Pandemics
and Pandemic Threats since 1900
Historical Overview
History suggests that
influenza pandemics have probably happened during at least
the last four
centuries. Since 1900, three pandemics and several
"pandemic threats" have occurred.
1918: Spanish Flu
The Spanish Influenza
pandemic is the catastrophe against which all modern
pandemics are
measured. It is estimated that approximately 20 to 40
percent of the worldwide population became ill and that over 50
million people died. Between September 1918 and April 1919, approximately 675,000
deaths from the flu occurred in the U.S. alone. Many people died from this very quickly.
Some people who felt well in the morning became sick by noon, and were dead by nightfall.
Those who did not succumb to the disease within the first few days often died of
complications from the flu (such as pneumonia) caused by bacteria.
One of the most unusual
aspects of the Spanish flu was its ability to kill young
adults. The reasons
for this remain uncertain. With the Spanish flu, mortality
rates were high among healthy
adults as well as the usual high-risk groups. The attack
rate and mortality was highest
among adults 20 to 50 years old. The severity of that
virus has not been seen again.
1957: Asian Flu
In February 1957, the
Asian influenza pandemic was first identified in the Far
East. Immunity to this
strain was rare in people less than 65 years of age, and a
pandemic was predicted.
In preparation, vaccine production began in late May 1957,
and health officials increased
surveillance for flu outbreaks.
Unlike the virus that
caused the 1918 pandemic, the 1957 pandemic virus was
quickly identified,
due to advances in scientific technology. Vaccine was
available in limited supply by August 1957. The virus came to the U.S.
quietly, with a series of small outbreaks over the summer of 1957. When U.S.
children went back to school in the fall, they spread the
disease in classrooms and
brought it home to their families. Infection rates were
highest among school
children, young adults, and pregnant women in October
1957. Most influenza-and
pneumonia-related deaths occurred between September 1957
and March 1958. The
elderly had the highest rates of death.
By December 1957, the
worst seemed to be over. However, during January and February 1958, there was another
wave of illness among the elderly. This is an example of the potential "second wave" of
infections that can develop during a pandemic. The disease infects one group of people
first, infections appear to decrease and then infections increase in a different part of the
population. Although the Asian flu pandemic was not as devastating as the Spanish flu,
about 69,800 people in the U.S. died.
1968: Hong Kong Flu
In early 1968, the Hong
Kong influenza pandemic was first detected in Hong Kong.
The first cases in the
U.S. were detected as early as September of that year, but
illness did not become
widespread in the U.S. until December. Deaths from this
virus peaked in December
1968 and January 1969. Those over the age of 65 were most
likely to die. The same
virus returned in 1970 and 1972. The number of deaths
between September 1968 and
March 1969 for this pandemic was 33,800, making it the
mildest pandemic in the 20th century.
There could be several
reasons why fewer people in the U.S. died due to this
virus. First, the Hong
Kong flu virus was similar in some ways to the Asian flu
virus that circulated between
1957 and 1968. Earlier infections by the Asian flu virus
might have provided some
immunity against the Hong Kong flu virus that may have
helped to reduce the severity
of illness during the Hong Kong pandemic. Second, instead
of peaking in September
or October, like pandemic influenza had in the previous
two pandemics, this pandemic
did not gain momentum until near the school holidays in
December. Since children
were at home and did not infect one another at school, the
rate of influenza illness among schoolchildren and their families
declined. Third, improved medical care and antibiotics that are more effective
for secondary bacterial infections were available for those who became ill.
1976: Swine Flu Threat
When a novel virus was
first identified at Fort Dix, it was labeled the "killer
flu." Experts were
extremely concerned because the virus was thought to be
related to the Spanish flu virus of 1918. The concern that a major
pandemic could sweep across the world led to a mass vaccination campaign in the
United States. In fact, the virus--later named "swine flu"--never moved outside the Fort
Dix area. Research on the virus later showed that if it had spread, it would probably have
been much less deadly than the Spanish flu.
1977: Russian Flu Threat
In May 1977, influenza
A⁄H1N1 viruses isolated in northern China, spread rapidly,
and caused epidemic
disease in children and young adults (23 years) worldwide.
The 1977 virus was
similar to other A⁄H1N1 viruses that had circulated prior
to 1957. (In 1957, the A⁄H1N1
virus was replaced by the new A⁄H2N2 viruses). Because of
the timing of the appearance
of these viruses, persons born before 1957 were likely to
have been exposed to
A⁄H1N1 viruses and to have developed immunity against
A⁄H1N1 viruses. Therefore, when the A⁄H1N1 reappeared in 1977, many
people over the age of 23 had some protection against the virus and it was
primarily younger people who became ill from A⁄H1N1 infections. By January 1978,
the virus had spread around the world, including the United States. Because illness
occurred primarily in children, this event was not considered a true pandemic. Vaccine
containing this virus was not produced in time for the 1977-78 season, but the virus was
included in the 1978-79 vaccine.
1997: Avian Flu Threat
The most recent pandemic
"threats" occurred in 1997 and 1999. In 1997, at least a
few hundred people
became infected with the avian A⁄H5N1 flu virus in Hong
Kong and 18 people
were hospitalized. Six of the hospitalized persons died.
This virus was different because it moved directly from chickens to
people, rather than having been altered by infecting pigs as an intermediate
host. In addition, many of the most severe illnesses occurred in young adults similar to
illnesses caused by the 1918 Spanish flu virus. To prevent the spread of this virus,
all chickens (approximately 1.5 million) in Hong Kong were slaughtered. The avian flu did
not easily spread from one person to another, and after the poultry slaughter, no new
human infections were found.
In 1999, another novel
avian flu virus - A⁄H9N2 - was found that caused illnesses
in two children in
Hong Kong. Although both of these viruses have not gone on
to start pandemics,
their continued presence in birds, their ability to infect
humans, and the ability of influenza viruses to change and become
more transmissible among people is an ongoing concern.
Colorado State Summit
Opening Remarks Prepared
for Delivery
By the Honorable Mike
Leavitt
Secretary of Health and
Human Services
March 24, 2006
The Great Pandemic also
touched Colorado.
It first appeared in
late September 1918, when some 33 suspected cases were
reported at the
University of Colorado. It raged across the state through
the month of October, sickening
those in the valleys, and bringing down residents of high
mountain towns.
More than 150 people
died in a single week here in Denver. Thousands were
afflicted (though
actual numbers are unknown).
One of those was
Katherine Porter, who would later earn fame and acclaim
(including a Pulitzer
Prize) for her short stories. One of her best-known works
was Pale Horse, Pale Rider,
a fictionalized account of her experience in the pandemic.
Porter contracted
influenza while working as a journalist for the Rocky
Mountain News. She
could not be admitted to the hospital at first, because
there was no room. Instead, she was threatened with eviction by her
landlady and then cared for by an unknown boarder who nursed her until a bed
was open at the hospital.
Porter was so sick that
her newspaper colleagues prepared an obituary and her
father chose a burial
plot. Her near-death experience changed Porter in a
profound way. She said
afterward, "It just simply divided my life, cut across it
like that. So that everything before that was just getting ready, and after
that I was in some strange way altered."
The lives of countless
other Coloradoans were also altered.
Residents of Boulder
experienced a quarantine. So did all of those living in
the entire San Juan
Basin (in the southwest corner of the state). All
gatherings were cancelled, including schools, sporting events, and social
outings. Voters and judges alike were required to wear surgical masks during the
November election. People were even prohibited to gather for funerals.
The city of Silverton
(located just north of Durango) lost nearly 10 percent of
its population,
including morticians. Coffins had to be sent from Durango
to accommodate the
large numbers of the dead.
The pandemic finally
faded, leaving echoes of terror and suffering and loss all
across the state.
When it comes to
pandemics, there is no rational basis to believe that the
early years of the
21st century will be different than the past. If a
pandemic strikes, it will come to Colorado.
New Mexico State Summit
Opening Remarks Prepared
for Delivery
By the Honorable Mike
Leavitt
Secretary of Health and
Human Services
March 28, 2006
That Great Pandemic also
touched New Mexico.
No one is sure when the
pandemic first arrived, though it may have been carried
into Carlsbad
(southeast corner of the state) by members of an
out-of-own circus. On October 4th, there were reports of "a few cases" in
"several places." A week later, epidemics were reported in Albuquerque, Gallup
(west of Albuquerque), and Carlsbad. And the pandemic continued to spread.
In some cases, Smith and
Wesson and Colt stood in the way. Fearing introduction of
the disease, armed
vigilantes from across the state stopped trains from
flu-ridden regions and forced
passengers to get back aboard and return from where they
came.
Those fears were well
founded. The flu was afflicting thousands of New Mexicans,
and claiming the lives
of hundreds.
But on one occasion,
fear proved more fatal than the flu itself.
A Las Vegas (east of
Santa Fe) family, the Gardunos, all fell ill with
influenza. Mrs. Clara Garduno
succumbed to the disease first, and was soon pronounced
dead. Health Department
officials demanded that she be buried immediately to
prevent the spread of the
disease, and her husband secured the services of an
undertaker.
Because three of her
children were also very ill at the time of her death and
not expected to
survive, Clara's grave was left uncovered to allow prompt
burial of the children as soon as they too perished. Two of the children
died the next day, and as the undertaker began to bury the children, Frank Garduno
asked to see his wife's body one last time.
To his horror, he
discovered that his wife had not been dead at the time she
was buried after all.
In his fear and haste to bury influenza victims, the
doctor who had pronounced Clara dead had been mistaken. She had been
buried alive, only to suffocate in her coffin.
When it comes to
pandemics, there is no rational basis to believe that the
early years of the
21st century will be different than the past. If a
pandemic strikes, it will come to New Mexico.
