Skeletons of 1918 flu victims reveal clues about who was most likely to die | ET REALITY


The flu usually kills the young, the elderly and the sick. That made the 1918 virus unusual, or so the story goes: It killed healthy young people as easily as those who were frail or chronically ill.

Doctors of the time reported that, among people in the prime of life, good health and youth were no protection: the virus was indiscriminate and killed at least 50 million people, or between 1.3 and 3 percent of the world’s population. Covid, on the other hand, killed 0.09 percent of the population.

but a paper published Monday in the Proceedings of the National Academy of Sciences challenges that persistent narrative. Using evidence from the skeletons of people who died in the 1918 outbreak, researchers reported that people who suffered from chronic diseases or nutritional deficiencies were more than twice as likely to die as those who did not suffer from such conditions, regardless of their age.

The 1918 virus killed young people, but, as the article suggests, it was no exception to the observation that infectious diseases more easily kill the frailest and sickest people.

Sharon DeWitte, an anthropologist at the University of Colorado, Boulder, and author of the paper, said the finding had a clear message: “We should never expect any non-accidental cause of death to be indiscriminate.”

The skeleton analysis, said J. Alex Navarro, a historian of the flu pandemic at the University of Michigan, constitutes “a fascinating paper and a very interesting approach to studying this topic.”

The paper’s lead author, Amanda Wissler, an anthropologist at McMaster University in Ontario, said she was intrigued by claims that the 1918 virus killed young, healthy people as easily as those with pre-existing diseases. At that time there were no antibiotics or vaccines against childhood diseases and tuberculosis was widespread among young adults.

However, there was a puzzle over who died from that flu, which helped fuel speculation that health was no protection. The flu mortality curve was unusual, it was W-shaped. Normally, mortality curves are U-shaped, indicating that babies with immature immune systems and older people have the highest mortality rates.

The War arose in 1918 because mortality rates skyrocketed in people between 20 and 40 years old, as well as in babies and the elderly. This seemed to indicate that young adults were extremely vulnerable and, according to numerous contemporary reports, it did not matter whether they were healthy or chronically ill. The flu killed equal opportunities.

In one report, Colonel Victor Vaughn, an eminent pathologist, described a scene at Fort Devens in Massachusetts. He wrote that he had seen “hundreds of young people in uniforms of their country, entering the wards in groups of 10 or more.” The next morning, he added, “the bodies are piled around the room like firewood.”

The flu pandemic, he wrote, “was taking its toll on the most robust, sparing neither soldiers nor civilians, and flaunting its red flag in the face of science.”

Dr. Wissler and Dr. DeWitte, who have made similar research about the Black Death, he saw a way to test the hypothesis about young people. When people have had persistent illnesses like tuberculosis or cancer, or other stressors like nutritional deficiencies, their pimples develop small bumps.

Assessing frailty by looking for these lumps “is a pretty legitimate method,” said Peter Palese, a flu expert at the Icahn School of Medicine at Mount Sinai.

The researchers used skeletons from the Cleveland Museum of Natural History. His collection of remains from 3,000 people, kept in large drawers in a huge room, includes each person’s name, age and date of death.

Dr. Wissler said she treated the remains “with great respect” as she examined the shins of 81 people between the ages of 18 and 80 who died in the pandemic. Twenty-six of them were between 20 and 40 years old.

For comparison, researchers examined the bones of 288 people who died before the pandemic.

The results were clear: those whose bones indicated they were fragile when they were infected (whether young adults or older people) were by far the most vulnerable. Many healthy people also died, but those who were chronically ill to begin with were much more likely to die.

That makes sense, said Dr. Arnold Monto, an epidemiologist and professor emeritus at the University of Michigan School of Public Health. But, he said, although the new study makes “an interesting observation,” the skeletons were not a random sample of the population, so it may be difficult to be specific about the risk that comes with fragility.

“We’re not used to the fact that younger, healthier adults are going to die,” which often happened in the 1918 pandemic, Dr. Monto said.

Dr. Palese said there was a reasonable explanation for the W-shaped mortality curve of the 1918 flu. It meant, he said, that people over 30 or 40 had probably been exposed to a similar virus that had given them some protection. The younger adults had not been exposed.

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