Meanwhile, a debate goes on:
a 2007 analysis of medical journals from the period of the pandemic[16][17] found that the viral infection was no more aggressive than previous influenza strains. Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene promoted bacterial superinfection. This superinfection killed most of the victims, typically after a somewhat prolonged death bed.
In 1993, Claude Hannoun, the leading expert on the 1918 flu for the Pasteur Institute, asserted the former virus was likely to have come from China. It then mutated in the United States near Boston and from there spread to Brest, France, Europe's battlefields, Europe, and the world with Allied soldiers and sailors as the main disseminators.[32] He considered several other hypotheses of origin, such as Spain, Kansas and Brest, as being possible, but not likely. Political scientist Andrew Price-Smith published data from the Austrian archives suggesting the influenza had earlier origins, beginning in Austria in early 1917.[33]
When an infected person sneezes or coughs, more than half a million virus particles can spread to those nearby.[37] The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have increased the lethality of the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility.[38][39]
Estimates vary as to the total number who died. An estimate from 1991 says it killed 25–39 million people.[49] A 2005 estimate put the death toll at probably 50 million (less than 3% of the global population), and possibly as high as 100 million (more than 5%).[50][51] But a reassessment in 2018 estimated the total to be about 17 million,[3] though this has been contested.[52] With a world population of 1.8 to 1.9 billion,[53] these estimates correspond to between 1 and 6 percent of the population.
This flu killed more people in 24 weeks than HIV/AIDS killed in 24 years.[54] However, the Black Death killed a much higher percentage of the world's then smaller population.[55] The disease killed in every area of the globe. As many as 17 million people died in India, about 5% of the population.[56] The death toll in India's British-ruled districts was 13.88 million.[57]
“This superinfection killed most of the victims, typically after a somewhat prolonged death bed.”
The problem is see here is that during the second round of the pandemic, when the young and healthy were the hardest hit, many victims fell ill in the morning and died by the afternoon.
I also don’t see how Boston could be the source of the outbreak if it begin there in August 1918 when the first case at Fort Riley in Kansas was in March of that year. Recent investigations have also pointed to a British army camp in Étaples, France as the possible source. Soldiers there experienced very similar symptoms I believe as far back as 1917.