Overall:

Higher number of stillbirths and premature deliveries during and shortly after the pandemicHealth of babies was affected because of flu, plus some mothers could not take care of their babies in great quality because of the flu.Some mothers could not provide healthy milk to their children because illness spreadMother’s illness or death, of course, affected the survival of their child

^ inadequate care and nutrition by mother

Effects on Infant and Child Mortality:

If mothers inhabited the flu during the first or second trimester of pregnancy, there was an increase in prematurity rates and therefore, neonatal mortality. (neonatal mortality-death rate during first 28 days of life) Pregnant mothers were at higher risks of having miscarriages between Sept 1918 to Jan 1919 (during the epidemic)Babies born between Jan 1919 to April 1919 were at greater risks of neonatal mortality during the epidemicInfluenza provoked premature births and disruptions during pregnancy as well as interruptions during the mothers maternityRisks of miscarriage rose during epidemic

Massive mortality rate during October 1918 (second wave) in Kansas because of Spanish Influenza, which was present during this time period.

Statistics Graph-Mortality Rate:

How was it Cured?

Due to the lack of knowledge there was no particular medical treatmentHome cures were created as to how to cure the flu.It included- wearing protective gauze face masks, strange remedies such as, eating fried onions, wearing medicated bags, sprinkling the streets with formaldehyde, compressed yeast, eating lemons and two of the most popular- drinking alcohol, and covering the body with raw onions.

Fried Onions

Raw Onions

Influenza in Canada:

Due to prohibition since 1915, alcohol was available only by doctor’s prescription.

Alcohol was considered an absolute necessity Before tending to influenza patients, the doctor at

Rouleau, Saskatchewan took a swig of brandy for medicinal purposes. “He advised parents to give their children one teaspoon of brandy in a cup of water each day, adults a mickey of brandy a day to ward off the flu,” the Rouleau states.

A small amount of brandy a day

How is it Affecting us Today? Research

Jan.18th, 2007- Kobasa et al. reported of money being affected with a disease, with symptoms of the 1918 pandemic and died from a cytokine storm (overreaction of immune system). The studies conducted on the monkeys explain why Spanish influenza affected the young & healthy. It is due to their strong immune system which would potentially have a stronger overreaction than of an elderly.

Sept. 16, 2008- The body of victim, Sir Mark Sykes was studied to understand the genetic structure of the modern H5N1 bird flu.

Dec. 2008- Research conducted by Yoshihiro Kawaoka at the University of Wisconsin, investigated the presence of genes- PA, PB1, and PB2 and a nucleoprotein originated from the samples of 1918 flu to the capability to invade human organs such as lungs.

Studies done from the samples of the flu help medial scientists produce drugs and vaccines that would help prevent the forth coming viruses that our nations might be struck with.

PreventionThe science today has progressed immensely (with the help of samples mentioned before) that drugs such as antiviral drugs Rimantadine (Flumadine) & Oseltamivir (Tamiflu) have been experimented and proved to be effective against such viruses.

These drugs and vaccinations provided protection against the Spanish flu virus in the mice.

Rimantadine HCL 100 MG Tablet

Flumadine 100 MG Tablet

Oseltamivir (Tamiflu)

Re-emergence

The probability of the virus returning from natural source is remote

It is believed by the experts that is it reemerges it would be caused by an influenza subtype, to which there are rare or no preexisting immunity in the human population.

Because of the vaccines provided today, the H1N1 component is taken care of, thus the virus eliminates to fit in the criteria of the new pandemic strain.

Conclusion!Through profound research, one can see that the Spanish Influenza was definitely not an “ordinary” epidemic. It was deadly, vicious, aggressive, and contagious. However, it has helped us in the present day for, for example, while researching a recent flu - the swine flu. Although most epidemics are all deathly and costly, they help the future generations to use these events in history to create our world a better, and safer, place to live in.

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