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Theories as to why the 1918 influenza pandemic was so deadly abound, ranging from a cytokine storm response to a novel `avian’ virus, to rampant bacterial pneumonias at a time before antibiotics were available.
A few years ago, one popular story was that fears of taking aspirin – which was developed by Bayer - a German Company (we were at war with Germany in 1918) - may have contributed to the death toll.
In fact, the opening paragraph of Gina Kolata’s book `Flu’, mentions one of the theories popular in America during the 1918 pandemic.
When the plague came, on those chilly days of autumn, some said it was a terrible new weapon of war. The plague germs were inserted into aspirin made by the German drug company Bayer. Take an aspirin for a headache and the germs will creep through your body. Then your fate is sealed.
Now, researchers - in a new study that appears in the November 1st issue of Clinical Infectious Diseases - are postulating that overuse of aspirin may have been a factor increasing the death toll.
First the press release, then the abstract.
Press Release
For Immediate Release: October 2, 2009Contact Name:
John HeysContact E-mail:
jheys@idsociety.orgContact Phone:
(703) 299-0412
Aspirin Misuse May Have Made 1918 Flu Pandemic Worse
The devastation of the 1918-1919 influenza pandemic is well known, but a new article suggests a surprising factor in the high death toll: the misuse of aspirin. Appearing in the November 1 issue of Clinical Infectious Diseases and available online now, the article sounds a cautionary note as present day concerns about the novel H1N1 virus run high.
High aspirin dosing levels used to treat patients during the 1918-1919 pandemic are now known to cause, in some cases, toxicity and a dangerous build up of fluid in the lungs, which may have contributed to the incidence and severity of symptoms, bacterial infections, and mortality. Additionally, autopsy reports from 1918 are consistent with what we know today about the dangers of aspirin toxicity, as well as the expected viral causes of death.
The motivation behind the improper use of aspirin is a cautionary tale, said author Karen Starko, MD. In 1918, physicians did not fully understand either the dosing or pharmacology of aspirin, yet they were willing to recommend it. Its use was promoted by the drug industry, endorsed by doctors wanting to “do something,” and accepted by families and institutions desperate for hope.
“Understanding these natural forces is important when considering choices in the future,” Dr. Starko said. “Interventions cut both ways. Medicines can save and improve our lives. Yet we must be ever mindful of the importance of dose, of balancing benefits and risks, and of the limitations of our studies.”
VIEWPOINTS
Salicylates and Pandemic Influenza Mortality, 1918–1919 Pharmacology, Pathology, and Historic Evidence
Karen M. Starko
Burlingame, California
The high case‐fatality rate—especially among young adults—during the 1918–1919 influenza pandemic is incompletely understood. Although late deaths showed bacterial pneumonia, early deaths exhibited extremely “wet,” sometimes hemorrhagic lungs. The hypothesis presented herein is that aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema in 33% and 3% of recipients, respectively. Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate‐intoxicated adults. Experimentally, salicylates increase lung fluid and protein levels and impair mucociliary clearance. In 1918, the US Surgeon General, the US Navy, and the Journal of the American Medical Association recommended use of aspirin just before the October death spike. If these recommendations were followed, and if pulmonary edema occurred in 3% of persons, a significant proportion of the deaths may be attributable to aspirin.
