Main contributor: Dr David Heffernan
Colorized transmission electron micrograph of influenza A/H1N1 virus particles (yellow). Influenza A/H1N1 can infect both humans and animals, including birds and pigs, and is one of several strains related to seasonal flu outbreaks.
Influenza A Virus (H1N1)

The Spanish Flu was a major pandemic which swept across the entire world between 1918 and 1920. Despite its name, it was recorded in the United States in the spring of 1918. The name ‘Spanish Flu’ came later on, as the media of Spain, a county that was not involved in the First World War, was the first national media system to report on the epidemic extensively. The Spanish Flu came and went in four successive waves across the world. It infected roughly half a billion people before it receded. Death tolls range from 20 to 100 million. The world was ravaged by war and pronounced famine/malnutrition were strongly present. Due to war and inaccurate demographic records there is a large range in these numbers. The period in the late 1910s and early 1920s is associated with mass migration in many parts of the world, though the extent to which this was caused by the Spanish Flu is debatable.[1]

Chronology of events of Spanish Flu

In early 1918 the world’s estimated population of 1.8 billion people was coming towards the end of a fourth full year of war and deprivation, the First World War, which had broken out in the late summer of 1914. Food rationing and poor living standards were taking their toll and borderline famine conditions prevailed in many countries. It was into this scenario that the Spanish Flu arrived, with the first recorded cases occurring in a military hospital, Camp Funston, in Kansas in the United States in March 1918.[2]

Disease Origins

Camp Funston, at Fort Riley, Kansas, during the 1918 Spanish flu pandemic
Camp Funston in Kansas

The disease was a novel type of influenza of an avian or bird origin. Because it was new to peoples’ systems they had limited immunity to it and the wartime conditions would make people more susceptible to its deleterious effects. The symptoms were similar to those of other types of influenza, just more severe. They included acute fevers and coughs, head and body aches, a sore throat, runny nose and a loss of appetite, with corollary symptoms over time such as dehydration and extreme fatigue. One particularly deadly aspect of the Spanish Flu was that it created an almost pneumonia-like condition in some patients early on and this was responsible for much of its lethality.[3]

Disease spread

After the initial confirmed outbreak in Kansas, the disease spread incredibly quickly. This was owing to the war as well, as soldiers, nurses, suppliers and other military officials and attendants were being shipped overseas and moved large distances within countries at all times bringing the disease with them. Then they were confined to cramped barracks, trenches and hospitals for days or weeks on end, conditions which are optimum for disease spread. By the summer of 1918 the disease was most prevalent in Europe. While most national newspapers in countries like Britain and France were preoccupied with reporting on the war in France as breakthroughs against the German lines seemed imminent, in neutral Spain reporters were more concerned about the new disease outbreak and reported extensively on it. This, combined with King Alfonso XIII’s falling ill with it in Madrid, meant that Spain became associated in many people’s minds with the disease. It consequently became erroneously known as the Spanish Flu, even though there was nothing to suggest Spain as an origin site of it.[4]

Disease waves and final result

Montage of photos made during the Russian Civil War (1917-23).
Russian Civil War

Four successive waves of the disease followed, not unlike the Covid-19 pandemic which mirrored the Spanish Flu in many significant ways. These occurred between the spring of 1918 and the end of 1920 and impacted on events in the wider world. For instance, the peace negotiations at Versailles in 1919 were interrupted when leading delegates fell ill. By the time all was said and done anywhere between and 20 and 100 million people may have died from the Spanish Flu pandemic. It is difficult to say with precision as some of the deaths in these years were owing to famines and malnutrition, as well as conflicts which followed from the end of the First World War, such as the Russian Civil War and the Greco-Turkish War. [5]Such was the level of fatalities during these conflicts that people were simply buried when dead and their cause of death was often not properly recorded or even understood.

Extent of migration following the Spanish Flu

The period from 1918 through to the mid-1920s was characterized by mass migration in many parts of the world. Some of this was people returning home after the wars. Some of it was workers in search of economic opportunity after being decommissioned from military service. Some of it was brought about by people crossing borders to relocate to new nation states in line with their religion or ethnicity. And some of it was people fleeing political persecution as new countries and ideological regimes emerged. It really is impossible to tell where the pandemic might have impacted on this. It may have had a role to play. For instance, millions of people moved from the southern states of the United States to northern industrial cities like Pittsburgh, Chicago and Detroit in the early twentieth century in search of work, a process known as the Great Migration. Perhaps at least a small proportion of those who did so, in the late 1910s and into the 1920s, were people who had lost loved ones and family during the pandemic and wanted a fresh start in a new environment.[6]

Demographic impact of the Spanish Flu

The lasting demographic impact of the Spanish Flu was in killing upwards of 100 million people. This constituted roughly 6% of the world’s population at the time.[7] Given natural population increase over time, the world’s population would possibly be substantially larger than the over eight billion it stands at right now had the Spanish Flu not impacted on the world, perhaps 300 to 400 million people larger. This would have been felt to a larger extent in some countries than others. For instance, approximately 675,000 people died from the pandemic, also known today as the Purple Flu, in the United States. Much of this came about in cramped, poor immigrant communities in cities like New York and Boston. Many people may have lost an ancestor in such a way just years or months after they arrived to the US in the great waves of migration that occurred there in the late nineteenth and early twentieth centuries.[1]

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