Flu in human civilisation

By DR Y.L.M

A look at the history of flu pandemics.

I am curious about how many influenza pandemics there have been in history, because this is the first time I have ever been in a WHO Pandemic Level 6 situation. Then again, I am only 15 years old! What is a pandemic anyway?

A pandemic (pan = all; demos = people or population) is defined as an epidemic (or sudden outbreak of a certain disease) that becomes very widespread and goes on to affect a whole region, or continent, or even the world.

A WHO definition of Pandemic Level 6, the highest level, is when a disease is widespread and sustaining rapid human-to-human transmission in two or more regions around the world. The H1N1 flu pandemic is the first global flu pandemic in over 41 years since the 1968 Hong Kong flu!

Note that the term “Pandemic Level 6”, which is scary-sounding in itself, denotes the spread of the disease, but not its severity. Being in a Pandemic Level 6 does not necessarily mean that a lot of people will die from the disease that is spreading.

Seasonal influenza, the type you get in certain months like winter, is not considered a pandemic.

Have all the flu pandemics been recorded only from the 20th century?

The first major influenza epidemic (not pandemic) was recorded by Hippocrates, the father of medicine, in 412 BC, though it wasn’t called “influenza” then. Only in 1357 AD was the term “influenza” coined, from the Italian word “influence”. At that time, it was thought that flu was “influenced” by the stars in the sky!

The first ever pandemic was recorded in 1580 – and you guessed it, it involved influenza. It originated in Asia Minor (the Middle East) and Northern Africa and swept into Europe within six weeks. It entered Europe by way of Malta into Italy, then propagated rapidly north through the Italian peninsula. It also entered Spain because at that time, Spain ruled several North African ports.

At least 10% of all Rome’s population (then numbering 81,000 people) died within the first week of contracting it. Some Spanish cities were almost completely depopulated.

Then for a long, long time, there was no further pandemics until the 18th century.

How do you explain that?

This historical fact has also baffled many scientists. This is called a period of pandemic stability. Many questions arise as to whether a pandemic comes by chance. Because during the period between 1580 and 1729, there were plenty of epidemics. And the question remains to be answered whether epidemic situations prevent pandemics, or at least help delay them.

So when was the next pandemic and what happened?

There were three pandemics in succession then, the first from 1729 to 1730, the second from 1732 to 1733 and the third from 1781 to 1782. You must remember that in the 18th century, doctors didn’t know influenza was caused by a virus. They blamed it an unknown poison in the air and wind/temperature and meteorological phenomena. So their documents on pandemics are filled with these theories!

The 1729-1730 pandemic was a flu, and it is believed to have originated from Russia. There were two outbreaks in Moscow and Astrakhan on the Caspian Sea in April. Surprisingly, the summer of 1729 was a quiet one, Then suddenly there were influenza reports in Sweden in Sept 1729, and in Vienna come October. By November 1729, the flu had swept through Hungary, Poland, Germany and England.

But this particular pandemic, although virulent, caused relatively few deaths. Flu was unknown in North America until 1732 (yes, the American Indians never had flu before that!), because of the settlers in New England.

The 1781-82 pandemic on the other hand was not only virulent but deadly. This one started in China, involved then British-occupied India and then spread to the Western hemisphere. There were tens of millions of cases, spreading through all transport modes available then.

I heard that the worst flu pandemic occurred in the 20th century.

Yes. There were major pandemics from 1830 to 1834. Then in 1918, the Spanish flu began. (Though researchers think it actually started in the US.) It was also caused by a H1N1 flu virus, and is the worst flu pandemic to date. It was very dangerous to young adults, especially those from age 20 to 40.

The Spanish flu was memorable because it killed millions of people and it killed those in the prime of their lives. At first, it attracted little attention as people thought it was the “normal” flu. Then when a second killer wave descended and young adults began to be affected, people panicked.

This pandemic was extremely deadly as well as virulent. From North America, it spread to Europe and the rest of the world. In Switzerland in July 1918, 53,000 people alone died in that one month.

By August 1918, the flu had morphed into a 3rd deadly strain. World War 1 occured, and the spread of troops and disruption of the world’s population then helped transmit the virus. What’s worse, this particular pandemic came before treatment was available, so people succumbed easily.

At the end of it, it was estimated that 20 million to 100 million people worldwide had died. In the US alone, half a million people died. It is difficult to say today whether this 1918 flu would have the same impact on us with the advent of antibiotics to treat secondary pneumonia.