Saturday, December 23, 2006



While other reports have cited a possible death toll of 40-160 million from a bird flu pandemic, this is the first report I've seen that details how and why the vast majority of the deaths would be confined to 'developing world' nations.

The revelations the researchers have come up with from the stats of the 1918-1919 'Spanish Flu' pandemic are particularly interesting.

From the Washington Post :

An influenza pandemic of the type that ravaged the globe in 1918 and 1919 would kill about 62 million people today, with 96 percent of the deaths occurring in developing countries.

That is the conclusion of a study published yesterday in the Lancet medical journal, which uses mortality records kept by governments during the time of "Spanish flu" to predict the effect of a similarly virulent outbreak in the contemporary world.

The analysis, the first of its kind, found a nearly 40-fold difference in death rates between central India, the place with the highest recorded mortality, and Denmark, the country with the lowest.

If a modern Spanish flu killed all its victims in one year, it would more than double global mortality. About 59 million people now die each year.

Historical accounts suggest that what became known as Spanish flu emerged at an Army camp in Kansas in early March 1918. It was carried to Europe by American troops, where it circulated before undergoing a change early the next fall that made it unusually lethal. It spread around the world and was brought back to the United States, where it killed hundreds of thousands of Americans in October and November 1919. It circulated until early 1920, with virtually everyone on Earth eventually exposed to the virus.

The global death toll from the pandemic is unknown. In the 1920s, it was estimated to be about 20 million. A more complete analysis in 1991 raised that to 30 million. One in 2002 said mortality "may fall in the range of 50 to 100 million."

The new study doesn't make a new estimate. Instead, it calculated the death rate in places that had good birth and death records in 1918 and 1919 in order to estimate what would happen in a larger, older and relatively more affluent world population nearly a century later.

The researchers compared the death rates during the 1918-1920 period with those in the three years before and after the pandemic. This gave an estimate of "excess mortality" during the flu years, which was assumed to be caused directly or indirectly by the virus. (Because men in countries fighting in World War I had elevated mortality in 1918, they were excluded from the calculation.) The extra deaths ranged from 0.2 percent of the population in Denmark to 7.8 percent in the Central Provinces and Berar region of India -- a 39-fold difference.

Murray and his colleagues analyzed the death patterns and deduced that about half the variation from region to region was explained by differences in per capita income. For every 10 percent increase in income, a person's risk of dying during the pandemic fell 10 percent.

Why the poor were so vulnerable is unknown. It could have been that many were already ill with parasites or other illnesses or lacked micronutrients such as Vitamin A and zinc that are essential to immunity.

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