Comment by tzs | Hacker News Reader

Comment by tzs | Hacker News Reader

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I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible.

In 1918 a lot of people, especially in rural areas, probably died before they even had a chance to see a doctor. A rural person could easily be a day's travel or more by horse drawn wagon away from a doctor.

It might take two people to take the sick person. One to handle the horse and wagon, and one to tend to the sick person. Having two healthy people away from work for several days, and having the wagon unavailable for that time, could be a serious hardship.

I'd thus expect such people to tend to wait until it was clear that what they had was more serious than any normal flu they had had before. News traveled much slower in 1918, especially in rural areas, so they might not know that there is an unusually deadly flu pandemic in progress.

So by the time they realize that they are going to need help, it might be logistically too late.

Even if our medical treatment was no better today than in 1918, we'd probably save a lot more just because news spreads faster and more widely, we have faster transportation, and we have faster communication.

"I would expect that a significant factor is that we both have better treatments nowadays and treatment is much more accessible."

If, by "treatment", you mean access to clean water, sanitary conditions and decent rest, then I would agree: we're certainly better off than rural populations circa 1918. I suppose access to IV fluids could be helpful if you're elderly, or otherwise immune-compromised.

Beyond that, not much has changed since 1918.

The flu is a virus and is not affected by antibiotics. Further, the two antivirals associated with influenza either do nothing[1] or almost nothing[2].

Very much like there is no such thing as "cold medicine" (contrary to what TV says) there is also no such thing as a broadly useful flu treatment. What you're most likely to receive from a doctor is relief of superficial symptoms.

Going to a hospital for the cold or the flu will potentially expose you to much more serious bacterial infection.

[1] "Overall the benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to be greater than the risks." (https://en.wikipedia.org/wiki/Influenza#Treatment)

[2] "These drugs (M2 inhibitors) are sometimes effective against influenza A if given early in the infection but are ineffective against influenza B viruses" (https://en.wikipedia.org/wiki/Influenza#Treatment)

And treatment of superficial symptoms might even be harmful

https://mobile.nytimes.com/2009/10/13/health/13aspirin.html

I hope you are not involved in public health because you are dangerously misinformed.

A major cause of flu death in otherwise healthy people is secondary bacterial infections and high quality home care would really help.

Your statement re: antibiotics is accurate re: the primary problem but not in terms of actual cause of death which is very often secondary infection.

I would choose hospital care over home care any day of the week, but if there were a serious outbreak then government paid time off for carers plus basically universal antibiotics would be a logical response.

I think you are being too directly logical and not thinking systemically.

"high quality home care would really help."

I am in complete agreement. Not only would high quality home care help, it is, largely, the only thing that helps.

"I would choose hospital care over home care any day of the week..."

I think that's a very bad heuristic that is widespread in the US - across a broad spectrum of socio-economic and cultural backgrounds. If you just have the flu a visit to the hospital is useless at best. At worst, that secondary bacterial infection you're (rightly) worried about is alive and well at the hospital. Hospitals are breeding grounds of such infections.

"I think you are being too directly logical and not thinking systemically."

I am indeed thinking systematically - as I have witnessed emergency rooms full of kids with colds and flu who will be given comfort and/or placebos and who are racking up healthcare costs and displacing actual emergencies. And then there's the exposure to bacterial infections ...

That feels wrong to me. I don’t know how the rest of the world operates, but here in America I suspect the health system would struggle to even begin to cope with seeing a 50fold increase in patients across the board across the country. Just the strain on hospitals and respiratory support systems like ventilators alone would quickly make modern healthcare seem more or less like it was in 1918. Additionally, unlike in 1918, few households today have spare capacity to homecare gravely ill family members as in most middle class families both partners must work to provide a living wage.

I would have thought that rural folks would’ve been less likely to get the flu sine they are around fewer people.

There are still communities. People go to church, sell their goods, and pay for services. You might be exposed to fewer people in a rural location, but in a world where even electricity is a luxury (rural Spain in 1918), there's still a good deal of human interaction.

> Rural Spain

The so called "Spanish" flu was not from Spain; the first reported case was from France. It killed happily people all around the world spreading from military camps and soldiers returning home. Was tagged as spanish because many countries were in war and censored carefully any bad news about people dying in mass in their territories to avoid the enemy (and their own citizens) having this sensible information. As Spain remained neutral in the first World War, the spanish press documented the problem freely and extensively instead. Spain lost only the 1% of their population (around 200.000 people) whereas France lost 400.000, USA lost the 28% of their population (around 550.000) and 30 millions of people died in China (maybe should be called chinese flu instead? or even better the WWI big flu?).

The tag was bassically an attempt from politicians to blame a foreigner country, hide the problem under the rug and avoid assuming responsabilities in his countries. The oldest trick in the bag.

550,000 would have been about 0.5% of the US population in 1918.

I think the parent is conflating two different numbers. It looks like about 675,000 died in the US and about 25% got sick.

thanks for the correction

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