The Nature editorial cited an “intriguing” 2008 paper, published in the Journal of Infectious Diseases, which examined and reviewed more than 8,400 tissue specimens from 1918–19 influenza fatalities found that the majority of deaths in the influenza pandemic a century ago “likely resulted directly from secondary bacterial pneumonia caused by common upper-respiratory-tract bacteria.”
“There are two hypotheses to explain the 1918 strain’s high lethality: cytokine storms and secondary bacterial infection,” according to a 2018 editorial in Nature.
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