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What will happen if the Spanish flu breaks out now? We all will die?

  • Rachel Nuwer
  • BBC Future

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100 years ago, the so-called Spanish flu, the «Spanish flu», swept through the world with a deadly scythe, claiming about 100 million lives. Scientists believe that sooner or later people will have to deal with a similar strain of this disease. What will happen then? Will the achievements of modern medicine help us?

It began almost exactly a century ago, and at first the seasonal incidence of influenza did not cause much concern. Most of those who had been ill in the spring recovered fairly quickly, and the death rate was no higher than usual.

The headlines of the then newspapers were dominated by news from the battlefields of the First World War, and not at all by reports of the flu. But autumn came and everything changed.

The virus, previously no different from the flu viruses of yesteryear, suddenly mutated into an extremely virulent strain and began its deadly march across North America and Europe.

Once infected, people sometimes died after a few hours, at best — days.

In just four months, the Spanish flu (as the disease was called) has spread throughout the world, from Barcelona to Cape Town, from Alaska to Australia, reaching the most remote and seemingly isolated settlements. («Spanish flu» infected about 550 million people, or 29.5% of the world’s population. — Translator’s note .)

The Spanish flu pandemic began to subside by the next spring, but by then, according to various estimates, it had claimed the lives of 50 up to 100 million people, that is, approximately 5% of the total population of the globe.

  • War on superbugs: it’s time to sound the alarm
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  • The Spooky Secrets of the Killer Spanish Flu

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We quickly, simply and clearly explain what happened, why it’s important and what’s next.

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A century later, the 1918 pandemic looks like the script for a horror movie, or something very distant, like medieval outbreaks of bubonic plague, smallpox and other deadly diseases that are now completely (or almost completely) eradicated.

However, the flu (influenza) does not even think of leaving us — every year from 250 thousand to 500 thousand people die from it.

Every year we encounter a slightly different strain of the seasonal influenza virus, but pandemics (epidemics that cover the entire territory of a country or continent) can also develop from different animal viruses.

Already after 1918, the world suffered quite serious pandemics in 1957, 1968, 1977 and 2009.

Given the propensity of this virus to mutate and its constant presence in nature (for example, in wild waterfowl), experts agree that the appearance of a strain as infectious and deadly as the «Spanish flu» (or even worse) is just a matter of time.

«Influenza pandemics are like volcanic eruptions, hurricanes or tsunamis: they just happen, and some of them are worse than others,» says Michael Osterholm, director of the Center for Infectious Disease Research at the University of Minnesota (USA). nothing like the events of 19 can happen18 years old, just stupid.»

But when exactly this will happen, he continues, it is impossible to foresee: «All we know is that it can start at any moment — for example, now, when we are talking with you. »

It’s also impossible to foresee how events will unfold if a pandemic with a virus like the Spanish flu breaks out — but we can make some educated guesses. were the ideal breeding ground for the «Spanish flu»

The first thing to say is that the effectiveness of the virus will depend on how quickly we respond to the outbreak and whether we can contain it at an early stage, said Robert Webster of the Department of Infectious Diseases at the St. Jude Thaddeus Children’s Hospital in Memphis, USA.

Early detection systems have been developed and are in place for this: for example, the World Health Organization’s Influenza Surveillance Team monitors the evolution of the disease in six major laboratories around the world, and additional agricultural laboratories monitor what happens to poultry and livestock.

«Our surveillance system may be good, but we can’t track every chicken and every pig in the world — it’s just not possible,» says Webster. «We’ll need a fair degree of luck to catch an epidemic early.»

The reality, he says, is that the virus will almost certainly begin to spread.

And when this happens, the whole world will be infected — most likely within a few weeks, given the current degree of population mobility.

«Influenza is one of those viruses that, as soon as it enters a susceptible environment, immediately gives rise to an outbreak,» said Gerardo Chowell, professor of epidemiology and biostatistics at the University of Georgia. — An infected person begins to spread the virus the day before, How does he develop symptoms?

Since the number of people on the planet has more than quadrupled over the past century, it can be assumed that there will be respectively more infected and dead than 1918 year.

If 100 years ago a virus killed 50 million, today we can expect more than 200 million deaths. «We simply won’t have enough body bags — they will run out very quickly. »

Image copyright, Getty Images

Photo caption,

It’s vital to isolate those who are infected — but how do you do that in today’s densely populated world?

As history shows, mortality on the planet will be unevenly distributed. During the Spanish flu pandemic, it was 30 times higher in some countries than in others.

For example, in India, the virus claimed the lives of 8% of the population, and in Denmark — less than 1%. Something similar happened in 2009 during the h2N1 virus pandemic: about 10 times more people died in Mexico than in France.

Experts believe that such inequalities are predetermined by many factors, including the genetic vulnerability of certain ethnic groups or, say, whether the population had a similar flu before.

For example, the Maori people, the indigenous people of New Zealand, at 19In 2018, people were seven times more likely to die from the Spanish flu than the world’s average population.

Other factors such as sanitation and hygiene, the level of development and the availability of health services also play an important role, Chowell says. «In 2009, in Mexico, many people went to hospitals for help already at such a stage of the disease that it was already too late,» he emphasizes.

For many victims of the virus, it was an economic decision: going to the doctor meant missing a day of work and losing pay.

«I’m not saying it applies to every Mexican, but it was true for the most vulnerable populations,» says Chowell.

If a pandemic breaks out in the US or other countries with no public health care, this socioeconomic pattern of behavior will almost certainly prevail among the underprivileged.

To avoid high medical bills, those without health insurance will wait until the last minute without seeing a doctor, and at some point in time it will be too late.

Image copyright, Getty Images

Image caption,

By the time flu symptoms become apparent, a person has been carrying the virus for at least a day and is spreading the virus

«We’ve seen this in outbreaks of other infectious diseases,» adds Chowell.

The best way to stop a pandemic is a vaccine, says Lone Simonsen, an epidemiologist at Roskilde University in Denmark and George Washington University in the US.

But to do this, you first need to identify what kind of virus it is, create a vaccine and then deliver it to all countries of the world — all this is easier said than done.

Antiviral influenza vaccines (which didn’t even exist until the 1940s) are now being created fairly quickly, but still the process takes several months.

And even if we succeed in developing such a drug, it will be absolutely impossible to produce enough doses for everyone, emphasizes Osterholm.

«Worldwide, only 1-2% of the population will have access to the vaccine in the first 6-9 months,» he says.

At the same time, Osterholm adds, one should not forget that the effectiveness of the current seasonal flu vaccines is at best 60%.

In addition, while we have flu medicines like Tamiflu, we don’t have the stocks we need in case of a pandemic.

«Today we don’t have enough antivirals even in the richest country in the world, the United States,» Chowell points out. «Then what can we expect from India, China or Mexico?»

If all this is not enough, then here’s another thing for you: the flu medicines that we now have are less effective than medicines for other diseases — primarily because the world is used to viewing seasonal flu as a rather ordinary, harmless sick, says Webster.

Image copyright, Getty Images

Image caption,

Governments will have to allocate huge financial resources to fight the «new Spanish flu»

«Something serious, like the HIV pandemic, is needed for the scientific community to pay more attention to the disease.»

All things considered, hospitals will fill up very quickly, says Osterholm, and medicines and vaccines will run out almost immediately.

«Here in the US, we’ve already overwhelmed the healthcare system with the usual seasonal flu, and this year hasn’t offered anything particularly unusual in that regard,» he notes. «.

Same as 19On the 18th, as soon as the number of cases and the number of deaths increase, life will simply stop in cities around the world.

Offices and schools will close, public transport will stop working, electricity may go out, and there will be more and more dead bodies on the streets.

Food will soon be in short supply — as well as medicines, which are critically needed for diseases such as diabetes, various cardiovascular diseases, etc.

“If the result of a pandemic is to disrupt the production and delivery of these drugs, people will just start dying,” says Osterholm. “Collateral damage from a pandemic like the one that happened in 19

Even when the virus pandemic fizzles out on its own, its effect may be long-lasting.

Thus, a very important part of the able-bodied population was destroyed. Many children were orphaned. Families were left without a breadwinner.0011

Image copyright, Getty Images

Image caption,

If a deadly epidemic breaks out, there will be a huge problem of burying all the dead.

Scientists realized this only in 2005, when researchers managed to reconstruct the Spanish flu virus from the tissues of an Inuit woman who died from it in the settlement of Brevig Mission in Alaska, where 72 out of 80 residents died in less than a week.

One of the bodies was preserved in the permafrost — well enough for microbiologists to find the genes of the virus in the lungs.

During experiments on animals using recreated viruses, scientists have found that the 1918 influenza virus strain develops incredibly quickly and aggressively in the body. This triggers a natural (and potentially lethal) immune response called a cytokine storm.

The body, in response to infection with a virus, begins to produce cytokines in large quantities — chemical compounds that should destroy the invading enemy.

But cytokines themselves are toxic — they cause pain (in the joints, etc.) during the flu, and when there are too many of them, this leads to a stoppage of the organs and death of a person.

Because a healthy adult’s immune system is stronger than that of a child or an old person, it responded to the invading virus with a more powerful release of cytokines, the researchers say — so powerful and indiscriminate that the entire body died.

«We finally figured out why the virus was so pathogenic,» says Webster. «The body was basically killing itself.»

Decades after the Spanish flu, researchers have developed various immunomodulators to help deal with cytokine storms. However, these drugs are not perfect and are not freely available.

«We’re not much better at dealing with cytokine storms now than we were in 1918,» Osterholm points out. very, very weak.»

Image copyright, Getty Images

Image caption,

If a pandemic of a virus like the Spanish flu breaks out, all the achievements of civilization that we used to rely on in everyday life will quickly stop working, and the shelves will be empty

This means that, as in 1918, we are likely to see a huge number of victims among young adults and middle-aged people.

And because life expectancy today is decades longer than it was a century ago, the death of these particular populations would be even more detrimental to the economy and society, says Chowell.

But amid this darkness, there is a ray of hope for salvation — the universal flu vaccine.

Significant financial resources have finally been allocated to this, and efforts to create such a breakthrough vaccine against any influenza are gaining momentum.

But we can only wait and hope that it will be created in time — before a new deadly pandemic breaks out on the planet.

«Research is in its early stages, so let’s hope we have a universal vaccine before this hypothetical scary virus comes along,» says Webster. «But we’re not ready at the moment.»

Read the original English version of this article at BBC Future .

The most important epidemics in the history of mankind — Picture of the day — Kommersant

«Plague of the Antonines» (3rd century AD) in the Mediterranean world

Most likely, it was an epidemic of smallpox. It was the result of contacts between the civilization of the Mediterranean (Rome) and the Indian civilization. In parallel with it, the same epidemic broke out in China. It also became a consequence of the contacts of civilizations — between China and India. For the population of the West and the Far East, this was a «new disease». She was not immune. Therefore, the consequences were severe.

The «Plague of the Antonines» led to the depopulation of the Roman Empire. The price of physical labor has risen sharply. Slavery became ineffective. There were not enough resources to hold back the onslaught of the barbarians. The empire was crumbling. The horror of the epidemic and widespread panic led to a weakening of faith in the old gods. Against this background, there was a natural spread of Christianity, which became the «religion of salvation» in this large region. Christians were not afraid of death, performed merciful deeds, cared for the dying, built hospitals. This was an important factor in the subsequent official recognition of Christianity as the official religion in the Mediterranean world. The same situation took place at the same time in China, where Buddhism, another «religion of salvation», spread.

The consequences of that epidemic were enormous. The Roman Empire collapsed in the West. The Han Empire collapsed in the Far East. There were «religions of salvation» — Christianity and Buddhism. At the turn of the 3rd and 4th centuries A.D. e. in the Mediterranean (Western) world and the Far Eastern (Chinese) world, a new type of social organization began to build — the church (community of believers). In the West society became Christian in a short period of time, in the Far East — Buddhist. In general, the response to this global epidemic in the two main regions of the world has been the strengthening of religiosity. There have been profound changes in morality.

Plague of Justinian, 6th century AD e. in the Middle East

It is generally accepted that this was the first bubonic plague pandemic. We know that it became the highest manifestation of the crisis of the Byzantine Empire. It was preceded by long years of war between Byzantium and Persia, famine. Both empires suffered from the plague. The dream of the Byzantine emperor to revive Rome failed. Huge territories in the Eastern Mediterranean, Asia Minor and North Africa were depopulated. A political and demographic vacuum formed, which was filled by Islam. The historical consequence of the plague was the emergence of an Arab state and Islam as a world religion.

The Black Death of the 14th century

The second bubonic plague pandemic. China and Western Christendom suffered from it. The exact causes are still unknown. I adhere to the hypothesis that it was the result of the revival of contacts between the civilizations of the West and the Far East. These contacts were interrupted after the 3rd century AD. e. The population of Europe, like the population of China, was not familiar with this disease. It was the «new disease». After the Mongol conquest and the creation of the transcontinental Mongol empire, the Silk Road was revived, trade over long distances intensified. Natural foci of plague (zoonoses) are scattered across the Eurasian steppes — from Mongolia to Ukraine. The infection has also spread to China and Europe. The consequences were dire. Numerous foci of plague formed in Europe. Rodents became carriers of the disease. With the growing number of cities, unsanitary conditions, constant wars in Europe, plague epidemics did not stop for another three centuries.

Smallpox and other infections in America in the 16th century

The discovery of the New World was accompanied by the introduction of smallpox and other diseases from Europe to America, where the people of Mexico and Peru had no immunity to them. For America, these were new diseases. As a result, 95% of the indigenous population of Mexico and Peru died out. The civilizations of the Aztecs and Incas perished. Two centuries later, a similar story repeated itself in Australia and Oceania, where contacts between Europeans and aborigines led to their mass extinction.

The spread of smallpox in America led to the rapid conquest of this continent by Europeans. America’s wealth poured into Europe. The import of capital contributed to the development of capitalism. Smallpox in the Americas was also an important factor in the emergence of global trade and European colonialism.

Smallpox in Europe, Russia and North America in the 18th century

After the end of the plague epidemics in Europe, smallpox became the main disease. Big cities became its centers. This is where the law of large numbers comes into play. Carrying smallpox is possible only in large populations, with a high birth rate and infant mortality. Widespread outbreaks, in fact, smallpox endemic, very often influenced both everyday life and big politics. Monarchs died. Soldiers died by the tens of thousands. In North America, smallpox was the cause of the mass extinction of the Indians. This allowed Europeans to begin settling the Northeast, Canada (XVIII century), and then the Wild West (XIX century). Smallpox on the American continent has become an important factor in the emergence of such a state as the United States.

The answer given by Europe and Russia to smallpox is well known. Enlightened secular authorities began to fight this disease. But the quarantines were ineffective, as the authorities wanted to encourage the development of trade, both local and global. Therefore, the monarchies of the Enlightenment began to encourage special, «biopolitical» approaches. The first effective instrument of biopolitics was the vaccination of the population. First — variolation, then vaccination. There was no scientific explanation for it until the very end of the 19th century (Pasteur), but the remedy showed itself well everywhere — from North America to Russia.

19th century cholera in India, Europe, Russia and North America

The first serious outbreaks of cholera appeared in India. In the humid tropical climate of this country, cholera was considered a common seasonal infection. With the arrival of the British in India, everything changed. British colonial policy disrupted the local communal way of life. British-imposed fiscal laws forced millions of Indians to stay in the same places for long periods of time. Residents were not allowed to lead a nomadic lifestyle, which was the traditional way of avoiding dangerous cholera sites. It was no longer possible for ordinary Indians to avoid infection with cholera. This soon led to dire consequences. A series of socio-economic crises turned cholera from a common disease into an ongoing epidemic. Beginning in 1817, cholera epidemics did not stop. There were five cholera pandemics in the 19th century alone, and they all started in India.

Experience with plague and smallpox helped authorities in Europe, Russia and North America to find effective measures to combat cholera. There were no vaccinations. Quarantine was often used, but this measure caused discontent among all sections of society. The commercial and industrial strata were especially dissatisfied, for whom quarantine was worse than cholera. Therefore, in England, and then in other countries, a new approach prevailed — social hygiene. Sanitary doctors, a sanitary inspection, etc. appeared. The practice of personal hygiene developed. Soap, boiling water, plumbing, sewerage, etc. There is a «medicine for the population», social medicine, the core of which is sanitary medicine. On this wave, the first measures to protect public health are being taken. The foundations of national health systems are beginning to be laid.

Spanish influenza (flu pandemic of 1918-1921)

By the beginning of the 20th century, national health care systems were in place in all developed countries. Strengthened the authority of medical workers. Many different vaccines have been created. The rapid eradication of dangerous infections began — plague, cholera, smallpox, «childhood infections» and so on. There was an improvement in material well-being. Improved sanitation. Personal hygiene has become the norm.

In 1914, a global world crisis began — the First World War. Everywhere in the territories where hostilities were fought, outbreaks of epidemics occurred — typhus, scarlet fever, measles, even plague.

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