Journal articles on the topic 'Influenza Epidemic, 1918-1919 – United States'

The classic risk factors for developing coronary heart disease (CHD) explain less than 50% of the decrease in mortality observed since 1950. The transition currently under way, from the degenerative to the infectious-inflammatory paradigm, requires a new causal interpretation of temporal trends. The following is an ecological study based on data from the United States showing that in men and women an association between the age distribution of mortality due to influenza and pneumonia (I&P) associated with the influenza pandemic in 1918-1919 in the 10-49-year age bracket and the distribution of CHD mortality from 1920 to 1985 in survivors from the corresponding birth cohorts. It further shows a significant negative correlation (r = -0.68, p = 0.042) between excess mortality from I&P accumulated in epidemics from 1931 to 1940 (used as indicator for persistent circulation of H1N1 virus combined with vulnerability to infection) and the order of the beginning in the decline in CHD mortality in nine geographic divisions in the United States. In light of current biological knowledge, the data suggest that the 1918 influenza pandemic and the subsequent epidemics up to 1957 might have played a determinant role in the epidemic of CHD mortality registered in the 20th century.

Whites rather than colored people were attacked by the pandemic of influenza and the young rather than the old, a reversal of usual conditions. These conclusions are based on the accurate figures obtainable from nearly 18,000,000 policies in force and 105,552 claims. The following is a brief statement of some of the basic findings of an investigation which has been made into the epidemic of influenza. It is limited to the policyholders of the Industrial Department of the Metropolitan Life Insurance Company and covers the period from October 1, 1918 to June 30, 1919. It should be noted in this connection that in this department there are represented over 12,000,000 policyholders, as of December 31, 1918; that these policyholders include both races, white and colored, males as well as females, and all age periods, excepting early infancy and extreme old age. This group of insured wage earners is well distributed over the entire United States and Canada. Effort was made, furthermore, to make the record of influenza deaths as complete as possible. In all, 105,552 policy claims were paid during the period under investigation, representing a total of 70,729 deaths from influenza-pneumonia.

During most of the twentieth century, cardiovascular mortality increased in the United States while other causes of death declined. By 1958, the age-standardized death rate (ASDR) for cardiovascular causes for females was 1.84 times that for all other causes,combined(and, for males, 1.79×). Although contemporary observers believed that cardiovascular mortality would remain high, the late 1950s and early 1960s turned out to be the peak of a roughly 70-year epidemic. By 1988 for females (1986 for males), a spectacular decline had occurred, wherein the ASDR for cardiovascular causes was less than that for other causes combined. We discuss this phenomenon from a demographic point of view. We also test a hypothesis from the literature, that the 1918 influenza pandemic caused the cardiovascular mortality epidemic; we fail to find support.

There is still limited understanding of key determinants of spatial spread of influenza. The 1918 pandemic provides an opportunity to elucidate spatial determinants of spread on a large scale. To better characterize the spread of the 1918 major wave, we fitted a range of city-to-city transmission models to mortality data collected for 246 population centres in England and Wales and 47 cities in the US. Using a gravity model for city-to-city contacts, we explored the effect of population size and distance on the spread of disease and tested assumptions regarding density dependence in connectivity between cities. We employed Bayesian Markov Chain Monte Carlo methods to estimate parameters of the model for population, infectivity, distance and density dependence. We inferred the most likely transmission trees for both countries. For England and Wales, a model that estimated the degree of density dependence in connectivity between cities was preferable by deviance information criterion comparison. Early in the major wave, long distance infective interactions predominated, with local infection events more likely as the epidemic became widespread. For the US, with fewer more widely dispersed cities, statistical power was lacking to estimate population size dependence or the degree of density dependence, with the preferred model depending on distance only. We find that parameters estimated from the England and Wales dataset can be applied to the US data with no likelihood penalty.

Throughout global history, various infectious diseases have emerged as particularly relevant within an era. Some examples include the Bubonic plague of the fourteenth century, the Spanish Influenza pandemic of 1918, the HIV epidemic of the 1980s, and the Zika virus outbreak in 2015–16. These instances of emerging infectious disease represent ideal opportunities for timely, relevant instruction in natural and health science courses through case studies. Such instructional approaches can promote student engagement in the material and encourage application and higher-order thinking. We describe here how the case study approach was utilized to teach students about emerging infectious diseases using the 2014–16 Ebola virus outbreak as the subject of instruction. Results suggest that students completing the case study not only had positive perceptions of the mode of instruction, but also realized learning gains and misconception resolution. These outcomes support the efficacy of case pedagogy as a useful teaching tool in emerging infectious diseases, and augment the paucity of literature examining Ebola virus knowledge and misconceptions among undergraduate students within United States institutions.

During epidemics, the poorest part of the population usually suffers the most. Alfred Crosby noted that the norm changed during the 1918 influenza pandemic in the US: The black population (which were expected to have higher influenza morbidity and mortality) had lower morbidity and mortality than the white population during the autumn of 1918. Crosby’s explanation for this was that black people were more exposed to a mild spring/summer wave of influenza earlier that same year. In this paper, we review the literature from the pandemic of 1918 to better understand the crossover in the role of race on mortality. The literature has used insurance, military, survey, and routine notification data. Results show that the black population had lower morbidity, and during September, October, and November, lower mortality but higher case fatality than the white population. The results also show that the black population had lower influenza morbidity prior to 1918. The reasons for lower morbidity among the black population both at baseline and during the herald and later waves in 1918 remain unclear. Results may imply that black people had a lower risk of developing the disease given exposure, but when they did get sick, they had a higher risk of dying.

During the first wave of the COVID-19 pandemic in the United States, many state governors faced an increasing number of acts of defiance as well as political and legal challenges to their public health emergency orders. Less well studied are the similar acts of protest that occurred during the 1918–1919 influenza pandemic, when residents, business owners, clergy, and even local politicians grew increasingly restless by the ongoing public health measures, defied public health edicts, and agitated to have them rescinded. We explore several of the themes that emerged during the late fall of 1918 and conclude that, although the nation seems to be following the same path as it did in 1918, the motivations for pushback to the 2020 pandemic are decidedly more political than they were a century ago.

Abstract Vashti Bartlett, a Johns Hopkins nurse and member of the American Red Cross Commission to Siberia, was part of a global expansion of United States (US) influence before and after World War I. Through close examination of Bartlett’s extensive personal archives and her experiences during a 1919 cholera epidemic in Harbin, North China, we show how an individual could embody a “friendly” or “capillary” form of imperialist US power. Significantly, we identify in Bartlett yet another form that US friendly power could take: scientific medicine. White, wealthy, female, and American, in the context of her international nursing activities Bartlett identified principally as a scientific practitioner trained at Johns Hopkins where she internalized a set of scientific ideals that we associate with a particular “Hopkins ethos.” Her overriding scientific identity rendered her a useful and conscientious agent of US friendship policies in China in 1919.

Background: Social and health inequities predispose vulnerable populations to adverse morbidity and mortality outcomes of epidemics and pandemics. While racial disparities in cumulative incidence (CmI) and mortality from the influenza pandemics of 1918 and 2009 implicated Blacks with survival disadvantage relative to Whites in the United States, COVID-19 currently indicates comparable disparities. We aimed to: (a) assess COVID-19 CmI by race, (b) determine the Black–White case fatality (CF) and risk differentials, and (c) apply explanatory model for mortality risk differentials. Methods: COVID-19 data on confirmed cases and deaths by selective states health departments were assessed using a cross-sectional ecologic design. Chi-square was used for CF independence, while binomial regression model for the Black–White risk differentials. Results: The COVID-19 mortality CmI indicated Blacks/AA with 34% of the total mortality in the United States, albeit their 13% population size. The COVID-19 CF was higher among Blacks/AA relative to Whites; Maryland, (2.7% vs. 2.5%), Wisconsin (7.4% vs. 4.8%), Illinois (4.8% vs. 4.2%), Chicago (5.9% vs. 3.2%), Detroit (Michigan), 7.2% and St. John the Baptist Parish (Louisiana), 7.9%. Blacks/AA compared to Whites in Michigan were 15% more likely to die, CmI risk ratio (CmIRR) = 1.15, 95% CI, 1.01–1.32. Blacks/AA relative to Whites in Illinois were 13% more likely to die, CmIRR = 1.13, 95% CI, 0.93–1.39, while Blacks/AA compared to Whites in Wisconsin were 51% more likely to die, CmIRR = 1.51, 95% CI, 1.10–2.10. In Chicago, Blacks/AA were more than twice as likely to die, CmIRR = 2.24, 95% CI, 1.36–3.88. Conclusion: Substantial racial/ethnic disparities are observed in COVID-19 CF and mortality with Blacks/AA disproportionately affected across the United States.

The Spanish flu appeared at the end of the First World War and spread around the world in three waves: spring-summer in 1918, which was mild; autumn fatal wave, in the same year; and winter wave in 1919, which also had great consequences. From the United States of America, as the cradle of its origin, the Spanish flu spread to all the inhabited continents, and it did not bypass Serbia either. Research on the Spanish flu, as the deadliest and most widespread pandemic in the human history, was mostly based on statistical researches. The development of the geographic information systems and spatial analyses has enabled the implementation of the information of location in existing researches, allowing the identification of the spatial patterns of infectious diseases. The subject of this paper is the spatial patterns of the share of deaths from the Spanish flu in the total population in Valjevo Srez (in Western Serbia), at the settlement level, and their determination by the geographical characteristics of the studied area-the average altitude and the distance of the settlement from the center of the Srez. This paper adopted hot spot analysis, based on Gi* statistic, and the results indicated pronounced spatial disparities (spatial grouping of values), for all the studied parameters. The conclusions derived from the studying of historical spatial patterns of infectious diseases and mortality can be applied as a platform for defining measures in the case of an epidemic outbreak with similar characteristics.

In my last editorial I was contemplating living the new and unexpected experience of life with Covid 19. Six months ago, was a time for contemplation. We were all entering into an event of major historical significance. The world has experienced epidemics before, and we had only to turn to the works of writers such as Camus to realise how recurrent human behaviour is. We tend so often to be caught by surprise despite the lessons that are so readily available to us through reference to history. The Spanish ‘flu epidemic of 1919 was the obvious benchmark to which we could turn. Following hot on the heels of the Great War of 1914-1918 it was responsible for more casualties than occurred in the war to end all wars (50 million). It infected 500 million people worldwide. After just over ten months we are a long, long way from those sorts of figures. As of 12th November, 51,975,458 case of infection have been reported. Deaths attributed to the virus number 1,281,309 worldwide. Of course, what makes Covid 19 so significant is not simply that it should have happened, but that it is the first pandemic in this era of globalisation which we have entered only comparatively recently. Some might remember the SARS epidemic which affected mainly people in Asia. As indicated by its name, severe acute respiratory syndrome (SARS-CoV-2), it was very similar initially in its effects. Yet, after first emerging in 2002, it was eradicated less than two years later. It seems that this was achieved largely by what has been called simple public health measures. This involved “testing people with symptoms (fever and respiratory problems), isolating and quarantining suspected cases, and restricting travel.” These same measures of course have been implemented in most countries following the virus’ spread to Italy early in 2020. However, the fact that different nations have responded differently and also experienced very different outcomes should be of considerable interest as we consider the whole concept of a global threat and global responses. The ten worst affected countries currently are in order: Contry; Confirmed Cases; Deaths United States; 10,460,302; 244,421 India; 8,684,039; 128,165 Brazil; 5,749,007; 163,406 France; 1,865,538; 42,535 Russia; 1,836,960; 31,593 Spain; 1,417,709; 40,105 Argentina; 1,273,343; 34,531 United Kingdom; 1,256,725; 50,365 Colombia; 1,165,326; 33,312 Italy; 1,028,424; 42,953 They are dominated by the advanced economies of the northern hemisphere. The countries who have previously experienced the SARS epidemic in Asia have fared comparatively lightly. Bearing in mind that statistics of this nature may not be strictly comparable given variation in the criteria used and the methods of sourcing and collecting this information, it is still interesting to hypothesise why outcomes can differ so much. Explanations might include reference to the environments in which people live – physical space, climate and availability of sophisticated health care systems to name a few – or they might dwell on the culture of those involved, their willingness to follow instructions imposed upon them, the importance of competing objectives that might make prioritising health and physical wellness less of a priority. Whatever the case, satisfactory explanations are more likely to involve some interactions involving measures of both the individuals and the environments within which they live. Any attempt to explain or understand human behaviour needs to consider a variety of factors and knowing how to take account of them is an important part of the skill base that scholars of international and comparative studies bring with them. Such skills and knowledge are more important in a globalised world than they have ever been. Yet such skills may be becoming harder to achieve, precisely because of some of the effects of processes associated with globalisation. I would recommend to you a recent documentary produced by Netflix and widely available on YouTube. “The Social Dilemma” is an examination of the use of social media and in particular focuses on the relationship between the growing addiction amongst young people to the use of smartphones and, specifically their social media programmes, and the rising levels of concern about deteriorating mental health and wellbeing among the world’s youth. It draws a relationship between the psychological disorder of narcissism and the failure of phone obsessed young people to experience real human to human interaction, with a related increase in aggressive bullying and dysfunctional behaviour. Thus, the results of experiencing interactions and personal validation through the proxy world of social media, rather than face to face, is a dehumanisation of the individual and leads to a distorted experience of the world in simple dichotomies of a single view, right or wrong. So, whatever the continuing effects of the pandemic, as these continue to unfold, it will be important that we continue to build our understanding of other people in their own worlds. We need to avoid the trap of believing that our own world is the only world and the right world. However smart artificial intelligence becomes, a screen is only two dimensional and it is the extra dimensions that enable us to grow as humans and cope with the complexity and challenges of our own unique worlds. One of the less helpful trends of our globalised digitised world, has been the pursuit and glorification of the cult of celebrity. One of the difficulties of that celebrity status is it is frequently awarded on the basis of undeserving and irrelevant characteristics such as, acting ability, physical beauty or sporting reputation. Yet many seem to feel that this status entitles them to pontificate or attempt to influence others in areas that have nothing to do with their expertise. Ricky Gervais, in his chairing of the 2020 golden globes award, brought a refreshing dose of reality in advising the celebrities who were to receive awards: You are in no position to lecture the public about anything. You know nothing about the real world. Most of you spent less time in school than Greta Thunberg. So, if you win, come up accept your little award. Thank your agent and your God and **** off. OK? It is in that spirit of willingness to learn from the work of a range of colleagues working in a range of places and professional situations around the world, I commend to you the contributions to be found in the following pages. To start the ball rolling, we have a report from Hairui Liu, Wei Shen and Peter Hastie on the application of a curriculum model which was developed in the US and has since gained some popularity in a number of settings around the world. The origins of sport education came from a realisation that, in too many situations, physical education had failed to excite the same degree of enthusiasm among school pupils as could often be observed when they involved themselves in sport. The model thus extends the skill/technique focus which is found in many traditional physical education settings, to include more of the dimensions of sport – formal competition, affiliation, festivity experienced over a season. They concluded that, within this Chinese university context, the students achieved a higher level of performance and more enthusiastic engagement when the model was adopted as a basis for their learning. Our second article moves from an education setting to a contemporary sport science framework, the world of professional sport and one of the higher levels of competition in the world – the English Championship. Rhys Carr, Rich Mullen and Morgan Williams monitored the running intensity of players throughout a season. In particular they questioned the demands for high intensity running when playing in a 4-4-2 formation and implementing a high press strategy, such as adopted by Liverpool in their highly successful 2019 English Premiership season. They concluded that, for players in the centre forward and wide midfield positions, the demands created were impossible to maintain for an entire match. They were then able to draw out some practical and tactical implications for managers and their support staff, relating to substitution strategy and the physical match preparation of players in these positions and with these strategic responsibilities. Our third article involves an exploration of the perpetual discomfort many of us feel as educators when we compare the practice of sport against the ideals we hold for it. As professionals in the field, many of us are driven by our belief in what sport can offer. Yet the modern commodification of sport, coupled with the excessive need to win as a motive that exceeds all others, consistently produces behaviours and outcomes which we seek to disassociate from our professional practices. The article by Irantzu Ibanez, Ana Zuazagoitia, Ibon Echeazarra, Luis Maria Zulaika and Iker Ros is set in the context of the Basque region of Spain and explores the values held by students in their pre-service training with regard to the practice of extracurricular sport. The students show an awareness of the mismatch between their ideals of extracurricular sport as an educational experience and the influence on current practices that comes from the way in which sport is conducted in the society at large. The authors conclude with a plea for greater alignment between the practice of sport in schools and teh educational values that should guide it. Our final contribution is from South Africa where Lesego Phetlhe, Heather Morris- Eyton and Alliance Kubayi report on the concerns of football (soccer) coaches in Guateng province. It is clear that these coaches, in common with others around the world, suffer a degree of stress in their chosen occupation. The sources of this stress are to be found in the nature of the complex tasks they are expected to manage, as well as in the always challenging job of managing the players for whom they are responsible. To this can be added the difficult environmental conditions they are faced with, as well as the inevitable concern with having to produce results for the players and their team. Their research has produced some useful guidelines for administrators that can facilitate the jobs of the coaches and lead to benefits in enhanced performances and results. Finally, in our book review, Luiz Uehara evaluates Jorge Knijnik’s thoughtful analysis of the impact of the 2014 world cup on Brazil. From both author and reviewer, it is possible to feel the pride and passion in their nation of birth and its special contribution to the world’s most popular game. It is my privilege to recommend the work of these international scholars to you. I leave you the reader with the hope that in introducing our next volume, I will be able to celebrate with you more positive news about the progress of the pandemic and its implications for international and comparative sport and physical education. John Saunders Brisbane, November 2020

Abstract The large spatial scale, geographical overlap, and similarities in transmission mode between the 1918 H1N1 influenza and 2020 SARS-CoV-2 pandemics together provide a novel opportunity to investigate relationships between transmission of two different diseases in the same location. To this end we use initial exponential growth rates in a Bayesian hierarchical framework to estimate the basic reproductive number, R0, of both disease outbreaks in a common set of 43 cities in the United States. By leveraging multiple epidemic time series across a large spatial area we are able to better characterize the variation in R0 across the United States. Additionally, we provide one of the first city-level comparisons of R0 between these two pandemics and explore how demography and outbreak timing are related to R0. Despite similarities in transmission modes and a common set of locations, R0 estimates for COVID-19 were uncorrelated with estimates of pandemic influenza R0 in the same cities. Also, the relationships between R0 and key population or epidemic traits differed between diseases. For example, epidemics that started later tended to be less severe for COVID-19, while influenza epidemics exhibited an opposite pattern. Our results suggest that despite similarities between diseases, epidemics starting in the same location may differ markedly in their initial progression.

War and human conflict have historically propelled the profession of nursing forward, due to the intense demand for large numbers of efficient, high-quality nurses to care for injured troops. This article begins with an overview of nursing in the United States Army and Navy Nurse Corps and the influences of war on the advancement of American nursing, with a specific focus on the Army School of Nursing. As a response to the need for nurses in World War I, the Army School of Nursing was a novel approach to educating new nurses to be quickly mobilized in wartime and to provide nursing care at base hospitals across the United States. Students provided care to thousands of troops during the influenza pandemic of 1918, and several lost their lives providing care at these military encampments, including Fort Riley, the suspected starting point of the influenza epidemic in the United States.

Abstract Background Benchmarks are needed for assessing the severity of the COVID-19 pandemic. However, comparisons can be misleading unless marked differences in age-specific mortality and differences in population age structure are considered. Methods Using COVID-19 death rates for New York City as at 2 June 2020, we used indirect age standardization to estimate standardized mortality ratios (SMR) for the first winter waves of the 1918 and 2009 influenza pandemics and the severe 2017-2018 influenza season in the United States (US). Data were obtained from published statistics. Results After adjusting for age, New York City’s death rate during the 1918 winter influenza pandemic wave was 6.7 times higher overall compared with the first wave of COVID-19 in 2020. New York City's first wave COVID-19 death rate was an estimated 59 times higher than that of the 2009 US influenza pandemic, and 14 times higher than that of the severe 2017-2018 influenza season. In < 45 year-olds, the 1918 influenza death rate was 42 times higher than COVID-19 in 2020. In ≥ 65 year-olds, compared with the 2009 pandemic, the COVID-19 death rate was 320 times higher, while in children it was one half. Conclusions The 1918 pandemic was more deadly than COVID-19, which was, in turn, far more deadly than both the 2009 influenza pandemic and severe seasonal influenza. Age-specific mortality differences should be considered in decisions on COVID-19 vaccination strategies. Key messages Fundamental epidemiological methods remain valuable for modern epidemic risk assessment. COVID-19 is not just a ‘flu’.

● At first haemophilus influenza was considered as the causative agent for influenza but after the research it has been found that it caused various other types of infections but not influenza. Influenza was caused by some flu virus which was first isolated from pigs in 1931 and from humans in 1933.(4) ● The 1918 influenza pandemic was the most severe pandemic in recent history it was caused by an H1N1 virus with the genes of avian origin although there is not universal consensus regarding where the virus originated it spread worldwide during 1918 and 1919. (3) ● It was first identified in military personnel in spring 1980 it is estimated that about 500 million people or one third of the world's population became infected with this virus.(3) ● The number of deaths was estimated to be at least 50 million worldwide with about 6,75,000 deaths occurring in the United States. (3) ● Mortality was high in people younger than five years old ,20 to 40 years old and in 65 years and older. The high mortality in healthy people including those in the 20 to 40 year age group was a unique feature of this pandemic. (3) ● There was no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infection control efforts worldwide were limited to non-pharmaceutical intervention such as isolation quarantine good personal hygiene use of disinfectants and limitations of public gathering which were applied unevenly.(3) ● In the northern and southern parts of the world outbreaks occur mainly in the winter while around the equator outbreaks may occur at any time of the year .In the northern and southern parts of the world outbreaks occur mainly in the winter while around the equator outbreaks may occur at any time of the year.(7) ● In the 20th century three influenza pandemics occurred Spanish influenza in 1918 where the death toll ranged from 17- 200 million deaths, Asian influenza in 1957- 2 million deaths and Hong Kong influenza in 1968 -1 million deaths. ● The world health organisation declared an outbreak of a new type of influenza A or H1N1 to be a pandemic in June 2009. ● influenza may also affect other animals including pig horses and birds.(9) ● The name “influenza” originated in 15th century Italy, from an epidemic attributed to “influence of the stars.” The first pandemic that fits the description of influenza was in 1580. At least four pandemics of influenza occurred in the 19th century, and three occurred in the 20th century. The pandemic of “Spanish” influenza in 1918–1919 caused an estimated 21 million deaths worldwide. The first pandemic of the 21st century occurred in 2009–2010. Historically, influenza viruses of three HA subtypes (H1, H2 and H3) have acquired the ability to be transmitted efficiently between humans. Currently, influenza viruses of the H1 and H3 subtype co-circulate in humans, however influenza viruses of the H2, H5, H6, H7 and H9 subtype are also considered to represent a pandemic threat. In 1997, a large outbreak of highly pathogenic avian influenza (HPAI) H5N1 virus in poultry in Hong Kong resulted in the first documented cases of direct transmission of HPAI H5N1 virus from poultry to humans, with a fatal outcome in 6 out of 18 cases [17]. As a result, this outbreak warranted the mass culling of 1.5 million chickens. In 2003, a large outbreak of an HPAI H7N7 virus in poultry in the Netherlands resulted in 89 cases of human infections, one of which was fatal [21]. HPAI H7N7 virus displayed an unusual tissue tropism; the virus targeted the conjunctiva, resulting in conjunctivitis, a symptom rarely reported for other influenza virus subtypes.(1)

● At first haemophilus influenza was considered as the causative agent for influenza but after the research it has been found that it caused various other types of infections but not influenza. Influenza was caused by some flu virus which was first isolated from pigs in 1931 and from humans in 1933.(4) ● The 1918 influenza pandemic was the most severe pandemic in recent history it was caused by an H1N1 virus with the genes of avian origin although there is not universal consensus regarding where the virus originated it spread worldwide during 1918 and 1919. (3) ● It was first identified in military personnel in spring 1980 it is estimated that about 500 million people or one third of the world's population became infected with this virus.(3) ● The number of deaths was estimated to be at least 50 million worldwide with about 6,75,000 deaths occurring in the United States. (3) ● Mortality was high in people younger than five years old ,20 to 40 years old and in 65 years and older. The high mortality in healthy people including those in the 20 to 40 year age group was a unique feature of this pandemic. (3) ● There was no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infection control efforts worldwide were limited to non-pharmaceutical intervention such as isolation quarantine good personal hygiene use of disinfectants and limitations of public gathering which were applied unevenly.(3) ● In the northern and southern parts of the world outbreaks occur mainly in the winter while around the equator outbreaks may occur at any time of the year .In the northern and southern parts of the world outbreaks occur mainly in the winter while around the equator outbreaks may occur at any time of the year.(7) ● In the 20th century three influenza pandemics occurred Spanish influenza in 1918 where the death toll ranged from 17- 200 million deaths, Asian influenza in 1957- 2 million deaths and Hong Kong influenza in 1968 -1 million deaths. ● The world health organisation declared an outbreak of a new type of influenza A or H1N1 to be a pandemic in June 2009. ● influenza may also affect other animals including pig horses and birds.(9) ● The name “influenza” originated in 15th century Italy, from an epidemic attributed to “influence of the stars.” The first pandemic that fits the description of influenza was in 1580. At least four pandemics of influenza occurred in the 19th century, and three occurred in the 20th century. The pandemic of “Spanish” influenza in 1918–1919 caused an estimated 21 million deaths worldwide. The first pandemic of the 21st century occurred in 2009–2010. Historically, influenza viruses of three HA subtypes (H1, H2 and H3) have acquired the ability to be transmitted efficiently between humans. Currently, influenza viruses of the H1 and H3 subtype co-circulate in humans, however influenza viruses of the H2, H5, H6, H7 and H9 subtype are also considered to represent a pandemic threat. In 1997, a large outbreak of highly pathogenic avian influenza (HPAI) H5N1 virus in poultry in Hong Kong resulted in the first documented cases of direct transmission of HPAI H5N1 virus from poultry to humans, with a fatal outcome in 6 out of 18 cases [17]. As a result, this outbreak warranted the mass culling of 1.5 million chickens. In 2003, a large outbreak of an HPAI H7N7 virus in poultry in the Netherlands resulted in 89 cases of human infections, one of which was fatal [21]. HPAI H7N7 virus displayed an unusual tissue tropism; the virus targeted the conjunctiva, resulting in conjunctivitis, a symptom rarely reported for other influenza virus subtypes.(1)

The epidemic is an imminent danger that all humans fear, as it does not differentiate between anyone, whether small or old, rich or poor. It is characterized by its ability and super speed to conquer the world and its primary goal is to target humans and eradicate their lives. In this article, the authors decided to provide a brief historical overview of the Spanish flu pandemic, where it initiated and how it influenced the people of the earth and review a set of images about events that occurred in the United States of America in 1918. All facts in this article are collected from a group of published articles on websites. This article found that the Spanish flu is one of the deadliest diseases in human history, as it managed to kill 40 to 100 million people around the world in two years.

Abstract 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.

Between November 20, 1918, and March 12, 1919, the US Public Health Service carried out a vast population-based survey to assess the incidence rate and mortality of the influenza pandemic among 146 203 persons in 18 localities across the United States. The survey attempted to retrospectively assess all self-reported or diagnosed cases of influenza since August 1, 1918. It indicated that the cumulative incidence of symptomatic influenza over 6 months had been 29.4% (range = 15% in Louisville, KY, to 53.3% in San Antonio, TX). The overall case fatality rate (CFR) was 1.70%, and it ranged from 0.78% in San Antonio to 3.14% in New London, Connecticut. Localities with high cumulative incidence were not necessarily those with high CFR. Overall, assuming the survey missed asymptomatic cases, between August 1, 1918, and February 21, 1919, maybe more than 50% of the population was infected, and about 1% of the infected died. Eight months into the COVID-19 pandemic, the United States has not yet launched a survey that would provide population-based estimates of incidence and CFRs analogous to those generated by the 1918 US Public Health Service house-to-house canvass survey of influenza. Published online ahead of print December 8, 2020: 1–8. https://doi.org/10.2105/AJPH.2020.306025 )

Abstract 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.

Abstract Scholars and journalists connect pandemics to a rise in support for radical political movements. In this study, we draw on this insight to investigate the relationship between the 1918–1919 Spanish influenza pandemic and political extremism—here, the rise of the second Ku Klux Klan—in the United States. Specifically, we ask whether U.S. states and cities with higher death rates from the Spanish flu also had stronger Ku Klux Klan organizations in the early 1920s. Our results do not provide evidence of such a connection; in fact, the data suggest greater Klan membership where the pandemic was less severe. This provides initial evidence that pandemic severity, as measured by mortality, is not necessarily a cause of extremism in the United States; power devaluation as a result of social and cultural change, however, does appear to spur such mobilization.

The COVID-19 pandemic, the most significant public health crisis since the 1918–1919 influenza epidemic, is the first such event to occur since the development of modern transportation systems in the twentieth century. Many states across the U.S. imposed lockdowns in early spring 2020, which reduced demand for trips of various types and affected transportation systems. In urban areas, the shift resulted in a reduction in traffic volumes and an increase in bicycling and walking in certain land use contexts. This paper seeks to understand the changes occurring at signalized intersections as a result of the lockdown and the ongoing pandemic, as well as the actions taken in response to these impacts. The results of a survey of agency reactions to COVID-19 with respect to traffic signal operations and changes in pedestrian activity during the spring 2020 lockdown using two case study examples in Utah are presented. First, the effects of placing intersections on pedestrian recall (with signage) to stop pedestrians from pushing the pedestrian button are examined. Next, the changes in pedestrian activity at Utah signalized intersections between the first 6 months of both 2019 and 2020 are analyzed and the impact of land use characteristics is explored. Survey results reveal the importance of using technologies such as adaptive systems and automated traffic signal performance measures to drive decisions. While pedestrian pushbutton actuations decreased in response to the implementation of pedestrian recalls, many pedestrians continued to use the pushbutton. Pedestrian activity changes were also largely driven by surrounding land uses.

Tiffany is running down a suburban street with headphones and a hoodie on. Her breath is clearly audible, rhythmic, steady, and in pace with her footsteps. The Tiffany’s Story video testimonial on the Be Smart. Be Well. website then cuts to Tiffany sitting at home describing her earlier experiences with asthma: “The hospital became like my second home... I couldn’t breathe on my own.” Dr. Wolf, who has been treating Tiffany since she was diagnosed with asthma at age 8, joins in, “At that time she had really severe asthma. It was very difficult to manage and remained very difficult to manage for many years” (Be Smart. Be Well). As a child, Tiffany could never run, with steady breath, as she did at the beginning of the video, titled The Right Meds Keep Her in the Ring (Be Smart. Be Well). But after figuring out a treatment regime that worked, Tiffany became a healthy teenager; the video features her in contexts where she is jogging, smiling radiantly with her mother, and holding up victory belts from her boxing matches. From a child unable to breathe on her own, to a teenager with dreams of going to the Olympics, Tiffany’s asthma story underscores some of the defining narratives of contemporary asthma care. Her experience moves from uncontrolled asthma that limited her activities to a well-managed condition where she is able to pursue her aspirations without interference. Her Olympic dreams fit perfectly, reproduce even, the iconic image of the asthmatic athlete. It’s an image that has been in circulation since the early years of the contemporary asthma epidemic, a moment in the 1990s when federal health agencies and advocacy organizations worked to give the growing population of child asthmatics hope and encouragement to overcome their asthma. Yet the figure of the athletic asthmatic, and other accomplished icons with well-controlled asthma, also promotes an idealized image of health: “you can be greater than you are,” when you take your medication. The messages, of course, are well intentioned, designed to educate and show kids that asthma does not equate with disability. Yet these messages frequently work on logic where drugs control symptoms to enable you to do better in life. In some corners of asthma care, concern with symptoms is subsumed by narratives of activity and accomplishment. This article sketches shifts in the meaning of health and disease in the context of asthma treatment, moving from a time when treatments were not disease-specific and illness was seen as debilitating, to the contemporary moment where pharmaceutical companies market disease and promote health through direct-to-consumer advertising (DTCA). It’s a move situated within a broader, biomedicalized context where health isn’t just achieved, it’s augmented. Tiffany’s story is typical of someone with severe or even moderate asthma: uncontrolled symptoms, use of emergency care, unresponsive to medications, and an inability to live life as fully as desired. Symptoms and the threat of symptoms prevent people from undertaking routine activities (such as exercise, visiting friends, or attending work or school) and going into spaces that might trigger an attack. Asthma, in other words, can prevent people from living a “normal” life. But it can also be more than a chronic inconvenience that shapes behaviors; in the U.S., asthma still kills more than 3,000 people each year (Moorman et al. 20). Medical practitioners, researchers, and patients persistently search for insight into asthma’s causes and possible cures (Whitmarsh). Both cause and cure still allude, but preventative measures have improved dramatically in the last thirty years, through both pharmaceutical advancements and better public health approaches. Whereas a century ago, or even 30 years ago, severe asthmatics would have lead quite restricted lives—confined to their homes and unable to be active—today’s asthmatics are not limited by their condition to the degree they were decades before. We see this in asthma research that shows improved morbidity, decreased hospitalizations, and better quality of life (Moorman et al. 1-67). We also see this in DTCA, asthma advocacy campaigns, and even public health messages that actively combat the historic image of the weak, invalid asthmatic with stories of famous athletes, entertainers, or politicians who overcame asthma to achieve great things. It moves the discourse from an overly negative image—as one asthmatic interlocutor conveyed, “there was a stereotype in the 80s, in the movies, where the nerdy wimpy kid always had asthma, and the inhaler was associated with that”—to an extraordinarily positive image of high achieving asthmatics. Inhalers, formerly a sign of weakness, are now common in competitive sport contexts (Arie 344). The contrast between these representations—the 1980s nerdy wimp and the 21st century athlete—is stark. The latter image participates in the shift towards augmented health, where active bodies have become the new idealized norm. The shifting representations of asthmatics, even over the last twenty years, makes sense in the context of biomedicalization (Clarke et al. 172), where treatment regimes moved from a focus on “attaining control over the body” under medicalization, to “enabling the transformation of bodies to include desired new properties and identities” (Clarke et al. 183). The right treatment will allow you to do things that your body wouldn’t let you do otherwise. The question is: should treatment be sold on this premise? What would have been considered a return to health a hundred years ago wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, the absence of symptoms would have been a success; today, the focus is on the degree to which one feels limited and how much you can accomplish in the span of 24-hours. Missed school and work days are a key measure in asthma epidemiology and care; these public health measures not only signal uncontrolled asthma, but do so by counting absence in the context of labor. The discursive shift can also be seen in the change from the urge to “breathe easy” (language from the Centers for Disease Control) to suggestions in pharmaceutical ads that you can “breathe better.” What new selves are being created by emergent health rhetorics, as Metzel asks (6), rhetorics which seem to be consumerist and neoliberal as much as they are biomedical? Role Reversal Historically, those with severe asthma led their lives carefully, or in reclusion. French novelist Marcel Proust, in addition to his literary accomplishments, spent much of his life confined to his home. Despite searching through medical texts and experimenting with various treatments, Proust’s asthma “dominated” his daily life, in the words of Mark Jackson (6). Writing of asthma’s history, Jackson continues, Proust constitutes the archetypal asthmatic, whose breathlessness and discomfort echo across space and time. Proust’s intimate descriptions of his symptoms—‘an asthmatic never knows if he will be able to breathe’ he wrote to the novelist Andre Gide in 1919—bear striking similarities both to Greek and medieval accounts of asthma many centuries earlier and to recent surveys suggesting that, at the turn of the millennium, many asthmatics continue to suffer from severe attacks that prevent them from speaking or make them fear for their lives. (8) In Proust’s time, advertisements for asthma and other respiratory treatments focused on providing symptom relief; some even purported to cure respiratory woes. These advertisements were rarely asthma specific, in part, because manufacturers sought the widest possible customer base, but also because it was difficult to distinguish one respiratory illness from another (Jackson 201). Asthmatics like Proust tried a range of remedies, including asthma cigarettes, the Carbolic Smoke Ball, and various forms of early inhalers. Most of these early asthma remedies instructed customers to use their product when in need of relief. Some ads stated that more regular use could stave off symptoms as well remedy them in the moment, but prevention wasn’t the primary message. The principle focus was addressing symptoms at hand. Just about a hundred years later, at the beginning of the U.S. asthma epidemic, symptoms were still center stage. National attention turned towards the asthmatic condition as the public health effects of severe asthma became visible—asthma-related deaths and hospitalizations had increased, along with rising prevalence rates. Asthma—formerly kept hidden in homes and in low-income communities—emerged as a major public health issue (Mitman 245). Advocacy campaigns were created on the heels of the epidemic’s emergence; they aimed to make asthma visible and show kids that their condition didn’t have to get in the way of life. Elite athletes became central figures in these campaigns. The Asthma All-Stars program, which featured Olympic medalists Jackie Joyner-Kersee and Amy Van Dyken, as well as Pittsburgh Steeler Jerome Bettis, worked to educate the public through acknowledgement of the condition as well as treatment advocacy. The National Library of Medicine’s exhibit on asthma, “Breath of Life” (1999), exemplifies this period with a showcase of famous asthmatics. In the exhibit, more than half the profiles of contemporary asthmatics feature Olympic or all-star athletes; entertainers, politicians, and scientists round out the exhibit. The legacy of the asthmatic athlete persists today; it’s still common to see sports figures speaking at fundraisers or spearheading events. These images are important, particularly for patient populations who truly feel limited and unable to do things because of their asthma. Athletes who speak about their condition are always clear: well-controlled asthma comes from adherence to treatment. The importance of these images also stems from the use of the image of the All-Star asthmatic to counter the historical stereotype of the weak, invalid asthmatic, who, like Proust, could not even leave the house. The man who recalled the stereotyped asthmatic from the 1980s, stated “I think I mapped myself onto that [stereotype], like, this is a disability, right, the media tells me this is a disability cause it’s always the kids who can’t do anything who are puffing their puffers.” In step with emergent 21st century health rhetoric, and increasing asthma prevalence, the image of the asthmatic was revised, falling in line with newly normalized health ideals (Clarke et al. 181; Metzel 2; Sinding 262). Active Asthmatics If 19th and early 20th century inhaler advertisements declared their products could relieve if not cure respiratory symptoms, at the beginning of the 21st century asthma treatment went beyond simply relieving symptoms; advertisements and medical discourse emphasized preventative symptom control, improved lung function, and better breathing. With the development of long-term controller medications, many asthmatics could reliably prevent symptoms a majority of the time. When combination inhalers hit the market in the early 2000s, the mood of advertisements could be summed up by a line from a GlaxoSmithKline commercial, “Coping is not the same as controlling” (GlaxoSmithKline). Prevention rather than symptom relief was the order of the new century. And yet just in the last ten years, pharmaceutical messages have shifted yet again, moving from an emphasis on controlling symptoms to living a better life: don’t let asthma slow you down, or stop you from living the life you want to live. It’s a message predicated on a particular view of what a normal life should look like, one characterized as augmented health. A 2012 Advair commercial reflects the tone of augmented health, “Asthma can hold you back, but it doesn’t always have to. Advair is clinically proven to significantly increase symptom free days, to help you do more of the things you like to do, more of the things you have to do, and more of what you want to do” (Advair). Strategically placed throughout the commercial, a voice chimes in “GO!” as the hero of the commercial, a middle aged asthmatic man, bikes down a wooded trail; moves through a busy hallway where he greets one person after the next, all of whom hand him file folders or blue prints; dances at a nightclub; and walks down bleachers to join a group of friends at a ballgame. The commercial ends with the man arriving home well after dark, comfortably settling into bed, and then energetically waking up to do it all over again the next day. Marked by words like increase, more, and go, the Advair commercial depicts a life full of activity. Not only that, the commercial leverages contexts that are commonly problematic for asthmatics: being outside and in foliage rich areas; biking and dancing, or other physical activities that could leave one breathless; and sleeping comfortably—nighttime attacks are common among asthmatics. The message is clear: look at all the things asthmatics can do when their condition is well controlled—with Advair, of course. It’s a message that builds on an earlier trend in asthma advocacy, during the 1990s, when well-known asthmatic athletes were used to bring visibility to asthma. If asthma control in the 1990s emphasized that asthmatics didn’t need to be held back, 21st century ads suggest that one could do more. By augmenting your health, asthma control can transform your life by allowing you to do more.Today, DTCA for asthma drugs are just as likely to emphasize improved lung function as they are symptom control, and, as advertised in the Advair commercial, improved lung function enables one to do more. A man featured in a 2012 Symbicort commercial explains, “Symbicort helps significantly improve my lung function, starting within five minutes… With Symbicort, today I’m breathing better” (Symbicort). The man’s renewed capacity to go on fishing trips with loved ones is the example in this commercial. Control, relief, and cure are nowhere to be found in these DTC advertisements; symptoms have been dropped from the frame. Rather than work off illness, or the older stereotype of the weak, homebound asthmatic, the new wave of DTCA champions augmented health: a higher quality of life, where patient-consumers can “do” whatever they like. What would have been considered a return to normal a hundred years ago, in Proust’s time, wouldn’t be considered doing enough to manage your asthma today. A hundred years ago, getting out of the house would have been enough; today, it’s a question of how much can you accomplish in the span of 24-hours. The portrayal of health in these DTCA calls to mind Lauren Berlant’s description of OTC cold medicine, which claim to make you feel better, but are really more concerned with making sure people can stay productive (28). Conclusion Had Proust lived a century later, he may have, like Tiffany, led a less restricted life. Or as Dr. Wolf put it, “A normal life. Busy and as active as she’d like to be. But she needs to take medication to do it” (Be Well. Be Smart). Symptom-free doesn’t seem to be enough anymore. Contemporary images of asthmatics—as an all-star athlete, an aspiring boxer, and a hyper-busy city dweller—are shaped by an imagined healthy norm. Advocacy campaigns originally intended to combat long-standing negative representations partake in the promotion of augmented health. Increasingly, health is no longer defined by the absence of symptoms, but by how active you are and how much you do. Busy and productive is a gold standard of the idealized norm, a norm that circulates—to a greater or lesser extent—in direct-to-consumer advertising, asthma advocacy campaigns, and public health messages (Sinding 262). Without doubt, the pharmaceutical industry plays a tremendous role in shaping contemporary health norms. Yet, as Joseph Dumit describes it, "the pharmaceutical industry is a massive elephant. Like the blind men of the famous parable, we each catch a hold of a tiny piece of it -- leg, tail, trunk -- and think we have a handle on it" (18). A powerful force with influence on many aspects of contemporary life, the pharmaceutical industry could be understood through the lens of biomedicalization: Biomedicalization imposes new mandates and performances that become incorporated into one’s sense of self. The subjectivities that arise out of these performances of what it is to be healthy (e.g., proactive, prevention-conscious, neo-rational) suggest how biomedical technoscience indicates a type of governmentality that can enact itself at the level of subjective identities and social relations. (Clarke et al. 182) Disease marketing—prevalent in the 1990s—is no longer needed or effective; health marketing has taken over and pharmaceutical companies are not at the table alone (Elliott 97). Instead of working through disease difference, health marketing attempts to level ground through images and standards that everyone can work towards, asthmatics included. Of course, pharmaceutical marketing simultaneously renders invisible socioeconomic conditions that contribute to asthma incidence, and marginalized populations that struggle to access medication and medical care in the first place. Augmented health works to flatten difference across social, economic, political, and ecological scales, as if these inequalities didn’t matter for disease management. Scholars writing about emergent modes of health—how health is imagined, constructed, studied, and sold—have documented how new health regimes work off potential risk categories, race, class, and gendered ideologies, or hoped-for modes of living. Some are literally “against health” (the title of Metzel and Kirkland’s edited volume). But to be against health, as Metzel writes is not to be against needed treatment (9). To examine the ways in which DTCA or advocacy campaigns promote specific, idealized images of health—images where people are athletic, outgoing, and busy—and question whether these drugs go above and beyond the restoration of health, should not be equated with a statement about whether medication is necessary. Epidemiological evidence and clinical studies are clear that contemporary treatments help reduce the burden of asthma in various ways: through reduced hospitalizations, lower death rates, and better-controlled asthma. Drugs keep many asthmatics relatively symptom-free. The point, rather, is that health is complex, structured by various institutions, actors, politics, and materials. One of the valences of the new health regime is augmented health, seen in the context of this paper at work in DTCA and possibly emerging in other corners of the asthma care arena as well. To date, most writing on augmentation has focused on how advancements in science and technology extend the capacity of human bodies—from prosthetics and fertility drugs, to steroids and life support (Hogle 696). Less has been written on the ways in which chronic conditions like diabetes, heart disease, and asthma—conditions where life hinges on medications, but are common enough that they are deemed unexceptional—produce a rhetoric of augmentation; where the new healthy is augmented living. It’s not the drugs for life rhetoric that works off new risk categories, as Dumit has shown (201); asthmatics are symptomatic, always at risk anyways, and often already on drugs for life. Drugs for chronic conditions like asthma may simply control symptoms, but they’re increasingly sold on the promise of enhancing life capacities as well. As Elliott has observed, it’s part of a move from disease marketing to health marketing (97). The discursive shift in asthma care, and perhaps other chronic disease contexts as well, doesn’t register as enhancement or augmentation because it mirrors the new health norm that is part of the broader context of biomedicalization. As the frame of health shifts, questions about bodies, ethics, and enhancement technologies might need to shift as well. Linda Hogle’s question is apt here: “what is necessary to sustain health? At which point does repair become something more than restorative, and for which (and whose) purposes are interventions defined as 'therapeutic'” (697). Since health norms have become augmented in the last ten years, this question becomes all the more difficult to answer. Within these new health regimes, potential has not only become open-ended, it also seems to be a therapeutic goal. References Arie, Sophie. “What Can We Learn from Asthma in Elite Athletes?” British Medical Journal 344 (2012). Be Smart. Be Well. “The Right Meds Keep Her in the Ring.” Be Smart. Be Well. 14 Aug. 2013. 1 Dec. 2013 ‹http://www.besmartbewell.com/childhood-asthma/tiffany.htm›. Clarke, Adele, Janet Shim, Laura Mamo, Jennifer Fosket, and Jennifer Fishman. “Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine.” American Sociological Review 68 (2003): 161-194. Dumit, Joseph. Drugs for Life: How Pharmaceutical Companies Define Our Health. 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