Ancient history

1918 Spanish Flu

The 1918 flu, also mistakenly called "Spanish flu", is due to a particularly virulent and contagious strain (H1N1) of flu which spread as a pandemic from 1918 to 1919. This pandemic killed 20 to 40 million dead, 30 million according to the Institut Pasteur, or even 100 million according to certain recent reassessments. It would be the most deadly pandemic in history in such a short period of time, ahead of the 34 million deaths (estimate) of the Black Death.

Its nickname "Spanish flu" comes from the fact that only Spain - not involved in the First World War - was able, in 1918, to freely publish information relating to this epidemic. French newspapers therefore spoke of the "Spanish flu" which was wreaking havoc "in Spain" without mentioning the French cases which were kept secret so as not to let the enemy know that the army was weakened.

In 1918, the King of Spain Alfonso XIII fell ill, with the flu like many Spaniards. The press is not censored in Spain, whereas it is among the belligerents. It was therefore through Spanish journalists that the world understood when an epidemic was born, which posterity will remember as the "Spanish Flu"
In 1918, the King of Spain Alfonso XIII fell ill, flu like many Spaniards. The press is not censored in Spain, whereas it is among the belligerents. It is therefore through Spanish journalists that the world understands that an epidemic was born, which posterity will remember under the name of "Spanish Flu"

Apparently originating in China (1918), the 1918 virus would have passed, according to now controversial hypotheses, from duck to pork then to humans, or according to an equally controversial hypothesis directly from birds to humans. She quickly won the United States, where the virus would have mutated to become more deadly (for 3% of patients, against less than 1/1000 for other flu epidemics). It then became a pandemic, across Europe, then throughout the world through its colonies.

It killed around 408,000 people in France, but the war censorship limited the echo of it, the newspapers announcing a new epidemic in Spain, a neutral country and therefore less censored, while the epidemic was already wreaking havoc in France. It deserves the name “pandemic”. It mainly took place during the winter of 1918-1919, with 1 billion patients and 20 to 40 million deaths, according to very imprecise initial estimates due to lack of statistics established at the time. At the beginning of the 20th century, the maximum of the range remains imprecise, but was increased to 50 - 100 million, after integrating retrospective estimates for Asian, African and South American countries.

In just a few months, the pandemic claimed more victims than the First World War, which ended in the same year, 1918, and some countries were still affected in 1919.

The progression of the virus was lightning:foci of infection were located in several countries and continents at the same time in less than 3 months, and on both sides of the USA in barely seven days. Locally, two or even three waves have succeeded each other, which seem to be linked to the development of transport by boat and rail in particular, and more particularly to the transport of troops.

This pandemic has raised awareness of the international nature of the threat of epidemics and diseases, and of the imperatives of hygiene and a surveillance network to deal with it. There is thus in one of the clauses of the charter of the League, the will to create an International Health Committee, which will eventually become the World Health Organization (WHO).

Medical impact, statistical anomalies

The deaths were mainly young adults, which is surprising:young adults are usually the generation most resistant to influenza. This was first explained by the fact that this age group (especially for professional or war reasons) moves the most or lives in places where it meets many people (workshops, etc.). The multiplicity of contacts increases the risk of being contaminated. This observation has been made by historians (notably during the cholera epidemic in Liège in 1866). In fact, it was the immune system of this age group that reacted too vigorously to this new virus, triggering a "storm of cytokines" that damaged all the organs, to the point of killing many patients.

It is estimated that 50% of the world's population was infected (i.e. 1 billion inhabitants at the time), 25 to 50 million people perished, with a consensus around 30 million deaths.

This flu is characterized first of all by a very high contagiousness:one in two people infected. It is then characterized by an incubation of 2 to 3 days, followed by 3 to 5 days of symptoms:fevers, weakening of the immune defences, which finally allow the appearance of normally benign complications, but here fatal in 3% of cases, i.e. 20 times more than "normal" flu. However, it only weakens the sick, who die of the resulting complications. Without antibiotics (discovered 10 years later), these complications could not be stopped.

The significant mortality was due to bacterial bronchial superinfection, but also to pneumonia due to the virus. The preferential attack of young adults could perhaps be explained by a relative immunization of older people who have been previously infected with a similar virus.

The 1918 virus

The genetic characteristics of the virus have been established thanks to the preservation of tissues taken during recent autopsies on Inuit and Norwegian corpses preserved in permafrost (frozen ground in Nordic countries). This virus is an H1N1 flu.

* Parent virus, unknown strain:source flu virus, highly contagious but with normal virulence which, by mutation, gave rise to the Spanish flu virus. The parent virus was only identified and rigorously monitored from April until June 1918, when it was probably raging from the winter of 1917-1918 in China.

* Spanish flu virus, strain H1N1:a highly virulent virus that apparently appeared in the United States and ultimately killed more than 21 million people worldwide; this designation generally also includes its “parent virus”. This more lethal version raged in 2 deadly waves, one from mid-September to December 1918, the other from February to May 1919. All continents and all populations were seriously affected.

* photomicrograph 1 of reconstituted Spanish flu virus

* photomicrograph 2 of reconstituted Spanish flu virus

Consequences of the Spanish flu
In Seattle, the puncher was ordered not to let passengers not wearing masks board. For nearly a year, transport and the economy of all countries will be affected by hygiene measures of masks. For nearly a year, transport and the economy of all countries will be affected by hygiene measures

Famous Victims

* Guillaume Apollinaire, French poet

* Edmond Rostand, French playwright

* Egon Schiele, Austrian painter

* Rodrigues Alves, President of Brazil

* Joe Hall, English ice hockey player

From a technical point of view, its specific pathogenic characteristics cannot be studied due to the absence of a viral strain, as no sample could be preserved in a sufficiently good state.

It is therefore only by studying the flu family, as a whole, that we can understand its mechanisms, which can be summed up as follows:

* very high contagiousness, inducing epidemic or pandemic behavior,

* high variability, leading to variable virulence as well as ineffective immunization from one year to the next,

* the virulence of this particularly large strain (severe weakening), as well as

* the fact that, ultimately, this virus only weakens the immune defenses, and is not in itself a source of death (it is the complications that accompany the flu that are fatal depending on the degree of weakening of organism).

The absence of antibiotics (which would not have stopped the viral disease but only the bacteriological complications) was also decisive.

Finally, with regard to the consequences, the essential element is the awareness of the biological threat on a global scale, that an epidemic starting in China could ultimately threaten the population of the United States, the Europe, and all the states of the world. This was followed by the creation -by the League- of a global health and medical surveillance body, which later became the World Health Organization (WHO).

It should also be noted, given the cycle of reappearance of deadly influenza epidemics spaced out, at the maximum observed, by 39 years, the last dating from 1968, the WHO predicts "statistically" the appearance of an influenza pandemic deadly by 2010 to 2015. This is why, in recent years, a number of studies have suddenly been devoted to the Spanish flu virus, some aimed at recovering intact strains, tangibly studyable, to allow the construction of defenses adequate.

The 1918-1919 pandemic was, with 30 million deaths according to the generally accepted consensus [1], the first major pandemic of the modern era. It is one of the greatest human pandemics, comparable in number of victims to those of the plague and AIDS. The latter, however, continues to kill beyond the 24 million victims already counted.


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