1. The Sick Years Examining the impact of the “Spanish Flu” Pandemic of 1918 to 1920 Teacher:

2. Geographic focus: Medical Geography How physical systems affect human systems

3. National & State Standards National Geography Standards Physical Systems 7. The physical processes that shape the patterns of earth’s surface. Environment & Society 15. How physical systems affect human systems. State Geography & other Standards NM B.3.: Analyze and evaluate changes in regions and recognize the patterns and causes of those changes. NM D.1.: Analyze how the Earth’s physical processes are dynamic and interactive. NM History Standard 4. Analyze the major political, economic, and social developments that occurred between WWI & WWII. School AYP focus: reading comprehension and writing skills

4. Objectives & Materials Objectives Students will be able to: 1.Identify when & where the “Spanish Flu” occurred. 2.Analyze and discuss why the virus was so deadly and how it spread so quickly. 3.Discuss the differences between epidemic, endemic, and a pandemic. 4.Analyze and discuss the impact of the “Spanish Flu”, worldwide, from 1918 to 1920. 5.Analyze and discuss the dangers of modern avian viruses, like the H5N1 virus, or “Avian Flu” and its potential global impact. Materials Students will need a: 1.World Map Teacher will need: 1.Laptop Projector 2.Essay instructions (homework) Lesson Time: Two sessions Session One: Presentation Session Two: Dr. Larry Brilliants “TED” video: Stop the next Pandemic & discussion

5. Introduction “The most deadly disease event in human history” WHO Who has heard of the Spanish Flu? Who has heard of the Spanish Flu? When did it occur?

6. The World in 1918  In 1918, the deadliest war ever (to that point) known was coming to an end.  The dead you see are not flu victims, but casualties of the western front of WWI.  By the end of the war, over 5.5 million allies and 4.8 million Germans lay dead. Another 8 million (both sides) were missing and over 20 million were wounded. Most of these were men between 20 and 40.  The entire European infrastructure was devastated by this war.  The United States, however, were not only credited as the victors, but were now officially becoming the most industrialized nation in the world.  But there was another enemy lurking; one that was much smaller but would take 5 to 10 times the number of casualties than the entire world war.

7. The “Spanish Influenza” “I had a little bird, it’s name was Enza, I opened the window, and in-flew-Enza”  Between March, 1918 and June, 1920 it was estimated that 25 to 50 million people died from this flu.  Current estimates indicate that the number was more likely as high as 100 million people and that over 500 million people were infected.  This virus was so widespread that there were reported cases as far as the Arctic and many remote South Pacific islands.  Hand out map of world  http://alliance.la.asu.edu/azga/

8. Where it began? Identify Ft. Riley, KS and date it 03/04.1918 Identify Queens, NY and date it 03/11/1918 Identify Brest, France and mark it “H1N1” 06/1918 Identify Sierra Leone, Africa and mark it “H1N1” 06/1918 By the way… the virus did not originate in Spain, as the name suggests. It was first really recognized in France, during the war. But because France was under wartime censorship, it would be the outbreak in Spain (a neutral, free-press nation) that would massively advertise the virus.

9. The Dynamic Virus  H5N1, H1N1, H3N2... the flu virus designations are interesting and puzzling. But how do scientists come up with these strange names. According to experts, there are 15 different types of hemagglutinin molecules and 9 different types of neuraminidase molecules. Virologists identify Influenza A viruses by their specific hemagglutinin and neuraminidase molecules. In 1980, scientists adopted a general formula for naming Influenza A viruses, HxNy (x represents the type of hemagglutinin molecule and y represents the type of neuraminidase molecule.)  For example, an avian flu virus with hemagglutinin molecule 3 and neuraminidase molecule 2, its name would be H3N2.  Virus is believed to come from the wild birds of south Asia (who infect domesticated birds).

10. The Dynamic Virus  RNA is extremely error prone: on average, each new virus differs from its parent by at least one nucleotide.  Influenza is the only virus that undergoes true antigenic drift (genetic changes in the virus that occur because of errors in replication.)  Two different viruses can infect a cell at the same time. For instance, if human and an avian flu virus infect a pig cell, they can swap genes. This swap results in a new flu subtype that has both avian and human flu characteristics. This 'reassortment' is known as antigenic shift.

11. How did it spread so fast?  Wild birds are migratory  Domesticated birds are everywhere  Humans are around domesticated birds  HxNy viruses are pathogenic and can spread from a bird to human host, quickly.  Humans, then, pass it to each other.

12. Non-vectored Disease: needs a “middleman” or “middlepig”

13. Endemic, Epidemic, and Pandemic Epidemic: An outbreak of a disease spreading throughout a community Endemic: Commonly found in a specific geographical area Pandemic: Occurring over a whole country or the whole world

14. Impact of the “Spanish Flu”  In the US, the impact was severe  Look at the top chart. What do you see?  The Spanish Flu killed young, healthy men more. Why?  Look at the bottom chart. What do you see?  Life expectancy dropped significantly during the Spanish Flu years.  Share my grandma’s story (optional)

15. Spanish Influenza Impact CityEstimated 1918 PopulationTotal Deaths Atlanta, GA201,752212 Boston, MA785,2456,225 Chicago, IL2,596,68114,014 Denver, CO268,4391,652 Los Angeles, CA568,4953,184 New York, NY3,215,87933,387 Philadelphia, PA1,761,37115,785 San Francisco, CA478,5303,755 Seattle, WA366,4451,441 Washington, DC401,6813,169

16. Impact on WWI “Far from being mutually exclusive, the Great War and the 1918- 1919 flu worked in symbiotic and destructive partnership”  The Great War created a perfect breeding ground for the H1N1 virus.  Soldiers, on both sides, were anxious, strained, depressed, physically overtaxed, and malnourished.  Because so many were infected, the over crowed factories, public offices, and trenches made it easy to spread.  War efforts were hampered, as well. War ammunition factories reported up to 40% absenteeism.  The flu thwarted major attacks, on both sides.  Result: over 225,000 civilians and 30,000 soldiers died.

17. Class discussion If the war casualties exceeded 20 million and the flu took another 50 to 100 million, what kind of affect did the two have on society? Remember: many of them were young men Remember: European infrastructure collapsed, sending them into a major depression.

18. Today’s Dangers!

19. H5N1, “Avian Flu”  Like the Spanish Flu of 1918- 1920, the Avian Flu is highly pathogenic!  The countries shown on the right have all reported the presence of this deadly strain.  Tens of millions of birds have been killed in an effort to prevent the spread to a human host.  WHO has reported that up to 90 people have died from the H5N1 strain of influenza  It is estimated that up to 1 billion people may die, should this strain transmit beyond a locale.

20. Cases in Asia

21. Migratory paths of infected birds (potential)

22. Dr. Larry Brilliant: Help Stop the next Pandemic  http://www.ted.com/talks/view/id/58 http://www.ted.com/talks/view/id/58  26 minutes  Watch and discuss:

23. Essay Homework Available as a handout Choose one of the following subjects and write a two page, double spaced reflective or research essay: 1.Reflect on Dr. Brilliant’s presentation and discuss his main points and potential solutions. Discuss whether you agree or disagree and add any additional suggestions to help stop the next pandemic. 2.Compare and contrast the Black Plague epidemic in 1347-1352 in Europe and the Spanish Flu of 1918-1920. What similarities and what differences did you find. Why did the Spanish Flu spread faster? How were both pandemics stopped? 3.Choose a global disease (AIDS, small pox of the past, polio, etc) and identify how many have perished, where they originated, who has been most affected, and what is being done to eradicate these diseases?

24. Grading Checklist  Essay included all criteria identified in handout?10 points  Essay sited sources used?2 points  Essay was 2 pages and double-spaced?2 points  Writing followed standard rules and conventions?6 points  Each day late will produce a 3 point penalty  Total point value: 20 points  Due date: to be determined

25. Sources  www.wikipedia.com www.wikipedia.com  www.nationalgeographicsociety.com www.nationalgeographicsociety.com  World Health Organization website