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A global team of researchers, examining the remains of victims from the 1918 flu pandemic, discovered that frail and young adults were more susceptible to death. This challenges the prevailing belief that the flu primarily affected healthy young individuals.
The 1918 influenza pandemic, known as the “Spanish flu,” claimed approximately 50 million lives worldwide, surpassing the casualties of World War I.
Due to the rapid spread of illness, doctors of that era believed that both healthy and previously ill individuals were equally likely to succumb to the flu. However, despite numerous historical accounts, there is no concrete scientific evidence to substantiate this belief.
Researchers from McMaster University in Canada and the University of Colorado Boulder, who examined victims’ ages at the time of death and studied bone lesions, reported that those most vulnerable to succumbing to the flu displayed signs of prior environmental, social, and nutritional stress.
Lead author Amanda Wissler, Assistant Professor in the Department of Anthropology at McMaster University, emphasized, “Our circumstances — social, cultural and immunological — are all intertwined and have always shaped the life and death of people, even in the distant past. We saw this during Covid-19, where our social backgrounds and our cultural backgrounds influenced who was more likely to die, and who was likely to survive.”
Much of the research on the 1918 pandemic relies on historical documentation, including vital statistics, census data, and life insurance records, none of which include information on pre-existing conditions or general environmental, dietary, or other chronic stressors that can impact one’s overall health over a lifetime.
For this study, published in the journal PNAS, researchers examined the skeletal remains of 369 individuals from the Hamman-Todd Documented skeletal collection, housed at the Cleveland Museum of Natural History. All had passed away between 1910 and 1938.
The sample was divided into two groups: a control group who had died before the pandemic, and those who died during the pandemic.
A living person’s skeletal structure may undergo lasting changes due to poor health, resulting in diminished height, irregular growth, developmental tooth defects, and other indicators.
The team searched for lesions, or indicators of stress, on the shin bones of the pandemic victims. New bone formation occurs in response to inflammation caused by physical trauma or infection, for example.
Researchers can determine if a lesion had been active, in the midst of healing, or had completely healed, all of which provide evidence of underlying conditions.
“By comparing who had lesions, and whether these lesions were active or healing at the time of death, we get a picture of what we call frailty, or who is more likely to die. Our study shows that people with these active lesions are the most frail,” explained co-author Sharon DeWitte, a biological anthropologist at the University of Colorado-Boulder.
Pre-existing medical conditions such as asthma or congestive heart failure are common risk factors that can contribute to poor outcomes from infectious diseases such as influenza. Racism and institutional discrimination can amplify these effects, as evidenced in the Covid-19 pandemic, said the researchers.
