The ghost of pandemics past: revisiting two centuries of influenza in Sweden

From pandemic to endemic: Spatial-temporal patterns of influenza-like illness incidence in a Swiss canton, 1918-1924

In pandemics, past and present, there is no textbook definition of when a pandemic is over, and how and when exactly a respiratory virus transitions from pandemic to endemic spread. In this paper we have compared the 1918/19 influenza pandemic and the subsequent spread of seasonal flu until 1924. We analysed 14,125 reports of newly stated 32,198 influenza-like illnesses from the Swiss canton of Bern. We analysed the temporal and spatial spread at the level of 497 municipalities, 9 regions, and the entire canton. We calculated incidence rates per 1000 inhabitants of newly registered cases per calendar week. Further, we illustrated the incidences of each municipality for each wave (first wave in summer 1918, second wave in fall/winter 1918/19, the strong later wave in early 1920, as well as the two seasonal waves in 1922 and 1924) on a choropleth map. We performed a spatial hotspot analysis to identify spatial clusters in each wave, using the Gi* statistic. Furthermore, we applied a robust negative binomial regression to estimate the association between selected explanatory variables and incidence on the ecological level. We show that the pandemic transitioned to endemic spread in several waves (including another strong wave in February 1920) with lower incidence and rather local spread until 1924 at least. At the municipality and regional levels, there were different patterns of spread both between pandemic and seasonal waves. In the first pandemic wave in summer 1918 the probability of higher incidence was increased in municipalities with a higher proportion of factories (OR 2.60, 95%CI 1.42-4.96), as well as in municipalities that had access to a railway station (OR 1.50, 95%CI 1.16-1.96). In contrast, the strong fall/winter wave 1918 was very widespread throughout the canton. In general, municipalities at higher altitude showed lower incidence. Our study adds to the sparse literature on incidence in the 1918/19 pandemic and subsequent years. Before Covid-19, the last pandemic that occurred in several waves and then became endemic was the 1918-19 pandemic. Such scenarios from the past can inform pandemic planning and preparedness in future outbreaks.

Lost Lessons of the 1918 Influenza: The 1920s Working Hypothesis, the Public Health Paradigm, and the Prevention of Deadly Pandemics

In standard historical accounts, the hyperlethal 1918 flu pandemic was inevitable once a novel influenza virus appeared. However, in the years following the pandemic, it was obvious to distinguished flu experts from around the world that social and environmental conditions interacted with infectious agents and could enhance the virulence of flu germs. On the basis of the timing and geographic pattern of the pandemic, they hypothesized that an "essential cause" of the pandemic's extraordinary lethality was the extreme, prolonged, and industrial-scale overcrowding of US soldiers in World War I, particularly on troopships. This literature synthesis considers research from history, public health, military medicine, veterinary science, molecular genetics, virology, immunology, and epidemiology. Arguments against the hypothesis do not provide disconfirming evidence. Overall, the findings are consistent with an immunologically similar virus varying in virulence in response to war-related conditions. The enhancement-of-virulence hypothesis deserves to be included in the history of the pandemic and the war. These lost lessons of 1918 point to possibilities for blocking the transformation of innocuous infections into deadly disasters and are relevant beyond influenza for diseases like COVID-19. (Am J Public Health. 2022;112(10):1454-1464. https://doi.org/10.2105/AJPH.2022.306976).

Not the great equalizers: Covid-19, 1918-20 influenza, and the need for a paradigm shift in pandemic preparedness

Despite common perceptions to the contrary, pandemic diseases do not affect populations indiscriminately. In this paper, we review literature produced by demographers, historians, epidemiologists, and other researchers on disparities during the 1918-20 influenza pandemic and the Covid-19 pandemic. Evidence from these studies demonstrates that lower socio-economic status and minority/stigmatized race or ethnicity are associated with higher morbidity and mortality. However, such research often lacks theoretical frameworks or appropriate data to explain the mechanisms underlying these disparities fully. We suggest using a framework that considers proximal and distal factors contributing to differential exposure, susceptibility, and consequences as one way to move this research forward. Further, current pandemic preparedness plans emphasize medically defined risk groups and epidemiological approaches. Therefore, we conclude by arguing in favour of a transdisciplinary paradigm that recognizes socially defined risk groups, includes input from the social sciences and humanities and other diverse perspectives, and contributes to the reduction of health disparities before a pandemic hits.

Are Working Children in Developing Countries Hidden Victims of Pandemics?

The consequences of the recent pandemic have been disproportionately disruptive to several social groups, including children. As developing economies have been firefighting the recent pandemic, the welfare of minors could be affected and children’s economic exploitation and abuse could increase. Therefore, the present research aims to shed light on and to investigate the association between child labour in developing countries and pandemics, including the coronavirus, through conducting a systematic literature review on previous empirical studies. The present research concludes that previous studies on non-COVID-19 pandemics have mainly focused on the African economies, while studies on the recent pandemic have focused on Asian countries. In addition, differences were observed in relation to the methodological approaches and the characteristics of minor employees and the protection services in certain countries have proven to be insufficient. Suggestions for future research and policy implications are presented.

Swedish nationwide time series analysis of influenza and suicide deaths from 1910 to 1978

OBJECTIVES

There is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths.

DESIGN

Time series analysis.

SETTING

Sweden.

PARTICIPANTS

Deaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910-1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza).

MAIN OUTCOME MEASURES

Annual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910-1978.

RESULTS

Between 1910 and 1978, there was no evidence of either short-term or long-term significant associations between influenza death rates and changes in suicides (β coefficients of 0.00002, p=0.931 and β=0.00103, p=0.764 for short-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates, and β=-0.0002, p=0.998 and β=0.00211, p=0.962 for long-term relationship of increases and decreases in influenza death rates, respectively, with suicide rates). The same pattern emerged in separate analyses for men and women.

CONCLUSIONS

We found no evidence of short-term or long-term association between influenza death rates and suicide death rates across three 20th century pandemics.

Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic

This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic. The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.

In education we trust: on handling the COVID-19 Pandemic in the Swedish welfare state

Keeping schools open was an active strategy in Sweden to meet the threats of the COVID-19 pandemic. In this article we analyze how a collection of welfare state agents with different tasks, resources and interests in interaction formed an assemblage in their responses to the pandemic and how education thereby became part of a strategy to keep the society going. The inquiries concern what this tells us about education as framed and constrained as a part of society. Our observations are based on statements presented by the government and public agencies, mass media and websites. We identified an assemblage of interwoven agents such as institutions, laws, regulations and recommendations, pandemic manuals, statistics and media. All these were brought together by actions and ideas to handle a pandemic when there were no preventive vaccines. The overarching principle was to educate the population to competent actions in dealing with the pandemic. To keep schools open was part of that principle combined with caretaking ambitions. This assemblage looked like a centralistic machine but it was not; risks were pushed back to local authorities and schools. In conclusion, we note that education is vital in the overarching strategy to deal with the pandemic in Sweden in terms of trust in people and governmentality.

Innovation during crisis: exploring reaction of Swedish university libraries to COVID-19

Purpose

While universities are using more digital tools such as learning management systems (canvas, blackboard, etc). or massive open online courses (MOOCS) such as MIT, OpenCourseWare, edX, Coursera, digitalization has also influenced university libraries. Digital services of academic libraries need exploration on how they provide digital services and how they respond to COVID-19. Therefore, the purpose of this paper is to explore and map digital services of academic libraries and their response to COVID-19 in Sweden.

Design/methodology/approach

Qualitative research approach is used in this study. Through a Web search, data was gathered from all 39 universities in Sweden through two means: visiting university and their respective library websites; examination of other documents provided by the university such as press releases, announcements. Evaluation of the content and digital services and libraries response to COVID-19 is conducted by thematic coding.

Findings

In response to the ongoing COVID-19 spread, a general trend seen among all is limited working hours, shutting down physical libraries for general public, unmanning operations. All 39 number of universities in Sweden have moved their offerings toward using online tools. The main themes that have been identified from our study are as follows: Availability of Information, Accessibility of resources, Collaboration with other actors, Increased use of existing services, motivation and support to practice social distancing.

Research limitations/implications

Owing to the limitations of COVID-19 conditions, time and other aspects, there was not any opportunity to visit the university libraries or book time to interview librarians or students, which led to limited level and imperfect research. There are many other activities that university libraries are offering to their employees and using their internal newsletters and email groups to reach their audience; as a result, some of digital services that are offered during COVID-19 might have not been noticed.

Practical implications

These findings can provide base to other universities on how to react to COVID-19 and bring more discussion.

Social implications

COVID-19 has big social impact on people. The findings present that libraries can go beyond their responsibilities and provide emotional and psychological support the community towards social distancing such as videos, social online meetings, live video workshops.

Originality/value

The findings from this study call for a review digital services of academic libraries and their response to COVID-19 in Sweden, so that best reactions and services could be understood.

Elusive Roles of the Different Ceramidases in Human Health, Pathophysiology, and Tissue Regeneration

Ceramide and sphingosine are important interconvertible sphingolipid metabolites which govern various signaling pathways related to different aspects of cell survival and senescence. The conversion of ceramide into sphingosine is mediated by ceramidases. Altogether, five human ceramidases—named acid ceramidase, neutral ceramidase, alkaline ceramidase 1, alkaline ceramidase 2, and alkaline ceramidase 3—have been identified as having maximal activities in acidic, neutral, and alkaline environments, respectively. All five ceramidases have received increased attention for their implications in various diseases, including cancer, Alzheimer’s disease, and Farber disease. Furthermore, the potential anti-inflammatory and anti-apoptotic effects of ceramidases in host cells exposed to pathogenic bacteria and viruses have also been demonstrated. While ceramidases have been a subject of study in recent decades, our knowledge of their pathophysiology remains limited. Thus, this review provides a critical evaluation and interpretive analysis of existing literature on the role of acid, neutral, and alkaline ceramidases in relation to human health and various diseases, including cancer, neurodegenerative diseases, and infectious diseases. In addition, the essential impact of ceramidases on tissue regeneration, as well as their usefulness in enzyme replacement therapy, is also discussed.

Transportation and _______

This chapter examines some topics that have not received as much attention, at least not concerning the potential roles for transportation in mitigating or avoiding public health impacts.