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.
History of Germany during World War I
The concept of "total war" in World War I, meant that food supplies had to be redirected towards the armed forces and, with German commerce being stopped by the British blockade, German civilians were forced to live in increasingly meagre conditions. Food prices were first controlled. Bread rationing was introduced in 1915 and worked well; the cost of bread fell. Allen says there were no signs of starvation and states, "the sense of domestic catastrophe one gains from most accounts of food rationing in Germany is exaggerated." However Howard argues that hundreds of thousands of civilians died from malnutrition—usually from a typhus or a disease their weakened bodies could not resist. (Starvation itself rarely caused death.) A 2014 study, derived from a recently discovered dataset on the heights and weights of German children between 1914-1924, found evidence that German children suffered from severe malnutrition during the blockade, with working-class children suffering the most. The study furthermore found that German children quickly recovered after the war due to a massive international food aid program.