The Spanish influenza pandemic seen through the BMJ's eyes: observations and unanswered questions

This article presents calculations and comparisons of mortality rates for influenza, for diseases of the respiratory system (with the exception of tuberculosis) and for all the causes of death, in 21 locations in the Basque Country (between Spain and France). The data were collected from all the entries in the death registers for the period between May 1918 and April 1919. The Spanish influenza pandemic affected this population sample to a varying extent. Depending on the characteristic of the different locations, the mortality rate varied between 2.2 and 19.7‰ for influenza, and between 7.5 and 25.7‰ for influenza and other diseases of the respiratory system. The mortality rate for the total population studied has been calculated to be 6.8‰ for Spanish influenza and 12.1‰ for influenza and other diseases of the respiratory system. The first wave of the pandemic (spring 1918) was benign like a seasonal influenza. The second wave (autumn 1918) was extremely virulent owing to the mutation of the virus in Europe during the summer. This article identifies one of the sites, on the border between France and Spain, from which the second wave of the Spanish flu spread.

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The COVID-19 pandemic and health inequalities

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-214401 ◽

2020 ◽

pp. jech-2020-214401 ◽

Cited By ~ 46

Author(s):

Clare Bambra ◽

Ryan Riordan ◽

John Ford ◽

Fiona Matthews

Keyword(s):

Health Inequalities ◽

Public Health Policy ◽

Influenza Pandemic ◽

Mortality Rates ◽

Future Generations ◽

Spanish Influenza ◽

Policy Responses ◽

Geographical Inequalities ◽

The Social ◽

H1n1 Outbreak

This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.

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Covid-19: implications for insurer risk management and the insurability of pandemic risk

The Geneva Risk and Insurance Review ◽

10.1057/s10713-020-00054-z ◽

2020 ◽

Vol 45 (2) ◽

pp. 171-199 ◽

Cited By ~ 7

Author(s):

Andreas Richter ◽

Thomas C. Wilson

Keyword(s):

Risk Management ◽

Financial Market ◽

Influenza Pandemic ◽

Lessons Learned ◽

Real Economy ◽

Spanish Influenza ◽

Crisis Scenarios ◽

To Come ◽

The Impact ◽

Business Interruption

Abstract This paper analyzes the insurability of pandemic risk and outlines how underwriting policies and scenario analysis are used to build resilience upfront and plan contingency actions for crisis scenarios. It then summarizes the unique “lessons learned” from the Covid-19 crisis by baselining actual developments against a reasonable, pre-Covid-19 pandemic scenario based on the 2002 SARS epidemic and 1918 Spanish influenza pandemic. Actual developments support the pre-Covid-19 hypothesis that financial market developments dominate claims losses due to the demographics of pandemics and other factors. However, Covid-19 “surprised” relative to the pre-Covid-19 scenario in terms of its impact on the real economy as well as on the property and casualty segment as business interruption property triggers and exclusions are challenged, something that may adversely impact the insurability of pandemics as well as the perception of the industry for some time to come. The unique lessons of Covid-19 reinforce the need for resilience upfront in solvency and liquidity, the need to improve business interruption wordings and re-underwrite the book, and the recognition that business interruption caused by pandemics may not be an insurable risk due to its large accumulation potential and the threat of external moral hazard. These insurability limitations lead to a discussion about the structure and financing of protection against the impact of future pandemics.

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