1919 Spanish flu: could it happen again?

In My Humble Opinion
1

I didn’t want to stomp on the “have you had the flu” thread, so starting this.

I’ve done a lot of reading on the 1918 pandemic. According to most writers, 20 - 50 million died worldwide in a span of two years. Could a catastrophic flu occur in the U.S. again? I’m especially interested in the medical aspects.

I’m interested in hearing your theories, I’ll throw in my opinion on sociological aspects.

In late 1918 the Government called for a virtual media blackout, ostensibly because truthful reporting on the flu would demoralize our soldiers and interfere with WWI operations if the enemies thought our military was compromised (the flu hit military personnel very hard, whole regiments were hospitalized).

For the most part, Federal and local governments took the attitude of “shucks! Don’t stop participating in public gatherings, everything is a-okay!” For example, Philadelphia reassured citizens that flu danger was greatly exaggerated and encouraged a mass showing for a military parade; in conjunction with a great number of sick Navy sailors who disembarked in Philly, the outcome was more than 13,000 flu deaths and countless non-fatal cases.

I don’t think a total media blackout in the U.S is possible today. I think print media would, for the most part, not cooperate with censorship. Information about flu would permeate social media Short of unplugging the interwebs, I don’t think digital media in the U.S. could be totally blacked out. (Ironically, fewer people now go to public events due to preferring virtual interactions).

So, I think flu information communications would dissuade people from being in a crowd or visiting stores, restaurants, churches, et al. While not all citizens would take precautions (or would dismiss info as paranoia), there’s no doubt that participation in public events fueled the flu in Philly, which became the worst regional outbreak in the U.S.

2

True that we have mass communications today to warn people, but we also have travel on a scale never seen in history.

Imagine one flight attendant in one airplane who starts her day flying from Houston to Atlanta, then to Chicago, then to Dallas and finally back to Houston that evening. On that day he exposes four groups of 100+ people each (in closed cabins breathing recirculated air) who then disembark in three new cities. Multiply that by the roughly 5,000 commercial airliners that fly every day. Even if only one percent of all the flight attendants working those flights have the flu, you’ll have a nationwide outbreak in a week.

3

China tried a media blackout of SARS and people just communicated via the internet and mobile devices to stay up to date on the illness. And that was over a decade ago, mobile technology and the internet are better now. So media blackouts didn’t work there.

Medicine has improved quite a bit in the last 100 years. However the main way to prevent the flu is prevent transmission. I don’t know how much better public health is now vs 100 years ago. I would hope it is better.

I wonder if there would be mandatory lockdowns and quarantines if a truly deadly flu that killed 10-20% of people showed up. I would hope so.

4

Excellent points, especially if it’s a flu with a long incubation period before symptoms are felt.

5

If the Chinese government can’t shutdown digital media, the U.S./Europe certainly wouldn’t be able to do so.

The quarantine question is very interesting. During the Philly epidemic many people self-quarantined; in some cases when a family member died the body was chucked into the street, a la Medieval style. Many men who picked up, transported, and buried bodies died. So, if a quarantine was enforced a better body disposal system would need to be figured out

6

1919 Spanish flu: could it happen again? Most certainly it can.

The Great Influenza by John M. Barry is a great book.

7

That may have been true in the early stages of the disease, but the government quickly changed its mind. In many cases, public gatherings were actually banned.

https://virus.stanford.edu/uda/fluresponse.html

I read about one small town in Colorado that actually posted armed guards at the train station to make sure that nobody disembarked.

8

Just today I heard of a eldercare facility that’s imposed a lockdown because of the flu. I’d guess they aren’t the only one.

9

I haven’t read the book, I may check it out.

How do they address advances in public and personal medicine? or better nutritional status? Or advances in state regulation regarding public health? Wouldn’t those things negate a lot of the damage to a true pandemic?

Has public health mostly stopped improving its ability to prevent disease transmission, or is it leaps and bounds better than a century ago?

10

Yes, an excellent read. There’s another good one, can’t recall the title at the moment.

11

Yes, an excellent read. There’s another good one, can’t recall the title at the moment.

Brain just kicked in, recalled two titles:
“The Coming Plague” Laurie Garrett
“Spillover” David Quammen

12

This article is rather sobering.

“Virtually every expert on influenza believes another pandemic is nearly inevitable, that it will kill millions of people, and that it could kill tens of millions—and a virus like 1918, or H5N1, might kill a hundred million or more—and that it could cause economic and social disruption on a massive scale. This disruption itself could kill as well.”

On the positive side, there is often advance warning of influenza pandemics, and we have much improved surveillance systems compared to 1918. Given enough time there could be sufficient vaccine production and dissemination of antivirals to limit casualties. On the negative side (as noted) international travel means an outbreak could spread much more quickly.

I’d like to see much more resources devoted to researching and developing a “universal” flu vaccine that could markedly lower the odds of another 1918-like pandemic. Given the current crew running things in Washington (including an antivax President) this is very unlikely to happen.

13

Was it this one?

14

I popped in to recommend this one. Love this author.

15

since there will never be a year 1919 again, in Spain or elsewhere, i don’t think it’s very likely.

16

The thing about the Spanish Flu was that who it killed was different than most flus. In most flu years it is the elderly, young, and those with compromised immune systems that die. The Spanish Flu was different because it would actually primarily target those with healthy immune systems. The overreaction of their strong immune systems paradoxically seems to have caused their downfall. So if we assume that due to nutrition and other factors that modern day people have stronger immune systems it may actually lead to an increase in fatalities. This is known as a Cytokine storm.

17

And we still don’t have a good way to treat a cytokine storm. So the best thing to do is not get the flu. The Spanish Flu could kill in less than a day - you’d feel ill in the morning and be dead by night.

18

Haven’t read it, will buy tonight! I have a keen (possibly odd) interest in diseases, especially the black/bubonic plague.

19

Thousands of young WWI soldiers contracted flu and died within 48 hours. Close living quarters fanned the flame, especially in boot/pre-staging camps – the Lost Generation . . .

The cytokine aspect is very interesting, I’m going to do some reading about this.

20

I don’t know a lot about it, but from looking online I"m under the impression that there isn’t a validated clinical intervention for cytokine storm. There are studies showing ‘take medication X or Y to reduce the risks of a cytokine storm’ are out there, but I don’t know if any has been validated enough to become mainstream clinical practice.