The Influenza Pandemic of 1918-1919

December 11, 2003 2:03 PM

The influenza pandemic of 1918-1919 killed between 20 and 40 million people worldwide and was the worst epidemic the US has ever known. This year's flu is a reminder that another pandemic is possible within the next 10 years, and we are poorly prepared.
posted by homunculus (39 comments total)

Two of my grandparents have told me really chilling stories about the pandemic. One was in Oklahoma and the other was in France, and both lost many friends and neighbors. I can't imagine being surrounded by that much death.
posted by homunculus at 2:05 PM on December 11, 2003

If people would stay home when they get sick it would really help out. I swear every time a type "A" personality gets ill in my office, we all go down.
posted by studentbaker at 2:08 PM on December 11, 2003

I've gotten my flu shot.
posted by brownpau at 2:14 PM on December 11, 2003

If people would stay home when they get sick it would really help out.

When someone with AIDS who knows they have the disease withholds that information from a sex partner, they can be prosecuted. I wonder if, using that as a precedent, someone who knowingly spread the flu during a season with well-publicized deaths could also be prosecuted.
posted by homunculus at 2:15 PM on December 11, 2003

My 32 year old great-grandfather, his 33 year old brother and their 50 year old father died within three days of each other in 1918, leaving my great-grandmother alone with five children, pregnant with a sixth. One hopes we've progressed in medical treatment since then, but it's definitely scary.
posted by judith at 2:24 PM on December 11, 2003

This is a pretty good book about it. What's so interesting is that such a great many people died, and yet people still never talk about it. I guess the Great War overshadowed it. Most of my grandparents' siblings died in the epidemic.
posted by CunningLinguist at 2:39 PM on December 11, 2003

Those of us old enough often heard stories about it from our parents...nice links. We quickly forget how we have adanced, and yet, alas, this time flue seems to have caught us offguard and insuffieient shots available.
posted by Postroad at 2:47 PM on December 11, 2003

It is believed that World War I had something to do with it. So many people were displaced, and so many who were sick were not able to stay in bed, due to the war.

Malcolm Gladwell wrote a great article about this in The New Yorker a few years ago.
posted by Danf at 3:05 PM on December 11, 2003

I can't even profess to be an amature immunologist, but are there any schools of thought out there that believe that getting flu shots actually causes "the flu" to mutate, adapt and get more virulent every year? The idea of it at least, seems to make some kind of sense to me, but don't know what the medical community has to say about it.
posted by psmealey at 3:09 PM on December 11, 2003

Ah, brownpau, it may not protect you. I got my flu shot and I got the flu anyway. A week and a half, and I'm just about over it. I stayed out of work, though, and managed to not infect any of my coworkers.
posted by tommasz at 3:11 PM on December 11, 2003

Btw, this earlier thought owes to my belief that the US is ridiculously over-medicated, so I'm skeptical about the flu shots that are pushed year after year. Anecdotally, I have never had a flu shot, while my older sister has had them 15+ years running;we both get the flu every year regardless. From an immunology/public health standpoint, this might not be the point of getting them, I have NFI. I am curious to see what other mefiers' thoughts were on the subject.
posted by psmealey at 3:18 PM on December 11, 2003

psmealey - Placebo effect?
posted by troutfishing at 3:30 PM on December 11, 2003

I don't get flu shots, I just pay particular attention to washing my hands, take plenty of vitamins, also Echinacea and Zinc supplements, and apologize to sick friends who ask if I wanna hang out.

But let's please not start predicting another Spanish Flu epidemic, ok? Every time a serious bug hits the news, people start talking about the end of the world, and it never does any good. Remember how scared you were about SARS? Ebola?

"Yeah, well, this could be the one, man."
"Ok, well, let's get really scared and work ourselves into a panic about it, as 9 out of 10 doctors do recommend freaking out."
posted by Hildago at 3:44 PM on December 11, 2003

Well, we just had a kid die here in North Carolina. That tends to get people's attention.

I just heard on the news that Blue Cross Blue Shield of North Carolina is now going to cover the inhalable flu vaccine-anyone who hasn't had a shot, wants one and can't get one should check with their insurance company-it's possible they may do the same thing under the circumstances.
posted by konolia at 3:52 PM on December 11, 2003

The reason there is a different "flu shot" each year has nothing to do with increasing virulence of the flu and everything to do with the fact that each year it is a different strain, and each year scientists effectively have to examine the evidence and make a best guess which one will be going around this year.

It's a little like trying to figure out if your country is going to be invaded by land, air, or sea, but only being able to mount defenses for one of them.

By the way, my understanding is that part of the reason the flu is so bad this year is that the scientists guessed wrong about what strain to vaccinate against. From the Slate article:

Congress will also want to know about the composition of this year's vaccine. As popular as it is, the vaccine does not quite match the nasty Fujian strain [that is currently spreading]. It will take two or three more weeks before researchers finish a series of tests to find out just how much protection the vaccine has afforded those who managed to get it. Every year in early spring, the CDC together with the World Health Organization surveys the strains circulating in the world. Based on that information, an FDA panel decides on the composition of the vaccine to be manufactured for the fall. The Fujian strain had appeared by the time of this year's survey, but the FDA panel decided against trying to get it into the vaccine because some panel members worried that trying to include it might create production delays.

Oh, and if everyone will please remember the "The Flu" is not just a cold, not a stomachache, not nausea, not some aches and pains, not a sore throat? "The Flu" is much more serious than a cold.
posted by ilsa at 3:55 PM on December 11, 2003

But let's please not start predicting another Spanish Flu epidemic, ok?

Now or ever? No one is predicting a pandemic this year, and for all we know the flu season is already peaking. But ignoring the possibility of another pandemic in the future would be silly, and Webster's analysis of the situation seems pretty rational to me.
posted by homunculus at 5:20 PM on December 11, 2003

Maybe it's Al Quaeda's fault. *ducks*
posted by afx114 at 5:36 PM on December 11, 2003

I have heard that the reason for the big PR campaign on flu shots this year is to help distinguish flu cases from any possible SARS outbreaks.

It does, however, seem to me that the media are engaged in their usual "wishful thinking" in trying to make up a story from loose bits. "Maybe if we keep talking about a flu pandemic, there'll be one..."

I'll also second a recommendation on both the book CunningLinguist linked and the Gladwell piece, although I liked Gladwell's better.
posted by briank at 6:09 PM on December 11, 2003

If you're going to prosecute people for coming to work with the flu, then you might as well also throw in the idiots who rail against the influenza vaccine, claiming--alternately--that it: a.) causes the flu, b.) causes flu to mutate and become deadlier [human flu mutates in waterfowl who pass it to pigs who pass it to us], c.) is anything less than the best available protection against a deadly virus.

Anti-flu shot people drive me f--king crazy. It's the mass hysteria, and for the life of me, I can't figure it out the reason behind the superstition and rampant misinformation.

From the second link listed below:

"Can the vaccine cause influenza?

No! This common misconception keeps many people from getting the influenza shot. The injectable influenza vaccine contains only killed viruses and cannot cause influenza disease. Fewer than 1% of people who are vaccinated develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza.

CDC: Flu Shot FAQ
VaccineInfo.org: Influenza Vaccine FAQ
posted by jengod at 6:16 PM on December 11, 2003

Here in Hong Kong a little boy has developed H9N2 bird flu.

It's not the same as the deadlier H5N1 flu that struck in 1997 and subsequent years, in that this new strain doesn't kill the birds. But scientists are checking to see if H9N2 has acquired human genes.

Humans would have no immunity to this flu, meaning that were it to mutate to allow person to person transmission, it could become a pandemic. Anyone with a poor immune system would be at risk.

Luckily, the Health Department in Hong Kong is right on top of any flu case that looks even mildly suspicious.
posted by bwg at 7:37 PM on December 11, 2003

An interesting story on the vaccine shortages/problems (it's not just flu), and how federal officials scrounged for more flu vaccine doses overseas in the midst of a serious influenza outbreak while we as individuals are not allowed to buy prescription drugs from other countries because of "safety issues."
posted by amberglow at 7:48 PM on December 11, 2003

Good link, amberglow. Thanks.

In 1967, nearly 30 U.S. companies made vaccines; now there are just five, according to the institute's report. Last year, three companies made flu vaccine; this year, it's only two with Madison, N.J.-based Wyeth dropping out, Gellin said.

Vaccines aren't very important to drug companies' bottom lines, the medicine institute's report concluded, because only 1.5 cents per dollar of drug-company revenue comes from vaccines.

This system sucks.
posted by homunculus at 8:36 PM on December 11, 2003

Now or ever? No one is predicting a pandemic this year

My house-mate is. I just got done with a heated argument with him fifteen minutes before I loaded up Mefi to post that. That's part of the reason I went on the offensive so quick. The other part is that, come on, juxtaposing this flu season with the 1918 Spanish Flu Pandemic in the text of the post IS making a tacit (in my mind groundless and somewhat irresponsible) connection between the two.
posted by Hildago at 8:39 PM on December 11, 2003

The flu vaccine is reformulated each year and this makes it more expensive to produce than a static vaccine such as those for Hep A or B. Also, due to this factor, estimating how much to produce becomes an issue - produce too much and the company has paid for the manufacture, but will not be able to recoup said monies.

Our office had more problems obtaining vaccine last year (due to a manufacturer being shut down) than we did this year, but once we used our initial doses (approx. 500) and went to reorder, the price had skyrocketed to the point of being cost-prohibitive.

An interesting note about the Flu-Mist nasal vaccination: Those of us who work with HIV patients were advised not to use this particular product (it is live v. killed virus) out of concern it would increase the risk of the patient population for contracting flu.
posted by sillygit at 8:41 PM on December 11, 2003

I had the worst flu since I was six years old this past month (does that parse?) It was awful, and there were a few times I mentioned to my wife that if I ever get ill like this for an extended period, she's to kill me. I don't really remember what being sick was like, probably because I was running an extreme fever for several days straight, but I'm thinking death wishes are a likely indicator that it was a really bad cold.

I've read several times that we're due for a pandemic, and I can readily believe it. I think I'll head out on a backpacking vacation when it happens.
posted by five fresh fish at 9:41 PM on December 11, 2003

juxtaposing this flu season with the 1918 Spanish Flu Pandemic in the text of the post IS making a tacit (in my mind groundless and somewhat irresponsible) connection between the two.

Well, on that I'm in agreement with the Slate article:

"Bad as they are, the difficulties in coping with this year's influenza epidemic are like the tiny tremors in California that remind you of the looming Big One. In the world of influenza, the Big One is a pandemic—a strain of influenza so different from what has circulated before that people have no immunity. That's what happened in 1918 when the flu killed between 20 million and 40 million people worldwide."

I don't see the juxtaposition in that sense as groundless or irresponsible. What is irresponsible is relying on two private companies to produce the vaccine. Some day we're going to pay for that.
posted by homunculus at 9:52 PM on December 11, 2003

>When someone with AIDS who knows they have the disease withholds that information from a sex partner, they can be prosecuted.

I had the flu for about 2 weeks last year and decided I must have gotten it by touching the keyboard/mouse of a co-worker who came to work sick. Of course I can't prove this but its very probable.

I'm certainly not advocating legislation, but what if sick people who show up for work were socially pressured to wear a face mask all day? Isn't that what they do in Japan to keep the germs from spreading? The holes in the mask are much larger than the flu germs but it cuts down on wiping you nose with your hand and leaving flu-saturated mucus everywhere and limits how far those bad boys can fly after a sneeze. It would also warn others that you're sick thus instinctively keeping our distance, not sitting next to them on the train, making sure to wash your hards before lunch, etc.
posted by skallas at 1:41 AM on December 12, 2003

I was about to post the same thing skallas. As a medical student, ironically enough, we have to attend clinics every single day, sick or not, but when sick we wear the little paper masks. The kids hate it and get scared but hey, it beats killing them, I guess.
posted by degnarra at 3:52 AM on December 12, 2003

Keep your immune system in top shape. It is much more effective then a vaccine, your body will manufacture the vaccine in days while it takes the CDC 6 months or more. There are tons of foods you can eat during the fly season that will help. It really comes down to educating yourself on how to take care of yourself rather than relying on corporate America to pop a shot in your arm that may or may not work.
posted by stbalbach at 6:41 AM on December 12, 2003

If people would stay home when they get sick it would really help out.

If people were able to stay home when they get sick, it would help out, too. I have sick days now, but that's only been the case for two months. When I had bronchitis this spring, I came in every day, because every day out was a day's lost pay, and how was I going to pay for a doctor if I couldn't even make my rent?
posted by Karmakaze at 8:18 AM on December 12, 2003

My company does not have separate vacation and sick days, which is nice if you don't get sick much (more vacation) but provides a disincentive to stay home when sick.
posted by callmejay at 8:47 AM on December 12, 2003

It will be interesting to see if we have a spike in the number of people with schizophrenia 15 - 25 years from now.
posted by echolalia67 at 9:40 AM on December 12, 2003

Now that's something to look forward to, echolalia! Similarly, I wonder if there's a way to explain the rampant ADD among members of my own age group (b. 1965-75). Maybe it was the anti-nausea drugs our mothers took.
posted by psmealey at 9:59 AM on December 12, 2003

Flu outbreak expected to reach epidemic level
posted by homunculus at 3:40 PM on December 12, 2003

Meanwhile, in national security news: Bioterror Preparedness Still Lacking, Health Group Concludes.
posted by homunculus at 4:28 PM on December 12, 2003

Why Can't They Make More Flu Vaccine? For one thing, there's a shortage of chicken eggs.
posted by homunculus at 5:33 PM on December 12, 2003

But, he said, it is unlikely to reach the next level -- a pandemic.
posted by Hildago at 12:03 AM on December 13, 2003

Danf, thank you so much for the Gladwell link. Spectacular article.

I've actually already had the flu this season, and it was a doozy. I was totally useless for about 4 or 5 days, and it quite depressing how long it took to start feeling better. (My DVD player became by best friend.) I took numerous days off from work across an 8 day span. I still have the residual nagging cough, but I'm getting better.
posted by complex at 9:53 PM on December 13, 2003

Similarly, I wonder if there's a way to explain the rampant ADD among members of my own age group (b. 1965-75). Maybe it was the anti-nausea drugs our mothers took.

That's probably due to overdiagnosis. My mother, a teacher of 47 years experience, says there's always been one in every other class she has (making the stat approximately one kid in every 50 or so). If every other kid on your street is diagnosed with it, there's something wrong.</offtopic
posted by orange swan at 11:33 AM on December 15, 2003