It is said that the flu of 1918 killed the young and the healthy. These bones say otherwise.

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Marian McKenna

During the difficult last days of World War I, just two weeks before the global powers agreed to an armistice, a doctor wrote a letter to a friend. The medic stationed at the U. S. Army’s Camp Devens, west of Boston, a base filled with 45,000 infantrymen preparing to depart for the battlefields of France. A fatal, fast-paced pneumonia had seeped into the base, and the ward he oversaw was filled with desperately unhealthy men.

“Two hours after admission, they have mahogany spots on their cheekbones, and a few hours later you may start to see cyanosis spreading from their ears and spreading all over their face,” he wrote to a medical colleague. “It’s only then that death comes, and it’s just a struggle to breathe until you suffocate. It’s horrible. “

No one knew what it meant to massacre those men, to kill a hundred more people every day in Devens alone, and more than 57,000 during the time the last military corporations were demobilized in 1919. It took years to realize that the disease, the roar of a mild, flu-like illness that had appeared in Kansas last year and reached Europe with the first deployments in the United States, a momentarily overwhelming wave that would sweep the world.

The death toll from the “Spanish” flu (which did not appear in Spain yet was covered in its newspapers because they had no wartime censorship) was at least 50 million people, several times the deaths recorded from Covid-19. In the midst of this assessment, the account of his attacks on Camp Devens has stood out, not only for the terror it embodies, but also for the victims it describes. In medicine, infectious epidemics are supposed to preferentially kill the very old and the very old. A curve that resembles a U-shape when comparing ages and deaths. But the 1918 flu mortality curve was W-shaped, with an average peak of other people in their 20s and 40s: young and healthy, as Devens’s army puts it. It would have been the recruits.

Since then, the narrative about the 1918 flu has been that it was an exclusively fatal disease, affecting all ages, regardless of physical condition, and mysteriously the deadliest for people with the most powerful immune systems. But now, a study of the skeletons of other people who died in 1918 shows that this story may not be accurate. Their bones retain lines of underlying fragility, due to other infections or malnutrition. This discovery may also rewrite the history of 1918 and how we planned for a long time. execute pandemics.

“This leads to a generalizable conclusion: that epidemics don’t strike neutrally, like thunder,” says Andrew Noymer, a demographer, epidemiologist and associate professor at the University of California, Irvine, who, while not interested in the charts, studies the interactions between tuberculosis and the 1918 flu. “They hit differently, and other people who are worse off at the beginning are going to be even worse off in the end. “

Andy Greenberg

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Brenda Stolyar

The analysis, published by biological anthropologists Amanda Wissler of McMaster University in Canada and Sharon DeWitte of the University of Colorado Boulder, uses a set of more than 3,000 skeletons preserved at the Cleveland Museum of Natural History. The bones, collectively known as the Hamann-Todd Human Osteological Collection, come from other people who died between 1910 and 1938 but whose bodies were never claimed. Because they were either inpatients or citizens of the county hospital, the bodies retained their identities and other data, adding names, ages, and gender. but also their ethnicity, the reasons for death and post-mortem measurements. In 2006, the museum declared it to be the largest and most data-rich collection of skeletons in the world.

Of the 3,000 skeletons, 81 belong to other people who died when the pandemic hit Cleveland, between September 1918 and the following March. The researchers took them, along with a control group of 288 other people who died before the flu hit, and looked for evidence that they had experienced health-related stress. The signs they chose were unhealed lesions on the surface of the tibiae, the anterior bones of the tibias. These injuries would imply that the general procedure of bone reconstruction, which occurs in life, has been disrupted. through trauma, malnutrition or chronic disease, but not through a flu infection, as it kills too temporarily to have an effect on the bones.

If the old 1918 account were correct, then the skeletons of flu sufferers would come with more healthy Americans than frail Americans, compared to the skeletons of other people who died before 1918. Or if the surprise of the death of so many healthy young people people had distorted memories. . . This gives the impression that more people in poor health were given than they actually were, when perhaps the other healthy and frail people would have been given it in equivalent amounts. But none of that was true. The bones showed that, during the seven months that the flu hit Cleveland, other people of any age with visual frailty symptoms were 2. 7 times more likely to die.

That’s not to say that other healthy people don’t die too. A tricky aspect of the research was that the 1918 flu killed more people of all categories: healthy and sick, young and old. “There’s less difference in threat compared to what was seen before the pandemic,” says DeWitte, a professor of anthropology in Colorado who uses burial sites to examine selective mortality similar to the Black Death. “Yes, the 1918 flu disproportionately killed other frail friends. But it was a new pathogen that killed a giant number of other people. So there were more supposedly healthy people who died from the 1918 flu than would have died before the 1918 flu. “

Andy Greenberg

Megan Farokhmanesh

Julien Chokkattu

Brenda Stolyar

Researchers have the option that the Cleveland collection is unique. Because their remains went unclaimed, those Americans likely would have been disconnected or disconnected from social media, although, given the circumstances of 1918, they may have had families who had died before them. . And because they lived in an urban area, they likely would have belonged to minority groups that found opportunities in cities and could have experienced discrimination that further weakened their health.

But even those warnings would reinforce, rather than weaken, the study’s central conclusion: that the mortality of 1918 was no different from other epidemics, which disproportionately affected the vulnerable, as well as the young and old.

“If you’re weakened by infectious diseases, like tuberculosis, whooping cough or measles, early in your life, or if you can’t get enough protein or fat in your body, then in your 20s and 30s, we’re going to be very vulnerable to a new acute virus, like the one we saw in 1918. ” says Taylor van Doren, a postdoctoral researcher at the National Science Foundation at the University of Alaska-Anchorage, who studies the effect on the 1918 flu in Newfoundland. “The physical fitness of the early formative years can uncover the underlying fragility and vulnerability. “

Researchers unfamiliar with this work see clear lessons in this. Since the Black Death, and as recently as Covid, the other people who suffered the most were the least wealthy, the least socially powerful, the least able to protect themselves in municipal systems that were not designed to serve them. The findings reinforce the fact that maximum protection for those likely to suffer from long-term epidemics requires re-tooling the situations that put them at risk.

“In times of pandemic, it is said to be a wonderful equalizer, that the rich will fall to the same extent as the poor. And in hindsight, that’s never true,” says Rachel Mason Dentinger, a historian of biology and medicine. and assistant professor at the University of Utah. ” What is emerging each time is that the social determinants of fitness play a huge role in how diseases have disproportionate effects on people. “

The story goes that the 1918 flu was so different from epidemics and so apocalyptic in its attack that nothing can be done to counter it. The skeletons of 1918 refute this idea. Rather, they demonstrate that Americans’ fitness helps protect society as a whole, and that ensuring public fitness between epidemics can be the most productive defense against the devastation they cause when they occur.

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