Factors Affecting the 1918 Influenza Pandemic
Changing Lifestyle and Treatments May Have Influenced Death Rate
Jul 24, 2009
Medical herbalist Paul Bergner has produced an excellent review and analysis of the literature on the 1918 influenza pandemic. His work covers the influence of urbanization on the health of young adults, as well as treatments of the time, which may have contributed to the high mortality.
Deaths From Seasonal Influenza Occur Every Year
An important fact to consider is that in the United States alone, there are generally between 30,000 and 70,000 influenza-related deaths each year. Elderly and immune-compromised patients make up the majority of the losses, which is one reason the term influenza-related deaths is used.
Health authorities are aware that influenza is not entirely responsible for the mortality. If the various forms of flu were that deadly more people with no other health problems would die as well. For example, many of the deaths from H5N1 have been the very old or the very young, and many of them in areas where animals and humans share living and sleeping space.
Some Data on the 1918 Influenza Outbreak
One striking factor in the Spanish flu outbreak was the high mortality in young adults. Today there is some thought that urbanization may have contributed to this, as more young people moved to the city and worked in factories where there was minimal exposure to sunlight. This was also the time when the US diet shifted to being high in processed foods.
Current knowledge has lead to an understanding of the importance of sunlight for maintaining healthy vitamin D levels. Vitamin D plays an important role in immune status. It is also accepted that a diet high in processed foods may result in compromised immunity.
Influenza Treatments May Have Contributed to the Influenza Deaths
Common treatment for influenza in 1918 included aspirin at 1300mg combined with phenacetine, which breaks down to acetaminophen. This product is rarely used today because of its high toxicity. It has also since been shown that, while aspirin and acetaminophen may ease symptoms of the flu, their use result in higher levels of virus production in the body.
Current recommendations on dosage restrict the use of aspirin to 325mg if the patient is also taking an NSAID such as acetaminophen. One of the symptoms listed for the 1918 influenza virus is hemorrhaging. It is not certain now whether that was a result of the virus or the high doses of anti-inflammatory drugs.
The high doses of aspirin may have also been a factor in the deaths of many younger influenza sufferers. Respiratory collapse and shock may have been the result of what is now known as Reyes syndrome rather than the flu.
The routine use of digitalis and opiates may have also played a role. The digitalis used at the time was often in powdered leaf form, making dosage calibration difficult. Opiates are known to inhibit both humoral and cellular immune response.
While each of these factors may have contributed to the losses in the 1918 influenza pandemic, it does not mean that another epidemic or pandemic with such high mortality cannot occur today. It is important to review all factors when looking at death rates of influenza cases, rather than simply accepting that all mortalities are the result of the virus involved.
Source: Bergner, Paul. 2007.Influenza: Lesson for the clinic from 1918. Medical Herbalism Vol15.No3.
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