Comparing the COVID-19 Pandemic to the 1918-1920 Flu Pandemic

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It appears that the current COVID-19 pandemic will not be anywhere near as harmful as the swine flu influenza pandemic of 1918-1920 that started near the end of World War I, infected 500 million people, and killed about 39 million people, which was 2.3 percent of the world’s population of 1.7 billion people at that time. World War I killed only nine million people in four years. The 1918 swine flu virus killed Frederick Trump, the grandfather of the current U.S. president; and artist Gustav Klimt, one of Alma Mahler’s many lovers; among millions of others.

U.S. President Woodrow Wilson and Walt Disney were among the survivors, but Wilson’s flu probably led to World War II. During the Versailles Treaty negotiations in 1919 to end World War I, Wilson was so sick that this previously highly-intelligent president foolishly agreed with the French to impose such harsh terms of negotiations that they sent Germany into a severe financial depression. The German people then chose to follow the lunatic Adolph Hitler because they thought he would put food on their tables.  Walt Disney was prominent in World War II as his cartoons encouraged Americans to work together against Nazi Germany. However, just before the onset of World War II, Disney attended meetings of the German American Bund (the American Nazi Party). He also personally hosted Nazi filmmaker Leni Riefenstahl when she came to promote her film Olympia in 1938, a month after the infamous assault on Jews in Germany known as Kristallnacht.

History of the 1918 Flu Pandemic
The origin of the 1918 flu virus is not known, but the first US case was recorded on the morning of March 11, 1918 at Camp Funston, Kansas. A company cook named Albert Mitchell reported to the infirmary with typical flu-like symptoms: a low-grade fever, mild sore throat, slight headache, and muscle aches. The doctor told him to go to bed. By noon, 107 soldiers were sick. Within two days, 522 people were sick. Many suffered from severe pneumonia. Then reports started coming in from other military bases around the country. Thousands of sailors docked off the East Coast were sick. Within seven days, every state in the Union had been infected. By April, European troops and civilians were infected. By mid-April, the disease had spread to China and Japan. By May, the virus was spread throughout Africa and South America.

In Philadelphia, 158 out of every 1000 infected people died; in Baltimore, 148 out of 1000 died; in Washington, DC, 109 out of 1000 died. In each city, the number of cases peaked in two to three weeks, lasted two or three more weeks and then disappeared as quickly as it arrived. The United States had one of the lowest death rates in the world from the disease. Sixty percent of infected Eskimos living in Nome, Alaska, died from the disease. Almost 90 percent of the Samoan population was infected with flu, and many of those who survived the infection died from starvation because they were too weak to seek out food and water. Eighteen months after the disease appeared, this particular flu bug vanished and did not show up again until 1957.

Pneumonia was the Most Common Cause of Death
It wasn’t just the flu virus that killed so many people, it was a secondary bacterial infection in the lungs caused by common upper respiratory bacteria, usually Hemophilus Influenza. Without this secondary bacterial infection, many patients might have survived in 1918. Now doctors can cure bacterial infections with antibiotics. Antibiotics are the primary reason why the 1957 and 1968 influenza pandemics did not kill nearly as many people (J Infect Dis, Oct 1, 2008;198(7):962–970). In the current coronavirus pandemic, one in seven COVID-19 patients go on to develop a secondary infection while hospitalized (Lancet, Mar 28, 2020;395(10229):1054-1062), and half of the deaths from COVID-19 are caused by a secondary infection. Not-yet published data show that 20 percent of hospitalized COVID-19 patients are also infected with other disease-causing germs.

Birds to Pigs to Humans
In March of 1997, researchers at the Armed Forces Institute of Pathology in Washington, DC, found a jar with the lungs, packed in formaldehyde, of a 21 year old soldier who died of the flu in 1918. They analyzed the genetic material of the virus and showed that it was the type that is passed from birds to pigs and then to humans. A bird’s immune system tolerates the virus so the virus lives quietly in birds without a strong immune response from the bird. However, when the virus is transmitted to pigs, the pig immune system reacts violently to kill it, so to survive in pigs, the virus changes to a different form that is so aggressive that it can kill the pig. When transmitted from pigs to humans, the virus can weaken a person’s immunity so much that a secondary bacterial infection can kill him. Both the Asian flu (1957) and the Hong Kong flu (1968), mutated from pig viruses and were very similar in structure to the flu virus of 1918, but were not as lethal. The H1N1 flu virus of 1918 closely resembled the hybrid H1N1 virus responsible for the 2009 swine flu pandemic, because it was similar to the virus that caused the 1918 pandemic, not because it came from pigs. The 2009 swine flu caused respiratory illnesses that killed an estimated 151,700-575,400 people worldwide in the first year, less than 0.005 percent of the world’s population, so it was far less serious than the 1918 epidemic. Strangely, 80 percent of the deaths caused by swine flu occurred in people younger than 65. Almost all influenza A pandemics since that time have been caused by descendants of the 1918 virus, including H1N1, H2N2 and H3N2 viruses, so that the 1918 swine flu pandemic is indeed the “mother” of other flu pandemics. A vaccine for the swine flu strain is included in your regular yearly flu vaccine.

You Need a Different Flu Immunization Each Year
The flu viruses are so contagious that almost everyone exposed to them gets the flu. Once a flu virus travels throughout the world, so many people are infected that the population becomes immune to it and the virus must change to another form to be able to infect people again. The virus mutates and changes its structure, so each year a new mutated flu virus shows up and most people do not have immunity to that new virus and it can spread rapidly through the population to cause a different flu epidemic. This is why you have to get a different flu vaccine each year. Flu epidemics usually start in China in the spring and summer, and spread to the rest of the world throughout that year. Scientists used to culture the new flu viruses in China in the spring and make a vaccine from these viruses. Now a special committee meets to guess what flu viruses should be in the next year’s vaccine.

Flu Still Kills
Yearly flu epidemics cause about 300,000 deaths worldwide, according to the World Health Organization.  In one report, researchers with the Centers for Disease Control and Prevention found that 830 children died from flu-related complications between October 2004 and September 2012 (Pediatrics, published online Nov 4, 2013):
• Most had not gotten a flu vaccine
• Pneumonia was the most commonly reported complication
• The median age was seven
• 43 percent of the children who died from flu were otherwise healthy
• 33 percent had neurological disorders
• 12 percent had genetic or chromosomal disorders
• 35 percent of the children died before hospital admission
• 63 percent of the children died within seven days of the onset of flu symptoms.

My Recommendations
I recommend that you get your flu shot every year, not because flu is likely to kill you, but because it can make you miserable. The flu virus that will come this year is not likely to kill you unless you suffer from heart or lung disease. People with heart or lung diseases should be protected by immunization.
This year, you will also want to try to get one of the recently-approved antibody blood tests for SARS-CoV-2 (the coronavirus that causes COVID-19), so you can find out if you have already been infected and may possibly be immune to that virus. If you have antibodies, you may be able to relax the strict rules of isolation for susceptible people.  As soon as a vaccine for COVID-19 becomes available, you will want to get that vaccine. See my latest advice for treatment and prevention of COVID-19