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Paul Kiesel
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A Short History of the Great Swine Flu Epidemic

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Below is an excerpt from Bill Bryson’s A Short History of Nearly Everything (2003), briefly describing the Great Swine Flu epidemic of 1918 (sometimes called the Great Spanish Flu epidemic). The entire book is an exceptional read and in this chapter, A Small World, Bryson discusses a short history of germ theory, disease and other microscopic mysteries that I’m sure will leave you fascinated.

From Bill Bryson’s "A Short History of Nearly Everything":

It is sometimes called the Great Swine Flu epidemic and sometimes the Great Spanish Flu epidemic, but in either case it was ferocious. World War I killed twenty-one million people in four years; swine flu did the same in its first four months. Almost 80 percent of American casualties in the First World War came not from enemy fire, but from flu. In some units the mortality rate was as high as 80 percent.

Swine flu arose as a normal, nonlethal flu in the spring of 1918, but somehow over the following months — no one knows how or where — it mutated into something more severe. A fifth of victims suffered only mild symptoms, but the rest became gravely ill and often died. Some succumbed within hours; others held on for a few days.

In the United States, the first deaths were recorded among sailors in Boston in late August 1918, but the epidemic quickly spread to all parts of the country. Schools closed, public entertainments were shut down, people everywhere wore masks. It did little good. Between the autumn of 1918 and spring of the following year, 548,452 people died of the flu in America. The toll in Britain was 220,000, with similar numbers dead in France and Germany. No one knows the global toll, as records in the Third World were often poor, but was not less than 20 million and probably more like 50 million. Some estimates have put the global total as high as 100 million.

In an attempt to devise a vaccine, medical authorities conducted tests on volunteers at a military prison on Deer Island in Boston Harbor. The prisoners were promised pardons if they survived a battery of tests. These tests were rigorous to say the least. First the subjects were injected with infected lung tissue taken from the dead and then sprayed in the eyes, nose, and mouth with infectious aerosols. If they still failed to succumb, they had their throats swabbed with discharges taken from the sick and dying. If all else failed, they were require to sit open-mouthed while a gravely ill victim was helped to cough into their faces.

Out of — somewhat amazingly — three hundred men who volunteered, the doctors chose sixty-two for the tests. None contracted the flu — not one. The only person who did grow ill was the ward doctor, who swiftly died. The probably explanation for this is that the epidemic had passed through the prison a few weeks earlier and the volunteers, all of whom had survived that visitation, had a natural immunity.

Much about the 1918 flu is understood poorly or not at all. One mystery is how it erupted suddenly, all over, in places separated by oceans, mountain ranges, and other earthly impediments. A virus can survive for no more than a few hours outside a host body, so how could it appear in Madrid, Bombay, and Philadelphia all in the same week?

The probable answer is that it was incubated and spread by people who had only slight symptoms or none at all. Even in normal outbreaks, about 10 percent of people have the flu but are unaware of it because they experience no ill effects. And because they remain in circulation they tend to be the great spreaders of the disease.

That would account for the 1918 outbreak’s widespread distribution, but it still doesn’t explain how it managed to lay low for several months before erupting so explosively at more or less the same time all over. Even more mysterious is that it was primarily devastating to people in the prime of life. Flu normally is hardest on infants and the elderly, but in the 1918 outbreaks deaths were overwhelmingly among people in their twenties and thirties. Older people may have benefited from resistance gained from an earlier exposure to the same strain, but why the very young were similarly spared is unknown. The greatest mystery of all is why the 1918 flu was so ferociously deadly when most flus are not. We still have no idea.

From time to time certain strains of virus return. A disagreeable Russian virus known as H1N1 caused severe outbreaks over wide areas in 1933, then again in the 1950s, and yet again in the 1970s. Where it went in the meantime each time is uncertain. One suggestion is that viruses hid out unnoticed in populations of wild animals before trying their hand at a new generation of humans. No one can rule out the possibility that the Great Swine flu epidemic might once again rear its head [. . .]