The emergence of a suburban penalty during the 1918/19 influenza pandemic in Malta: The role of a marketplace, railway, and measles

The Malta 1918/19 influenza experience adds to our understanding of the pandemic by illustrating the importance of suburban populations, their vulnerabilities, and elevated mortality rates. Studies on the socio-geographical variation in the 1918/19 influenza mortality has largely overlooked the suburban experience, and thus the often-hidden heterogeneity of the disease experience is missing. A comparison of mortality rates across the three settlement types (urban, suburban, and rural) for the second wave of the pandemic revealed that there were significant differences across the settlement types (x2 = 22.67, 2df, p <0.0001). There was a statistically significant divide between suburban settlement type versus urban and rural communities. Further, the geographical division of the central suburban region had the highest mortality rate at 4.28 per 1000 living of all suburban regions. A closer examination of the central suburban communities revealed that the town of Birchicara was the driving force behind the elevated influenza mortality, with a rate of 5.28 per 1000 living. The exceedingly high rate of influenza mortality in Birchicara was significantly different from the other suburban communities (Z = 2.915, p = 0.004). Birchicara was notable as both a transmission and burden hotspot for influenza infection because of a unique conflation of factors not observed elsewhere on the island. Foremost, was the pitkali market, which was a produce wholesale distributing centre; second, was the fact that the train station was a central hub especially for Maltese labourers; third, was that the measles epidemic in 1916/17 contributed to elevated childhood influenza deaths because the presence of military personnel and their families. We argue that the interaction of the three factors, and in particular, the measles epidemic with childhood influenza, amounted to a syndemic. Factors associated with urbanization and high rates of infectious diseases, such as overcrowding and infant mortality, did not play a primary role in the syndemic.

Did the 1918 influenza pandemic cause a 1920 baby boom? Demographic evidence from neutral Europe

In 1919-20, the European countries that were neutral in the First World War saw a small baby bust followed by a small baby boom. The sparse literature on this topic attributes the 1919 bust to individuals postponing conceptions during the peak of the 1918-20 influenza pandemic and the 1920 boom to recuperation of those conceptions. Using data from six large neutral countries of Europe, we present novel evidence contradicting that narrative. In fact, the subnational populations and maternal birth cohorts whose fertility was initially hit hardest by the pandemic were still experiencing below-average fertility in 1920. Demographic evidence, economic evidence, and a review of post-pandemic fertility trends outside Europe suggest that the 1920 baby boom in neutral Europe was caused by the end of the First World War, not by the end of the pandemic.

Bayesian Modeling of COVID-19 to Classify the Infection and Death Rates in a Specific Duration: The Case of Algerian Provinces

COVID-19 causes acute respiratory illness in humans. The direct consequence of the spread of the virus is the need to find appropriate and effective solutions to reduce its spread. Similar to other countries, the pandemic has spread in Algeria, with noticeable variation in mortality and infection rates between regions. We aimed to estimate the proportion of people who died or became infected with SARS-CoV-2 in each provinces using a Bayesian approach. The estimation parameters were determined using a binomial distribution along with an a priori distribution, and the results had a high degree of accuracy. The Bayesian model was applied during the third wave (1 January–15 August 2021), in all Algerian’s provinces. For spatial analysis of duration, geographical maps were used. Our findings show that Tissemsilt, Ain Defla, Illizi, El Taref, and Ghardaia (Mean = 0.001) are the least affected provinces in terms of COVID-19 mortality. The results also indicate that Tizi Ouzou (Mean = 0.0694), Boumerdes (Mean = 0.0520), Annaba (Mean = 0.0483), Tipaza (Mean = 0.0524), and Tebessa (Mean = 0.0264) are more susceptible to infection, as they were ranked in terms of the level of corona infections among the 48 provinces of the country. Their susceptibility seems mainly due to the population density in these provinces. Additionally, it was observed that northeast Algeria, where the population is concentrated, has the highest infection rate. Factors affecting mortality due to COVID-19 do not necessarily depend on the spread of the pandemic. The proposed Bayesian model resulted in being useful for monitoring the pandemic to estimate and compare the risks between provinces. This statistical inference can provide a reasonable basis for describing future pandemics in other world geographical areas.

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

WITHDRAWN: The Spanish Flu, COVID-19 and Malta's reactions: Contrasts and similarities

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Tuberculosis as a Risk Factor for 1918 Influenza Pandemic Outcomes

Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts of TB on influenza-like illness (% of population sick) and case fatality (% of cases dying) by age and sex through case-control comparisons of patients (N = 201) and employees (N = 97) from two Norwegian sanatoriums. Female patients, patients at Landeskogen sanatorium, and patients aged 10–39 years had significantly lower morbidity than the controls. None of the 62 sick employees died, while 15 of 84 sick patients did. The case-control difference in case fatality by sex was only significant for females at Lyster sanatorium and females at both sanatoriums combined. Non-significant case-control differences in case fatality for males were likely due to small samples. Patients 20–29 years for both sexes combined at Lyster sanatorium and at both sanatoriums combined, as well as females 20–29 years for both sanatoriums combined, had significantly higher case fatality. We conclude that TB was associated with higher case fatality, but morbidity was lower for patients than for employees. The results add to the study of interactions between bacterial and viral diseases and are relevant in preparing for pandemics in TB endemic areas.