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.
World War I memorials
One result of this style of warfare was a level of casualties unknown in previous conflicts. Approximately 2 million Germans and 1.3 million Frenchmen died during the war; 720,000 British soldiers died, along with 61,000 Canadian, 60,000 Australian and 18,000 New Zealand servicemen. On the Eastern front, 300,000 Romanians alone died. The war had a global impact, and at least 2,000 Chinese died in the European theatre of the conflict alone. Many of the deaths occurred within a short period of time, or affected particular groups: half of France's casualties occurred during the first 17 months of the war, for example, while the French middle and upper classes suffered disproportionate losses. Many of those who survived were injured in the course of the fighting; some injuries, such as facial traumas, resulted in the victim being shunned by wider society and banned from public events. These losses also left large numbers of widows and orphans – 1.36 million in France alone – and affected most families in some way: in Australia, every second family had lost a relative. Even those left at home had suffered extensively from stress, anxiety and grief.