Low but highly variable mortality among nurses and physicians during the influenza pandemic of 1918–1919

BACKGROUND During the 1918-1919 influenza pandemic, nurses and physicians were intensively exposed to the pandemic A/H1N1 strain. There are few published summaries of the mortality experiences of nurses and physicians during the pandemic. METHODS Mortality records from U.S. and British Armies during the First World War and obituary notices in national medical association journals were reviewed to ascertain death notices of nurses and physicians likely to have died of influenza. RESULTS Illness-related mortality among U.S. military nurses (1·05%) was one and one-half times higher than among U.S. medical officers (0·68%), nearly two times higher than among British medical officers (0·55%), and nine times higher than among British nurses (0·12%). Among U.S. nursing officers, mortality was approximately twice as high among those assigned in the United States than in Europe. Among civilian physicians, mortality during the influenza pandemic was markedly increased in Canada, New Zealand, South Africa and the United States but not Australia. CONCLUSIONS During the 1918 pandemic, mortality among nurses and physicians was relatively low compared to their patients and significantly varied across locations and settings. Medical-care providers (particularly U.S. nursing officers) who were new to their assignments when pandemic-related epidemics occurred may have had higher risk of influenza-related mortality because of occupational exposures to bacterial respiratory pathogens that they had not previously encountered.