Is This The Long Awaited Pandemic?

[Bruce Clemens]

Magda said:

What is known is that Donald Rumsfeld and others will be making a packet as they have shares in the pharmaceutical compnay, Gilead, that makes Tamiflu which is said to be the most effective drug against this strain.

Gilead Sciences, the benefactor of royalties from Tamiflu, has had some interesting insider stock transactions lately.

I was looking for some indication that insiders were betting that the stock was going to rise...

On April 14th, John C. Martin, the CEO, sold 100,000 shares of his company’s stock for almost USD 1.6 million and the same day bought 100,000 call options in the same stock.

http://www.secform4.com/filings/882095/0...006512.htm

The options expire on July 21, 2009.

On March 12th, he did the same thing, with the same amounts and the same expiration.

http://www.secform4.com/filings/882095/0...004884.htm

On February 12th he did the same thing.

http://www.secform4.com/filings/882095/0...002561.htm

January 15th, ditto.

http://www.secform4.com/filings/882095/0...001104.htm

August ’08, same with 70,000 shares. Then there was July…and June…

You may know that stock options are derivatives, and derivatives are MUCH riskier than buying the underlying security. But, you can make a much larger profit per your investment dollar in derivatives than you can in the stock itself. Investing in derivatives is a gambler’s game.

They've been cashing out- ready to pounce on the opportunity when their stock rises- and if it rises significantly before July 21, Mr. Martin and several others will be able to buy their shares back at guaranteed low rates, or sell the options themselves at a nice premium.

[Bruce Clemens]

From:

http://www.reuters.com/article/latestCrisis/idUSN25479998


Mexico gov't decrees [size=12]special powers in flu crisis[/SIZE]

Sat Apr 25, 2009 6:53pm EDT

Email | Print | Share
| Reprints | Single Page
[-] Text [+]




MEXICO CITY, April 25 (Reuters) - Mexican President Felipe Calderon issued an emergency decree on Saturday giving the government special powers to run tests on sick people and order them isolated to fight the deadly flu crisis.

Mexico City has already shut schools and museums and canceled sporting and cultural events as an outbreak of a new type of swine flu killed up to 68 people in the country and spread north to infect some people in the United States.

Saturday's decree, published in Mexico's official journal, gives the government power to isolate sick people, enter homes or workplaces and regulate air, sea and land transportation to try to stop further infection.

The flu has rattled residents of Mexico's overcrowded capital of some 20 million people.

Calderon tried to calm Mexicans earlier on Saturday, saying the flue was curable. He said health authorities easily had enough antiviral medicine for the 1,000 or so people suspected to be infected with the swine flu and that his government was monitoring the situation "minute by minute."

Tests on Saturday showed eight New York City schoolchildren had a type A influenza virus likely to be the same type as the Mexican flu, adding to nine people in California and Texas who tested positive for it, although they later recovered. Two swine flu cases were also confirmed in Kansas.

The World Health Organization declared the outbreaks a "public health event of international concern" and urged all countries to boost their surveillance for any unusual outbreaks of influenza-like illness and severe pneumonia.

The agency stopped short of raising the threat level to a pandemic -- a global epidemic of a serious disease.

Mexico City residents mainly hunkered down at home on Saturday, as children's parties were canceled and bars were closed and many of those on the street wore surgical masks. (Reporting by Catherine Bremer; Editing by Peter Cooney)

[Bruce Clemens]

From
http://www.nydailynews.com/ny_local/2009...e_flu.html

"It is clear that this is widespread," Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said.

"And that is why we have let you know that we cannot contain the spread of this virus."

[Magda Hassan]

Magda said:

What is known is that Donald Rumsfeld and others will be making a packet as they have shares in the pharmaceutical compnay, Gilead, that makes Tamiflu which is said to be the most effective drug against this strain.

Gilead Sciences, the benefactor of royalties from Tamiflu, has had some interesting insider stock transactions lately.

I was looking for some indication that insiders were betting that the stock was going to rise...

On April 14th, John C. Martin, the CEO, sold 100,000 shares of his company’s stock for almost USD 1.6 million and the same day bought 100,000 call options in the same stock.

http://www.secform4.com/filings/882095/0...006512.htm

The options expire on July 21, 2009.

On March 12th, he did the same thing, with the same amounts and the same expiration.

http://www.secform4.com/filings/882095/0...004884.htm

On February 12th he did the same thing.

http://www.secform4.com/filings/882095/0...002561.htm

January 15th, ditto.

http://www.secform4.com/filings/882095/0...001104.htm

August ’08, same with 70,000 shares. Then there was July…and June…

You may know that stock options are derivatives, and derivatives are MUCH riskier than buying the underlying security. But, you can make a much larger profit per your investment dollar in derivatives than you can in the stock itself. Investing in derivatives is a gambler’s game.

They've been cashing out- ready to pounce on the opportunity when their stock rises- and if it rises significantly before July 21, Mr. Martin and several others will be able to buy their shares back at guaranteed low rates, or sell the options themselves at a nice premium.

Thanks for this Bruce. Very interesting. It would be good to know what his previous form is like in buying and selling for comparison purposes. I wonder who else is doing similar things?

[Peter Lemkin]

The CDC is obviously VERY worried. This kind of virus can spread widely and quickly. Its virulance is not yet known, but is definitely on the side of quite to very virulant [having killed 80+]. The most frightening thing about such viruses is they can very quickly increase [or decrease] in virulance. If it increases and if not controlled by isolation etc. a pandemic could erupt in N.A. or worldwide. The numbers of people that travel from Mexico to the USA is huge. I wonder what the incubation period for this virus is and how long someone could be a 'silent carrier' before even knowing it, by coming down with symptoms that would clue them in not to travel - or incapacitate them to travel? The CDC is very conservative on calls like this and doesn't like to panic the public, usually. They just issued a warning that this posed a substantial and immenent worldwide danger. Unless they are trying to raise the stock of and sales of Tamiflu. :flute: It is very odd and sinister that Rummy is in on that medicine! My, what a world we live in! NB - in a full pandemic there is NOT enough antiviral drug(s) to give to everyone on the planet, not the means to distribute them quickly enough - let alone the troubling problem of the high price for the poor. I believe the drugs are only helpful if taken BEFORE infection.

The fact that Mexico City is the second largest in the World is not a good factor - population density is a big factor in such a pandemic spreading. Kansas health officials said two people there had swine flu and a seventh case emerged in California near the Mexican border, taking the number of confirmed U.S. cases to 11. A married Kansas couple both were confirmed with a mild case. The husband recently visited Mexico. The USA only because of the lack of public transportation and many sigle-family homes, has a slight advantage over other countries. Europe and the developing world use much public transport and/or have fewer single-family dewllings. I have a bad felling about this. In two days it has gone from 20 dead to 81. Increases will be exponential, if this catches on.

Another very odd fact is it is killing in Mexico, but not in the USA, yet.

CDC says too late to contain U.S. flu outbreak
24 Apr 2009 19:31:20 GMT
Source: Reuters
WASHINGTON, April 24 (Reuters) - The U.S. Centers for Disease Control and Prevention said on Friday it was too late to contain the swine flu outbreak in the United States.

CDC acting director Dr. Richard Besser told reporters in a telephone briefing it was likely too late to try to contain the outbreak, by vaccinating, treating or isolating people.

"There are things that we see that suggest that containment is not very likely," he said.

He said the U.S. cases and Mexican cases are likely the same virus. "So far the genetic elements that we have looked at are the same." But Besser said it was unclear why the virus was causing so many deaths in deaths in Mexico and such mild disease in the United States.

A new flu virus suspected of killing as many as 81 people in Mexico has the potential to become a pandemic, the World Health Organization's chief says.

Margaret Chan said the outbreak was a "health emergency of international concern" and must be closely monitored.

Health experts say tests so far seem to link the illnesses in Mexico with a swine flu virus in the southern US.

Several people have also fallen ill in the US, and the authorities there are watching the situation.

A top US health official said the strain of swine flu had spread widely and could not be contained.

Speaking after a meeting of the WHO's emergency committee, Mrs Chan said that "the current events constitute a public health emergency of international concern".

I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from 'under control'
Yeny Gregorio Davila, Mexico City
Read more experiences
HAVE YOUR SAY I work as a resident doctor in one of the biggest hospitals in Mexico City and sadly, the situation is far from 'under control'
Yeny Gregorio Davila, Mexico City
Read more experiences

The WHO is advising all member states to be vigilant for seasonally unusual flu or pneumonia-like symptoms among their populations - particularly among young healthy adults.

Officials said most of those killed so far in Mexico were young adults - rather than more vulnerable children and the elderly.

The committee has not recommended declaring an international public health emergency and raising the global pandemic alert level, a move that could lead to travel advisories, trade restrictions and border closures.

New strain

At least some of the cases show a new version of the H1N1 swine flu sub-strain - a respiratory disease which infects pigs but only sporadically infects humans.

The RC church has issued advice to its priests to help halt the spread of the flu


H1N1 is the same strain that causes seasonal flu outbreaks in humans, but the newly-detected version contains genetic material from versions which usually affect pigs and birds.

The virus is spread through coughs and sneezes and through direct and indirect contact between people.

Mexican officials have confirmed 20 deaths from the virus and are investigating dozens more.

Schools, museums and libraries have been closed across the capital's region and people are being urged to avoid shaking hands or sharing crockery.

Hundreds of public events have been suspended and schools in the Mexico City area have been closed until 6 May.

Two previously sold-out soccer matches were played in empty stadiums to avoid potentially spreading the virus.

Health officials are isolating individuals suspected of having the virus and inspecting their homes.

The Roman Catholic Church in Mexico has recommended measures to avoid further contagion at Mass this Sunday.

Priests have been told to place communion wafers in the hands of worshippers rather than in their mouths and to suggest to the congregation that kissing or shaking hands be avoided during the service.

'Caution'

In the US, 11 people are now known to have been infected with the new strain - seven people in California, two in Texas, and two in Kansas.

There are also eight suspected cases in New York City after 200 students at a high school fell ill.

Specimens were taken from nine students, and eight were determined to be probable cases of swine flu, said city health commissioner Dr Thomas Frieden.

Those samples are now being examined by the US Centers for Disease Control and Prevention (CDC).

No children had required hospital treatment and many had fully recovered, said Dr Frieden, but the school could remain closed out of "an abundance of caution".

He urged people to maintain basic hygiene, such and covering their mouths when coughing and sneezing, washing hands regularly and keeping surfaces clean.

Dr Frieden said most people would not need to take antiviral medication if they fell ill, unless they had an underlying medical condition.

Hopeful sign

CDC officials have said that with cases arising in so many communities, containment is unlikely to be feasible.

There is currently no vaccine for the new strain.
SWINE FLU
Swine flu is a respiratory disease found in pigs
Human cases usually occur in those who have contact with pigs
Human-to-human transmission is rare and such cases are closely monitored
Q&A: Swine flu
UK monitoring flu outbreak



Tom Skinner of the CDC told the BBC that it was too early too tell how widespread the impact would be.

"We don't know how well or efficiently this virus is spreading and how easily it is going to be sustained in the human population."

He said it was not yet clear which side of the border the virus had originated.

But the US was likely to take "normal and routine" steps within the next few days to screen passengers coming into the US and to distribute information, he said.

The CDC plans to send experts to Mexico to help investigate the virus which has infected more than 1,000 people in the country.

The BBC science editor Susan Watts says the new strain is a classic "re-assortment" - a combination feared most by those watching for the flu pandemic.

This from the CDC website front page:
Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness who:
Live in San Diego County or Imperial County, California or San Antonio, Texas or
Have traveled to San Diego and/or Imperial County, California or San Antonio, Texas or
Have been in contact with ill persons from these areas in the 7 days prior to their illness onset.

If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
State Public Health Laboratories

Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.
Public Health /Animal Health Officials

Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.

[Peter Lemkin]

In the last few hours it has spread to New Zealand - a group of student coming from Mexico via the USA. This could be the 'Big One'!

[Magda Hassan]

Well if it is in NZ, likely to be here tomorrow then if not already. It was the soldiers returning home after WW1 which enabled the Spanish flu to spread it so widely. With modern air travel it just makes it so much easier to spead germs. Plus all that lovely recycled air and germs from the air conditioners.

[Peter Lemkin]

Well if it makes you feel better it is in a city I was to fly into in two months time....but a virus like this would spread like the fires did there...fast and then faster. Better dig a hole in the back yard and put air filters on it that collect even viral particles...or stock up on the two drugs. I just checked their price and availability on the internet. Still available, but prices are going up. I guess the guys into derivatives and futures will have a field day as the rest of us die - may they be the first.

[Peter Lemkin]

The Influenza Pandemic of 1918
http://virus.stanford.edu/uda/

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.


The Grim Reaper by Louis Raemaekers

In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace. As noted in the Journal of the American Medical Association final edition of 1918:

"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).




An Emergency Hospital for Influenza Patients

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):

I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.


The influenza pandemic circled the globe. Most of humanity felt the effects of this strain of the influenza virus. It spread following the path of its human carriers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown). The Great War, with its mass movements of men in armies and aboard ships, probably aided in its rapid diffusion and attack. The origins of the deadly flu disease were unknown but widely speculated upon. Some of the allies thought of the epidemic as a biological warfare tool of the Germans. Many thought it was a result of the trench warfare, the use of mustard gases and the generated "smoke and fumes" of the war. A national campaign began using the ready rhetoric of war to fight the new enemy of microscopic proportions. A study attempted to reason why the disease had been so devastating in certain localized regions, looking at the climate, the weather and the racial composition of cities. They found humidity to be linked with more severe epidemics as it "fosters the dissemination of the bacteria," (Committee on Atmosphere and Man, 1923). Meanwhile the new sciences of the infectious agents and immunology were racing to come up with a vaccine or therapy to stop the epidemics.

The experiences of people in military camps encountering the influenza pandemic:


An excerpt for the memoirs of a survivor at Camp Funston of the pandemic Survivor

A letter to a fellow physician describing conditions during the influenza epidemic at Camp Devens

A collection of letters of a soldier stationed in Camp Funston Soldier

The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.

The war brought the virus back into the US for the second wave of the epidemic. It first arrived in Boston in September of 1918 through the port busy with war shipments of machinery and supplies. The war also enabled the virus to spread and diffuse. Men across the nation were mobilizing to join the military and the cause. As they came together, they brought the virus with them and to those they contacted. The virus killed almost 200,00 in October of 1918 alone. In November 11 of 1918 the end of the war enabled a resurgence. As people celebrated Armistice Day with parades and large partiess, a complete disaster from the public health standpoint, a rebirth of the epidemic occurred in some cities. The flu that winter was beyond imagination as millions were infected and thousands died. Just as the war had effected the course of influenza, influenza affected the war. Entire fleets were ill with the disease and men on the front were too sick to fight. The flu was devastating to both sides, killing more men than their own weapons could.


With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.


The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War (Tice). Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News). Bodies pilled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers (Knox). The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages.

In 1918-19 this deadly influenza pandemic erupted during the final stages of World War I. Nations were already attempting to deal with the effects and costs of the war. Propaganda campaigns and war restrictions and rations had been implemented by governments. Nationalism pervaded as people accepted government authority. This allowed the public health departments to easily step in and implement their restrictive measures. The war also gave science greater importance as governments relied on scientists, now armed with the new germ theory and the development of antiseptic surgery, to design vaccines and reduce mortalities of disease and battle wounds. Their new technologies could preserve the men on the front and ultimately save the world. These conditions created by World War I, together with the current social attitudes and ideas, led to the relatively calm response of the public and application of scientific ideas. People allowed for strict measures and loss of freedom during the war as they submitted to the needs of the nation ahead of their personal needs. They had accepted the limitations placed with rationing and drafting. The responses of the public health officials reflected the new allegiance to science and the wartime society. The medical and scientific communities had developed new theories and applied them to prevention, diagnostics and treatment of the influenza patients.

Return to the Top

Graphs of the Influenza Epidemic Impact

The Public Health Response
Authoritative Measures
Preventative Measures
Prophylaxis


The Scientific and Medical Response
Clinical Descriptions
Treatment and Therapy
The Etiology of Influenza


Bibliography
by Molly Billings, June, 1997 modified RDS February, 2005

[Peter Lemkin]

1918 flu pandemic
From Wikipedia, the free encyclopedia

The 1918 flu pandemic (commonly referred to as the Spanish flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly Influenza A virus strain of subtype H1N1. Historical and epidemiologic data are inadequate to identify the geographic origin of the virus.[1] Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The pandemic lasted from March 1918 to June 1920,[2] spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 20 to 100 million people were killed worldwide,[3] or the approximate equivalent of one third of the population of Europe,[4][5][6] more than double the number killed in World War I.[7] This extraordinary toll resulted from the extremely high illness rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. The pandemic is estimated to have infected up to one billion people: half the world's population at the time.[8]

The flu probably originated in the Far East.[9] The disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918,[10] and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.[11]

Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.Contents [hide]
1 Mortality
2 History
2.1 Patterns of fatality
2.2 Devastated communities
2.3 Less affected areas
2.4 Government response
2.5 Cultural impact
3 Spanish flu research
4 Victims
4.1 Notable fatalities
4.2 Notable survivors
4.3 Fictional
5 See also
6 References
7 Further reading
8 External links


[edit]
Mortality

The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).[12]

Chart of deaths in major cities

The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25 million in its first 25 weeks (in contrast, AIDS killed 25 million in its first 25 years)[citation needed]. Older estimates say it killed 40–50 million people[3] while current estimates say 50 million to 100 million people worldwide were killed.[13] This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.[14]

An estimated 7 million died in India, about 2.78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it[citation needed]. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died.[15] In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa. Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived,[16] although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher,[17] while in British Somaliland one official there estimated that 7% of the native population died from influenza.[18] In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%.

This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.[3] Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."[13] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.[12]

The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[12][13] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.[19] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.[20]

[edit]
History

While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic. Some researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease.[21]

A large factor of worldwide flu occurrence was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide.

American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918

Two poems, dedicated to the Spanish flu, were popular in those days[citation needed]:

I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza.
-American Skipping Rhyme circa 1918

Obey the laws
And wear the gauze.
Protect your jaws
From septic paws.

[edit]
Patterns of fatality

The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly infants (aged 0–2 years), the elderly, and the immunocompromised. Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months.

People without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids (pneumonia). In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and blood loss.[citation needed]

In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.[citation needed]

[edit]
Devastated communities

Street car conductor in Seattle not allowing passengers aboard without a mask in 1918.

In most places less than one-third of the population was infected, only a small percentage of whom died. In a number of towns in several countries entire populations were wiped out.[citation needed]

Even in areas where mortality was low, those incapacitated by the illness were often so numerous as to bring much of everyday life to a stop. Some communities closed all stores or required customers not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places.[citation needed]

Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which belatedly implemented measures to prevent ships carrying the flu from leaving its ports. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9000 people). Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed. By contrast, "[t]he flu was excluded from American Samoa by a commander who imposed a blockade".[22] The mortality rate in New Zealand itself was 5%.[23]

[edit]
Less affected areas

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck.

In the Pacific, American Samoa[24] and the French colony of New Caledonia [25] also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.[26]

[edit]
Government response

The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from WWI was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza. On Sept. 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations. While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, which affected both sides alike.[27]

[edit]
Cultural impact The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article or discuss the issue on the talk page.


In the United States, Great Britain and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918-1919, the Spanish flu began to fade from public awareness over the decades until the arrival of frightening news about bird flu and other pandemics in the 1990s and 2000s.[28] This has led some historians to label the Spanish flu a “forgotten pandemic.”[29] Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. However, in 1937 William Keepers Maxwell, Jr., the American novelist, wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, also wrote about her parents' deaths in Memories of a Catholic Girlhood. In 1992 Bodie and Brock Thoene's "Shiloh Legacy Series" leads off with an account of the Spanish Flu in New York and Arkansas in their fictional novel, "In My Father's House." More recently (2006), author Thomas Mullen wrote a novel called The Last Town on Earth, about the impact of the Spanish flu on a fictional mill town in Washington and author Myra Goldberg wrote a novel called Wickett's Remedy that is set in Boston during the pandemic.

Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years. These include the rapid pace of the pandemic (it killed most of its victims in the United States, for example, within a period of less than nine months); previous familiarity with pandemic disease in the late 19th and early 20th centuries; and the distraction of the First World War.[30]

Another explanation involves the age group affected by the disease. The majority of fatalities, in both World War I and in the Spanish Flu epidemic, were young adults. The deaths caused by the flu may have been overlooked due to the large numbers of deaths of young men in the war or as a result of injuries, shortly afterwards. When people read the obituaries of the era, they saw the war or post-war deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was extremely high, the flu may not have had a great, separate, psychological impact, or may have seemed a mere "extension" of the war's tragedies.[31] The fact that the disease would usually only affect a certain area for a month before leaving, left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.[32]

[edit]
Spanish flu research
Main article: Spanish flu research

Centers for Disease Control and Prevention’s Dr. Terrence Tumpey examining a reconstructed version of the 1918 flu.

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms – genetic drift and antigenic shift – in viruses in poultry and swine which the fort bred for food, but evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine. The soldiers were then sent from Fort Riley to different places around the world, where they spread the disease.[33]

An effort to recreate the 1918 flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in New York; the effort resulted in the announcement (on October 5, 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered from a female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers.[34]

On January 18, 2007, Kobasa et al. reported that monkeys (Macaca fascicularis) infected with the recreated strain exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm[35] – an overreaction of the immune system. This may explain why the 1918 flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.[36]

On September 16, 2008, the body of Yorkshire landowner Sir Mark Sykes was exhumed to study the RNA of the Spanish flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hope will have helped preserve the virus.[37]

In December, 2008 research by Yoshihiro Kawaoka of University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from 1918 flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.[38]