Virology tidbits

Virology tidbits

Friday, 21 March 2014

Influenza and the Great War: a contribution to the centenary of the Great War

This year marks the centenary of the beginning of the Great War -or outside of Great Britain more commonly known as World War 1 - so I think it is time to look at a chapter of the war often neglected. Instead of focusing on the beginning of the war, I would like to draw attention to the end of the war in 1918 – in particular on Germany whose defeat in 1918 coincided with the Influenza epidemic.

The influenza epidemic of 1918/1919 became widely known as the “Spanish Influenza”, a title misleading since the first cases of the disease were not reported in Spain but in the USA; Spain however was a neutral country and press reports were uncensored so cases were reported to the public in contrast to those parties involved in the war. The disease (known as “la grippe”) crossed the Atlantic with the soldiers bound for the battlefields of France and Belgium and would soon lead to a worldwide pandemic - the “single worst demographic disaster of the twentieth century” as one author in 2003 would label it. In contrast to this standard view, there is some 

evidence that the 1918 virus (or its precursor) occurred first in western Europe – in army camps located at Aldershot (UK) and Étaples (France), causing local outbreaks between 1915 and 1917. It is there that pigs, geese, horses and duck  as well as vulnerable soldiers in large numbers were mixing; a contributing factor might have been the presence of poison gas victims among the soldiers as well as the wet weather. Indeed the army camp at Étaples was suffering from a high number of Influenza cases resembling those in the second wave of the latter epidemic were reported between December 1916 and March 1917, preceding cases in the US by one year as were areas in England. Those cases however were not diagnosed as Influenza but as pneumonia, severe bronchiolitis or severe respiratory disease. Additionally the affected soldiers were predominately within 25 and 35 years of age - again an age not associated with severe cases of during "common" Influenza epidemics.

It is commonly accepted that the 1918/1919 epidemic occurred in three to four waves, with 22 to 50 million people dead, more than both World Wars combined. The first wave of the wave swept the US in the early months of 1918 almost unnoticed, indistinguishable from the annual wave. The second wave however started in mid-late August simultaneously in West Africa, France and on the east coast of the US, climaxing in October/November 1918 with a higher mortality than the previous wave.
This wave was followed by a third (less lethal) wave early 1919 and maybe by a fourth wave at the beginning of 1920. Contemporaries in the 1920s claimed that Encephalitis lethargica, a disease claiming hundreds of thousands of victims between 1920 and 1925, was linked to the Influenza epidemic in 1918/1919, thus representing a fifth wave (there is no proof for this claim).

Influenza hit the western front in the last phase of the Great War and is considered to have been transmitted to the German Army by French prisoners of war, starting at the end of May and reaching its zenith in June/July 1918. It was due to this disease that the Oberste Heeresleitung (OHL/German High Command) decided to postpone of would be the last German offensive of the war.  Similar measures were taken by the French army - the virus did not distinguish between the invaders and the defenders.
Despite the low mortality of the first wave, soldiers were left weakened and ordered to reconvalescence in field hospitals behind the front and at home. It was because of those transports -soldiers on leave and prisoners of war transported to camps into the Reich- that the disease would travel from the west to the east, from the western front into Germany. The second wave hit German soldiers in late August 1918, and would soon reach Germany with a mortality rate similar to those observed in other countries. Unlike the first wave however, it seemed that the second wave appeared simultaneously throughout Germany, first affecting urbane centers in the west followed by rural areas and -to a lesser extent- cities in the east. At the same time the US army ceased to recruit soldiers due to the spread of the disease among soldiers, so there is some speculation that Germany might have been able to prolong the war in the west beyond November 1918. Soldiers however fared better than civilians since they received better medical care. Inside the Reich, it was left to the municipal authorities to combat the disease. In order to prevent a nationwide panic however measures to close schools, restaurants, and theaters or to prohibit other public gatherings were not introduced. In some places, even the care for Influenza patients had to be organized by the Protestant and Catholic Church. The press in France, Britain and Germany would blame enemy spies for introducing the disease. Once the epidemic was over, the German public would forget about it altogether, replaced by fears of a Bolshevik revolution and the defeat in the west.

Given that Germany suffered from the Flu epidemic the same way as France or Great Britain did, the virulence cannot be attributed to the special circumstances of Germany. Nonetheless, at the time the public linked the Influenza pandemic in 1918 to the starvation induced by the naval blockade imposed by the British naval forces.  The Influenza epidemic did however increase the willingness to end the war - among soldiers and civilians alike.

Further reading:

Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, & Johnson NP (2002). World War I may have allowed the emergence of "Spanish" influenza. The Lancet infectious diseases, 2 (2), 111-4 PMID: 11901642 

Oxford JS, Lambkin R, Sefton A, Daniels R, Elliot A, Brown R, & Gill D (2005). A hypothesis: the conjunction of soldiers, gas, pigs, ducks, geese and horses in northern France during the Great War provided the conditions for the emergence of the "Spanish" influenza pandemic of 1918-1919. Vaccine, 23 (7), 940-5 PMID: 15603896

Erkoreka A (2009). Origins of the Spanish Influenza pandemic (1918-1920) and its relation to the First World War. Journal of molecular and genetic medicine : an international journal of biomedical research, 3 (2), 190-4 PMID: 20076789 

Michels, E. (2010). Die „Spanische Grippe“ 1918/19. Verlauf, Folgen und Deutungen in Deutschland im Kontext des Ersten Weltkriegs
The Spanish Flu 1918/19. Course, Consequences and Interpretations in Germany in the Context of the First World War Vierteljahrshefte für Zeitgeschichte, 58 (1), 1-33 DOI: 10.1524/vfzg.2010.0001

“The plague that was not allowed to happen: German medicine and the influenza epidemic of 1918–19 in Baden”

in Howard Phillips and David Killingray “The Spanish Influenza Pandemic of 191819.” (iBooks edition). 

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