From: imbibe@mindspring.com   
      
   Skeletons of 1918 Flu Victims Reveal Clues About Who Was Likely to Die   
   By Gina Kolata, Oct. 9, 2023, NY Times   
   The flu typically kills the very young, the old and the sick. That made the   
   virus in 1918 unusual, or so the story goes: It killed healthy young people as   
   readily as those who were frail or had chronic conditions.   
      
   Doctors of the time reported that, among those in the prime of their lives,   
   good health and youth were no protection: The virus was indiscriminate,   
   killing at least 50 million people, or between 1.3 and 3 percent of the   
   world’s population. Covid, in    
   contrast, killed 0.09 percent of the population.   
      
   But a paper published on Monday in the Proceedings of the National Academy of   
   Sciences challenges that persistent narrative. Using evidence in skeletons of   
   people who died in the 1918 outbreak, researchers reported that people who   
   suffered from chronic    
   diseases or nutritional deficiencies were more than twice as likely to die as   
   those who did not have such conditions, no matter their age.   
      
   The 1918 virus did kill young people, but, the paper suggests, it was no   
   exception to the observation that infectious diseases kill frail and sicker   
   people most readily.   
      
   Sharon DeWitte, an anthropologist at the University of Colorado, Boulder, and   
   an author of the paper, said the finding had a clear message: “We should   
   never expect any nonaccidental cause of death to be indiscriminate.”   
      
   The analysis of skeletons, said J. Alex Navarro, a historian of the flu   
   pandemic at the University of Michigan, makes for “a fascinating paper and a   
   very interesting approach to studying this issue.”   
      
   The lead author of the paper, Amanda Wissler, an anthropologist at McMaster   
   University in Ontario, said she was intrigued by claims that the 1918 virus   
   killed young and healthy people as readily as those with pre-existing   
   conditions. In those days, there    
   were no antibiotics or vaccines against childhood diseases, and tuberculosis   
   was widespread among young adults.   
      
   There was a puzzle about who died from that flu, though, which helped fuel   
   speculation that health was no protection. The flu’s mortality curve was   
   unusual, shaped like a W. Ordinarily, mortality curves are shaped like a U,   
   indicating that babies with    
   immature immune systems and older people have the highest death rates.   
      
   The W arose in 1918 because death rates soared in people aged from about 20 to   
   40, as well as in babies and older people. That seemed to indicate that young   
   adults were extremely vulnerable and, according to numerous contemporaneous   
   reports, it did not    
   matter if they were healthy or chronically ill. The flu was an equal   
   opportunity killer.   
      
   In one report, Colonel Victor Vaughn, an eminent pathologist, described a   
   scene at Fort Devens in Massachusetts. He wrote that he had seen “hundreds   
   of young men in uniforms of their country, coming into the wards in groups of   
   10 or more.” By the    
   next morning, he added, “the dead bodies are stacked about the ward like   
   cord wood.”   
      
   The influenza pandemic, he wrote, “was taking its toll of the most robust,   
   sparing neither soldier nor civilian, and flaunting its red flag in the face   
   of science.”   
      
   Dr. Wissler and Dr. DeWitte, who have done similar research on the Black   
   Death, saw a way to test the hypothesis about young people. When people have   
   had lingering illnesses like tuberculosis or cancer, or other stressors like   
   nutritional deficiencies,    
   their shin bones develop tiny bumps.   
      
   Assessing frailty by looking for those bumps “is quite legitimate” as a   
   method, said Peter Palese, a flu expert at the Icahn School of Medicine at   
   Mount Sinai.   
      
   The researchers used skeletons at the Cleveland Museum of Natural History. Its   
   collection of 3,000 people’s remains, kept in large drawers in a massive   
   room, includes each person’s name, age of death and date of death.   
      
   Dr. Wissler said she treated the remains “with great respect,” as she   
   examined the shin bones of 81 people aged 18 to 80 who died in the pandemic.   
   Twenty-six of them were between the ages of 20 and 40.   
      
   For comparison, the researchers examined the bones of 288 people who died   
   before the pandemic.   
      
   The results were clear: Those whose bones indicated they were frail when they   
   got infected — whether they were young adults or older people — were, by   
   far, the most vulnerable. Many healthy people were killed, too, but those who   
   were chronically ill    
   to start with had a much greater chance of dying.   
      
   That makes sense, said Dr. Arnold Monto, an epidemiologist and professor   
   emeritus at the University of Michigan’s School of Public Health. But, he   
   said, although the new study makes “an interesting observation,” the   
   skeletons were not a random    
   sample of the population, so it can be difficult to be specific about the risk   
   that came with frailty.   
      
   “We are not used to the fact that younger healthy adults are going to   
   die,” which often occurred in the 1918 pandemic, Dr. Monto said.   
      
   Dr. Palese said there was a reasonable explanation for the W-shaped mortality   
   curve of the 1918 flu. It means, he said, that people older than 30 or 40 had   
   most likely been exposed to a similar virus that had given them some   
   protection. Younger adults    
   had not been exposed.   
      
   [Gina Kolata has written extensively about the 1918 flu, including the   
   discovery of bodies in permafrost and preserved lung tissue containing the   
   virus that caused it.]   
      
   https://www.nytimes.com/2023/10/09/health/1918-flu-skeletons.html   
      
   --- SoupGate-Win32 v1.05   
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