Living with Enza: the forgotten story of Britain and the Great Flu Pandemic of 1918 by Mark Honigsbaum
(Macmillan, £15.99)
The question of forgetting lies at the heart of Mark Honigsbaum’s Living with Enza. Both my parents were teenagers in 1918-19. Neither of them ever mentioned the great global pandemic of influenza, which killed 228,000 Britons and at least 50m people during those years, on every inhabited continent. Why did they, and so many of their contemporaries, put it out of mind? Perhaps the war-weary world could face no more mass death; perhaps bad things which take place over a relatively long period (in this case about eight months) fade rapidly from memory. Yet this was death on a scale unmatched even by the recent war; and the 50m figure is almost certainly an underestimate. There were many other deaths to follow the main pandemic: from depression, suicide, and complications of the central nervous system, notably Economo’s disease, the “sleeping sickness” endemic to Europe and North America from 1919 to 1929 so graphically described by Oliver Sacks in his book Awakenings.
Minor influenza epidemics are not uncommon—they simply entail an unusually high incidence of a strain of influenza in a given population, as can occur in most countries at some point during most winters. An influenza pandemic, however, represents an outbreak of disease across a far larger region, such as a continent, associated with much higher rates of illness and death than any ordinary seasonal epidemic. Three conditions are necessary for a pandemic: a novel virus, its ability to cause illness, and the ability of the virus to be transmitted between humans. The H5N1 flu virus, “avian influenza,” has been a potential pandemic threat since 2003. At present, only the final condition is in doubt with regard to H5N1, because person to person transmission seems to have taken place in very few cases and under unusual circumstances. A new influenza pandemic will certainly occur in the future, although not necessarily as a result of H5N1.
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