Why the Second Wave of the 1918 Spanish Flu Was So Bloody

Why the Second Wave of the 1918 Spanish Flu Was So Bloody

People are so ready to get back to life, forgetting that in 1918 the second wave of the Spanish Flu reportedly killed 20-50 million. The first wave only killed 3-5 million. History does indeed repeat.

The horrific scale of the 1918 influenza pandemic—known as the “Spanish flu”—is hard to fathom. The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims—that’s more than all of the soldiers and civilians died during World War I consolidated. 

While the global pandemic lasted for twenty-four months, a significant amount of deaths were packed into three exceptionally rough months in the autumn of 1918. Annalists now accept that the deadly sharpness of the Spanish Flu’s “second wave” was caused by a mutated virus dispersed by wartime company actions.

When the Spanish Flu first appeared in early March 1918, it had all the hallmarks of the seasonal Flu, albeit a profoundly transmissible, infectious contagious, dangerous, and destructive strain. One of the first recorded cases was Albert Gitchell, a U.S. Army cook at Camp Funston in Kansas, who was hospitalized with a 104-degree fever. The virus expanded swiftly through the Army base, home to 54,000 troops. By the end of the month, 1,100 soldiers had been hospitalized, and 38 had fallen after contracting pneumonia.

As U.S. troops stationed en masse for the war effort in Europe, they carried the Spanish Flu with them. Throughout April and May of 1918, the virus flowed like wildfire through England, France, Spain, and Italy. A predicted three-quarter of the French military was tainted in the spring of 1918 and as many as half of British troops. Yet the first wave of the virus didn’t appear to be particularly deadly, with symptoms like high fever and malaise usually lasting only three days. According to restricted public health data from the time, fatality rates were related to annual Flu.

Historians believe that the fast spread of Spanish Flu in the fall of 1918 was somewhat to impute on public health officials opposed to imposing quarantines during wartime. In Britain, for example, a government official named Arthur Newsholme understood full well that a strict private lockdown was the most reliable way to fight the scope of the profoundly infectious virus. But he wouldn’t jeopardize damaging the battle manufacturers by keeping munitions industry artisans and other noncombatants homely.

According to many researchers, “the constant needs of warfare proved to incur [the] risk of spreading disease” and encouraged Britons to “carry on” during the pandemic.

A severe nursing shortage further thwarted the public health answer to the crisis in the United States as thousands of nurses had been deployed to military camps and the front lines. The deficit was worsened by the American Red Cross’s refusal to use trained African American nurses until the worst of the pandemic had already passed.

1918 Pandemic (H1N1 virus)

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The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is no universal consensus regarding where the virus originated, it spread worldwide from 1918-1919.  In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.

Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

Advancing Veterinary Care: Cancer Care

Talking canine cancer awareness with UMN

jaime modiano Talking canine cancer awareness with UMN
Credit: Liz Banfield

Hemangiosarcoma is a highly invasive type of cancer that grows rapidly. It primarily forms in dogs, but can also develop in humans and other animals.

Jaime Modiano with the University of Minnesota College of Veterinary Medicine and Masonic Cancer Center answers questions about what hemangiosarcoma is, the current standard of care, and the implications his cancer research has for veterinary and human medicine.

Q: What is hemangiosarcoma?
Dr. Modiano: Few canine cancers are deadlier than hemangiosarcoma, a cancer of blood vessel-forming cells. This cancer is unpredictable, develops painlessly and is often advanced by the time it is discovered. Severe internal bleeding and sudden death occur frequently and unexpectedly with this disease. A dog’s breed, age, gender, diet and environment do not impact the progression of this cancer.

Q: What is the survival rate for dogs with hemangiosarcoma?
Dr. Modiano: Hemangiosarcoma is most common in older dogs; more than half of the dogs that develop hemangiosarcoma are over 10 years old. Without treatment, the probability of survival can range from days to a few weeks. With treatment, the expected survival is four to six months, though this depends on the tumor’s location. Despite the aggressive nature of the disease, about five to 15 percent of dogs with hemangiosarcoma may survive a year or longer.

Q: What is the current standard of care for dogs with hemangiosarcoma?
Dr. Modiano: The standard of care is surgical removal of accessible tumors — depending on the location — followed by chemotherapy. Treatment is meant to prevent fatal blood loss and to extend life, but is seldom curative. Chemotherapy delays the recurrence of metastasis, which occurs in virtually every dog diagnosed with this cancer. The combination of surgery and chemotherapy is the only approach that has repeatedly shown to be effective. I strongly recommend owners pursue treatment options based on objective data and not on anecdotal information that creates false hope and unrealistic expectations by the pet owners and their veterinarians.

Q: How might research about hemangiosarcoma impact human medicine?
Dr. Modiano: There are many similarities between human and dog cancers — they arise spontaneously in both species, and, in some form, cancer will affect between 25 to 35 percent of both populations. Cancer is the major cause of disease-related mortality in dogs, as it is in humans in an increasing number of countries. Dogs can help us understand the lifelong impact of new strategies to diagnose, prevent and treat cancer  because their lives are measured in the span of about a decade. As we develop tests for early detection that can be paired with new drugs for active, targeted prevention, success in dogs would provide an impetus for, and confidence in, further developing these approaches to assign cancer risk, and to use preventative strategies in humans. 

Q: What are you and your team doing to reduce the impact of hemangiosarcoma?
Dr. Modiano: The Shine On Project at the University of Minnesota College of Veterinary Medicine is following over 200 healthy dogs at risk for developing hemangiosarcoma. The goal is to evaluate the use of a novel blood test to assign a level of risk to each of these dogs. Dogs that are at a high risk are eligible to receive eBAT — a promising drug developed at the University of Minnesota — as a preventative tool. eBAT is unique because it can kill the emerging cancer cells and irreparably damage the environment they need before they have a chance to form a tumor. An added advantage to eBAT is that it is exceptionally safe.

Our approach of detecting hemangiosarcoma early on through The Shine On Project and then combating it with eBAT is something our team now looks to apply to other types of cancer — most notably, osteosarcoma. Rather than curing dogs that already have cancer, we set ourselves apart by detecting it early and fighting it with specific, customized treatments, as we have done with the Shine On Project and our use of eBAT.

Jaime Modiano is the Alvin and June Perlman Professor of Oncology and Comparative Medicine in the University of Minnesota College of Veterinary Medicine and a Masonic Cancer Center member. His areas of expertise include cancer and immunology research.

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