The article has been automatically translated into English by Google Translate from Russian and has not been edited.

Without antiviral and mechanical ventilation: as 100 years ago treated for deadly Spanish flu



In some countries, plasma donors are now being sought for the treatment of patients with coronavirus - those who have undergone COVID-19 and recovered. The fact is that their plasma may contain antibodies against the SARS-CoV-2 virus, which is the causative agent of COVID-19. Transfusing the plasma of the recovered to those undergoing treatment can provide passive immunity to the patient and thereby help speed up the healing process. This method has been used since the 1918 Spanish flu epidemic. 42.TUT.BY decided to recall what else they tried to overcome one of the worst epidemics of influenza at the beginning of the XNUMXth century when there were no antiviral drugs and mechanical ventilation devices.

At the Walter Reed Hospital during the Spanish Flu epidemic of 1918-1919 in Washington, DC Photo: Shutterstock

What was the danger of “Spanish flu”

The Spanish flu, or “Spanish flu”, is considered one of the most massive influenza pandemics in the history of mankind, both in terms of the number of people infected and the number of deaths. According to various estimates, 18 million people, or 550% of the world's population, fell ill in 29,5 months worldwide. About 50-100 million people died, or from 2,7 to 5,3% of the world's population. The spread of the disease was facilitated by overcrowding and dirt in the trenches of the First World War, military camps where animals lived next to people, the low standard of living of people in Europe (all due to the same war), as well as the system itself, when qualified medical care was available in the first turn to wealthy segments of the population.

Most victims of the Spanish flu were young and healthy people aged 20-40, although children, the elderly, pregnant women and people with chronic diseases are usually at high risk. Even today, a person felt good, for example, waiting to be sent to the fields of the First World War in a military camp or working in an office. But soon his head began to ache, his eyes became inflamed, a chill appeared in his whole body, which could not be appeased by anything. Then the sick person fell into oblivion and began to suffer from hallucinations.

Someone eventually recovered. For example, the American journalist Catherine Ann Porter, who suffered a “Spanish flu” in 1918, left the hospital very weak and almost bald, and when her hair grew back, it turned out to be almost gray. And someone was dying, and before death his face turned blue, and the skin was so dark that, according to the recollections of an eyewitness, a certain military doctor named Roy, "a white man was indistinguishable from a negro." The feet were black too. The man coughed up blood, and when his body was opened after death, the lungs turned out to be heavy and swollen.

Perhaps the reason for the high mortality among young people was the peculiarity of this virus strain, which causes hypercytokinemia or cytokine storm. Simply put, the person infected with the Spanish flu showed an inadequately high response of the immune system, which led to the rapid destruction of inflamed lung tissues and their filling with fluid.

In 1997, the U.S. Army Institute of Molecular Pathology (AFIP) obtained a 1918 virus sample from the corpse of an Alaskan native who was buried in permafrost 80 years ago and named it H1N1.

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What the hospitals and medical staff had to face at the time

The Spanish flu epidemic lasted from 1918 to 1920. At that time, scientists had not yet isolated human influenza viruses (this will happen only in 1933), there were no antibiotics (penicillin was discovered in September 1928), antiviral drugs, vaccines and ventilators (the first samples appeared in 1927).

As stated on the CDC website, at that time people were fighting the “Spanish flu” using the non-drug methods available to them: isolation, quarantine, personal hygiene, the use of disinfectants and restrictions on public events that were applied in many cities. In particular, the townspeople were advised to avoid crowds and pay special attention to personal hygiene. In some cities in the United States, dance halls were closed, trams were instructed to keep windows open in all weather, except rain. Individual municipalities have moved court cases to the streets, and many doctors and nurses have been instructed to wear gauze masks.

The US health care system was overwhelmed, not only because US nurses went to the front, but also because of the refusal to attract trained African American nurses. For example, the authorities in Massachusetts eventually began to call for help from anyone who had at least some kind of medical education (and was white, apparently).

And the state of health in Europe at that time is well described by the diary of the London doctor Basil Hood. He worked at St. Marylebone's Hospital in the British capital, where during the second wave of the "Spanish flu", in October 1918, patients with pneumonia poured. In his memoirs, he describes how the hospital was barely coping. There was not enough staff for everyone: about half of the nurses were called to the front, and those who remained became infected with the flu. So Hood made the medical staff wear masks and keep their face away from the patient's face. But this did not always help, especially when the nurse had to take care of a sick colleague and neglected the rules of personal safety.

Those who remained on their feet tried to alleviate the symptoms of the sick, gave them food and drink, and changed their linen. Some nurses remained at their post until the end. Thus, Hood recalls a girl with "terribly acute influenza pneumonia." She did not want to stay in bed and asked to be leaned against the wall by the bed - in this position she soon died. The doctor himself also ended up with nervous and physical exhaustion and was forced to go on sick leave for a month.

Hood called the epidemic "the worst and saddest event in my professional life." In total, 850 patients with influenza were admitted to the hospital. In the era before vaccines and antibiotics, many developed pneumonia due to secondary bacterial infections, and 197 people died.

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Aspirin, quinine and bed rest: what was the treatment for "Spanish flu"

H1N1 was treated differently in different places. Somewhere, patients were instructed to simply lie in bed and take diaphoretics. Somewhere they made injections of a solution of quinine hydrochloride and sodium salicylate as an antipyretic.

Aspirin was popular. True, in 2009 he was “accused” of increasing the number of deaths. Karen Starko, the author of the study, stated that some patients with “Spanish flu” died from aspirin poisoning, justifying this by saying that the peak of mortality in the United States occurred in October 1918, shortly after medical specialists advised large doses of aspirin (from 8 to 31 grams per day ) as a treatment. Such doses, the study says, cause hyperventilation in 33% of patients and pulmonary edema in 3%.

Starko suggested that the "poisoning wave" was triggered by a combination of circumstances - at that time Bayer's patent for aspirin expired, so many companies rushed to buy it and significantly increased supplies. This coincided with the Spanish flu, and the symptoms of aspirin poisoning were not yet known.

However, this theory was called into question in 2010 by scientists at the University of California, Irvine and the Australian Healthcare Safety and Quality Commission. In their letter, they rightly noted that the mortality rate in countries such as India, where aspirin was hardly used, was higher than in countries with similar practices.

And one of the ways was to use the blood plasma of those who recovered from the "Spanish flu" to stimulate the immune system of critically ill patients. This was not a new idea. In fact, the earliest example of a method called "convalescent plasma" was used by the German physician Emil Adolph von Bering, who received the Nobel Prize in Physiology or Medicine in 1901 for the creation of an anti-diphtheria serum: he administered antibodies taken from those who had already recovered from this disease.

A recovering blood plasma interacts differently with the immune system than a vaccine. When a person is given a vaccine, the immune system actively produces its own antibodies. This is called active immunity. And with the introduction of plasma, the so-called passive immunity is obtained, when the body as if borrows foreign antibodies.

Unlike vaccines, protection does not last a lifetime, but borrowed antibodies can significantly reduce recovery time.

During the pandemic influenza outbreak in 1918, mortality rates for patients treated with blood plasma were almost halved compared to those who did not receive this treatment. True, some of those who passed the procedure nevertheless died. Perhaps later treatment or the low level of the then medicine played a role here.

In the end, the epidemic began to decline. There are several explanations for this. Maybe doctors began to use more effective ways to prevent and treat pneumonia. Or, more likely, the virus mutated very quickly to a less lethal strain, which is common for influenza: pathogenic viruses tend to become less deadly over time, as hosts of more dangerous strains die.

One of the positive developments after the 1918 pandemic was that humanity began to rethink its approach to healthcare. When everyone realized that the virus does not spare either the poor or the rich, the authorities of different countries began to develop the concept of public medicine, accessible to all segments of the population. In Europe, free medical care for the population began to be organized at the expense of the state, and in the United States they introduced a health insurance system paid by the employer.

Subsequently, the League of Nations created the Health Organization, which was then restructured as the World Health Organization, that is, WHO.

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