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In this paper, we discuss the classical modelling approach of pandemics as a negative labour shock. We perform an archival analysis of one of the largest Italian banks (Credito Italiano) during the First World War – Spanish Flu period (1914–1920). In particular, we scrutinise the circulars that the central management of the bank sent out to the local branches, with the aim to assess whether the Spanish Flu has been perceived by contemporaries as an event seriously affecting personnel management. Though restricted to a single case-study, archival evidence does not support the existence of a remarkable negative labour supply shock affecting personnel management because of the Spanish Flu pandemic. Other war-related events probably increased the system’s resilience.

It is estimated that the Spanish flu pandemic, which affected the entire planet from 1918 to 1919, affected about five hundred million people, or one-third of the world's population at the time, and killed about fifty million people. The disease was noticed among Serbian soldiers in Corfu in April 1918, and in May among soldiers on the Salonika Front, but without fatal consequences. During the summer, fatalities were also reported, mainly due to lung compaction. Then the epidemic was reported in occupied Serbia as well. Just at the time of the breakthrough of Salonika Front on the 15th of September, a new wave of the epidemic started, this time fatal. Many soldiers remained lying and dying in military hospitals set up along the way. Some soldiers made it home but then passed away, and some found their homes empty. In occupied Serbia, mass dying began before liberation. In the region of Valjevo, the first deaths occurred in early October, but mass deaths started in late October. This lasted less than two months. Then, by the beginning of the spring of 1919, sporadic deaths due to "pneumonia" were seen as a common complication of Spanish flu, which does not necessarily mean that the epidemic had stopped, but that its end did not have any fatal consequences. In the lowlands of the Valjevo region, mortality was relatively low (in the parish of the church in Rabrovica - 0,44%), in the hilly area the mortality rate was slightly higher (in the parish of the church in Brankovina - 1,32%), and in the high mountain areas, it was very high. An analysis of the number of recorded deaths in the books of the church in Krčmar indicates that over these two months 141 people (4.47% of the population) died in seven villages that belong to the parish of this church. That number is almost equal to the number of deaths from all possible causes over a 33month period: throughout 1917, the first 9 months of 1918, and throughout 1919. The highest mortality rate , 9,38% of the population, was recorded in the village of Mratišić, and the lowest, 1,61% in the village of Gornji Lajkovac. A higher number of deaths were recorded among the female population, but this can be attributed to the decrease in the number of males due to previous years of war.

The architectural history of healthcare in South Africa remains greatly understudied, as do the consequences of the 1918–19 Spanish Flu, which ravaged its population. Yet that pandemic had great consequences for South African society, spatial planning and the development of healthcare, of which the latter two were still in their infancy at the time. This article explores the link between disease and design in South Africa through the presentation of the histories of selected hospitals, maternity homes, orphanages and a special care school designed by émigré Dutch architects from the 1920s to the 1970s. It is the product of desktop and archival research, site visits and interviews undertaken in both South Africa and the Netherlands. It outlines the disparity of care that was provided for different groups and is a first attempt to identify healthcare ideas transposed into the subcontinent fuelled by the tragic experiences of the Spanish Flu pandemic. Due to this health crisis, communities – structured in terms of language, faith and race – attempted to develop their own facilities for the care of their own. Where communities had no means of their own, charitable organisations tried to fill the void. Over the course of the twentieth century, public healthcare was centralised, but many of the community and charitable institutions persist. By chance or choice, émigré Dutch architects made a disproportionately large contribution to the development of healthcare facilities in South Africa, not only in the number and range of facilities they designed, but also by introducing contemporary ideas into South African healthcare design.

Background Although it is known that mortality due to COVID-19 increases progressively with age, the probability of dying from this serious infection among the oldest-old population is little known, and controversial data are found in literature. Methods We examine the mortality by year and month of birth of Belgians who had turned 100 during the current COVID-19 pandemic and whose birth fell on the years around the end the First World War and the outbreak of the H1N1 "Spanish flu" pandemic. Findings The COVID-19 mortality of the "older" centenarians is significantly lower than that of "younger" centenarians, and this difference between the two groups reaches a maximum on August 1, 1918 as the discriminating cut-off date of birth. Having excluded the plausible impact of the end of WWI it becomes clear that this date corresponds to the time of reporting the first victims of the Spanish flu pandemic in Belgium. Interpretation In this study, the striking temporal coincidence between the outbreak of the Spanish flu epidemic and the birth of the cohorts characterized by greater fragility towards COVID-19 in 2020 strongly suggests a link between exposure to 1918 H1N1 pandemic influenza and resistance towards 2020 SARS-Cov-2. It can be speculated that the lifetime persistence of cross-reactive immune mechanisms has enabled centenarians exposed to the Spanish flu to overcome the threat of COVID-19 a century later.

According to a staple in the social sciences, pandemics particularly spread among people of lower social status. Challenging this staple, we hypothesize that it holds true in later phases of pandemics only. In the initial phases, by contrast, people of higher social status should be at the center of the spread. We tested our phase-sensitive hypothesis in two studies. In Study 1, we analyzed region-level COVID-19 infection data from 3,132 U.S. regions, 299 English regions, and 400 German regions. In Study 2, we analyzed historical data from 1,159,920 U.S. residents who witnessed the 1918/1919 Spanish Flu pandemic. For both pandemics, we found that the virus initially spread more rapidly among people of higher social status. In later phases, that effect reversed; people of lower social status were most exposed. Our results provide novel insights into the center of the spread during the critical initial phases of pandemics.

STOVIA was founded by the Dutch East Indies government in 1849, which was then named Dokter Djawa School. When STOVIA still existed a pandemic case that attracted enough attention for its big impact happened. The case was the spread of the Spanish flu plague which killed 1.5 million to 4.37 million people. The native doctors who graduated from STOVIA became the people who took the responsibility in dealing with the pandemic. Historical research with a sociological approach was conducted to examine the contribution of the native doctors who graduated from STOVIA in handling the Spanish flu pandemic. The results showed that the contributions of these doctors were not limited to the medical field, but also in the social, academic and politic

We consider some descriptive analysis of the main short- and medium-term economic indicators in Italy in the aftermath of the Spanish Flu pandemic. We analyse them in the light of the main neoclassical macroeconomic models of pandemics. Since most of the existing economic models about the consequences of a pandemic deal the pandemic event merely as a negative labour supply shock, we observe that some predictions of the theory about the economic impact of a pandemic seem not to be confirmed in the case of the Spanish Flu in Italy. In particular, economic indicators in Italy in the upsurge of the Spanish Flu need to be explained also in light of the consequences of the First World War. We use this evidence to discuss the predictions on the effects of the Covid-19 pandemic. We stress the importance of putting the analysis of the economic consequences of the current pandemic into the appropriate historical context.

This article introduces three historical situations where governments, or more accurately, specific leaders in office, shaped the international context in dealing with a transboundary crisis—and were in turn crucially affected in their reign by this crisis. The question at stake is: under what conditions did leaders (and their governments) engage in international cooperation to deal with the transboundary crisis at hand, and how did this cooperation impact the development of the crisis? An informed argument is made for combining crisis management research—in particular a model operationalizing conditions for transboundary cooperation—with an applied history perspective to shed light on the current obstacles to international cooperation in Covid-19 times.

La pandemia que padecemos ha dado pie a considerar (o reconsiderar) los varios aspectos de la más devastadora de las epidemias de las que se tiene registro: la epidemia de 1918. En la actualidad, la información sobre esta enfermedad es bastante amplia y diversa, pero todavía hay puntos concretos poco investigados, como el de las denominaciones que recibió en la prensa de la época. Las razones para llevar a cabo este estudio son dos. En primer lugar, se trata de la primera crisis sanitaria que recibió una amplia cobertura en la prensa. En segundo lugar, en esos momentos, la denominación de la epidemia supuso un reto para los periodistas que, entre la creatividad popular y el rigor, tuvieron que ingeniárselas para tratar con las incertidumbres de la situación, empezando por la cuestión irresoluta del origen y de las causas de esta enfermedad, que, aún hoy en día, es objeto de controversia. Para llevar a cabo este propósito, se elaboró un corpus periodístico con textos pertenecientes al diario El Imparcial. Posteriormente, se analizaron los datos obtenidos, que pusieron de manifiesto que, en la prensa española, está prácticamente ausente la denominación gripe española con la que esta epidemia se conoce en todo el mundo. Es más, la prensa de la época manifestó abiertamente su rechazo al apelativo “española”. Pero no fue hasta mediados del siglo XX cuando se empezó a desconfiar realmente de esta denominación, y posteriores investigaciones desvelaron la inexactitud del nombre. The pandemic we are experiencing has prompted us to consider (or reconsider) various aspects of the most devastating epidemic on record: the 1918 epidemic. At present, the information on this disease is quite extensive and diverse, but there are still specific points that are little researched, such as the names it received in the press of the time. There are two reasons for carrying out this study. First of all, it was the first health crisis to receive extensive coverage in the press. Second, at that time, the name of the epidemic posed a challenge for journalists who, caught between popular creativity and rigour, had to figure out how to deal with the uncertainties of the situation, starting with the unresolved questions of the origin and causes of this disease, which are still controversial today. In order to carry out this aim, a journalistic corpus was prepared with texts belonging to the newspaper El Imparcial. Subsequently, the data obtained was analysed, revealing that the name Spanish flu, with which this epidemic is known throughout the world, is practically absent in the Spanish press. Moreover, the press of the time openly expressed its rejection of the name "Spanish". But it was not until the middle of the 20th century that this term became suspect, and subsequent research revealed the inaccuracy of the name.

The Spanish flu pandemic spread in 1918-19 and infected about 500 million people, killing 50 to 100 million of them. People were suffering from severe poverty and malnutrition, especially in Europe, due to the First World War, and this contributed to the diffusion of the disease. In Italy, Spanish flu appeared in April 1918 with several cases of pulmonary congestion and bronchopneumonia; at the end of the epidemic, about 450.000 people died, causing one of the highest mortality rates in Europe. From the archive documents and the autoptic registers of the Hospital of Pisa, we can express some considerations on the impact of the pandemic on the population of the city and obtain some information about the deceased. In the original necroscopic registers, 43 autopsies were reported with the diagnosis of grippe (i.e. Spanish flu), of which the most occurred from September to December 1918. Most of the dead were young individuals, more than half were soldiers, and all of them showed confluent hemorrhagic lung bronchopneumonia, which was the typical feature of the pandemic flu. We believe that the study of the autopsy registers represents an incomparable instrument for the History of Medicine and a useful resource to understand the origin and the evolution of the diseases.

In this scientific paper the authors analyse the impact of the Spanish flu on the number of deaths in Varaždin from 1918 to 1920 as well as other causes of death in the period concerned. The research is based on the following registries of deaths: Občeniti grobovi (28. VI. 1917.-31. III. 1919.) [Eng. General graves (28/VI/1917-31/III/1919)], Knjiga mrtvaca općeniti grobovi III (1879) 1903 – 1918 [Eng. Book of the dead – general graves III (1879) 1903 – 1918] and Knjiga mrtvacah obiteljskih grobnica (1902-1919) [Eng. Book of the dead – family tombs (1902- 1919)] which are kept in the State Archives in Varaždin. The research also included the Grobni očevidnik (1919-1939.) [Eng. Cemetery records (1919-1939)], kept in the municipal company Parkovi d.d. 1 The books comprise information on all deceased people buried in the Varaždin cemetery in the aforementioned three-year period. Beside their identity, profession, age, place of birth, marital status, and time of burial, the cause of death was also recorded. The analysis included the three-year period – from the beginning of 1918 until the end of 1920, i.e. the period when the Spanish flu appeared and disappeared from Varaždin. In order to investigate all causes of deaths in the period concerned, the authors processed 1, 435 separate entries. The research results showed that 121 people died from flu in Varaždin (mostly in 1918 – 114 people, while the number of the dead reached the peak in October). In the years that followed the number of the people who died from flu decreased and the infection vanished – four people died in 1919 and three in 1920.

The Spanish flu, one of the worst epidemics in history, appeared in 1918, on the eve of the end of the World War I. The characteristic of the epidemic on the territory of the city of Rijeka has been poorly studied. Certainly, the lack of primary sources, such as hospital registries, have made the understanding of the incidence and the course of the epidemic in the city more difficult. Therefore, the death certificates have emerged as the main primary source. The purpose of this paper is to explore and describe mortality caused by the (Spanish) flu during 1918 and at the beginning of 1919, using the death registers of those who lived in the area of the city center and the surrounding parishes. The results of the Spanish flu mortality research in the area of Rijeka are compared to the Spanish flu specific mortality on the territory of the three parishes situated in the wider area of Rijeka – Brseč, Mošćenice and Lovran. The elucidation of the characteristics of the Spanish flu epidemic and its impact on the quotidian life in the city of Rijeka is possible through the analysis of daily newspapers as well. In this paper, we have explored such articles in the La Bilancia, Rijeka’s newspaper published in Italian.

Der Text entstand als Weihnachtsgruß für die Mitglieder desVereins für Stadtgeschichte Halle (Saale) und reflektiert Ereignisse der Weihnachtszeit im Dezember 1920 in einem sehr breiten, dezidiert kulturwissenschaftlichen Panorama. Betrachtet wird die Entwicklung der Einkaufskultur und die Ausgestaltung von weihnachtlichen Traditionen in Zeiten des Mangels und der politischen Auseinandersetzung. Skizziert werden die im Dezember im Stadtrat verhandelten Diskussionen, die sich etwa um die Unterstützung der Kriegsverwundeten, die Schaffung von Gemeinschaftsschulen oder Spendenaktionen für ganz verschiedene politische Ambitionen und soziale Projekte. ). Zudem kam es durch die Verhaftung des Redakteurs Viktor Stern (1885-1958) selbst in der Vorweihnachtszeit zu neuen Massenkundgebungen und Streiks in der Stadt. Ein Blick auf kulturelle Veranstaltungen und die Folgen der Spanischen Grippe runden den Blick auf die gesamte städtische Gesellschaft ab. The text was written as a Christmas greeting for the members of the Verein für Stadtgeschichte Halle (Saale) and reflects events of the Christmas season in December 1920 in a very broad, decidedly cultural-scientific panorama. It looks at the development of shopping culture and the shaping of Christmas traditions in times of scarcity and political conflict. The discussions that took place in the city council in December are sketched out, which, for example, dealt with the support of the war-wounded, the creation of community schools or fundraising campaigns for very different political ambitions and social projects. ). In addition, the arrest of the editor Viktor Stern (1885-1958) led to new mass rallies and strikes in the city even in the pre-Christmas period. A look at cultural events and the consequences of the Spanish flu round off the view of urban society as a whole.

En este artículo, estudiamos la elaboración de dos métodos para combatir la gripe española o influenza en la Argentina: el suero y la vacuna. Las investigaciones sobre el agente etiológico y la elaboración de estos instrumentos se llevaron a cabo en el Instituto Bacteriológico, institución estatal que al momento en que ingresó y se expandió la enfermedad estaba dirigida por el médico bohemio Rudolf Kraus y junto a él trabajaba una parte de la élite médica porteña y extranjera. Realizamos un análisis de las metodologías que se utilizaron tanto para la elaboración como en las pruebas que se desarrollaron a lo largo de los años 1918 y 1919. Consideramos que el mismo Estado que permitió y alentó la elaboración de ambos métodos de prevención y de cura, en especial de la vacuna, también fue un factor que, por su misma dinámica, impidió que se llevaran adelante las pruebas para validarla y aplicarla. El estudio se llevó a cabo a partir de diversas fuentes, como documentación estatal, artículos científicos y notas periodísticas, desde un análisis hermenéutico. This article studies the development of two methods to combat Spanish influenza (flu) in Argentina: sera and vaccines. Research on the etiological agent and development of these instruments were carried out at the Bacteriological Institute. At the time of the entry and spread of the disease, this state institution was directed by the Bohemian physician Rudolf Krauss, working with a part of the Buenos Aires and foreign medical elite. We analyze the methodologies used for creating these instruments and for the tests that were developed throughout 1918 and 1919. We consider that the same State that allowed and encouraged the development of both prevention and therapeutic methods, in particular the vaccine, was also, due to its own dynamics, a factor that prevented the implementation of tests for its validation and application. The study was based on a hermeneutical approach and drew on various sources, including state documentation, scientific articles, and journalistic notes.

Among every pandemic, the Spanish flu of 1918 was without any doubt the deadliest in absolute terms, with some estimations reaching the amount of 100 million deaths. It is caused by the influenza A virus subtype H1N1 and it developed during the first World War, something never seen before in the appearance of a disease. Its repercussions jumbled with the armed conflict, making its consequences even worse. However, this pandemic made it obvious that a public health system was needed. During the following years, most of the countries all over the world took action in this regard. 100 years later, science and medicine have been overtaken by the COVID-19 pandemic, fighting against it with tools and weapons also used against the spanish flu. We hope to learn the lesson this time. De entre todas las pandemias, la gripe española de 1918 es, sin duda, la más mortífera y destructiva en términos absolutos que haya sufrido la especie humana, llegando algunas estimaciones a los 100 millones de muertes. Provocada por el virus de la gripe A subtipo H1N1, se desarrolló en el contexto de la I Guerra Mundial, un hecho totalmente novedoso en la presentación de una enfermedad. Sus repercusiones se entremezclan y difuminan con las de un conflicto que asoló buena parte del viejo continente, agravando así sus consecuencias. Sin embargo, esta pandemia hizo evidente la necesidad de un sistema de salud pública eficaz, de modo que la mayoría de los países del mundo tomó medidas en este aspecto. Cien años después, la ciencia y la medicina se han visto desbordadas en la pandemia de COVID-19, combatiéndola con armas muy similares a las ya vistas contra la gripe española. ¡Ojalá hayamos aprendido la lección!

Due to war turmoil, border lability, and administrative chaos accompanying the recreation of an independent Polish state, national or even regional demographic statistics that could shed some light on the spread and intensity of the influenza pandemic in Polish territory are absent. Hence, I try to scrutinize the timing and extent of Spanish flu mortality through the local statistics gathered by the municipal statistical offices (mainly Warsaw, Lviv, Krakow, and Łódź). The gathered data is modelled using Serfling Regression to estimate excess mortality and identify waves and recurrences of the flu. These results are then juxtaposed with the outcomes of similar procedures done for other countries to address the question of direction and spread of the Spanish flu across Central and Eastern Europe. The study shows a weaker impact of the Spanish flu in Polish cities than in Western and most notably Southern Europe. It also confirms that the spread of the pandemics in Poland was not linear, as it depended on the size, importance, and connectivity of the city rather than on the mere geographic location.

It seems obvious that while others around us are concerned with trying to understand the nature of the COVID-19 pandemic and the ways in which it has disrupted so much of our lives and professional work, history educators should be concerned rather to look back, to study previous epidemics for the light that they can shed on today. The 1918 ‘Spanish’ flu is a logical starting place. But it presents two obstacles: first, that there is so little that is truly comparable to the 2020 experience and, secondly, that the material of 1918 in South Africa is potentially so difficult to use in the classroom. How does one, for instance, teach about the number of cases where people narrowly avoided being buried alive, escaping in the nick of time. (And what about those who were not as fortunate?) This is an exploration of uncharted territory that presents an initial map to anyone who might be tempted to follow suit and put it to the test. As there is no ready model at hand to use to teach about dying and death in the history classroom, a sequence of five themes is proposed as a way in which one can approach the issue of mortality without coming at it head-on. The themes are explained and justified and an exemplar of a possible class activity is provided for each. The question posed is whether one should teach about dying and death in this way. The conclusion suggests what the possible benefits accruing might be.

Cilj je rada istražiti razmjere haranja španjolske gripe u dolini Neretve. U radu su korišteni tadašnji novinski izvještaji te matične knjige umrlih sedam neretvanskih župa (Borovci-Nova Sela, Desne-Bagalovići, Dobranje, Opuzen, Metković, Vidonje i Vid). Iz matica su prikupljeni podaci o smrtnim slučajevima na temelju kojih je provedena statistička analiza. U radu je prikazana spolna i dobna struktura umrlih. Utvrdilo se i žarište epidemije te rekonstruirao vremenski tijek širenja bolesti. Prvi smrtni slučajevi uzrokovani španjolskom gripom u dolini Neretve pojavljuju se u listopadu 1918. Vrhunac epidemije bio je u drugoj polovici studenoga i krajem prosinca. Najviše umrlih bilo je u Desnama i Vidonjama. Treći val gripe zahvatio je naselje Vid tek 1920. Prosječna dob umrlih bila je 26,06 godina, a od bolesti je stradalo više žena nego muškaraca., The Spanish flu is a pandemic that was neglected even though it killed more people than World War I. At the end of 1918, newspaper reports are scarce due to war events, press censorships, and burst political events. For decades after the epidemic was over, the Spanish flu was not the subject of scientific research. By analysing the entry from the registers of the six Neretva parishes (Borovci-Nova Selo, Desne-Bagalovići, Dobranje, Opuzen, Metkovic, Vidonje, and Vid), statistical data on the scale of the epidemic were reconstructed as well as the time course of the spread of the disease in the valley. The sex and age structure of the deceased were also analysed. The disease was spreading from Opuzen throughout the valley. The peak of the epidemic was in the second half of November and late December. The villages of the Desne and Vidonje were the most affected. Vid was also captured by the third wave in 1920, which was as deadly as that in 1918. The most affected were women, which fits in Croatian statistics. Comparing the timeline of epidemics in Zagreb and Neretva valley, it is visible that Zagreb was affected earlier by an epidemic. The third wave did not affect Zagreb as much as it did Neretva, especially the village of Vidonje. In these Neretva parishes, people under twenty were mostly affected. This deviates from the general rules and statistics of the Spanish flu, which stated that the most affected population was between the ages of twenty and forty. The article deals with data on the Spanish Neretva flu cases, while the number of infections remains unknown.

L’histoire de la grippe espagnole, survenue il y a un siecle, presente un cas exemplaire du renouvellement du questionnaire des historiens concernant un evenement du passe. Plusieurs strates historiographiques ont transforme la comprehension de cette pandemie depuis les annees 1970. Cet article retrace ces strates interpretatives donnant a l’evenement une pluralite de sens, fondee sur une documentation dissemblable. Je distingue trois moments : la construction d’un evenement catastrophique global a partir d’une mosaique d’etudes de cas locaux ; le morcellement de cet evenement au prisme de l’experience des individus et du contexte de la Grande Guerre ; la grippe espagnole comme un episode de l’histoire longue de cette maladie. Ces strates sont inextricablement liees aux transformations du rapport des societes a la menace infectieuse depuis 1918. L’enjeu des debats historiographiques et leur reception doivent etre resitues dans les batailles pour dire le passe et mobiliser son sens dans le present.

Colonoscopy procedure has been the key screening method to detect colorectal cancer (CRC). As a fatal disease, CRC needs early detection. The COVID-19 pandemic caused screening tests (colonoscopy) to be halted and delayed. As a result, there could be dire consequences such as later-stage or missed diagnosis or greater mortality. This report will analyze scientific literature pertaining to interrupted CRC screenings due to COVID-19 while drawing historical parallels from the 1918 flu pandemic. We conducted literature searches in the PubMed database as well as in Google Scholar. One of the main lessons learned from the 1918 flu pandemic was to employ social distancing to stop the spread of the virus. So, the global response at the start and peak of the COVID-19 pandemic was decreased hospital visits for any non-emergency cases. That led to a halt and delays in cancer (including CRC) screenings. The Medical community predicted this lag will cause more CRC cases and deaths in the future. However, reorganizing and changing screening method strategies were helpful during the ongoing pandemic. In conclusion, COVID-19 greatly affected CRC screening, including how we view the future of CRC screening. We can learn from this prospect to better prepare for future pandemics or other public health crises.

Resumo Investigam-se as tensões surgidas durante a epidemia de gripe espanhola na cidade de Sorocaba, ocorrida entre os meses de outubro e dezembro de 1918. São utilizadas como fontes privilegiadas e inéditas as narrativas repercutidas pela imprensa local, tomando como estudo de caso a fábrica Santa Rosália, envolvida na recusa de seu proprietário em manter a interrupção dos trabalhos no auge da crise epidêmica, mesmo sob pedidos do poder municipal. Busca-se contribuir com os estudos sobre as epidemias nos municípios do interior do país, ressaltando as colaborações da história local às investigações sobre a história das doenças no Brasil. Abstract An investigation is presented of the tensions that emerged during the Spanish flu epidemic in the city of Sorocaba, Brazil, between October and December 1918. It draws on previously unused primary sources, namely the narratives contained in the local press, taking the Santa Rosália factory as a case study, particularly its owner’s refusal to maintain the work stoppage at the height of the epidemic, even when requested to by the municipal authority. This research contributes to the study of epidemics in Brazil’s inland municipalities, emphasizing how local history can contribute to investigations of the history of disease in the country.

Summary Spanish flu spread worldwide between 1918 and 1920 causing over 20 million deaths, exceeding even the number of deaths registered during the First World War (WWI). The main symptom of the disease was hemorrhagic tracheobronchitis, the onset of which was typically sudden and fatal. Young, healthy people died quickly. Despite the tragic impact of the disease on populations, already exhausted by the First World War, there is very little documentation. This was likely due to the severe censorship of the time. For this reason, autopsy reports can be a relevant source of information on the disease. Historical catalogues kept in Turin, where all autopsies were detailed, can be consulted. According to the “Regolamento di Polizia Mortuaria” dating back to 1892, autopsies were to be performed on all patients that died at home or in hospital. Therefore, autopsy reports showing the spread of diseases among the population can also help us obtain information about the spread of Spanish flu in Turin. While not documented, almost certainly the “Regolamento” was improperly implemented since just 45 cases of Spanish flu were reported, while deaths were most certainly daily and in their hundreds. According to autopsy reports, the first case occurred on 8th October 1918, although, the first official diagnosis is dated as being 24th November 1918. The records show that 18 people died during the first Italian pandemic wave. The second Italian pandemic wave seems to have been even more aggressive in Turin with 27 people having died between 8th January 1920 and 7th February 1920.

With an increasing frequency of infectious disease outbreaks, the COVID-19 pandemic causing mortality around the world and the threat of similar future events looming large, mankind is faced with the herculean task of counteracting such threats with the best possible strategies and public health decisions. It is key that such decisions should be guided by previous examples of similar health emergencies. Here we review some of the significant infectious disease outbreaks, including epidemics and pandemics occurring worldwide in the past including their impact at population and global levels, unique challenges presented by each and the measures taken by authorities worldwide as well as the crucial lessons each epidemic or pandemic provided. This review highlights that throughout history measures such as contact tracing, quarantine and isolation have been incredibly effective in limiting an outbreak in its severity, thus ensuring accurate information flow to the public is as essential as limiting the spread of misinformation. With global populations rising, surveillance for emerging and re-emerging pathogens will play an immense role in preventing future epidemics or pandemics. And finally that even though for novel strains or pathogens, although vaccines are thought to be an irreplaceable defense, but their development and distribution in time to curb an epidemic has seldom been witnessed and remains an important challenge for the future. Hence, we conclude that looking at these past examples not only highlights the important knowledge gained for the strategies to devise, but also the mistakes that can be avoided in the way forward.

The Spanish flu of 1918 and 100 years later, the COVID 19 pandemic, paralyzed the entire world, causing numerous casualties and halting life flows. Although there is a hundred-year gap between them, the facts indicate that both pandemics are of viral origin, which primarily attack the respiratory system, but affect different age groups, have a similar course, different mortality. 20-50 million people died from the Spanish flu and 1.6 million from COVID- 19. Prevention has remained almost the same after 100 years. The aim of this article is to evaluate new findings on COVID-19 based on the Spanish flu paradigm, comparing these two pandemic, including scientific research in the field of virology and epidemiology related to this issue.

This study looks at public awareness and understanding of the Spanish flu in the United States between June 1918, when the flu became “Spanish,” and the end of September when the deadly second wave reached the majority of the country. Based on an extensive reading of local newspapers, it finds a near universal lack of preparation or panic or other signs of personal concern among those in the unaffected areas, despite extensive and potentially worrying coverage of the flu's progress. The normal reaction to news of the inexorable approach of a pandemic of uncertain virulence is anxiety and action. The Spanish flu produced neither in the uninfected areas for a month. The most likely reason appears to be cognitive inertia—the tendency of existing beliefs or habits of thought to blind people to changed realities. This inertia grew out of the widespread understanding of flu as a seasonal visitor that while frequently unpleasant almost never killed the strong and otherwise healthy. This view of the flu was powerful enough that it blinded many in the unaffected regions to the threat for weeks even in the face of daily or near daily coverage of the pandemic's spread.

Influenza A virus encodes two segments (7 and 8) that produce mRNAs that can be spliced. We have investigated if naturally occurring sequence polymorphisms in the influenza A virus family affects splicing of these viral mRNAs, as that could potentially alter the NS1/NS2- and/or M1/M2-protein ratios. We compared splicing efficiency of segment 7 and 8 mRNAs of A/Brevig Mission/1918/1 (H1N1) and A/Netherlands/178/95 (H3N2), as well as various H5N1 avian strains. Results revealed that both segment 7 and 8 mRNAs of A/Brevig Mission/1918/1 (H1N1) were inefficiently spliced compared to other influenza virus segment 7 and 8 mRNAs. This resulted in production of higher levels of functional NS1 protein, which could potentially contribute to the pathogenic properties of the A/Brevig Mission/1918/1 (H1N1). We also show that A/Brevig Mission/1918/1 (H1N1) segment 8 mRNAs responded differently to overexpression of SR proteins than A/Netherlands/178/95 (H3N2).

Please cite this paper as: Erkoreka A. (2010) The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age. Influenza and Other Respiratory Viruses 4(2), 81–89. Background Studies of the Spanish Influenza pandemic (1918–1920) provide interesting information that may improve our preparation for present and future influenza pandemic threats. Methods We studied archives from France, Italy, Spain and Portugal, obtaining high-quality data that allowed us to calculate mortality rates associated with the Spanish flu and to characterize the proportional distribution of influenza deaths by age in the capital cities of these countries. Results French and American troops who fought in the First World War began to be affected from April 1918 onwards by a benign influenza epidemic, which hardly caused any deaths. The first occidental European country in which the pandemic spread to large sectors of the population, causing serious mortality, was Spain. The associated influenza provoked in Madrid a mortality rate of 1·31 per 1000 inhabitants between May and June (1918). In the following months of June and July, the epidemic spread to Portugal, but did not reach the Pyrenees. In September 1918, the influenza pandemic spread with tremendous virulence, presenting itself simultaneously during the month of October in South Western European countries. In Madrid, the 1918 excess mortality due in large part to the influenza pandemic is estimated at 5·27 per 1000. In Paris, the 1918 mortality rate provoked by the influenza and pathologies of the respiratory system was 6·08 per 1000. In South Western European countries, mortality rates oscillated between 10·6 and 12·1 per 1000 inhabitants. A study of the age distribution of deaths due to influenza between 1916 and 1921 reveals that the Spanish influenza principally affected men and women between 15 and 44 years of age. Deaths associated with the seasonal influenza of 1916, 1917 and 1921 represented 19·7%, 12·5% and 21·0% of all deaths respectively, whereas during the rawest moments of the Spanish influenza, in 1918, the proportion of deaths due to flu for those aged between 15 and 44 years of age reached 68·2% in Paris and 66·3% in Madrid. Conclusion Victim age is an important criterion that can be used to evaluate the phase and evolution of pandemic influenza. The Spanish Influenza affected particularly the 25- to 34-year-old and 15- to 24-year-old age groups.

Nonhomogeneous Markov models of nucleotide substitution have received scant attention. Here we explore the possibility of using nonhomogeneous models to identify host shift nodes along phylogenetic trees of pathogens evolving in different hosts. It has been noticed that influenza viruses show marked differences in nucleotide composition in human and avian hosts. We take advantage of this fact to identify the host shift event that led to the 1918 'Spanish' influenza. This disease killed over 50 million people worldwide, ranking it as the deadliest pandemic in recorded history. Our model suggests that the eight RNA segments which eventually became the 1918 viral genome were introduced into a mammalian host around 1882-1913. The viruses later diverged into the classical swine and human H1N1 influenza lineages around 1913-1915. The last common ancestor of human strains dates from February 1917 to April 1918. Because pigs are more readily infected with avian influenza viruses than humans, it would seem that they were the original recipient of the virus. This would suggest that the virus was introduced into humans sometime between 1913 and 1918.

Esse artigo tem como objetivo analisar os impactos políticos e sociais da epidemia de gripe espanhola em 1918, sobre a cidade do Rio de Janeiro, então capital federal da República. A partir da análise dos registros na imprensa carioca e de conjuntos documentais que incluem anais, relatórios e boletins de um ministério, da Prefeitura da cidade e da Câmara dos Deputados, bem como estudos da Academia Nacional de Medicina e teses da Faculdade de Medicina, analisamos a utilização da epidemia como mecanismo de engenharia política. Buscaremos focalizar os seus impactos sobre a representação de alguns atores políticos e sociais do período, bem como sobre a reafirmação de um grupo de higienistas como intelligentzia, com vocação para a liderança política e peça fundamental no processo de modernização da sociedade brasileira. The article analyzes the political and social impacts of the 1918 Spanish flu epidemic in the city of Rio de Janeiro, then Brazil's federal capital. Based on an analysis of Rio de Janeiro press reports and of other documentation (including annals, reports, and bulletins from a federal ministry, the Mayor's Office, and the Chamber of Deputies, along with studies from the Brazilian National Academy of Medicine and dissertations from Rio de Janeiro's Faculdade de Medicina), we explore use of the epidemic as a means of political engineering. Our focus is on how the epidemic impacted not only the representation of certain political and social actors but also the reaffirmation of a group of sanitarians as an intelligentsia with a vocation for political leadership who played a key role in the process of modernizing Brazilian society.

Este artigo tem como objetivo investigar o episódio da epidemia de gripe espanhola que atingiu a cidade de Salvador e outras áreas da Bahia, tendo seu ápice entre setembro e dezembro de 1918. Utilizando como fonte privilegiada a imprensa local, analiso o jogo do poder, a condição sanitária da capital, alguns aspectos da economia, as condições materiais de sobrevivência dos moradores de Salvador, a fragilidade das políticas de saúde e assistência pública e outros aspectos de uma sociedade complexa e desigual evidenciados pela epidemia. The article investigates the Spanish flu epidemic that hit the city of Salvador and the state of Bahia, reaching its height between September and December of 1918. The local press is a primary source in this analysis of power politics, sanitary conditions in the state capital, some economic issues, the material conditions for survival in Salvador, and the fragility of public health and assistance policies - all features of a complex, unequal society made visible by the epidemic.

To determine the difference in age-specific immunoprotection during waves of influenza epidemics, we analyzed excess monthly death data for the 1918–1920 influenza pandemic in Taiwan. For persons 10–19 years of age, percentage of excess deaths was lowest in 1918 and significantly higher in 1920, perhaps indicating lack of immunoprotection from the first wave.

We study the impact of the 1918 influenza pandemic on economic performance in Sweden. The pandemic was one of the severest and deadliest pandemics in human history, but it has hitherto received only scant attention in the economic literature – despite important implications for modern-day pandemics. In this paper, we exploit seemingly exogenous variation in incidence rates between Swedish regions to estimate the impact of the pandemic. Using difference-in-differences and high-quality administrative data from Sweden, we estimate the effects on earnings, capital returns and poverty. We find that the pandemic led to a significant increase in poverty rates. There is also relatively strong evidence that capital returns were negatively affected by the pandemic. On the other hand, we find robust evidence that the influenza had no discernible effect on earnings. This finding is surprising since it goes against most previous empirical studies as well as theoretical predictions.

Influenza is an RNA virus that causes mild to severe respiratory symptoms in humans and other hosts. Every year approximately half a million people around the world die from seasonal Influenza. But this number is substantially larger in the case of pandemics, with the most dramatic instance being the 1918 “Spanish flu” that killed more than 50 million people worldwide. In the last few years, thousands of Influenza genomic sequences have become publicly available, including the 1918 pandemic strain and many isolates from non-human hosts. Using these data and developing adequate bioinformatic and statistical tools, some of the major questions surrounding Influenza evolution are becoming tractable. Are the mutations and reassortments random? What are the patterns behind the virus's evolution? What are the necessary and sufficient conditions for a virus adapted to one host to infect a different host? Why is Influenza seasonal? In this review, we summarize some of the recent progress in understanding the evolution of the virus.

Vaccine strategies and antimicrobial drug stockpiling to control empyema will increase preparedness as we prepare for the next influenza pandemic., Bacterial pneumonia with empyema is a serious complication of influenza and commonly resulted in death during the 1918 influenza pandemic. We hypothesize that deaths caused by parapneumonic empyema are increasing in Utah once again despite advances in critical care and the availability of antimicrobial drugs and new vaccines. In this study, we analyzed the historical relationship between deaths caused by empyema and influenza pandemics by using 100 years of data from Utah. Deaths caused by empyema have indeed increased from 2000–2004 when compared with the historic low death rates of 1950–1975. Vaccine strategies and antimicrobial drug stockpiling to control empyema will be important as we prepare for the next influenza pandemic.

The reproduction number, R, defined as the average number of secondary cases generated by a primary case, is a crucial quantity for identifying the intensity of interventions required to control an epidemic. Current estimates of the reproduction number for seasonal influenza show wide variation and, in particular, uncertainty bounds for R for the pandemic strain from 1918 to 1919 have been obtained only in a few recent studies and are yet to be fully clarified. Here, we estimate R using daily case notifications during the autumn wave of the influenza pandemic (Spanish flu) in the city of San Francisco, California, from 1918 to 1919. In order to elucidate the effects from adopting different estimation approaches, four different methods are used: estimation of R using the early exponential-growth rate (Method 1), a simple susceptible-exposed-infectious-recovered (SEIR) model (Method 2), a more complex SEIR-type model that accounts for asymptomatic and hospitalized cases (Method 3), and a stochastic susceptible-infectious-removed (SIR) with Bayesian estimation (Method 4) that determines the effective reproduction number R t at a given time t. The first three methods fit the initial exponential-growth phase of the epidemic, which was explicitly determined by the goodness-of-fit test. Moreover, Method 3 was also fitted to the whole epidemic curve. Whereas the values of R obtained using the first three methods based on the initial growth phase were estimated to be 2.98 (95% confidence interval (CI): 2.73, 3.25), 2.38 (2.16, 2.60) and 2.20 (1.55, 2.84), the third method with the entire epidemic curve yielded a value of 3.53 (3.45, 3.62). This larger value could be an overestimate since the goodness-of-fit to the initial exponential phase worsened when we fitted the model to the entire epidemic curve, and because the model is established as an autonomous system without time-varying assumptions. These estimates were shown to be robust to parameter uncertainties, but the theoretical exponential-growth approximation (Method 1) shows wide uncertainty. Method 4 provided a maximum-likelihood effective reproduction number 2.10 (1.21, 2.95) using the first 17 epidemic days, which is consistent with estimates obtained from the other methods and an estimate of 2.36 (2.07, 2.65) for the entire autumn wave. We conclude that the reproduction number for pandemic influenza (Spanish flu) at the city level can be robustly assessed to lie in the range of 2.0-3.0, in broad agreement with previous estimates using distinct data. © 2006 The Royal Society., link_to_subscribed_fulltext

The global spread of the coronavirus pandemic has prompted inevitable comparisons with the flu pandemic of 1918-1920. However, in order for such comparisons to be fruitful, it is necessary to acknowledge the similarities between the two outbreaks and their differences. This paper compares different aspects of the "Spanish" flu and coronavirus pandemics in Ireland and the UK during the two periods. The first part of the paper provides a general overview, taking account of the nature of the two diseases and the contexts in which they occurred. The following two sections explore the extent to which both outbreaks exposed underlying social and economic inequalities and the measures taken by central and local government, as well as civil society, to combat the spread of disease. The final section examines the extent to which both pandemics highlighted existing failures and sparked demands to "build back better."