
Why the second wave of the 1918 Spanish flu was so deadly - onetimemanytime
https://www.history.com/news/spanish-flu-second-wave-resurgence
======
fxj
Differences in health systems and infrastructure also matter. The Spanish flu
hit the world in the days before antibiotics were invented; and many deaths,
perhaps most, were not caused by the influenza virus itself, but by secondary
bacterial infections. Morens et al (2008) found that during the Spanish flu
“the majority of deaths … likely resulted directly from secondary bacterial
pneumonia caused by common upper respiratory–tract bacteria.

Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of
bacterial pneumonia as a cause of death in pandemic influenza: implications
for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.

~~~
dragontamer
> The Spanish flu hit the world in the days before antibiotics were invented;

IIRC: Antibiotics and germ theory were invented. But the scientific community
and the medical community weren't fully on board yet.

~~~
btilly
You are confusing two things. AntiSEPTICS and germ theory were both well
established by the Spanish Flu. AntiBIOTICS were not. In other words we knew
how to prevent surgical infection but not how to treat a bacteria that had
already settled into someone's body.

Louis Pasteur came up with and proved the germ theory in the 1860s. Joseph
Lister proved in 1865 that carbolic acid would prevent infection in surgery.
Adoption took many years, but by the 1880s antiseptic surgery was widely
adopted and Lister was made a baronet in recognition.

The Spanish flu was 1918, decades after the widespread adoption of
antiseptics.

The first antibiotic, penicillin, was discovered in 1928. But it did not enter
medical use until 1942. This was not a result of doctors resisting a good idea
though. Penicillin is created by a bacteria. How do you produce useful
quantities of a substance that in concentration kills the very thing that
produces it?

~~~
dan_hawkins
"Penicillin is created by a bacteria" \- I think Penicillin is made by a
fungus.

~~~
btilly
You are correct, my bad. But the production problem is what I described. The
fungus is resistant but not immune to its own poison. It therefore proved very
hard to produce commercially viable amounts. However once a mass production
method was found, it was considered vital to the war effort and we quickly
ramped up production.

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andrewseanryan
Good article, but this one from Smithsonian is much more detailed.
[https://www.smithsonianmag.com/history/journal-plague-
year-1...](https://www.smithsonianmag.com/history/journal-plague-
year-180965222/)

~~~
ipnon
Useful given history.com responded to my request with an empty document

------
sebastianconcpt
_Harris believes that the rapid spread of Spanish flu in the fall of 1918 was
at least partially to blame on public health officials unwilling to impose
quarantines during wartime. In Britain, for example, a government official
named Arthur Newsholme knew full well that a strict civilian lockdown was the
best way to fight the spread of the highly contagious disease. But he wouldn’t
risk crippling the war effort by keeping munitions factory workers and other
civilians home._

~~~
dhosek
Or in 2020: must keep the stock market up.

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sschueller
All interesting but you just can't compare a Flu in 1918 with today.

The list is endless of what we didn't have in 1918, from computers to do DNA
sequencing to even testing the way we do today.

~~~
dsun180
Also we have some disadvantages we didn't had 1918. Like most people living in
dense cities. Or it is harder to force people into quarantine.

~~~
usrusr
And supply chains! There are many things that a 1918 city could manufacture in
an emergency that a 2020 city can't.

~~~
fock
example? I guess if you wanted it, the 2020 city can manufacture anything it
could in 1918...

~~~
varjag
OK, let's start with a soap bar or a face mask..

~~~
rwmj
You can make soap at home, a factory anywhere can trivially make it. And face
masks are paper plus string, again hardly difficult to manufacture in any city
in 2020. (In the UK most paper was made centrally in 1918, I happen to know
this because I live near the site of the former paper mills -
[https://www.thepapertrail.org.uk/](https://www.thepapertrail.org.uk/)).

~~~
varjag
Look, _I_ have a lathe at home and can make an engine if I want to, thing is
other people can't because they never were interested in that. And I used the
simplest things possible as examples.

Realistically, where would you start with these in a typical deindustrialized
town today? "A factory" is a poor answer, some towns have none really, and
factories are not interchangeable anyway.

~~~
rwmj
There are small factories - everything from workshops to industrial estates -
all over the place. If anything it's much better now because CNC machines and
lathes are cheap, widely available and very versatile.

~~~
throwanem
Yes, they're cheap and widely available. That's because we import them from
China.

If your plan for resilience against a long-term disruption of global trade has
a critical dependency on global trade, you may need to rethink it somewhat.

------
cletus
There's a surprising amount of well-intentioned but misinformed speculation in
this thread.

"We don't know" is the best answer to a lot of the questions about Spanish
flu. What we do know is that it disproportionally killed young, healthy people
who could go from no symptoms to dear in 24 hours. There's a lot of
speculation as to why. I've seen medical experts theorize this is likely due
too a cytokine response, meaning basically that a healthy immune system goes
nuts. Apparently there are other diseases that have fit this pattern.

The mortality rate is estimated at about 3%. Influenza is 0.1%. Coronavirus is
somewhere between those.

Best guess of why the second wave was so deadly was due to a mutation that
likely happened in Europe.

It's true we have things we didn't in 1918 but we still have surprisingly few
tools to combat viruses. Fun fact: only one virus has had a cure developed and
that was Hepatitis-C in recent years. To be clear, vaccines != cures.

We also have problems we didn't have in 1918, specifically mobility of people.
It's that mobility combined with people being highly contagious while being
asymptomatic that makes this particular diseases such a challenge.

~~~
kakwa_
The mortality rate of Covid-19 seems higher than that.

The around 3% mortality rate is what you get by dividing the number of deaths
by the number of infection (past and present) (as of today: 5359 / 140875 =
3.8%).

But this is incorrect as the number of currently infected people is quite high
(half the total number of infections) and unfortunately, a few will die in the
near future.

If you divide the number of deaths by (recovered + deaths), the mortality is
much higher (as of today: 5359 / (70174 + 5359) = 7.1%).

Which seems actually about as high as the Spanish Flue right in between the
low and high estimate (20M/500M, 50M/500M). And it's source for worries since
our medical systems are 1) much more developed than in 1918, and 2) they are
not yet completely overloaded. If it were to spread rapidly and overload our
health systems, the mortality rate could rise even more, let's hope it doesn't
reach that level.

~~~
dntbnmpls
> The mortality rate of Covid-19 seems higher than that.

Sure if you intentionally mislead people by cherrypicking data.

> The around 3% mortality rate is what you get by dividing the number of
> deaths by the number of infection (past and present) (as of today: 5359 /
> 140875 = 3.8%).

140875 is the number of confirmed and tested infections. The number of actual
infections is certainly much higher. So the mortality rate is most likely much
lower than 3.8%. After all, most coronavirus infections are mild for the vast
majority of people.

> If you divide the number of deaths by (recovered + deaths), the mortality is
> much higher (as of today: 5359 / (70174 + 5359) = 7.1%).

Sure if you ignore the hundreds of thousands of infected who "recovered" from
mild symptoms.

> If it were to spread rapidly and overload our health systems, the mortality
> rate could rise even more, let's hope it doesn't reach that level.

The standard pattern. Try to fearmonger with intentionally misleading stats
and then try to come off as a good samaritan. Why do all the coronavirus
fearmongering comments all follow the same template?

~~~
kakwa_
If it was fearmonguering, it was not intentional on my part. Sorry for that.

Indeed I missed the mild cases which are not quantified but likely quite
numerous.

------
fxj
There is a very good post from univ oxford on this topic:

[https://ourworldindata.org/spanish-flu-largest-influenza-
pan...](https://ourworldindata.org/spanish-flu-largest-influenza-pandemic-in-
history)

which provides more scientific background and real numbers and compares it
with other flu pandemics and the ongoing covid pandemia.

------
andyjohnson0
_" The virus infected 500 million people worldwide and killed an estimated 20
million to 50 million victims"_

 _" Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged
that had the power to kill a perfectly healthy young man or woman within 24
hours of showing the first signs of infection."_

I knew this, but its still utterly terrifying to see it expressed so bluntly.

As the article says, rapid population movement was a key factor in its spread
and mutation. We can't take the world back to a time when international travel
was rare, so when we're done with the immediate effects of the Covid-19
pandemic, we (as a species) need to get better at rapid vaccine creation. Like
an order of magnitude better. Otherwise the next one could be one that takes
us down.

~~~
avip
Can we not? Why can't Australia for example close all borders and call it the
day?

~~~
mikekchar
For one thing, most countries are not self sufficient in basic necessities
(not even food!). You could do it for a very short time, but not sustain it.
Also, the economy of the country depends on international trade. Modern
economies actually don't have a lot of slack. If you shut down trade, quite a
few companies will just go under. You would have to back that up with _huge_
subsidies. It would be a massive undertaking.

~~~
asah
Viruses don't live long enough to survive ocean shipping, so as long as the
(tiny) crew is kept isolated, ocean shipping is fine. Within a country, it's
not hard to disinfect a truck and keep the driver isolated.

Of course, if the originating factory is shut, then you're screwed - but
that's true regardless of trade.

Also worth noting: it takes a tiny number of people to produce tons of food
(calories). Maybe not true for artisanal salami but for bulk basics.

~~~
blaser-waffle
The US is the single largest exporter of grain in the world. Not the largest
producer, not the largest consumer, but the largest exporter.

And the US farming population is ~1% of the total US pop. Modern tractors and
combines are amazing.

Doesn't mean there aren't a ton of bodies involved in processing and
transportation, though. You can probably find local-ish wheat in the US, but
you're not going to boil and eat the wheat berries for a porridge like it's
1850 (though you could); you're going to buy breakfast cereal.

------
andrekandre
in case you don’t read the article, there is an interesting historical
anecdote: why it’s called “spanish flu”

> Interestingly, it was during this time that the Spanish flu earned its
> misnomer. Spain was neutral during World War I and unlike its European
> neighbors, it didn’t impose wartime censorship on its press. In France,
> England and the United States, newspapers weren’t allowed to report on
> anything that could harm the war effort, including news that a crippling
> virus was sweeping through troops. Since Spanish journalists were some of
> the only ones reporting on a widespread flu outbreak in the spring of 1918,
> the pandemic became known as the “Spanish flu.”

------
yters
Once the quarantine is lifted we will have a bunch of non inoculated people,
and the corona will spread all over again.

~~~
Agenttin
The goal isn't to stop those people from being infected, it's to delay their
infection. A massive spike of infections would overwhelm the hospitals. The
same number of patients, slower, is doable.

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raphaelj
The article does not answer the question, except for "it mutated"

~~~
gambiting
Does it not? It clearly says that countries like the UK knew full well that
the best way to combat the illness was to isolate and quarantine people and
cities, but decided not to do it to avoid harming the war effort - resulting
in a lot more deaths. How is that not an answer to this question?

~~~
Spare_account
I'm watching the UK government decide not to implement 'delay' measures today,
ostensibly to protect the economy. It seems there is always a reason not to do
the right thing.

I hope they change their mind very soon.

~~~
codeulike
(deleted)

~~~
senordevnyc
Has anyone done the math on how long a flattened curve stretches out if you
flatten it enough to not overwhelm the medical system?

So for example, if we have 100,000 ICU beds in the US and we somehow make them
all available for COVID-19 patients (unlikely), how flat do we need to make
the curve to not go above 100k ICU patients, and how long will that flattened
curve last? A month? Six months? Two years?

Assuming 70% of the adult population gets it, that's roughly 140 million
infected. Assuming 5% need ICU beds, that's 7 million ICU patients. And
assuming the average ICU stay is 2 weeks, we'd need to therefore spread our
ICU patients over 140 weeks, or almost three years. Is that how long we can
expect social distancing to last if things go perfectly?

~~~
nicoburns
The UK only has ~4000 ICU beds, and these are mostly already full. We've got
no chance.

~~~
senordevnyc
Yeah, just to be clear, I think there's no chance in the US either. I just saw
something that said we actually only have 45k beds, and they're mostly already
full anyway. Plus there's no chance we're going to be able to keep this
clamped down for months. We'll be overwhelmed in weeks.

------
known
[https://en.wikipedia.org/wiki/Information_asymmetry](https://en.wikipedia.org/wiki/Information_asymmetry)

