Many doctors fear a repeat of the world's 1st, only flu pandemic 100 years later

It’s been 100 years since the United States, and the entire world, felt the wrath of the influenza pandemic. With over 50 million people killed, including an estimated 675,000 Americans, it still remains the most impactful and dangerous public health pandemic in modern history.

“The 1918 pandemic was the worst in recorded history,” said William Schaffner, M.D., medical director for the National Foundation of Infectious Diseases. “We still don’t know exactly why that virus was so fierce, but it indeed was said to affect around one-third of the entire population of the earth.”

The Centers for Disease Control and Prevention (CDC) defines a pandemic as an outbreak of disease that spreads across several countries or continents, affecting a large number of people. This differs greatly from an epidemic, which is a more sudden spread of disease in a more concentrated area, affecting a more specific population.

The 1918 influenza pandemic defined itself as unique for a multitude of reasons, the greatest being the widespread risk it imposed on everyone it encountered.

“When we look at influenza outbreaks today, the two most susceptible groups are the very young and the very old,” said Schaffner. “However, one of the striking characteristics of the 1918 influenza outbreak was that young and middle-aged adults also had very high mortality rates. We have never seen another influenza epidemic or pandemic with that configuration.”

In 1918, however, the flu was an unidentified virus. Spreading at an alarming rate, there was no vaccination and understanding of how to treat the symptoms.

“People fell ill in the morning, by the afternoon they were struggling for breath and they were dead by the evening,” said Schaffner. “It was a profoundly ferocious virus, different from any other that we ever had.”

Treatments of the virus in 1918 included isolation, practicing good hygiene, disinfectants and limited public outings and gatherings. There were also no resources or procedures to treat bacterial infections that we now know as common complications that can develop from the flu.

“Frequently, what happens with influenza is that it sets you up for the complication of pneumonia,” said Schaffner. “Back then, we didn’t have antibiotics, we didn't have the diagnostic skills, we didn't have the capacity to care for you in intensive care units. If you were admitted to a hospital bed, that's about all anybody could do.”

Today, the flu is thought of lightly, resembling the symptoms and treatments of the common cold. Most stories of those becoming severely ill or dying of the flu are usually related to people with preexisting conditions or illnesses or those who are elderly.

Last year, however, brought a different flu result than most are used to. The CDC reported that there were record-breaking doctor's visits and hospitalizations for the flu, and it is unknown if that trend will follow suit, decrease or increase heading into this flu season.

Everyone should be conscious of the dangers of the flu and the possibility of another pandemic. According to the CDC, "a vast reservoir of flu viruses circulating in animals, mainly birds, pose an ever-present threat for the emergence of another flu pandemic."

The CDC says there is still much to do to prepare for the next pandemic. The agency says "there's a need for more broadly effective vaccines that can be made quicker and the global infrastructure to produce and distribute flu vaccines also must be improved." Making cheaper and more effective flu treatment drugs is recommended as is improving the surveillance of flu viruses in animals.

The influenza virus has the ability to mutate, according to Schaffner. Someone who has been exposed to every strain that came before can become susceptible and fall ill to the new one.

A new virus arose in 1918 and wreaked havoc on a world that was not prepared for its arrival. Although advancements have come along tremendously in the 100 years since the outbreak, there is no predicting if or when an influenza pandemic could happen again.

“It was a huge lesson and remains with us today,” said Schaffner. “If you ask people in public health or infectious diseases which infection they fear the most, they will almost invariably say influenza even more so than the AIDS virus, because influenza could mutate once more and spread around the world.”

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