Flu in Mexico City May Be Next Pandemic: Firsthand Account of 1918 and 1957

The swine flu outbreak in Mexico City hits home on several levels and raises great alarm, worldwide. It takes me back immediately to stories my mother told me of the flu pandemic in America in 1918, an epidemic that actually cost more casualties than World War I. At one point during the Spanish flu epidemic of 1918-1920, public funerals were even banned in cities like Washington, D.C. Many large cities ran out of caskets. There was profiteering in some instances, with exorbitant amounts charged for funerals (which, at the time, meant amounts in the neighborhood of $200 to $300.)

My mother was born in 1907 and remembered the Spanish flu epidemic of 1918 well. The first flu pandemic raged from 1918 to 1920. In the case of the 1918 epidemic, it arose from an H1N1 strain. [The "H" in a flu vaccine name refers to hemagluttinin and the "N" references neuraminidase. There are 16 different "H" types and 9 different "N" types. The numbers indicate the strains, not the intensity of the disease.]

The flu epidemic of 1918-1920 was called the Spanish flu because only Spain publicized the existence of this new and deadly flu strain, even though it had been discovered in the United States initially. The flu struck primarily healthy young adults and 40 to 50 million people died worldwide. Because the press was being censored due to World War I, even though the initial outbreak occurred in the United States, Spain gave the flu outbreak more media attention, more press coverage, and the deadly outbreak became known as the Spanish flu.

Mom reminisced about watching the locals in her small hometown of Hospers, Iowa (in the northwest corner of the state) burning the Kaiser in effigy in the streets of her small hometown. Two neighborhood boys had gone to war and brought my mother, the little 11-year-old girl who lived down the street, back souvenirs (colorful handkerchiefs and Belgian lace). A little boy in my mother's 6^th grade class fell ill one day. By week's end, he was dead.

There are many books that have been written about the flu epidemic of 1918----"A Cruel Wind: Pandemic Flu in America 1918-1920" by Dorothy Pettit and another being "America's Forgotten Pandemic: The Influenza of 1918" by Alfred W. Crosby, who quotes William Henry Welch, the nation's most distinguished scientist, pathologist and physician in the early years of the twentieth century. All such books portray the Spanish flu pandemic of 1918-1920 as the deadliest epidemic of its kind in the 20^th century and certainly among the most horrifying in all of history, including the Black Death that Edgar Allan Poe memorialized for all time in his stories.

The second flu epidemic of the twentieth century occurred in 1957 when I was 12 years old. I remember it well. It originated in China, was an H2N2 strain, and there were 2 waves of illness: one hitting mostly children, the second hitting mostly the elderly. Sputnik had just been launched by Russia as the world's first satellite. Those of us in 7^th grade were being told that we were falling behind in the space race. Furthermore, we were told, we must step up our study of languages. [The only problem was that the languages we should have been "stepping up" our study of were Chinese and Spanish, not Russian and French...or, as in my school, the already dead language of Latin.] What I primarily remember about the Asian flu epidemic was that band trips for our marching band to VEISHA at Ames and other student body activities had to be canceled, in some cases, due to absenteeism among the student body. However, this second flu epidemic of the 20^th century was far less deadly than that of 1918, and I did not personally experience classmates dying from it. This may have been due to improved hygiene and better medical treatment(s), or it may simply have been a less deadly virus, but, whatever the reason, the Asian flu epidemic of 1957 killed only about 2 million people, worldwide.

The third flu epidemic of the twentieth century occurred in 1968, the year my first child was born. An H3N2 flu strain, it spread globally over the next two years, becoming known as the Hong Kong flu. It killed an estimated 1 million people worldwide, but was the mildest of the three pandemics of this century.

The current swine flu is a highly contagious respiratory disease and is normally found in pigs. It spreads through direct contact and is also an air-borne pathogen. In swine, it kills between 1 and 4% of those infected. In Mexico City, where the current flu has broken out, those who have died are between 20 and 40 years old and died of severe pneumonia from a flu-like illness. In Mexico, during this most recent outbreak, there have been 70 deaths out of about 1,000 cases, which represents a fatality rate of 7%. The Spanish flu epidemic of 1918, although it killed 40 million people globally, had a fatality rate of 2.5%.

The U.S. Health Agency the CDC sent 2 investigators to Mexico on Saturday, April 24^th, to help Mexico diagnose, control and assess this latest outbreak of what may be the next big pandemic since 1968.