Friday, April 10, 2020



Dr K K Aggarwal
President Confederation of Medical Associations of Asia and Oceania


The Spanish flu or 1918 flu pandemic was an unusually deadly influenza pandemic.

427: How long it lasted

January 1918 to December 1920

428: How many people it infected

500 million people – about a quarter of the world's population at the time.

429: How many people died

50 million (3-5% of global population)

430: what was the age group who got killed

Most influenza outbreaks disproportionately kill the very young and the very old, with a higher survival rate for those in between, but the Spanish flu pandemic resulted in a higher than expected mortality rate for young adults.[3] Scientists offer several possible explanations for the high mortality rate of the 1918 influenza pandemic.

431: did it cause cytokine storm

Yes. Also Malnourishment, overcrowded medical camps and hospitals, and poor hygiene promoted bacterial superinfection. This superinfection killed most of the victims, typically after a somewhat prolonged death bed.

432: Which virus was it

The Spanish flu was the first of two pandemics caused by the H1N1 influenza virus; the second was the swine flu in 2009.[9]

433: how many people died in India

Some 12-17 million people died in India, about 5% of the population.

434: Were pregnant women at risk

According to historian John M. Barry, the most vulnerable of all – "those most likely, of the most likely", to die – were pregnant women. He reported that in thirteen studies of hospitalized women in the pandemic, the death rate ranged from 23% to 71%. Of the pregnant women who survived childbirth, over one-quarter (26%) lost the child.[

435: Was it as winter flu

Another oddity was that the outbreak was widespread in the summer and autumn (in the Northern Hemisphere); influenza is usually worse in winter.

436: was there a deadly second wave

The second wave of the 1918 pandemic was much more deadly than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. By August, when the second wave began in France, Sierra Leone, and the United States,  the virus had mutated to a much more deadly form. October 1918 was the month with the highest fatality rate of the whole pandemic.

437: What was Aspirin poisoning

In a 2009 paper published in the journal Clinical Infectious Diseases, Karen Starko proposed that aspirin poisoning contributed substantially to the fatalities.

438 How was the end of the pandemic

After the lethal second wave struck in late 1918, new cases dropped abruptly – almost to nothing after the peak in the second wave.

In Philadelphia, for example, 4,597 people died in the week ending 16 October, but by 11 November, influenza had almost disappeared from the city.

Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out.

439: why it is called forgotten epidemic
 Despite the high morbidity and mortality rates that resulted from the epidemic, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a "forgotten pandemic".

440: what were the non pharmacological methods used

Control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

441: Where did we fault

We forgoer earlier recommendation of flu
A:  NPIs routinely recommended for prevention of respiratory virus transmission, such as seasonal influenza, include personal protective measures for everyday use (voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene) and environmental surface cleaning measures (routine cleaning of frequently touched surfaces and objects).
During an influenza pandemic, these NPIs are recommended regardless of the pandemic severity level.
Additional personal and community NPIs also might be recommended.

Personal protective measures reserved for pandemics include voluntary home quarantine of exposed household members and use of face masks in community settings when ill.

Community NPIs might include temporary closures or dismissals of child care facilities and schools with students in grades kindergarten through 12 (K–12), as well as other social distancing measures that increase the physical space between people (e.g., workplace measures such as replacing in-person meetings with teleconferences or modifying, postponing, or cancelling mass gatherings)

442: What are Personal protective measures for everyday use

These include voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene.

443: What are Personal protective measures reserved for pandemics

These include voluntary home quarantine of exposed household members and use of face masks in community settings when ill.

444: What are Voluntary home isolation (staying home when ill or self-isolation)

Persons with influenza stay home for at least 24 hours after a fever or signs of a fever (chills, sweating, and feeling warm or flushed) are gone (, except to obtain medical care or other necessities.
To ensure that the fever is gone, patients’ temperature should be measured in the absence of medication that lowers fever. In addition to fever, common influenza symptoms include cough or chest discomfort, muscle or body aches, headache, and fatigue. Persons also might experience sneezing, a runny or stuffy nose, sore throat, vomiting, and diarrhea (

445: What is the Rationale for use as a public health strategy

Most persons infected with an influenza virus might become infectious 1 day before the onset of symptoms and remain infectious up to 5–7 days after becoming ill

However, studies found that infants and immunocompromised persons might shed influenza viruses for prolonged periods (up to 21 days and a mean of 19 days, respectively)

446: what is the triple prevention

Voluntary home isolation, which is a form of patient isolation, prevents an ill person from infecting other people outside of their household.

Respiratory etiquette reduces the dispersion of droplets contaminated with influenza virus being propelled through the air by coughing or sneezing.

Hand hygiene reduces the transmission of influenza viruses that occurs when one person touches another (e.g., with a contaminated hand).

Contamination also can occur through self-inoculation via fomite transmission (indirect contact transmission) when persons touch a contaminated surface and then touch their nose with a contaminated hand.

447: Why clean fingers

Additional studies found that influenza viruses can remain viable on the human hand for roughly 3–5 minutes and that influenza viruses can remain on fingers for 30 minutes after contamination

448: What are CDC recommendations for flu

Voluntary home isolation: CDC recommends voluntary home isolation of ill persons (staying home when ill) year-round and especially during annual influenza seasons and influenza pandemics.

Respiratory etiquette and hand hygiene: CDC recommends respiratory etiquette and hand hygiene in all community settings, including homes, child care facilities, schools, workplaces, and other places where people gather, year-round and especially during annual influenza seasons and influenza pandemics.

449: How will face mask help in healthy individuals

Face mask use by well persons also might reduce self-inoculation (e.g., touching the nose with the hand after touching a contaminated surface).

Face mask use by well persons is not routinely needed in most situations to prevent acquiring the influenza virus. However, use of face masks by well persons might be beneficial in certain situations (e.g., when persons at high risk for influenza complications cannot avoid crowded settings or parents are caring for ill children at home). 

450: When are Environmental surface cleaning measures are recommended

For frequently touched surfaces and objects in homes, child care facilities, schools, workplaces, and other places where persons gather. These measures can be used for prevention of seasonal influenza and in all pandemic severity scenarios.
Use of these measures might result in some secondary consequences (e.g., failing to read instruction labels before applying disinfectants to ensure that they are safe and appropriate to use or cleaning with poor ventilation during the application process).

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