By Dean L. Winslow, MD, MACP, FIDSA, FPIDS
Professor of Medicine, Division of General Medical Disciplines, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine
SYNOPSIS: The 1889-1891 Russian flu pandemic was noted to spread rapidly through Western Europe, Great Britain, and North America. Contemporary clinical reports described prominent gastrointestinal, rheumatologic and neurologic abnormalities, including loss of taste and smell, and pathologic reports described prominent thrombosis. Molecular clock analysis suggests that a beta coronavirus emerged in humans following cross-species transmission at around this time.
SOURCE: Brussow H, Brussow L. Clinical evidence that the pandemic from 1889 to 1891 commonly called the Russian flu might have been an earlier coronavirus pandemic. Microbial Biotechnology 2021;14:1860-1870.
The authors presented an extensive and masterful review of clinical and pathological literature showing contemporary case descriptions from the pandemic of 1889-1891, which included descriptions of cases with features remarkably similar to what has been observed since human cases of SARS-CoV-2 began appearing in 2019. They postulated that trans-species infection with a bovine coronavirus may have been the etiologic agent responsible for the Russian flu. A 344-page report (The Parsons Report) published in 1891 documented the clinical experience from several hundred patients cared for at several hospitals across England and Scotland. Common clinical observations that suggest coronavirus infection rather than influenza included: relatively mild illness in adolescents; higher mortality in men, elderly individuals, and those with comorbidities; “long hauler” persistence of symptoms; pathologic evidence of inflammation and thrombosis; multisystem disease (with frequent gastrointestinal and neurological symptoms); presymptomatic transmission of infection; occasional symptomatic reinfection; and lack of protection by previous infection with influenza. Similar observations were made in reports published in the British Medical Journal, Encyclopaedia Britannica, and the German “Verein fur Innere Medicin” Report.
I have been fascinated with the history of influenza since I was a 10-year-old boy in the 1960s looking through my grandfather’s high school yearbook. He grew up in a small town in southern Indiana and graduated from high school in 1916. I remember as he pointed to three of his high school classmates (from his class of 20) who died during the 1918-1919 Spanish flu pandemic.
Just a few years ago, I heard a brilliant lecture from a French doctor who carefully documented how rapidly the Russian flu spread throughout Europe and the United Kingdom via rail lines and then to North America in just a couple of weeks via transatlantic steamship, and subsequently by railroads in the United States and Canada.1 We now know conclusively that the 1918-1919 influenza was caused by infection with a particularly virulent strain of influenza A H1N1, based on molecular reconstruction of the virus from individuals who died of flu and whose remains were preserved in Arctic permafrost.2
The most commonly accepted theory of the etiologic agent of the 1889-1891 Russian flu is that this was Influenza A H3N2, based on serologic analysis of blood obtained in the 1950s and 1960s from individuals born before vs. after 1890.3,4 We do not have frozen specimens from Russian flu patients to examine to demonstrate conclusively the etiology of this pandemic, so the Brussow paper postulating trans-species infection with a bovine coronavirus as the cause remains speculative. However, reading the clinical reports from 1889-1891 and seeing the similarities with the COVID-19 patients I have cared for since February 2020 is fascinating.
REFERENCES
- Valleron AJ, Meurisse S, Boelle PY. Historical analysis of the 1889-1890 pandemic in Europe. Int J Infect Dis 2008;12(Suppl 1):E95.
- Taubenberger JK, Reid AH, Lourens RM, et al. Characterization of the 1918 influenza virus polymerase genes. Nature 2005;437:889.
- Masurel N. Serological characteristics of a “new” serotype of influenza A virus: The Hong Kong strain. Bull World Health Organ 1969;41:461-468.
- Schoenbaum SC, Coleman MT, Dowdle WR, Mostow SR. Epidemiology of influenza in the elderly: Evidence of virus recycling. Am J Epidemiol 1976;103:166-173.
The 1889-1891 Russian flu pandemic was noted to spread rapidly through Western Europe, Great Britain, and North America. Contemporary clinical reports described prominent gastrointestinal, rheumatologic, and neurologic abnormalities (including loss of taste and smell), and pathologic reports described prominent thrombosis. A molecular clock analysis suggests a beta coronavirus emerged in humans following cross-species transmission around this time.
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