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Influenza Virus – Spanish Flu

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    A boy in Philadelphia lies in bed with a fever of 104 degrees as his mother dabs a cool cloth on his head in effort to bring down his fever. A nurse scrambles through her hospital in London trying to find intubation bags as a young woman struggles for air, her respiratory system completely shut down. A soldier in the U. S. army begins to feel worn down, his body racked with coughing fits, not from war, but from something much deadlier and unseen. These are the tell-tale signs of the pandemic that is known as the “Spanish Flu”.

    The influenza virus is a potentially lethal illness that can infect birds as well as humans and other mammals. The virus can evolve rapidly, resulting in new outbreaks of the disease. There are two major categories of the influenza virus: A and B. About 95% of influenza cases are caused by type A. Symptoms of the virus includes fever, sore throat, coughing/sneezing, and muscle aches. The disease also incubates for one to five days after exposure and may be transmitted before symptoms are recognized. Influenza is spread through the air in the form of droplets formed when people cough, talk, or sneeze.

    Though not usually the cause of death, influenza does tend encourage secondary bacterial infections, like pneumonia, which is often the direct cause of death during flu outbreaks. In rare cases, the virus can also trigger an overreaction of the immune system, kind of like an allergic response, which causes massive damage to the lungs. It is known as acute respiratory distress syndrome (ARDS) and it quickly leads to death. In contrast to common flu victims, who are often very young or old, ARDS occurs most often in relatively young people with strong immune systems.

    The most devastating occurrence of a mutated influenza virus in history was the 1918-1919 flu pandemic. The 1918 pandemic of the Spanish flu was an unusually deadly pandemic that spread worldwide, killing an estimated 50-100 million people. The exact origin of the disease is unknown, however. Theories exist as to where the disease originated. In Europe, many stated that it began in Spain, hence the name. Spain was neutral during World War I, which was occurring in Europe, and as such, they had no wartime censorship to keep its health problems secret. The Spanish claimed it came from France. Every country had its own heory and none can be proven. However, the first recorded case of the flu was at Haskell County, Kansas, in March of 1918. Scholars maintain that Fort Riley is the most likely site of origin. During this time, World War I was ravaging Europe and thousands of troops were being deployed to assist in the war effort. The transportation of troops provided a gateway for the flu virus to spread to Europe. By May, the flu had been established in Europe, particularly in Brest, France, which happened to be “the single largest port of disembarkation for American troops. ” The flu traveled with ease throughout Europe, passing from army to army.

    By July of 1918, 700 people had died of the flu in London and 475 of pneumonia. Hamburg had a death toll of 214. Thousands more in Germany, Copenhagen, Switzerland, and the rest of Europe were ill with the disease. Reports of mortality records from London and Paris showed that nearly one-half of the dead were between 20-45 years old, not typical of flu victims. 9 It was later learned that a large percentage of the deaths among the fairly young were because of ARDS. Despite the threat of the disease and the ever increasing death rates, the flu wasn’t considered a reportable disease.

    World War I played a huge part in why it wasn’t reported. More people, both laymen and medical professionals, thought the war was more interesting. Just as it spread like wildfire to and throughout Europe, the Spanish flu also began to spread worldwide. Because of World War I, thousands of ships were carrying people between Europe and the rest of the world. It was the perfect way to spread the flu. Within 4 months, the virus had spread around the globe and had killed tens of thousands in its path. Yet it could not break into North America.

    Dozens of ships laced with influenza came into American ports but with the exception of an isolated outbreak in Fort Morgan, Alabama, which was diagnosed as the usual flu, nothing happened. The disease could not penetrate past the coastline. Had it done so, the second wave of the virus may not have been so deadly. The citizens of the United States could have built up immunity or the United States could have been better prepared in response to the outbreak. But in the summer of 1918, the United States picture of health was nearly perfection. The only cloud was that reports from hospitals for the United States Army, both in

    Europe and at home, stated that admission and death rates for respiratory illness had gone up in August. It was not such a significant rise that officials became concerned, yet August usually has the lowest rates of respiratory illness reports for the year. Things were about to change drastically for the United States. In August of 1918, the Spanish flu hit three port cities at the same time: Boston, Massachusetts; Freetown, Sierra Leone; and Brest, France. In Boston, the flu surfaced on August 27th with 2 or 3 sailors reported to Commonwealth Pier with flu symptoms.

    The next day, there were 8 new cases: on the following day, 58. The authorities were informed that an epidemic was likely underway. The amount of flu cases was overwhelming for Commonwealth Pier’s medical facilities and they began to transfer cases to Chelsea Naval Hospital. Two weeks after the first appearance, 2,000 officers and men of the First Naval District had the flu. For the majority of people, the symptoms lasted for several days and then they recovered. But for the remaining 5 to 10 percent, severe pneumonia set in. By September 11, 95 cases of pneumonia had been or were being treated at Chelsea Naval Hospital.

    Thirty-five of these cases had died. The epidemic was moving too fast for authorities to handle. Lieutenant Junior Grade J. J. Keegan, who was a physician at Chelsea, stated that the flu “promises to spread rapidly across the entire country, attacking between 30-40 percent of the population and running an acute course in 4-6 weeks in each community. ” Evidence of Lt. Keegan’s prediction was piling up. On September 13, Surgeon General Rupert Blue of the United States Public Health Service (USPHS) issued advice to the press on how to recognized the flu and how to treat its symptoms.

    The next day, September 14, the Public Health Service of Massachusetts requested that more nurses be rushed to Boston from the national headquarters of the Red Cross. Within several days, the Red Cross received similar calls from throughout New England. But the disease was not slowing down. By September 20th, the army had gotten over 9,300 new cases of the flu since in first was recognized in the United States. The army was taking all the precautions it could in the transfer of men between camps but their efforts did very little to stop the spread. By September 23, the case number was over 20,000.

    At the end of September, the army personnel that became infected with the flu was over 50,000. Of that, over 1,100 had died of complications from the flu. There was no real way that the USPHS could grab statistics for civilian cases either. They knew that the Spanish flu was prevalent from New Hampshire to Virginia and there were scattered cases throughout the United States. The lack of information was a problem for the USPHS. Many physicians as well as laymen knew very little about the “Spanish flu” so the fullest information about influenza was broadcast nationwide, setting the stage for panic, confusion, and unhelpful home remedies.

    Organization was also a bit of an issue for the USPHS. Health organizations existed all over the country but in 1918, they had never truly united to combat a health crisis. The USPHS appointed a director to fight the influenza in every state. The director would control the USPHS personnel and all requests for aid went through him. But there was still a shortage of medical personnel, particularly nurses. That’s when the Red Cross became involved. Fifteen hundred nurses volunteered to help fight the Spanish flu. The Red Cross even called on those with no nursing experience to volunteer because they knew that 1,500 nurses was still not enough.

    By October 1st, when the Surgeon General made the request for more nurses, the Red Cross was on its way to filling it. Despite their efforts, the pandemic continued to spread. It quickly jumped from infecting military personnel to the civilian population. With many civilians now traveling by train, the Spanish flu moved across the United States following the railroads. The pandemic started in Massachusetts and made its way to Virginia. It then bypassed the Appalachians and made base in areas along inland waterways: Buffalo, Cleveland, Philadelphia, Detroit, Chicago, Minneapolis, St. Louis, Louisville, and New Orleans to name a few.

    At the same time, it seemed to skip over the Great Plains and Rockies, and settled in Los Angeles, San Francisco, and Seattle. With both coastlines securely infected with influenza, the disease then swept over the rest of America. To keep panic down, public health officials all over the country began to issue simple directives on how to protect oneself from the flu virus. Posters and cartoons were used to warn people of the dangers of influenza. Schools, saloons, and even churches were being forced to close in effort to stop public gatherings from causing further spread of the virus.

    Laws made to force people to wear masks as well as bans on spitting were put into place. There were even complete quarantines in some communities throughout the country. By November, two months after the pandemic hit the United States, the USPHS began to report that the Spanish flu cases were on the decline. Public places, like schools and churches, began to re-open. People discarded their masks and communities lifted their quarantines. The pandemic had ended by the summer of 1919. Nearly 675,000 Americans were dead from influenza.

    States, like Pennsylvania and Colorado, were among the hardest hit during the pandemic. Yet there is little in common between the two states to suggest why the pandemic was felt worse there. Research has been done in comparing larger cities for answers to what happened to the American people during the pandemic. In larger cities, it is likely that potential flu victims are packed together very tightly in comparison to the countryside. Immigration became a problem in the early 20th century with many people fleeing poverty-stricken lands like Eastern Europe.

    Many cities, like Philadelphia, packed their large, poor populations into urban ghettos. The housing situation was dreadful and many people could not avoid contact with one another. Immigrants were especially susceptible to the Spanish flu and, in Philadelphia, many of the immigrants lived in overcrowded slums. To make matters worse, many of the young men that had come to the United States, were nationalized and drafted into the army. As stated previously, the military were the most vulnerable to spreading the flu because of movement from base to base. Each city tried to deal with the pandemic in their own way.

    Philadelphia is one that stands out as it had the most severe experience of any city in the United States, yet the aspects of their pandemic were common to almost every city in the United States. ——————————————– [ 1 ]. The Merck Manual Home Health Handbook for Patients and Caregivers, “Influenza,” http://www. merckmanuals. com/home/infections/viral_infections/influenza. html? qt=&sc=&alt= [accessed November 1, 2012]. [ 2 ]. Byrne, Joseph P. ,ed. In Encyclopedia of Pestilence, Pandemics, and Plagues. [Santa Barbara, CA: Greenwood, 2008], under “Influenza,” http://ebooks. bc-clio. com/reader. aspx? isbn=9781573569590&id=GR4101-3531 [accessed November 4, 2012]. [ 3 ]. Centers for Disease Control and Prevention, “Seasonal Influenza (Flu)” http://www. cdc. gov/flu/about/disease/spread. htm [accessed November 1, 2012] [ 4 ]. Byrne, Joseph P. ,ed. In Encyclopedia of Pestilence, Pandemics, and Plagues. [Santa Barbara, CA: Greenwood, 2008], under “Influenza,” http://ebooks. abc-clio. com/reader. aspx? isbn=9781573569590&id=GR4101-3531 [accessed November 4, 2012]. [ 5 ]. Byrne, Joseph P. ,ed. In Encyclopedia of Pestilence, Pandemics, and Plagues. Santa Barbara, CA: Greenwood, 2008], under “Influenza,” http://ebooks. abc-clio. com/reader. aspx? isbn=9781573569590&id=GR4101-3531 [accessed November 4, 2012]. [ 6 ]. Barry, John M, “The site of origin of the 1918 influenza pandemic and its public health implications” Journal of Translational Medicine 2, no. 1 [January 2004] http://www. ncbi. nlm. nih. gov/pmc/articles/PMC340389/ [accessed November 1, 2012] [ 7 ]. Barry, John M, “The site of origin of the 1918 influenza pandemic and its public health implications” Journal of Translational Medicine 2, no. 1 [January 2004] http://www. ncbi. nlm. nih. ov/pmc/articles/PMC340389/ [accessed November 1, 2012] [ 8 ]. Barry, John M, “The site of origin of the 1918 influenza pandemic and its public health implications” Journal of Translational Medicine 2, no. 1 [January 2004] http://www. ncbi. nlm. nih. gov/pmc/articles/PMC340389/ [accessed November 1, 2012] [ 9 ]. Crosby, Alfred, Epidemic and Peace. [Conn. Greenwood Press, 1976], 27 [ 10 ]. Crosby, Epidemic and Peace. 29 [ 11 ]. Crosby. Epidemic and Peace. 29 [ 12 ]. Crosby. Epidemic and Peace. 30 [ 13 ]. Crosby. Epidemic and Peace. 32 [ 14 ]. Crosby. Epidemic and Peace. 32 [ 15 ]. Crosby. Epidemic and Peace. 39

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