The 1918 influenza pandemic, also known as the Spanish flu, has long been noted as an anomaly in the history of infectious diseases. While most contagious outbreaks decimate the very young and the very old, the 1918 flu is remembered for having a mortality curve resembling a ‘W‘, with a peak in the middle signifying the deaths of those aged 20 to 40. This unique pattern has led generations of scientists and historians to believe that the pandemic was particularly lethal to individuals in the prime of their lives, regardless of the state of their health. However, a recent analysis of the skeletal remains of victims from the 1918 pandemic suggests that this narrative may need to be rewritten.
“Epidemics don’t strike neutrally, a bolt out of the blue. They strike differentially, and people who are worse off, to begin with, will be even worse off at the far end.” – Andrew Noymer, an epidemiologist.
Challenging the Established Narrative
Biological anthropologists Amanda Wissler of McMaster University in Canada and Sharon DeWitte of the University of Colorado–Boulder recently published an analysis of over 3,000 skeletons preserved in the Cleveland Museum of Natural History. Among these, 81 belonged to individuals who perished during the 1918 flu pandemic. The researchers compared these skeletal remains with those of individuals who died before the pandemic, looking for signs of health stress, such as unhealed lesions on the surface of the tibias.
The findings were surprising. Contrary to the established narrative, the researchers discovered that during the seven months the flu besieged Cleveland, individuals of any age with visible signs of frailty were 2.7 times more likely to die. This discovery suggests that the pandemic’s victims were not indiscriminately chosen; instead, it disproportionately affected those already in poor health.
Implications for Future Pandemics
This study redefines our understanding of the 1918 influenza pandemic and offers critical insights for future pandemics. It emphasizes the importance of improving public health and addressing social determinants of health, such as poverty and discrimination. As history has shown, from the Black Death to the recent Covid-19 pandemic, the most vulnerable in society are often the most affected. Hence, changing the conditions that put them at risk is crucial to mitigating the impact of future epidemics.
“During a pandemic, there is always an assertion that it’s a great equalizer, that the wealthy will be dropping to the same degree as the poor. And in retrospect, that is never true,” says Rachel Mason Dentinger, a historian of biology and medicine. “What emerges every time is that social determinants of health play a huge role in how diseases affect people disproportionately.”
In conclusion, the skeletons of 1918 serve as a stark reminder that the health of individuals contributes to the resilience of society as a whole. Ensuring the public’s health between epidemics may be our best defense against the devastation they can unleash.