Updating the Count of the 1918 Spanish flu

Johnson, N. P., & Mueller, J. (2002). Updating the accounts: global mortality of the 1918-1920″ Spanish” influenza pandemic. Bulletin of the History of Medicine, 76(1), 105-115

This was a super interesting article for me because it combined history, biology, and epidemiology. The paper is from John Hopkins University and the main gist of it is that in 1991 a study was published saying that the total death count from the spanish flu was around 24 to 39 million, while this article states the this is no where near the number. Before we look at the numbers, we need to ask why did the simple flu kill so many people? Statistically the highest number of people killed where of teens to middle age, while the extremely old and extremely young were relatively untouched. This was because the flu evolved to trigger a extreme over response from the bodies immune system, called a cytokine storm, in which the immune system clears the body of infection but doing deadly damage to the bodies systems in the process. This is why teens to middle age people, with the strongest immune systems where the most likely to die from the spanish flu.

As for the total death numbers, the Spanish flu was a Pandemic that covered the globe. Most experts agree that this occurred in three different waves, and that densely pack, port cities were the most hard hit while isolated town were the least affected. The problem with trying to get a solid number of the global  death toll in 2017 is simple, lost records, non reporting , poor reporting and misdiagnosis. As a doctor its relatively easy to forget how many people died that day when you have to treat thousands of people. In 1920 is was stated that the global death toll was 21 million people, this number is completely unrealistic due to the fact that in India alone its death toll was 18 million people, and china was 4 million. Stats from northern, isolated counties such as Scandinavia and Russia are incomplete as they suffered a later “4th wave”, due to tier isolated nature. This report says that the global death toll was more likely to be near 50 million people, but has a very high likelihood of being double that. with the estimated world population at the time being 1,860 million that roughly 2% of the global population died in 3 years.

This was really staggering to me because when you have about such a large number of people die like that, wars sound like the only causes and not something so small you need a microscope to see.




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