In fall of 1918 the United States experiences a severe shortages of professional nurses, because of the deployment of large numbers of nurses to military camps in the United States and abroad, and the failure to use trained African American nurses.  After this, death would follow within hours or days due to the lungs being filled with fluids. 66 s. ill. (Haukeland sykehus. _____ First, the numbers. , There were also geographic patterns to the disease's fatality. , The second wave began in the second half of August, probably spreading to Boston and Freetown, Sierra Leone, by ships from Brest, where it had likely arrived with American troops or French recruits for naval training. Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD), The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus, Allocating & Targeting Pandemic Influenza Vaccine, Vaccination of Tier 1 at All Pandemic Severities, Implementation of this Guidance during a Future Pandemic, Vaccination Tier 2 through 5 by Pandemic Severity, Next Steps for the U.S. Government, States, and Communities, Regulations and Laws That May Apply During a Pandemic, Surveillance, Epidemiology and Laboratory, Vaccine and Other Medical Countermeasures, Healthcare System Preparedness and Response, PanVax Tool for Pandemic Vaccination Planning, U.S. Department of Health & Human Services. In order to determine the cause of the death during the pandemic, war scientists used the Commonwealth War Graves Commission (CWGC), which reported under 2 million men and women died during the wars, with record of those who died from 1917 to 1918. , In Britain, as many as 250,000 died; in France, more than 400,000. By the time three waves of Spanish flu swept across the globe in 1918 and 1919, at least 50 million people were dead, including 675,000 Americans. Outbreaks of flu-like illness are first detected in the United States. Some communities closed all stores or required customers to leave orders outside. It was caused by an H1N1 virus with genes of avian origin. , Records indicate the most deaths during the first wave of the pandemic were among young men in their 20s, which reflects the age of enlistment in the war. The report informs officials of 18 severe cases and three deaths in Haskell, Kansas.  By the end of the pandemic, the isolated island of Marajó, in Brazil's Amazon River Delta had not reported an outbreak.  It primarily affected Spain, Serbia, Mexico and Great Britain, resulting in hundreds of thousands of deaths. Worobey extracted tissue from the slides to potentially reveal more about the origin of the pathogen. , Many businesses in the entertainment and service industries suffered losses in revenue, while the healthcare industry reported profit gains. The first confirmed cases originated in the United States. Many scholars have noted that tuberculosis increased the mortality rate of the influenza in males, decreasing their life expectancy. In the Four Corners area, there were 3,293 registered deaths among Native Americans. The first wave was very much like the virus we are having right now.  Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene, all exacerbated by the recent war, promoted bacterial superinfection. 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