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PostPosted: Sat Jan 13, 2018 11:23 am 
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The ‘greatest pandemic in history’ was 100 years ago – but many of us still get the basic facts wrong

Links at: https://theconversation.com/the-greates ... rong-89841


January 11, 2018 6.41am EST

This year marks the 100th anniversary of the great influenza pandemic of 1918. Between 50 and 100 million people are thought to have died, representing as much as 5 percent of the world’s population. Half a billion people were infected.

Especially remarkable was the 1918 flu’s predilection for taking the lives of otherwise healthy young adults, as opposed to children and the elderly, who usually suffer most. Some have called it the greatest pandemic in history.

The 1918 flu pandemic has been a regular subject of speculation over the last century. Historians and scientists have advanced numerous hypotheses regarding its origin, spread and consequences. As a result, many of us harbor misconceptions about it.

By correcting these 10 myths, we can better understand what actually happened and learn how to prevent and mitigate such disasters in the future.

1. The pandemic originated in Spain No one believes the so-called “Spanish flu” originated in Spain.

The pandemic likely acquired this nickname because of World War I, which was in full swing at the time. 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.

In fact, the geographic origin of the flu is debated to this day, though hypotheses have suggested East Asia, Europe and even Kansas.

2. The pandemic was the work of a ‘super-virus’ A Chicago Public Health poster outlines flu regulations during the pandemic. origins.osu.edu 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 has long fueled the supposition that the strain of influenza was particularly lethal.

However, more recent study suggests that the virus itself, though more lethal than other strains, was not fundamentally different from those that caused epidemics in other years.

Much of 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. It’s now thought that many of the deaths were due to the development of bacterial pneumonias in lungs weakened by influenza.

3. The first wave of the pandemic was most lethal Actually, the initial wave of deaths from the pandemic in the first half of 1918 was relatively low.

It was in the second wave, from October through December of that year, that the highest death rates were observed. A third wave in spring of 1919 was more lethal than the first but less so than the second.

Scientists now believe that the marked increase in deaths in the second wave was caused by conditions that favored the spread of a deadlier strain. People with mild cases stayed home, but those with severe cases were often crowded together in hospitals and camps, increasing transmission of a more lethal form of the virus.

4. The virus killed most people who were infected with it In fact, the vast majority of the people who contracted the 1918 flu survived. National death rates among the infected generally did not exceed 20 percent.

However, death rates varied among different groups. In the U.S., deaths were particularly high among Native American populations, perhaps due to lower rates of exposure to past strains of influenza. In some cases, entire Native communities were wiped out.

Of course, even a 20 percent death rate vastly exceeds a typical flu, which kills less than one percent of those infected.

5. Therapies of the day had little impact on the disease 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.

One hypothesis suggests that many flu deaths could actually be attributed to aspirin poisoning. Medical authorities at the time recommended large doses of aspirin of up to 30 grams per day. Today, about four grams would be considered the maximum safe daily dose. Large doses of aspirin can lead to many of the pandemic’s symptoms, including bleeding.

However, death rates seem to have been equally high in some places in the world where aspirin was not so readily available, so the debate continues.

6. The pandemic dominated the day’s news Public health officials, law enforcement officers and politicians had reasons to underplay the severity of the 1918 flu, which resulted in less coverage in the press. In addition to the fear that full disclosure might embolden enemies during wartime, they wanted to preserve public order and avoid panic.

However, officials did respond. At the height of the pandemic, quarantines were instituted in many cities. Some were forced to restrict essential services, including police and fire.

7. The pandemic changed the course of World War I 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, there is little doubt that the war profoundly influenced the course of the pandemic. Concentrating millions of troops created ideal circumstances for the development of more aggressive strains of the virus and its spread around the globe.



Patients receive care for the Spanish flu at Walter Reed Military Hospital, in Washington, D.C. origins.osu.edu

8. Widespread immunization ended the pandemic Immunization against the flu as we know it today was not practiced in 1918, and thus played no role in ending the pandemic.

Exposure to prior strains of the flu may have offered some protection. For example, soldiers who had served in the military for years suffered lower rates of death than new recruits.

In addition, the rapidly mutating virus likely evolved over time into less lethal strains. This is predicted by models of natural selection. Because highly lethal strains kill their host rapidly, they cannot spread as easily as less lethal strains.

9. The genes of the virus have never been sequenced In 2005, researchers announced that they had successfully determined the gene sequence of the 1918 influenza virus. The virus was recovered from the body of a flu victim buried in the permafrost of Alaska, as well as from samples of American soldiers who fell ill at the time.

Two years later, monkeys infected with the virus were found to exhibit the symptoms observed during the pandemic. Studies suggest that the monkeys died when their immune systems overreacted to the virus, a so-called “cytokine storm.” Scientists now believe that a similar immune system overreaction contributed to high death rates among otherwise healthy young adults in 1918.

10. The 1918 pandemic offers few lessons for 2018 Severe influenza epidemics tend to occur every few decades. Experts believe that the next one is a question not of “if” but “when.”

While few living people can recall the great flu pandemic of 1918, we can continue to learn its lessons, which range from the commonsense value of handwashing and immunizations to the potential of anti-viral drugs. Today we know more about how to isolate and handle large numbers of ill and dying patients, and we can prescribe antibiotics, not available in 1918, to combat secondary bacterial infections. Perhaps the best hope lies in improving nutrition, sanitation and standards of living, which render patients better able to resist the infection.

For the foreseeable future, flu epidemics will remain an annual feature of the rhythm of human life. As a society, we can only hope that we have learned the great pandemic’s lessons sufficiently well to quell another such worldwide catastrophe.

theconversation.com

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PostPosted: Sat Jan 13, 2018 11:25 am 
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Flu season is shaping up as one of the worst in years, officials say
By HELEN BRANSWELL @HelenBranswell JANUARY 12, 2018

The entire continental United States is experiencing widespread flu right now, the first time in the 13 years of the current tracking system that that has happened, according to the Centers for Disease Control and Prevention.

Officials said that this flu season is shaping up to be one of the worst in recent years.

The rate of flu hospitalizations — the number of people hospitalized with flu per 100,000 — nearly doubled last week compared with the previous week. Last week it was 22.7 per 100,000 people; the week before that rate was 13.7.

At the peak of the 2014-15 season, one of the two most severe seasons in the last 15 years or so, 29.9 people out of every 100,000 were hospitalized for flu.

The latest data — for the week ending Jan. 6 — suggest the season may be peaking right now, the CDC’s director, Dr. Brenda Fitzgerald, told reporters Friday. But she warned that many more people will be infected before the season is over.

There’s a difference between an active flu season — when a large number of people get sick — and a severe season, when the numbers of people hospitalized for flu or who die from the infection are unusually high.

It can be hard to tell in real time where a flu season will fall on the severity scale, because sometimes reports of influenza hospitalization and deaths — especially deaths among children — lag.

That said, this year is starting to look like a severe season, and maybe more severe than last year, which was also bad, said Dr. Dan Jernigan, head of CDC’s influenza division.

“There’s lots of flu in lots of places,” he said.

So far, Jernigan said, this year’s season doesn’t appear to be quite as bad as 2014-15.

The influenza A virus H3N2 has caused the lion’s share of the illness in most parts of the country this year.

But recently there’s been an uptick in activity by another influenza A virus, H1N1, Jernigan said, warning that even if the season appears to have peaked, flu viruses will circulate for weeks to come and people should continue to take precautions against getting infected.

Jernigan said that people over the age of 65 are being hospitalized for flu this season more than any other population. Even people age 50 to 64 are being hospitalized in high numbers.

Related Story: Why fentanyl is deadlier than heroin, in a single photo
Flu often hits the ends of the age spectrum more than the middle, and that’s the case this year as well. The CDC reported seven more children have died from flu, bringing the season total to 20 so far. While tragic, that number is low in comparison with other years — 110 last year, 92 in 2015-2016. But if other seasons are a gauge, that grim tally may continue to rise in coming weeks.

Officials feared that the flu vaccine may not work particularly well this season, but it appears to be faring slightly better than expected.

Preliminary testing by the CDC suggests the vaccine is probably more protective than it was in Australia during its 2017 winter. The Australian interim estimate suggested the H3N2 component of the vaccine — and H3N2 was the main virus there during their most recent winter — was only about 10 percent effective.

That means if 100 people got the flu shot and all were exposed to H3N2 viruses, only 10 would have been protected.

Jernigan said it looks more like the H3N2 portion of the vaccine is performing here like it did last year, when it was 34 percent effective at preventing infection. Unfortunately, that’s about on par for the flu shot’s H3N2 component, which is the weak link of flu vaccine.

The CDC should have interim data on the question of the vaccine’s effectiveness in the second half of February.

https://www.statnews.com/2018/01/12/flu-season-cdc/

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PostPosted: Sat Jan 13, 2018 3:29 pm 
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Eric wrote:
Flu season is shaping up as one of the worst in years, officials say


"It's a new flu season, Bob."
"Pull out the standard article form, Alice, I'll get the pencil to fill in the blank spaces..."

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PostPosted: Sat Jan 13, 2018 6:13 pm 
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10 years ago we switched from sick leave that accrued up to a maximum, to a system for the hourly paid guys whereby they got paid for 10 additional leave days a year, but no sick leave. That means if they were sick they used up a day's leave. This was psychologically brilliant, the number of sickies dropped, and we were able to schedule leave taking. Then they realised that people who came to work with colds or flu were infecting the others, and causing them to lose leave days.

Within a year anybody with a cold got told to go home, and if you didn't wash your hands after using the toilet you got yelled at.

It was very noticeable that visiting engineers from certain countries tended not to wash their hands. They didn't much appreciate being told off by the mechanics!


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PostPosted: Sat Jan 13, 2018 9:03 pm 
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Greg, do you recall TV adds for Codral? “Soldier on With Codral”.?

If you had a heavy cold you just needed to take some cheap legal amphetimes to mask the symptoms and go to work. There to infect others.

Jonathan


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PostPosted: Sat Jan 13, 2018 11:46 pm 
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Good one. Luckily my favorite doctor gave me a letter that said that my immune system is so battered (it was stuffed for a bit, but hasn't been tested for a couple of years)that it is unwise for me to work in a germ pit air conditioned open plan office. So my employer lets me work from home. Hee hee.


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PostPosted: Sun Jan 14, 2018 10:23 am 
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In 1918, my grandfather was with the YMCA doing volunteer work at Camp Lewis -- now Fort Lewis -- in Washington State. He was in his mid 30's at the time. He caught the flu in fall 1918 and said later it was the worst illness of any kind he ever experienced. As he recalled it fifty years later, two hundred soldiers died at Camp Lewis before the epidemic receded.


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PostPosted: Tue Jan 16, 2018 12:54 pm 
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Think Flu Season Is Bad? It Might Get Even Worse
“This is the first year we have had the entire continental U.S. be the same color on the graph.” New strains may be coming.
By Michelle Cortez
January 16, 2018, 5:00 AM EST

https://www.bloomberg.com/news/articles ... even-worse

The influenza virus that’s sickened millions of Americans this season is already the most widespread outbreak since public health authorities began keeping track more than a dozen years ago. Now, with the threat of more strains emerging, it might get even worse.

“Flu is everywhere in the U.S. right now,” said Dan Jernigan, director of the influenza division at the national Center for Immunization and Respiratory Diseases. “This is the first year we have had the entire continental U.S. be the same color on the graph, meaning there is widespread activity in all of the continental U.S. at this point.”

The most optimistic assumption among government experts is that the season peaked a few weeks ago, marking the apex of what was already an early and severe outbreak. However, such an outlook requires observers to ignore that outpatient doctor visits have continued to climb (albeit more slowly) in the first week of 2018, yielding the most flu cases ever for this time of the year.

Even if the hopeful assessment by the U.S. Centers for Disease Control and Prevention bears out, there will still be an additional 11 weeks to 13 weeks of flu circulating across the country. “In general, we see things peaking right about now, but that means there is still a whole lot more flu to go,” Jernigan said. “In addition, there are other strains of influenza still to show up that could be a major cause of disease.”


That may already be happening. The CDC is starting to see infections caused by the H1N1 strain of the virus in states grappling with high levels of the H3N2 strain, the predominant version this season. In addition, Jernigan said, yet another type of flu caused by influenza B viruses is expected to show up later in the season.

H3N2 has compounded the damage usually wrought by the annual flu outbreak. It’s known for both its severity and ability to evade the protection provided by vaccinations that are typically more effective against the other types of flu.

Most flu vaccines are made using eggs, which are less hospitable to growing the H3N2 strain and thus less likely to develop an effective vaccine. That strain goes through more changes over time than other versions, so vaccines are often behind the curve when they reach the general public.

Recent advances in manufacturing have yielded two immunizations that aren’t made in eggs: Sanofi SA’s Flublok and CSL Ltd.’s Flucelvax. Flublok is a recombinant vaccine, which includes only the protein expressed on the surface of the influenza virus, while Flucelvax is grown in mammalian cells. Since neither uses eggs in the manufacturing process, it’s possible that the vaccines that result may look more like what’s actually circulating, Jernigan said.

“Ultimately a broadly protective, longer-lasting vaccine—one that you would get once or twice in life and it would cover every flu—we would love to see something like that,” he said. “I think it will be several years before we will have something like that.”


But in the first week of January, the most recent period for which numbers are available, the current iteration of the virus was sickening and sending more patients to the doctor than any time in recent memory. The question for the rest of the flu season is whether levels drop off precipitously, as they do in most years, or if the return to school and work following the holidays accelerates the spread.

One thing that’s sure to rise is the number of Americans who’ve died from influenza or related pneumonia, especially among the very young and old, since the reports tend to lag infection rates. With an additional seven children dying from flu-related disease in the week ended Jan. 6, the total number of child fatalities attributable to the flu this season has reached 20.


The CDC’s latest method to categorize the severity of a flu outbreak, which takes into account indicators including hospitalizations, outpatient visits and deaths across an entire outbreak, already places the current season in the top three. During the 2014-2015 season, there were more than 700,000 hospitalizations. The current outbreak is matching the beginning of that period, though it’s unclear what the remainder of the season will look like, Jernigan said. Last year’s entire season saw more than 600,000 hospitalizations.

“You didn’t have this all-at-once phenomena that we’re getting now, where hospitals are having lots of cases all at once all across the U.S.,” he said.

Jernigan is forthright about the agency’s inability to accurately predict the intensity of the influenza season.

“We are always expecting there to be an unusual season,” he said. “We are rather humbled by this virus. We are always preparing for a severe season and welcome a less severe season, but it’s difficult to predict what will happen.”

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PostPosted: Tue Jan 16, 2018 4:50 pm 
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Scott Brim wrote:
In 1918, my grandfather was with the YMCA doing volunteer work at Camp Lewis -- now Fort Lewis -- in Washington State. He was in his mid 30's at the time. He caught the flu in fall 1918 and said later it was the worst illness of any kind he ever experienced. As he recalled it fifty years later, two hundred soldiers died at Camp Lewis before the epidemic receded.


On of my granduncles was a little then when he caught it. He survived but it gave him severe asthma.

Wound up literally crawling to school and back as a result.

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PostPosted: Tue Jan 16, 2018 5:59 pm 
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Not really 'The Greatest Pandemic'. Yes to 'The Greatest Influenza Pandemic'.

After all, the editors writing the headline skipped over

The Black Death

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PostPosted: Tue Jan 16, 2018 6:36 pm 
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Eric wrote:
Think Flu Season Is Bad? It Might Get Even Worse
“This is the first year we have had the entire continental U.S. be the same color on the graph.” New strains may be coming.


WE'S ALLL GONNA DIIIIIIIIIIIIIIIIIIE!

Seriously, they run the same stories every year with new neames and dates slipped into the Mad Libs boxes.

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PostPosted: Tue Jan 16, 2018 11:02 pm 
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KDahm wrote:
Not really 'The Greatest Pandemic'. Yes to 'The Greatest Influenza Pandemic'.

After all, the editors writing the headline skipped over

The Black Death

Depends how you measure things, and how widespread something has to be to be a pandemic.

H1N1 1917-1919 killed 50-100 million, but had minimal social effects compared to WWI.

The Black Death killed 75-200 million, but was just one of a whole host of societal uphevals in the 1300s. Mortality estimates put losses at 30-60% of the population, but society survived.

In terms of societal destruction, the worst pandemics were those triggered by European exploration of the New World. Few to none of those societies survived, with up to 80% or 90% of the native populations killed.

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