This is the first time in my life I've experienced a healthy young adult dying of influenza. It's terrifying.
What's terrifying is healthy adults dying of flu.
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?
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.
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 or almost nothing.
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.
 "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)
 "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)
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.
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 ...
The so called "Spanish" flu was not from Spain; the first reported case was from France. It killed happily people all around the world spreading from military camps and soldiers returning home. Was tagged as spanish because many countries were in war and censored carefully any bad news about people dying in mass in their territories to avoid the enemy (and their own citizens) having this sensible information. As Spain remained neutral in the first World War, the spanish press documented the problem freely and extensively instead. Spain lost only the 1% of their population (around 200.000 people) whereas France lost 400.000, USA lost the 28% of their population (around 550.000) and 30 millions of people died in China (maybe should be called chinese flu instead? or even better the WWI big flu?).
The tag was bassically an attempt from politicians to blame a foreigner country, hide the problem under the rug and avoid assuming responsabilities in his countries. The oldest trick in the bag.
They could be off by a factor of ten. In the wrong direction. We won’t know until it’s time.
AFAIK, immunity to a particular flu strain is acquired through exposure (via infection or vaccine) rather than passed genetically.
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.'
I shall step up my defense level an extra notch or two if a serious pan- or epidemic comes around. Some will chide me for squeemishness, but really, I find not sticking my fingers in my mouth an acceptable price for a markedly reduced risk of illness and death.
 Shopping trolleys and baskets considered harmful
Maintain a flag: Did I touch some probably disgusting surface [trolley/phone/mouse/keyboard/door handle/seat/other people/whatever]? If so, do not touch mouth/nose/eyes/wounds/food until hand properly washed.
Is some idiot coughing or sneezing his heart out? Shut my fuck up and breath through the nose.
Consider everything brought home from supermarket to have potentially contaminated surfaces (checkout-conveyors are disgusting).
That kind of thing. Really just a question of habit. Not in any way going Howard Hughes. I once had a girlfriend who did that (going slightly bonkers from studying medicine (but fine today, and a practicing doctor, better for the experience)), and am well aware of the danger signs.
No arguing with those results.
I had managed not to throw up for 20 years. That all went out the window when I had a child that attended school.
But now that my youngest is 12, things are much better and I rarely get sick :)
I recommend the book.
Also, the book explains how huge numbers of deaths were caused by politicians and bureaucrats. The political machine in one city (Philadelphia, I think) refused to shut down a popular parade, as urged by the health authorities, to stop the spread of the flu. Lots of people needlessly got infected and died. The military packed excessive numbers of WWI recruits into camps designed for a fraction of the number of people, also against the advice of doctors; huge numbers of healthy young men caught the flu and died.
And the scientific detective story of how researchers tried to find a cure for the flu was very interesting, with ongoing controversy over what the infectious agent was (virus? bacteria?). We know the answer today, but it wasn't so clear back then.
It's a very good read on many levels.
Here's a link to the book on Amazon: https://www.amazon.com/dp/0143036491
Another puzzling disease that appeared at that time and have disappeared since then was encephalitis lethargica: https://en.m.wikipedia.org/wiki/Encephalitis_lethargica
Some hypothesize that the two were in fact related.
I got the flu this year. My symptoms were almost exclusively a fever. No significant aches.
I gave myself 2-3 days of 102 fever. Taking no medication, but laying in bed, drinking water, and eating as much as I ibuprofen and the fever broke. I continued taking for the next day, and by the end of the 4th day, I felt fine.
It's scary to think I may have just gotten lucky. I don't "know" what the right course of action is. I'd like to believe that letting your body fight the infection visa vi a fever is a good idea, assuming you're healthy enough to take that kind of physical stress. I don't know.
More likely if he went to the doctor with aches and pains then it was prescribed on the theory that it might have been shingles.
Herpes simplex virus type I (HSV-1)
Herpes simplex virus type II (HSV-2)
Varicella zoster virus (VZV)
Epstein-Barr virus (EBV)
Cytomegalovirus (CMV) – least activity”
Because it caused a cytokine storm in the patient. People were killed by their own inmune system. The most healthy inmune system (young adults in prime condition), the worst.
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.
The non-human source of the Spanish Influenza is still debatable.
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.
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.
The movie Contagion was partially set where I live in Minnesota - it contained depictions of people assembling for food, vaccines, treatment, and mass burial. Seeing local landmarks in the movie made it feel very real and made me think more about emergency preparedness.
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?
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.
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, 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") 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.
 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.
 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.
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 ;)
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 and marked it off-topic.
Thank you for your response and the info :)
There's unlimited opportunity to prosecute that cause elsewhere. Let's keep this place for discussing and learning interesting new things.
The first is unlikely, but some people do have reactions. It's more likely they had a coincidental cold or a psychosomatic reaction.
The second is irrelevant. Getting a vaccination isn't about YOU, it's about the vulnerable people around you and the vulnerable that will interact with the people around you. Also you could be infected and have no symptoms, so pass it around without knowing.
But I'm sure you already know that. I'm only mentioning it for fuel against the antivaxers you engage with, because they're endangering us all and need to be stopped.
Its not a psychosomatic reaction. People frequently get minor, flu-like symptoms for a few days after getting a vaccine. While its not as severe as having the flu, people feel "sick" and so they accurately describe themselves as having gotten sick from the flu vaccine because it makes far more sense to talk about these things in the context of the way they make us feel, and no sense at all to talk about the underlying science behind vaccines that doesn't magically make us feel better just because its technically correct.
I get minor, flu like symptoms, which are still a pain in the ass, about 85% of the time when I get a flu vaccine (which is every year). Its still significantly better than getting the flu, but its pretty obnoxious that the medical community tries to shame people for noting the objective fact that getting a vaccine is still rather unpleasant. Its like our society is incapable of understanding nuance. You're forced to either take the side of anti-vax lunatics or pretend that vaccines have no side-effects.
Also, about your comment on the vaccination being for the good of the "herd". That's mostly correct, but it doesn't tell the whole story. According to the CDC, if you get vaccinated and then get the flu, the severity of it will be somewhat lessened and the chances of it becoming a severe illness will be reduced. So its still allegedly worth it for the individual.
Nope, it's the side effect of having bodied cognition. We're optimized to make good-enough decisions in less than a second with three pounds of expensive to maintain rarefied material.
Short cuts within hacks within crufty work-arounds. It's amazing that it works so well, naturally. But it's not American, it's not Western, heck, it's not even human, it's the nature of thought and action in an ever changing world.
Thinking in binaries is a supremely powerful way to chop up the world and let's not discount it as a first approximation towards survival.
Just another data point: I've never gotten flu-like symptoms from the vaccine, and I've gotten vaccinated every year for many, many years now. At worst, my shoulder (around the injection site) is sore for a day after I get the shot. I've never had any symptoms at all from the nasal vaccine.
That's the pattern I see in a lot of public discourse. What I see all the time is: X may be a better position than Y, even though argument A for X is wrong and argument B for Y is very well thought out.
I know of absolutely no science that supports that oft-repeated claim about influenza as a whole.
If the flu infection is from a different strain from any that person was vaccinated for, there is no demonstrated cause-and-effect from the vaccine that provides blanket mitigation for different strains.
I'd bet that it wasn't. Fact is, for the past several years, the three/four candidate strains chosen for the USA vaccine were badly mismatched for what strains actually circulated in the wild.
Flu vaccines aren't like genetic vaccines (like for HPV), which are essentially foolproof for the targeted strain(s) and carry little risk of side-effects. Flu vaccines are more of a scattershot approach, with the "misses" generally ignored by the media.
In addition, influenza vaccine effectiveness (VE) in general has been lower against A(H3N2) viruses than against influenza A(H1N1)pdm09 or influenza B viruses. Last season, VE against circulating influenza A(H3N2) viruses was estimated to be 32% in the U.S. CDC expects that VE could be similar this season, should the same A(H3N2) viruses continue to predominate.
Plus, it's very early in the season. That's 70% failure already, and every new case grows that number.
On the other hand, 60% is better than 0%. I always get my flu shots each year.
> or learn where I went wrong
Statistics and probability.