Bacterial Pneumonia was not the novel danger of the "Spanish" flu; They cytokine storm it caused in perfectly healthy people was horrifying, with perfectly healthy people who would normally fight off any flu dying from this one. A lot of young twenty somethings, strong people who were not malnourished died from it.
Hell, people got cytokine storms from COVID-19 and we still can only treat it if we catch it really early, otherwise it's still a great way to die for a normal person.
To be fair. Seasonal flu usually induces secondary sickness (bacterial pneumonia) that causes mortality in the elderly and very young population.
Spanish flu wiped out the young and elderly but also the middle aged directly with things like cytokine storms. Something we are not seeing with Covid 19.
People keep comparing this to the Spanish flu, but there was a big difference between this and the Spanish flu: most people who died from Spanish flu actually died from bacterial infections and other complications. Back then, antibiotics weren't really a thing yet.
Primarily death was due to bacterial pneumonia, the cytokine storm likely accelerating the deterioration of the lungs. That particularly viral strain may have been more dangerous, but overall the current pandemic is comparable in death rates.
It would seem during the Spanish flu your best chance of survival was being in a location where strict quarantine and travel restrictions were imposed so the health system was able to cope with those who did contract the virus.
The places with the highest fatality rates were those with poor or non-existent health services or where people didn't seek medical assistance.
The mortality rate in the US was around 0.5%, <1% in East Asia, but 5% in India and as high as 20% in some Pacific nations. Iran's current Covid-19 mortality rate is quite comparable to the Spanish Flu around 14%.
Important to remember that older and immunocompromised people are not always the only vulnerable ones. The Spanish flu had an unusual mortality pattern of killing young adults [1]. It also had an overall morality rate around 2%, which caused multiple years of health catastrophe around the entire world. We don't have enough information to say whether COVID19 will match the characteristics of something like the Spanish flu, but the signs are ominous.
If they screw up other measures, like hygiene for the sick and food delivery to 50 million people they can multiply the death rate.
Modern theory of Spanish flu[1] is that the flu itself was not that deadly. Combination of influenza with bacteria in the lungs caused most of the deaths. It was the World War I with lots of wounded in the same place, bad hygiene conditions, many with scarred lungs from poison gas and civilians suffering from malnutrition.
> However, it is possible that — as in 1918 — a similar pattern of viral damage followed by bacterial invasion could unfold, say the authors. Preparations for diagnosing, treating and preventing bacterial pneumonia should be among highest priorities in influenza pandemic planning, they write. "We are encouraged by the fact that pandemic planners are already considering and implementing some of these actions," says Dr. Fauci.
Huge difference to Spanish Flu is that at that time we did not have antibiotics and most people did not die from the flu, but from pneumonia caused by a bacterial superinfection. Thanks to Alexander Fleming and other great researchers we can treat bacterial infections quite well now, so the corona virus would have to be a lot more lethal than the Spanish Flu to cause the same number of deaths.
On the Spanish Flu specifically, the evidence indicates most people who died were killed by secondary bacterial infection, not the virus itself[1]. This was the result of a combination of poor hygienic conditions and lack of antibiotics. Considering that, I think what we are witnessing with SARS-CoV-2 is about what the Spanish Flu would look like today.
That's a hypothesis. It is known that (supposedly) that strain can cause cytokine storm more than other flus do. I would not assume that means cytokine storm was the primary cause of death or even the primary cause of death in young adults. Based on my experience my guess is that the pneumonia was a much bigger cause of death than the storm
I was under the impression that the Spanish flu was very different from the regular flu and COVID-19, because it was the young/old people that survived it and the healthy 20-50 year old that died the most. Most people died of the Spanish Flu because of their immune response. It looks like COVID-19 is really mild* for lots of people in that age group.
Am I missing something? Did the Spanish flu start like COVID-19 and evolved later?
Differences in health systems and infrastructure also matter. The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perhaps most, were not caused by the influenza virus itself, but by secondary bacterial infections. Morens et al (2008) found that during the Spanish flu “the majority of deaths … likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria.
Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.
The flu regularly migrates between pigs, chickens and humans. Whenever it does, the poorly adapted flu is unusually lethal.
The misnamed Spanish flu seems to have killed by triggering a strong immune response. That response is called a cytokine storm. Which means that the stronger your immune system, the more likely you were to be hit hard. It therefore killed the reverse of the groups that normally get killed by diseases.
There is also some evidence that people who experienced the "Russian flu" of 1889-1890 had some level of protection from the Spanish flu.
When it was new, the "Spanish Flu" (influenza A subtype H1N1) killed as many people as covid killed in 2020, in a far younger, healthier population. Now people have immunity, so even though H1N1 is still around, it's not as deadly as it was in 1918.
So while it's true that covid was more deadly than influenza in 2020, that's not because covid is inherently more deadly, but simply because people weren't immune to it yet.
Now that we have a vaccine, and a significant number of people who've had the disease, covid death rates are much, much lower. Currently about 250 per day in the US, an annual rate of less than 100k per year, not much worse than the flu.
the 1918 flu pandemic caused a cytokine storm, which is hypothesized to have caused so many otherwise healthy people to die. if there's cytokine activity that's another parallel to the Spanish flu.
The information release so fare makes this look more like a bad flu with a 2.5% mortality rate, nothing like the Spanish Flu's 10%~20%. The Spanish Flu was also especially bad because it effected young adults disproportionately[1]. This caused massive problems because that was the age group of most care givers.
The Spanish flu really was very bad but would not have killed as many people if it occurred today. Malnutrition might have been a factor (though today's obesity rate might also be a problem) but the bigger thing was lack of antibiotics. Flu almost never kills you directly- it's the bacterial pneumonia you develop on top of it that does. Without antibiotics back then there would have been little they could do
Right I wasn't expressing the cytokine storm as the primary cause of death but rather a phenomenon that definitely pushed it above a normal flu, especially for healthy young adults.
Hell, people got cytokine storms from COVID-19 and we still can only treat it if we catch it really early, otherwise it's still a great way to die for a normal person.
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