** Remaking of the world's worst flu"*

Just some of the 1918 flu victims.

Molecular pathologists gave the world some scary news on Wednesday. They said the strain of "bird flu" that has now killed more than 140 million birds in Asia is changing in ways that make it more like the "Spanish flu" that killed more than 20 million people in 1918 and 1919--in the deadliest pandemic since the Middle Ages' Black Death.

How do they know? Because of some even scarier research. Pathologists, led by Dr. Jeffery Taubenberger of the U.S. Armed Forces Institute of Pathology, actually reconstructed the virus that caused the Spanish flu. It took a decade, a high-security lab at the Centers for Disease Control and Prevention, and lung tissue from three of the Spanish flu's many victims, but they did it. If animal experiments are any indication, the reconstructed virus is as lethal as the original.

Study of the reconstructed virus suggests the Spanish flu was once a bird virus, too--one that mutated and jumped directly to human hosts. Researchers hope that studying the reconstructed virus will help them fight today's bird flu should it make the same jump. Here at KnowledgeNews, we're looking back to 1918, to see what experts fear most.

The Deadliest Flu Ever


In 1918 and 1919, nearly one-fifth of the world's population caught the flu. And not just any flu--the deadliest flu ever, one of the worst pandemics in human history.

Before it was over, 2 to 3 percent of those infected had died. That's at least 20 million people worldwide, more than twice the number killed in all of brutal World War I.

Swift and Fatal

Military bases served as incubators for the virus, in America and Europe especially. In fact, a huge number of casualties in World War I came from the flu, rather than from enemy fire. Within months, following troop movements and trade routes, the virus had traveled around the world.

The illness was so fast and so deadly that doctors couldn't even believe it was influenza. It wasn't like any flu they had seen before. A patient who started to feel under the weather on Monday was often dead by Wednesday. Many patients turned a blue-gray hue, as fluid built up in their lungs. "It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate," reported a doctor at a military base near Boston. "It is horrible."

Even worse, this virus devastated people for whom flu is normally just an inconvenience. Healthy men and women in their twenties, thirties, and forties were dropping dead on the street on their way to work or the market. How could this be the flu? Some even speculated it was a plot by the Germans, or a side effect of the mustard gas used during World War I.

Dramatic Mutation

But it was the flu--a horrible new strain, but just the flu. Every few decades, the flu virus, which mutates at least a little bit every year, undergoes a dramatic change. This new virus is especially dangerous because no one has built up an immunity to it. The virus of 1918-19, from the time it likely got started in Asia, was this kind, different enough from previous strains that few people were immune.

Because flu spreads through the air, it was also frighteningly easy to get infected. All you had to do was breathe the air that a sick person had just coughed or sneezed into. The most dangerous place you could be was in a crowd.

Unfortunately, it was hard to avoid crowds in 1918. Hundreds of thousands of soldiers were being packed into barracks and onto troop ships. And huge military parades and war-bond rallies helped the virus make the leap from soldiers to the civilian population.

Flu Crosses the Nation

By autumn of 1918, life in big cities had become nightmarish. In one month--October 1918--nearly 200,000 Americans died from flu. Medical care was hard to come by, because so many doctors and nurses had been dispatched to Europe to care for the troops (and because many of those who stayed got sick, too). Churches, theaters, and taverns closed. In some cities, even funerals were limited to 15 minutes.

When one person in a family got sick, the flu usually spread to everyone else in the house. Volunteer nurses, arriving with broth and clean sheets, were seen as saviors by people too ill or too poor to get to a doctor. "In some cases," a New York City nurse wrote, "the nurses were even locked in the house by the patient's friends, or kidnapped on their rounds, so panic-stricken had people become."

The East Coast was ravaged in September 1918, and it took only a few weeks for the epidemic to spread to the West. In San Francisco and Seattle, wearing gauze masks was required by law. In Prescott, Arizona, the town council made it illegal to shake hands. Other towns quarantined themselves, forbidding trains from stopping, only to fall ill when they welcomed the postman. On the playground, children had a new jump-rope rhyme:

I had a little bird, and its name was Enza
I opened the window, and in-flew-Enza.

It's a Small World

By the time it had run its course, the 1918-19 flu had killed more than half a million Americans. Beyond the United States, the death toll was even more appalling. What Americans called the "Spanish flu" (incorrectly believing that was where it started) cropped up all over the world.

Germany, France, and the United Kingdom each lost at least 200,000 civilians between June 1918 and May 1919. More than a half a million Italians died. In poorer and more densely populated areas, the death toll was catastrophic. In parts of Mexico, more than 10 percent of the population perished. On South Pacific islands, more than 20 percent did. In India, at least 12 million people died from flu.

The death toll for the whole world is difficult to know, but the most conservative estimate is that 20 million people died. Many researchers double that number, and some go so far as to say that the death toll could have reached 50 million.

The 1918-19 pandemic was extreme, but not unprecedented. The World Health Organization has records showing that there have been 31 documented influenza pandemics since 1580, most recently in 1968-69. And medical experts say we're overdue for another devastating flu.

~ Colleen Kelly
October 6, 2005
Knowledge News