H1N1 2009 and the 1918 Spanish Flu Pandemic
Comparing Pandemics Then and Now: Same Patterns, Different Eras
Nov 5, 2009
Like the H1N1 swine flu that preceded it 91 years earlier, the pandemic of 2009-2010 has taken an unusual course. It appeared in the spring only to be followed by a more severe outbreak in the fall. It strikes healthy young adults and children over five with greater fervor than seasonal flu. Death rates and complications are higher because of a particularly vigorous secondary infection in the respiratory tract. Even the weather phenomenon El Nino of 2009 bears a striking similarity to El Nino 1918 and has been implicated in at least one study. Fortunately, today’s world is armed with better health care and education, global communications networks and far superior medical information.
Pandemic ProportionsIndeed, the 1918 pandemic, commonly called the “Spanish flu,” was also caused by a strain of the H1N1 virus. That event was arguably one of the greatest medical holocausts in history. It lasted from March of 1918 to June of 1920, and claimed 50 million lives. Some reports published by the National Institutes of Health suggest the global death toll may have approached 100 million while nearly 500 million people worldwide became infected.
Today, the numbers are not as severe, but they are alarming. By October 25, 2009, H1N1 had claimed over 5,700 lives worldwide as the World Health Organization reported 440,000 laboratory confirmed cases globally. In the United States, the proportion of deaths attributed to pneumonia and influenza had already exceeded the epidemic threshold for four weeks, according to the Centers for Disease Control (CDC).
Similarities: Timing
Both the 1918 pandemic and the 2009 H1N1 share a pattern of timing unique among “off season” influenzas (those that appear first in the spring as opposed to the fall). Both demonstrate distinct successive outbreaks, appearing in the spring with a moderate effect only to recur in the fall and rapidly reach pandemic proportions.
The World Health organization reported that Mexico, which reported one of the earliest cases of H1N1 in the spring, has reported a larger number of confirmed cases during September and October than during the springtime epidemic. According to global health and epidemiology expert from University of California, San Francisco, George Rutherford, “The Spanish flu made a relatively quiet debut in the spring of 1918, but then reemerged in a more virulent form in the fall, killing people quickly and on a large scale throughout the world.”
If 2009 follows 1918, a third wave is expected in winter and could be even worse with still higher frequency of complicated, severe, and fatal cases.
Similarities: Population
Unlike seasonal flu, which has the greatest impact on young children and the elderly, the Spanish flu targeted a disproportionate number of healthy adults. “This so-called ‘W-shaped mortality curve,’ with clusters of deaths occurring among the very young, the very old and adults under 50, is evident in the current swine flu pandemic as well,” said Rutherford .
The CDC reports that among the fatalities from H1N1 2009, people between 25 and 49 years old are hardest hit, comprising nearly 40 percent. H1N1 reports in the US have been highest among people ages five to 24, followed by children under five, who have been hospitalized at the highest rate.
It is interesting to note that people born before 1918 have very high titers for the H1N1 disease, meaning their immune system has been exposed to it before—more evidence that the two diseases are the same or very similar.
Differences: Medical Access and SophisticationFlu vaccines and over the counter medicines in existence today were not even conceived of in 1918. Today the medical establishment understands the mechanism of disease much more than before.
In 1918, diagnostic criteria for influenza and pneumonia were vague and treatment was limited by a lack of understanding. Today, doctors can not only diagnose flu and pneumonia, but they can determine the strain of flu and differentiate viral from bacterial pneumonia and treat accordingly. Anti-viral drugs and a spectrum of antibiotics unavailable in the early 1900s protect today’s flu victims against secondary infections. Once a person is diagnosed, today’s treatments include re-hydration with electrolytes and IV in severe cases, and improved monitoring for secondary infections.
Differences: Communications NetworksIn 1918, influenza was not a nationally reportable disease. It would be another quarter of a century--when the World Health Organization and the Centers for Disease Control were established--before a coordinated effort arose to monitor health trends, gather information and assist states and nations in managing communicable diseases.
Today, municipalities, states, national and international governments communicate in near-real time, thanks to modern telecommunications. They work together to monitor and manage emerging health issues around the world. These measures provide crucial forewarning, allowing managers to prepare for outbreaks of disease.
Differences: Health EducationThat global health network and coordination, combined with communications technology of the 21st century, results in a better informed public. In 1918, there were no television ads telling people to cough into their elbows or wash their hands. Needless to say, there was no hand sanitizing gel passed out at school. In 1918, this article would not be accessible to the billions of people surfing the world wide web. In the industrialized nations, it is also possible that sick members of the population have options for avoiding contact with others that were not available in 1918—sick leave, vacation time, etc.
Stay Calm, Be InformedGiven the similarities between the 1918 Spanish flu pandemic and the 2009-2010 N1N1 swine flu pandemic, it’s easy to understand the public apprehension, even fear.
But there are reasons to remain calm. Education is the best prevention. Follow the CDC guidelines for flu safety this season and have confidence that this time, it won’t be as bad.
References:
United Stated Centers for Disease Control (CDC) H1N1 Flu Information Page
World Health Organization (WHO) H1N1 tracking and information site
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