Mar 22 2020
One must be deaf and unable to read not to hear about “Spanish flu” in the last few months. It became an axiom repeated over and over on TV, in newspapers and scientific journals claiming that up to 500 million people were infected by influenza virus in 1918 and 50 million died (some claim 100 million death toll).
Being a contrarian by nature, I started wondering what is the basis for this dogma. Is it based on facts? Where, when, and by whom those facts we collected and analyzed?
First, a few facts about viruses:
Two scientists contributed to the discovery of the first virus, Tobacco mosaic virus. Ivanoski reported in 1892 that extracts from infected leaves were still infectious after filtration through a Chamberland filter-candle. Bacteria are retained by such filters, a new world was discovered: “filterable” pathogens. However, Ivanovski probably did not grasp the full meaning of his discovery. Beijerinck, in 1898, was the first to call 'virus', the incitant of the tobacco mosaic
Foot-and-mouth disease virus was described in 1898
The first ‘filterable agent’ to be discovered in humans was yellow fever virus in 1901
However, it was not until Wendell Stanley first crystallized tobacco mosaic virus in 1935 that the non-cellular nature of viruses was appreciated
Second, a few facts about influenza:
Influenza, also known as “the flu” is an infectious disease caused by influenza viruses
The multiple for “viruses” is crucial. We use adjectives such as “avian”, “swine”, “bird”, “stomach”, etc. as well as letter/number abbreviations such as H1N1, H2N2, H3N2, etc. to define flu viruses. This essentially means that these are different diseases causing similar clinical presentation
The word Influenza comes from the Italian language meaning "influence" and refers to the cause of the disease; initially, this ascribed illness to unfavorable astrological influences. It was introduced into English in the mid-eighteenth century during a pan-European epidemic. Archaic terms for influenza include epidemic catarrh, la grippe (from the French), sweating sickness, and Spanish fever
The first probable description of influenza dates back to 6000 BC in China. Hippocrates described it 2400 yeas ago
The entire indigenous population of the Antilles was killed by an epidemic resembling influenza that broke out in 1493, after the arrival of Christopher Columbus
The first influenza virus to be isolated was from poultry, when in 1901, the agent causing a disease called "fowl plague" was passed through Chamberland filters, which have pores that are too small for bacteria to pass through
The etiological cause of influenza was first discovered in pigs by Richard Shope in 1931
This discovery was shortly followed by the isolation of the virus from humans by a group headed by Patrick Laidlaw at the Medical Research Council of the United Kingdom in 1933
Third, a few facts about “Spanish flu”
To maintain morale, World War I censors minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States. Papers were free to report the epidemic's effects in neutral Spain, such as the grave illness of King Alfonso XIII, and these stories created a false impression of Spain as especially hard hit. This gave rise to the pandemic's nickname, "Spanish flu"
The total number of “Spanish flu” victims is estimated based on monthly all-cause civilian mortality rates in the 14 countries, accounting for approximately three-quarters of the European population (250 million in 1918). A mathematical model was applied to estimate excess mortality. These estimates were published in 1990s-2000s
The first and only (I did not find any other references) 1918 influenza virus was reconstructed in 2005 from a presumed “Spanish flu” victim, an indigenous Inuit man, whose body was excavated in 1998 from a gravesite in permafrost in Alaska. This fascinating story can be found on CDC web site https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus
Today, the general consensus is that the 1918 influenza virus originated in the Midwest of the United States of America. Medical records reported the first cases of “influenza of a severe type” around March 1918 in military camps in Kansas
From there, the virus is thought to have spread throughout the United Stated and then transported by American troop ships to the battlefields of France, where it gradually spread throughout Europe and the rest of the world. The spread of the virus beyond port cities was further facilitated by local transport networks, predominately railways
Interestingly, no records of civilian influenza cases around that time exist, possibly because influenza cases were not recorded at the time or because they got lost with time
Military camps, with their high population density, close proximity to livestock, high mobility, and large number of people with pre-existing lung conditions, stressed, malnourished, living in trenches or crowded barracks with poor or no sanitation, combat wounds, exposure to gases used as chemical weapons, served as the perfect breeding ground for the emergence of this catastrophic pandemic
The majority of victims died from bacterial pneumonia. This was confirmed by autopsies performed at the time and reconfirmed later
The largest number of deaths attributed to “Spanish flu” was recorded in (in the order of magnitude - higher from lower):
Romania, Yugoslavia, Turkey - all or parts of which were in Ottoman Empire
Russia
Italy
Germany
Spain
France
Prussia - this was a part of Germany, not an independent state!
England and Wales
Croatia
Hungary
Austria is much lower in the list, but, Austria and Hungary were in the Austro-Hungarian Empire, which also included Czechoslovakia, parts of Italy, Slovenia, Croatia, Yugoslavia, Romania, and western Russia
Forth, a few facts about World War I:
The pandemic occurred during World War I which claimed estimated 40 million lives
The United States entered the war in 1917 and sent a large expeditionary force - more than 2 million soldiers to Western Europe and Russia
The peak of chemical warfare use occurred in 1918
The number of soldiers imprisoned in concentration camps reached a little over seven million for all the belligerents, of whom around 2,400,000 were held by Germany
There was mass dislocation of people, starvation, casualties, destroyed infrastructure, and genocide affecting civilian population
There were other epidemics during the war, most notably typhus epidemics
A number of civilian conflicts occurred in the same time frame, most notably in Russia, Ottoman Empire, Yugoslavia
Here are contrarian questions:
How can we assess the number of infected and the number of victims of the disease in 1918, when the humanity did not identify the virus in question until 1933?
How can we prove that disease and mortality in 1918 were due to this particular virus?
Can we make that assumption based on ONE (1) patient found in Alaska 80 years later?
How much can we trust statistics/public records from 100 years ago?
Assuming that public records from that time were accurate and complete, can we reliably extrapolate data from 14 countries to the World?
What about impact of the war itself?
What about other epidemics and causes of death, most notably typhus?
Why estimates do not seem to be adjusted to any of the factors above?