Unknown aspects of the Spanish flu

Spanish flu 1918 pandemic of H1N1 influenza virus The Spanish flu, also known as the 1918 flu pandemic, was an unusually deadly influenza pandemic. Lasting from January 1918 to December 1920, it infected 500 million people – about a third of the world's population at the time. The death toll is estimated to have been anywhere from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in human history.

To maintain morale, World War I censors minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States. Newspapers were free to report the epidemic's effects in neutral Spain, such as the grave illness of King Alfonso XIII, and these stories created a false impression of Spain as especially hard hit. This gave rise to the name Spanish flu. Historical and epidemiological data are inadequate to identify with certainty the pandemic's geographic origin, with varying views as to its location. Most influenza outbreaks disproportionately kill the very young and the very old, with a higher survival rate for those in between, but the Spanish flu pandemic resulted in a higher than expected mortality rate for young adults. Scientists offer several possible explanations for the high mortality rate of the 1918 influenza pandemic. Some analyses have shown the virus to be particularly deadly because it triggers a cytokine storm, which ravages the stronger immune system of young adults. In contrast, a 2007 analysis of medical journals from the period of the pandemic found that the viral infection was no more aggressive than previous influenza strains. Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene promoted bacterial superinfection.

This superinfection killed most of the victims, typically after a somewhat prolonged death bed. Etymology Despite its name, historical and epidemiological data cannot identify the geographic origin of the Spanish flu. The origin of the "Spanish flu" name stems from the pandemic's spread to Spain from France in November 1918. Spain was not involved in the war, having remained neutral, and had not imposed wartime censorship. Newspapers were therefore free to report the epidemic's effects, such as the grave illness of King Alfonso XIII, and these widely-spread stories created a false impression of Spain as especially hard hit. More modern terms for this virus include the "1918 influenza pandemic," the "1918 flu pandemic," or variations of these. Spread As U.S. troops deployed en masse for the war effort in Europe, they carried the Spanish flu with them. When an infected person sneezes or coughs, more than half a million virus particles can spread to those nearby. The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have increased the lethality of the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility. A large factor in the worldwide occurrence of this flu was increased travel.

Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease. Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks. In the United States, the disease was first observed in Haskell County, Kansas, in January 1918, prompting local doctor Loring Miner to warn the US Public Health Service's academic journal. On 4 March 1918, company cook Albert Gitchell, from Haskell County, reported sick at Fort Riley, a US military facility that at the time was training American troops during World War I, making him the first recorded victim of the flu. Within days, 522 men at the camp had reported sick.

By 11 March 1918, the virus had reached Queens, New York. Failure to take preventive measures in March/April was later criticised. In August 1918, a more virulent strain appeared simultaneously in Brest, France; in Freetown, Sierra Leone; and in the U.S., in September, at the Boston Navy Yard and Camp Devens (later renamed Fort Devens), about 30 miles west of Boston. Other U.S. military sites were soon afflicted, as were troops being transported to Europe. The Spanish flu also spread through Ireland, carried there by returning Irish soldiers. In a 2009 paper published in the journal Clinical Infectious Diseases, Karen Starko proposed that aspirin poisoning contributed substantially to the fatalities. She based this on the reported symptoms in those dying from the flu, as reported in the post mortem reports still available, and also the timing of the big "death spike" in October 1918. This occurred shortly after the Surgeon General of the U.S. Army and the Journal of the American Medical Association both recommended very large doses of 8 to 31 grams of aspirin per day as part of treatment.

Starko also notes that many early deaths showed "wet", sometimes hemorrhagic lungs, whereas late deaths showed bacterial pneumonia. She suggests that the wave of aspirin poisonings was due to a "perfect storm" of events: Bayer's patent on aspirin expired, so many companies rushed in to make a profit and greatly increased the supply; this coincided with the Spanish flu; and the symptoms of aspirin poisoning were not known at the time. A street car conductor in Seattle in 1918 refusing to allow passengers aboard who are not wearing masks As an explanation for the universally high mortality rate, this hypothesis was questioned in a letter to the journal published in April 2010 by Andrew Noymer and Daisy Carreon of the University of California, Irvine, and Niall Johnson of the Australian Commission on Safety and Quality in Health Care. They questioned the universal applicability of the aspirin theory, given the high mortality rate in countries such as India, where there was little or no access to aspirin at the time, compared to the death rate in places where aspirin was plentiful. They concluded that "the salicylate poisoning hypothesis was difficult to sustain as the primary explanation for the unusual virulence of the 1918–1919 influenza pandemic".

In response, Starko said there was anecdotal evidence of aspirin use in India and argued that even if aspirin overprescription had not contributed to the high Indian mortality rate, it could still have been a factor for high rates in areas where other exacerbating factors present in India played less of a role. Long-term effects A 2006 study in the Journal of Political Economy found that "cohorts in utero during the pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments received compared with other birth cohorts." A 2018 study found that the pandemic reduced educational attainment in populations. The flu has been linked to the outbreak of encephalitis lethargica in the 1920s.

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