Why 2009 is not 1918

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The current swine flu pandemic is often compared with the Spanish Flu of 1918 but the world is a very different place today.

With swine flu burgeoning in the UK and the death toll approaching 30, it might be time to take a little look at why comparisons between 1918 and 2009 may be somewhat misleading.

The Spanish Flu of 1918 was possibly the biggest killer in history – bigger even than the Black Death in terms of numbers (though not in terms of percentage of population). But 1918 is a long way from now and the western world has changed immeasurably. Even if this virus is related to the earlier virus, here are some facts about 1918.

* Many people lived below the poverty line – they were literally hungry poor.

* Every year, thousands died in childbirth and of diseases such as diphtheria, typhoid and measles. 

* Housing was overcrowded and insanitary.

* The physiology of infections, nutrition etc were not as well understood as today.

* Europe was coming to the end of a terrible war and the health of the general population was very debilitated.

* Close troop quarters and massive troop movements hastened the pandemic.

* Seriously ill people were moved (from the Front to hospitals back home), allowing the more severe form of the disease to spread, rather than the milder strain.

* Antibiotics did not exist.

* Nor did anti-virals.

* Nor did biocides such as Dettol. 

* There was no national health service and many people could not afford to see a doctor.

* There was no flu vaccine, and no prospect of one. 

* There were no government plans in place to deal with an epidemic.

* The vast majority of people who died of ‘flu’ actually died of secondary bacterial infections, not the virus itself. Today, these are treated with antibiotics.

* Many people lived in close proximity to animals such as pigs and fowl, much as they do in the third world today. 

In the UK today, however, people are much healthier and live much longer. Few go hungry. Rates of all diseases have dropped. The vast majority of people live in good or adequate housing and not in unsanitary conditions surrounded by animal faeces. Everyone has unlimited access to free healthcare. All have access to antibiotics and doctors. Most will have access to anti-virals. When a vaccine comes, which will hopefully be in September, those at risk will be first in line, and seriously ill people will remain at home, as they do in most flu epidemics, rather than being put on overcrowded trains. 

Flu can kill, but that is true of all flu. This flu is not more virulent than any other, but fewer people have immunity to it, which means it’s probable more people will die, especially in the younger age groups (I know, this is scant comfort to parents).

If you are in an at-risk group (roughly a third of the population), you should take special care – 70 per cent of all hospitalisations are of people in at-risk groups. However, if you are over 40, you may have higher immunity to this flu due to exposure to similar viruses throughout your lifetime.

At-risk groups include:

* People with lung disease

* People with heart disease

* People with kidney disease

* People with diabetes

* Those with immunosuppression problems either because of treatment or disease

* Patients who have had drug treatment for asthma

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