
The Untreatable: The Spanish Flu of 1918 - Vigier
https://www.lrb.co.uk/v40/n02/gavin-francis/the-untreatable
======
koheripbal
The Plague was one of the major causes of the contraction of Eastern Roman
empire. Never underestimate the ability of a disease to shift the balance of
political power in the world.

------
HN15718653
Wow, I wish more articles were like this. Just two quick paragraphs of story
time, then: fact, fact, fact, fact, fact.

------
CodeWriter23
Then there’s this study, which contrasts with the author’s anecdotal
statements regarding aspirin use during the Spanish Flu Epidemic.

[https://academic.oup.com/cid/article/49/9/1405/301441](https://academic.oup.com/cid/article/49/9/1405/301441)

~~~
da02
Doesn't aspirin also contribute to less Vitamin C absorption in the body? For
example:
[https://www.ncbi.nlm.nih.gov/pubmed/6811490](https://www.ncbi.nlm.nih.gov/pubmed/6811490)

I also remember reading an article that mentioned the 1800s led to adoption of
artificial fertilizers that contributed to higher crop yields, but less
nutritious fruits and vegetables. I thought these factors, plus WWI, led to
weaker immune systems and great conditions for infections.

------
z3t4
It might have been a biological weapon. I don't think anyone want to take
credit for it though.

------
euyyn
I think anybody that got all conspiranoid about the bird flu and swine flu
alarms of the last decade should read the accounts of the Spanish flu, a bird
flu.

Young adults coughing blood foam. Towns where every single person died. Cities
with bodies piled up on the streets because the undertakers died or wouldn't
approach them.

The WHO raised the alarms because a bad bird flu _is_ alarming.

~~~
thephyber
> read the accounts of the Spanish flu, a bird flu

The non-human source of the Spanish Influenza is still debatable.[1]

[1]
[https://en.wikipedia.org/wiki/Spanish_flu_research](https://en.wikipedia.org/wiki/Spanish_flu_research)

~~~
euyyn
The article and the footnotes make it sound like the real debate is whether it
went directly from bird to human, or jumped to swine first.

EDIT: The abstract of the paper that questions the origin asserts:

> In light of this alternative interpretation, we suggest that the current
> intense surveillance of influenza viruses should be broadened to include
> mammalian sources.

------
drdeadringer
A few years ago I read 'The Great Influenza' by John Barry, which includes a
historical perspective of US medical history leading up to the 1918 pandemic
as well as digging into the pandemic itself.

I recommend the book.

~~~
Aloha
This is a fantastic book - I can wholeheartedly concur with your
recommendation.

~~~
pmoriarty
Recommendation thirded. It's one scary and very informative book.

------
krylon
I read somewhere that the Spanish flu was basically what ended the first World
War. Not sure if I believe it. In school, I had this history teacher who made
a point of telling us - repeatedly - that major historical events can rarely,
if ever, be traced to a single cause. But it might have played a significant
role.

Also, I had _no idea at all_ that it had spread globally. And a lot more
people died from it than I had thought.

What would happen if such a disease came along today? Are we just lucky that
it has not happened, yet?

~~~
loopbit
IMHO, no, I don't think it ended WWI, it was probably the end of WWI that
spread it globally so fast (plenty of malnourished soldiers going back home).

Maybe a bit off-topic, I wholeheartedly agree with your teacher, but even if a
historical event has several causes, it's very common for there to be a single
trigger that starts the whole thing. Everybody "knows" that the first world
war started with the assasination of the archduke Ferdinand, but the causes
were many (the alliance between France and Russia, between Germany and Austro-
Hungary, the problems in the Balkans between Russia, the Ottoman empire and
Austro-Hungary...)

As for your question, it probably has happened a few times (avian flu a few
years ago?), but medicine is much better now and, on average, the population
is healthier. Just these two facts alone make it much more difficult (but not
impossible) for something like that from happening again.

Another off-topic, but I find it weird that it's called the Spanish flu when,
apparently, it started in France. Spain was not part of WWI and didn't have
wartime censorship at the time, so it was the first place that started
reporting cases of it, but it didn't originate there.

~~~
krylon
> Maybe a bit off-topic, I wholeheartedly agree with your teacher [...] it's
> very common for there to be a single trigger that starts the whole thing.
> Everybody "knows" that the first world war started with the assasination of
> the archduke Ferdinand, but the causes were many

Yes! That is exactly what he tried to make us understand!

I _loved_ that teacher. To him, learning history was not about memorizing
dates and places[1], but understanding causal relationships. Also that us
Germans had kind of lost our historical memory after World War II.

Also, he taught me the important lesson that two people can have diametrically
opposing opinions (I was very left-wing at the time, he was "conservative"[2])
and still respect each other as human beings and acknowledge that the fact I
disagreed with him on some important issues did not make either one of us an
idiot or a bad person. When I look at the people often "debate" on the
Internet, I think lesson might be more important than anything else he taught
me.

[1] Those are important, too, obviously. But knowing the exact date World War
I broke out was not nearly as important to him as understanding _why_ it broke
out, and why it would have broken out sooner or later, even if Archduke
Ferdinand hat not been killed.

[2] Note that "conservative" in Germany does not mean the same thing as in the
USA. My teacher was, for example, vehemently anti-Marxist, but he also pointed
out to us that Marx's analysis of capitalism and its inherent contradictions
was spot-on in many ways and still very relevant today.

------
jcadam
I get the flu shot every year (I have asthma - otherwise healthy), and have
only had the flu a few times in my life. This year, with all of the stories of
healthy adults being felled by flu has me nervous.

Bah, my germophobic ways (I avoid touching door handles, my face holes, etc.)
will hopefully protect me. Except maybe from those jack-holes who need to
prove how 'hard' they are by coming to work with a fever. You know who they
are because not only do they look like shit, they make sure to announce to
everyone that they're sick so that they get 'credit.'

~~~
pselbert
When you have children everything changes. Then your success depends on
teaching them to adhere to the same countermeasures—there isn’t much chance of
that until they are older.

I had managed not to throw up for 20 years. That all went out the window when
I had a child that attended school.

~~~
koheripbal
Same here. ...and while I can teach _some_ basics to my 4 year old, there is
absolutely nothing I can do about my 2 year old in daycare.

------
Aloha
Bear in mind, another 1918 like flu will come - and even modern medicine is
basically helpless to stop it - we just know better how to treat it.

~~~
z3t4
There is a flu almost every year. And we're pretty good at making vaccines. A
couple of years ago there was a "training" in Sweden where every citizen was
called in for mass vaccination. You didn't have to take it, but most people
did. First medicine personnel, then pregnant, children and elders, then
everyone else. If there is a dangerous flue like the Spanish Flu again, this
is probably what will happen.

~~~
beamatronic
Exactly, we have knowledge now and this knowledge will help us - everyone has
heard of the swine flu for instance

~~~
DrScump
The 1976 Swine Flu[0] is _not_ a vaccination success story.

[0]
[https://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outb...](https://en.wikipedia.org/wiki/Swine_influenza#1976_U.S._outbreak)

------
tzahola
It’s fascinating that we had the theory of relativity and quantum mechanics at
the time, yet we don’t know to this day why the Spanish flu was so deadly.

Another puzzling disease that appeared at that time and have disappeared since
then was encephalitis lethargica:
[https://en.m.wikipedia.org/wiki/Encephalitis_lethargica](https://en.m.wikipedia.org/wiki/Encephalitis_lethargica)

Some hypothesize that the two were in fact related.

~~~
sargare
Some years ago I got the flu and two days later I became unconscious, went to
a coma for five days. It took atleast six month for the hallucinations and the
body aches to stop. Doctor said it was Viral Encephalitis. Worst days of my
life, but still lucky to be alive.

~~~
tzahola
Wow, encephalitis is no joke! You’re lucky to be alive. May I ask how old were
you at the time?

~~~
sargare
I was 26 at that time.

------
beat
Last week, someone I know died of this year's influenza. He was 33 years old
and reasonably healthy. He got pneumonia, and his heart failed.

This is the first time in my life I've experienced a healthy young adult dying
of influenza. It's terrifying.

~~~
dmckeon
Pneumonia vaccine might have prevented such a death - depends on the
individual, of course. This option appears to be less well-known than the flu
vaccine (and is only reccomended for some of the population).
[https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html](https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html)

~~~
beat
A health care system that isn't a cause of stark financial terror for the poor
would have prevented his death. He didn't go to the doctor because he was poor
and uninsured, until it was too late.

------
AceJohnny2
> _Computer modelling suggests that if the 1918 H1N1 virus were to break out
> of the facility in Atlanta it would cause around_ thirty _million deaths._

Considering the original death toll of 50-100M deaths, and today's increased
population and rapid communication (air flight), that's actually a very
impressive number in how _low_ it is.

Edit: I wonder how much of the improvement is due to the surviving
population's natural immunity?

~~~
tzs
I would expect that a significant factor is that we both have better
treatments nowadays and treatment is much more accessible.

In 1918 a lot of people, especially in rural areas, probably died before they
even had a chance to see a doctor. A rural person could easily be a day's
travel or more by horse drawn wagon away from a doctor.

It might take two people to take the sick person. One to handle the horse and
wagon, and one to tend to the sick person. Having two healthy people away from
work for several days, and having the wagon unavailable for that time, could
be a serious hardship.

I'd thus expect such people to tend to wait until it was clear that what they
had was more serious than any normal flu they had had before. News traveled
much slower in 1918, especially in rural areas, so they might not know that
there is an unusually deadly flu pandemic in progress.

So by the time they realize that they are going to need help, it might be
logistically too late.

Even if our medical treatment was no better today than in 1918, we'd probably
save a lot more just because news spreads faster and more widely, we have
faster transportation, and we have faster communication.

~~~
rsync
"I would expect that a significant factor is that we both have better
treatments nowadays and treatment is much more accessible."

If, by "treatment", you mean access to clean water, sanitary conditions and
decent rest, then I would agree: we're certainly better off than rural
populations circa 1918. I suppose access to IV fluids could be helpful if
you're elderly, or otherwise immune-compromised.

Beyond that, not much has changed since 1918.

The flu is a virus and is not affected by antibiotics. Further, the two
antivirals associated with influenza either do nothing[1] or almost
nothing[2].

Very much like there is no such thing as "cold medicine" (contrary to what TV
says) there is also no such thing as a broadly useful flu treatment. What
you're most likely to receive from a doctor is relief of superficial symptoms.

Going to a hospital for the cold or the flu will potentially expose you to
much more serious bacterial infection.

[1] "Overall the benefits of neuraminidase inhibitors in those who are
otherwise healthy do not appear to be greater than the risks."
([https://en.wikipedia.org/wiki/Influenza#Treatment](https://en.wikipedia.org/wiki/Influenza#Treatment))

[2] "These drugs (M2 inhibitors) are sometimes effective against influenza A
if given early in the infection but are ineffective against influenza B
viruses"
([https://en.wikipedia.org/wiki/Influenza#Treatment](https://en.wikipedia.org/wiki/Influenza#Treatment))

~~~
zxcmx
I hope you are not involved in public health because you are dangerously
misinformed.

A major cause of flu death in otherwise healthy people is secondary bacterial
infections and high quality home care would really help.

Your statement re: antibiotics is accurate re: the primary problem but not in
terms of actual cause of death which is very often secondary infection.

I would choose hospital care over home care any day of the week, but if there
were a serious outbreak then government paid time off for carers plus
basically universal antibiotics would be a logical response.

I think you are being too directly logical and not thinking systemically.

~~~
rsync
"high quality home care would really help."

I am in complete agreement. Not only would high quality home care help, it is,
largely, the _only thing that helps_.

"I would choose hospital care over home care any day of the week..."

I think that's a very bad heuristic that is widespread in the US - across a
broad spectrum of socio-economic and cultural backgrounds. If you _just have
the flu_ a visit to the hospital is _useless at best_. At worst, that
secondary bacterial infection you're (rightly) worried about is alive and well
at the hospital. Hospitals are breeding grounds of such infections.

"I think you are being too directly logical and not thinking systemically."

I am indeed thinking systematically - as I have witnessed emergency rooms full
of kids with colds and flu who will be given comfort and/or placebos and who
are racking up healthcare costs and displacing actual emergencies. And then
there's the exposure to bacterial infections ...

------
natecavanaugh
This is going to sound insanely insensitive, but did he get the vaccine?

Actually, it is insensitive, because I would like to either use it in my
arguments against anti-vaxxers, or learn where I went wrong.

I honestly worry about friends who don't vaccinate their kids, and I'd
appreciate either vindication, or piece of mind that I shouldn't look for
goblins ;)

~~~
dang
Anti-anti-vaxx is pure flameland of the most tedious sort, and therefore off
topic on HN.

Although I appreciate the self-awareness in your comment, it's also a pretty
uncivil thing to post; so while it's good that you phrased it that way, better
still would have been not to post it at all. Moreover, the data point you're
asking for would rather obviously not have the significance you're ascribing
to it.

We detached this subthread from
[https://news.ycombinator.com/item?id=16190609](https://news.ycombinator.com/item?id=16190609)
and marked it off-topic.

~~~
natecavanaugh
I apologize if it was inflammatory, I didn't know that it was a flame bait
topic (which I guess shows my own bias).

Thank you for your response and the info :)

~~~
dang
Appreciated!

