Historical and clinical aspects of the 1918 H1N1 pandemic in the United States

An Outlook on Harnessing Technological Innovative Competence in Sustainably Transforming African Agriculture

Agricultural value chains worldwide provide essential support to livelihoods, ecosystem services, and the growing bioeconomy. The coronavirus disease 2019 (COVID-19) pandemic slowed down or reversed decades of agricultural growth and exposed the vulnerabilities of farmers and the food insecure in Africa, thus reiterating the need to build resilience, agility, and adaptability for a sustainable agriculture. Existing social, political, environmental, and economic challenges demonstrate that a path to faster sustainable growth is increased productivity through improved input quality, of which technical inputs are a part. This work presents a perspective calling for African innovative competence in technological and methodological applications and solutions as part of the most critical area of a holistic organization for social progress. It finds that while performances of previous agricultural transformation efforts offer insights for future directions, novel pathways fitting to the diversity of situations and contexts on the continent are needed. These may include vertical agriculture in land-constrained regions to grow high-value products, ocean or sea farming in coastal regions, development of multiple-harvesting crops, and self-replicating plants. Developing standards that integrate current scientific methodologies and technologies with indigenous knowledge for agricultural growth and disaster management will bring the complementary benefits of both worlds into optimal development.

Have Diagnostics, Therapies, and Vaccines Made the Difference in the Pandemic Evolution of COVID-19 in Comparison with "Spanish Flu"?

In 1918 many countries, but not Spain, were fighting World War I. Spanish press could report about the diffusion and severity of a new infection without censorship for the first-time, so that this pandemic is commonly defined as "Spanish flu", even though Spain was not its place of origin. "Spanish flu" was one of the deadliest pandemics in history and has been frequently compared with the coronavirus disease (COVID)-19 pandemic. These pandemics share similarities, being both caused by highly variable and transmissible respiratory RNA viruses, and diversity, represented by diagnostics, therapies, and especially vaccines, which were made rapidly available for COVID-19, but not for "Spanish flu". Most comparison studies have been carried out in the first period of COVID-19, when these resources were either not yet available or their use had not long started. Conversely, we wanted to analyze the role that the advanced diagnostics, anti-viral agents, including monoclonal antibodies, and innovative COVID-19 vaccines, may have had in the pandemic containment. Early diagnosis, therapies, and anti-COVID-19 vaccines have markedly reduced the pandemic severity and mortality, thus preventing the collapse of the public health services. However, their influence on the reduction of infections and re-infections, thus on the transition from pandemic to endemic condition, appears to be of minor relevance. The high viral variability of influenza and coronavirus may probably be contained by the development of universal vaccines, which are not easy to be obtained. The only effective weapon still remains the disease prevention, to be achieved with the reduction of promiscuity between the animal reservoirs of these zoonotic diseases and humans.

The Enigma of Lymphocyte Apoptosis in the Response to Influenza Virus Infection

In the pathogenesis of influenza virus infection, lymphocyte apoptosis as a part of the infection and/or the immune response to the virus can be somewhat puzzling. The percentage of human T lymphocytes within the peripheral blood mononuclear cell population that becomes apoptotic greatly exceeds the percentage that are infected after exposure to the virus, consistent with substantial apoptosis of bystander T lymphocytes. Studies reveal an important role of viral neuraminidase expression by co-cultured monocyte/macrophages in induction of apoptosis, including that of uninfected bystander lymphocytes. Despite these observations, it is a reasonable perspective to recognize that the development of lymphocyte apoptosis during the response to infection does not preclude a successful immune response and recovery of the infected host in the great majority of cases. Further investigation is clearly warranted to understand its role in the pathogenesis of influenza virus infection for human subjects.

Narrative review on century of respiratory pandemics from Spanish flu to COVID-19 and impact of nanotechnology on COVID-19 diagnosis and immune system boosting

The rise of the highly lethal severe acute respiratory syndrome-2 (SARS-2) as corona virus 2019 (COVID-19) reminded us of the history of other pandemics that happened in the last century (Spanish flu) and stayed in the current century, which include Severe-Acute-Respiratory-Syndrome (SARS), Middle-East-Respiratory-Syndrome (MERS), Corona Virus 2019 (COVID-19). We review in this report the newest findings and data on the origin of pandemic respiratory viral diseases, reservoirs, and transmission modes. We analyzed viral adaption needed for host switch and determinants of pathogenicity, causative factors of pandemic viruses, and symptoms and clinical manifestations. After that, we concluded the host factors associated with pandemics morbidity and mortality (immune responses and immunopathology, ages, and effect of pandemics on pregnancy). Additionally, we focused on the burdens of COVID-19, non-pharmaceutical interventions (quarantine, mass gatherings, facemasks, and hygiene), and medical interventions (antiviral therapies and vaccines). Finally, we investigated the nanotechnology between COVID-19 analysis and immune system boosting (Nanoparticles (NPs), antimicrobial NPs as antivirals and immune cytokines). This review presents insights about using nanomaterials to treat COVID-19, improve the bioavailability of the abused drugs, diminish their toxicity, and improve their performance.

The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era

The uncontrollable COVID-19 crises in the SARS-CoV-2 high-prevalence areas have greatly disrupted the routine treatment of liver cancer and triggered a role transformation of radiotherapy for liver cancer. The weight of radiotherapy in the treatment algorithm for liver cancer has been enlarged by the COVID-19 pandemic, which is helpful for the optimal risk-benefit profile.

T Cell Epitope Discovery in the Context of Distinct and Unique Indigenous HLA Profiles

CD8⁺ T cells are a pivotal part of the immune response to viruses, playing a key role in disease outcome and providing long-lasting immunity to conserved pathogen epitopes. Understanding CD8⁺ T cell immunity in humans is complex due to CD8⁺ T cell restriction by highly polymorphic Human Leukocyte Antigen (HLA) proteins, requiring T cell epitopes to be defined for different HLA allotypes across different ethnicities. Here we evaluate strategies that have been developed to facilitate epitope identification and study immunogenic T cell responses. We describe an immunopeptidomics approach to sequence HLA-bound peptides presented on virus-infected cells by liquid chromatography with tandem mass spectrometry (LC-MS/MS). Using antigen presenting cell lines that stably express the HLA alleles characteristic of Indigenous Australians, this approach has been successfully used to comprehensively identify influenza-specific CD8⁺ T cell epitopes restricted by HLA allotypes predominant in Indigenous Australians, including HLA-A*24:02 and HLA-A*11:01. This is an essential step in ensuring high vaccine coverage and efficacy in Indigenous populations globally, known to be at high risk from influenza disease and other respiratory infections.

The Continued Threat of Influenza A Viruses

Influenza A virus (IAV) is a major cause of respiratory infections worldwide, with the most severe cases occurring in the very young and in elderly individuals [...]

New endemic and pandemic pathologies with interhuman airborne transmission through ear, nose and throat anatomical sites

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has once again stigmatised the importance of airborne pathogens and their clinical, social and public health impact. Respiratory viruses are transmitted between individuals when the pathogen is released from the upper airways or from the lower respiratory tract of an infected individual. Airborne transmission is defined as the inhalation of the infectious aerosol, named droplet nuclei which size is smaller than 5 mm and that can be inhaled at a distance up to 2 metres. This route of transmission is relevant for viral respiratory pathogens, including severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)-CoV, influenza virus, human rhinovirus, respiratory syncytial virus (RSV) and other respiratory virus families that differ in viral and genomic structures, susceptibility of a population to the infection, severity, transmissibility, ways of transmission and seasonal recurrence. Human respiratory viruses generally infect cells of the upper respiratory tract, eliciting respiratory signs and symptoms, sometimes without the possibility to differentiate them clinically. As seen by the current Coronavirus Disease 2019 (COVID-19) pandemic, human respiratory viruses can substantially contribute to increased morbidity and mortality, economic losses and, eventually, social disruption. In this article, we describe the structural, clinical and transmission aspects of the main respiratory viruses responsible for endemic, epidemic and pandemic infections.

Déjà vu all over again: racial, ethnic and age disparities in mortality from influenza 1918-19 and COVID-19 in the United States

Background

Examination of the mortality patterns in the United States among racial, ethnic, and age groups attributed to the 1918–19 influenza pandemic revealed stark disparities, causes for which could have been addressed and rectified this past century. However, these disparities have been amplified during the current COVID-19 pandemic.

We have ignored the lessons of the past, and were destined to repeat its failings.

Objectives

Compare and contrast mortality patterns by age, race, and ethnicity attributable to the 1918–19 influenza pandemic in the United States with corresponding patterns during the COVID-19 pandemic.

Methods

This is a retrospective study, establishing mortality rates according to age, race and ethnicity attributable to the 1918–19 influenza pandemic in the United States and to the current COVID-19 pandemic, using mortality data published by the U.S. Public Health Service and the Centers for Disease Control and Prevention. Negative binomial regression models were used to establish rate ratios, that is, ratios of mortality rates across the various racial/ethnic groups, and associated 95% confidence intervals.

Results

Mortality patterns by age differ significantly between the 1918–19 influenza pandemic and the COVID-19 pandemic: with infant and young adult (25–40 years old) mortality substantially higher in the former. Disparities in mortality between racial and ethnic groups are amplified in the COVID-19 pandemic compared to the 1918–19 experience.

Conclusions

As we evaluate our nation's response to COVID-19 and design public policy to prepare better for coming pandemics, we cannot ignore the stark disparities in mortality rates experienced by different racial and ethnic groups. This will require a sustained resolve by society and government to delineate and remedy the causative factors, through science devoid of political interpretation and exploitation.

Clinical data to be used as a foundation to combat Covid-19 vaccine hesitancy

The coronavirus has become the paramount subject in peoples' lives, affecting and disrupting virtually every aspect of society, as the pandemic casts a shadow over the world. The facts, myths, and conspiracy theories centered on the Covid-19 pandemic have dominated social media accounts, local and national newspapers, as well as television programs. Strategies need to be evolved to counter Covid-19 vaccine hesitancy and mitigate health disparities in at-risk populations. Overcoming misinformation and distrust will require an interdisciplinary approach to deal with Covid-19. The purpose of this review is to offer a factual basis to all healthcare providers to assist in framing strategies to mitigate vaccine hesitancy and achieve herd immunity to combat the deadly Covid-19 pandemic. First an overview of the discovery of the viruses and their molecular structures will be presented. Secondly, a historical perspective is offered, comparing the differences between the 1918 flu pandemic and the current covid-19 pandemic. Lastly, an overview for proposed techniques and methods to counter and or mitigate covid-19 vaccine misinformation that may be used by an interdisciplinary team will be offered narratively and graphically.

Impact of 1918 influenza pandemic on mental asylums in India: An analysis of asylum reports

INTRODUCTION

Not much is known about impact of 1918 Influenza on patients confined inside mental asylums of that period.

AIM AND METHODS

The study aimed to assess impact of Influenza pandemic on mentally ill patients in asylums, based on data extracted from provincial asylum reports (1915-1923) from British India.

RESULTS

The asylum population in most provinces was impacted both in terms of direct mortality (1918) as well as all-cause morbidity and mortality (1918; 1918-1920). Agra and Oudh lost 9.5% of average daily asylum strength directly due to influenza in 1918. All-cause mortality (1918) was highest for mental asylum/s in provinces of Agra and Oudh (16.83%), Punjab (14.83%), and Bombay (14.4%). Isolated outbreaks continued till 1923. Another peculiar finding was markedly reduced sickness and death rates in 1921-1923 compared to 1915-1917, across asylums of all provinces.

CONCLUSION

Findings point to a significant impact of Influenza pandemic in mental asylums across several provinces, and provide historical insights with implications for the current pandemic.

Responses against infectious disease pandemics: a narrative review on COVID-19

Currently, the world is facing the coronavirus disease 2019 (COVID-19) pandemic. With this, an emerging infectious disease pandemic in the absence of effective antiviral agents and vaccines for a novel virus is no different from the 1918 influenza pandemic, which became a great disaster for humankind. We also experienced a global lockdown with a stringent implementation of social distancing, which is a first for mankind living in the present day, and has led to enormous economic damage and restrictions on individual freedom. The microorganism that will cause the next pandemic may be a highly fatal avian influenza virus, another coronavirus, or a completely different microorganism. This COVID-19 pandemic is an enormous lesson for humankind and is tantamount to a vaccine in preparation for the next pandemic. Important and urgent undertakings were given to each country in terms of complementing laws and regulations for a stronger and more resilient healthcare system, such as investment in research and development for new rapid diagnostic technologies, vaccines, new therapeutic agents, among others.

Are Pandemics Gender Neutral? Women's Health and COVID-19

In December 2019, coronavirus disease 2019 (COVID-19) emerged as a health crisis in Wuhan, China, and was later declared by the World Health Organization (WHO) as a Public Health Emergency of International Concern. As it spread and its death toll increased, on the 11th of March 2020 it was declared a pandemic at 4,369 deaths worldwide, and cases and deaths have since surged. With gender disparities already known to leave women and their health at the margins of society during outbreaks, it is important to understand how COVID-19 affects women's health. In this article, we discuss how the COVID-19 pandemic can create vulnerabilities for women and their health and further exacerbate long-existing inequalities and social disparities. These include gender-based roles, economic and food security, violence, work pressure, and access to health and healthcare facilities. These issues have significant repercussions on the physical and mental health of women. To focus our lenses on these issues, we draw lessons from three specific examples of past outbreaks: 1918 Flu pandemic, Zika virus disease, and Ebola virus disease. We conclude by stating how public health responses and strategies for COVID-19 can be inclusive to women's health.

Riboflavin as a Mucosal Adjuvant for Nasal Influenza Vaccine

Intranasal immunization with whole inactivated virus (WIV) is an important strategy used for influenza prevention and control. However, a powerful mucosal adjuvant is required to improve nasal vaccine efficacy. Riboflavin, as a food additive with the advantages of being safe and low-cost, widely exists in living organisms. In this paper, the mucosal adjuvant function of riboflavin was studied. After intranasal immunization with H1N1 WIV plus riboflavin in mice, we found that the mucosal immunity based on the secretory IgA (sIgA) levels in the nasal cavity, trachea, and lung were strongly enhanced compared with H1N1 WIV alone. Meanwhile, the IgG, IgG1, and IgG2a levels in serum also showed a high upregulation and a decreased ratio of IgG1/IgG2a, which implied a bias in the cellular immune response. Moreover, riboflavin strongly improved the protection level of H1N1 inactivated vaccine from a lethal influenza challenge. Furthermore, riboflavin was found to possess the capacity to induce dendritic cell (DC) phenotypic (MHCII, CD40, CD80, and CD86) and functional maturation, including cytokine secretion (TNF-α, IL-1β, IL-12p70, and IL-10) and the proliferation of allogeneic T cells. Lastly, we found that the DC maturation induced by riboflavin was dependent on the activation of the mitogen-activated protein kinase (MAPK) signaling pathway, which plays an important role in immune regulation. Therefore, riboflavin is expected to be developed as an alternative mucosal adjuvant for influenza nasal vaccine application.

Epidemics, pandemics, and social conflict: Lessons from the past and possible scenarios for COVID-19

Since COVID-19 broke out, there has been renewed interest in understanding the economic and social dynamics of historical and more recent epidemics and pandemics, from the plagues of Antiquity to modern-day outbreaks like Ebola. These events can have significant impacts on the interplay between poverty and social cohesion, i.e. how different groups in society interact and cooperate to survive and prosper. To that effect, this paper provides a theory-driven overview of how social responses to past epidemics and pandemics were determined by the epidemiological and non-epidemiological characteristics of these outbreaks, with a particular focus on the conditions giving rise to scapegoating and persecution of minority groups, including migrants. We discuss existing theories as well as historical and quantitative studies, and highlight the cases where epidemics and pandemics may lead to milder or more severe forms of scapegoating. Finally, we conclude with a summary of priorities for future research on epidemics, pandemics and social conflict and discuss the possible effects and policy implications of COVID-19.

An Overview of Influenza Viruses and Vaccines

Influenza remains one of the major public health concerns because it causes annual epidemics and can potentially instigate a global pandemic. Numerous countermeasures, including vaccines and antiviral treatments, are in use against seasonal influenza infection; however, their effectiveness has always been discussed due to the ongoing resistance to antivirals and relatively low and unpredictable efficiency of influenza vaccines compared to other vaccines. The growing interest in vaccines as a promising approach to prevent and control influenza may provide alternative vaccine development options with potentially increased efficiency. In addition to currently available inactivated, live-attenuated, and recombinant influenza vaccines on the market, novel platforms such as virus-like particles (VLPs) and nanoparticles, and new vaccine formulations are presently being explored. These platforms provide the opportunity to design influenza vaccines with improved properties to maximize quality, efficacy, and safety. The influenza vaccine manufacturing process is also moving forward with advancements relating to egg- and cell-based production, purification processes, and studies into the physicochemical attributes and vaccine degradation pathways. These will contribute to the design of more stable, optimized vaccine formulations guided by contemporary analytical testing methods and via the implementation of the latest advances in the field.

Pandemics Throughout the History

As we move amidst the coronavirus disease 2019 (COVID-19) pandemic, we have witnessed tremendous distress, death, and turmoil of everyday life for more than one year now. However, they are not modern phenomena; deadly pandemics have happened throughout recorded history. Pandemics such as the plague, Spanish Flu, HIV, and Ebola caused deaths, destruction of political regimes, as well as financial and psychosocial burdens. However, they sometimes resulted in scientific discoveries. Understanding the mechanism of the emergence of these pandemics is crucial to control any spreading pandemic and prevent the emergence of a potential new one. Public health agencies need to work on improving the countries' pandemic preparedness to prevent any future pandemics. The review article aims to shed light on some of the deadliest pandemics throughout history, information of critical importance for clinicians and researchers.

M2e conjugated gold nanoparticle influenza vaccine displays thermal stability at elevated temperatures and confers protection to ferrets

Currently approved influenza vaccines are not only limited in breadth of protection but also have a limited shelf-life of 12-18 months when stored under appropriate conditions (2-8 °C). Inadvertent alteration in storage temperatures during manufacturing, transportation, distribution until delivery to patient, can damage the vaccine thus reducing its efficacy. A thermally stable vaccine can decrease the economic burden by reducing reliance on refrigeration system and can also enhance outreach of the vaccination program by allowing transportation to remote areas of the world where refrigerated conditions are scarce. We have previously developed a broadly protective influenza A vaccine by coupling the highly conserved extracellular region of the matrix 2 protein (M2e) of influenza A virus to gold nanoparticles (AuNPs) and upon subsequent addition of toll-like receptor 9 agonist - CpG, as an adjuvant, have shown its breadth of protection in a mouse model. In this study, we show that the vaccine is thermally stable when stored at 4 °C for 3 months, 37 °C for 3 months and 50 °C for 2 weeks in its lyophilized form, and later it was possible to readily reconstitute it in water without aggregation. Intranasal vaccination of mice using reconstituted vaccine induced M2e-specific IgG and IgG subtypes in serum similar to the freshly formulated vaccine, and fully protected mice against lethal influenza A challenge. Immunization of ferrets intranasally or intramuscularly with the vaccine induced M2e-specific IgG and there was reduced virus level in nasal wash of ferrets immunized through intranasal route.

Sensitive pH-responsive point-of-care electrochemical immunoassay for influenza A (H1N1) virus using glucose oxidase-functionalized Ti3C2-MXene nanosheets

Influenza A (H1N1) virus is a serious health threat and potential leading cause of death around the world during the processes of immunity and inflammation. Herein a sensitive pH-responsive point-of-care (POC) electrochemical immunoassay was designed for the quantitative monitoring of H1N1 influenza virus using glucose oxidase (GOx) and secondary antibody-functionalized Ti₃C₂-MXene nanosheets. The assay was carried out on the basis of the sandwich-type immunoreaction in the capture antibody-coated microplate. Two-dimensional (2D) Ti₃C₂-MXene nanosheets with a large surface area could efficiently enhance the loading amount of GOx molecules, thereby resulting in the signal amplification. Accompanying the formed immunocomplexes, labeled GOx molecules catalyzed glucose into gluconic acid and hydrogen peroxide. The generated gluconic acid caused a pH change of the detection solution, which was quantitatively determined on a handheld pH meter. Two labeling strategies with and without Ti₃C₂-MXene nanosheets were investigated to determine the target H1N1 influenza virus, and improved properties were acquired with the Ti₃C₂-MXene-labeled system. Under optimum conditions, the Ti₃C₂-MXene-based immunoassay gave good dynamic responses toward the target H1N1 influenza virus from 0.01 μg mL^-1 to 100 μg mL^-1 with a detection limit of 1.3 ng mL^-1. Good reproducibility, high specificity, and acceptable stability were also achieved in the analysis of the target H1N1 influenza virus. Significantly, measurements of the H1N1 influenza virus from clinical human samples were demonstrated to further confirm the method reliability and accuracy of the Ti₃C₂-MXene-based electrochemical immunoassay. Importantly, such a pH-meter-based immunoassay can be suitable for use in point-of-care applications and opens new opportunities for diagnostics.

Death, demography and the denominator: Age-adjusted Influenza-18 mortality in Ireland

Using the Irish experience of the 1918-1919 Spanish flu pandemic ("Influenza-18"), we demonstrate how pandemic mortality statistics can be sensitive to the demographic composition of a country. We build a new spatially disaggregated population database for Ireland's 32 counties for 1911-1920 with vital statistics on births, ageing, migration and deaths. Our principal contribution is to show why, and how, age-at-death data should be used to construct the age-standardised statistics necessary to make meaningful comparisons of mortality rates across time and space. We conclude that studies of the economic consequences of pandemics must better control for demographic factors if they are to yield useful policy-relevant insights. For example, while Northern Ireland had a higher crude death rate during the first wave of the Covid-19 pandemic, it also has an older population; age-adjusted mortality paints a very different picture.

Antiviral Activity of Isoimperatorin Against Influenza A Virus in vitro and its Inhibition of Neuraminidase

Influenza A virus (IAV) poses a severe threat to human health and is a major public health problem worldwide. As global anti-influenza virus drug resistance has increased significantly, there is an urgent need to develop new antiviral drugs, especially drugs from natural products. Isoimperatorin, an active natural furanocoumarin, exhibits a broad range of pharmacologic activities including anticoagulant, analgesic, anti-inflammatory, antibacterial, anti-tumor, and other pharmacological effects, so it has attracted more and more attention. In this study, the antiviral and mechanistic effects of isoimperatorin on influenza A virus in vitro were studied. Isoimperatorin illustrated a broad-spectrum antiviral effect, especially against the A/FM/1/47 (H1N1), A/WSN/33 (H1N1, S31N, amantadine resistant), A/Puerto Rico/8/34 (H1N1), and A/Chicken/Guangdong/1996 (H9N2) virus strains. The experimental results of different administration modes showed that isoimperatorin had the best antiviral activity under the treatment mode. Further time-of-addition experiment results indicated that when isoimperatorin was added at the later stage of the virus replication cycle (6–8 h, 8–10 h), it exhibited an effective antiviral effect, and the virus yield was reduced by 81.4 and 84.6%, respectively. In addition, isoimperatorin had no effect on the expression of the three viral RNAs (mRNA, vRNA, and cRNA). Both the neuraminidase (NA) inhibition assay and CETSA demonstrated that isoimperatorin exerts an inhibitory effect on NA-mediated progeny virus release. The molecular docking experiment simulated the direct interaction between isoimperatorin and NA protein amino acid residues. In summary, isoimperatorin can be used as a potential agent for the prevention and treatment of influenza A virus.

Robust and secured telehealth system for COVID-19 patients

The demand for Telehealth is rapidly increasing worldwide. Digital solutions in the current epidemic are revealing the powers and flaws of current Telehealth infrastructures. Telehealth brings remote access to medical facilities and covering the extent of physicians and health services. The outbreak of COVID-19 emphasizes the necessity for timely tracking of persons who are infected, and preferably, their connections. Telehealth facilities are speedily becoming a frontline force in the struggle to lessen healthcare-linked COVID-19 spreads, and eventually shielding healthcare professional. Whereas telehealth can substitute competence and accessibility, its dependence on real-time communication of medical records over the cloud also generates danger. At each phase of the practice, hostile measures may happen, together with diagnostic blunders, technical problems, and patient confidentiality and safety defilements. This paper developed a highly secure and robust decoder for the Telehealth model to monitor the patients' vital signs and psychological signals. The proposed Telehealth system reduced the transmission power and congestion on the database and ensured secured reliable data at the receiving end.

COVID-19: The Lessons We Should Have Learned from Existing Literature

The linkages between natural resources and human well-being lie at the heart of biophysical economics. Huge disruptions to human well-being which can occur as a result of the impact of particular natural resources or species are, or should be, an obvious focus of interest for the biophysical economist whose focus is on flows between the natural world and human society. The causes and consequences of such disruptions, such as emanate from pandemics and epidemics, are a clear example of this. There is a need for better understanding of these causes and consequences. As an example, twelve books on epidemics and pandemics are considered here as providing the core for what guidance they might, and should, have provided on the sources, spreaders, and responses to COVID-19. A substantial amount of guidance is given in these and other sources referenced, which if followed would have reduced spread and mortality, but in far too many countries preparedness and speed of responses were inadequate. An effective global network and funding are required, as long advocated, but still not implemented. The economic and resource costs of this failure are huge.

Surgical Critical Care at the Epicenter of the COVID-19 Pandemic

The number of deaths and infected people by Corona-19 virusin 2020 around the world is alarming and numbing at the same time. It almostdifficult to remember when the world was normal, although it just started fewmonths ago. Our world and everything around have changed, our surgical practicehas changed, our life has changed, but Intensive Care Units (ICU)in WestchesterMedical center in Valhalla, NY, continue to care for the sickest of thesickest. But this time, different disease with different prognosis. Everycritical care specialist, every surgery resident and surgical critical carefellow, are COVID-19 doctors. As I round in the ICU, I imagine myself in one ofthose beds that I could have been few weeks ago. Now, fully recovered fromCOVID-19, and coming back to work is a real treat. Yet, I still have morequestions than answers.

The 1918 "Spanish Flu" Pandemic in the Ottoman Capital, Istanbul

Although the general course, possible transmission routes, and actual sociodemographic destruction of the 1918 influenza pandemic in the Western world are well documented, the literature lacks similar data about the Middle East. On the calamity's centenary, this article aims to contribute to filling this gap, investigating the presence and effects of the pandemic in Istanbul, the city bridging the West and East, then as the capital of the Ottoman Empire. After the retrieval of the most relevant articles in Vakit, a daily Istanbul newspaper active throughout the pandemic, a variety of items, including articles with firsthand pronouncements from contemporaneous medical authorities and a clinical account of supportive autopsy findings, are scrutinized and interpreted. The reviewed data are concluded to indicate no epidemiological or factual exception, showing significant parallelism with the Western experience of the pandemic in terms of increased influenza mortality and morbidity, severe clinical presentation, common misinformation and misdiagnosis, and failure to provide effective prevention and medical treatment.