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Epidemiology and pathology

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Transmission and mutation The basic reproduction number of the virus was between 2 and 3. The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have reduced people's resistance to the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility. A large factor in the worldwide occurrence of the flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease. citation needed Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks. The severity of the second wave has been attributed to the circumstances of the First World War. In civilian life, natural selection favors a mild strain. Those who get very ill stay home, and those mildly ill ...
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Etymology

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Although its geographic origin is unknown, the disease was called Spanish flu from the first wave of the pandemic. Spain was not involved in the war, having remained neutral, and had not imposed wartime censorship. Newspapers were therefore free to report the epidemic's effects, such as the grave illness of King Alfonso XIII, and these widely-spread stories created a false impression of Spain as especially hard hit. Alternative names were also used at the time of the pandemic. Similar to the name of Spanish flu, many of these also alluded to the purported origins of the disease. In Senegal it was named 'the Brazilian flu', and in Brazil 'the German flu', while in Poland it was known as 'the Bolshevik disease'. In Spain itself, the nickname for the flu, the "Naples Soldier", was adopted from a 1916 operetta, The Song of Forgetting ( La canción del olvido ) after one of the librettists quipped that the play's most popular musical number, Naples ...
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Mortality

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Around the globe The Spanish flu infected around 500 million people, about one-third of the world's population. Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the deadliest pandemics in history. An early estimate from 1927 put global mortality at 21.6 million. An estimate from 1991 states that the virus killed between 25 and 39 million people. A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%). However, a 2018 reassessment in the American Journal of Epidemiology estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population. A 2009 study in Influenza and Other Respiratory Viruses based on data from fourteen European countries estimated a total of 2.64 million excess deaths in Europe attributable to the S...
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