We now know that in 1918 the first emergence of what was to be called "the Spanish Flu" began with a weak initial foray (akin to a 'mild flu' today) in the spring. It then abated, and returned with a vengeance in the fall.
How bad was the resurgence when it peaked? John M. Barry's (The Great Influenza) description of the scene in Philadelphia in the winter of 1918-19 says it all (p. 326):
"The corpses had backed up at undertakers, filling every area of these establishments and pressing up into living quarters; in hospitals morgues overflowing into corridors; in the city morgue overflowing into the street. And they had backed up in homes. They lay on porches, in closets, in corners of the floor, on beds."
Obviously no corpses were actually counted but best estimates - according to Mr. Barry and other researchers -put the infected global total at 500 million, and up to 100 million dead. If this is an upper limit estimate it means 5 % of the world population dead from this flu pandemic.
One of the tropes which circulated after this pandemic was that the 1918 flu singled out healthy young people many of whom literally died where they stood - maybe waiting for a trolley. But now new research at the University of Colorado - Boulder by Prof. Sharon Dewitte and her co-author Amanda Wissler skewers that belief. According to Prof. Dewitte, quoted in a Denver Post piece (10/22, 'CU Researchers Offer New Insights From Studying 1918 Flu', p. 3B):
"The idea that the 1918 flu killed healthy young people is not supported by our findings. Instead, we found that this pandemic, like many others across history, disproportionately killed frail people."
How did Dewitte arrive at this conclusion which turns many existing beliefs from that pandemic on their heads? Basically by studying bones at the Hamann-Todd Human Osteological Collection at the Cleveland Museum of Natural History. There, in the basement, they found more than 3,000 century old human skeletons. Wissler herself spent hours in that basement during the Covid-19 pandemic poring over the bones of 369 people who died during the 1918 flu.
According to her (a professor at McMaster University):
"It's very important to always remember these were actual people, so it can be intense work."
Wissler carefully examined the shin bones in search of porous lesions, which is a lasting indicator of trauma, stress, infection or malnutrition. The research - recently published Oct. 9 in the journal PNAS, found that the most frail - based on their bone lesions - were 2.7 times more likely to have died during the Spanish flu pandemic.
How did the trope of young victims get propagated for so long? In DeWitte's opinion:
"It may be one of those ideas that began as folk wisdom and just gets reproduced in the literature over and over until it becomes canon. We wanted to take a step back and ask: Do we really know what we think we know? "
To be sure the bone sample is small - and entirely from the Cleveland area - so one has to be careful in drawing firm conclusions and more research is needed. Still, the lesson appears to be more care is needed in public health messaging when it suggests everybody is equally likely to get seriously ill when a new scourge erupts.
Of course, given the virulence and widespread occurrence of the 1918 flu, we can be sure many young people did perish from it, and as Wissler notes: "When a 25-year old dies you remember it more" Given this the accounts would have resonated more with the media and others and contributed to the idea that the Spanish flu commonly killed more young than old But the point of DeWitte's and Wissler's work is that even the young who died tended to have bones that hinted at prior health problems.
In the words of DeWitte:
"What we have learned is that in future pandemics there will almost certainly be variation in individuals in the risk of death. If we know what factors elevate that risk we can expend resrouces to reduce them - and that's better for the population in general."
Nevertheless, this research does not provide an 'escape hatch' for healthy young people to 'play the fool', i.e. avoiding masking or vaccines when a new pandemic erupts. As we know, those two powerful tools are designed to protect others as much or more than oneself.
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