1918 Pandemic Research Paper

majority of excess influenza deaths.”2 The reason that the Influenza pandemic of 1918 killed so many young people has baffled scientists for decades. It has been hypothesized that this younger generation of people were born in the late 1800’s and were only exposed to the “H3 influenza virus, which appeared as a pandemic 1889.”2 Their immune systems were not prepared for a virus with a combination of influenza viruses, leading to the higher mortality rates. In opposition, another possibility explored was that the “vigorous immune responses directed against the virus in healthy young persons could have caused severe disease in 1918.”2

In total there were three pandemic waves that spread across the world infecting and killing millions of people.

From a public health perspective, the most important part of any pandemic is understanding the spread pattern.2 Knowing the pattern of the of spread of the pandemic helps for the planning of containment strategies and possible “public health and medical burdens.”2 The first wave of the Spanish flu pandemic started in the northern hemisphere during the spring and into the summer of 1918. The first wave was “associated with high morbidity but low mortality.”2 The next two waves started in the summer and extended into the fall of 1918 and winter of 1919. Both of these waved also proved deadly.2 After over a year of sickness and death, the Spanish flu disappeared almost as fast as it spread across the world. In the summer of 1919, the Spanish flu pandemic came to a close, due to all the people who were infected either developing immunity or dying of the virus.5

The best way to prepare for a pandemic such as influenza would be the ability to predict when one might strike. According to the Journal of Infectious Disease “…the occurrences of 3 influenza pandemics during the 19th century and of another 3 during the 20th century have led some experts to conclude that pandemics occur in cycles.”2 Unfortunately, it has proven very difficult to predict when an influenza epidemic will arise again. Renowned expert on influenza, Edwin Kilbourne, stated that “there is no predictable periodicity or pattern of major influenza epidemics and that all differ from one another; without pandemic cycles there can be little basis for predicting pandemic emergence.”2
As stated by noted virologist Jeffery Taubenberger, it is evident that pandemics are caused by two different mechanisms.1,2 The appearance of a totally new and distinctive virus from the avian family or a mutation of a “currently circulating human-adapted virus.”1,2 The modern use of vaccines and the wider variety of viruses circulating throughout the world, allowing for increased immunity in many people also make it difficult for another pandemic like the one in 1918 to occur again.

If a unique virus similar to the one that caused the Spanish pandemic flu were to emerge today it could be catastrophic. It is estimated that a virus of that magnitude would cause up to 1.9 million casualties.2 In this modern age with travel by air, we might expect global spread to proceed rapidly and to be difficult to control, but hardly much more so than the 1918 pandemic, in which most of the world was affected by W2 [Wave 2] within a matter of a few

weeks.”2

In this day and age, the public health system is more advanced and prepared to handle a disease pandemic like the one that occurred in 1918.

Today health care providers have more advanced information regarding prevention, disease reporting, competent training, vaccination schedules and education regarding disease prevention.2 Along with vaccines for influenza there are also modern antiviral drugs that did not exist in 1918. There are two classes of antiviral drugs that would be used during an influenza, “adamantanes and neuraminidase inhibitors, one or both of which have proven effective, in culture, against most of the currently circulating H5N1 viruses.”2 There are also more advance treatments to treat the accompanying diseases of influenza, such as pneumonia and bronchitis. These treatments include antibiotics, hospital intensive care units including ventilators that have the ability to aid patients who develop ARDS.2

Even though medical advances in the 21st century are far better than they were in 1918, there is still the problem for dealing with the sheer number of patients that could be infected by a flu pandemic. Without the ability to increase medical resources like doctors, PAs, nurses, hospital beds, medicine and medical supplies the healthcare system would be overwhelmed and could possibly

fail.1,2

Another issue is access to healthcare. Not all people have the same access to competent healthcare, this could lead to an increased mortality rate in areas that are underserved medically.2 The best hope for surviving a pandemic on the level of the Spanish flu of 1918-1919 is to be ready. Exercises such as disaster preparedness and mass casualty exercises are essential to prepare healthcare providers for dealing with large numbers of severely ill patients. Another act of preparedness would be the “…stockpiling of vaccines that are more broadly efficacious—for example, “universal” influenza vaccines based on either immunogenic antigens shared by all influenza viruses [100] or multivalent HAs and NAs [101], both of which are currently being developed.”2

In conclusion, the Spanish flu pandemic 1918-1919 was a public health disaster. With no disease surveillance, anti-viral drugs, antibiotics, competently trained medical personal and adequate hospital services unless people developed immunity to the virus they did not stand much of a chance.1,2 Today we have all of the above-mentioned tools along with proper training to survive an influenza pandemic, yet we could suffer a similar fate if we do not remain vigilant. I am a firm believer that prevention is the best medicine. Regular training to keep health care providers up to date on the latest procedure and drugs to treat influenza and its accompanying diseases, along with strict disease reporting are the only way to be ready if the day ever comes. Furthermore, it is important that as providers we keep up on our vaccinations and that we always educate our patients on the importance of keeping up on theirs.