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How the 1918 Flu Spread Across America (2017)
- generalpass 7y agoWas there ever a better example of why the government needs to be kept away from news outlets?
- war1025 7y agoI don't know that it's a correct reply for this comment, but it sparked in my mind the memory of "All Quiet on the Western Front" [1] The initial premise of which is that the townsfolk talk war up as a glamorous and noble thing, so all the boys enlist at the outbreak of WWI, only to find what absolute hell it is. Actually makes me want to go back and read the book. Or maybe re-read? I don't remember if we read it before we watched the film. [1] https://www.goodreads.com/book/show/355697.All_Quiet_on_the_Western_Front https://www.goodreads.com/book/show/355697.All_Quiet_on_the_...
- dragontamer 7y ago> In 1918, medicine had barely become modern; some scientists still believed “miasma” accounted for influenza’s spread. Does anyone know where I can learn more about the "miasma" model of disease? Whenever I'm looking up old plagues / diseases / etc. etc., they bring up the "miasma" model. But what is the miasma theory (or pseudo-science?) that people used to believe in? And how does it differ from our modern germ theory? Ex: I know plague doctors wore airtight masks and waxxed leather to suit-up and protect themselves from the "miasma" of the plague. As an early sanitization model, it probably worked (at least, "worked" as much as modern masks work on untrained laypeople). But where did the miasma model fall short compared to germs?
- graeme 7y agohttps://en.wikipedia.org/wiki/Miasma_theory https://en.wikipedia.org/wiki/Miasma_theory
- ceejayoz 7y agoBasically it's https://en.wikipedia.org/wiki/Spontaneous_generation https://en.wikipedia.org/wiki/Spontaneous_generation for disease. Some of the mitigations would've been effective, but the mechanism was all wrong. It doesn't permit person-to-person transmission, so you could be in a place with "good air" and still be transmitting disease while thinking you can't.
- danso 7y agoI believe the "miasma" model was the dominant theory at the time of John Snow's famous cholera investigation. In fact, IIRC the dot map method that Snow is famous for (e.g. via Edward Tufte) had also been usedby miasma-proponents; I think the takeaway is that Snow strongest argument weren't the maps, but the investigative surveying and research he conducted in addition to those maps. https://www.ph.ucla.edu/epi/snow/choleratheories.html https://www.ph.ucla.edu/epi/snow/choleratheories.html
- NikolaeVarius 7y agoI dislike this idea of calling theories that ended up being wrong as "pseudo-science". Not all wrong ideas were just random ramblings. Miasma Theory came from imperfect knowledge and not understanding the mechanisms of some of their observations. If you read the debates on how miasma works, you can totally see reasonable rational arguments if you strip away a few generations of scientific knowledge.
- astine 7y agoMy understanding is that the term 'pseudo-science' refers to theories that people pretend have scientific backing but really don't, as opposed to theories that just eventually prove to be false. So I might claim that homeopathy is based on the principle of 'like-heals-like' and claim that it is based in science, but in reality there is no scientific evidence to back that idea and so homeopathy would then be pseudo-science.
- vikramkr 7y agoI agree. It becomes pseudoscience when it contradicts existing scientific knowledge without any rationale or explicitly comes from a a rejection of the scientific method. There's a difference between being pseudoscientific and being wrong. A lot of hypothesis about how the world works today, including some seemingly strong beliefs backed by pots of evidence, will be found to be wrong or incomplete as we move forward and develop better tools and science.
- mushysyntax 7y agoYou clearly lack an understanding of the scientific method and what makes "science" science. It was pseudo science because using those suits was not based on any proof from empirical observations. Plague suits did nothing to decrease mortality rates.
- smacktoward 7y agoIn a nutshell, miasma theory argued that illness was transmitted through the air, which could be poisoned by emissions from rotting organic matter. If you breathed this poisoned air, the theory said, you got sick. "Bad" air could be distinguished from "good" air by its offensive odor -- the stronger the odor, the worse the miasma. The way you prevented disease was by removing things that smelled bad to somewhere people weren't. The miasma theory fell short compared to germ theory in several respects. While germs can be transmitted through air, for instance, they can also be transmitted through water, physical contact, etc. -- so miasma theory was spectacularly unhelpful in dealing with diseases like cholera, which is transmitted through water. There are also lots of situations where germs can be present even though there's no obvious bad smell, so miasma theory is no help there. Germ theory can explain why a doctor who doesn't sanitize his instruments between operations can pass an infection from one patient to another, for example; miasma theory cannot. And since it identifies the germ as the underlying vehicle of transmission, germ theory provides a means of protection -- kill the germ and you prevent the transmission. Miasma theory had no explanation for what exactly in the supposed miasma was causing the transmission, so its prophylactic utility was limited. It's one of those things where people very early on made an intuitive observation (that being in places full of things that smelled bad tended to make people sick), and since that observation was "good enough" to make it useful in a lot of cases, it became part of the conventional wisdom. But once the scientific approach started finally being applied to medicine, its limitations became clear.
- astine 7y agoMiasma theory was the belief that it was the smells themselves that caused the disease, or rather, that bad air which was synonymous with with bad smell, that caused disease. The plague doctor outfits, for example, were not actually airtight. The 'beak' contained incenses and perfumes intended to protect against miasma by preventing smelling of bad smells. It actually was not very effective (fleas getting in through under the coat was among the many defects,) and the mortality rates of plague doctors was very high.
- danso 7y agoI read this article a few weeks ago when I fell down the rabbit hole of trying to figure out why the Spanish Flu was called the "Spanish Flu". I knew it didn't originate from Spain, but hadn't heard that the traditional consensus is that it likely started in Kansas, owing to the first detected case being in Kansas. The CDC has a variety of history pages [0] about the Spanish Flu. The main one acknowledges that there isn't a "universal consensus" about the virus's origin, but doesn't assert any of the other alternative explanations. The theories that the Spanish Flu might have actually come from China seem to be more recent. Such as this one in 2014 [1] that found reports from 1917 of Chinese suffering Spanish Flu like symptoms. But his explanation for how the first known case in the West was in Kansas – that thousands of Chinese workers were sent to labor around the world – seems really speculative. Given that there isn't compelling evidence to think the Spanish Flu started elsewhere outside of Kansas, it is funny how not only did it get the name of "Spanish Flu", but also that Kansas managed to not have a long-lasting reputation for terrible disease, even though the Spanish Flu killed more people than (IIRC) all the other 20th century pandemics combined. [0] https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm https://www.cdc.gov/flu/pandemic-resources/1918-commemoratio... [1] https://www.history.com/news/china-epicenter-of-1918-flu-pandemic-historian-says https://www.history.com/news/china-epicenter-of-1918-flu-pan... https://en.wikipedia.org/wiki/Spanish_flu https://en.wikipedia.org/wiki/Spanish_flu
- LeoTinnitus 7y agoI heard it was called it because the Spanish were the only ones reporting it during the war.
- smacktoward 7y agoYes, that was the explanation I got in history class as well. The flu emerged during World War I, and every combatant country had strict censorship of the press in place, which suppressed news of its spread in those countries. But Spain was neutral in that conflict and thus had an uncensored press, so reports of the flu's impact quickly made it to print there. And those reports got picked up worldwide as the first reporting on the influenza, leading people to think of it as a disease that began in Spain.
- jtdev 7y ago“ Philadelphia had scheduled a big Liberty Loan parade for September 28. Doctors urged Krusen to cancel it, fearful that hundreds of thousands jamming the route, crushing against each other for a better view, would spread disease. They convinced reporters to write stories about the danger. But editors refused to run them, and refused to print letters from doctors. The largest parade in Philadelphia’s history proceeded on schedule.” I see that Switzerland has imposed a ban on gathering of 1000 or more in response to COVID19 - maybe other countries should consider doing the same?
- wincy 7y agoFor the USA at least, wouldn't imposing a ban rather than a recommendation be a violation of the Constitutional right to freedom of assembly?
- t-writescode 7y agoNot a lawyer, I think it would depend on the exact laws and rulings around martial law. Curfews are a thing, but I don’t know if they’re constitutional.
- jtdev 7y agoSure, a recommendation seems good too... anything rather than just burying our heads in the sand.
- close04 7y agoAren’t some authorizations still needed to organize larger events? I think that’s the ban, no more concerts, sold out football matches, etc.
- ceejayoz 7y agoSCOTUS has repeatedly recognized quarantine as an exception.
- PopePompus 7y agoIf the CDC merely urged that all large gatherings be cancelled, that would probably result in the cancellation of 95% of them, with no constitutional implications.
- devy 7y agoThis article was from November 2017, can the mod put a year tag in the title?
- mbreese 7y agoI agree and think that in this case, the (2017) year is an important distinction. It helps to emphasize that this is not a story written with our current fears in mind. But rather, it is an unbiased look at what happened during the spread of the 1918 flu pandemic. And there are lessons to be learned.
- deleted 7y ago[deleted]
- moultano 7y agoFor those of you reading this from the bay area, we already have suspected community transmission 50 miles away, in a town with a lot of people who commute to the Bay. If it's easy for you to work from home, consider doing so, giving explicit permission to your reports to do so, and asking your manager to give permission to their reports to do so. We're fortunate to be in an industry where WFH has relatively little cost, and we can afford to get ahead of this in a way that other industries can't. We don't have to wait for the government to give us guidance. For people doing technical tasks, IMHO, the cost/benefit tipped in favor of WFH yesterday.
- ronyeh 7y agoFor those who haven't kept up: https://www.ucdavis.edu/news/message-campus-community-covid-19/ https://www.ucdavis.edu/news/message-campus-community-covid-... In addition to the confirmed Solano county case (unknown transmission), three UC Davis students are currently in isolation, with one showing symptoms (tested, pending results).
- bcrosby95 7y agoI'm not sure why officials haven't come out suggesting things like this. And to avoid non-mandatory travel. It's probably a bit late for this stuff from a containment perspective. But it would help reduce the r0. Speaking personally, I have to decide by mid March if we should take our trip to Legoland in San Diego. Right now I'm leaning towards "no". And I don't imagine the outlook will be much better in just 2 weeks.
- deleted 7y ago[deleted]
- SpicyLemonZest 7y agoOfficials have to calibrate their guidance against how the general public will react. If they announce that you should try to stay home and cancel your travel plans, but the average Joe looks around and says "nah it's not really spreading in the US right now", how do you get him to actually stay home if/when it's absolutely necessary?
- howmayiannoyyou 7y agoI fear we are going to regret not taking draconian measures right now. Mandatory social distancing right now likely could buy additional time for the healthcare system to advance preparations for a wide scale outbreak, including stockpiling additional PPE and advancing triage procedures. It provides valuable time for drug & medical device manufacturers to ramp up production of needed supplies and drugs that should be proved effective in a few days or weeks. A 14 - 30 hold would do disproportionate good over potential damage.
- Loughla 7y agoFlip side of your argument, just for brevity's sake. I fear many governments and leaders are going to use this as an excuse to take full control and become the tin-pot dictators they want to be through those same draconian measures. So here we are.
- dharma1 7y agoI agree. Nothing will slow this down except isolation. Even if it's too early, better too early than too late. What's worse - everyone taking a month off to work from home and watch Netflix with their closest ones, or do nothing and risk high numbers of casualties and rapid spread?
- stevenwoo 7y agoThe outbreak started in one of the most authoritarian regimes in the world and it still spread (could not have more effective quarantine except in North Korea and the former Soviet republics) and there is no drug treatment (besides trying different current/experimental antivirals), only waiting out the infection. That cruise ship quarantine showed there is something else wrong as well since it appears either the test is faulty or people can be infected without triggering a positive test based on the people who got sick again after leaving quarantine.
- lcfcjs2 7y agoDid they have an incompetent President then too?
- js2 7y agoWhile doing ancestry research years ago, I learned I had a 2nd great uncle who immigrated to America from Romania aboard the RMS Carpathia in 1904. (Eight years later in 1912, this would be the first ship to come to the Titanic’s rescue, and six years after that would itself be sunk by a U-Boat.) He had left Romania likely to escape anti-semitism. He’d eventually find his way out to Denver. Sadly, he’d die in 1918 (the same year the Carpathia was sunk) at the age of 25, very probably from the flu. This is a picture of him, along with his headstone and declaration of intent to become a citizen: - https://ibb.co/xggjjnJ https://ibb.co/xggjjnJ (Photo) - https://ibb.co/vvnSqMg https://ibb.co/vvnSqMg (Headstone) - https://ibb.co/zmNzdC9 https://ibb.co/zmNzdC9 (Declaration) Google Maps for his Denver, CO address: - https://goo.gl/maps/CvmeCsUARnwXNnBu6 https://goo.gl/maps/CvmeCsUARnwXNnBu6
- Loughla 7y agoThat's neat (even if it's a sad way to go). This is the kind of thing about the internet that makes all the rest of the noise and nonsense worth it. Just think, 30 years ago, all of that information would've taken years to put together, if you even could've put it together! Just fascinating.
- nostromo 7y agoIt's worth noting that the 1918 flu was unique in that it killed many young, healthy people. Corona virus is more typical in that it's primarily killing the very old or otherwise ill. https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/ https://www.worldometers.info/coronavirus/coronavirus-age-se...
- Macha 7y agoHow much of that was down to the disease, compared to the conditions that "young, healthy" people would have been subjected to during a world war?
- refurb 7y agoThe belief is that it was disease related. Younger, healthier people have more active immune systems and the Spanish flu was causing it to kick into overdrive (similar to a cytokine storm). I think the war definitely helped spread it as living conditions were rough and there was plenty of migration.
- kaonashi 7y agoThe biggest thing I took away is that it wasn't the initial outbreak that was abnormally lethal. It was the only after it had been incubating and mutating in millions of human hosts that the second wave broke out.
- smacktoward 7y agoIt may be worth noting that while this piece presents it as settled that the Spanish flu originated in Kansas, that's not really the case. The author of this piece, John Barry, has long been an advocate for that position, but there are other theories of origination as well supported by at least as much evidence as the Kansas theory. Wikipedia has a write-up on the various theories of origination here: https://en.wikipedia.org/wiki/Spanish_flu#Hypotheses_about_the_source https://en.wikipedia.org/wiki/Spanish_flu#Hypotheses_about_t...
- sadfev 7y agoHere comes the fear mongering. We are far better equipped to handle epidemics and pandemics now than 100 years ago.
- vikramkr 7y agoPart of that is rapid transfer of information though - I could argue that the ability to rapidly spread fear of the disease to get people to worry and change their behaviors helps make us better at dealing with pandemics than when the news and the government would push propoganda saying there's nothing to worry about. I don't know if I would argue that or complete believe that argument since I agree with you that a lot of this is needless fear mongering and there are likely detrimental effects to that, but I don't know if it's as cut and dry?
- sadfev 7y agoAgreed it’s not cut & dry. We should put everything in context. As crude as it sounds there haven’t been that many deaths. Yes this seems to have outbreaks in waves but that’s about the only scary part. We should be alert but not anxious!
- vikramkr 7y agoThe point of my response was that fear mongering and rapid information spread might be a reason that we haven't seen that many deaths. The whole point is to minimize how many more deaths there are, and it's the potential for disruption and death that matters right now, not the existing number of deaths except as indicators of what the extent of the risk might be
- yodsanklai 7y agoI wonder. I'm less worried about the handling of the pandemics than its impact on the globalized economy. I assume it was less an issue 100 years ago, and that we are not fully equipped to deal with this.
- albroland 7y agoIt's not even a matter of being equipped to handle it imo; all signs also point to COVID19 not being as serious as initially thought and far more mild than expected. Administrating the test for it is both expensive, and time consuming, so the gross number of known infections is likely to be substantially underreported because of selection bias (why run expensive RNA analysis on a blood sample if the person is having mild cold symptoms?). There are probably a bunch of other confounding factors, such as most people getting it are probably asymptomatic or just think they have a typical cold/flu. It also appears to be non-lethal to children, as opposed to seasonal influenza. In simple gross numbers, more people die in car accidents every day than the current worldwide totality for this virus. Comparing against US CDC stats, it isn't even remotely close to statistical estimates for flu deaths so far this year in the US alone(~16k). My suspicion is if you concede that gross numbers of COVID19 infections are substantially underreported, the death rates fall into line with typical flu, maybe marginally worse. The reasonable response to this is what people should already be doing for influenza: practice good hygiene, stay home if you're sick, take caution when interacting with at risk populations to minimize their exposure, etc.
- dang 7y agoA thread from last year: https://news.ycombinator.com/item?id=19237730 https://news.ycombinator.com/item?id=19237730
- gradschool 7y agoA BBC documentary called "The Flu That Killed 50 Million" is informative. As of time 130 million were infected and 200 thousand dead, Sir Arthur Newsholme, senior medical officer at Whitehall, sent a message to his European counterparts proposing a cease fire because an existential threat to humanity transcends national rivalries. (Just kidding!) He actually decided against even warning the public to take any precautions because it would not be "expedient" for the munitions factories to slow down. My takeaway is never to put it past those in power to decimate of the population if it suits their ends.
- technotony 7y agoTo be fair, those in authority were doing a pretty good job decimating the male working age population before flu came along. They could probably model the daily death rate from flu in it's early days to be less than that on the Western front... especially if they weren't very good at modelling exponential growth.
- stevenwoo 7y agoThe SIR model for infectious disease growth was proposed in 1927, https://en.wikipedia.org/wiki/Mathematical_modelling_of_infectious_disease https://en.wikipedia.org/wiki/Mathematical_modelling_of_infe.... We got taught this in our undergrad calculus class and wrote programs to play with the different parameters - it's kind of eye opening if one has never thought too much about it - pretty much everyone gets infected within some constraints.
- cheshire137 7y agoThere's an episode of American Experience from PBS that's about the 1918 flu epidemic that's also good.
- bredren 7y agoHandy link to the 2018 50 million film: https://www.bbc.co.uk/programmes/b0blmn5l https://www.bbc.co.uk/programmes/b0blmn5l Doesn't work for outside UK IPs. It is on TPB, though.
- lqet 7y ago> history’s worst epidemic Come again?
- phyzome 7y agoI suppose it depends on whether you look at total killed or percent killed. The Black Death might have had a higher total body count, but smallpox hitting the Americas had a massive mortality rate, something like 50% or higher.