Interesting that the 1892 data doesn't show the W shaped curve, only the 1918 pandemic. Given that 1892 fits the curve seen in non-pandemic influenza, this indicates to me that 1918 is the outlier rather than the rule.
There's also an obvious cause - the First World War. Diets depleted due to malnutrition, and (critically) huge army barracks and hospitals with many thousands of young people living in extremely close proximity in poor conditions.
I'll bet if you standardised those death curves based on exposure or incidence, that bump in the middle would disappear.
I don't think there's any good reason to assume the 1918 mortality pattern would necessarily be replicated in subsequent pandemics.
Interesting that the 1892 data doesn't show the W shaped curve, only the 1918 pandemic. Given that 1892 fits the curve seen in non-pandemic influenza, this indicates to me that 1918 is the outlier rather than the rule.
Note that the data is incomplete for 1892. I'm not sure why they used that year as a comparison--I have other graphs where it's compared to a "normal" year, which IMO is a better comparison.
There's also an obvious cause - the First World War. Diets depleted due to malnutrition, and (critically) huge army barracks and hospitals with many thousands of young people living in extremely close proximity in poor conditions.
And that's been brought up frequently as a reason for All Things Bad about the 1918 flu. What I've not seen are numbers where civilians and military are looked at separately. That would be one way to tease that out. But even so, there certainly is antecdotal evidence that it hit this population harder than your average flu, even in those who weren't under conditions like those you mention.
I'll bet if you standardised those death curves based on exposure or incidence, that bump in the middle would disappear.
Could be. And that goes back to the need for good, accurate, surveillance for current viruses. Doubt we'll be fortunate enough to find enough banked 1918 samples to ever test that hypothesis, though.
I don't think there's any good reason to assume the 1918 mortality pattern would necessarily be replicated in subsequent pandemics.
I agree--I don't necessarily think it would be repeated. It wasn't in 1957 or 1968, so it's not a requirement of pandemic viruses. But given the data regarding H5N1--killing this age group quickly, sparking "cytokine storms" leading to ARDS (seen also in mouse models), the W-shaped curve is a possibility that should be considered when deciding who the priority groups would be for vaccination.
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The requested URL /
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