Spanish flu - Knowledge

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underlying condition for people and increases the |mortality rate when infected by the influenza disease. There was diverse labor in Newfoundland, men and women had various occupations that involved day-to-day interaction. But, fishing had a major role in the economy and so males were more mobile than females and had more contact with other parts of the world. The spread of the pandemic is known to have begun in the spring of 1918, but Newfoundland did not see the deadly wave until June or July, which aligns with the high demand for employment in the fishery. The majority of men were working along the coast during the summer and it was typical for entire families to move to Newfoundland and work. Studies show a much higher mortality rate in males compared with females. But, during the first, second, and third waves of the pandemic, the mortality shifted. During the first wave, men had a higher mortality rate, but the mortality rate of females increased and was higher during the second and third waves. The female population was larger in certain regions of Newfoundland and therefore had a bigger impact on the death rate.

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pandemic, from September to December 1918. Mortality figures follow closely the concurrent increase in precipitation and decrease in temperatures. Several explanations have been proposed for this, including the fact that lower temperatures and increased precipitation provided ideal conditions for virus replication and transmission, while also negatively affecting the immune systems of soldiers and other people exposed to the inclement weather, a factor proven to increase likelihood of infection by both viruses and pneumococcal co-morbid infections documented to have affected a large percentage of pandemic victims (one fifth of them, with a 36% mortality rate). A six-year climate anomaly (1914–1919) brought cold, marine air to Europe, drastically changing its weather, as documented by eyewitness accounts and instrumental records, reaching as far as the

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China. For instance, Iijima in 1998 estimates the death toll in China to be between 1 and 1.28 million based on data available from Chinese port cities. The lower estimates of the Chinese death toll are based on the low mortality rates that were found in Chinese port cities (for example, Hong Kong) and on the assumption that poor communications prevented the flu from penetrating the interior of China. However, some contemporary newspaper and post office reports, as well as reports from missionary doctors, suggest that the flu did penetrate the Chinese interior and that influenza was severe in at least some locations in the countryside of China.

3011: 2808: 2824:. In 1918, older adults may have had partial protection caused by exposure to the 1889–1890 flu pandemic, known as the "Russian flu". According to historian John M. Barry, the most vulnerable of all – "those most likely, of the most likely", to die – were pregnant women. He reported that in thirteen studies of hospitalized women in the pandemic, the death rate ranged from 23% to 71%. Of the pregnant women who survived childbirth, over one-quarter (26%) lost the child. Another oddity was that the outbreak was widespread in the summer and autumn (in the Northern Hemisphere); influenza is usually worse in winter. 1573: 5791:[In Europe, the Spanish flu was also referred to as 'Blitzkatarrh', as 'Flanders fever', 'Flanders flu', in English and Americans as 'three-day' or 'knock-me-down' fever, and in France as 'la flu', as 'bronchite purulente' (purulent bronchitis) or by French military doctors as 'disease 11' (maladie onze). The naming of diseases and especially epidemics according to their presumed place of origin is nothing unusual. It is an attempt to track down what is happening. At the same time, in this way, diseases are marked as something external, as something foreign that has invaded or been introduced.] 2046: 2963: 3411: 2723:. However, the outbreak was delayed into 1926 for American Samoa and 1921 for New Caledonia as the quarantine period ended. On American Samoa, at least 25% of the island residents were clinically attacked and 0.1% died, and on New Caledonia, there was widespread illness and 0.1% population died. Australia also managed to avoid the first two waves with a quarantine. Iceland protected a third of its population from exposure by blocking the main road of the island. By the end of the pandemic, the isolated island of 2153: 1279: 5093:[In Spain, it was initially called 'the three-day fever', based on the belief, as in other countries, that the flu was a mild illness. The first reports about the flu, drawing attention to the fact that something different was happening, appeared in the press at the end of May. For example, in the newspaper ABC on 22 May, through a brief note on page 24: "The doctors have verified, in Madrid, the existence of an epidemic of a influenza nature, very widespread, but, fortunately, of a mild nature.'] 1928:, based his conclusions on newly unearthed records. He found archival evidence that a respiratory illness that struck northern China (where the laborers came from) in November 1917 was identified a year later by Chinese health officials as identical to the Spanish flu. Unfortunately, no tissue samples have survived for modern comparison. Nevertheless, there were some reports of respiratory illness on parts of the path the laborers took to get to Europe, which also passed through North America. 1608:

York City began to see its own sudden increase in cases, and other cities around the country were soon to follow. Certain pandemic restrictions, such as the closing of schools and theaters and the staggering of business hours to avoid congestion, were reimposed in cities like Chicago, Memphis, and New York City. As they had during the epidemic in fall 1918, schools in New York City remained open, while those in Memphis were shuttered as part of more general restrictions on public gatherings.

2206: 575: 3431: 2912: 2597: 802: 2861:. (2011) used a mechanistic modeling approach to study the three waves of the 1918 influenza pandemic. They examined the factors that underlie variability in temporal patterns and their correlation to patterns of mortality and morbidity. Their analysis suggests that temporal variations in transmission rate provide the best explanation, and the variation in transmission required to generate these three waves is within biologically plausible values. Another study by He 1468:. By 21 February, with some local variation, influenza activity was reported to have been declining since mid-January in all parts of the country. Following this "first great epidemic period" that had commenced in October 1918, deaths from pneumonia and influenza were "somewhat below average" in the large cities of the United States between May 1919 and January 1920. Nonetheless, nearly 160,000 deaths were attributed to these causes in the first six months of 1919. 5692:'The Serbian Newspaper' wrote in the period October 23 / November 5, 1918 at the peak of the second, deadliest wave of the pandemic: 'Various countries have been assigning the origin of this imposing guest to each other for quite some time, and at one point in time they agreed to assign its origin to the kind and neutral Spain, which had been fighting off this honour just as much as German submarines, so imposing in their search for hospitality off Spanish shores.' 2412: 760: 2828:

times higher mortality in Hungary and Spain compared to Denmark, two to three times higher chance of death in Sub-Saharan Africa compared to North Africa, and possibly up to ten times higher rates between the extremes of Asia. Cities were affected worse than rural areas. There were also differences between cities, which might have reflected exposure to the milder first wave giving immunity, as well as the introduction of social distancing measures.

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of January. The Public Health Service announced it would take steps to "localize the epidemic", but the disease was already causing a simultaneous outbreak in Kansas City and quickly spread outward from the center of the country in no clear direction. A few days after its first announcement, PHS issued another assuring that the disease was under the control of state health authorities and that an outbreak of epidemic proportions was not expected.

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Chinese and Southeast Asian workers in Europe suggests that the Asian units were not different from other Allied military units in France at the end of 1918 and, thus, were not a likely source of a new lethal virus. Further evidence against the disease being spread by Chinese workers was that workers entered Europe through other routes that did not result in a detectable spread, making them unlikely to have been the original hosts.

3427:(or biological groups each descended from a common ancestor), which gave rise to the classical swine and human H1N1 influenza lineages. The last common ancestor of human strains dates between February 1917 and April 1918. Because pigs are more readily infected with avian influenza viruses than are humans, they were suggested as the original recipients of the virus, passing the virus to humans sometime between 1913 and 1918. 18296: 156: 4437:, p. 7: "In short, although the Spanish flu 'had nothing "Spanish" about it,' from a strictly epidemiological perspective, its discursive link to the Iberian nation is beyond dispute. The importance of narrative for a historically informed appreciation of the epidemic stems from the importance of this discursive link and is tied directly to the scientific uncertainty about the etiological agent of the epidemic;" 2799:

Shanghai International Settlement, and the actual death toll in Shanghai was much higher. The medical records from China's interior indicate that, compared to cities, rural communities have substantially higher mortality rate. A published influenza survey in Houlu County, Hebei Province, found that the case fatality rate was 9.77% and 0.79% of county population died from influenza in October and November 1918.

22599: 3655: 3641: 2746:. China may have experienced a relatively mild flu season in 1918 compared to other areas of the world. However, some reports from its interior suggest that mortality rates from influenza were perhaps higher in at least a few locations in China in 1918. At the very least, there is little evidence that China as a whole was seriously affected by the flu compared to other countries in the world. 22587: 909: 2403: 5789:

als 'Krankheit 11' (maladie onze) bezeichnet. Die Benennung von Krankheiten und insbesondere Seuchen nach ihrem vermuteten Ursprungsort ist nichts Ungewöhnliches. Es ist der Versuch, einem Geschehen auf die Spur zu kommen. Zugleich werden auf diese Weise Krankheiten als etwas Äußerliches gekennzeichnet, als etwas Fremdes, das eingedrungen ist oder eingeschleppt wurde.

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then sent from Fort Riley around the world, where they spread the disease. Similarities between a reconstruction of the virus and avian viruses, combined with the human pandemic preceding the first reports of influenza in swine, led researchers to conclude the influenza virus jumped directly from birds to humans, and swine caught the disease from humans.

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crowded field hospitals, spreading the deadlier virus. The second wave began, and the flu quickly spread around the world again. Consequently, during modern pandemics, health officials look for deadlier strains of a virus when it reaches places with social upheaval. The fact that most of those who recovered from first-wave infections had become

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as many deaths as the 1918–1919 experience. New York City alone reported 6,374 deaths between December 1919 and April 1920, almost twice the number of the first wave in spring 1918. Other U.S. cities including Detroit, Milwaukee, Kansas City, Minneapolis, and St. Louis were hit particularly hard, with death rates higher than all of 1918. The

2006:, which escaped with a combined mortality rate of just 0.29% (0.02% in the first wave and 0.27% in the second wave) because of exposure to the less-lethal first wave. For the rest of the population, the second wave was far more deadly; the most vulnerable people were those like the soldiers in the trenches – adults who were young and fit. 897:, a Spanish official protested, "we were surprised to learn that the disease was making ravages in other countries, and that people there were calling it the 'Spanish grip'. And wherefore Spanish? …this epidemic was not born in Spain, and this should be recorded as a historic vindication." But before this letter could be published, 3492:) infected with the recreated flu strain exhibited classic symptoms of the 1918 pandemic, and died from an overreaction of the immune system. This may explain why the Spanish flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction. 2625:, managed to avoid the extent of the pandemic between 1918 and 1919, but the flu at last reached the town in spring 1920. Reports suggested that during the first two weeks of May, the majority of the town's population became infected; 10% of the population were estimated to have died, most of whom were Alaska Natives. 1444:, for example, experienced a swift resurgence of influenza that reached its peak in December, possibly as a result of the lifting of the ban on public gatherings. Pandemic interventions, such as bans on public gatherings and the closing of schools, were reimposed in many places in an attempt to suppress the spread. 1990:

susceptibility. A large factor in the worldwide occurrence of the flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease. Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks.

6047:[The following month, a number of sumo wrestlers were absent from the summer tournament in Tokyo due to high fevers. People called it the "sumo flu" or "wrestler flu," but in fact, this mysterious infection is believed to be the Spanish flu, which began spreading in the United States early that year.] 5620:

in question, influenza, had been sowing misery in France and Britain for weeks, and in America for longer, but Salazar did not know this because the governments of those countries, a group then at war with Germany and its allies, had made strenuous efforts to suppress such potentially morale-damaging news.

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John M. Barry : The government lied. They lied about everything. We were at war and they lied because they didn't want to upend the war effort. You had public health leaders telling people this was just the ordinary flu by another name. They simply didn't tell the people the truth about what was

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Medical professionals and officials in Spain protested. They said the Spanish people were being falsely stigmatized.... If you've ever wondered about the staying power of a brand, the 'Spanish Flu' is a case in point. A full 100 years later, the 'Spanish Flu' is still referenced — and still remains a

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In Europa wurde die Spanischer Grippe auch als 'Blitzkatarrh', als 'Flandern-Fieber', 'flandische Grippe', bei Engländern und Amerikanern als 'three-day'- oder 'knock-me-down'-Fieber, und in Frankreich als 'la grippe', als 'bronchite purulente' (eitrige Bronchitis) oder beim französische Militärärzte

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The Russians called it the Chinese flu. In Japan, it was wrestler's fever. In South Africa, it was known as either the white man's sickness or kaffersiekte blacks' disease. Soldiers fighting in the Great War called it the three-day fever—a highly inaccurate description—and when it first struck in the

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published a scant article titled 'Can One Live? The Fashionable Illness.' Likely the first account in Spain of the Spanish flu, it begins: 'For several days, Madrid has been affected by an epidemic, which fortunately is mild; but which, from what it appears, intends to kill doctors from overwork'....

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French doctors gave it the name of "la grippe," which is now anglicized into "the grip" ... It is known all over the world, and there is a disposition in every nation to shift the odium of it upon some other country. Then the Russians call it the Chinese catarrh, the Germans often call it the Russian

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Two papers were published in The Lancet in 1917 describing an outbreak of disease constituting 'almost a small epidemic'. The first paper was written by physicians at a hospital center in northern France,3 and the second by a team at an army hospital in Aldershot, in southern England. In both earlier

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When people read the obituaries, they saw the war or postwar deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was high, the flu may not have had a tremendous psychological impact or may have seemed an extension of the war's tragedies. The duration of

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In South Africa it is estimated that about 300,000 people amounting to 6% of the population died within six weeks. Government actions in the early stages of the virus' arrival in the country in September 1918 are believed to have unintentionally accelerated its spread throughout the country. Almost a

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communities. New South Wales and Victoria saw the greatest relative mortality, with 3.19 and 2.40 deaths per 1,000 people respectively, while Western Australia, Queensland, Southern Australia, and Tasmania experienced rates of 1.70, 1.14, 1.13, and 1.09 per 1,000 respectively. In Queensland, at least

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hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have reduced people's resistance to the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their

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that principally affected those 26 years of age and younger. While some natural explanations, such as the virus remaining in some frozen state for 20 years, have been proposed to explain this unprecedented phenomenon, the nature of influenza itself has been cited in favor of human involvement of some

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reaching a peak of 158 deaths in a single week, compared to the peak of 92 reached in December 1918; however, the 1920 epidemic passed in a matter of weeks, while the 1918–1919 wave had developed over the entire second half of 1918. By contrast, the outbreak in western Europe was considered "benign",

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The fourth wave in the United States subsided as swiftly as it had appeared, reaching a peak in early February. "An epidemic of considerable proportions marked the early months of 1920", the U.S. Mortality Statistics would later note; according to data at this time, the epidemic resulted in one third

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remained free from it until mid-August. Out of the six states, Victoria and New South Wales experienced generally more extensive epidemics. Each experienced another significant wave of illness over the winter. The second epidemic in New South Wales was more severe than the first, while Victoria saw a

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The first wave of the flu lasted from the first quarter of 1918 and was relatively mild. Mortality rates were not appreciably above normal; in the United States ~75,000 flu-related deaths were reported in the first six months of 1918, compared to ~63,000 deaths during the same time period in 1915. In

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On June 29th 1918 Martín Salazar, Spain's inspector-general of health, stood up in front of the Royal Academy of Medicine in Madrid. He declared, not without embarrassment, that the disease which was ravaging his country was to be found nowhere else in Europe. In fact, that was not true. The illness

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En España, se le llamó al principio 'la fiebre de los tres días', atendiendo a la creencia, como en otros países, de que la gripe era una enfermedad leve. Las primeras noticias sobre la gripe, llamando la atención sobre que algo distinto estaba ocurriendo, aparecieron en la prensa a finales de mayo.

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was one of the deadliest diseases in the 1900s, and killed more men than women. But with the spread of influenza disease, the cases of tuberculosis cases in men decreased. Many scholars have noted that tuberculosis increased the mortality rate of influenza in males, decreasing their life expectancy.

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The origin of the Spanish flu pandemic, and the relationship between the near-simultaneous outbreaks in humans and swine, have been controversial. One hypothesis is that the virus strain originated at Fort Riley, Kansas, in viruses in poultry and swine which the fort bred for food; the soldiers were

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There are various theories of why the Spanish flu was "forgotten". The rapid pace of the pandemic, which killed most of its victims in the United States within less than nine months, resulted in limited media coverage. The general population was familiar with patterns of pandemic disease in the late

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writes that "Many researchers have suggested that the conditions of the war significantly aided the spread of the disease. And others have argued that the course of the war (and subsequent peace treaty) was influenced by the pandemic." Kahn has developed a model that can be used on home computers to

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incorporating three factors to infer the cause of the three waves of the 1918 influenza pandemic. These factors were school opening and closing, temperature changes throughout the outbreak, and human behavioral changes in response to the outbreak. Their modeling results showed that all three factors

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based on data from fourteen European countries estimated a total of 2.64 million excess deaths in Europe attributable to the Spanish flu during the major 1918–1919 phase of the pandemic, in line with the three prior studies from 1991, 2002, and 2006 that calculated a European death toll of between 2

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in history. An early estimate from 1927 put global mortality at 21.6 million. An estimate from 1991 states that the virus killed between 25 and 39 million people. A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%).

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While systems for alerting public health authorities of infectious spread did exist in 1918, they did not generally include influenza, leading to a delayed response. Nevertheless, actions were taken. Maritime quarantines were declared on islands such as Iceland, Australia, and American Samoa, saving

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troops suffered extremely cold temperatures despite the normally Mediterranean climate of the region. The climate anomaly likely influenced the migration of H1N1 avian vectors which contaminate bodies of water with their droppings, reaching 60% infection rates in autumn. The climate anomaly has been

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favors a mild strain. Those who get very ill stay home, and those mildly ill continue with their lives, preferentially spreading the mild strain. In the trenches, natural selection was reversed. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to

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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

6660:"The Memoirs of Herbert Hoover: Years of Adventure, 1874–1920. (New York: Macmillan Company. 1951. pp. xi, 496.) and Herbert Hoover and the Russian Prisoners of World War I: A Study in Diplomacy and Relief, 1918–1919. By Edward F. Willis. (Stanford: Stanford University Press. 1951. pp. viii, 67.)". 5231:

One is, that every epidemic owns one unknown source, whence it spreads; each nation, in turn, attributing to its neighbour from whom it derived the disease, the unenviable honour of originating it. Thus the Italians have termed it the German disease; the Germans, the Russian pest; the Russians, the

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during 1917 about a respiratory illness outbreak beginning in 1916 in Étaples, France. Worobey traced recent references to that article to family members who had retained slides that Rolland had prepared during that time. Worobey extracted tissue from the slides to potentially reveal more about the

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Many businesses in the entertainment and service industries suffered losses in revenue, while the healthcare industry reported profit gains. Historian Nancy Bristow has argued that the pandemic, when combined with the increasing number of women attending college, contributed to the success of women

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among the Chinese population in 1918. If extrapolated from the extensive data recorded from Chinese cities, the suggested mortality rate from influenza in China as a whole in 1918 was likely lower than 1% – much lower than the world average (which was around 3–5%). In contrast, Japan and Taiwan had

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officials in China. As a whole, data from China's port cities show low mortality rates compared to other cities in Asia. For example, the British authorities at Hong Kong and Canton reported a mortality rate from influenza at a rate of 0.25% and 0.32%, much lower than the reported mortality rate of

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has been estimated at 450,000, though the epidemiologists who suggested this number called it a "shot in the dark". If it is correct, Russia lost roughly 0.4% of its population, meaning it suffered the lowest influenza-related mortality in Europe. Another study considers this number unlikely, given

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to develop, whereby the skin would first develop two mahogany spots over the cheekbones which would then over a few hours spread to color the entire face blue, followed by black coloration first in the extremities and then further spreading to the limbs and the torso. After this, death would follow

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found that Spanish flu mortality simultaneously peaked within the two-month period of October and November 1918 in all fourteen European countries analyzed, which is inconsistent with the pattern that researchers would expect if the virus had originated somewhere in Europe and then spread outwards.

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Influenza began to be reported again from many places in 1921. The pandemic continued to be felt in Chile, where a fourth wave affected seven of its 24 provinces between June and December 1921. The winter of 1921–1922 was the first major reappearance of seasonal influenza in the Northern Hemisphere

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In the United States, there were "almost continuously isolated or solitary cases" of flu throughout the spring and summer months of 1919. An increase in scattered cases became apparent as early as September, but Chicago experienced one of the first major outbreaks of the flu beginning in the middle

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A popular playground skipping rhyme caught the ease with which this 'new disease' was transmitted: I had a little bird; Its name was Enza; I opened the window; And in-flu-enza. As influenza spread from Glasgow to Aberdeen, and from Liverpool to London's Mile End, it was not long before playgrounds

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Another rhyme with deadly origins appeared during a worldwide influenza pandemic in 1889-1890. Certain the disease could be stopped by sealing up the home from the poisoned air outside, this safety tip emerged in schools: There was a little girl, and she had a little bird; And she called it by the

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Many other nicknames were given to the pandemic, many based on nationality or race: 'Spanish Lady', 'French Flu', 'Naples Soldier', 'Purple Death', 'War Plague', 'Flanders Grippe', 'Kirghiz Disease', 'Black Man's Disease', 'Hun Flu', 'German Plague', 'Bolshevik Disease' or even the 'Turco-Germanic

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The outbreak immediately preceding the present one was in 1879, and has been well described by Da Costa. Like every other disease about whose pathology we know very little, this malady has not a scientifically correct name, but at different times and in different countries has received names which

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London, Dec. 20. — The grip is a disease without a country, according to a new book just issued which is devoted to the malady. Every country tries to make it out a native of another land.... Eighteenth-century Italian writers say Dr. Hopkirk spoke of "una influenza di freddo" (influence of cold),

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Studies have shown that the immune system of Spanish flu victims could have been weakened by adverse climate conditions which were particularly unseasonably cold and wet for extended periods of time during the duration of the pandemic. This affected especially WWI troops exposed to incessant rains

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It became apparent within days of the start of Chicago's explosive growth in cases that the flu was spreading in the city at an even faster rate than in winter 1919, though fewer were dying. Within a week, new cases in the city had surpassed its peak during the 1919 wave. Around the same time, New

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Cases began to rise again in some parts of the United States as early as late November 1918, with the Public Health Service issuing its first report of a "recrudescence of the disease" being felt in "widely scattered localities" in early December. This resurgent activity varied across the country,

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There were also geographic patterns to the disease's fatality. Some parts of Asia had 30 times higher death rates than some parts of Europe, and generally, Africa and Asia had higher rates, while Europe and North America had lower ones. There was also great variation within continents, with three

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The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old. In 1920, the mortality rate among people under 65 had decreased sixfold to half the mortality rate of

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Even in areas where mortality was low, so many adults were incapacitated that much of everyday life was hampered. Some communities closed all stores or required customers to leave orders outside. There were reports that healthcare workers could not tend the sick nor the gravediggers bury the dead

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In Australia, the flu killed around 12,000 to 20,000 people. The country's death rate, 2.7 per 1,000 people, was one of the lowest recorded compared with other countries at the time; however, as much as 40 percent of the population were infected, and a mortality rate of 50 percent was recorded by

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After the lethal second wave struck in late 1918, new cases dropped abruptly. In Philadelphia, for example, 4,597 people died in the week ending 16 October, but by 11 November, influenza had almost disappeared from the city. One explanation for the rapid decline in the lethality of the disease is

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French journalists had, initially, called it the 'American flu'; but the fact that the American soldiers were his allies in the warlike conflict advised not to assign such a link to them.... Another most popular name in Madrid, was the 'Soldado de Nápoles' (Naples soldier), a popular song in the

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status of people. Although social variability allowed the disease to move quickly geographically, it tended to spread faster and affect men more than women due to labor and social contact. Newfoundland's leading cause of death before the pandemic was tuberculosis and this is known to be a severe

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who is examining the history of the 1918 pandemic, revealed that he obtained tissue slides created by William Rolland, a physician who reported on a respiratory illness likely to be the virus while a pathologist in the British military during World War One. Rolland had authored an article in the

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Additionally, the outbreak coincided with the deaths and media focus on the First World War. Another explanation involves the age group affected by the disease. The majority of fatalities, from both the war and the epidemic, were among young adults. The high number of war-related deaths of young

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A 2020 study found that U.S. cities that implemented early and extensive non-medical measures (quarantine, etc.) suffered no additional adverse economic effects due to implementing those measures. However, the validity of this study has been questioned because of the coincidence of WWI and other

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was 13.88 million. Another estimate gives at least 12 million dead. The decade between 1911 and 1921 was the only census period in which India's population fell, mostly due to devastation of the Spanish flu pandemic. While India is generally described as the country most severely affected by the

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Much of Spain was affected by "a substantial recrudescent wave" of influenza between January and April 1919. Portugal experienced a resurgence in pandemic activity that lasted from March to September 1919, with the greatest impact being felt on the west coast and in the north of the country; all

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Records indicate the most deaths during the first wave of the pandemic were among young men in their 20s, which reflects the age of enlistment in the war. The mobility of young men during 1918 was linked to the spread of influenza and the biggest wave of the epidemic. In late 1917 and

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In 2013, the AIR Worldwide Research and Modeling Group "characterized the historic 1918 pandemic and estimated the effects of a similar pandemic occurring today using the AIR Pandemic Flu Model". In the model, "a modern-day 'Spanish flu' event would result in additional life insurance losses of

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However, it is noted that the influenza mortality rate in Hong Kong and Canton are under-recorded, because only the deaths that occurred in colony hospitals were counted. Similarly, in Shanghai, these statistics are limited to that area of the city under the control of the health section of the

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The first estimate of the Chinese death toll was made in 1991 by Patterson and Pyle, which estimated a toll of between 5 and 9 million. However, this 1991 study was criticized by later studies due to flawed methodology, and newer studies have published estimates of a far lower mortality rate in

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found no evidence that the 1918 virus was imported to Europe via Chinese and Southeast Asian soldiers and workers and instead found evidence of its circulation in Europe before the pandemic. The 2016 study found that the low flu mortality rate (an estimated one in a thousand) recorded among the

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By mid-1920, the pandemic was largely considered to be "over" by the public as well as governments. Though parts of Chile experienced a third, milder wave between November 1920 and March 1921, the flu seemed to be mostly absent through the winter of 1920–1921. In the United States, for example,

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and one affected the other. The ages of males dying of the flu show that tuberculosis was a factor, and as males primarily had this disease at the time of the pandemic, they had a higher mortality rate. Life expectancy dropped in males during the pandemic but then increased two years after the

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identified a severe climate anomaly that impacted Europe from 1914 to 1919, with several environmental indicators directly influencing the severity and spread of the Spanish flu pandemic. Specifically, a significant increase in precipitation affected all of Europe during the second wave of the

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A 2018 study of tissue slides and medical reports led by evolutionary biology professor Michael Worobey found evidence against the disease originating from Kansas, as those cases were milder and had fewer deaths compared to the infections in New York City in the same period. The study did find

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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

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The first patients in Japan, reported Shukan Gendai (May 2–9), began showing symptoms around April 1918. Initially the disease was referred to as the "Sumo Kaze" (sumo cold) because a contingent of sumo wrestlers contracted it while on a tour of Taiwan. Three well known grapplers, Masagoishi,

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daily newspapers carried an increasing number of advertisements for influenza-related remedies as drug companies played on the anxieties of readers and reaped the benefits. From the Times of London to the Washington Post, page after page was filled with dozens of advertisements for preventive

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Etymology: In ancient times, before epidemiology science, people believed the stars and "heavenly bodies" flowed into us and dictated our lives and health—influenza means 'to influence' in Italian, and the word stems from the Latin for 'flow in.' Sickness, like other unexplainable events, was

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Labelled 'purulent bronchitis' for want of a better term, the disease proved fatal in half the cases and many soldiers also developed cyanosis. 2 years later, British respiratory experts, also writing in The Lancet, but this time in the wake of the pandemic, would decide the disease had been

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in the field of nursing. This was due in part to the failure of medical doctors, who were predominantly men, to contain and prevent the illness. Nursing staff, who were mainly women, celebrated the success of their patient care and did not associate the spread of the disease with their work.

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The second wave of the 1918 pandemic was much more deadly than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. October 1918 was the month with the highest fatality rate of the whole

1944:

to the flu virus. In the Guangdong Province it was reported that early outbreaks of influenza in 1918 disproportionately impacted young men. The June outbreak infected children and adolescents between 11 and 20 years of age, while the October outbreak was most common in those aged 11 to 15.

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Between October 1919 and 23 January 1920, 780,000 cases were reported across the country, with at least 20,000 deaths recorded by that date. This apparently reflected "a condition of severity three times greater than for the corresponding period of" 1918–1919, during Japan's first epidemic.

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In Japan, the flu broke out again in December and spread rapidly throughout the country, a fact attributed at the time to the coming of cold weather. Pandemic-related measures were renewed to check the spread of the outbreak, and health authorities recommended the use of masks. The epidemic

3629:(CWGC), which reported under 2 million men and women died during the wars, with a record of those who died from 1917 to 1918. The movement of soldiers during this time and the transportation from United States between Canada likely had a significant effect on the spread of the pandemic. 1336:

saw its first cases in some soldiers. From Freetown, the pandemic continued to spread through West Africa along the coast, rivers, and the colonial railways, and from railheads to more remote communities, while South Africa received it in September on ships bringing back members of the

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the Purple Death … name resulted from the specific skin colour in the most severe cases of the diseased, who by the rule also succumbed to the disease, and is also at the same time the only one which does not link this disease with the Iberian peninsula. This name is actually the most

3570:

During the 1900s tuberculosis was more common in males than females, but studies show that when influenza spread the tuberculosis mortality rate among females changed. The death rate of tuberculosis in females increased significantly and would continue to decline until post-pandemic.

2982:, who has charted a complex history of social and cultural forgetting, demonstrating how the pandemic was overshadowed by the commemoration of the First World War and mostly neglected in mainstream historiography, yet was remembered in private and local traditions across the globe. 5646: 5122:

In the popular mind calamities often need to have their origin and cause identified and other countries or peoples credited with blame. This xenophobic response has been common in Europe, that impulse to blame others or the silent places of the Asian heartlands for the source of

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as being at the center of the Spanish flu. His study found that in late 1916 the Étaples camp was hit by the onset of a new disease with high mortality that caused symptoms similar to the flu. According to Oxford, a similar outbreak occurred in March 1917 at army barracks in

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Others have disagreed, and more recent research has suggested the strain may have originated in a nonhuman, mammalian species. An estimated date for its appearance in mammalian hosts has been put at the period 1882–1913. This ancestor virus diverged about 1913–1915 into two

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250 million in 1918), considerably higher than the mortality rate in the U.S., which the authors hypothesize is likely due to the severe effects of the war in Europe. The excess mortality rate in the U.K. has been estimated at 0.28%–0.4%, far below this European average.

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In the Northern Hemisphere, fears of a "recurrence" of the flu grew as fall approached. Experts cited the history of past flu epidemics, such as that of 1889–1890, to predict that such a recurrence a year later was not unlikely, though not all agreed. In September 1919,

2994:, and cholera all occurred near the same time. These outbreaks probably lessened the significance of the influenza pandemic for the public. In some areas, the flu was not reported on, the only mention being that of advertisements for medicines claiming to cure it. 1424: 3594:

One major cause of the spread of influenza was social behavior. Men had more social variation and were mobile more than women due to their work. Even though there was a higher mortality rate in males, each region showed different results, due to such factors as

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segments. "While the pandemic human influenza viruses of 1957 (H2N2) and 1968 (H3N2) arose through reassortment between human and avian viruses, the influenza virus causing the 'Spanish flu' in 1918 appears to be entirely derived from an avian source (Belshe

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was instead mistakenly thought to be the cause, as it was big enough to be seen and was present in many, though not all, patients. For this reason, a vaccine that was used against that bacillus did not make an infection rarer but did decrease the death rate.

1689:, a major epidemic (the fifth since 1918) prevailed between November and December 1921. The flu was also widespread in the United States, its prevalence in California reportedly greater in early March 1922 than at any point since the pandemic ended in 1920. 9223: 4508:

local interpretations of the crisis had become deeply reminiscent of the increasing disobedience of the Israelites in the wilderness of Sin. It was therefore urged that the epidemic be called 'Man hu,' (an obvious corruption of "manna") meaning 'what is

2465:

Spanish flu, at least one study argues that other factors may partially account for the very high excess mortality rates observed in 1918, citing unusually high 1917 mortality and wide regional variation (ranging from 0.47% to 6.66%). A 2006 study in

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A later study found that measures such as banning mass gatherings and requiring the wearing of face masks could cut the death rate up to 50 percent, but this was dependent on their being imposed early in the outbreak and not being lifted prematurely.

2144:, the view of the country's elite was that the nation was in severe decline, and therefore doctors assumed that the disease was typhus caused by poor hygiene, and not an infectious one, causing a mismanaged response which did not ban mass gatherings. 1591:

said a return of the flu later in the year would "probably, but by no means certainly," occur. France had readied a public information campaign before the end of the summer, and Britain began preparations in the fall with the manufacture of vaccine.

2245:, limitations on crowd size, selective closing of businesses, curfews, and lockdowns. After October's strict containment measures showed some success, Armistice Day celebrations in November and relaxed attitudes by Thanksgiving caused a resurgence. 2406:

Difference between the flu mortality age-distributions of the 1918 pandemic 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

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kind, such as an accidental leak from a lab where the old virus had been preserved for research purposes. Following this miniature pandemic, the reemerged H1N1 became endemic once again but did not displace the other active influenza A virus,

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Nonetheless, the disease was regarded as being milder than it had been the year before, albeit more infectious. Despite its rapid peak at the beginning of the year, the outbreak persisted throughout the winter, before subsiding in the spring.

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There was "a very sudden and very marked rise in general death rate" in most cities in January 1919; nearly all experienced "some degree of recrudescence" of the flu in January and February. Significant outbreaks occurred in cities including

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Madrid, Spain, fewer than 1,000 people died from influenza between May and June 1918. There were no reported quarantines during the first quarter of 1918. However, the first wave caused a significant disruption in the military operations of

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Despite the toll of the pandemic, it was never a large theme in American literature. Alfred Crosby suspects that it may be due to the fact that it occurred after World War I, which was the most important event in that generation's lives.

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of the influenza pandemic is one aspect that sets the pandemic apart from other disease outbreaks. Another factor is the higher mortality rate of men compared with women. Men with an underlying condition were at significantly more risk.

2839:, a recently arrived group at the time, were nearly twice as likely to die compared to the average Americans. These disparities reflected worse diets, crowded living conditions, and problems accessing healthcare. Paradoxically, however, 1931:

China was one of the few regions of the world seemingly less affected by the Spanish flu pandemic, where several studies have documented a comparatively mild flu season in 1918. (Although this is disputed due to lack of data during the

1328:), about 30 miles west of Boston, other U.S. military sites were soon afflicted, as were troops being transported to Europe. Helped by troop movements, it spread over the next two months to all of North America, and then to Central and 12121: 2020:

is a common occurrence: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out. Fatal cases did continue into 1919, however. One notable example was that of

5912:

The use of 'Spanish' can often have negative connotations, with the adjective often unfairly used to describe unwelcome events and problems. The most obvious example is the so-called 'Spanish flu,' a reference to the 1918 influenza

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also noted that Indian provinces had excess mortality rates ranging from 2.1% to 7.8%, stating: "Commentators at the time attributed this huge variation to differences in nutritional status and diurnal fluctuations in temperature."

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The majority of the infected experienced only the typical flu symptoms of sore throat, headache, and fever, especially during the first wave. However, during the second wave, the disease was much more serious, often complicated by

13717: 12441: 11187: 2835:, death rates were inversely correlated with apartment size, as the poorer people living in smaller apartments died at a higher rate. Social status was also reflected in the higher mortality among immigrant communities, with 1253:

started releasing Russian prisoners of war, who then brought the disease to their country. It reached North Africa, India, and Japan in May, and soon after had likely gone around the world as there had been recorded cases in

542:

with increased likelihood of spread through bodies of water. However, the claim that young adults had a high mortality during the pandemic has been contested. Malnourishment, overcrowded medical camps and hospitals, and poor

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as it gradually evolved over the years. The period since its initial appearance in 1918 has been termed a "pandemic era", in which all flu pandemics since its emergence have been caused by its own descendants. Following the

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and English physicians, mistaking the word influenza for the name of the disease itself, used it. The same term is also used in Germany, where a host of dialect names still prevail, such as lightning catarrh and fog plague.

1692:

In the years after 1920, the disease, a novel one in 1918, assumed a more familiar nature, coming to represent at least one form of the "seasonal flu". The virus, H1N1, remained endemic, occasionally causing more severe or

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the names given to this disease in different parts of the world reflected prevailing concerns about certain ethnic groups and ideologies. The disease was called the 'Singapore fever' in Penang and the Bolshevik disease in

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Por ej. en el diario ABC el 22 de mayo mediante una escueta nota en la página 24: 'Los médicos han comprobado, en Madrid, la existencia de una epidemia de índole gripal, muy propagada, pero, por fortuna, de carácter leve'.

1506:

and then spread across the country throughout the year. New South Wales experienced its first wave of infection between mid-March and late May, while a second, more severe wave occurred in Victoria between April and June.

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Crosby's America's Forgotten Pandemic: The Influenza of 1918, Wilson asked Army Chief of Staff General Peyton March in October 1918 if he had heard of the popular jump rope rhyme parodying the virus, and recited part of

2165:

and lower-than-average temperatures for the duration of the conflict, and especially during the second wave of the pandemic. Ultra-high-resolution climate data combined with highly detailed mortality records analyzed at

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within hours or days due to the lungs being filled with fluids. Other signs and symptoms reported included spontaneous mouth and nosebleeds, miscarriages for pregnant women, a peculiar smell, teeth and hair falling out,

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are almost purely local; thus the Russians have called it the Chinese catarrh, because it has often invaded Russia from China. The Germans call it the Russian pest, while the Italians in turn call it the German disease.

5358:

The unknown disease which appeared in Madrid a fortnight ago spread with remarkable rapidity.... It is reported that there are well over 100,000 victims in Madrid alone.... Although the disease is clearly of a gripal

789:, also known as the 'Russian flu', when the Russians already called epidemic influenza the 'Chinese catarrh', the Germans called it the 'Russian pest', while the Italians in turn called it the 'German disease'. These 1842:, and military pathologists later recognized these early outbreaks as the same disease as the Spanish flu. The overcrowded camp and hospital at Étaples was an ideal environment for the spread of a respiratory virus. 3507:

derived from Spanish flu samples to the ability of the 1918 flu virus to invade the lungs and cause pneumonia. These genes were inserted into a modern H1N1 strain and triggered similar symptoms in animal testing.

11251: 9814:"A hypothesis: the conjunction of soldiers, gas, pigs, ducks, geese and horses in northern France during the Great War provided the conditions for the emergence of the "Spanish" influenza pandemic of 1918-1919" 6336:

As this included the period of the great influenza epidemic when Type IV infections were usually prevalent, it will be seen that the proportion of fixed types among carriers and among cases is not far from the

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reported a mortality rate from influenza around 0.45% and 0.69% respectively, higher than the mortality rate collected from data in Chinese port cities, such as Hong Kong (0.25%), Canton (0.32%), and Shanghai.

6010:

In one area where Blacks were the first victims, the accusatory term 'Kaffersiekte' was coined; in another district, where the position was reversed, Blacks returned the compliment with, White man's sickness'

2419:

The Spanish flu infected around 500 million people, about one-third of the world's population. Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the

11912: 9779: 13250:]. Skrifter utgit av Klaus Hansens fond, nr. III. Bergen: Haukeland Sykehus, 1923 (Writings published by the Klaus Hansen Foundation, No. III, Haukeland Hospital Bergen (in Norwegian). Grieg. p. 66. 12424: 12709:

Yet the "Spanish" flu epidemic of 1918–19 resulted in about 25,000 extra deaths in Ireland, many of them young adults. This was almost as many deaths as occurred among the Irish fighting in the First World

905:) said, "Various countries have been assigning the origin of this imposing guest to each other for quite some time, and at one point in time they agreed to assign its origin to the kind and neutral Spain…" 2102:). The strong immune reactions of young adults were postulated to have ravaged the body, whereas the weaker immune reactions of children and middle-aged adults resulted in fewer deaths among those groups. 16767: 8623: 7112: 5993: 2854:, which severely worsened the chances of recovery. However, in India the opposite was true, potentially because Indian women were neglected with poorer nutrition, and were expected to care for the sick. 2527:

In the U.S., about 28% of the population of 105 million became infected, and 500,000 to 850,000 died (0.48 to 0.81 percent of the population). Native American tribes were particularly hard hit. In the

2478:

In Japan, the flu killed nearly 500,000 people over two waves between 1918 and 1920, with nearly 300,000 excess deaths between October 1918 and May 1919 and 182,000 between December 1919 and May 1920.

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Choshunada and Wakagiyama, died before they could return from Taiwan. As the contagion spread, the summer sumo tournament, which would have been held on the grounds of Yasukuni shrine, was cancelled.

2883:

Academic Andrew Price-Smith has made the argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. He provides data that the viral waves hit the

1035:

names with new diseases, listing "Spanish flu" under "examples to be avoided". Many authors now eschew calling this the Spanish flu, instead using variations of '1918–19/20 flu/influenza pandemic'.

13368:

Mamelund SE (February 2006). "A socially neutral disease? Individual social class, household wealth and mortality from Spanish influenza in two socially contrasting parishes in Kristiania 1918-19".

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Influenza entered Australia for the first time in January 1919 after a strict maritime quarantine had shielded the country through the latter part of 1918. It assumed epidemic proportions first in

929:

French press initially used 'American flu', but adopted 'Spanish flu' in lieu of antagonizing an ally. In the spring of 1918, British soldiers called it 'Flanders flu', while German soldiers used '

7416: 5466: 2431:

estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population.

6292: 17630: 12117: 10028: 6724: 5754:(The forgotten song) due both, were 'highly contagious'. Today, there are many authors who avoid such a name (the Spanish flu) and they aptly refer to it as the '1918- 1819 influenza pandemic' 642:: "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 22345: 12248: 6943: 6394:, p. 64: "In … Rhodesia (Zimbabwe) … officials labelled the new affliction 'influenza (vera)', adding the Latin word vera, meaning 'true' … German doctors … called it 'pseudo-influenza'" 2012: 16391: 12696: 10325: 9961: 888:'s illness, making Spain the apparent locus of the epidemic. The censorship was so effective that Spain's health officials were unaware its neighboring countries were similarly affected. 10134: 13725: 12437: 10532: 6465: 4684:"A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian" 2098:

in the lungs. Modern analysis has shown the virus to be particularly deadly because in animal trials it triggers an overreaction of the body's immune system (sometimes referred to as a

1717:

In 1977, an influenza virus bearing a very close resemblance to the seasonal H1N1, which had not been seen since the 1950s, appeared in Russia and subsequently initiated a "technical"

1681:

after the pandemic ended, in many parts its most significant occurrence since the main pandemic in late 1918. Northwestern Europe was particularly affected. All-cause mortality in the

1530:, which saw its first cases in April; the outbreak had spread to practically all sections of the island by June. In other parts, influenza recurred in the form of a true "third wave". 13153: 13047: 13008: 2010:

that doctors became more effective in the prevention and treatment of pneumonia that developed after the victims had contracted the virus. However, John Barry stated in his 2004 book

18585: 18580: 14892: 2974:

Despite the high morbidity and mortality rates that resulted from the epidemic, the Spanish flu began to fade from public awareness over the decades until the arrival of news about

20676: 2978:

and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a "forgotten pandemic". However, this label has been challenged by the historian

1475:

by mid-February, peaking in early March, though it did not fully subside until May. France also experienced a significant wave that peaked in February, alongside the Netherlands.

1913:

soldiers and sailors as the main disseminators. Hannoun considered several alternative hypotheses of origin, such as Spain, Kansas, and Brest, as being possible, but not likely.

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received compared with other birth cohorts." A 2018 study found that the pandemic reduced educational attainment in populations. The flu has also been linked to the outbreak of

696:, "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 " 12072: 3002:

the pandemic and the war could have also played a role. The war, however, had initially been expected to end quickly but lasted for four years by the time the pandemic struck.

20875: 5245: 3617:

throughout 1918, thousands of male troops gathered at the Halifax port before heading to Europe. Any soldier that was ill and could not depart was added to the population of

1940:.) This has led to speculation that the Spanish flu pandemic originated in China, as the lower rates of flu mortality may be explained by the Chinese population's previously 15774: 1545:

Parts of South America experienced a resurgence of pandemic activity throughout 1919. A third wave hit Brazil between January and June. Between July 1919 and February 1920,

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and Great Britain, resulting in hundreds of thousands of deaths. It was in general less severe than the second wave but still much more deadly than the initial first wave.

12377: 11156: 3533:

One of the few things known for certain about influenza in 1918 and for some years after was that it was, except in the laboratory, exclusively a disease of human beings.

1175: 15113: 11243: 22216: 17033:

Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K (July 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution".

15389: 20773: 11904: 9787: 6309:

In Tehran, the disease was called the "illness of the wind" (nakhushi-yi bad) due to its initial occurrence during a strong westerly wind burst and its rapid spread.

2680:, the mortality was very high: according to an estimate, between 902,400 and 2,431,000, or 8% to 22% of the total population died. The country was going through the 426: 16991: 11347: 21310: 20410: 19581: 6626: 2110:

Because the virus that caused the disease was too small to be seen under a microscope at the time, there were problems with correctly diagnosing it. The bacterium

2016:

that researchers have found no evidence to support this position. Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. Such

1794: 22381: 20852: 16756: 16179:"Using non-homogeneous models of nucleotide substitution to identify host shift events: application to the origin of the 1918 'Spanish' influenza pandemic virus" 12565: 11978: 8619: 7108: 4413: 1654:, the capital city, between January and March, resulting in an all-cause excess mortality rate approximately four times greater than that of the 1918–1919 wave. 16955: 20880: 19394: 16107: 7014: 4903:

I came across this seemingly astute analysis in the Dec. 21, 1913, Gazette.... It was a 'Special Cable to the Gazette Through the International News Service.'

2261:

became common in some places, such as Japan, though there were debates over their efficacy. There was also some resistance to their use, as exemplified by the

1786:

of the virus suggest that it originated long before 1918, and other studies suggest that the reassortment of the H1N1 virus likely occurred in or around 1915.

15082: 2090:

associated with influenza. This pneumonia was itself caused by common upper respiratory-tract bacteria, which were able to get into the lungs via the damaged

1436:, where it was winter and thus the usual time for influenza activity. The pandemic nonetheless continued into 1919 largely independent of region and climate. 21068: 20795: 20487: 19452: 17486: 15437: 11759: 11117: 3515:

antigen and observe the adaptive immunity in 32 survivors of the 1918 flu pandemic, all of them presented seroreactivity and 7 of 8 further tested presented

2257:

measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings. Wearing

829:

reported over 100,000 victims of, "The unknown disease…clearly of a gripal character," without referring to "Spanish influenza" directly. Three weeks later

12756: 11594: 5458: 4478:, p. 65: "In Freetown, a newspaper suggested that the disease be called manhu until more was known about it. Manhu, a Hebrew word meaning 'what is it?' 1404:

pandemic. In the United States, ~292,000 deaths were reported between September–December 1918, compared to ~26,000 during the same time period in 1915. The

21175: 16365: 15230: 5867: 2943:

during the pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher

2816:

people over 65, but 92% of deaths still occurred in people under 65. This is unusual since influenza is typically most deadly to weak individuals, such as

1871:

found evidence that the 1918 virus had been circulating in the European armies for months and possibly years before the 1918 pandemic. Political scientist

13427: 12147: 10294: 5823:

bacterium criminal entreprise'. These discriminatory epithets reflect the many rumors and theories that quickly spread about the origins of the pathology.

4310: 3850: 2742:

Estimates for the death toll in China have varied widely, a range which reflects the lack of centralized collection of health data at the time due to the

21083: 20838: 18740: 12730: 7406: 4967:

published their first stories about the epidemic: 'What is the Cause? An Epidemic in Madrid' and 'Benign Epidemic. The Sickbay in Madrid,' respectively."

1432:

Pandemic activity persisted, in general, into 1919 in many places. This persistence in activity is possibly attributable to climate, specifically in the

10407: 6126: 21078: 20768: 20719: 20634: 18322:– largest digital collection of newspapers, archival manuscripts, and interpretive essays exploring the impact of the epidemic on 50 U.S. cities ( 14386: 13510: 8375: 3045:

set in Dublin during the Spanish flu. Its final draft was submitted in March 2020, and publishers fast-tracked publication because of the then ongoing

2632:

territories were hit particularly hard. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent ships, such as

17848:

Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NP (February 2002). "World War I may have allowed the emergence of "Spanish" influenza".

17626: 15366: 13886: 8801: 8645: 5529: 2669:

by imposing a blockade. The disease spread fastest through the higher social classes among the indigenous peoples, because of the custom of gathering

1809: 20922: 10012: 8697: 6706: 6357:

On September 13, 1918, the first cases of the great influenza epidemic were admitted, and during the next 10 weeks over 4,100 patients were admitted.

6272: 5212:[In Britain, on the other hand, the disease was called the 'Flanders flu' because many soldiers became infected in the trenches of Flanders.] 5210:

In Großbritannien wurde die Krankheit dagegen als 'Flandrische Grippe' bezeichnet, weil sich viele —en in den Schützengräben von Flandern ansteckten.

2572:) was one of the first Ethiopians who contracted influenza but survived. Many of his subjects did not; estimates for fatalities in the capital city, 13620:

Almond D (1 August 2006). "Is the 1918 Influenza Pandemic Over? Long-Term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population".

11939:"Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis" 8911: 8882: 6935: 18981: 16382: 14870: 6529: 5595: 2285:

to treat the secondary bacterial infections, doctors would rely on a random assortment of medicines with varying degrees of effectiveness, such as

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Land quarantine measures hindered the spread of the disease, resulting in varied experiences of exposures and outbreaks among the various states.

20763: 20128: 10372: 9971: 8749: 8453: 6279:

There was a high west wind at the time and this was thought to be the carrying agent so that the affliction was called 'the disease of the wind.'

1471:

It was not until later in the winter and into the spring that a clearer resurgence appeared in Europe. A significant third wave had developed in

10142: 9657: 8245: 6197: 22493: 22259: 22161: 21879: 10524: 8775: 8349: 7071: 5560: 1857:

was regularly brought in from surrounding villages to feed the camp. Oxford and his team postulated that a precursor virus, harbored in birds,

1631:

experienced its peak of the pandemic in early 1920, recording 1,489 deaths from flu-related causes, compared with 615 in 1918 and 796 in 1919.

19559: 18086:

Birge JR, Kärtner FX (May 2007). "Efficient optimization of multilayer coatings for ultrafast optics using analytic gradients of dispersion".

17214:"Integrating historical, clinical and molecular genetic data in order to explain the origin and virulence of the 1918 Spanish influenza virus" 7527: 6783: 6166: 6100: 4723:

instances and in the 1918 pandemic the disease was characterized by a 'dusky' cyanosis, a rapid progression from quite minor symptoms to death

4464:

in the original Hebrew the people of Israel asked: "Ma'n Hu?" {?מן הוא} – English for 'what is it?' and that is the origin of the name 'manna'

19621: 12810: 12345: 12016: 11648: 2588:, and the infrastructure of daily life had broken down; the study suggests that Russia's death toll was closer to 2%, or 2.7 million people. 2183:

associated with an anthropogenic increase in atmospheric dust, due to the incessant bombardment; increased nucleation due to dust particles (

2067:, dizziness, insomnia, loss of hearing or smell, and impaired vision. One observer wrote, "One of the most striking of the complications was 137:

Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

17415: 17145: 14561:"The age-specific cumulative incidence of infection with pandemic influenza H1N1 2009 was similar in various countries prior to vaccination" 13137: 13031: 12992: 11217: 8827: 8671: 2241:

1918 Chicago newspaper headlines reflect mitigation strategies such as increased ventilation, arrests for not wearing face masks, sequenced

1549:, which had been affected for the first time just in October 1918, experienced a severe second wave, with mortality peaking in August 1919. 21303: 20823: 20753: 20392: 19611: 19522: 17464: 16313: 13176: 11179: 9697: 2580: 1730:). For the first time, two influenza A viruses were observed in cocirculation. This state of affairs has persisted even after 2009, when a 14900: 14406:

Schwarzmann SW, Adler JL, Sullivan RJ, Marine WM (June 1971). "Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969".

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similarly experienced another severe pandemic wave in 1920, between July and October. A fourth wave also occurred in Brazil, in February.

22179: 22071: 20847: 19745: 19199: 16739: 16457: 16424: 13575: 12304:"1918–1920 – Influenza and Pneumonia Pandemic – Nationwide ~820,000–850,000 – Deadliest American Disasters and Large-Loss-of-Life Events" 5651: 4978: 2954:

Survivors faced an elevated mortality risk. Some survivors did not fully recover from physiological conditions resulting from infection.

1186:

The pandemic is conventionally marked as having begun on 4 March 1918 with the recording of the case of Albert Gitchell, an army cook at

893: 454: 15659: 15600: 15488: 14227: 7329:"Pandemic Reemergence and Four Waves of Excess Mortality Coinciding With the 1918 Influenza Pandemic in Michigan: Insights for COVID-19" 6595: 5479:

In turn, when Russia reported on the situation in Moscow, Pravda printed "Ispanka (The Spanish Lady) is in town" and the name has stuck.

2895:

study corroborates higher excess mortality rates in Germany (0.76%) and Austria (1.61%) compared to Britain (0.34%) and France (0.75%).

1210:. Within days of the 4 March first case at Camp Funston, 522 men at the camp had reported sick. By 11 March 1918, the virus had reached 22351: 22022: 19422: 14791: 14620:"Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study" 13914: 10694:"Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature in mouse airway cells" 9813: 8568:"A comparative study of the 1918-1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning" 7462: 5806: 5040: 3476: 1969: 14221:"Report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009" 12303: 2753:

Although medical records from China's interior are lacking, extensive medical data were recorded in Chinese port cities, such as then

22375: 19752: 19030: 12080: 10571:"Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness" 368: 12649: 6350: 4940:

pest, the Italians name it the German disease, and the French call it sometimes the Italian fever and sometimes the Spanish catarrh.

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in New York City. The effort resulted in the announcement (on 5 October 2005) that the group had successfully determined the virus'

2367:

and being "blown all over the world by winds". There were also rumors that the Germans were behind it, for example by poisoning the

2221: 22315: 22223: 22143: 21975: 19404: 16338: 14659:"Epidemiological characteristics of 2009 (H1N1) pandemic influenza based on paired sera from a longitudinal community cohort study" 12399: 11464:

Flecknoe D, Charles Wakefield B, Simmons A (June 2018). "Plagues & wars: the 'Spanish Flu' pandemic as a lesson from history".

10845:"Two interferon-independent double-stranded RNA-induced host defense strategies suppress the common cold virus at warm temperature" 6321: 5810: 1194:, United States, despite there having been cases before him. The disease had already been observed 200 miles (320 km) away in 22291: 21073: 6058: 5224: 1361:

for World War I, resulted in 12,000 deaths after a major outbreak of the illness spread among people who had attended the parade.

22321: 21885: 21320: 21296: 21005: 20843: 20830: 20787: 20696: 20422: 20231: 20138: 20040: 19798: 19445: 15738: 14926: 13906: 12223: 11874: 9937:. La Grippe Espagnole de 1918. Ed Techniques Encyclopédie Médico-Chirurgicale (EMC), Maladies infectieuses. Vol. 8-069-A-10. 5959: 5926: 4836:"Relationship between "purulent bronchitis" in military populations in Europe prior to 1918 and the 1918-1919 influenza pandemic" 4095:

attributed to the influence of the stars... But the name for the infamous 1918 outbreak, the Spanish flu, is actually a misnomer.

3952: 2443: 2235: 1884: 12367: 11148: 5012: 55: 22285: 21669: 21497: 21197: 21187: 21055: 19136: 17141: 1643:. Five countries in Europe (Spain, Denmark, Finland, Germany and Switzerland) recorded a late peak between January–April 1920. 15105: 4920: 833:

reported that, "Everybody thinks of it as the 'Spanish' influenza to-day." Three days after that an advertisement appeared in

22010: 21915: 21843: 21788: 20969: 20903: 20740: 20619: 20292: 19318: 19174: 19141: 17933: 17795: 17769: 17707: 17688: 17657: 17596: 17523: 17089: 17023: 17001: 16980: 16949: 16905: 16733: 16570: 16451: 16241: 16132: 16101: 16068: 16047: 15973: 15933: 15830: 13147: 13041: 13002: 12178: 12047: 11312: 10022: 8241: 7456: 6505: 6475: 6302: 6003: 5287: 5115: 4655: 4190: 4058: 2532: 2345:, many countries engaged in wartime censorship, and suppressed reporting of the pandemic. For example, the Italian newspaper 1237:

by the middle of the month. It then quickly spread to the rest of France, Great Britain, Italy, and Spain and in May reached

1217:

As the U.S. had entered World War I, the disease quickly spread from Camp Funston, a major training ground for troops of the

17663: 16074: 14050:"Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature" 5767: 22265: 22209: 22034: 21981: 21144: 20564: 19356: 18273: 15412: 15052: 13099: 12471: 11636: 7390: 4566: 2899: 1585: 1313: 22040: 16655: 15800: 2658:

in 1914. 90% of the population was infected; 30% of adult men, 22% of adult women, and 10% of children died. By contrast,

1973:

U.S. Army flu patients at Field Hospital No. 29 near Hollerich, Luxembourg 1918. As U.S. troops deployed en masse for the

1113:, false), while in Africa, doctors tried to get patients to take it more seriously by calling it 'influenza vera' (Latin: 22149: 21945: 21939: 21921: 21819: 21739: 21540: 20915: 19874: 19379: 18677: 18389: 18351: 16473:

He D, Dushoff J, Day T, Ma J, Earn DJ (2011). "Mechanistic modelling of the three waves of the 1918 influenza pandemic".

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In flew Enza—say it fast and it becomes 'influenza.' It was a catchy little rhyme, and boys and girls skipped rope to it.

3446: 2846:

More men than women were killed by the flu, as they were more likely to go out and be exposed, while women would tend to

1921: 373: 17: 21129: 6618: 6222:

What's in a name. Spanish Influenza in sub-Saharan Africa and what local names say about the perception of this pandemic

2136:, which was common in circumstances of social upheaval, and was therefore also affecting Russia in the aftermath of the 22203: 21963: 21849: 21114: 20404: 19813: 19571: 18708: 17615: 16609:

Johnson NP, Mueller J (2002). "Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic".

14342:

Johnson NP, Mueller J (2002). "Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic".

12561: 12328: 5303:

spring of 1918, German soldiers called it Flanders fever, after one of the war's most notorious and deadly battlefields

3626: 3537:

between US$ 15.3–27.8 billion in the United States alone", with 188,000–337,000 deaths in the United States.

2688: 2551: 2157: 1364:

From Europe, the second wave swept through Russia in a southwest–northeast diagonal front, as well as being brought to

14957: 13304: 11938: 11674:

Chandra S, Christensen J (July 2019). "Re: "Reassessing the Global Mortality Burden of the 1918 Influenza Pandemic"".

10646:"Washington State Board of Health pessimistic about influenza pandemic in a report to the governor on January 1, 1919" 5445:

measures and over-the-counter remedies. 'Influenza!' proclaimed an advert extolling the virtues of Formamint lozenges.

4377: 1182:

policemen wearing cloth face masks handed out by the American Red Cross during the Spanish flu pandemic, December 1918

530:, creating a false impression of Spain as the epicenter and leading to the "Spanish flu" misnomer. Limited historical 22386: 22357: 22247: 22191: 22107: 20989: 20683: 20499: 19778: 19249: 18880: 18875: 18682: 17505: 16937: 15902: 13970:

Hilleman MR (August 2002). "Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control".

13765: 11703: 9254: 6986: 5632: 4884: 3680: 2703:, one official estimated that 7% of the native population died. This huge death toll resulted from an extremely high 2262: 1346: 1338: 1259: 378: 238: 233: 16091: 15359:"A shot-in-the-dark e-mail leads to a century-old family treasure – and hope of cracking a deadly flu's secret" 10653: 7006: 6422:

pretty name of Enza; But one day it flew away, but it didn't go to stay; For when she raised the window, in-flu-Enza

1849:

attacks, and other casualties of war, and 100,000 soldiers passed through the camp every day. It also was home to a

22499: 22303: 22173: 22137: 22125: 22028: 21951: 20241: 20176: 19214: 18988: 18943: 15074: 14258: 13820: 12976:

Iijima W (2003). "Spanish influenza in China, 1918–1920: a preliminary probe". In Phillips H, Killingray D (eds.).

7447: 7007:"What happens if parades aren't canceled during pandemics? Philadelphia found out in 1918, with disastrous results" 3603:, the pandemic spread was highly variable. Influenza did not discriminate who was infected, indeed it attacked the 3164: 2774: 2427: 1993:

The severity of the second wave has been attributed to the circumstances of the First World War. In civilian life,

1699: 383: 323: 16253:"Age-specific mortality during the 1918 influenza pandemic: unravelling the mystery of high young adult mortality" 15429: 13858: 11763: 8937: 1095:

This outbreak was also commonly known as the 'great influenza epidemic', after the 'great war', a common name for

22644: 22639: 22634: 22629: 22369: 22363: 22333: 22253: 22155: 22095: 22058: 22046: 21957: 21782: 21568: 21450: 21240: 21045: 21025: 20812: 20748: 20571: 20440: 19351: 19271: 19209: 18968: 18575: 18570: 18565: 15222: 13098:. Spanish 'Flu 1918–1998: Reflections on the Influenza Pandemic of 1918 after 80 Years. Cape Town, South Africa. 11571: 8427: 2681: 2376: 1846: 1230: 447: 221: 19912: 16355: 12438:"A gripe espanhola no Brasil – Elísio Augusto de Medeiros e Silva, empresário, escritor e membro da AEILIJ" 5890: 22481: 22469: 22463: 22451: 22445: 22439: 22327: 22271: 22241: 22229: 21040: 21035: 21030: 21020: 20714: 19366: 19341: 19239: 18754: 18652: 18595: 18560: 18555: 18550: 18545: 18540: 18535: 18530: 18525: 18520: 18515: 18510: 18505: 18500: 18495: 18490: 18485: 18480: 18475: 18470: 18465: 18460: 17542: 17495: 17349:

Vana G, Westover KM (June 2008). "Origin of the 1918 Spanish influenza virus: a comparative genomic analysis".

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Humphries MO (2014). "Paths of Infection: The First World War and the Origins of the 1918 Influenza Pandemic".

15892: 14765: 13944: 13755: 13682: 12143: 11149:"How environmental conditions like cold and wet weather can affect pandemics, and what that means for COVID-19" 10286: 9966: 6225:. Spanish 'Flu 1918–1998: Reflections on the Influenza Pandemic of 1918 after 80 Years. Cape Town, South Africa 5556: 4297: 4012: 3480: 3457: 3035:

focuses on a town which attempts to limit the spread of the flu by preventing people from entering or leaving.

1723: 1703: 704: 555: 487: 199: 177: 93: 38: 15565:"Sex- and age-based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland" 13754:

Beiner G (2021). "Rediscovering the Great Flu between Pre-Forgetting and Post-Forgetting". In Beiner G (ed.).

12722: 9152:"The 1918 Influenza Pandemic and Japanese Government-General of Korea's Preventive Measures against Epidemics" 6245: 598:

This pandemic was known by many different names—some old, some new—depending on place, time, and context. The

22619: 22197: 22113: 21715: 21015: 21010: 20974: 20908: 20800: 20646: 20236: 20088: 19626: 19554: 19485: 19254: 19224: 19219: 18224: 15461:"Brief communication: Rethinking the impact of the 1918 influenza pandemic on sex differentials in mortality" 13210:

Hong NH (2015). "Epidemic Analysis of 1918 Influenza in China – Research on Huolu County in Zhili Province".

10415: 6550:"The 1918 Flu Pandemic Killed Hundreds of Thousands of Americans. The White House Never Said a Word About It" 6134: 3789: 3453: 2494: 1901:, asserted the precursor virus was likely to have come from China and then mutated in the United States near 1750:

data cannot identify the geographic origin of the Spanish flu. However, several theories have been proposed.

1389: 1218: 37:

This article is about the influenza pandemic that began in 1918. For the virus that caused the pandemic, see

15944: 12042:(in Swedish). Uppsala; Stockholm: Ubsaliensis Academiae; Distributor, Almqvist & Wiksell International. 8723: 8401: 6707:"Queer Epidemic Sweeps North China; Banks and Silk Stores in Peking Closed – Another Loan Sought from Japan" 5863: 3986: 687:

of the face. This characteristic blue-violet cyanosis in expiring patients led to the name 'purple death'.

22167: 21987: 21873: 21867: 21776: 20964: 20591: 20531: 20428: 20333: 20103: 19889: 19593: 19432: 19331: 13718:"Another warning from the 1918 flu for COVID-19: 'Survival does not mean that individuals fully recovered'" 13500: 12894:"Pacific islands which escaped the 1918-1919 influenza pandemic and their subsequent mortality experiences" 12281: 11118:"Catastrophic effect of 1918 flu may have been aided by peculiar influx of cold air into Europe during WWI" 9151: 6331: 5537: 5069: 4217:"What really happened during the 1918 influenza pandemic? The importance of bacterial secondary infections" 2504:, capital of the Ottoman Empire, 6,403 to 10,000 died, giving the city a mortality rate of at least 0.56%. 1974: 1345:, reaching Ethiopia in November. On 15 September, New York City saw its first fatality from influenza. The 1282: 534:

data make the pandemic's geographic origin indeterminate, with competing hypotheses on the initial spread.

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Report of the Surgeon-General of the Army to the Secretary of War for the Fiscal Year Ending June 30, 1919

1920:

to work behind the British and French lines might have been the source of the pandemic. Humphries, of the

1668:, both colonies of Japan at this time, also experienced pronounced outbreaks in late 1919 and early 1920. 22551: 22545: 22339: 22309: 22119: 22089: 21969: 21745: 21202: 20639: 20624: 20482: 20434: 20206: 19757: 19631: 19544: 19539: 19308: 19296: 19291: 18769: 18687: 18672: 11057:

Tucker MA, Böhning-Gaese K, Fagan WF, Fryxell JM, Van Moorter B, Alberts SC, et al. (January 2018).

7523: 6779: 3778:"The 1918 influenza pandemic in New York City: age-specific timing, mortality, and transmission dynamics" 2619:, suffered a death rate of 40 percent of the total population, with some villages entirely disappearing. 2561: 1951: 1925: 1867: 1234: 388: 363: 19818: 17109:"Salicylates and pandemic influenza mortality, 1918-1919 pharmacology, pathology, and historic evidence" 15799:. Fasc. 2. Vol. XIII (Online ed.). New York City: Bibliotheca Persica Press. pp. 140–43. 15161:

Taubenberger JK, Baltimore D, Doherty PC, Markel H, Morens DM, Webster RG, et al. (November 2012).

14862: 10941:"Does influenza A virus infection affect movement behaviour during stopover in its wild reservoir host?" 4078: 1270:, with three-quarters of French troops, half the British forces, and over 900,000 German soldiers sick. 680:. Clinical indications in common with the 1918 pandemic included rapid symptom progression to a "dusky" 22565: 22131: 21800: 21770: 21182: 21139: 20416: 20181: 20166: 20068: 19937: 19505: 19417: 19374: 16938:"The Spanish Influenza Pandemic of 1918–1919: Perspectives from the Iberian Peninsula and the Americas" 16783:

More AF, Loveluck CP, Clifford H, Handley MJ, Korotkikh EV, Kurbatov AV, et al. (September 2020).

12276: 11244:"We're celebrating Thanksgiving amid a pandemic. Here's how we did it in 1918 – and what happened next" 7075: 4122:

More AF, Loveluck CP, Clifford H, Handley MJ, Korotkikh EV, Kurbatov AV, et al. (September 2020).

3668: 3010: 2777:, which was largely staffed by non-Chinese foreigners, such as the British, French, and other European 2659: 2655: 2565: 2457: 1665: 1413: 1203: 440: 18230: 15137:"The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus" 10368: 5371: 5339: 4489: 2600:

Deaths from all causes for New York, London, Paris, and Berlin with peaks in October and November 1918

1300:, plays a "tragic game of football" with a skeleton personification of the Spanish flu, November 1918 21855: 21518: 21507: 21124: 20892: 20476: 20464: 20226: 20211: 19932: 19823: 19517: 19495: 19244: 19234: 19167: 19115: 18730: 18162:"Existing antivirals are effective against influenza viruses with genes from the 1918 pandemic virus" 16845: 15787:– Open access material by the Psychiatry and Behavioral Sciences at Health Sciences Research Commons. 14866: 14761: 8237: 6189: 5399: 4889: 4305: 3858: 3703: 3600: 3527: 3512: 2392: 2184: 1982: 1822:, painted a few days before his death and just after the death of his wife Edith from the Spanish flu 1783: 1661: 1388:), and then later India in September, as well as China and Japan in October. The celebrations of the 1369: 1048: 1024: 20078: 17047: 13598: 5552: 3573:

Death rates were particularly high in those aged 20–35. The only comparable disease to this was the

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million and 2.3 million. This represents a mortality rate of about 1.1% of the European population (

22523: 22505: 21470: 21379: 21099: 20586: 20576: 20505: 20458: 20446: 20386: 20201: 20196: 20118: 19527: 19500: 19204: 14537: 13471:"The Forgotten American Pandemic: Historian Dr. Nancy K. Bristow on the Influenza Epidemic of 1918" 9533:"Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission" 8963: 7516: 6772: 6443: 6161: 6156: 2696: 1534:

experienced another outbreak in June, as did South Africa during its fall and winter months in the

1416:

was especially deadly, with an estimated 12.5–20 million deaths in the last quarter of 1918 alone.

1320:, where it had likely arrived with American troops or French recruits for naval training. From the 1226: 936: 527: 17761:

Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It

15624:"The first wave of the 1918 influenza pandemic among soldiers of the Canadian expeditionary force" 14488:

Donaldson LJ, Rutter PD, Ellis BM, Greaves FE, Mytton OT, Pebody RG, et al. (December 2009).

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Arnold D (December 2019). "Death and the Modern Empire: The 1918–19 Influenza Epidemic in India".

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Tolf C, Bengtsson D, Rodrigues D, Latorre-Margalef N, Wille M, Figueiredo ME, et al. (2012).

9224:"What Came Next?: Reflections on the Aftermath(s) of the 1918–19 Flu Pandemic in the Age of COVID" 5553:"Analysis of Spanish flu cases in 1918–1920 suggests transfusions might help in bird flu pandemic" 2227:

In September 1918, the Red Cross recommended two-layer gauze masks to halt the spread of "plague".

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that the virus likely had a North American origin, though it was not conclusive. In addition, the

22529: 22433: 22427: 21794: 21727: 21709: 21533: 21384: 21374: 21170: 21162: 21104: 20864: 20559: 20322: 20156: 20151: 20083: 19942: 19927: 19922: 19902: 19783: 19660: 19072: 18958: 18928: 18923: 18817: 18622: 18344: 18261: 18240: 17945:"The re-appearing shadow of 1918: trends in the historiography of the 1918-19 influenza pandemic" 17734:

Johnson N (2003). "Scottish 'flu – The Scottish mortality experience of the 'Spanish flu'".

17155: 11209: 6435: 3910: 3674: 3500: 3287: 3108: 2948: 2891:

and mortality in Germany and Austria were considerably higher than in Britain and France. A 2006

2807: 2212: 2034: 1735: 1539: 1246: 1141: 1133: 563: 358: 338: 20123: 18157: 17444: 17387: 16305: 15390:"Purulent bronchitis: A study of cases occurring amongst the British troops at a base in France" 15049:"Researchers reconstruct 1918 pandemic influenza virus; effort designed to advance preparedness" 13188: 12818: 12403: 10939:

Bengtsson D, Safi K, Avril A, Fiedler W, Wikelski M, Gunnarsson G, et al. (February 2016).

9689: 4615:"The Purple Death. Some things remembered about the influenza epidemic of 1918 at one army camp" 2351:

was prohibited from reporting daily death tolls. The newspapers of the time were also generally

2002:

showed that it must have been the same strain of flu. This was most dramatically illustrated in

22475: 22421: 22235: 21826: 21812: 21629: 20937: 20661: 20596: 20452: 20186: 20113: 20063: 20048: 20030: 20003: 19917: 19884: 19549: 19510: 19490: 19301: 19194: 19131: 18933: 18735: 18703: 18638: 18323: 18269: 17554:"Connectivity and seasonality: the 1918 influenza and COVID-19 pandemics in global perspective" 17042: 16673:"Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus" 15925: 13534:"Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu" 12253: 12107: 11302: 10369:"Summer Flu Outbreak of 1918 May Have Provided Partial Protection Against Lethal Fall Pandemic" 7143:"Connectivity and seasonality: the 1918 influenza and COVID-19 pandemics in global perspective" 7061: 6045:翌月の東京の夏場所は高熱などによる全休力士が相次いだ。世間はこれを「相撲風邪」「力士風邪」と呼んだが、実はこの謎の感染症こそが同年初めから米国で流行の始まった「スペイン風邪」とみられている。 4905:

Grip Is a Disease Without a Country; All Nations Repudiate Malady: Each Blaming Other Kingdoms,

3298: 3031: 3025: 2112: 2017: 1771: 1731: 1572: 1381: 1195: 1047:

did not name specific regions or groups of people. Examples specific to this pandemic include:

786: 657: 421: 411: 313: 18305: 17807:"The 1918 influenza epidemic's effects on sex differentials in mortality in the United States" 16723: 16441: 16414: 15512:"The 1918 influenza epidemic's effects on sex differentials in mortality in the United States" 14442: 9724:"The so-called Great Spanish Influenza Pandemic of 1918 may have originated in France in 1916" 5428: 2790:– which had a population of over 2 million in 1918 – there were only 266 recorded deaths from 908: 22457: 22415: 21993: 20927: 20581: 20470: 20246: 20216: 20146: 20093: 20015: 19983: 19957: 19907: 19838: 19740: 19693: 19477: 19346: 19229: 18713: 17480: 16520:"Inferring the causes of the three waves of the 1918 influenza pandemic in England and Wales" 15564: 14220: 11000:"Birds and viruses at a crossroad--surveillance of influenza A virus in Portuguese waterfowl" 9693: 6603: 4787:

Honigsbaum M (June 2018). "Spanish influenza redux: revisiting the mother of all pandemics".

3541: 3037: 3020: 2520: 2033:, fell victim to the flu in April after an outbreak that resulted in the cancellation of the 2026: 1910: 1779: 1137: 665: 16915:

Patterson KD, Pyle GF (1991). "The geography and mortality of the 1918 influenza pandemic".

14618:

Dawood FS, Iuliano AD, Reed C, Meltzer MI, Shay DK, Cheng PY, et al. (September 2012).

14490:"Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study" 11348:"How NYC beat deadly 1918 flu without vaccines, lockdowns, mask mandates or school closures" 9844: 7442: 6495: 6022: 5193: 4298:"Influenza Pandemic Plan. The Role of WHO and Guidelines for National and Regional Planning" 2415:

Three pandemic waves: weekly combined flu and pneumonia mortality, United Kingdom, 1918–1919

22064: 21861: 21806: 21721: 21502: 21440: 21277: 21192: 19879: 19853: 19803: 19160: 18723: 18277: 18244: 18173: 17358: 17268: 16796: 16684: 16482: 16264: 16190: 15699: 15277: 14572: 14112: 13505: 11386: 11070: 11011: 10952: 10856: 10705: 10218: 7708:

Nunes B, Silva S, Rodrigues A, Roquette R, Batista I, Rebelo-de-Andrade H (December 2018).

7198: 5967: 4495: 4135: 3618: 3604: 3520: 3405: 2318: 1917: 1818: 1694: 1650:

experienced "asynchronous recrudescent waves" throughout the year. A severe third wave hit

994: 976:

Other names derived from geopolitical borders and social boundaries. In Poland it was the '

881: 523: 19828: 15223:"Research on monkeys finds resurrected 1918 flu killed by turning the body against itself" 14538:"First Global Estimates of 2009 H1N1 Pandemic Mortality Released by CDC-Led Collaboration" 12757:"South Africa bungled the Spanish flu in 1918. History mustn't repeat itself for COVID-19" 10804:"Avian influenza virus in water: infectivity is dependent on pH, salinity and temperature" 10692:

Foxman EF, Storer JA, Fitzgerald ME, Wasik BR, Hou L, Zhao H, et al. (January 2015).

9812:

Oxford JS, Lambkin R, Sefton A, Daniels R, Elliot A, Brown R, et al. (January 2005).

8985: 8189:"The 1918 influenza pandemic in Montevideo: The southernmost capital city in the Americas" 2673:

from chiefs on their deathbeds; many community elders were infected through this process.

8: 22297: 21927: 21692: 21645: 21639: 21369: 21364: 21339: 21259: 20398: 20262: 20221: 20098: 20058: 20053: 19998: 19681: 19675: 19576: 18783: 18667: 18384: 18231:

Presentation by Nancy Bristow on the Influenza Pandemic and World War I, November 1, 2019

17784:

If I Die Before I Wake: The Flu Epidemic Diary of Fiona Macgregor, Toronto, Ontario, 1918

15264:

Yu X, Tsibane T, McGraw PA, House FS, Keefer CJ, Hicar MD, et al. (September 2008).

14419: 14304: 12641: 12599: 7659:"Spatial-temporal excess mortality patterns of the 1918-1919 influenza pandemic in Spain" 7065: 5279:

More deadly than war : the hidden history of the Spanish flu and the First World War

5140:""Spanish Flu": When Infectious Disease Names Blur Origins and Stigmatize Those Infected" 4044: 3958: 3488: 2569: 2544: 2347: 2170: 2094:

of the victims. The virus also killed people directly by causing massive hemorrhages and

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Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences

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Denoon D (2004). "New Economic Orders: Land, Labour and Dependency". In Denoon D (ed.).

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Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences

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Chowell G, Viboud C, Simonsen L, Miller MA, Hurtado J, Soto G, et al. (July 2011).

7202: 5807:"From the 'Spanish Flu' to COVID-19: lessons from the 1918 pandemic and First World War" 4139: 3519:

able to produce antibodies that bound to the HA antigen highlighting the ability of the

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Kobasa D, Jones SM, Shinya K, Kash JC, Copps J, Ebihara H, et al. (January 2007).

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Economic Effects of the 1918 Influenza Pandemic: Implications for a Modern-day Pandemic

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In the Face of Disaster: True Stories of Canadian Heroes from the Archives of Maclean's

15917: 15766: 15725: 15651: 15592: 15536: 15511: 15298: 15266:"Neutralizing antibodies derived from the B cells of 1918 influenza pandemic survivors" 15265: 15187: 15162: 14839: 14814: 14734: 14709: 14685: 14658: 14595: 14560: 14514: 14489: 14470: 14443:"Novel swine-origin influenza A virus in humans: another pandemic knocking at the door" 14367: 14280: 14253: 14182: 14157: 14133: 14100: 14076: 14049: 14030: 13645: 13599:"RPT-COLUMN-Coronavirus lockdowns: can we learn from the 1918 influenza pandemic? Kemp" 13567: 13541: 12931: 12918: 12893: 12866: 12841: 11970: 11811: 11786: 11489: 11422: 11409: 11374: 11034: 10999: 10975: 10940: 10879: 10844: 10779: 10752: 10728: 10693: 10595: 10570: 10501: 10474: 10239: 10206: 10067: 9752: 9723: 9639: 9626: 9601: 9559: 9532: 9501: 9476: 9452: 9427: 9398: 9373: 9346: 9321: 9297: 9276: 9199: 9174: 9127: 9106: 9082: 9057: 9033: 9008: 8592: 8567: 8300: 8287: 8267: 8213: 8188: 8164: 8139: 8110: 8093: 8070: 8053: 8030: 8013: 7990: 7973: 7950: 7925: 7901: 7884: 7788: 7763: 7734: 7709: 7685: 7658: 7634: 7609: 7578: 7553: 7493: 7476: 7353: 7328: 7304: 7287: 7261: 7244: 7221: 7186: 7164: 6894: 6873: 6834: 6809: 6711: 6534: 5735: 5710: 5626: 5164: 5139: 4925: 4860: 4835: 4812: 4769: 4708: 4683: 4447: 4405: 4358: 4329:"Novel swine-origin influenza A virus in humans: another pandemic knocking at the door" 4166: 4123: 3927: 3898: 3806: 3777: 3103: 2811:

A nurse wears a cloth face mask while treating a flu patient in Washington, DC, c. 1919

2700: 2175: 2166: 2137: 2030: 1999: 1872: 1615: 1453: 1222: 1121: 681: 483: 416: 306: 263: 18196: 18161: 17861: 16863:"Questioning the salicylates and influenza pandemic mortality hypothesis in 1918-1919" 16251:

Gagnon A, Miller MS, Hallman SA, Bourbeau R, Herring DA, Earn DJ, et al. (2013).

16144:"The Politics of Pandemic Othering: Putting COVID-19 in Global and Historical Context" 15871: 15845:"The site of origin of the 1918 influenza pandemic and its public health implications" 15844: 15408: 14970:

Sometimes a virus contains both avian-adapted genes and human-adapted genes. Both the

14922: 14635: 13983: 12203: 11958: 9876:"No evidence of 1918 influenza pandemic origin in Chinese laborers/soldiers in France" 6549: 4800: 4756: 4739: 4553: 4393: 2962: 1526:

The disease also reached other parts of the world for the first time in 1919, such as

22535: 22016: 21681: 21618: 21476: 21400: 21354: 21252: 21246: 21207: 21109: 20942: 20525: 20380: 20363: 20171: 19993: 19973: 19808: 19793: 19723: 19711: 19412: 19389: 19336: 18938: 18867: 18425: 18379: 18201: 18124: 18111: 18066: 18061: 18044: 18035: 17966: 17929: 17900: 17865: 17836: 17822: 17791: 17765: 17703: 17684: 17653: 17611: 17592: 17579: 17538: 17519: 17501: 17407: 17374: 17337: 17286: 17243: 17200: 17130: 17095: 17085: 17068: 17019: 16997: 16976: 16945: 16924: 16901: 16884: 16832: 16814: 16729: 16702: 16626: 16601: 16566: 16549: 16498: 16447: 16360: 16292: 16237: 16216: 16169: 16128: 16097: 16064: 16043: 16014: 15979: 15969: 15929: 15898: 15876: 15826: 15820: 15758: 15717: 15643: 15584: 15541: 15527: 15480: 15303: 15192: 14844: 14739: 14690: 14639: 14600: 14519: 14462: 14423: 14391: 14359: 14324: 14285: 14187: 14138: 14081: 14022: 14018: 13987: 13761: 13665:"Fetal shock or selection? The 1918 influenza pandemic and human capital development" 13637: 13571: 13559: 13385: 13296: 13143: 13074: 13037: 12998: 12923: 12871: 12215: 12184: 12174: 12053: 12043: 12008: 11962: 11816: 11726: 11691: 11628: 11586: 11481: 11414: 11308: 11098: 11039: 10980: 10921: 10884: 10825: 10784: 10733: 10600: 10547: 10506: 10244: 10187: 10115: 10063: 10018: 9897: 9836: 9757: 9631: 9564: 9506: 9457: 9403: 9351: 9302: 9250: 9204: 9132: 9087: 9073: 9038: 8597: 8305: 8218: 8169: 8115: 8075: 8035: 7995: 7955: 7941: 7906: 7866: 7819: 7793: 7739: 7690: 7639: 7625: 7583: 7569: 7498: 7452: 7411: 7407:"Here are Exact Facts About the Influenza and Its Toll in City, State, Nation, world" 7358: 7309: 7266: 7226: 7168: 6982: 6899: 6839: 6825: 6716: 6673: 6501: 6471: 6298: 5999: 5740: 5683: 5603: 5511: 5293: 5283: 5169: 5111: 5017: 4865: 4851: 4804: 4761: 4713: 4661: 4651: 4626: 4591: 4557: 4397: 4350: 4279: 4238: 4171: 4153: 4054: 3932: 3811: 3698: 3686: 3496: 3065: 3046: 2944: 2840: 2836: 2691:, during the worst 12 months, the Spanish flu accounted for one-third of all deaths. 2662: 2564:, the influenza epidemic killed at least 100,000 people. Tafari Makonnen (the future 2482: 2421: 2306: 2254: 1994: 1941: 1909:, France, Europe's battlefields, the rest of Europe, and the rest of the world, with 1898: 1876: 1634:

Poland experienced a devastating outbreak during the winter months, with its capital

1531: 1523:

third wave that was somewhat less extensive than its second, more akin to its first.

1515: 1472: 1377: 1214:, New York. Failure to take preventive measures in March/April was later criticized. 1032: 500: 491: 214: 18078: 16638: 16026: 15770: 15739:"Compromised constitutions: the Iranian experience with the 1918 influenza pandemic" 15655: 15596: 14923:"Open Collections Program: Contagion, Spanish Influenza in North America, 1918–1919" 14474: 14371: 14034: 13649: 13381: 12935: 12840:

Bell D, Nicoll A, Fukuda K, Horby P, Monto A, Hayden F, et al. (January 2006).

11974: 11493: 11426: 11375:"The effect of public health measures on the 1918 influenza pandemic in U.S. cities" 9643: 7187:"The effect of public health measures on the 1918 influenza pandemic in U.S. cities" 4816: 4773: 4409: 4362: 3434:

Dr Terrence Tumpey examines a reconstructed version of the Spanish flu virus at the

1985:

of the virus was between 2 and 3. The close quarters and massive troop movements of

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More Deadly Than War: The Hidden History of the Spanish Flu and the First World War

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Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918

16539: 16531: 16510: 16490: 16410: 16282: 16272: 16206: 16198: 16155: 16004: 15866: 15856: 15750: 15729: 15707: 15635: 15576: 15560: 15531: 15523: 15472: 15404: 15293: 15285: 15182: 15174: 14834: 14826: 14729: 14721: 14680: 14670: 14631: 14590: 14580: 14509: 14501: 14454: 14415: 14351: 14316: 14275: 14267: 14177: 14169: 14128: 14120: 14071: 14061: 14014: 13979: 13672: 13629: 13551: 13377: 12913: 12905: 12861: 12853: 11954: 11855: 11806: 11798: 11718: 11683: 11473: 11404: 11394: 11088: 11078: 11029: 11019: 10970: 10960: 10911: 10874: 10864: 10815: 10774: 10764: 10723: 10713: 10590: 10582: 10496: 10486: 10234: 10226: 10177: 10105: 10059: 9887: 9828: 9747: 9739: 9621: 9613: 9554: 9544: 9496: 9488: 9447: 9439: 9393: 9385: 9341: 9333: 9292: 9284: 9194: 9186: 9122: 9114: 9077: 9069: 9028: 9020: 8587: 8579: 8295: 8279: 8208: 8200: 8159: 8151: 8105: 8065: 8025: 7985: 7945: 7937: 7896: 7856: 7783: 7775: 7729: 7721: 7710:"The 1918-1919 Influenza Pandemic in Portugal: A Regional Analysis of Death Impact" 7680: 7670: 7629: 7621: 7573: 7565: 7488: 7348: 7340: 7299: 7256: 7216: 7206: 7154: 6889: 6881: 6829: 6821: 6665: 6497:

Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918

5995:

Black October: The Impact of the Spanish Influenza Epidemic of 1918 on South Africa

5730: 5722: 5503: 5159: 5151: 4855: 4847: 4796: 4751: 4703: 4695: 4549: 4389: 4340: 4269: 4228: 4161: 4143: 3922: 3914: 3801: 3793: 3625:. To determine the cause of the death during the pandemic, war scientists used the 3547: 3461: 3442: 3336: 3254: 2870:

are important, but human behavioral responses showed the most significant effects.

2821: 2121: 1759: 1718: 1321: 1297: 1109:). German doctors downplayed the severity by calling it 'pseudo influenza' (Latin: 1080: 1056: 869: 815:

Outside Spain, the disease was soon misnamed 'Spanish influenza'. In a 2 June 1918

718: 559: 333: 189: 184: 18160:, Mikulasova A, Taubenberger JK, Swayne DE, Palese P, et al. (October 2002). 17978:

Phillips H (1 September 2014). "The Recent Wave of 'Spanish' Flu Historiography".

15792: 14387:"Why the coronavirus outbreak isn't likely to be a repeat of the 1918 Spanish flu" 11572:"Ten things you need to know about pandemic influenza (update of 14 October 2005)" 11477: 11059:"Moving in the Anthropocene: Global reductions in terrestrial mammalian movements" 10916: 10903: 9832: 9118: 7554:"Understanding mortality in the 1918-1919 influenza pandemic in England and Wales" 4699: 3410: 3057:

The Spanish flu killed a much lower percentage of the world's population than the

1738:, and thereafter took the place of the seasonal H1N1 to circulate alongside H3N2. 1341:

returning from France. From there it spread around southern Africa and beyond the

22591: 22101: 21657: 21612: 21585: 21288: 21119: 20959: 20298: 19858: 19833: 19532: 19440: 19279: 19053: 19037: 17759: 17718: 17647: 17165:"hsa-miR-33-5p as a Therapeutic Target Promotes Apoptosis of Breast Cancer Cells 16277: 16058: 15913: 15048: 14725: 14675: 14585: 13887:"1918 Flu Inspired Donoghue's 'Pull Of The Stars' — A Disquieting Pandemic Novel" 12842:"Non-pharmaceutical interventions for pandemic influenza, international measures" 11024: 10820: 10803: 6525: 5105: 3646: 3029:

is one of the most well-known fictional accounts of the pandemic. The 2006 novel

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began appearing on 21 May. Reports from both places called it 'three-day fever' (

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Pandemic Re-Awakenings: The Forgotten and Unforgotten 'Spanish' Flu of 1918–1919

17370: 17255:

Taubenberger JK, Reid AH, Lourens RM, Wang R, Jin G, Fanning TG (October 2005).

16785:"The Impact of a Six-Year Climate Anomaly on the "Spanish Flu" Pandemic and WWI" 15894:

Pandemic Re-Awakenings: The Forgotten and Unforgotten 'Spanish' Flu of 1918-1919

13757:

Pandemic Re-Awakenings: The Forgotten and Unforgotten 'Spanish' Flu of 1918–1919

13248:

Investigations into the appearance of influenza, especially in Bergen 1918-1922)

13093: 12463: 12040:

Spanska sjukan: den svenska epidemin 1918–1920 och dess internationella bakgrund

11620: 9660:[Influenza: a multi-millennial and pest virus discovered only in 1933]. 9658:"Grippe : un virus plurimillénaire et ravageur découvert seulement en 1933" 9222:

Nichols CM, Ewing ET, Gaston KH, Marinari M, Lessoff A, Huyssen D (April 2022).

9175:"Excess deaths and immunoprotection during 1918-1920 influenza pandemic, Taiwan" 9058:"The Spanish influenza pandemic in occidental Europe (1918-1920) and victim age" 7764:"Public Health in a Federation: Lessons from the Spanish Influenza in Australia" 6810:"The Spanish influenza pandemic in occidental Europe (1918-1920) and victim age" 5494:

Trilla A, Trilla G, Daer C (September 2008). "The 1918 "Spanish flu" in Spain".

4537: 4124:"The Impact of a Six-Year Climate Anomaly on the "Spanish Flu" Pandemic and WWI" 2786:

or Bombay, where influenza was much more devastating. Similarly, in the city of

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deaths from pneumonia and influenza were "very much lower than for many years".

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25–50 million (generally accepted), other estimates range from 17 to 100 million

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