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Could Swine Flu Be the Next Spanish Influenza?

April 28, 2009 07:40 PM
by Cara McDonough
Forget the swine flu outbreak of 1976. Today’s outbreak may turn out to be more like the 1918 Spanish influenza epidemic, which started off mild then reemerged to kill millions.

Swine Flu Eerily Similar to Spanish Influenza

Swine flu continues to affect Mexico, the United States and other countries around the world. The outbreak has confounded experts who wonder how the flu is spreading and what it will do next.

One possibility is that the flu could behave like the 1918 Spanish influenza—a terrifying prospect as estimates put the death toll from that flu strain at anywhere from 20 to 50 million, or more. 

There are striking similarities between the two outbreaks. Swine flu, like the 1918 pandemic, began in the spring. Both outbreaks have also mostly been reported in healthy adults; the elderly and the very young, usually the hardest hit by the flu, have not been significantly affected.

Historical Context: The Spanish flu

In 1918, the flu did not immediately incite hysteria. According to PBS, a Spanish wire service announced late that spring that "A strange form of disease of epidemic character has appeared in Madrid," but that "The epidemic is of a mild nature, no deaths having been reported."

But the Spanish flu didn’t remain mild, to say the least. As summer became fall, the flu—which had at first seemed “benign as the common cold,” according to a Stanford University report—changed. People began to die around the world in huge numbers, most likely due to a mutation in its makeup, making it more virulent. 

The Spanish flu became known for its high mortality rate compared to previous influenza outbreaks, and its quick onset. One anecdote from 1918 involved four women playing bridge late into the night; overnight, three of them died from the flu.

Background: Predicting the course of swine flu

Could the current outbreak of swine flu follow a similar pattern? After being declared a somewhat low risk to the world population, could it become more virulent? Or will the flu behave more like it did during a 1976 outbreak among 500 soldiers (only one of whom died) at Fort Dix, N.J. ?

According to a 2003 Washington Post article that compared the 1918 flu to SARS, both the Spanish flu and SARS appear to have arisen from animal sources and gained the ability to infect humans “through mutation or genetic reassortment.” Swine flu undoubtedly arose from an animal source—pigs—and now is able to spread not only from animal to human, but from human to human. 

Time will tell how the swine flu will pan out, but if it follows the course of its distant relative, the 1918 influenza, the results could be disastrous. According to Bloomberg, which compared the two, “A flu pandemic that’s similar in scope to the 1918 pandemic could kill 71 million people worldwide and push the economy into a ‘major global recession’ costing more than $3 trillion.”

Related Topic: Tracing the origins of the 1918 influenza epidemic

In 1997, a group of researchers announced that they had discovered genetic material from the Spanish flu in the formaldehyde-preserved lung tissue of a 21-year-old soldier who died of the flu.

The discovery helped scientists figure out what made the 1918 outbreak so deadly, The New York Times reported. One part of the puzzle was the discovery that it passed from birds to pigs to humans, which is believed to create the most deadly strains of the flu.

When the research was conducted, some predicted that an epidemic of 1918 proportions would affect the world again. Such a flu outbreak ''can come again, and it will,'' Dr. Robert Webster, chairman of viral and molecular biology at St. Jude's Children's Research Hospital, told the Times.

Dr. Joshua Lederberg, a Nobel laureate geneticist and president emeritus of Rockefeller University, said that influenza is “the most urgent, patently visible, acute threat in the world of emerging infections.'' He added that the sooner the world can learn what to anticipate in another appearance of deadly influenza, the better.

Reference: Swine flu


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