Maybe a 1918 style flu pandemic could happen again - but not due to virulence of a new virus

[Emily]

https://academic.oup.com/milmed/article/181/8/878/4158345

Variable Mortality From the 1918?1919 Influenza Pandemic During Military Training





COL G. Dennis Shanks , MC USA (Ret.)*?; 1LT Steven Burroughs , IN USA?; ENS Joshua D. Sohn , MC USN?; LTC Norman C. Waters , MSC USA?; Virginia F. Smith , PhD?; Michael Waller , MSc?; COL John F. Brundage , MC USA (Ret.)∥

*Australian Army Malaria Institute, Gallipoli Barracks, Weary Dunlop Drive, Enoggera, QLD 4051, Australia.
?University of Queensland, 288 Herston Road, Centre for Australian Military and Veterans' Health, School of Population Health, Brisbane, QLD 2006, Australia.
?Department of Chemistry, US Military Academy, 646 Swift Road, West Point, NY 10996.
?Department of Chemistry, United States Naval Academy, 572M Holloway Road, MS-9B, Annapolis, MD 21402.
∥Armed Forces Health Surveillance Center (AFHSC), 11800 Tech Road, Suite 220, Silver Spring, MD 20904.


ABSTRACT
During the 1918?1919 pandemic, influenza mortality widely varied across populations and locations. Records of U.S. military members in mobilization camps (n = 40), military academies, and officer training schools were examined to document differences in influenza experiences during the fall 1918. During the fall?winter 1918?1919, mortality percentages were higher among soldiers in U.S. Army mobilization camps (0.34?4.3%) than among officer trainees (0?1.0%). Susceptibility to infection and clinical expressions of 1918 pandemic influenza varied largely based on host epidemiological characteristics rather than the inherent virulence of the virus.

[Gert van der Hoek]

Susceptibility to infection and clinical expressions of 1918 pandemic influenza varied largely based on host epidemiological characteristics rather than the inherent virulence of the virus.

Host factors often seem to be ignored when analysing an epidemic or pandemic.

Great find Emily!

[Emily]

I found one article about host factors from the 1918 pandemic era. Dr. Doty was the health officer of the Port of New York. He thought that stress and diet changes from the war had weakened even affluent people in the U.S. (His views about sugar and gluten are really interesting.) Also he thought crowding in military installations and the health care practitioner shortage among the general public were factors in poor outcomes. It's not that he thought that strain immunity was unimportant as far as who got sick, he just thought that it didn't explain the deaths:

http://query.nytimes.com/gst/abstract.html?res=9906E6DB1139E13ABC4E52DFB4668382609EDE&legacy=true

INFLUENZA EPIDEMIC AND LOW RESISTANCE; Dr. Alvah H. Doty

This second article about how well Sing Sing did is really interesting, too. They managed isolation of the sick well, but really focused on nutrition. They used quinine and aspirin as medications. I think quinine compounds today are used to control autoimmune illnesses, (caution: some people are extremely sensitive to quinine itself and can get uncontrolled bleeding from the small amount in tonic waters), so maybe the quinine helped temper the immune response:

http://query.nytimes.com/gst/abstract.html?res=9401E5D71139E13ABC4B51DFB4668382609EDE&legacy=true

SING SING HAD NO INFLUENZA DEATHS; All of the 106 Cases and 14 Pneumonia Patients Saved--Precautions and Treatment During Epidemic Infection from the Tombs.

[gsgs]

the most important factor is, where those people were during the first wave.

[Emily]

the most important factor is, where those people were during the first wave.

It sounds like they had a pretty stable population and very good health care and record-keeping at Sing Sing, gsgs. From the PDF:

"It was noted that not one of the 160 men who suffered an attack of the ordinary grippe in the early months of 1918, had influenza. The observation supports the opinion of Sir Henry Osler that influenza, or grippe, produces an immunity that lasts about 30 years."

The late 1918 case count of influenza at the prison was 106, (so a slightly smaller infection rate but maybe not statistically significant), with 14 of those cases complicated with pneumonia, but everyone made an "excellent" recovery, even without using modern antibiotics. They just seem to have had great doctors and care at that prison. Besides the quinine, aspirin and nutrition - rest was important. Fevers lasted 5-7 days only but rest was continued for 10 days.