Aspirin may be the enhancer of virulence in 1918 pandemic

BMJ ^

[GulfMan]

I would like to mention the possibility of aspirin as the enhancer of virulencein 1918 pandemic. During 18 months of so called "Spanish Flu pandemic" in 1918-19, 27 million people died world-wide. Mortality rate was the highest especially in the second wave of the pandemic: October 1918, especially in US.

The age-specific mortality curve did not trace the "U", but resembled a "W" with very high mortality rates in healthy young adults aged 20-40 years as well as in those less than 5 years of age and those aged 65 years and older. No adequate explanation of this mortality pattern has been presented. It was wartime and young men were crowded together in military camps, but the mortality was also high in men of the same age who remained at home.

September 13, 1918 US Surgeon General Rupert Blue of the U.S. Public Health Service, President of Medical Association (1916-17) dispatched advice to doctors ... aspirin success in the relief of the symptoms"[2]

In the first month after his advice, October 1918, the highest mortality was recorded.

Even five to ten grain (or about 324 to 648 mg) of aspirin tablets every three hours and more (up to 7 g within 24 hours) were prescribed to subdue fever ...

According to the reports by homeopathic medicine, under the non aspirin therapy the mortality rate was 1 percent or less, while more than five, even thirty percent of patients treated with aspirin in hospitals or in armed forces died.

Considering together with the significantly and very high pooled odds ratio of mortality in the meta-analysis of infected animal toxicity studies and the reanalysis of epidemiological studies in Japan reported by Hama, I believe that aspirin may be the enhancer of virulence also in 1918 pandemic.

[BenLurkin]

Is this perhaps an instance of correlation without causation?

[House Atreides]

Even five to ten grain (or about 324 to 648 mg) of aspirin tablets every three hours and more (up to 7 g within 24 hours) were prescribed to subdue fever ...
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Crimey... they might have subdued the fever at the cost of increased risk of internal bleeding.

[Responsibility2nd]

I was reading earlier that Aspirin was the go-to medicine for the Spanish Flu.

If modern medicines were available back then - millions of lives would have been saved.

[COBOL2Java]

Mortality rate was the highest especially in the second wave of the pandemic: October 1918, especially in US.

My dad was born in October 1918, in Vermont.

Glad he didn't die! LOL

[PGR88]

So they are saying from this little sliver of information, that 100 years of use of aspirin as an anti-inflammatory drug is wrong???

[GulfMan]

> Crimey... they might have subdued the fever at the cost of increased risk of internal bleeding.

Aspirin Regimens (Dose and Schedule) Recommended in 1918 Are Now Known to Regularly Produce Toxicity. n 1977, a US Food and Drug Administration panel [22] recommended that the maximum safe daily dose of aspirin for the general population was 4000 mg, with a mean hourly rate of 167 mg/h Although these pathology findings have been induced with the 1918 influenza virus in models [6], they are also consistent with aspirin toxicity. A study of 177 adults with aspirin toxicity (and a 15% mortality rate) found the most common presentations were depressed consciousness (61%) and respiratory failure (47%), even “at therapeutic levels” [19]. Autopsy findings for patients with the 26 fatal cases were pulmonary edema (46%), ulcers (46%), cerebral hemorrhage (23%), and cerebral edema (31%). Coagulation disturbance or thrombocytopenia was found in 38%. A detailed autopsy of an adult with aspirin poisoning revealed cyanosis, pulmonary congestion, alveolar hemorrhage, subpleural and subepicardial hemorrhages, petechiae, cloudy swelling of the kidneys, and fatty degeneration of the liver [51, 52]. ARDS-like disease has also been reported [53]. Children with aspirin toxicity (or Reye syndrome) are less likely than adults to present with pulmonary edema [35], although in addition to brain swelling, fatty liver, and cloudy swelling of the kidneys [54, 55], some have pulmonary edema [55, 56], “frothy, blood-tinged fluid” [57], and lung hemorrhages [54].

[Mount Athos]

i am extremely skeptical of this.
They wouldn’t notice 40 times more of the treated people were dying?

If 1918 flu turned your own immune system against you, it wouldn’t be the first illness to do so

[GulfMan]

The autopsy reports from the time exactly match Aspirin toxicity. The evidence I have read is overwhelming that the use of Aspirin was what made it bad. In place they didn’t use Aspirin death rate was less than 1% too

[Lonesome in Massachussets]

My dad was born in October 1918, in Vermont.

Glad he didn't die! LOL

My old barber's mother died from the flu in 1918, when he was two. (He died in 1994.) He really never got over his mother's death. You should be glad your grandmother didn't die, too. I am sure your father was.

[GulfMan]

Autopsy reports by pathologists of the day describe extremely wet, sometimes hemorrhagic lungs in early deaths. On 23 September 1918 at Camp Devens in Massachusetts, 12,604 soldiers had influenza, and 727 had pneumonia; after examining the lungs of a dead soldier, Colonel Welch concluded, “This must be some new kind of infection or plague” [48, p 190].

What struck E. R. Le Count [49], consulting pathologist to the US Public Health Service, as most unusual was the amount of lung tissue actually “pneumonic” seemed “too little in many cases to explain death by pneumonia.” He saw a thin, watery, bloody liquid in the lung tissue, “like the lungs of the drowned,” as well as pleural exudates with small hemorrhages unlike those seen in “any other form of acute pneumonia of which I am familiar.”

Importantly, he also noted the brain was “quite regularly swollen,” the kidneys were “regularly the seat of cloudy swelling,” and the liver had “superficial fatty change,” (changes noted in children with salicylate intoxication; see below). He concluded, “It is difficult to believe that a disease with so many distinctive features and…novelty…can fail to possess a correspondingly definite etiology.” Brain weight was increased by 100–200 g in ∼50% of persons, most likely indicating cerebral edema; cerebral bleeding was common [9, 10]. Wolbach [50], chief pathologist at the Peter Bent Brigham Hospital in Boston, Massachusetts, found bacterial infection in late deaths, yet a person dying on day 2 exhibited edema and congestion of the lung, a purpuric rash, and no bacterial growth. He surmised a natural progression from the early lesion to the bacterial lesions: “Two types of lungs stand out.”

In early deaths, the lungs were “dark red and wet…dripping wet.” French [25] described the lesion as “albuminuous, non-cellular, coagulable.…One realized that this albuminous exudate…was the probable cause of the cyanosis.” The exudates were “so entirely unlike what is met with in any ordinary forms of pneumonia that they seemed to be essential importance, the other changes—haemorrhages, broncho-pneumonia and so on—being super additions.…”

[DesertRhino]

Recommended doses got as higher as 35-40 325mg aspirin per day. As long as fever kept up they pounded the patient with more aspirin. The hemorrhaging and fluid build ups were toxic.
They were barely out of the Middle Ages medically.

[BuffaloJack]

I take aspirin for pain, headaches and fever. Ibuprofen and acetaminophen give me the worst headaches, the kind you can almost see behind your eyeball.

[Spirochete]

If modern medicines were available back then - millions of lives would have been saved.

Modern medicine was in its infancy in 1918. Other than antiseptics, there were very few *effective* medicines. Opium, quinine, cocaine, and heroin were all available over-the-counter. Arsenic-based syphilis treatments like salvarsan were recently introduced. Vitamins were a new discovery.

[DesertRhino]

No- they are saying that aspirin shouldn’t be given as an anti-inflammatory in 8000 to 12000 mg per day doses.

[yefragetuwrabrumuy]

The far more recent H1N1 influenza epidemic in Ukraine confirmed the widely held suspicion that mortality was caused by the “cytokine storm”. That is, an overreaction of the immune system, instead of the virus, is what killed so many.

Many doctors initially rejected the idea that it was an influenza at first, because in autopsy, many of the victims lungs looked like they had been “burned”. This was because the fight between the immune system and the virus took place in the lungs, destroying them.

The great majority of those who died were young people with healthy immune systems. The very young, old and infirm actually had lower mortality than those from 20-40.

This was the same demographic from the Spanish flu.

Blaming aspirin for it likely had little or no direct effect, unless the overdose caused its own separate damage.

[PIF]

via wiki fwiw:
It infected 500 million people around the world, or about 27% of the then world population of between 1.8 and 1.9 billion, including people on remote Pacific islands and in the Arctic.

The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history.

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Not 27 million.

[drypowder]

The excessive body temp is what kills the pathogen and the aspirin stops the fever. Makes sense that taking aspirin would result in a higher mortality due to increasing the longevity of the pathogen.

[outhousepatrol]

Not to mention macular degeneration

https://www.webmd.com/eye-health/news/20130118/aspirin-blinding-eye-disease#1

[Eagles6]

My Grandfather came over from Ireland when he was 3 yrs old.

Joined the Army in WWI.

Was gassed in France and the caught the Spanish Flu while in the hospital in France.

And you thought you had a bad day...