What can we learn from historical pandemics? A systematic review of the literature.

What are the insights from historical pandemics for policymaking today? We carry out a systematic review of the literature on the impact of pandemics that occurred since the Industrial Revolution and prior to Covid-19. Our literature searches were conducted between June 2020 and September 2023, with the final review encompassing 169 research papers selected for their relevance to understanding either the demographic or economic impact of pandemics. We include literature from across disciplines to maximise our knowledge base, finding many relevant articles in journals which would not normally be on the radar of social scientists. Our review identifies two gaps in the literature: (1) the need to study pandemics and their effects more collectively rather than looking at them in isolation; and (2) the need for more study of pandemics besides 1918 Spanish Influenza, especially milder pandemic episodes. These gaps are a consequence of academics working in silos, failing to draw on the skills and knowledge offered by other disciplines. Synthesising existing knowledge on pandemics in one place provides a basis upon which to identify the lessons in preparing for future catastrophic disease events.

The Efficiency of Bacterial Vaccines on Mortality during the 'Spanish' Influenza Pandemic of 1918-19.

The worldwide 'Spanish' influenza pandemic of 1918-19, which extended into the 1920s, infected more than a third of the world's population and killed an estimated 50-100 million people, more than the civilian and military casualties of World War I. Present-day medical scholars, journalists, and other commentators have often ignored, downplayed or treated with scepticism the role of bacterial vaccines in reducing mortality during the pandemic. There have been repeated claims in this century that these vaccines were 'useless', 'concocted', and possibly harmful. Focussing on the Australian scene, I show that bacterial vaccines from reputable sources did indeed reduce mortality, perhaps to a greater extent in some cases than modern anti-viral influenza vaccines.

Encephalitis lethargica. What is still wrong?

Encephalitis lethargica developed in epidemic from 1919 to 1926 in Europe and throughout the world. From the clinical point of view, the disturbances of consciousness and alertness and the possible outcomes of a postencephalitic Parkinsonism has attracted much attention. For a long time, it was thought that such a disease may still occur sporadically. In this review, the authors examined historical and current pictures of epidemics that may be related to Encephalitis lethargica. The previous Nona and Russian Influenza exhibited frequent neurological symptoms. The Spanish flu, formerly related to Encephalitis lethargica, would appear an epidemic that had its development in a partially overlapping period. The current pandemic linked to COVID-19 sometimes has aspects that can resemble Encephalitis lethargica. Based on historical analysis and the more recent immunological data, it could be suggested that Encephalitis lethargica was an autoimmune encephalitis that arose in a secondary form to the action of a viral agent. It cannot be ruled out that this agent was a coronavirus. From the nosological point of view, the term Encephalitis lethargica should be abolished in designating autoimmune encephalitis pictures that run sporadically.

Public Health in a Federation: Lessons from the Spanish Influenza in Australia.

Public health policy has been identified by scholars as a principal means by which the state has expanded its control over human populations. Yet, as the COVID-19 pandemic has shown, public health responses do not necessarily reinforce the authority and prestige of the state, even while governments employ strict measures such as lockdowns and border closures. This article examines arguments about the nation-making effects of public health measures through an examination of the Spanish influenza outbreak in the recently federated Australian nation during 1919. It examines the effort of the central government to co-ordinate quarantine and other public health measures in the face of serious tensions within the Australian federation. In doing so, the article suggests a need to think more subtly about the role of 'bio-political' events such as public health crises in consolidating state control and fostering exclusionary forms of nationalism. These lessons apply particularly to federal nation-states.

Living With the Flu: Public Health and Civic Life During the Spanish Influenza Pandemic of 1918.

Most studies of how United States cities responded to the first deadly wave of Spanish influenza focus on the ways public health officials and their allies reacted to the crisis. This study expands our understanding of the pandemic by focusing on how members of the public responded to those efforts to contain the flu. It does so through a close look at social and civil life in a small city in the southern Midwest during the thirty-two days the flu was epidemic there. Shifting the focus in this way brings previously obscured gaps in the public health response into the light. Specifically, this study finds that while compliance in most areas was high there were two places where it was low: activities in support of American involvement in the European War, and participation in social or civic activities. From the first day of the epidemic to the last the society pages of the local newspapers reported a stream of activities that clearly violated emergency measures. Despite the ban on public gatherings, social clubs, fraternal societies, and civic groups all regularly met. The local college football team practiced, and people continued to turn out for weddings, funerals, birthday parties, dinner parties, and extended visits from out-of-town friends and family. With one possible exception, none of the social or civic activities were carried out as protests against health regulations. Instead local newspapers reported these activities as items of social interest.

The Emergence and Development of Hygienic Masks in Colonial Korea.

This paper examines the social life of masks in colonial Korea with a focus on their use in hygienic practices. It argues that masks first appeared in the disease control scene in late 1919 when the Governor-General of Korea belatedly introduced preventative measures against the Spanish Influenza pandemic. Since then, the central and regional hygiene authorities had begun to encourage colonial Koreans to wear masks whenever respiratory disease epidemics transpired. Simultaneously, Korean doctors and news reporters framed mask-wearing as something needed for family hygiene, particularly for trans-seasonal child health care, and advised colonial Korean women to manage and wear masks. This paper also reveals that the primary type of masks used in colonial society was black-colored Japanese respirators. Its design was the main point of contention in the debates on the effectiveness of masks against disease infection. Finally, it also highlights that the wide support of using masks by medical doctors and authorities was not based on scientific evidence but on empirical rules they developed through the pandemic and epidemics. The mask-usage practice would be challenged only when South Korean doctors reframed it as a "Japanese custom not grounded on science" at the height of postcolonial nationalism and the raised concern about the artifact's usefulness during the Hong Kong Influenza pandemic of 1968.

Not the great equalizers: Covid-19, 1918-20 influenza, and the need for a paradigm shift in pandemic preparedness.

Despite common perceptions to the contrary, pandemic diseases do not affect populations indiscriminately. In this paper, we review literature produced by demographers, historians, epidemiologists, and other researchers on disparities during the 1918-20 influenza pandemic and the Covid-19 pandemic. Evidence from these studies demonstrates that lower socio-economic status and minority/stigmatized race or ethnicity are associated with higher morbidity and mortality. However, such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully. We suggest using a framework that considers proximal and distal factors contributing to differential exposure, susceptibility, and consequences as one way to move this research forward. Further, current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches. Therefore, we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups, includes input from the social sciences and humanities and other diverse perspectives, and contributes to the reduction of health disparities before a pandemic hits.

A bitter epidemic: The impact of the 1918 influenza on sugar production in Java.

Research about the economic consequences of past epidemics has mostly focused on the experience of industrialized countries, thus providing little knowledge about the effects of health shocks on developing economies. We fill this gap by studying the impact of the 1918 influenza in Java, with a new dataset on aggregate food production and district-level figures on (i) sugar production, the major export commodity and the predominant source of labour demand; (ii) agricultural and plantation wages, and (iii) annual crude death rates. The mortality impact of the influenza on Java was high, as crude mortality rates doubled in 1918 relative to the preceding years, but its economic impact was mixed. Aggregate food production did not decline, but sugar output did fall in 1919. Indeed, our regional panel data analysis does not establish a direct relationship between regional epidemic mortality variation and sugar output decline. Instead, we hypothesize that economic activity was rediverted towards food production in order to avoid famine that could have resulted from the combined effects of disrupted shipping at the end of the First World War, climatic conditions and the public health crisis. This is supported by both qualitative observations and quantitative evidence suggesting that those regions that were highly suitable for rice production saw a larger reduction in sugar production, and that in regions that had more flexibility in land tenure arrangements experienced substantially greater reductions in sugar output.

Combating an invisible enemy: the American military response to global pandemics.

The present moment is not the first time that America has found itself at war with a pathogen during a time of international conflict. Between crowded barracks at home and trenches abroad, wartime conditions helped enable the spread of influenza in the fall of 1918 during World War I such that an estimated 20-40% of U.S. military members were infected. While the coronavirus disease 2019 (COVID-19) pandemic is unparalleled for most of today's population, it is essential to not view it as unprecedented lest the lessons of past pandemics and their effect on the American military be forgotten. This article provides a historical perspective on the effect of the most notable antecedent pandemic, the Spanish Influenza epidemic, on American forces with the goal of understanding the interrelationship of global pandemics and the military, highlighting the unique challenges of the current pandemic, and examining how the American military has fought back against pandemics both at home and abroad, both 100 years ago and today.

Dr Joseph Dudley 'Benjy' Benjafield: Microbiologist, soldier and Bentley Boy racing driver.

Dr Joseph Dudley 'Benjy' Benjafield qualified from University College Hospital Medical School, London in 1912. He joined the Royal Army Medical Corps during World War I and was in charge of the 37th Mobile Bacteriological Laboratory serving with the British Egyptian Expeditionary Force when the Spanish flu struck in late 1918. He observed the features and clinical course of the pandemic and published his findings in the British Medical Journal in 1919. On return to civilian life, he was appointed as Consultant physician to St George's Hospital, Hyde Park Corner, London where he remained in practice for the rest of his career. He was a respected amateur gentleman racing driver frequently racing at the Brooklands circuit from 1924 after buying a Bentley 3-litre and entering the Le Mans 24 h race seven times between 1925 and 1935, winning in 1927. He was one of an elite club of young men known as The Bentley Boys and went on to become a founding member of the British Racing Drivers Club (BRDC) in 1927. He rejoined the Royal Army Medical Corps during World War II, serving briefly again in Egypt. He died in 1957.

May the analysis of 1918 influenza pandemic give hints to imagine the possible magnitude of Corona Virus Disease-2019 (COVID-19)?

BACKGROUND: In 1918 an unknown infectious agent spread around the world infecting over one-third of the general population and killing almost 50 million people. Many countries were at war, the First World War. Since Spain was a neutral country and Spanish press could report about the infection without censorship, this condition is commonly remembered as "Spanish influenza". This review examines several aspects during the 1918 influenza pandemic to bring out evidences which might be useful to imagine the possible magnitude of the present coronavirus disease 2019 (COVID-19). METHODS: In the first part of this review we will examine the origin of the SARS-Coronavirus-2 and 1918 Spanish Influenza Virus and the role played by host and environment in its diffusion. We will also include in our analysis an evaluation of different approaches utilized to restrain the spread of pandemic and to treat infected patients. In the second part, we will try to imagine the magnitude of the present COVID-19 pandemic and the possible measures able to restrain in the present environment its spread. RESULTS: Several factors characterize the outcome in a viral pandemic infection. They include the complete knowledge of the virus, the complete knowledge of the host and of the environment where the host lives and the pandemic develops. CONCLUSION: By comparing the situation seen in 1918 with the current one, we are now in a more favourable position. The experience of the past teaches us that their success is linked to a rapid, constant and lasting application. Then, rather than coercion, awareness of the need to observe such prevention measures works better.

Fatal Infectious Epidemics in Iran in the Last Two Centuries; What Lessons Can We Learn from Preceding Outbreaks? A Brief Historical Review.

In the past two centuries, several fatal infectious outbreaks have arisen in Iran. Presented here is a brief historical account of four fatal epidemics including cholera, plague, Spanish influenza of 1918 and smallpox between1796 and 1979. The lessons from these outbreaks could be helpful for better combatting other deadly epidemics including the present-day disastrous COVID-19 pandemic.

Vaccines from the Spanish Influenza as a firm foundation for new developments.

In 1914, the concept of a prophylactic vaccine, administered to a person before the disease had been contracted, was still controversial. Nevertheless, Almroth Wright tested new pneumococcus vaccines in South Africa, where the incidence of bacterial pneumonia was high amongst workers in the gold mines. He established the use of clinical trials, using around ten thousand workers, both in vaccinated and unvaccinated groups. The two groups were not matched to modern standards. Also, of course, those workers in the control unvaccinated group could not be protected: but some considered a prophylactic vaccine would exacerbate the disease. The vaccines were manufactured to contain a range of pneumococci from different clinical samples, in a serious attempt to match the microbes in the vaccine to the field bacteria. Deaths were averted by the vaccine; and side effects were noted to be minimal. Reexamination of pathology samples from the Spanish Influenza Pandemic showed quite clearly the contribution of pneumococci and streptococci to the mortality of over fifty million people in 1918-1919. The microbe causing this Pandemic was isolated in 1933, and was shown to be a true virus; this finding initiated a huge expanse and interest in influenza virus vaccines, both killed and live. A chance discovery allowed the purification of Influenza M and NP proteins then permitted the production of experimental vaccines. These vaccines were formulated to induce and B and/or T cell responses to the internal proteins. Several of these Universal Influenza Vaccines have been tested in quarantine, and have now reached Phase III trials in the community.

The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968-2012.

The 1918 influenza pandemic had not only a massive instant death toll but also lasting effects on its survivors. Several studies have shown that children born in 1919, and thus exposed to the H1N1 virus in utero, experienced worse health and socioeconomic outcomes in older ages than surrounding birth cohorts. This study combines several sources of contemporary statistics with full-population individual-level data for Sweden during 1968-2012 to examine the influence of fetal exposure to the Spanish flu on health, adulthood income, and occupational attainment. For both men and women, fetal exposure resulted in higher morbidity in ages 54-87, as measured by hospitalization. For males, exposure during the second trimester also affected mortality in cancer and heart disease. Overall, the effects on all-cause mortality were modest, with about three months shorter remaining life expectancy for the cohorts exposed during the second trimester. For socioeconomic outcomes, results fail to provide consistent evidence supporting any long-term consequences of fetal exposure. We conclude that although the immediate health effects of exposure to the 1918 pandemic were huge, the long-term effects were modest in size.

A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian.

When we reconsider the virology and history of the Spanish Influenza Pandemic, the science of 2018 provides us with tools which did not exist at the time. Two such tools come to mind. The first lies in the field of 'gain of function' experiments. A potential pandemic virus, such as influenza A (H5N1), can be deliberately mutated in the laboratory in order to change its virulence and spreadability. Key mutations can then be identified. A second tool lies in phylogenetics, combined with molecular clock analysis. It shows that the 1918 pandemic virus first emerged in the years 1915-1916. We have revisited the literature published in Europe and the United States, and the notes left by physicians who lived at the time. In this, we have followed the words of the late Alfred Crosby: who wrote that "contemporary documentary evidence from qualified physicians" is the key to understanding where and how the first outbreaks occurred. In our view, the scientists working in Europe fulfill Crosby's requirement for contemporary evidence of origin. Elsewhere, Crosby also suggested that "the physicians of 1918 were participants in the greatest failure of medical science in the twentieth century". Ours is a different approach. We point to individual pathologists in the United States and in France, who strove to construct the first universal vaccines against influenza. Their efforts were not misdirected, because the ultimate cause of death in nearly all cases flowed from superinfections with respiratory bacteria.

Back to the Future for Influenza Preimmunity-Looking Back at Influenza Virus History to Infer the Outcome of Future Infections.

The influenza virus-host interaction is a classic arms race. The recurrent and evolving nature of the influenza virus family allows a single host to be infected several times. Locked in co-evolution, recurrent influenza virus infection elicits continual refinement of the host immune system. Here we give historical context of circulating influenza viruses to understand how the individual immune history is mirrored by the history of influenza virus circulation. Original Antigenic Sin was first proposed as the negative influence of the host's first influenza virus infection on the next and Imprinting modernizes Antigenic Sin incorporating both positive and negative outcomes. Building on imprinting, we refer to preimmunity as the continual refinement of the host immune system with each influenza virus infection. We discuss imprinting and the interplay of influenza virus homology, vaccination, and host age establishing preimmunity. We outline host signatures and outcomes of tandem infection according to the sequence of virus and classify these relationships as monosubtypic homologous, monosubtypic heterologous, heterosubtypic, or heterotypic sequential infections. Finally, the preimmunity knowledge gaps are highlighted for future investigation. Understanding the effects of antigenic variable recurrent influenza virus infection on immune refinement will advance vaccination strategies, as well as pandemic preparedness.

Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919-1920.

We examined preserved medical charts of 470 Spanish influenza patients (8 with fatal cases) hospitalized at former army hospitals in Japan during 1919-1920. The following factors were associated with longer periods of hospitalization: adventitious discontinuous lung sounds, maximum respiration rate, continuation of high fever after hospital admission, and diphasic fever.

A Missed Summer Wave of the 1918-1919 Influenza Pandemic: Evidence From Household Surveys in the United States and Norway.

Background. Reanalysis of influenza survey data from 1918 to 1919 was done to obtain new insights into the geographic and host factors responsible for the various waves. Methods. We analyzed the age- and sex-specific influenza morbidity, fatality, and mortality for the city of Baltimore and smaller towns and rural areas of Maryland and the city of Bergen (Norway), using survey data. The Maryland surveys captured the 1918 fall wave, whereas the Bergen survey captured 3 waves during 1918-1919. Results. Morbidity in rural areas of Maryland was higher than in the city of Baltimore during the fall of 1918, that was almost equal to that in Bergen during the summer of 1918. In Bergen, the morbidity in the fall was only half of that in the summer, with more females than males just above the age of 20 falling ill, as seen in both regions of Maryland. In contrast, more males than females fell ill during the summer wave in Bergen. Individuals <40 years had the highest morbidity, whereas school-aged children had the lowest fatality and mortality. Conclusion. A previously unrecognized pandemic summer wave may have hit the 2 regions of Maryland in 1918.

[The "Spanish flu" pandemic of 1918-1919 in La Réunion (Indian Ocean)]. / La pandémie de grippe espagnole de 1918-1919 à la Réunion.

Brought in by the ship Madonna, which was taking local survivors of World War I back to Reunion, the 1918 Spanish flu pandemic reached the island in March 1919 and lasted for three months. The controversies between doctors and between doctors and the colonial administrators, officials' desertion of their posts, and food shortages together caused a major panic. The epidemic appears to have ravaged people under the age of 40 and the most disadvantaged neighborhoods, at a period when the economy was already in the doldrums and the population had been declining since the late 19th century. Estimates indicate 2000 deaths in the capital of Saint-Denis, among a population of 25,000 inhabitants, and 7 to 20,000 deaths on the island as a whole, representing 4-11% of the population - far more than the 949 local soldiers killed on the battlefields of Europe. According to legend, salvation came from the sky as a small cyclone on May 11, 1919: it lasted an hour, swept away the "miasmas" and washed the island clean of all its impurities.

Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence.

The Meuse-Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1.2 million U.S. troops. With over 26,000 deaths among American soldiers, the offensive is considered "America's deadliest battle". The Meuse-Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45,000 American soldiers making it questionable which battle should be regarded "America's deadliest". The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918.