Are We In for a Repeat of the Killer Flu Pandemic of 1918?

In 1918, the Spanish flu raced around the globe, ending the lives of an estimated 40 million people in less than a year. Epidemiologists believe one in four Americans became infected during that pandemic with 750,000 dying.

Fears are mounting that the H1N1 flu, which appeared in the spring of this year, will turn as virulent and deadly and mimic the course of the Spanish flu that initially struck in mild waves in the spring and summer of 1917 only to turn lethal in the fall and early winter of 1918. It’s understandable why so many people are fearful of H1N1 flu, which is also known as swine flu, said Dr. Jorge Parada, associate professor of medicine and infectious diseases at Loyola University Chicago Stritch School of Medicine.

The virus usually infects pigs and has rapidly spread around the world.“The hysteria is primarily driven by two things: It’s new and the data we have are not well established,” said Parada, who is also medical director of the infection control program at Loyola University Health System in Maywood. “Another component of the fear is based on who is being most infected by H1N1 – young people – and the unexpected deaths among those young and otherwise healthy people.”

Though there is some cause for concern about H1N1 flu, particularly during this time of the year with the regular seasonal flu season looming, there is little reason for panic, Parada said. Dramatic differences exist in medical knowledge and technology, epidemiology and clinical care between 1918 and today.

“Back then it was not quite as clear how diseases like the flu were transmitted and what could be done to decrease transmission,” said Parada.In 1918, in the few cities where organized measures were instituted to limit infectious disease outbreaks, the spread of the Spanish flu was much lower, Parada said.

Measures we take now include the frequent washing of hands, covering the nose and mouth after sneezing, avoiding touching the eyes, nose and mouth and using disinfectants on frequently touched surfaces where germs can linger.

“In most places that wasn’t done. There was very little effort to block transmission and those people paid the price,” Parada said. Significantly, the Spanish flu pandemic occurred before the advent of antibiotics, which are effective in treating secondary infections caused by the flu, Parada said. A great many of the deaths that occurred during the 1918 pandemic were the results of secondary bacterial infections called post-influenza pneumonia.

“It was the pre-antibiotic age. If you had post-influenza pneumonia, the likelihood of doing poorly and dying were much higher,” Parada said. “We’re in the antibiotic age now and we do a much better job of treating and preventing post-influenza pneumonia.”