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A teacher's guide to the Spanish Flu simulator

The Spanish Flu

A world-wide epidemic caused by influenza viruses led to between 50 and 100 million deaths in 1918 and 1919 (as much as 1 of every 18 people). Because neutral Spain was not censoring news it became associated with Spain but its origins are more likely to be the USA or France. It came in three waves (Spring 1918, Autumn 1918, and Winter 1919) and the second wave was unusually deadly. And unlike typical flu pandemics it disproportionately killed young healthy adults. Many researchers have suggested that the conditions of the war significantly aided the spread of the disease. And others have argued that the course of the war (and subsequent peace treaty) was influenced by the pandemic. To help understand questions about the worst diseaster in history we have built a computer model of the pandemic.

How to use the simulator and how it works

How to use the simulator in teaching

It can be used in courses in history (of World War One or epidemics), public health, geography, or computer modelling. See Things to think about in the student guide.  It can be used as a focus of discussions about uncertainties and controversies in history. And how, if at all, one can attempt to answer questions in counter-factual history.

Many aspects of the Spanish Flu are not known (or are debated):
  1. Where it started? The two prominent theories are Camp Funston, Kansas (The site of origin of the 1918 influenza pandemic and its public health implications [open access]) and  Etaples, France (The so-called Great Spanish Influenza Pandemic of 1918 may have originated in France in 1916 [open access]).  The simulator can be run with either theory of the origin.
  2. Why were there three different waves? (See Mechanistic modelling of the three waves of the 1918 influenza pandemic [open access?], Cross-Protection between Successive Waves of the 1918–1919 Influenza Pandemic: Epidemiological Evidence from US Army Camps and from Britain [open access], and  The 1918 influenza pandemic: insights for the 21st century [open access]) Why was the second wave so deadly?
  3. Was it a single virus strain? (Integrating historical, clinical and molecular genetic data in order to explain the origin and virulence of the 1918 Spanish influenza virus [open access]).  Also a portion of, We Heard the Bells: The Influenza of 1918 (2010), an open access documentary addresses this.
  4. Why did young healthy people  disproportionately?
  5. How many died? Estimates have grown from about 20 million in the 1920s to 50-100 million today. ( The geography and mortality of the 1918 influenza pandemic [not open access] and Updating the Accounts: Global Mortality of the 1918–1920 “Spanish” Influenza Pandemic [open access?]) (Some also attribute the .5 to 5 million who died of Encephalitis lethargica in the 1920s to previous Spanish Flu infections. The relationship between encephalitis lethargica and influenza: a critical analysis [open access] )
  6. How effective were interventions? (The effect of public health measures on the 1918 influenza pandemic in U.S. cities [open access]). Story of American Samoa and West Samoa very compelling  (America’s forgotten pandemic [not open access]).
  7. What effect did the virus have on the war itself ? Clearly there were major effects but probably equally bad for both sides. Also infrastructure often drastically affected as workers became ill or could not get to work. It has been argued that the flu had a major effect on the Treaty of Versailles since the American delegation were opposed to German  reparations but were disabled by the flu during negotiations.
  8. Do local events (for example those simulated by the model: the Australian quarantine, the American forces sent to Archangel, Russia, and the ship that brought the Spanish Flu to Brazil)  have significant effects upon the global dynamics of the pandemic or are they limited to the region they occur in?
  9. Could an equally terrible pandemic happen again? Understanding the Spanish Flu and its relationship with World War One might help us answer this question.
  10. As the peace treaty was being negotiated the American team (including President Wilson) were incapacitated by the flu. They wanted a treaty that didn't punish Germany as much as France and Britain wanted. A different treaty might have prevented World War Two from arising. There is chapter in America’s forgotten pandemic on this topic.
Personal perspectives

Stories of whole villages starving in Alaska (America’s forgotten pandemic [not open access]) and Labrador ( "the virus had decimated Okak, killing 204 of its 263 residents"  and "Seven-year-old Martha Joshua survived alone for five weeks in Uivaq before a search party from Okak found her in early January." from http://www.heritage.nf.ca/society/sflu.html. A documentary film was made of this - http://www.onf-nfb.gc.ca/eng/collection/film/?id=16164 - freely available at http://apsts.alberta.ca/video/watch/2qPkzCS4J78rSRNWJrEQno).

First-hand account videos

Please, Let Me Put Him in a Macaroni Box: The Spanish Influenza of 1918 in Philadelphia [OER] An eye witness describes how there were huge numbers of bodies


Books

Pandemic of Influenza 1918-19 by the UK Ministry of Health, a medical history of the pandemic published in 1920. [OER/public domain]
America’s forgotten pandemic by Alfred Crosby [not OER]
Living With Enza by Mark Honigsbaum
Vera Brittain's Testament of Youth -- first-hand account of the hospital at Etaples
Katherine Anne Porter's Pale Horse, Pale Rider -- novella based upon first-hand account of the illness

More videos

Two short videos of Michael Palin interviewing experts [open access]
http://www.open.edu/openlearn/history-the-arts/history/world-history/death-on-the-eve-armistice

Yale history course Epidemics in Western Society Since 1600 has one lecture on Pandemic Influenza which has a 24-minute segment on the Spanish Flu.  [OER]

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