Pandemic would hit poor the hardest, new flu study says

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Pandemic would hit poor the hardest, new flu study says

By Brown, The Washington Post

WASHINGTON — An influenza pandemic of the type that ravaged the globe

in 1918 and 1919 would kill about 62 million people today, with 96

percent of the deaths occurring in developing countries.

That is the conclusion of a new study in the journal Lancet published

Thursday that uses mortality records kept by governments during the

time of " Spanish flu " to predict the effect of a similarly virulent

outbreak in the contemporary world.

The analysis, the first of its kind, found a nearly 40-fold difference

in death rates between central India, the place with the highest

recorded mortality, and Denmark, the country with the lowest. The

reason for the huge variation isn't known, but it may reflect

differences in nutrition and crowding.

If a modern Spanish flu killed all its victims in one year, it would

more than double global mortality. About 59 million people now die

each year.

" It is a huge, huge number, " said Dr. Murray, a physician

and biostatistician at the Harvard School of Public Health, who headed

the study. " This really took us by surprise. "

Historical accounts suggest that what became known as Spanish flu

emerged at an Army camp in Kansas in early March 1918. It was carried

to Europe by U.S. troops, where it circulated before undergoing a

change early the next fall that made it unusually lethal. It spread

around the world and was brought back to the United States, where it

killed hundreds of thousands of Americans in October and November

1919. It circulated until early 1920, with virtually everyone on Earth

eventually exposed to the virus.

The global death toll from the pandemic is unknown. In the 1920s, it

was estimated to be about 20 million. A fuller analysis in 1991 raised

that to 30 million. One in 2002 said mortality " may fall in the range

of 50 to 100 million. "

The new study doesn't make a new estimate. Instead, it calculated the

death rate in places that had good birth-and-death records in 1918 and

1919 to estimate what would happen in a larger, older and relatively

more affluent world population nearly a century later.

The places with good records included most European nations, the

United States, Canada, Australia, Japan and several Latin American

countries. The key to the project, however, were accurate death

registries in India, Sri Lanka, Taiwan and the Philippines. They

allowed Murray and his colleagues to estimate what happened among the

world's non-European poor, where eyewitness accounts describe many

deaths, but few reliable statistics existed.

Murray and his colleagues analyzed the death patterns and deduced that

about half the variation from region to region was explained by

differences in per-capita income. For every 10 percent increase in

income, a person's risk of dying during the pandemic fell 10 percent.

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Why the poor were so vulnerable is unknown. It could have been that

many were already ill with parasites or other illnesses or lacked

nutrients such as vitamin A and zinc that are essential to immunity.

To estimate the effects of a modern Spanish flu, the researchers

applied the 1918-1920 death rates to the current world population

broken down by income, sex and age. They came up with a range of 51

million to 81 million deaths, with a median of 62 million.

Even though the world's population is three times what it was during

the pandemic, the estimated mortality of a modern Spanish flu isn't

three times what it was in 1918. That is mainly because per-capita

income is higher now — and the higher the income, the lower the risk

of dying of influenza.

The illness caused by the 1918 virus was largely untreatable. There

were no antiviral drugs, no mechanical ventilators to help people

breathe and no antibiotics to treat bacterial pneumonias that often

set in. All are available now and would reduce the death toll, though

some interventions would be in short supply during a pandemic.

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