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Q: Spanish Flu Pandemic in 1918 ( Answered 5 out of 5 stars,   3 Comments )
Question  
Subject: Spanish Flu Pandemic in 1918
Category: Health > Medicine
Asked by: jim87-ga
List Price: $15.00
Posted: 27 Apr 2003 06:47 PDT
Expires: 27 May 2003 06:47 PDT
Question ID: 196121
What percentage of the people who contracted Spanish Flu in 1918 died?
This will vary from country to country, I suppose, depending on health
facilities. Let me therefore confine my question to statistics for the
US/Canada and countries in what is now called "Western Europe".

Request for Question Clarification by pafalafa-ga on 27 Apr 2003 13:43 PDT
Hello Jim87, fascinating question.

I agree with my colleague, Piknfreud, that this is a tough nut to
crack.  I've come across several firm references to the death rate
from the Spanish flu, from the 2.5% figure in the U.S. and 5% in India
cited by pinkie, to others, including figures from communities in
Canada, Australia, Britain, parts of Europe, etc.

Trouble is, they are very often of questionable value, as they are not
clear whether the numbers are a percent of the overall population that
has died, or a percent of the subpopulation who got sick (which is
what you requested).  Some of the data even fall into other categories
-- such as the percentages with certain symptoms who later died.

Bottom line -- there's a lot of fascinating info out there about the
Spanish Flu, but there doesn't seem to be the consistent, comparative
type of mortality data you're seeking.  Would any other sort of
information suit you as an answer?

Clarification of Question by jim87-ga on 27 Apr 2003 16:14 PDT
Hello pafalafa-ga.
Thank you for your interest.I am really trying to get a feel for how
the virus responsible for SARS compares in its mortality figures with
the 1918 virus.It's early days but I suspect Homo sapiens is going to
have to face the fact that this new virus will become endemic
throughout the world in the next year or two. I am trying to get an
idea of the relative virulence of the two viruses. At this stage
morbidity studies on SARS are meaningless - it's too new.I am simply
wondering what data of value exists on "Spanish Flu".I would be happy
to be pointed in the direction of any data which you consider
reasonably reliable.In due course, we will no doubt have many SARS
epidemiological studies but that is away down the line.

Request for Question Clarification by pinkfreud-ga on 27 Apr 2003 16:44 PDT
jim87,

Did you look at the vortex links at the bottom of my previous comment?
There's some good information there regarding the mortality rate of
the 1918 influenza pandemic in several different areas of the world.

Request for Question Clarification by pafalafa-ga on 27 Apr 2003 18:55 PDT
Thanks for the added information, which makes this question even more
interesting.  I won't be able to get back to this any time in the next
few days (much as I'd like to), but hopefully one of the other
researchers here can give you an answer to this in a faster timeframe.
Answer  
Subject: Re: Spanish Flu Pandemic in 1918
Answered By: tehuti-ga on 28 Apr 2003 08:56 PDT
Rated:5 out of 5 stars
 
Hello jim87,

I have found some figures on numbers of cases of Spanish flu and
number of deaths among these cases in communities of various types and
sizes.  Where the figures are reasonably detailed, I have calculated
the death rate as a percentage of cases.  You will notice there is
quite a difference in the resulting death rates.  There is also quite
a disagreement in the various overall estimates of death rates which I
also cite. It is important to note that statistics from this period
are not totally reliable. Also, the point is made in one of the
references cited below, that not all cases of Spanish flu were
necessarily reported, and that the cause of death in flu cases might
not always have been noted as being the flu itself.

1. “The Spanish Lady and the Newfoundland Regiment” by W. David
Parsons, MD, C.M., FRCP (C) on the World War I Document Archive at
http://www.ku.edu/carrie/specoll/medical/parsons.htm

Parsons makes the point that the first wave of Spanish Flu (which
actually originated in Canton, not Spain) was fairly mild with low
mortality. Some people called it the “Three-day Flu”  This first wave
lasted from February until June, 1918.  The second wave first appeared
in late August, 1918, and was quite different to the first wave: “The
sudden onset of high fever, severe incapacitating aches and pains,
severe headaches, sudden collapse and prostration and death within
hours or days, puzzled the doctors at first. Was it Cholera, or
Typhus? Dengue Fever or Botulism were suggested.”

The second wave peaked in September/October, and then decreased over
November and December. A third wave followed in February-April, 1919.

Parsons cites a book by Richard  Collier, "The Plague of the Spanish
Lady”, published byAtheneum, New York in 1974, as saying that most
accounts of the Spanish Flu give a mortality rate of 1% of all cases.

He cites  the following statistics for deaths from Spanish Flu (I have
selected only those which give the number of cases as well as the
number of deaths).  The military statistics show how mortality can be
affected by factors such as overcrowding in confined areas.

“Crowding men in barracks is a certain way of spreading infectious
diseases. Confine them to a crowded troopship and it can be explosive.
Draft 24 of 173 officers and men left St.John's on September 22, 1918
en route Overseas via Nova Scotia. One soldier is buried in Cape
Breton and 3 died on the voyage. Nine men were hospitalized on arrival
at Plymouth, six of whom died within the next week”  (ref: Ledger of
the Royal Newfoundland Regiment. A listing of the service of all
members of the Regiment from Number 1 in Aug., 1914 to Number 6400 in
November, 1918, including deaths, wounds, sickness, and location of
occurrence.)  - death rate of 10/13, ie 77%, in this small group
Parsons gives the total tally for the Regiment as 351 cases and 29
deaths out of a total regimental strength of about 3,000.  i.e. death
rate of  8.2%

“A convoy arriving at Brest on October 8 with 24,000 men, had 4,000
with the flu and 200 died at sea. In the next few days, over 200 of
those hospitalized from the "Leviathan" died” (ref: Crosby, Alfred W.,
Jr. Epidemic and Peace, 1918. Westport, CT: Greenwood Press, 1976) ie
death rate of 10%

“the British from mid October to Mid November had 62000 cases and 3600
deaths” (ref: Crosby, as above)  death rate = 5.8%

American Expeditionary Force in France: 113,000 cases with 9,000
deaths (ref: Crosby) death rate = 8%

“Over 621,000 of all American service men had Flu-1/6 of the total of
all Services, of whom 43,000 died… [death rate of  7%] The French Army
had 132,000 cases with 10,000 deaths.” [death rate of 7.5%](both sets
of figures from Crosby).


German Army and Germany as a whole: “ one estimate places the number
at 14% of the 1.2 million men under arms-about 168000 deaths. Another
source states that Germany suffered an estimated 2.75 million cases
with 186,000 deaths in the military and 400,000 civilian deaths...
[death rate of 21%!]  The Canadian Army in Canada, Britain, and France
had 45,960 cases with 776 deaths. [death rate = 1.7%] (refs from:
McGinnis, J.P.D. The Impact of Epidemic Influenza in Canada Medicine
in Canada. Historical Perspectives, 1981;  History of the Canadian
Forces 1914-1919. Medical Services. Sir Andrew MacPhail, ed.
D.N.D.1923;  Bouchard, A. CMJ.8, December 1918)

2. Iceland: “At the time when the Influenza ravaged in ReykjavÝk there
were about 15.0000 people living there and with in two weeks about
10.000 people were infected with the Spanish Influenza… It is beliefed
that around 260 people died from the Influenza in ReykjavÝk [death
rate =  2.6%] and around 300 in all of Iceland” From “The Spanish
Influenza in Iceland” by Sigr˙n Gu­nadˇttir
http://www.vortex.is/~sigrun/IcelandE.html

3. “Spanish Influenza Mortality of Ethnic Minorities in
Norway 1918–1919” published this year (2003) by Svenn-Erik Mamelund,
in the European Journal of Population Volume 19, pages 83–102, and
available in full text (pdf file) at
http://www.oekonomi.uio.no/memo/saertrykk/2003/spanish.pdf

“Spanish Influenza, the nickname of the influenza pandemic of
1918–1920, swept the entire globe in four waves, leaving 500 million
people sick, over one fourth of the world’s population at that time
(Laidlaw, 1935). It killed between 50 and 100 million, five to ten
times the death toll of soldiers during World War I (Johnson and
Mueller, 2002).”
The references are to: Laidlaw, P.P., 1935. ‘Epidemic influenza: A
virus disease’, Lancet i: 1118–1124. and Johnson, N.P.A.S. and
Mueller, J., 2002. ‘Updating the accounts: Global mortality of the
1918–1920 “Spanish Influenza” Pandemic’, Bulletin of the History of
Medicine 76: 105–115.

“Spanish Influenza probably infected 1.2 million Norwegians 1918–1919
and led to 15,000 recorded deaths in a population of 2.6 million
[death rate = 1.25%] (Mamelund, 1998).” Ref to: Mamelund, S-E., 1998. 
Spanskesyken i Norge 1918-1920: Diffusjon og demografiske
konsekvenser. Hovedoppgave (masters thesis) i Samfunnsgeografi h°sten
1998. Institutt for Sosiologi og Samfunnsgeografi, Universitetet i
Oslo, Oslo.”

NB The author also makes the following point, which is an important
reason for why statistics may be difficult to produce: “It is
estimated that Spanish Influenza struck 1.2 million Norwegians whereas
only a third of the cases were reported… Although doctors and local
health departments were overworked and failed to report complete
morbidity figures, every death was reported… In 1918, cause of death
in Norway was registered by secondary cause of death, i.e., the last
cause that ultimately ended a person’s life… Fatal cases usually
occurred when Spanish influenza was followed by pneumonia. As a
consequence, pneumonia, not influenza was sometimes reported as the
cause
of death”

“Several authors have also shown that urban populations experienced
higher mortality than rural ones…  There are also studies showing that
the population living in areas heavily affected by the first influenza
wave suffered less in the succeeding waves, as relative immunity was
acquired.”

The author was looking at differences between the general population
and indigenous peoples, and came to the following conclusion:
“This paper documents that areas with high shares of an indigenous
population, the Sami in Norway, have high Spanish Influenza mortality,
net of such confounding factors as wealth, poverty, crowding, and
occupational structure. The cause is probably a lack of inherited and
acquired immunity against influenza among the Sami. The lack of
acquired immunity is not only explained by late arrival of the
1918–1920 pandemic in peripheral areas where the Sami lived, but also
by cultural factors. The pastoral Sami probably used flight to escape
the pandemic.”

4. A different estimate of the worldwide death rate to that given by
Johnson and Mueller is found in “In Search of an Enigma: The "Spanish
Lady"” by Rod Daniels, a Mill Hill essay from the UK National
Institute of Medical Research:
http://www.nimr.mrc.ac.uk/millhillessays/1998/influenza1918.htm

“the so-called "Spanish Lady" or "Spanish Flu" pandemic of 1918-19
which infected one billion people, half the world’s population at that
time, and killed between forty and fifty million. This makes it the
most devastating disease of man known, surpassing even the bubonic
plague of the fourteenth century, smallpox in the sixteenth century
and the human immunodeficiency virus/AIDS pandemic that is happening
now.”

5. “Alberta had a population of 590,000 people and 38,000 came down
with the flu and 4,300 died.”
http://www.telusplanet.net/public/dgarneau/alberta14.htm (“Alberta
History” – no source supplied for these figures) death rate = 11.3%

6. Victoria, Australia, cases reported on 11th April, 1919: cases
12,972, deaths 803 - 714 metropolitan, 89 country.
http://www.ballaratgenealogy.org.au/digby/1919flu.htm  death rate = 6%

7. San Francisco: “The city had survived its attack of Spanish
influenza in better shape than many of its eastern counterparts:
23,639 cases reported, 2122 deaths. [death rate = 8.97%] But, any
thoughts of victory over "The Spanish Lady" were premature. Barely two
weeks after the celebratory removal of masks, new flu cases were
reported. Five thousand new flu cases would surface in December 1918
alone. Fortunately round three of the Spanish influenza was far less
severe than either rounds one or two. Still, scores were brought low
by flu and many eventually succumbed to it, bringing the final tally
of influenza fatalities to over 3500.”
http://www.dde.liverpool.k12.ny.us/Whacked/WebWhacker%201.0/Influenza/sanfran.html
 (Elementary school web site)

8. Saginaw County, Michigan: During the Spanish flu epidemic the there
were 4,500 sick in Saginaw County, with 170 deaths.  death rate = 3.7%
http://www.saginawimages.org/essay.asp?ItemID=HEES0017&SearchTerm=290
(Web site from Public Libraries of Saginaw)

9. “in the United States alone over 25 million were infected, with
over 670,000 dying From the end of September 1918 through the end of
the year, Beloit had over 5,000 cases of the “grip” as it was called,
and over 100 deaths.” (From “Autumn 1918: The Deadliest Season by
Scott Reichard, Beloit Historical Society)
http://www.ticon.net/~beloiths/Newsletter/Articles/deadliestseason.htm

10. The influenza pandemic claimed more victims in the USA than all of
their armed conflicts of the 20th century and America was one of the
least devastated countries on the planet with approximately 850,000
deaths from 20,000,000 cases….  The cause… is believed to have been a
mutated swine virus from China, brought about by a rare genetic shift
leading to the recombination of surface proteins which led to a lack
of immunity among the world population. The virus infected a fifth of
the world's population and was most deadly for people aged 20-40, a
change from normal influenza, which is mainly a killer of the elderly
and young children. The mortality rate was 2.5% compared with 0.1%
normally. The killer was not the influenza itself but the pneumonia
accompanying the infection…  the disease was spread by human carriers
along trade routes and shipping lines. The mass movements of the
troops… aided the rapid diffusion… and the conditions the men were
exposed to even before they reached the front line made the job of the
virus all the easier.”
From: “A Brief History of Epidemics
http://www.bath.ac.uk/~ns0sjcg/website/P4.html (a web site produced as
a coursework assignment by a student at University of Bath, UK)

11. “The mortality rate was more than two in every hundred who caught
the disease. … Outbreaks swept through all the continents - in India,
mortality was 50 deaths per 1,000 cases [ie 5%].”
From “Flu: A warning from history” BBC News web site, Monday, 17
March, 2003, http://news.bbc.co.uk/1/hi/health/2856447.stm

12. Gibraltar: 3,000 cases were reported and 111 deaths recorded.
death rate = 3.7% http://www.thegibraltarmagazine.com/gc.html (The
Gibraltar Magazine)

13. Philadelphia: “In Philadelphia; the “Spanish lady” left in its
wake 12,191 deaths and 47,904 cases in four weeks.”
http://www.cdphe.state.co.us/bt/HealthProviders/Conference/bioterrorismppt.pdf
 (Presentation by F Judson on the Colorado Dept of Public Health and
Environment web site) death rate = 25.45%

And finally, a comparison between SARS and Spanish Flu from the
Washington Post, April 25:

Death Rate for Global Outbreak Rising
By Shankar Vedantam and Rob Stein
Washington Post Staff Writers
Friday, April 25, 2003; Page A01
http://www.washingtonpost.com/ac2/wp-dyn/A35146-2003Apr24?language=printer

“The death rate [for SARS] “has gone from 3.5 and 4 percent, and is
now between 5.9 and 6 percent,” said Julie Gerberding, director of the
U.S. Centers for Disease Control and Prevention, yesterday…. 
Statistics in Hong Kong show that the death rate among people younger
than 55 is 3.6 percent. For patients between 65 and 75, it is 18.9
percent. For those older than 75, the death rate is 28.6 percent…. In
Canada, the death rate yesterday… was 10.71 percent, one of the
highest in the world, with most of the cases in the Toronto area. The
number was based on WHO’s count of 15 deaths and 140 cases…. However,
Andrew Simor… said that communication lags meant that the WHO
statistics are not always based on the latest figures: “We have 16
deaths out of 270 cases,” he said, for a death rate of about 5.93
percent…. Yesterday’s statistics, for example, counted 4,439 cases of
SARS and 263 deaths worldwide, for a death rate of 5.92 percent…. 
Only two places, mainland China and Hong Kong, have enough cases to
calculate meaningful local death rates: China’s stands at 4.54
percent, while Hong Kong is at 7.32 percent… Reliable death rates are
available for the flu. In a typical year, it is usually below 1
percent. The Spanish flu pandemic of 1918-19 had a death rate
estimated to have been about 2 percent. It, however, killed perhaps 25
million people worldwide because it quickly swept the globe and
infected millions.”
NB Death rate here is used for the percentage of people who die out of
the total number of cases.

Search strategy: 1. "Spanish flu" mortality statistics  2. "Spanish
flu" cases deaths
jim87-ga rated this answer:5 out of 5 stars
I am delighted with the answer by tehuti-ga and grateful for the
various comments posted to my question by others. The references given
by tehuti-ga and his narrative gave me all I wanted.

Comments  
Subject: Re: Spanish Flu Pandemic in 1918
From: pinkfreud-ga on 27 Apr 2003 09:57 PDT
 
I have not been able to find statistics on the mortality rate of the
1918 influenza pandemic in Canada nor in Europe. Here are a few items
that may be of use to other Researchers:

"The 1918 flu that killed more than 20 million people may have quietly
percolated for several years, trading back and forth between pigs and
people, until suddenly growing strong enough to become the worst
recorded global epidemic... In the United States, about a quarter of
the population had the flu and 2 percent to 3 percent died -- some
700,000 people."

CNN
http://www.cnn.com/HEALTH/9902/15/historic.flu/

"It infected 28% of all Americans (Tice). An estimated 675,000
Americans died of influenza during the pandemic, ten times as many as
in the world war... The influenza virus had a profound virulence, with
a mortality rate at 2.5% compared to the previous influenza epidemics,
which were less than 0.1%... In India the mortality rate was extremely
high at around 50 deaths from influenza per 1,000 people... The
influenza pandemic circled the globe. Most of humanity felt the
effects of this strain of the influenza virus. It spread following the
path of its human carriers, along trade routes and shipping lines.
Outbreaks swept through North America, Europe, Asia, Africa, Brazil
and the South Pacific (Taubenberger). In India the mortality rate was
extremely high at around 50 deaths from influenza per 1,000 people
(Brown)... A study attempted to reason why the disease had been so
devastating in certain localized regions, looking at the climate, the
weather and the racial composition of cities. They found humidity to
be linked with more severe epidemics as it "fosters the dissemination
of the bacteria," (Committee on Atmosphere and Man, 1923). "

http://www.stanford.edu/group/virus/uda/

Many good links may be found here:

http://www.vortex.is/~sigrun/Evropa.html

http://www.vortex.is/~sigrun/othercontries.html

http://www.vortex.is/~sigrun/Newresearch.html
Subject: Re: Spanish Flu Pandemic in 1918
From: pinkfreud-ga on 27 Apr 2003 17:41 PDT
 
Regarding the mortality rate of the 1918 pandemic, I have come across
several sources that make statements such as this one:

"The influenza virus had a profound virulence, with a mortality rate
at 2.5% compared to the previous influenza epidemics, which were less
than 0.1%."

http://bitworking.org/news/78

Infectious disease expert C. J. Peters, M.D. says that the mortality
rate during the 1918 pandemic was 1%. He sets the mortality rate for
SARS at 3% to 4%:

http://my.webmd.com/content/article/63/71969.htm

From another comparison of SARS to the 1918 pandemic:

"SARS is actually deadlier than the 1918 flu virus, killing 4 per cent
of its victims compared with 2.5 per cent."

http://www.globeandmail.com/servlet/ArticleNews/TPStory/LAC/20030405/FCFLUU/Comment/Idx
Subject: Re: Spanish Flu Pandemic in 1918
From: pafalafa-ga on 28 Apr 2003 09:35 PDT
 
As usual, tehuti-ga has provided a splendid answer.  Hats off to you,
Tehuti -- I'm glad to see you were the one to tackle this challenging
question.

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