The Spanish Flu in 1918 infected roughly 500 million patients across the globe, killing 50 to 100 million of that number. Unlike most influenza outbreaks, it killed more healthy, juvenile patients than it did the very young or elderly; this is because the robust immune systems of younger people triggered cytokine storms - immune reactions characterized by high fever, swelling and redness, extreme fatigue and nausea. This is the immune system’s attempt to kill the virus and somatic cells infected with the virus: fever denatures viral proteins and renders them inoperable, while swelling and redness are caused by the same chemicals (histamines) that cause allergies. T-cells and macrophages are recruited to the site of infection, attracted to these histamines, and they in turn produce more histamines to enable further recruitment of white blood cells. Children and middle-aged adults had lower mortality rates in the pandemic, because their bodies did not produce cytokine storms.
Patients affected by the pandemic
Unlike recent pandemics such as AIDS, SARS and Ebolavirus, we don’t know the disease’s exact geological origin; did it come from the hot zone in Africa? Was it an import from the Asian or Southeast Asian countries? Or was it European in nature? It was called Spanish Flu because the American press at the time selectively reported the outbreak as being in Spain, whereas state censorship blocked reporting of its existence in Britain, Germany, France and the U.S., giving the illusion to the American Public that Spain was particularly hard-hit. What IS certain is that massive troop movements and deployments in World War I were the vectors responsible for the global spread of this disease. As with all pandemics, it spread as far as the people infected with it could move - which corroborates with scientific consensus that quarantine is the most effective method of containing any outbreak of any disease.
When the bubonic plague, smallpox and syphilis ravaged through Europe, certain countries were notable for having an infection rate of nearly zero. Venice was the first European country to impose a systematic quarantine after the black death in the 14th century depopulated the city, in which incoming ships had to remain anchored in the port for 40 days before making landfall. The Republic of Ragusa, a city-state located in modern-day Dubrovnik, Croatia, required quarantine for a month for ‘purification by sun and wind’ before merchants could enter the city. Both countries were much less affected by subsequent plagues than neighboring countries
The modern city of Dubrovnik, which still retains the fortified walls from its days as a city-state
In 24 weeks, the Spanish Flu killed 3-6% of the global population at the time. Of those infected, however, only 10-20% actually died from the illness. This is startlingly low compared to the more recent Ebola outbreak, whose mortality rate averages at around 50% of infected patients. Clinical symptoms included nasal, gastric and intestinal hemorrhaging, as well as pulmonary edema. These were unusual enough at the time that initial cases were often mistaken for Typhoid Fever, Dengue Fever, or Cholera. Although the American public has largely forgotten about this pandemic, it WAS significant - and the lessons it taught remain applicable today: the best weapon again SARS, Ebola, H1N1 ‘swine flu’, and any other pathogenic virus is still quarantining patients away from those who are not infected. This has been proven by successful efforts in West Africa to contain Ebola outbreaks by mandatory, military-enforced quarantines. It’s remarkable to me that one of the primary vectors for the outbreak was the open-casket funerals held for Ebola victims in these countries, and that those attending these funerals would come into physical contact with the body. Even more incredible is how difficult it was to convince the populace that the virus could spread that way!
Quarantining is what has kept Ebola from spreading here in the U.S. It applies to every single contagious illness, and if there is one take-home message I would impart to my audience, it woudl be to stay home if you are feeling unwell. Don’t go to school, don’t go to work. I recently saw on reddit a claim that Americans who do not get paid sick leave as part of their jobs are responsible for much of the spreading of seasonal flu and other communicable diseases. One can only hope that, if this claim is substantiated, our leaders in D.C. will realize that expanding sick leave is one tangible way to boost economic productivity. Assuming they have the stones to do it.