Mutulese Flu
The 1915 Influenza Epidemic, or Mutulese Flu, was an episode of deadly influenza epidemic, the second of the three flu epidemics that touched the Mutul (the other being the 1889 and 1920 Influenza Epidemic) and the most deadly of them. In the Mutul only, it touched a third of the population, killing around 2 millions people, two percent of the total population at the time, which came on top of the lives lost during the Belfro-Mutulese War of 1912. The viral infection itself was not more deadly than any previous influenza, but the special circumstances of the epidemic (malnourishment, overcrowded medical camps and hospitals, poor hygiene) promoted bacterial superinfection that killed most of the victims, typically after a somewhat prolonged death bed.
History
Origin
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The source of the disease may have been the major hospital camps near the battlefields of the Xuman Campaign which were ideal sites for the spreading of a respiratory virus and poultry were regularly brought in for food supplies. A common theory is that migratory birds from Norumbia arrived during summer 1914 carrying with them a H1N1 virus that had mutated in contact with the vast piggeries of the northern continent, and transmitted it to the Mutuleses poultry farms.
Spread
When an infected person sneezes or coughs, more than half a million virus particles can be spread to those close by. The close quarters and massive troop movements of the war 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.
Mortality
Because of the war and to preserve the troops morales, informations about the epidemic were censored by the Divine Throne. But today, it is estimated that around a third of the total population of the Mutul was infected at one point or another. An estimated 10 or 20% of those who were infected died, so around 1 to 2 millions people, with some estimates going as far as 3 or 4 millions. A opposed to the usual flu mortality rate of 0,1%. This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms. The symptoms were so unusual that at first, medical personnels believed it was an especially nefarious case of dengue. The majority of death were from bacterial pneumonia, but the virus also killed directly by causing edema in the lungs.
Patterns of fatality
Influenza is normally most deadly to weak individuals, such as infants, the very old, and the immunocompromised. The Mutulese Flu does not respect this pattern as an unusual number of death occurred in people under 65, especially among people in between 20 to 40 years old. But the most vulnerable of all were pregnant women, with death rate ranged from 23% to 71% depending on the studied hospital. And of the pregnant women who survived childbirth, over one-quarter lost the child.
Second wave
The second wave came after the end of the war when troops returned to their civilian life. In civilian life, natural selection favors a mild strain. Those who get very ill stay home, and do not contribute to the spreading of the flu. In the Xuman Campaign, soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus.
Those who had recovered from first-wave infections had become immune, a proof that it was indeed still the same strain as the first wave. As a result the most vulnerable people were those like the soldiers – young previously healthy adults who had avoided the first wave and were now put into contact for the first time with the disease.
End of the Pandemic
After the lethal second wave struck, new cases dropped abruptly – almost to nothing after the peak in the second wave. A common theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out.
Legacy
Despite its virulence and mortality, the Mutulese Flu was somewhat forgotten, leaving a far weaker impact on the public consciousness than the War of 1912 which happened at the same time. Its rapidity and lack of coverage, all news and informations on it being censored by the Central Library, left only the advertisements for medicaments to relay the existence of the epidemic. The second wave however, happening right at the end of the war, killing soldiers who just returned from war right in front of their families, left its impact, but was too short for it to stay vivid for long. It did however participate in the general climate of the first half of the 20th century in the Mutul, punctuated with wars, epidemics, and political turmoils. With the Influenza Pandemics of 1889 and of 1920 (the Reze Flu), it earned the nickname of the “Three Flu”, along with the “Three Dengues” (1901, 1933, and 1950), and the “Three Fevers” (Yellow fever of 1897, Swamp Fever of 1910, and Black fever of 1940). These nicknames were given long-after the fact by historians and epidemiologists, once the HIV crisis of the 80s popularized health and medical issues among Mutuleses, and rekindled memories of past epidemics and pandemics.