Economist, Sept 29, 2018 (II)

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Pandemic disease | A Deadly Touch of Flu; The next few months mark the 100th anniversary of the peak of the 20th century's most deadly catastrophe: neither a war nor a genocidal ideology, but a plague.

Quote:

"ON JUNE 29TH 1918 Martín Salazar, Spain's inspector-general of health, stood up in front of the Royal Academy of Medicine in Madrid. He declared, not without embarrassment, that the disease which was ravaging his country was to be found nowhere else in Europe.  In fact, that was not true. The illness in question, influenza, had been sowing misery in France and Britain for weeks, and in America for longer, but Salazar did not know this because the governments of those countries, a group then at war with Germany and its allies, had made strenuous efforts to suppress such potentially morale-damaging news. Spain, by contrast, was neutral, and the press had freely reported on the epidemic since the first cases had appeared in the capital in May. Before the summer was out, the disease Spaniards knew as the 'Naples soldier' -- after a tune from a popular operetta -- had been dubbed the 'Spanish illness' abroad, and that, somewhat unfairly, was the name which stuck.  Spanish flu was probably the worst catastrophe of the 20th century. The current estimate is that it killed at least 50m people and perhaps as many as 100m. At minimum, therefore, it ended the lives of three times as many as died in the first world war (in the region of 17m). It was probably also more lethal than the second world war (60m), and may well have outstripped the effects of both wars out together. The death toll was so high partly because Spanish flu was truly pandemic (some 500m people, more than a quarter of those then alive, are believed to have been infected), and partly because of its high mortality rate (5-10%, compared with 0.1% for subsequent influenza epidemics).

"The actual cause of death in most cases was pneumonia brought on by opportunistic bacteria [ie, bacterial, not viral, pneumonia]. This made the diagnosis complicated -- for in 1918 the concept of a 'virus' was a newish one. Most of the world's doctors therefore thought they were dealing with a bacterial infection. The 1918 influenza thus appears in historical records under a kaleidoscope of labels ranging from common cold to pneumonic plague [plague 黑死病, caused by one bacteria, has three forms: bubonic (swelling of lymph nodes), septicemic (patient turns black and die) and pneumonic (short of breath, cough and chest pain)] . That is one reason why estimating the death toll accurately is hard.  At the molecular level, the explanation for the virulence of the Spanish flu remains unknown.