#Comparing #SARS-CoV-2 with SARS-CoV and #influenza #pandemics (Lancet Infect Dis., abstract)

[Source: Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics

Prof Eskild Petersen, MD, Prof Marion Koopmans, DVM, Unyeong Go, MD, Davidson H Hamer, MD, Nicola Petrosillo, MD, Prof Francesco Castelli, MD et al.

Published: July 03, 2020 | DOI: https://doi.org/10.1016/S1473-3099(20)30484-9



The objective of this Personal View is to compare transmissibility, hospitalisation, and mortality rates for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with those of other epidemic coronaviruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), and pandemic influenza viruses. The basic reproductive rate (R0) for SARS-CoV-2 is estimated to be 2·5 (range 1·8–3·6) compared with 2·0–3·0 for SARS-CoV and the 1918 influenza pandemic, 0·9 for MERS-CoV, and 1·5 for the 2009 influenza pandemic. SARS-CoV-2 causes mild or asymptomatic disease in most cases; however, severe to critical illness occurs in a small proportion of infected individuals, with the highest rate seen in people older than 70 years. The measured case fatality rate varies between countries, probably because of differences in testing strategies. Population-based mortality estimates vary widely across Europe, ranging from zero to high. Numbers from the first affected region in Italy, Lombardy, show an all age mortality rate of 154 per 100 000 population. Differences are most likely due to varying demographic structures, among other factors. However, this new virus has a focal dissemination; therefore, some areas have a higher disease burden and are affected more than others for reasons that are still not understood. Nevertheless, early introduction of strict physical distancing and hygiene measures have proven effective in sharply reducing R0 and associated mortality and could in part explain the geographical differences.

Keywords: SARS-CoV-2; COVID-19; SARS-CoV; MERS-CoV; Pandemic Influenza.


Historical #Insights on #Coronavirus Disease 2019 (#COVID19), the 1918 #Influenza #Pandemic, and #Racial #Disparities: Illuminating a Path Forward (Ann Intern Med., abstract)

[Source: Annals of Internal Medicine, full page: (LINK). Abstract, edited.]

Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward

Lakshmi Krishnan, MD, PhD, S. Michelle Ogunwole, MD, Lisa A. Cooper, MD, MPH

DOI: https://doi.org/10.7326/M20-2223



The coronavirus disease 2019 (COVID-19) pandemic is exacting a disproportionate toll on ethnic minority communities and magnifying existing disparities in health care access and treatment. To understand this crisis, physicians and public health researchers have searched history for insights, especially from a great outbreak approximately a century ago: the 1918 influenza pandemic. However, of the accounts examining the 1918 influenza pandemic and COVID-19, only a notable few discuss race. Yet, a rich, broader scholarship on race and epidemic disease as a “sampling device for social analysis” exists. This commentary examines the historical arc of the 1918 influenza pandemic, focusing on black Americans and showing the complex and sometimes surprising ways it operated, triggering particular responses both within a minority community and in wider racial, sociopolitical, and public health structures. This analysis reveals that critical structural inequities and health care gaps have historically contributed to and continue to compound disparate health outcomes among communities of color. Shifting from this context to the present, this article frames a discussion of racial health disparities through a resilience approach rather than a deficit approach and offers a blueprint for approaching the COVID-19 crisis and its afterlives through the lens of health equity.

Keywords: SARS-CoV-2; COVID-19; Spanish Flu; USA; Society.


The 1918 #Influenza #Pandemic and Its #Legacy (Cold Spring Harb Perspect Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Cold Spring Harb Perspect Med. 2019 Dec 23. pii: a038695. doi: 10.1101/cshperspect.a038695. [Epub ahead of print]

The 1918 Influenza Pandemic and Its Legacy.

Taubenberger JK1, Morens DM2.

Author information: 1 Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. 2 Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.



Just over a century ago in 1918-1919, the “Spanish” influenza pandemic appeared nearly simultaneously around the world and caused extraordinary mortality-estimated at 50-100 million fatalities-associated with unexpected clinical and epidemiological features. The pandemic’s sudden appearance and high fatality rate were unprecedented, and 100 years later still serve as a stark reminder of the continual threat influenza poses. Sequencing and reconstruction of the 1918 virus have allowed scientists to answer many questions about its origin and pathogenicity, although many questions remain. Several of the unusual features of the 1918-1919 pandemic, including age-specific mortality patterns and the high frequency of severe pneumonias, are still not fully understood. The 1918 pandemic virus initiated a pandemic era still ongoing. The descendants of the 1918 virus remain today as annually circulating and evolving influenza viruses causing significant mortality each year. This review summarizes key findings and unanswered questions about this deadliest of human events.

Copyright © 2019 Cold Spring Harbor Laboratory Press; all rights reserved.

PMID: 31871232 DOI: 10.1101/cshperspect.a038695

Keywords: Influenza A; H1N1; Pandemic Influenza; Spanish Flu.


The #matrix segment of the “#Spanishflu” virus originated from intragenic #recombination between #avian and #human #influenza A viruses (Transbound Emerg Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transbound Emerg Dis. 2019 Sep;66(5):2188-2195. doi: 10.1111/tbed.13282. Epub 2019 Jul 15.

The matrix segment of the “Spanish flu” virus originated from intragenic recombination between avian and human influenza A viruses.

He CQ1, He M1, He HB1, Wang HM1, Ding NZ1.

Author information: 1 The Key Laboratory of Animal Resistant Biology of Shandong, College of Life Science, Shandong Normal University, Jinan, China.



The 1918 Spanish flu virus has claimed more than 50 million lives. However, the mechanism of its high pathogenicity remains elusive; and the origin of the virus is controversial. The matrix (M) segment regulates the replication of influenza A virus, thereby affecting its virulence and pathogenicity. This study found that the M segment of the Spanish flu virus is a recombinant chimera originating from avian influenza virus and human influenza virus. The unique mosaic M segment might confer the virus high replication capacity, showing that the recombination might play an important role in inducing high pathogenicity of the virus. In addition, this study also suggested that the NA and NS segments of the virus were generated by reassortment between mammalian and avian viruses. Direct phylogenetic evidence was also provided for its avian origin.

© 2019 Blackwell Verlag GmbH.

PMID: 31241237 DOI: 10.1111/tbed.13282 [Indexed for MEDLINE]

Keywords: Avian Influenza; Pandemic Influenza; Reassortant strain; H1N1; Spanish Flu.


One hundred years ago in 1919: #NZ’s #birth #reduction #shock associated with an #influenza #pandemic (N Z Med J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

N Z Med J. 2019 Dec 13;132(1507):57-62.

One hundred years ago in 1919: New Zealand’s birth reduction shock associated with an influenza pandemic.

Wilson N1, Turner N2, Baker MG1.

Author information: 1 Department of Public Health, University of Otago, Wellington. 2 Department of General Practice and Primary Care, University of Auckland, Auckland.




We aimed to conduct a preliminary analysis of any association between the 1918 influenza pandemic and its impact on birth rates in New Zealand.


Official data covering the period 1910 to 1930 were sourced from multiple New Zealand Yearbooks. Estimates were made of the size of the natality impacts and estimates made of the potential causes.


In 1919 there were 3,756 fewer non-Māori and 239 fewer Māori births than the pre-pandemic year of 1917, with these representing reductions in birth rates per 1,000 population of 16.6% and 19.8% respectively. The birth rate reductions in the pandemic year of 1918 (relative to 1917) were less at 8.8% and 6.7% reductions respectively. We estimated the likely major driver of the natality deficit in 1919 was embryonic and fetal loss due to influenza infection in pregnancy. Smaller roles were plausibly played by adult deaths during the pandemic and reduced sexual activity associated with the social turbulence of the peak pandemic months.


The reduction in birth rates in New Zealand in 1918 and especially 1919 are consistent with international data associated with the 1918 influenza pandemic. The relatively higher natality loss for Māori for 1919 is also consistent with other epidemiological data on the unequal burden from this pandemic. Pandemic planning needs to consider ways to prevent such future burdens and associated inequalities. There is also a need to improve on the current low level of routine influenza vaccination in pregnancy so as to minimise fetal loss from seasonal influenza infection.

PMID: 31830017

Keywords: Pandemic Influenza; Spanish Flu; New Zealand.


#Stories of the 1918 #influenza #pandemic and its legacy (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Stories of the 1918 influenza pandemic and its legacy

Marta Gritti

Published: December 09, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30710-8


A century has passed since the 1918 influenza pandemic, the deadliest epidemic in human history, that killed 50–100 million people in a matter of months, causing more deaths than World War 1. Today, with influenza vaccinations available and established health-care systems, we might feel that the events and stories of the 1918 pandemic are distant from our everyday lives. Yet, the fear that a new pandemic could occur exists, and in our globalised world the risk of spread is extreme. Researchers and international health organisations are committed to constant investigation and surveillance to prevent such a risk from becoming a reality, but how have they reached this milestone?


Copyright © 2019 Elsevier Ltd. All rights reserved.

Keywords: Pandemic Influenza; Spanish Flu.


#Oseltamivir Is Effective against 1918 #Influenza Virus Infection of #Macaques but Vulnerable to Escape (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

Oseltamivir Is Effective against 1918 Influenza Virus Infection of Macaques but Vulnerable to Escape

Friederike Feldmann, Darwyn Kobasa, Carissa Embury-Hyatt, Allen Grolla, Tracy Taylor, Maki Kiso, Satoshi Kakugawa, Jason Gren, Steven M. Jones, Yoshihiro Kawaoka, Heinz Feldmann

Diane E. Griffin, Editor

DOI: 10.1128/mBio.02059-19



The 1918 influenza virus, subtype H1N1, was the causative agent of the most devastating pandemic in the history of infectious diseases. In vitro studies have confirmed that extreme virulence is an inherent property of this virus. Here, we utilized the macaque model for evaluating the efficacy of oseltamivir phosphate against the fully reconstructed 1918 influenza virus in a highly susceptible and relevant disease model. Our findings demonstrate that oseltamivir phosphate is effective in preventing severe disease in macaques but vulnerable to virus escape through emergence of resistant mutants, especially if given in a treatment regimen. Nevertheless, we conclude that oseltamivir would be highly beneficial to reduce the morbidity and mortality rates caused by a highly pathogenic influenza virus although it would be predicted that resistance would likely emerge with sustained use of the drug.



Oseltamivir phosphate is used as a first line of defense in the event of an influenza pandemic prior to vaccine administration. Treatment failure through selection and replication of drug-resistant viruses is a known complication in the field and was also demonstrated in our study with spread of resistant 1918 influenza virus in multiple respiratory tissues. This emphasizes the importance of early treatment and the possibility that noncompliance may exacerbate treatment effectiveness. It also demonstrates the importance of implementing combination therapy and vaccination strategies as soon as possible in a pandemic situation.

Keywords: Antivirals; Drugs Resistance; Oseltamivir; Animal models; H1N1; Pandemic Influenza; Spanish flu.


Long-term #dynamics of #measles in #London: Titrating the impact of #wars, the 1918 #pandemic, and #vaccination (PLoS Comput Biol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS Comput Biol. 2019 Sep 12;15(9):e1007305. doi: 10.1371/journal.pcbi.1007305. eCollection 2019 Sep.

Long-term dynamics of measles in London: Titrating the impact of wars, the 1918 pandemic, and vaccination.

Becker AD1, Wesolowski A2, Bjørnstad ON3,4, Grenfell BT1,4,5.

Author information: 1 Department of Ecology and Evolutionary Biology, Princeton, New Jersey, United States of America. 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. 3 Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania, United States of America. 4 Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America. 5 Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America.



A key question in ecology is the relative impact of internal nonlinear dynamics and external perturbations on the long-term trajectories of natural systems. Measles has been analyzed extensively as a paradigm for consumer-resource dynamics due to the oscillatory nature of the host-pathogen life cycle, the abundance of rich data to test theory, and public health relevance. The dynamics of measles in London, in particular, has acted as a prototypical test bed for such analysis using incidence data from the pre-vaccination era (1944-1967). However, during this timeframe there were few external large-scale perturbations, limiting an assessment of the relative impact of internal and extra demographic perturbations to the host population. Here, we extended the previous London analyses to include nearly a century of data that also contains four major demographic changes: the First and Second World Wars, the 1918 influenza pandemic, and the start of a measles mass vaccination program. By combining mortality and incidence data using particle filtering methods, we show that a simple stochastic epidemic model, with minimal historical specifications, can capture the nearly 100 years of dynamics including changes caused by each of the major perturbations. We show that the majority of dynamic changes are explainable by the internal nonlinear dynamics of the system, tuned by demographic changes. In addition, the 1918 influenza pandemic and World War II acted as extra perturbations to this basic epidemic oscillator. Our analysis underlines that long-term ecological and epidemiological dynamics can follow very simple rules, even in a non-stationary population subject to significant perturbations and major secular changes.

PMID: 31513578 DOI: 10.1371/journal.pcbi.1007305

Keywords: Pandemic Influenza; Spanish Flu; Wars; Society; Measles.


Better Prepare Than React: Reordering #PublicHealth #Priorities 100 Years After the #SpanishFlu #Epidemic (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2018 Nov;108(11):1465-1468. doi: 10.2105/AJPH.2018.304682. Epub 2018 Sep 25.

Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic.

Greenberger M1.

Author information: 1 Michael Greenberger is with the Carey School of Law and the Center for Health and Homeland Security, University of Maryland, Baltimore. He is also the founder and director of the University of Maryland Center for Health and Homeland Security.



This commentary argues that 100 years after the deadly Spanish flu, the public health emergency community’s responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources. Rather than relying on nonpharmaceutical interventions, such as quarantine, the United States must reorder its health priorities to ensure adequate preparation for a large-scale pandemic.

PMID: 30252520 PMCID: PMC6187800 DOI: 10.2105/AJPH.2018.304682 [Indexed for MEDLINE] Free PMC Article

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; USA.


The #SpanishFlu, #Epidemics, and the Turn to #Biomedical #Responses (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2018 Nov;108(11):1455-1458. doi: 10.2105/AJPH.2018.304581. Epub 2018 Sep 25.

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses.

Schwartz JL1.

Author information: 1 The author is with the Department of Health Policy and Management, Yale School of Public Health, and Section of the History of Medicine, Yale School of Medicine, New Haven, CT.



A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished. The Spanish Flu functioned as an inflection point in the history of epidemic responses, a critical moment in the long transition from approaches dominated by traditional public health activities to those in which biomedical interventions are viewed as the most potent and promising tools in the epidemic response arsenal.

PMID: 30252511 DOI: 10.2105/AJPH.2018.304581 [Indexed for MEDLINE]

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; Infectious diseases; Vaccines; Quarantine measures.