How the World Learned to Manage the Flu

We'll cover the first pandemic, vaccinations, and record-keeping lessons learned. But before we get started, let's review some of the most important things we know about the virus. First of all, let's review how scientists spotted the virus using electron microscopes. This allowed medical researchers to identify a new subtype, H3N2, in 1968.

Influenza pandemic

When influenza first struck the world, the deadly 1918 flu pandemic had a global impact. At the time, 500 million people were infected, and 50 million were killed. In the United States alone, the disease claimed nearly 675,000 lives. Though science and vaccine development has advanced dramatically since 1918, scientists still did not know the exact mechanisms of the virus responsible for influenza. To end a pandemic, the virus must be unable to spread. The only way to prevent an outbreak is through vaccination.

In the 1950s, the World Health Organization (WHO) set up a Global Influenza Surveillance and Response System (GISRS) to collect data on the flu around the globe and coordinate global efforts to fight the disease. In 1938, the United States Army began testing a flu vaccine with the help of Jonas Salk. A bivalent vaccine was first introduced in 1945, and by the 1960s, the world had learned enough about the virus to use it to protect against two different strains of the virus.

While the disease was spread by humans, its economic effects were just as dire. In the United States, the city of New York was particularly vulnerable to the 1918 strain, and air pollution may have played a role in the deaths of the citizens in that city. In fact, studies suggest that air pollution may have contributed to the deadly epidemic. Nonetheless, the effect of the influenza pandemic on the global economy was immediate. Many businesses and large US cities were shut down due to widespread panic. Private gatherings and sporting events were cancelled or closed completely to prevent the spread of the disease.

The 1918 pandemic was largely over by spring of 1919, but in early 1920 it spiked again. It is unclear what caused the outbreak, but some of the actions taken by city health departments were similar to those of today's pandemic plans. For example, the use of masks and ineffective vaccines to prevent infection, improved sanitation practices, and increased public safety all were effective measures during the epidemic. Finally, hospitals coordinated with physicians and nursing students to make the most of their limited resources.

Influenza subtypes

The subtypes of influenza viruses are based on the surface proteins that they produce. Influenza A viruses cause epidemics in humans and other mammals. There are 18 known subtypes of influenza A viruses. They are also categorized by their lineages. B viruses belong to the lineages A/Yamagata and B/Victoria. Here is a breakdown of the subtypes.

Most people get infected with influenza type A, which has caused most epidemics and pandemics. Influenza type B has been a different virus and has not yet developed into a pandemic. Influenza subtypes A and B circulate in the community and change every winter. New strains are released each winter, making it important to receive a flu vaccine every year.

In 1918, influenza and pneumonia caused a huge increase in deaths. However, the new influenza subtypes did not kill everyone in that year. In fact, the "Hong Kong" influenza subtype was not as deadly as H3N2, which remained circulating for eleven years. In this way, we can say that influenza is not the same as H3N2, which is why we must know as much as we can about it.

Infection with any of the influenza subtypes can provide protection against the virus later in life. This protection is greatest against the first subtype, so if you are exposed to a particular influenza subtype in childhood, you have a good chance of long-term immunity. However, as the influenza virus subtype drifts into the seasonal flu, any protection from prior exposure will wane as the virus changes.

Influenza vaccines

Flu virus is a complex multi-protein forest, covering the surface of the virus. The virus' genes change the proteins on its surface, but two of these are of preeminent importance. Hemagglutinin (HA) and neuraminidase (NA) are responsible for causing infection. The flu virus' code names reflect the dozens of variations in these two proteins, which mutate and evolve as the virus reproduces. Because influenza vaccines target the more susceptible HA proteins, they are designed to target the latest virus version.

There are two types of influenza vaccines, one for humans and one for nonhumans. Human influenza vaccines contain two strains of influenza A and one for each of the three major flu viruses. Live virus vaccines are meant for people older than six months. Live virus vaccines contain a live but weakened virus, and are recommended for adults. The FDA approves two different vaccines for each strain, and these are used to treat the flu when it strikes.

In the mid-1930s, the first influenza vaccine was developed. The bivalent influenza vaccine contained viruses of both types A and B. It was later marketed as an over-the-counter vaccine. Vaccination was first licensed in the United States in 1944 and has been used ever since. The first vaccine for influenza was administered for healthy non-pregnant people aged five to 49. It was later approved for younger children between the ages of two and five.

The COVID-19 pandemic revealed that the supply chain for influenza vaccines has many vulnerabilities. Lack of coordination and distribution during the COVID-19 pandemic exposed serious deficiencies in global supply chains. After reviewing the challenges faced, the Pancorbo committee issued recommendations to U.S. government agencies and global stakeholders. The recommendations were made in mid-November. The committee has since published their report.

Record-keeping lessons

The 1918 influenza pandemic teaches us about record-keeping, and the importance of it. Unlike other pandemics, however, there are very few records of the epidemic, and the victims are rarely memorialized. However, the survivors of the pandemic wanted to move on from the crisis. As a result, record-keeping was a critical component of the pandemic response.

The early twentieth century world was dramatically different from today's. There were no influenza vaccines, and the U.S. health care system was not nearly as sophisticated. The influenza virus targeted a younger population, and the response was much less politicized than it is today. Yet, despite the challenges, the outbreak was ultimately successful and did not result in mass deaths and destruction. By the end of 1918, the nation had fewer cases than usual, and the epidemic was no longer in the headlines every day. In fact, public health experts and physicians expressed optimism that future outbreaks would be less severe.

While some businesses have found creative ways to reduce employee absence, the problem of presenteeism during an influenza pandemic persists. Many hourly wage earners are the most at risk for presenteeism. Some businesses have responded by creating a plan to allow sick employees to work from home instead of phoning in sick to work. However, the challenge of presenteeism during an influenza pandemic is particularly difficult to tackle.

The record-keeping lessons learned by the world to manage and study the flu pandemic are invaluable in predicting future outbreaks. However, it's difficult to identify an influenza pandemic without prior data, and in pre-modern times, life expectancies were much shorter. As a result, flu would have escaped notice and only the most alarming events would have been recorded. A good record-keeping system is essential to accurately forecast pandemics and respond to them.

Economic impact

There are many implications for the economic burden of seasonal influenza. The illness can spread rapidly through schools, nursing homes, workplaces, and towns, leading to high rates of worker absenteeism and lost productivity. Clinics can also become overwhelmed during a high-infection season, resulting in a huge economic burden. This impact comes from lost work time, decreased productivity, and the increased use of medical resources such as antibiotics, laboratory investigations, and hospitalizations.

A recent study aimed to determine the economic impact of seasonal influenza in 3143 counties across the United States. It also sought to characterize regional variation in influenza impact and examine the cost-effectiveness of vaccination strategies. Researchers modified existing methods to account for spatial variation. They conducted spatial analyses and simulated the costs of four different county-based vaccination strategies. Based on the results, the optimal vaccination strategy was determined. Vaccination strategies should be targeted to counties with high influenza attacks.

Although there is no precise estimate of how much the cost of influenza affects each county, the data show a clear spatial pattern. Ziebach County, South Dakota, had an annual economic cost per capita of $32.5 while Llano County, Texas, had a cost per capita of $272.4. Compared to the lower-income southern regions, the Mountain States were insulated from the costs of influenza, despite having high infection rates.

In addition to the economic costs, infectious diseases often have life-long effects. Infections are particularly expensive in pandemics, as they increase the risk of disease-related mortality. Furthermore, the spread of the pandemic contaminates infrastructure and decreases healthcare access. These economic consequences are often magnified, as seen in the case of Liberia, where GDP growth decreased eight percentage points while the overall mortality rate dropped.