The 1918 Spanish Flu

Before the 20^th century, the world had experienced some of the deadliest pandemics in its history. For example, the world experienced the sixth cholera pandemic (1910-1911), which claimed more than 800,000 persons, the flu pandemic (1889-1890), which killed about 1 million persons globally, and the third cholera pandemic (1852-1860), which also killed close to 1 million persons globally (MPH online, 2021). However, at the start of the 20^th century, the world experienced one of the deadliest pandemics in its history. The Spanish Flu, also known as the1918 influenza pandemic, or the Great Influenza pandemic, remains one of the most significant pandemics that hit the globe in the 20^th century. According to Taubenberger and Morens (2006), the Flu was caused by the H1N1 virus. During the pandemic (1918-1919), more than 500 million people globally were infected (about a third of the world’s population during that time) (Taubenberger & Morens, 2006). Generally, due to the number of persons who got infected and succumbed to the virus, the pandemic was considered the deadliest pandemic in the 20^th century.

The mystery surrounding the origin of the virus remains unsolved up to date. Some medical historians aiming to explain the source of the virus had theorized that the virus might have originated from Asia, particularly in China, because China had experienced a lethal outbreak of a pulmonary disease before the pandemic began. The medical historians suggest that the virus might have spread to other parts of the world through the migration of Vietnamese or Chinese laborers working in France or traversing through the United States of America (Barry, 2004). On the other hand, a British scientist J.S. Oxford hypothesized that the virus might have originated in a British Army post in France because, in 1916, British physicians had discovered a disease they named “purulent bronchitis,” whose symptoms were similar to those of the Influenza pandemic (Oxford, 2001). The pandemic significantly disrupted major global economies due to its transmissibility. For example, in the United States of America, the pandemic reduced the manufacturing output by 18% (Bishop, 2020). In general, the pandemic disrupted major global economies, leading to a reduced GDP in most countries.

Biocultural perspectives of the Spanish Flu

Understanding biocultural perspectives is significant for medical anthropologists. According to Wiley (2018), biocultural perspectives enable scientists and researchers to understand variations in diseases across human populations. In addition, researchers use biocultural perspectives to understand the relationship between culture and biology, as they play a crucial role in health and diseases affecting human populations. Wiley (2018) affirms that some vital methods in biocultural analyses include biomarkers, environmental effects, and social and cultural data. Collectively, these perspectives influence the variation in health and diseases across human populations.

Biological aspects of the Spanish Flu

The devastating impacts, such as the loss of millions of lives globally, left behind by the Spanish Flu spurred scientists to research more about the virus because little information about it was known then. The virus victims experienced lung inflammation, fluid-filled lungs, and severe pneumonia (Jordan, 2020). Therefore, scientists researched, for example, the possible strains of the virus and its transmissibility, as they tried to uncover the mystery surrounding the virus given that it was one of the deadliest pandemics the world experienced in the 20^th century. Jordan (2020) affirms that the involved researchers aimed to answer questions like why the virus was so fatal, its origin, and lessons learned from the pandemic, which could play a significant role in the world’s preparation for similar situations pandemics should they occur in the future. Around the mid-20^th century, researchers successfully began finding answers regarding the virus. In the late 1930s, researchers who had analyzed the antibody titers of the pandemic’s survivors suggested that the 1918 Spanish Flu was caused by the HIN1-subtype influenza A virus (Dowdle, 1999). According to Taubenberger (2006), the virus might have contained a hemagglutinin gene encoding, which most populations during that period lacked protective immunity. Taubenberger (2006) further affirms that based on the data released by Jordan (1927; as cited in Taubenberger, 2006) regarding influenza infection rates globally before the 1918 pandemic, the 5-15 age group accounted for approximately 11% of the influenza cases, while age group of above 65% accounted for 6% of the overall cases of the influenza infections between 1900 to 1917. However, during the 1918 influenza pandemic, the virus’s infection rates among the age group5-15 rose to approximately 25%, while that for the age group of greater than 65% reduced to about 0.6%, implying that persons within the age group 5-15 years were more susceptible to the virus. It was suggested that persons in the past 65 years might have developed pre-existing H1-antibodies, which reduced their susceptibility to the virus during the 1918 pandemic (Taubenberger, 2006).

Researchers hypothesized that persons born before 1889 might have been subjected to the H1-like virus strain that existed during that period, thus enabling their bodies to develop the H1-antibodies that partially protected them against the 1918 virus strain (Taubenberger et al., 1997). Microbiologists derived the virus sequence from multiple victims. They found that the sequence of the 1918 H.A. and that of the A/swine/lowa/30 virus had many avian features though they were closely related (Taubenberger, 2006). In addition, a study by Weis et al. (1988) revealed that for the influenza virus to survive in the host cell surface, the H.A. protein must bind to the sialic acid receptors, preferentially to receptors with α (2–6) linkages. Generally, based on the reviewed studies, sequencing and analyses of the RNA of the 1918 influenza pandemic strongly reveal that the virus was a strain of both swine and HINI lineage, giving ground for further studies, including testing of the 1918 influenza’s virulence.

Cultural aspects of the 1918 Spanish flu

The 1918 Spanish Flu remains one of the worst pandemics of the 20^th century due to the high number of people who succumbed to it. Researchers estimate that the pandemic infected more than 500 million persons and left more than 50 million persons dead (Taubenberger & Morens, 2006). The pandemic happened during the period when the world was recovering from the devastating aftermaths of the first world war, which had left at least 20 million persons dead and more than 40 million persons wounded globally (“World War 1 Causalities,” n.d.). Based on the number of persons that succumbed during these two significant events of the early 20^th century, it is evident that the Spanish Flu killed more people than the first world war. According to Shanks (2014), the influenza pandemic killed more people than the first world war, bringing a critical transition point towards scientific medicine. Shanks (2014) affirms that the pandemic’s aftermath and its devastating impacts revealed how much remained beyond scientists’ and doctors’ capability to handle infectious diseases during the first world war because researchers believed that the first world war escalated the spread of the virus. For example, Byerly (2010) affirms that crowding conditions in the U.S. military camps and other camps in the Western Front in Europe during the first world war significantly intensified the spread of the virus because it was airborne. Byerly (2010) reports that 20% to 40% of American personnel, specifically U.S. Navy and U.S. Army personnel, got infected by the virus. These statistics reveal how the first world war contributed to the spread of the virus.

The influenza pandemic happened in two waves. The first wave, also known as the spring wave, happened around March 1918. The second wave, also known as the fall wave, occurred between September to November 1918. The second wave was the deadliest because many people died (Taubenberger & Morens, 2006). The second wave was characterized by severe illnesses, although scientists failed to uncover why the virus generated repeated waves of illnesses. One factor contributing to high mortality rates during the influenza pandemic was the lack of antibiotics in 1918 (Taubenberger & Morens, 2006). In general, the first world war and limited medical inventions contributed to the devastating impacts of the influenza pandemic, laying a foundation for researchers to invest in research involving infectious diseases.

References

Barry, J. M. (2004). The site of origin of the 1918 influenza pandemic and its public health implications. Journal of Translational Medicine, 2(1), 3. https://doi.org/10.1186/1479-5876-2-3

Byerly, C. R. (2010). The U.S. military and the influenza pandemic of 1918–1919. Public Health Reports, 125(3_suppl), 81-91. https://doi.org/10.1177/00333549101250s311

Oxford, J. S. (2001). The so-called great Spanish influenza pandemic of 1918 may have originated in France in 1916. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 356(1416), 1857-1859. https://doi.org/10.1098/rstb.2001.1012

Shanks, G. D. (2014). How World War 1 changed global attitudes to war and infectious diseases. The Lancet, 384(9955), 1699-1707. https://doi.org/10.1016/s0140-6736(14)61786-4

Taubenberger, J. K., & Morens, D. M. (2006). 1918 influenza: The mother of all pandemics. Emerging Infectious Diseases, 12(1), 15-22. https://doi.org/10.3201/eid1209.05-0979

Wiley, A. S. (2018). Medical anthropology methods: Biocultural perspectives. The International Encyclopedia of Anthropology, 1-8. https://doi.org/10.1002/9781118924396.wbiea2080

World War 1 Causalities. (n.d.). Maison de l’Europe à Scy-Chazelles – CERS. https://www.centre-robert-schuman.org/userfiles/files/REPERES%20%E2%80%93%20module%201-1-1%20-%20explanatory%20notes%20%E2%80%93%20World%20War%20I%20casualties%20%E2%80%93%20EN.pdf

Taubenberger, J. K. (2006). The origin and virulence of the 1918 “Spanish” influenza virus. Proceedings of the American Philosophical Society, 150(1), 86.

Dowdle, W. R. (1999). Influenza A virus recycling revisited. Bulletin of the World Health Organization, 77(10), 820.

Taubenberger, J. K., Reid, A. H., Krafft, A. E., Bijwaard, K. E., & Fanning, T. G. (1997). Initial genetic characterization of the 1918 “Spanish” influenza virus. science, 275(5307), 1793-1796.

Weis, W., Brown, J. H., Cusack, S., Paulson, J. C., Skehel, J. J., & Wiley, D. C. (1988). Structure of the influenza virus haemagglutinin complexed with its receptor, sialic acid. Nature, 333(6172), 426-431.

Jordan, D. (2020, June 16). The discovery and reconstruction of the 1918 pandemic virus. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html

Bishop, J. (2020, June 18). Economic Effects of the Spanish Flu. Reserve Bank of Australia. https://10.3386/w26866

MPH online. (2021, April 7). Outbreak: 10 of the worst pandemics in history. MPH Online. https://www.mphonline.org/worst-pandemics-in-history/