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The 1918 flu pandemic, commonly referred to as the Spanish flu, was a Category 5 influenza pandemic caused by an unusually severe and deadly Influenza A Virus Strain of subtype H1N1 . Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The Spanish flu pandemic lasted from 1918 to 1919. Older estimates say it killed 40–50 million people1 while current estimates say 50 million to 100 million people worldwide were killed.2 This pandemic has been described as "the greatest medical holocaust in history" and may have killed as many people as the Black Death .3 This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by Cytokine Storm s. Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, Cholera , or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and Petechial Hemorrhages in the skin also occurred." The majority of deaths were from Bacterial Pneumonia , a Secondary Infection caused by influenza, but the virus also killed people directly, causing massive Hemorrhages and Edema in the lung.4 The 1918 flu pandemic was truly global, spreading even to the Arctic and remote Pacific islands. The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic Mortality Rate of 0.1%. Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.5 This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70). The total mortality of the 1918–1919 pandemic is not known, but it is estimated that 2.5% to 5% of the world's population was killed. As many as 25 million may have been killed in the first 25 weeks; in contrast, HIV/AIDS has killed 25 million in its first 25 years. The disease was first observed at came to call it the Spanish Flu, primarily because the pandemic received greater press attention in Spain than in the rest of the world, as Spain was not involved in the war and had not imposed wartime Censorship . Scientists have used tissue samples from frozen victims to reproduce the virus for study. {Link without Title} Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a Cytokine Storm , which explains its unusually severe nature and the unusual age profile of its victims. HISTORY The global Mortality Rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 – 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25 million in its first 25 weeks; in contrast, AIDS killed 25 million in its first 25 years. Some estimates put the total killed at over twice that number, possibly even 100 million. An estimated 17 million died in India , about 5% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it. In the U.S. , about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. Entire villages perished in Alaska and Southern Africa . In Australia an estimated 12,000 people died and in the Fiji Islands , 14% of the population died during only two weeks, and in Western Samoa 22%. While World War I did not cause the flu, the close quarters and mass movement of troops quickened its spread. Researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease. A large factor in the spread of the disease was the increased amount of travel. The modernization of transportation made it easier for sailors to spread the disease more quickly and to a wider range of communities. Patterns of fatality The influenza Strain was unusual in that this pandemic killed many young adults and otherwise healthy victims - typical influenzas kill mostly infants (aged 0-2 years), the old, and the Immunocompromise d. Another oddity was that this influenza outbreak struck hardest in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months. People without symptoms could be struck suddenly and within hours be too feeble to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable Hemorrhaging that filled the Lungs , and patients drowned in their body fluids. In fast-progressing cases, mortality was primarily from Pneumonia , by virus-induced Consolidation . Slower-progressing cases featured secondary bacterial pneumonias, and there may have been Neural involvement that led to Mental Disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities. Devastated communities While in most places less than one-third of the population was infected, only a small percentage of whom died, in a number of towns in several countries entire populations were wiped out. Even in areas where mortality was low, those incapacitated by the illness were often so numerous as to bring much of everyday life to a stop. Some communities closed all stores or required customers not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by Steam Shovel and bodies buried without coffins in many places. Unaffected Locales In Japan , 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck. The only sizeable inhabited place with no documented outbreak of the flu in 1918–1919 was the island of Marajó at the mouth of the Amazon River in Brazil . In the Pacific, American Samoa Influenza of 1918 (Spanish Flu) and the US Navy and the French colony of New Caledonia |
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