1, 3, 11 Mortality reached alarming levels. The symptoms were so severe that there was speculation that it was some other disease such as “trench fever,” dengue, anthrax, cholera, or even plague. 1, 3 There was much debate about the origins of the illness and whether it was indeed influenza. With so many infected, and so many dying within a few weeks, the burden on medical staff and the funerary industry were immense, as was the accompanying economic and social disruption. The remaining 200 suffered pulmonary complications of these, the mortality rate for those developing heliotrope cyanosis was 95%. This was more severe than the so-called “three-day fever” of the spring of 1918, but no worse than ordinary influenza. 9, 10 According to one estimate of the period, 800 of every 1000 people who showed symptoms suffered from uncomplicated influenza. The mortality in India alone has been estimated at 18 million. 8 Figures suggest that China was spared the worst of the pandemic, although this may simply reflect a lack of accurate records.
1, 3 Death rates in Africa were comparable to or higher than those in North America and Europe. In less than a year, 220 000 influenza-related deaths occurred in Britain, and between September 1918 and June 1919 it proved fatal to at least half a million US citizens. The second wave, which spread around the world in a few months, was disastrous. This was a fairly mild form of influenza and caused relatively few fatalities. The first, in the spring of 1918, spread through parts of the United States, Europe, and Asia.
There were 3 waves of infection between 19. 5, 6 Pleurisy, hemorrhage, edema, inflammation of the middle ear, meningitis, nephritis, and pericarditis were among the many complications reported. Others succumbed to a condition similar to acute respiratory distress syndrome that could kill within days or hours. 3, 5 Many victims died of pneumonia caused by secondary bacterial infections. Another striking feature was the discoloration of the seriously ill, who often exhibited “heliotrope cyanosis,” which is characterized by a blue-gray tinge to the face and other parts of the body. 4 Unusually, many of those who died were young adults, who normally have a low death rate from influenza. 2 Most deaths occurred between mid-September and mid-December of 1918.
3 However, some regions reported mortality rates for the entire population as high as 5% to 10%. 2 Morbidity was high, at anywhere from 25% to 90%, and the fatality rate was between 1% to 3%. In 1991, this figure was revised to between 24.7 million and 39.3 million, and more-recent scholarship suggests 50 million to 100 million people may have died. In the 1920s, it was estimated that the disease had killed 21 million people. Global mortality from the pandemic is not known, because there are large areas of the world for which there is little information. No other pandemic in history killed so many in such a short time. Although the fatality rate was relatively low, the incidence of infection was so great that the number of deaths was high.
The H1N1 influenza pandemic of 1918–1919 is notorious because of the infectivity of the virus and the number of lives it claimed. Each was caused by a novel type A influenza virus of avian origin. THREE INFLUENZA PANDEMICS occurred during the last century: in 1918, 1957, and 1968.
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