WW1 and spanish flu

The 1918 flu pandemic, also known as the Great Influenza epidemic or by the common misnomer of the Spanish flu, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was March 1918 in the state of Kansas in the United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in history.

The pandemic broke out near the end of World War I, when wartime censors in the belligerent countries suppressed bad news to maintain morale, but newspapers freely reported the outbreak in neutral Spain, creating a false impression of Spain as the epicenter and leading to the “Spanish flu” misnomer.^[8] Limited historical epidemiological data make the pandemic’s geographic origin indeterminate, with competing hypotheses on the initial spread.

Most influenza outbreaks disproportionately kill the young and old, with a higher survival rate in-between, but this pandemic had unusually high mortality for young adults. Scientists offer several explanations for the high mortality, including a six-year climate anomaly affecting migration of disease vectors with increased likelihood of spread through bodies of water.The virus was particularly deadly because it triggered a cytokine storm, ravaging the stronger immune system of young adults, although the viral infection was apparently no more aggressive than previous influenza strains. Malnourishment, overcrowded medical camps and hospitals, and poor hygiene, exacerbated by the war, promoted bacterial superinfection, killing most of the victims after a typically prolonged death bed.

The 1918 Spanish flu was the first of three flu pandemics caused by H1N1 influenza A virus; the most recent one was the 2009 swine flu pandemic.The 1977 Russian flu was also caused by H1N1 virus.

Etymologies

This pandemic was known by many different names—some old, some new—depending on place, time, and context. The etymology of alternative names historicises the scourge and its effects on people who would only learn years later that invisible viruses caused influenza. This lack of scientific answers led the Sierra Leone Weekly News (Freetown) to suggest a biblical framing in July 1918, using an interrogative from Exodus 16 in ancient Hebrew: “One thing is for certain—the doctors are at present flabbergasted; and we suggest that rather than calling the disease influenza they should for the present until they have it in hand, say Man hu—’What is it?'”

Descriptive names

Outbreaks of influenza-like illness were documented in 1916–17 at British military hospitals in Étaples, France, and just across the English Channel at Aldershot, England. Clinical indications in common with the 1918 pandemic included rapid symptom progression to a “dusky” heliotrope cyanosis of the face. This characteristic blue-violet cyanosis in expiring patients led to the name ‘purple death’.

The Aldershot physicians later wrote in The Lancet, “the influenza pneumococcal purulent bronchitis we and others described in 1916 and 1917 is fundamentally the same condition as the influenza of this present pandemic.” This “purulent bronchitis” is not yet linked to the same A/H1N1 virus, but it may be a precursor.

In 1918, ‘epidemic influenza‘ (Italian: influenza, influence), also known at the time as ‘the grip’ (French: la grippe, grasp),appeared in Kansas in the U.S. during late spring, and early reports from Spain began appearing on 21 May. Reports from both places called it ‘three-day fever’