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Here’s How Bad the Flu Can Get

If you think you’d rather risk getting the flu than get a flu shot, Cohen Medical Associates’s primary care doctors in Delray Beach, Florida would like to offer some food for thought.

Exactly one hundred years ago in 1918, while World War I was being fought in Europe, between 50 million and 100 million people died of the flu. That’s nearly a third of the population of the United States today. In those days, the death total equaled one-fifth of the world’s population. While 20 million died in WWI, as many as five times that number perished from the flu during the height of the war. Over two-thirds of them died in the fall of 1918. In the U.S., 100,000 Americans died in October alone.

Remember that this was before the advent of modern air travel. Yet the so-called Spanish flu engulfed nations worldwide, from the U.S. to the Arctic to Tahiti, seemingly overnight, ultimately infecting an estimated 500 million people, a third of the world’s population at the time. And while the flu normally kills children, the elderly, and those with compromised immune systems, the 1918 pandemic was unusual in that it primarily preyed on healthy young adults between the ages of 20 and 40.

The 1918 flu was dubbed the “Spanish” flu because King Alfonso III and several Spanish court members contracted it. But later studies—which theorize such various points of origin as China, Kansas, and France—have never conclusively determined where it began. The most popular explanation for its rapid worldwide dispersal, however, seems to have been the large mobilization of troops worldwide, with tens of thousands gathered in close quarters on ships and in military camps. A single sneeze or a cough from an infected person spreads more than a half-million particles of the flu virus to those nearby and can linger on adjacent surfaces for hours.

The 1918 flu also seemed to kill its victims unusually quickly. During the height of last year’s especially virulent flu season, The Washington Post recounted some of the stories from the 1918 pandemic: “In New York, there were accounts of people feeling perfectly healthy when they boarded the subway in Coney Island and being taken off dead when they reached Columbus Circle.” And the masks that were ubiquitous when people dared venture out in public didn’t seem to make a bit of difference. “Four women who gathered to play bridge in Albuquerque in November prudently wore six-ply cloth masks. Three of them were dead the next day.”

Can this happen again?

Because the flu virus evolves rapidly from season to season, it is possible. The 1918 flu actually first appeared in the spring of that year in a relatively mild form, but by fall it had mutated into the deadly killer it ultimately became. On the other hand, the U.S. Centers for Disease Control and Prevention (CDC) notes that “tremendous advancements have been made over the last hundred years.

“Flu viruses with pandemic potential can now be detected through a global influenza surveillance system . . . Seasonal flu vaccines to prevent flu infection are made annually, and pre-pandemic flu vaccines also are produced and stored by the U.S. federal government for possible use during a pandemic event.”

In addition, the CDC says, we have available many tools to combat the disease which weren’t available in 1918: antiviral drugs, antibiotics to treat pneumonia, ventilators and intensive care units, and such standard equipment as gloves, gowns, and masks. And the flu shot, of course, which wasn’t available in 1918.

So even though such an outbreak is possible, it’s unlikely that we’d see as many deaths as in the fall and winter of 1918-19. But the sad fact is, however, that every year many people die from the flu. Just last year, 80,000 Americans died from complications of the flu, according to the CDC. The 2017-18 flu season death toll was the highest in nearly 40 years, and almost twice as high as what health experts would typically consider a “bad” flu season. It also lasted longer—from November to March—than any recent flu outbreak.

So now is the time to protect yourself and your family by getting your annual flu shot. The CDC notes that it takes at least two weeks for the vaccine to become effective, not reaching its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected. Since the first seasonal infections typically begin in November, there’s no time to waste.

If you have any questions about whether or when to be vaccinated, please contact your doctor. We can provide all the information you need to make an informed decision about this important matter.

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