niman wrote:
The 1918 pandemic was severe and the severity was related to the sequence of the recombinant swine virus, which led to 20-100 million deaths of previously healthy young adults. The very young and very old were largely spared, and this distribution was NOT related to environmental factors.
I partially agree.
Yes, this was a characteristic of the 1918 pandemic and H1N1 (2009). But, we are mainly talking about severity and we know that there were many environmental factors pushing for a severe outcome in those who contracted it. Of course, 222G mutation played a big role in severe and fatal cases. But, you are ignoring that India was the hardest hit by 1918 H1N1 and I think we have much to say about factors here at this point. India didn't even have an established mortality surveillance and the social disruption was also great, there.
You cannot claim that we know the real magnitude of the 1918 pandemic as we have very difference numbers (20M-100M) and this are extrapolated from very limited mortality surveillance systems in 1918, so we could have only 5M-10M or less, other story is morbidity and its effects in social order. I like seeing how you hate to hear 36,000 flu deaths a year and how you love 650,000 flu deaths in the U.S (1918-1919) when this are drawn from the same methods that you distrust. In Spain this goes from 100,000 to 800,000, even some time ago there were people saying 8M people. As you see it's not possible to quantify the real magnitude in numbers.
I would like to stress once more that a 1918-like pandemic is possible but not likely and if this happens we are better prepared than ever. We have stockpiled antivirals and in some cases pre-pandemic vaccines. Influenza surveillance systems around the world are working very closely to detect and to stop novel influenza A viruses.