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“What Explains Cross-City Variation in Mortality During the 1918 Influenza Pandemic? Evidence From 438 U.S. Cities” by Karen Clay, Joshua Lewis, and Edson Severnin: What Is the General Question That the Article Is Trying to Answer?

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In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold

The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace.

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The Influenza Pandemic took place during World War I in 1918. The main cause of this disease in the United States was due to military ships traveling to foreign countries and carrying it back to the U.S. There were three waves of infection during 1918-1919. Through research done, the first wave started in the spring of 1918 in the United States. The second and the third waves spread around the world in the fall and winter. These waves were the most lethal. During the first wave of the influenza pandemic, military and government leaders didn’t acknowledge the disease. The reason for this was fear that the cost of health care would take money away from the war. Because of their negligence the countries involved in the war didn’t take the proper precautions against the flu, leading to the devastation of the second wave. The government was putting all the money toward the war which caused a lack of healthcare. As a result many men on the battlefield were getting the infection and dying. This forced the government to devote more money to healthcare which affected our lead in the war. The Influenza Pandemic was an infectious disease that involved fever, chills, coughing spells, skin that turned deep blue, extremely red eyes, and phlegm. The sense of panic and hopelessness impacted many communities. The poor living conditions and the agglomeration of many soldiers contributed to the quick spread of this disease. Another serious issue that affected patients was the fatal inflammation of the respiratory tracts. Symptoms include developing brown spots over their cheek bones turning to a bluish color of the face, coughs that brought up blood stained sputum. Postmortem examination indicated swollen lungs, filled with fluid, and a bluish color; in the matter of days people were put in bed which resulted in pneumonia and death followed. It started on a military base near Boston, in 1917 Dr. Victor Vaughan who was a medical lieutenant in the medical reserve corps, was promoted to the rank of major

He was assigned to the duty with the Medical Division of the Council of the Washington, D.C. In 1918, the mobilization of many soldiers during World War I brought into the country a mysterious virus. Different Camps were opened up during the war; soldiers were to travel frequently and when they return to the camps, it was in a filthy condition. Dr. Vaughan was assigned to find out where the virus was coming from. In a camp known by the name of “Camp Devens,” 11 ½ million Americans were sent across the Atlantic during the war, most of them from Kansas. When it was time for them to return, they did it carrying some kind of virus. All of a sudden American soldiers, English soldiers, French, and German, became sick. It was like the microbe mutated and spread in a matter of days.

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With the H5N1 virus showing these characteristics, the health sector around the globe had to contain the panic that has struck the public due to the notorious background of the 1918 pandemic (Salaam-Blyther, Tiaji, 2009). The alarming reaction of the public intensified in January 2006 when several H5N1 virus samples from selected Turks reported to be brought for analysis. However, the study of the samples proved that the H5N1 virus’ similarity with the H1N1 strain is inconclusive considering that both influenza strains were multigenic. Although the tensions hampered regarding the H5N1 disease, it proved to the public that even the scientific community is vulnerable in the midst of viral panic. After the H5N1 Avian flu strain, reports in April 2009 reported the return of the H1N1 strain. The first reported case came from the US Centers for Disease Control and Prevention as two children reported infliction of a unique strain of the influenza virus. The strain reported to have gene structures similar to that of the swine flu virus. By April 23rd, the CDC recorded five more similar cases, this time in California and Texas. Mexico also reported the same H1N1 strain on April 24, announcing that the whole country contracted the virus. Schools and gatherings around Mexico closed due to the epidemic, in fear that many would also be prone in acquiring the illness. The WHO had also reported cases on April 27, 2009 from Canada and Spain. Immediately, the WHO raised the influenza pandemic alert to Phase 5, noting that a possible pandemic could hit the entire globe. By June 11, 2009, the WHO announced that the H1N1 strain is now virulent, and increased the pandemic alert to Phase 6. At least 50,000 cases of the H1N1 complication in 80 countries with 231 deaths recorded traces back to the beginning of the pandemic in April. The response to the 2009 H1N1 strain around the globe was prominent due to the WHO advisory of the nature of the virus. China has issued quarantine orders to any Mexican nationals entering or living in the country due to the virus’ capacity to be transmitted directly. Mexico found the Chinese action discriminatory and ordered all flights to China cancelled until such time China releases the quarantine order. The members of the European Union had issued travel advisories in lieu of the 2009 outbreak and warned their citizens to refrain travelling to the US or to Mexico. The US had also issued travel advisories to its citizens to refrain travelling to Mexico as the first severe case of the H1N1 pandemic began

For other countries, they installed “thermal scanners” in key entrances to the country such as airports and ports to detect the temperature of incoming and outgoing passengers. A passenger with body temperature reaching 100 degrees Fahrenheit becomes subjected to further screening. In Egypt, the government ordered the immediate slaughtering of pigs since the virus can originate from swines. Pork imports, especially those coming from the US, Canada, and Mexico discontinued importation due to the pandemic (Zimmer, Shanta and Donald Burke, 2009).

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In sum, mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

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Elzouki, Abdelaziz, et al. Textbook of Clinical Pediatrics. New York: Springer, 2011. Print.

Panter-Brick, Catherine and Agustin Fuentes. Health, Risk, and Adversity. Oxford: Berghahn Books, 2010. Print.

Salaam-Blyther, Tiaji. 2009 Influenza Pandemic: US Responses to Global Human Cases. Report. Washington D.C: US Congressional Research Service, 2009. Print.

Shors, Teri. Understanding Viruses. Burlington: Jones and Bartlett Publishers, 2008. Print.Tibayrenc, Michel. Encyclopedia of Infectious Diseases: Modern Methodologies. Hoboken: John Wiley and Sons, 2007. Print.

Zimmer, Shanta and Donald Burke. "Historical Perspective - Emergence of Influenza A (H1N1) Viruses." The New England Journal of Medicine 361 (2009): 279-85. Print.

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