Syndemic
The worst of the 20th century influenza pandemics was the 1918 pandemic, where between 20-40 percent of the world’s population became ill between 40-100 million people died. More people died of the so-called Spanish flu (caused by the H1N1 viral strain) pandemic in the single year of 1918 than during all four-years of the Black Death. The pandemic had devastating effects as disease spread along trade and shipping routes and other corridors of human movement until it had circled the globe. InIndia, the mortality rate reached 50 per 1,000 population. Arriving during the closing phase of the World War I, the pandemic impacted mobilized national armies. Half of U.S. soldiers who died in the "Great War," for example, were victims of influenza. It is estimated that almost ¾ of a million Americans died during the pandemic. In part, the death toll during the pandemic was caused by viral pneumonia characterized by extensive bleeding in the lungs resulting in suffocation. Many victims died within 48 hours of the appearance of the first symptom. It was not uncommon for people who appeared to be quite healthy in the morning to have died by sunset. Among those who survived the first several days, however, many died of secondary bacterial pneumonia. It has been argued that countless numbers of those who expired quickly from the disease were co-infected with tuberculosis, which would explain the notable plummet in TB cases after 1918.
Effect of World War I on children in the United States
Over the course of the war, the United States mobilized hundreds of thousands of men and endured an estimated 117,465 casualties. Of the men who survived and returned home, post-traumatic stress disorder created a major impact on society. During this time, and still today, post-traumatic stress (then more likely to be known as "shell shock") was not fully understood, but because of the traumatic nature of battle, many men were negatively affected after the war. Some men were forced to leave battle, which many people considered cowardice, and there were asylums throughout Europe housing men suffering from this condition. In some extreme cases, men were even shot for showing weakness. There are still people living today who lost family members because of this practice, which created lasting impacts on these children. Additionally, many of these men were teenagers when they left for war, and virtually all were under the age of 30; therefore many of these soldiers were barely out of childhood themselves.