The influenza pandemic of 1918–1919 in Sri Lanka: its demographic cost, timing, and propagation

Abstract

BackgroundAs an island and a former British colony, Sri Lanka is a case of special interest for the study of 1918–1919 influenza pandemic because of its potential for isolation from as well as integration into the world epidemiologic system.ObjectivesTo estimate population loss attributable to the influenza pandemic and weekly district-level excess mortality from the pandemic to analyze its spread across the island.MethodsTo measure population loss, we estimated a population growth model using a panel of 100 district-level observations on population for five consecutive censuses from 1891 to 1931, allowing for a one-time drop in population in 1918–1919. To estimate weekly excess mortality from the pandemic, we estimated a seasonally adjusted weekly time series of district-specific mortality estimates from vital registration records, ranked them, and plotted the ranks on weekly maps to create a picture of the geographic pattern of propagation across Sri Lanka.ResultsTotal loss of population from the influenza pandemic was 307 000 or approximately 6·7% of the population. The pandemic peaked in two discrete (northern and southern) regions in early October of 1918 and in a third (central) region in early March 1919.ConclusionsThe population loss estimate is significantly higher than earlier estimates of mortality from the pandemic in Sri Lanka, suggesting underreporting of influenza-attributable deaths and a role for influenza-related fertility declines. The spatial pattern of peak mortality indicates the presence of two distinct entry points and three distinct epidemiologic regions, defined by population density and ethnicity, in colonial Sri Lanka.

Early assessment of the relationship between the COVID-19 pandemic and births in high-income countries

“…The largest pandemic of the last century, the 1918–1919 H1N1 influenza A pandemic (Spanish flu), caused, in the United States, a decline in birth rates from 23 per 1,000 population in 1918 to 20 per 1,000 in 1919, a 13% drop ( 2 ). As Spanish flu swept the world, comparable effects were recorded in Britain ( 3 ), India ( 4 ), Indonesia ( 5 ), Japan ( 6 ), New Zealand ( 7 ), Norway ( 8 ), Sri Lanka ( 9 ), and Taiwan ( 10 ).…”

The Great Influenza Pandemic of 1918–20: An interpretative survey in the time of COVID-19

“…In New Zealand, the death toll was much higher among the Maori population compared to the non-Maori majority population 17 (Pool 1973;Rice 1988: Chapter 6). In Ceylon (Sri Lanka), indentured labourers and their families in the plantation sector suffered more than the other communities in the country (Chandra and Sarathchandra 2014;Langford and Storey 1992).…”

The COVID-19 Pandemic

“…Such well-known modern pandemics include the plague pandemics of Europe and Russia in the eighteenth century, the tuberculosis pandemic that commenced with the Industrial Revolution in the 1760s and is still continuing (with a resurgence after the emergence of the human immunodeficiency virus and acquired immune deficiency syndrome [HIV/AIDS]), the cholera pandemics of the nineteenth century, the successive influenza pandemics since 1918, and the HIV/AIDS pandemic from 1981 to date. Some of these pandemics badly affected our country too -including major annual outbreaks of cholera from the 1830s until the 1880s (with case fatality rates ranging from 54% to 84% 7 ) and the influenza pandemic of 1918-1919 (which, according to one estimate, killed 6.7% of the country's population 8 ).…”