title: Munich

text: Some notable nightclubs are: popular techno clubs are Blitz Club, "Harry Klein", "Rote Sonne", Bahnwärter Thiel, "Pimpernel", "Charlie", "Palais" and "Pathos". Popular mixed music clubs are "Call me Drella", "Wannda Circus", "Tonhalle", "Backstage", "Muffathalle", "Ampere", "Pacha", "P1", Zenith, "Minna Thiel" and the party ship Alte Utting. Some notable bars (pubs are located all over the city) are "Schumann's Bar", "Havana Club", "Sehnsucht", "Bar Centrale", "Holy Home", "Negroni", "Die Goldene Bar" and "Bei Otto".


title: Munich

text: Munich is a leading location for science and research with a long list of Nobel Prize laureates from Wilhelm Conrad Röntgen in 1901 to Theodor Hänsch in 2005. Munich has become a spiritual centre already since the times of Emperor Louis IV when philosophers like Michael of Cesena, Marsilius of Padua and William of Ockham were protected at the emperor's court. The Ludwig Maximilian University (LMU) and the Technische Universität München (TUM), were two of the first three German universities to be awarded the title "elite university" by a selection committee composed of academics and members of the Ministries of Education and Research of the Federation and the German states (Länder). Only the two Munich universities and the Technical University of Karlsruhe (now part of Karlsruhe Institute of Technology) have held this honour, and the implied greater chances of attracting research funds, since the first evaluation round in 2006.


title: Munich

text: The Max Planck Society, an independent German non-profit research organisation, has its administrative headquarters in Munich. The following institutes are located in the Munich area:


title: Munich

text: The Fraunhofer Society, the German non-profit research organization for applied research, has its headquarters in Munich. The following institutes are located in the Munich area:


title: Munich

text: Munich has the strongest economy of any German city according to a study and the lowest unemployment rate (5.4% in July 2020) of any German city of more than a million people (the others being Berlin, Hamburg and Cologne). Munich ranks third on the list of German cities by gross domestic product (GDP). In addition, it is one of the most attractive business locations in Germany. The city is also the economic centre of southern Germany. Munich topped the ranking of the magazine "Capital" in February 2005 for the economic prospects between 2002 and 2011 in 60 German cities.


title: Munich

text: Munich is a financial center and global city that holds the headquarters of many companies. This includes more companies listed by the DAX than any other German city, as well as the German or European headquarters of many foreign companies such as McDonald's and Microsoft. One of the best-known newly established Munich companies is Flixbus.


title: Munich

text: Munich holds the headquarters of Siemens AG (electronics), BMW (car), MAN AG (truck manufacturer, engineering), MTU Aero Engines (aircraft engine manufacturer), Linde (gases) and Rohde & Schwarz (electronics). Among German cities with more than 500,000 inhabitants, purchasing power is highest in Munich (€26,648 per inhabitant) . In 2006, Munich blue-collar workers enjoyed an average hourly wage of €18.62 (ca. $20).


title: Munich

text: The breakdown by cities proper (not metropolitan areas) of Global 500 cities listed Munich in 8th position in 2009. Munich is also a centre for biotechnology, software and other service industries. Furthermore, Munich is the home of the headquarters of many other large companies such as the injection moulding machine manufacturer Krauss-Maffei, the camera and lighting manufacturer Arri, the semiconductor firm Infineon Technologies (headquartered in the suburban town of Neubiberg), lighting giant Osram, as well as the German or European headquarters of many foreign companies such as Microsoft.


title: Munich

text: Munich has significance as a financial centre (second only to Frankfurt), being home of HypoVereinsbank and the Bayerische Landesbank. It outranks Frankfurt though as home of insurance companies such as Allianz (insurance) and Munich Re (re-insurance).


title: Munich

text: Munich is the largest publishing city in Europe and home to the "Süddeutsche Zeitung", one of Germany's biggest daily newspapers. The city is also the location of the programming headquarters of Germany's largest public broadcasting network, ARD, while the largest commercial network, Pro7-Sat1 Media AG, is headquartered in the suburb of Unterföhring. The headquarters of the German branch of Random House, the world's largest publishing house, and of Burda publishing group are also in Munich.


title: Munich

text: The Bavaria Film Studios are located in the suburb of Grünwald. They are one of Europe's biggest film production studios.


title: Munich

text: Most Munich residents enjoy a high quality of life. Mercer HR Consulting consistently rates the city among the top 10 cities with the highest quality of life worldwide – a 2011 survey ranked Munich as 4th. In 2007 the same company also ranked Munich as the 39th most expensive in the world and most expensive major city in Germany. Munich enjoys a thriving economy, driven by the information technology, biotechnology, and publishing sectors. Environmental pollution is low, although the city council is concerned about levels of particulate matter (PM), especially along the city's major thoroughfares. Since the enactment of EU legislation concerning the concentration of particulate in the air, environmental groups such as Greenpeace have staged large protest rallies to urge the city council and the State government to take a harder stance on pollution. Due to the high standard of living in and the thriving economy of the city and the region, there was an influx of people and Munich's population surpassed 1.5 million by June 2015, an increase of more than 20% in 10 years.


title: Munich

text: Munich has an extensive public transport system consisting of an underground metro, trams, buses and high-speed rail. In 2015, the transport modal share in Munich was 38 percent public transport, 25 percent car, 23 percent walking, and 15 percent bicycle. Its public transport system delivered 566 million passenger trips that year. Munich is the hub of a well-developed regional transportation system, including the second-largest airport in Germany and the Berlin–Munich high-speed railway, which connects Munich to the German capital city with a journey time of about 4 hours. The trade fair transport logistic is held every two years at the "Neue Messe München" (Messe München International). Flixmobility which offers intercity coach service is headquartered in Munich.


title: Munich

text: For its urban population of 2.6 million people, Munich and its closest suburbs have a comprehensive network of public transport incorporating the Munich U-Bahn (underground railway), the Munich S-Bahn (suburban trains), trams and buses. The system is supervised by the Munich Transport and Tariff Association ("Münchner Verkehrs- und Tarifverbund GmbH"). The Munich tramway is the oldest existing public transportation system in the city, which has been in operation since 1876. Munich also has an extensive network of bus lines.


title: Munich

text: The extensive network of subway and tram lines assists and complement pedestrian movement in the city centre. The 700m-long Kaufinger Straße, which starts near the Main train station, forms a pedestrian east–west spine that traverses almost the entire centre. Similarly, Weinstraße leads off northwards to the Hofgarten. These major spines and many smaller streets cover an extensive area of the centre that can be enjoyed on foot and bike. The transformation of the historic area into a pedestrian priority zone enables and invites walking and biking by making these active modes of transport comfortable, safe and enjoyable. These attributes result from applying the principle of "filtered permeability", which selectively restricts the number of roads that run through the centre. While certain streets are discontinuous for cars, they connect to a network of pedestrian and bike paths, which permeate the entire centre. In addition, these paths go through public squares and open spaces increasing the enjoyment of the trip (see image). The logic of filtering a mode of transport is fully expressed in a comprehensive model for laying out neighbourhoods and districts – the Fused Grid.


title: Munich

text: The average amount of time people spend commuting to and from work with public transit in Munich on a weekday is 56 min. 11% of public transit users, spend more than two hours travelling each day. The average amount of time people wait at a stop or station for public transit is ten minutes, whilst 6% of passengers wait for over twenty minutes on average every day. The average distance people usually ride in a single trip with public transit is 9.2 km, while 21% travel for over 12 km in a single direction.


title: Munich

text: Cycling has a strong presence in the city and is recognised as a good alternative to motorised transport. The growing number of bicycle lanes are widely used throughout the year. Cycle paths can be found alongside the majority of sidewalks and streets, although the newer and/or renovated ones are much easier to tell apart from pavements than older ones. The cycle paths usually involve a longer route than by the road, as they are diverted around objects, and the presence of pedestrians can make them quite slow.


title: Munich

text: München Hauptbahnhof is the main railway station located in the city centre and is one of three long-distance stations in Munich, the others being München Ost (to the east) and München-Pasing (to the west). All stations are connected to the public transport system and serve as transportation hubs.


title: Munich

text: München Hauptbahnhof serves about 450,000 passengers a day, which puts it on par with other large stations in Germany, such as Hamburg Hauptbahnhof and Frankfurt Hauptbahnhof. It and München Ost are two of the 21 stations in Germany classified by Deutsche Bahn as a category 1 station. The mainline station is a terminal station with 32 platforms. The subterranean S-Bahn with 2 platforms and U-Bahn stations with 6 platforms are through stations.


title: Munich

text: ICE highspeed trains stop at Munich-Pasing and Munich-Hauptbahnhof only. InterCity and EuroCity trains to destinations east of Munich also stop at Munich East. Since 28 May 2006 Munich has been connected to Nuremberg via Ingolstadt by the Nuremberg–Munich high-speed railway line. In 2017, the Berlin–Munich high-speed railway opened, providing a journey time of less than 4 hours between the two German cities.


title: Munich

text: Munich is an integral part of the motorway network of southern Germany. Motorways from Stuttgart (W), Nuremberg, Frankfurt and Berlin (N), Deggendorf and Passau (E), Salzburg and Innsbruck (SE), Garmisch Partenkirchen (S) and Lindau (SW) terminate at Munich, allowing direct access to the different parts of Germany, Austria and Italy.


title: Munich

text: Traffic, however, is often very heavy in and around Munich. Traffic jams are commonplace during rush hour as well as at the beginning and end of major holidays in Germany. There are few "green waves" or roundabouts, and the city's prosperity often causes an abundance of obstructive construction sites. Other contributing factors are the extraordinarily high rates of car ownership per capita (multiple times that of Berlin), the city's historically grown and largely preserved centralised urban structure, which leads to a very high concentration of traffic in specific areas, and sometimes poor planning (for example bad traffic light synchronisation and a less than ideal ring road).


title: Munich

text: Franz Josef Strauss International Airport (IATA: MUC, ICAO: EDDM) is the second-largest airport in Germany and seventh-largest in Europe after London Heathrow, Paris Charles de Gaulle, Frankfurt, Amsterdam, Madrid and Istanbul Atatürk. It is used by about 46 million passengers a year, and lies some north east of the city centre. It replaced the smaller Munich-Riem airport in 1992. The airport can be reached by suburban train lines from the city. From the main railway station the journey takes 40–45 minutes. An express train will be added that will cut down travel time to 20–25 minutes with limited stops on dedicated tracks. A magnetic levitation train (called Transrapid), which was to have run at speeds of up to from the central station to the airport in a travel time of 10 minutes, had been approved, but was cancelled in March 2008 because of cost escalation and after heavy protests. Lufthansa opened its second hub at the airport when Terminal 2 was opened in 2003.


title: Munich

text: In 2008, the Bavarian state government granted a licence to expand Oberpfaffenhofen Air Station located west of Munich, for commercial use. These plans were opposed by many residents in the Oberpfaffenhofen area as well as other branches of local Government, including the city of Munich, which took the case to court. However, in October 2009, the permit allowing up to 9725 business flights per year to depart from or land at Oberpfaffenhofen was confirmed by a regional judge.


title: Munich

text: Despite being from Munich, Memmingen Airport has been advertised as Airport Munich West. After 2005, passenger traffic of nearby Augsburg Airport was relocated to Munich Airport, leaving the Augsburg region of Bavaria without an air passenger airport within close reach.


title: Munich

text: The Munich agglomeration sprawls across the plain of the Alpine foothills comprising about 2.6 million inhabitants. Several smaller traditional Bavarian towns and cities like Dachau, Freising, Erding, Starnberg, Landshut and Moosburg are today part of the Greater Munich Region, formed by Munich and the surrounding districts, making up the Munich Metropolitan Region, which has a population of about 6 million people.


title: Munich

text: South of Munich, there are numerous nearby freshwater lakes such as Lake Starnberg, Ammersee, Chiemsee, Walchensee, Kochelsee, Tegernsee, Schliersee, Simssee, Staffelsee, Wörthsee, Kirchsee and the Osterseen (Easter Lakes), which are popular among Munich residents for recreation, swimming and watersports and can be quickly reached by car and a few also by Munich's S-Bahn.


title: Spanish flu

text: The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was March 1918 in Kansas, United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17 million to 50 million, and possibly as high as 100 million, making it one of the deadliest pandemics in history.


title: Spanish flu

text: The pandemic broke out near the end of World War I, when wartime censors suppressed bad news in the belligerent countries to maintain morale, but newspapers freely reported the outbreak in neutral Spain, creating a false impression of Spain as the epicenter and leading to the "Spanish flu" misnomer. Limited historical epidemiological data make the pandemic's geographic origin indeterminate, with competing hypotheses on the initial spread.


title: Spanish flu

text: Most influenza outbreaks disproportionately kill the young and old, with a higher survival rate in-between, but this pandemic had unusually high mortality for young adults. Scientists offer several explanations for the high mortality, including a six-year climate anomaly affecting migration of disease vectors with increased likelihood of spread through bodies of water. The virus was particularly deadly because it triggered a cytokine storm, ravaging the stronger immune system of young adults, although the viral infection was apparently no more aggressive than previous influenza strains. Malnourishment, overcrowded medical camps and hospitals, and poor hygiene, exacerbated by the war, promoted bacterial superinfection, killing most of the victims after a typically prolonged death bed.


title: Spanish flu

text: The 1918 Spanish flu was the first of three flu pandemics caused by H1N1 influenza A virus; the most recent one was the 2009 swine flu pandemic. The 1977 Russian flu was also caused by H1N1 virus.


title: Spanish flu

text: This pandemic was known by many different names—some old, some new—depending on place, time, and context. The etymology of alternative names historicises the scourge and its effects on people who would only learn years later that invisible viruses caused influenza. This lack of scientific answers led the "Sierra Leone Weekly News" (Freetown) to suggest a biblical framing in July 1918, using an interrogative from Exodus 16 in ancient Hebrew: "One thing is for certain—the doctors are at present flabbergasted; and we suggest that rather than calling the disease influenza they should for the present until they have it in hand, say —'What is it?'"


title: Spanish flu

text: Outbreaks of influenza-like illness were documented in 1916–17 at British military hospitals in Étaples, France, and just across the English Channel at Aldershot, England. Clinical indications in common with the 1918 pandemic included rapid symptom progression to a "dusky" heliotrope cyanosis of the face. This characteristic blue-violet cyanosis in expiring patients led to the name 'purple death'.


title: Spanish flu

text: The Aldershot physicians later wrote in "The Lancet", "the influenza pneumococcal purulent bronchitis we and others described in 1916 and 1917 is fundamentally the same condition as the influenza of this present pandemic." This 'Purulent bronchitis' is not yet linked to the same A/H1N1 virus, but it may be a precursor.


title: Spanish flu

text: In 1918, 'epidemic influenza' (, influence), also known at the time as 'the grip' (, grasp), appeared in Kansas in the U.S. during late spring, and early reports from Spain began appearing on 21 May. Reports from both places called it 'three-day fever' ().


title: Spanish flu

text: Many alternative names are exonyms in the practice of making new infectious diseases seem foreign. This pattern was observed even before the 1889–1890 pandemic, also known as the 'Russian flu', when the Russians already called epidemic influenza the 'Chinese catarrh', the Germans called it the 'Russian pest', while the Italians in turn called it the 'German disease'. These epithets were re-used in the 1918 pandemic, along with new ones.


title: Spanish flu

text: Outside Spain, the disease was soon misnamed 'Spanish influenza'. In a 2 June 1918 "The Times" of London dispatch titled, "The Spanish Epidemic," a correspondent in Madrid reported over 100,000 victims of, "The unknown disease…clearly of a gripal character," without referring to "Spanish influenza" directly. Three weeks later "The Times" reported that, "Everybody thinks of it as the 'Spanish' influenza to-day." Three days after that an advertisement appeared in "The Times" for Formamint tablets to prevent "Spanish influenza". When it reached Moscow, "Pravda" announced, " (the Spanish lady) is in town," making 'the Spanish lady' another common name.


title: Spanish flu

text: The outbreak did not originate in Spain (see below), but reporting did, due to wartime censorship in belligerent nations. Spain was a neutral country unconcerned with appearances of combat readiness, and without a wartime propaganda machine to prop up morale; so its newspapers freely reported epidemic effects, including King Alfonso XIII's illness, making Spain the apparent locus of the epidemic. The censorship was so effective that Spain's health officials were unaware its neighboring countries were similarly affected.


title: Spanish flu

text: In an October 1918 "Madrid Letter" to the "Journal of the American Medical Association", a Spanish official protested, "we were surprised to learn that the disease was making ravages in other countries, and that people there were calling it the 'Spanish grip'. And wherefore Spanish? …this epidemic was not born in Spain, and this should be recorded as a historic vindication." But before this letter could be published, "The Serbian Newspaper" (Corfu) said, "Various countries have been assigning the origin of this imposing guest to each other for quite some time, and at one point in time they agreed to assign its origin to the kind and neutral Spain…"


title: Spanish flu

text: French press initially used 'American flu', but adopted 'Spanish flu' in lieu of antagonizing an ally. In the spring of 1918, British soldiers called it 'Flanders flu', while German soldiers used " (Flemish fever), both after a famous battlefield in Belgium where many soldiers on both sides fell ill. In Senegal it was named 'Brazilian flu', and in Brazil, 'German flu'. In Spain it was also known as the 'French flu' (), or the 'Naples Soldier' (), after a popular song from a zarzuela. Spanish flu () is now a common name in Spain, but remains controversial there.


title: Spanish flu

text: Other names derived from geopolitical borders and social boundaries. In Poland it was the 'Bolshevik disease', while the Bolsheviks referred to it as the 'Kirghiz disease'. Some Africans called it a 'white man's sickness', but in South Africa, white men also used the ethnophaulism (lit. negro disease). Japan blamed sumo wrestlers for bringing the disease home from a match in Taiwan by calling it 'sumo flu' (), even though three top wrestlers died there.


title: Spanish flu

text: World Health Organization 'best practices' first published in 2015 now aim to prevent social stigma by no longer associating culturally significant names with new diseases, listing "Spanish flu" under "examples to be avoided". Many authors now eschew calling this the Spanish flu, instead using variations of '1918–19/20 flu/influenza pandemic'.


title: Spanish flu

text: Some language endonyms did not name specific regions or groups of people. Examples specific to this pandemic include: (let enquiries be made concerning it), (the disease of head and coughing and spine), (disease from seeking to make a profit in wartime), (disease which passes through like a bullet), and (disease of the wind).


title: Spanish flu

text: This outbreak was also commonly known as the 'great influenza epidemic', after the 'great war', a common name for World War I before World War II. French military doctors originally called it 'disease 11' (). German doctors downplayed the severity by calling it 'pseudo influenza' (, false), while in Africa, doctors tried to get patients to take it more seriously by calling it 'influenza vera' (, true).


title: Spanish flu

text: A children's song from the 1889–90 flu pandemic was shortened and adapted into a skipping-rope rhyme popular in 1918. It is a metaphor for the transmissibility of 'Influenza', where that name was clipped to the apheresis 'Enza':


title: Spanish flu

text: The pandemic is conventionally marked as having begun on 4 March 1918 with the recording of the case of Albert Gitchell, an army cook at Camp Funston in Kansas, United States, despite there having been cases before him. The disease had already been observed away in Haskell County as early as January 1918, prompting local doctor Loring Miner to warn the editors of the U.S. Public Health Service's academic journal "Public Health Reports". Within days of the 4 March first case at Camp Funston, 522 men at the camp had reported sick. By 11 March 1918, the virus had reached Queens, New York. Failure to take preventive measures in March/April was later criticized.


title: Spanish flu

text: As the U.S. had entered World War I, the disease quickly spread from Camp Funston, a major training ground for troops of the American Expeditionary Forces, to other U.S. Army camps and Europe, becoming an epidemic in the Midwest, East Coast, and French ports by April 1918, and reaching the Western Front by the middle of the month. It then quickly spread to the rest of France, Great Britain, Italy, and Spain and in May reached Wrocław and Odessa. After the signing of the Treaty of Brest-Litovsk (March 1918), Germany started releasing Russian prisoners of war, who then brought the disease to their country. It reached North Africa, India, and Japan in May, and soon after had likely gone around the world as there had been recorded cases in Southeast Asia in April. In June an outbreak was reported in China. After reaching Australia in July, the wave started to recede.


title: Spanish flu

text: The first wave of the flu lasted from the first quarter of 1918 and was relatively mild. Mortality rates were not appreciably above normal; in the United States ~75,000 flu-related deaths were reported in the first six months of 1918, compared to ~63,000 deaths during the same time period in 1915. In Madrid, Spain, fewer than 1,000 people died from influenza between May and June 1918. There were no reported quarantines during the first quarter of 1918. However, the first wave caused a significant disruption in the military operations of World War I, with three-quarters of French troops, half the British forces, and over 900,000 German soldiers sick.


title: Spanish flu

text: The second wave began in the second half of August 1918, 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. From the Boston Navy Yard and Camp Devens (later renamed Fort Devens), about 30 miles west of Boston, other U.S. military sites were soon afflicted, as were troops being transported to Europe. Helped by troop movements, it spread over the next two months to all of North America, and then to Central and South America, also reaching Brazil and the Caribbean on ships. In July 1918, the Ottoman Empire saw its first cases in some soldiers. From Freetown, the pandemic continued to spread through West Africa along the coast, rivers, and the colonial railways, and from railheads to more remote communities, while South Africa received it in September on ships bringing back members of the South African Native Labour Corps returning from France. From there it spread around southern Africa and beyond the Zambezi, reaching Ethiopia in November. On 15 September, New York City saw its first fatality from influenza. The Philadelphia Liberty Loans Parade, held in Philadelphia, Pennsylvania, on 28 September 1918 to promote government bonds for World War I, resulted in 12,000 deaths after a major outbreak of the illness spread among people who had attended the parade.


title: Spanish flu

text: From Europe, the second wave swept through Russia in a southwest–northeast diagonal front, as well as being brought to Arkhangelsk by the North Russia intervention, and then spread throughout Asia following the Russian Civil War and the Trans-Siberian railway, reaching Iran (where it spread through the holy city of Mashhad), and then later India in September, as well as China and Japan in October. The celebrations of the Armistice of 11 November 1918 also caused outbreaks in Lima and Nairobi, but by December the wave was mostly over.


title: Spanish flu

text: The second wave of the 1918 pandemic was much more deadly than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. October 1918 was the month with the highest fatality rate of the whole pandemic. In the United States, ~292,000 deaths were reported between September–December 1918, compared to ~26,000 during the same time period in 1915. The Netherlands reported 40,000+ deaths from influenza and acute respiratory disease. Bombay reported ~15,000 deaths in a population of 1.1 million. The 1918 flu pandemic in India was especially deadly, with an estimated 12.5–20 million deaths in the last quarter of 1918 alone.


title: Spanish flu

text: In January 1919, the third wave of the flu hit Australia for the first time, where it killed around 12,000 to 20,000 people following the lifting of a maritime quarantine, and then spread quickly through Europe and the United States, where it lingered through the spring and until June 1919. The Australian death rate, 2.7 per 1000 people, was one of the lowest recorded compared with other countries at the time; however, as much as 40 per cent of the population were infected, and a mortality rate of 50 per cent was recorded by some Aboriginal communities.


title: Spanish flu

text: In the rest of the world, the third wave particularly affected Spain, Serbia, Mexico and Great Britain, resulting in hundreds of thousands of deaths. It was less severe than the second wave but still much more deadly than the initial first wave. In the United States, isolated outbreaks occurred in some cities including Los Angeles, New York City, Memphis, Nashville, San Francisco, and St. Louis. Overall, American deaths were in the tens of thousands during the first six months of 1919.


title: Spanish flu

text: In the northern hemisphere, fears of a "recurrence" of the flu grew as fall approached. Experts cited the history of past flu epidemics, such as that of 1889–1890, to predict that such a recurrence a year later was not unlikely, though not all agreed. In September, U.S. Surgeon General Rupert Blue said a return of the flu later in the year would "probably, but by no means certainly," occur. France had readied a public information campaign before the end of the summer, and Britain began preparations in the fall with the manufacture of vaccine.


title: Spanish flu

text: In the United States, there were "almost continuously isolated or solitary cases" of flu throughout the spring and summer months. An increase in scattered cases became apparent as early as September, but Chicago experienced one of the first major outbreaks of the flu beginning in the middle of January. The Public Health Service announced it would take steps to "localize the epidemic", but the disease was already causing a simultaneous outbreak in Kansas City and quickly spread outward from the center of the country in no clear direction. A few days after its first announcement, PHS issued another assuring the disease was under the control of state health authorities and an outbreak of epidemic proportions was not expected.


title: Spanish flu

text: It became apparent within days of the start of Chicago's explosive growth in cases that the flu was spreading in the city at an even faster rate than in winter 1919, though fewer were dying. Within a week, new cases in the city had surpassed its peak during the 1919 wave. Around the same time, New York City began to see its own sudden increase in cases, and other cities around the country were soon to follow. Certain pandemic restrictions, such as the closing of schools and theaters and staggered business hours to avoid congestion, were reimposed in cities like Chicago, Memphis, and New York City. As they had during the epidemic in fall 1918, schools in New York City remained open, while those in Memphis were shuttered as part of more general restrictions on public gatherings.


title: Spanish flu

text: Amidst the spreading outbreak, Surgeon General Blue warned the public not to get "panicky" over the flu. Nevertheless, the Senate had sensed a turn in the tide (as the flu began to afflict their own families) and on 27 January passed an appropriations bill for $500,000 for the study of influenza. First introduced in July 1919 by Senator Warren G. Harding after the third wave had subsided, the bill had been whittled down from $5 million. Senator William H. King of Utah fundamentally opposed the bill, criticizing PHS for the "vast autocracy" it had become; Senator James D. Phelan of California sought to have the bill recommitted to the Committee on Public Health until there was an investigation into what previous flu funding had produced, but this failed. Ultimately, a letter from Carter Glass, Secretary of the Treasury, regarding the outbreaks occurring in large cities and the threat they posed to the rest of the country persuaded many senators to vote for the package.


title: Spanish flu

text: The fourth wave in the United States subsided as swiftly as it had appeared, reaching a peak in early February. "An epidemic of considerable proportions marked the early months of 1920", the U.S. Mortality Statistics would later note; according to data at this time, the epidemic resulted in one third as many deaths as the 1918–1919 experience. New York City alone reported 6,374 deaths between December 1919 and April 1920, almost twice the number of the first wave in spring 1918. Other US cities including Detroit, Milwaukee, Kansas City, Minneapolis, and St. Louis were hit particularly hard, with death rates higher than all of 1918. The Territory of Hawaii experienced its peak of the pandemic in early 1920, recording 1,489 deaths from flu-related causes, compared with 615 in 1918 and 796 in 1919. Nenana, Alaska, had similarly avoided the extent of the pandemic for the previous two years, but by May 1920 an outbreak had consumed the town. Reports suggested that during the first two weeks of the month, the majority of the town's population became infected; 10% of the population were estimated to have died.


title: Spanish flu

text: In winter and spring 1920, a fourth wave also occurred in various areas including Switzerland, Scandinavia, Mexico, and some South American islands. Poland experienced a devastating outbreak during the winter months, with its capital Warsaw reaching a peak of 158 deaths in a single week, compared to the peak of 92 reached in December 1918; however, the 1920 epidemic passed in a matter of weeks, while the 1918–1919 wave had developed over the entire second half of 1918. By contrast, the outbreak in western Europe was considered "benign", with the age distribution of deaths beginning to take on that of seasonal flu. Five countries in Europe (Spain, Denmark, Finland, Germany and Switzerland) recorded a late peak between January–April 1920. Peru experienced a late wave in early 1920, and Japan had one from late 1919 to 1920, with the last cases in March.


title: Spanish flu

text: By 1920, the virus that caused the pandemic evolved to become much less deadly and subsequently caused only ordinary seasonal flu. By 1921, deaths had returned to pre-pandemic levels.


title: Spanish flu

text: Despite its name, historical and epidemiological data cannot identify the geographic origin of the Spanish flu. However, several theories have been proposed.


title: Spanish flu

text: The first confirmed cases originated in the United States. Historian Alfred W. Crosby stated in 2003 that the flu originated in Kansas, and author John M. Barry described a January 1918 outbreak in Haskell County, Kansas, as the point of origin in his 2004 article.


title: Spanish flu

text: A 2018 study of tissue slides and medical reports led by evolutionary biology professor Michael Worobey found evidence against the disease originating from Kansas, as those cases were milder and had fewer deaths compared to the infections in New York City in the same period. The study did find evidence through phylogenetic analyses that the virus likely had a North American origin, though it was not conclusive. In addition, the haemagglutinin glycoproteins of the virus suggest that it originated long before 1918, and other studies suggest that the reassortment of the H1N1 virus likely occurred in or around 1915.


title: Spanish flu

text: The major UK troop staging and hospital camp in Étaples in France has been theorized by virologist John Oxford as being at the center of the Spanish flu. His study found that in late 1916 the Étaples camp was hit by the onset of a new disease with high mortality that caused symptoms similar to the flu. According to Oxford, a similar outbreak occurred in March 1917 at army barracks in Aldershot, and military pathologists later recognized these early outbreaks as the same disease as the Spanish flu. The overcrowded camp and hospital at Etaples was an ideal environment for the spread of a respiratory virus. The hospital treated thousands of victims of poison gas attacks, and other casualties of war, and 100,000 soldiers passed through the camp every day. It also was home to a piggery, and poultry was regularly brought in from surrounding villages to feed the camp. Oxford and his team postulated that a precursor virus, harbored in birds, mutated and then migrated to pigs kept near the front.


title: Spanish flu

text: A report published in 2016 in the Journal of the Chinese Medical Association found evidence that the 1918 virus had been circulating in the European armies for months and possibly years before the 1918 pandemic. Political scientist Andrew Price-Smith published data from the Austrian archives suggesting the influenza began in Austria in early 1917.


title: Spanish flu

text: A 2009 study in "Influenza and Other Respiratory Viruses" found that Spanish flu mortality simultaneously peaked within the two-month period of October and November 1918 in all fourteen European countries analyzed, which is inconsistent with the pattern that researchers would expect if the virus had originated somewhere in Europe and then spread outwards.


title: Spanish flu

text: In 1993, Claude Hannoun, the leading expert on the Spanish flu at the Pasteur Institute, asserted the precursor virus was likely to have come from China and then mutated in the United States near Boston and from there spread to Brest, France, Europe's battlefields, the rest of Europe, and the rest of the world, with Allied soldiers and sailors as the main disseminators. Hannoun considered several alternative hypotheses of origin, such as Spain, Kansas, and Brest, as being possible, but not likely. In 2014, historian Mark Humphries argued that the mobilization of 96,000 Chinese laborers to work behind the British and French lines might have been the source of the pandemic. Humphries, of the Memorial University of Newfoundland in St. John's, based his conclusions on newly unearthed records. He found archival evidence that a respiratory illness that struck northern China (where the laborers came from) in November 1917 was identified a year later by Chinese health officials as identical to the Spanish flu. However, no tissue samples have survived for modern comparison. Nevertheless, there were some reports of respiratory illness on parts of the path the laborers took to get to Europe, which also passed through North America.


title: Spanish flu

text: China was one of the few regions of the world seemingly less affected by the Spanish flu pandemic, where several studies have documented a comparatively mild flu season in 1918. (Although this is disputed due to lack of data during the Warlord Period, see Around the globe.) This has led to speculation that the Spanish flu pandemic originated in China, as the lower rates of flu mortality may be explained by the Chinese population's previously acquired immunity to the flu virus.


title: Spanish flu

text: A report published in 2016 in the Journal of the Chinese Medical Association found no evidence that the 1918 virus was imported to Europe via Chinese and Southeast Asian soldiers and workers and instead found evidence of its circulation in Europe before the pandemic. The 2016 study found that the low flu mortality rate (an estimated one in a thousand) recorded among the Chinese and Southeast Asian workers in Europe suggests that the Asian units were not different from other Allied military units in France at the end of 1918 and, thus, were not a likely source of a new lethal virus. Further evidence against the disease being spread by Chinese workers was that workers entered Europe through other routes that did not result in a detectable spread, making them unlikely to have been the original hosts.


title: Spanish flu

text: The basic reproduction number of the virus was between 2 and 3. The close quarters and massive troop movements of World War I hastened the pandemic, and probably both increased transmission and augmented mutation. The war may also have reduced people's resistance to the virus. Some speculate the soldiers' immune systems were weakened by malnourishment, as well as the stresses of combat and chemical attacks, increasing their susceptibility. A large factor in the worldwide occurrence of the flu was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease. Another was lies and denial by governments, leaving the population ill-prepared to handle the outbreaks.


title: Spanish flu

text: The severity of the second wave has been attributed to the circumstances of the First World War. In civilian life, natural selection favors a mild strain. Those who get very ill stay home, and those mildly ill continue with their lives, preferentially spreading the mild strain. In the trenches, natural selection was reversed. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus. The second wave began, and the flu quickly spread around the world again. Consequently, during modern pandemics, health officials look for deadlier strains of a virus when it reaches places with social upheaval. The fact that most of those who recovered from first-wave infections had become immune showed that it must have been the same strain of flu. This was most dramatically illustrated in Copenhagen, which escaped with a combined mortality rate of just 0.29% (0.02% in the first wave and 0.27% in the second wave) because of exposure to the less-lethal first wave. For the rest of the population, the second wave was far more deadly; the most vulnerable people were those like the soldiers in the trenches – adults who were young and fit.


title: Spanish flu

text: After the lethal second wave struck in late 1918, new cases dropped abruptly. In Philadelphia, for example, 4,597 people died in the week ending 16 October, but by 11 November, influenza had almost disappeared from the city. One explanation for the rapid decline in the lethality of the disease is that doctors became more effective in the prevention and treatment of pneumonia that developed after the victims had contracted the virus. However, John Barry stated in his 2004 book "" that researchers have found no evidence to support this position. Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. Such evolution of influenza is a common occurrence: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out. Some fatal cases did continue into March 1919, killing one player in the 1919 Stanley Cup Finals.


title: Spanish flu

text: The majority of the infected experienced only the typical flu symptoms of sore throat, headache, and fever, especially during the first wave. However, during the second wave, the disease was much more serious, often complicated by bacterial pneumonia, which was often the cause of death. This more serious type would cause "heliotrope cyanosis" to develop, whereby the skin would first develop two mahogany spots over the cheekbones which would then over a few hours spread to color the entire face blue, followed by black coloration first in the extremities and then further spreading to the limbs and the torso. After this, death would follow within hours or days due to the lungs being filled with fluids. Other signs and symptoms reported included spontaneous mouth and nosebleeds, miscarriages for pregnant women, a peculiar smell, teeth, and hair falling, delirium, dizziness, insomnia, loss of hearing or smell, blurred vision, and impaired color vision. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred". The severity of the symptoms was believed to be caused by cytokine storms.


title: Spanish flu

text: The majority of deaths were from bacterial pneumonia, a common secondary infection associated with influenza. This pneumonia was itself caused by common upper respiratory-tract bacteria, which were able to get into the lungs via the damaged bronchial tubes of the victims. The virus also killed people directly by causing massive hemorrhages and edema in the lungs. Modern analysis has shown the virus to be particularly deadly because it triggers a cytokine storm (overreaction of the body's immune system). One group of researchers recovered the virus from the bodies of frozen victims and transfected animals with it. The animals suffered rapidly progressive respiratory failure and death through a cytokine storm. The strong immune reactions of young adults were postulated to have ravaged the body, whereas the weaker immune reactions of children and middle-aged adults resulted in fewer deaths among those groups.


title: Spanish flu

text: Because the virus that caused the disease was too small to be seen under a microscope at the time, there were problems with correctly diagnosing it. The bacterium "Haemophilus influenzae" was instead mistakenly thought to be the cause, as it was big enough to be seen and was present in many, though not all, patients. For this reason, a vaccine that was used against that bacillus did not make an infection rarer but did decrease the death rate.


title: Spanish flu

text: During the deadly second wave there were also fears that it was in fact plague, dengue fever, or cholera. Another common misdiagnosis was typhus, which was common in circumstances of social upheaval, and was therefore also affecting Russia in the aftermath of the October Revolution. In Chile, the view of the country's elite was that the nation was in severe decline, and therefore doctors assumed that the disease was typhus caused by poor hygiene, and not an infectious one, causing a mismanaged response which did not ban mass gatherings.


title: Spanish flu

text: Studies have shown that the immune system of Spanish flu victims was weakened by adverse climate conditions which were particularly unseasonably cold and wet for extended periods of time during the duration of the pandemic. This affected especially WWI troops exposed to incessant rains and lower-than-average temperatures for the duration of the conflict, and especially during the second wave of the pandemic. Ultra-high-resolution climate data combined with highly detailed mortality records analyzed at Harvard University and the Climate Change Institute at the University of Maine identified a severe climate anomaly that impacted Europe from 1914 to 1919, with several environmental indicators directly influencing the severity and spread of the Spanish flu pandemic. Specifically, a significant increase in precipitation affected all of Europe during the second wave of the pandemic, from September to December 1918. Mortality figures follow closely the concurrent increase in precipitation and decrease in temperatures. Several explanations have been proposed for this, including the fact that lower temperatures and increased precipitation provided ideal conditions for virus replication and transmission, while also negatively affecting the immune systems of soldiers and other people exposed to the inclement weather, a factor proven to increase likelihood of infection by both viruses and pneumococcal co-morbid infections documented to have affected a large percentage of pandemic victims (one fifth of them, with a 36% mortality rate). A six-year climate anomaly (1914–1919) brought cold, marine air to Europe, drastically changing its weather, as documented by eyewitness accounts and instrumental records, reaching as far as the Gallipoli campaign, in Turkey, where ANZAC troops suffered extremely cold temperatures despite the normally Mediterranean climate of the region. The climate anomaly likely influenced the migration of H1N1 avian vectors which contaminate bodies of water with their droppings, reaching 60% infection rates in autumn. The climate anomaly has been associated with an anthropogenic increase in atmospheric dust, due to the incessant bombardment; increased nucleation due to dust particles (cloud condensation nuclei) contributed to increased precipitation.


title: Spanish flu

text: While systems for alerting public health authorities of infectious spread did exist in 1918, they did not generally include influenza, leading to a delayed response. Nevertheless, actions were taken. Maritime quarantines were declared on islands such as Iceland, Australia, and American Samoa, saving many lives. Social distancing measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings. Wearing face masks became common in some places, such as Japan, though there were debates over their efficacy. There was also some resistance to their use, as exemplified by the Anti-Mask League of San Francisco. Vaccines were also developed, but as these were based on bacteria and not the actual virus, they could only help with secondary infections. The actual enforcement of various restrictions varied. To a large extent, the New York City health commissioner ordered businesses to open and close on staggered shifts to avoid overcrowding on the subways.


title: Spanish flu

text: A later study found that measures such as banning mass gatherings and requiring the wearing of face masks could cut the death rate up to 50 percent, but this was dependent on their being imposed early in the outbreak and not being lifted prematurely.


title: Spanish flu

text: As there were no antiviral drugs to treat the virus, and no antibiotics to treat the secondary bacterial infections, doctors would rely on a random assortment of medicines with varying degrees of effectiveness, such as aspirin, quinine, arsenics, digitalis, strychnine, epsom salts, castor oil, and iodine. Treatments of traditional medicine, such as bloodletting, ayurveda, and kampo were also applied.


title: Spanish flu

text: Due to World War I, many countries engaged in wartime censorship, and suppressed reporting of the pandemic. For example, the Italian newspaper "Corriere della Sera" was prohibited from reporting daily death tolls. The newspapers of the time were also generally paternalistic and worried about mass panic. Misinformation also spread along with the disease. In Ireland there was a belief that noxious gases were rising from the mass graves of Flanders Fields and being "blown all over the world by winds". There were also rumors that the Germans were behind it, for example by poisoning the aspirin manufactured by Bayer, or by releasing poison gas from U-boats.


title: Spanish flu

text: The Spanish flu infected around 500 million people, about one-third of the world's population. Estimates as to how many infected people died vary greatly, but the flu is regardless considered to be one of the deadliest pandemics in history. An early estimate from 1927 put global mortality at 21.6 million. An estimate from 1991 states that the virus killed between 25 and 39 million people. A 2005 estimate put the death toll at 50 million (about 3% of the global population), and possibly as high as 100 million (more than 5%). However, a 2018 reassessment in the "American Journal of Epidemiology" estimated the total to be about 17 million, though this has been contested. With a world population of 1.8 to 1.9 billion, these estimates correspond to between 1 and 6 percent of the population.


title: Spanish flu

text: A 2009 study in "Influenza and Other Respiratory Viruses" based on data from fourteen European countries estimated a total of 2.64 million excess deaths in Europe attributable to the Spanish flu during the major 1918–1919 phase of the pandemic, in line with the three prior studies from 1991, 2002, and 2006 that calculated a European death toll of between 2 million and 2.3 million. This represents a mortality rate of about 1.1% of the European population ( 250 million in 1918), considerably higher than the mortality rate in the US, which the authors hypothesize is likely due to the severe effects of the war in Europe. The excess mortality rate in the UK has been estimated at 0.28%–0.4%, far below this European average.


title: Spanish flu

text: Some 12–17 million people died in India, about 5% of the population. The death toll in India's British-ruled districts was 13.88 million. Another estimate gives at least 12 million dead. The decade between 1911 and 1921 was the only census period in which India's population fell, mostly due to devastation of the Spanish flu pandemic. While India is generally described as the country most severely affected by the Spanish flu, at least one study argues that other factors may partially account for the very high excess mortality rates observed in 1918, citing unusually high 1917 mortality and wide regional variation (ranging from 0.47% to 6.66%). A 2006 study in "The Lancet" also noted that Indian provinces had excess mortality rates ranging from 2.1% to 7.8%, stating: "Commentators at the time attributed this huge variation to differences in nutritional status and diurnal fluctuations in temperature."


title: Spanish flu

text: In Japan, 23 million people were affected, with at least 390,000 reported deaths. In the Dutch East Indies (now Indonesia), 1.5 million were assumed to have died among 30 million inhabitants. In Tahiti, 13% of the population died during one month. Similarly, in Western Samoa 22% of the population of 38,000 died within two months.


title: Spanish flu

text: In Istanbul, capital of the Ottoman Empire, 6,403 to 10,000 died, giving the city a mortality rate of at least 0.56%.


title: Spanish flu

text: In New Zealand, the flu killed an estimated 6,400 Pakeha (or "New Zealanders primarily of European descent") and 2,500 indigenous Maori in six weeks, with Māori dying at eight times the rate of Pakeha.


title: Spanish flu

text: In the US, about 28% of the population of 105 million became infected, and 500,000 to 850,000 died (0.48 to 0.81 percent of the population). Native American tribes were particularly hard hit. In the Four Corners area, there were 3,293 registered deaths among Native Americans. Entire Inuit and Alaskan Native village communities died in Alaska. In Canada, 50,000 died.


title: Spanish flu

text: In Ghana, the influenza epidemic killed at least 100,000 people. Tafari Makonnen (the future Haile Selassie, Emperor of Ethiopia) was one of the first Ethiopians who contracted influenza but survived. Many of his subjects did not; estimates for fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, or higher.


title: Spanish flu

text: The death toll in Russia has been estimated at 450,000, though the epidemiologists who suggested this number called it a "shot in the dark". If it is correct, Russia lost roughly 0.4% of its population, meaning it suffered the lowest influenza-related mortality in Europe. Another study considers this number unlikely, given that the country was in the grip of a civil war, and the infrastructure of daily life had broken down; the study suggests that Russia's death toll was closer to 2%, or 2.7 million people.


title: Spanish flu

text: Even in areas where mortality was low, so many adults were incapacitated that much of everyday life was hampered. Some communities closed all stores or required customers to leave orders outside. There were reports that healthcare workers could not tend the sick nor the gravediggers bury the dead because they too were ill. Mass graves were dug by steam shovel and bodies buried without coffins in many places.


title: Spanish flu

text: Bristol Bay, a region of Alaska populated by indigenous people, suffered a death rate of 40 percent of the total population, with some villages entirely disappearing.


title: Spanish flu

text: Several Pacific island territories were hit particularly hard. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent ships, such as , carrying the flu from leaving its ports. From New Zealand, the flu reached Tonga (killing 8% of the population), Nauru (16%), and Fiji (5%, 9,000 people). Worst affected was Western Samoa, formerly German Samoa, which had been occupied by New Zealand in 1914. 90% of the population was infected; 30% of adult men, 22% of adult women, and 10% of children died. By contrast, Governor John Martin Poyer prevented the flu from reaching neighboring American Samoa by imposing a blockade. The disease spread fastest through the higher social classes among the indigenous peoples, because of the custom of gathering oral tradition from chiefs on their deathbeds; many community elders were infected through this process.


title: Spanish flu

text: In Iran, the mortality was very high: according to an estimate, between 902,400 and 2,431,000, or 8% to 22% of the total population died. The country was going through the Persian famine of 1917–1919 concurrently.


title: Spanish flu

text: In South Africa it is estimated that about 300,000 people amounting to 6% of the population died within six weeks. Government actions in the early stages of the virus' arrival in the country in September 1918 are believed to have unintentionally accelerated its spread throughout the country. Almost a quarter of the working population of Kimberley, consisting of workers in the diamond mines, died. In British Somaliland, one official estimated that 7% of the native population died. This huge death toll resulted from an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.


title: Spanish flu

text: In the Pacific, American Samoa and the French colony of New Caledonia succeeded in preventing even a single death from influenza through effective quarantines. However, the outbreak was delayed into 1926 for American Samoa and 1921 for New Caledonia as the quarantine period ended. On American Samoa, at least 25% of the island residents were clinically attacked and 0.1% died, and on New Caledonia, there was widespread illness and 0.1% population died. Australia also managed to avoid the first two waves with a quarantine. Iceland protected a third of its population from exposure by blocking the main road of the island. By the end of the pandemic, the isolated island of Marajó, in Brazil's Amazon River Delta had not reported an outbreak. Saint Helena also reported no deaths.


title: Spanish flu

text: Estimates for the death toll in China have varied widely, a range which reflects the lack of centralized collection of health data at the time due to the Warlord period. China may have experienced a relatively mild flu season in 1918 compared to other areas of the world. However, some reports from its interior suggest that mortality rates from influenza were perhaps higher in at least a few locations in China in 1918. At the very least, there is little evidence that China as a whole was seriously affected by the flu compared to other countries in the world.


title: Spanish flu

text: The first estimate of the Chinese death toll was made in 1991 by Patterson and Pyle, which estimated a toll of between 5 and 9 million. However, this 1991 study was criticized by later studies due to flawed methodology, and newer studies have published estimates of a far lower mortality rate in China. For instance, Iijima in 1998 estimates the death toll in China to be between 1 and 1.28 million based on data available from Chinese port cities. The lower estimates of the Chinese death toll are based on the low mortality rates that were found in Chinese port cities (for example, Hong Kong) and on the assumption that poor communications prevented the flu from penetrating the interior of China. However, some contemporary newspaper and post office reports, as well as reports from missionary doctors, suggest that the flu did penetrate the Chinese interior and that influenza was severe in at least some locations in the countryside of China.


title: Spanish flu

text: Although medical records from China's interior are lacking, extensive medical data were recorded in Chinese port cities, such as then British-controlled Hong Kong, Canton, Peking, Harbin and Shanghai. These data were collected by the Chinese Maritime Customs Service, which was largely staffed by non-Chinese foreigners, such as the British, French, and other European colonial officials in China. As a whole, data from China's port cities show low mortality rates compared to other cities in Asia. For example, the British authorities at Hong Kong and Canton reported a mortality rate from influenza at a rate of 0.25% and 0.32%, much lower than the reported mortality rate of other cities in Asia, such as Calcutta or Bombay, where influenza was much more devastating. Similarly, in the city of Shanghai – which had a population of over 2 million in 1918 – there were only 266 recorded deaths from influenza among the Chinese population in 1918. If extrapolated from the extensive data recorded from Chinese cities, the suggested mortality rate from influenza in China as a whole in 1918 was likely lower than 1% – much lower than the world average (which was around 3–5%). In contrast, Japan and Taiwan had reported a mortality rate from influenza around 0.45% and 0.69% respectively, higher than the mortality rate collected from data in Chinese port cities, such as Hong Kong (0.25%), Canton (0.32%), and Shanghai.


title: Spanish flu

text: However, it is noted that the influenza mortality rate in Hong Kong and Canton are under-recorded, because only the deaths that occurred in colony hospitals were counted. Similarly, in Shanghai, these statistics are limited to that area of the city under the control of the health section of the Shanghai International Settlement, and the actual death toll in Shanghai was much higher. The medical records from China's interior indicate that, compared to cities, rural communities have substantially higher mortality rate. A published influenza survey in Houlu County, Hebei Province, found that the case fatality rate was 9.77% and 0.79% of county population died from influenza in October and November 1918.


title: Spanish flu

text: The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old. In 1920, the mortality rate among people under 65 had decreased sixfold to half the mortality rate of people over 65, but 92% of deaths still occurred in people under 65. This is unusual since influenza is typically most deadly to weak individuals, such as infants under age two, adults over age 70, and the immunocompromised. In 1918, older adults may have had partial protection caused by exposure to the 1889–1890 flu pandemic, known as the "Russian flu". According to historian John M. Barry, the most vulnerable of all – "those most likely, of the most likely", to die – were pregnant women. He reported that in thirteen studies of hospitalized women in the pandemic, the death rate ranged from 23% to 71%. Of the pregnant women who survived childbirth, over one-quarter (26%) lost the child. Another oddity was that the outbreak was widespread in the summer and autumn (in the Northern Hemisphere); influenza is usually worse in winter.


title: Spanish flu

text: There were also geographic patterns to the disease's fatality. Some parts of Asia had 30 times higher death rates than some parts of Europe, and generally, Africa and Asia had higher rates, while Europe and North America had lower ones. There was also great variation within continents, with three times higher mortality in Hungary and Spain compared to Denmark, two to three times higher chance of death in Sub-Saharan Africa compared to North Africa, and possibly up to ten times higher rates between the extremes of Asia. Cities were affected worse than rural areas. There were also differences between cities, which might have reflected exposure to the milder first wave giving immunity, as well as the introduction of social distancing measures.


title: Spanish flu

text: Another major pattern was the differences between social classes. In Oslo, death rates were inversely correlated with apartment size, as the poorer people living in smaller apartments died at a higher rate. Social status was also reflected in the higher mortality among immigrant communities, with Italian Americans, a recently arrived group at the time, were nearly twice as likely to die compared to the average Americans. These disparities reflected worse diets, crowded living conditions, and problems accessing healthcare. Paradoxically, however, African Americans were relatively spared by the pandemic.


title: Spanish flu

text: More men than women were killed by the flu, as they were more likely to go out and be exposed, while women would tend to stay at home. For the same reason men also were more likely to have pre-existing tuberculosis, which severely worsened the chances of recovery. However, in India the opposite was true, potentially because Indian women were neglected with poorer nutrition, and were expected to care for the sick.


title: Spanish flu

text: A study conducted by He "et al". (2011) used a mechanistic modeling approach to study the three waves of the 1918 influenza pandemic. They examined the factors that underlie variability in temporal patterns and their correlation to patterns of mortality and morbidity. Their analysis suggests that temporal variations in transmission rate provide the best explanation, and the variation in transmission required to generate these three waves is within biologically plausible values. Another study by He "et al". (2013) used a simple epidemic model incorporating three factors to infer the cause of the three waves of the 1918 influenza pandemic. These factors were school opening and closing, temperature changes throughout the outbreak, and human behavioral changes in response to the outbreak. Their modeling results showed that all three factors are important, but human behavioral responses showed the most significant effects.


title: Spanish flu

text: Academic Andrew Price-Smith has made the argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. He provides data that the viral waves hit the Central Powers before the Allied powers and that both morbidity and mortality in Germany and Austria were considerably higher than in Britain and France. A 2006 "Lancet" study corroborates higher excess mortality rates in Germany (0.76%) and Austria (1.61%) compared to Britain (0.34%) and France (0.75%).


title: Spanish flu

text: Kenneth Kahn at Oxford University Computing Services writes that "Many researchers have suggested that the conditions of the war significantly aided the spread of the disease. And others have argued that the course of the war (and subsequent peace treaty) was influenced by the pandemic." Kahn has developed a model that can be used on home computers to test these theories.


title: Spanish flu

text: Many businesses in the entertainment and service industries suffered losses in revenue, while the healthcare industry reported profit gains. Historian Nancy Bristow has argued that the pandemic, when combined with the increasing number of women attending college, contributed to the success of women in the field of nursing. This was due in part to the failure of medical doctors, who were predominantly men, to contain and prevent the illness. Nursing staff, who were mainly women, celebrated the success of their patient care and did not associate the spread of the disease with their work.


title: Spanish flu

text: A 2020 study found that US cities that implemented early and extensive non-medical measures (quarantine, etc.) suffered no additional adverse economic effects due to implementing those measures,


title: Spanish flu

text: however, the validity of this study has been questioned because of the coincidence of WWI and other problems with data reliability.


title: Spanish flu

text: A 2006 study in the "Journal of Political Economy" found that "cohorts "in utero" during the pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments received compared with other birth cohorts." A 2018 study found that the pandemic reduced educational attainment in populations. The flu has also been linked to the outbreak of encephalitis lethargica in the 1920s.


title: Spanish flu

text: Survivors faced an elevated mortality risk. Some survivors did not fully recover from physiological conditions resulting from infection.


title: Spanish flu

text: Despite the high morbidity and mortality rates that resulted from the epidemic, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a "forgotten pandemic". However, this label has been challenged by the historian Guy Beiner, who has charted a complex history of social and cultural forgetting, demonstrating how the pandemic was overshadowed by the commemoration of the First World War and mostly neglected in mainstream historiography, yet was remembered in private and local traditions across the globe.


title: Spanish flu

text: There are various theories of why the Spanish flu was "forgotten". The rapid pace of the pandemic, which killed most of its victims in the United States within less than nine months, resulted in limited media coverage. The general population was familiar with patterns of pandemic disease in the late 19th and early 20th centuries: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time. These outbreaks probably lessened the significance of the influenza pandemic for the public. In some areas, the flu was not reported on, the only mention being that of advertisements for medicines claiming to cure it.


title: Spanish flu

text: Additionally, the outbreak coincided with the deaths and media focus on the First World War. Another explanation involves the age group affected by the disease. The majority of fatalities, from both the war and the epidemic, were among young adults. The high number of war-related deaths of young adults may have overshadowed the deaths caused by flu.


title: Spanish flu

text: When people read the obituaries, they saw the war or postwar deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was high, the flu may not have had a tremendous psychological impact or may have seemed an extension of the war's tragedies. The duration of the pandemic and the war could have also played a role. The disease would usually only affect a particular area for a month before leaving. The war, however, had initially been expected to end quickly but lasted for four years by the time the pandemic struck.


title: Spanish flu

text: Mary McCarthy referred to it in her memoir "Memories of a Catholic Girlhood" (1957), as she and her three brothers were orphaned by their parents' deaths from the Spanish flu.


title: Spanish flu

text: The Spanish flu killed a much lower percentage of the world's population than the Black Death, which lasted for many more years.


title: Spanish flu

text: In the ongoing COVID-19 pandemic, as of , more than cases have been identified and more than deaths recorded worldwide.


title: Spanish flu

text: The origin of the Spanish flu pandemic, and the relationship between the near-simultaneous outbreaks in humans and swine, have been controversial. One hypothesis is that the virus strain originated at Fort Riley, Kansas, in viruses in poultry and swine which the fort bred for food; the soldiers were then sent from Fort Riley around the world, where they spread the disease. Similarities between a reconstruction of the virus and avian viruses, combined with the human pandemic preceding the first reports of influenza in swine, led researchers to conclude the influenza virus jumped directly from birds to humans, and swine caught the disease from humans.


title: Spanish flu

text: Others have disagreed, and more recent research has suggested the strain may have originated in a nonhuman, mammalian species. An estimated date for its appearance in mammalian hosts has been put at the period 1882–1913. This ancestor virus diverged about 1913–1915 into two clades (or biological groups each descended from a common ancestor), which gave rise to the classical swine and human H1N1 influenza lineages. The last common ancestor of human strains dates between February 1917 and April 1918. Because pigs are more readily infected with avian influenza viruses than are humans, they were suggested as the original recipients of the virus, passing the virus to humans sometime between 1913 and 1918.


title: Spanish flu

text: An effort to recreate the Spanish flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, the USDA ARS Southeast Poultry Research Laboratory, and Mount Sinai School of Medicine in New York City. The effort resulted in the announcement (on 5 October 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered by pathologist Johan Hultin from an Inuit female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers Roscoe Vaughan and James Downs.


title: Spanish flu

text: On 18 January 2007, Kobasa et al. (2007) reported that monkeys ("Macaca fascicularis") infected with the recreated flu strain exhibited classic symptoms of the 1918 pandemic, and died from cytokine storms – an overreaction of the immune system. This may explain why the Spanish flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.


title: Spanish flu

text: On 16 September 2008, the body of British politician and diplomat Sir Mark Sykes was exhumed to study the RNA of the flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hoped had helped preserve the virus. The coffin was found to be split and the cadaver badly decomposed; nonetheless, samples of lung and brain tissue were taken.


title: Spanish flu

text: In December 2008, research by Yoshihiro Kawaoka of the University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from Spanish flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.


title: Spanish flu

text: In June 2010, a team at the Mount Sinai School of Medicine reported the 2009 flu pandemic vaccine provided some cross-protection against the Spanish flu pandemic strain.


title: Spanish flu

text: One of the few things known for certain about influenza in 1918 and for some years after was that it was, except in the laboratory, exclusively a disease of human beings.


title: Spanish flu

text: In 2013, the AIR Worldwide Research and Modeling Group "characterized the historic 1918 pandemic and estimated the effects of a similar pandemic occurring today using the AIR Pandemic Flu Model". In the model, "a modern-day 'Spanish flu' event would result in additional life insurance losses of between US$15.3–27.8 billion in the United States alone", with 188,000–337,000 deaths in the United States.


title: Spanish flu

text: In 2018, Michael Worobey, an evolutionary biology professor at the University of Arizona who is examining the history of the 1918 pandemic, revealed that he obtained tissue slides created by William Rolland, a physician who reported on a respiratory illness likely to be the virus while a pathologist in the British military during World War One. Rolland had authored an article in the "Lancet" during 1917 about a respiratory illness outbreak beginning in 1916 in Étaples, France. Worobey traced recent references to that article to family members who had retained slides that Rolland had prepared during that time. Worobey extracted tissue from the slides to potentially reveal more about the origin of the pathogen.


title: Spanish flu

text: In 2021 an investigation used the virus sequence to obtain the Hemagglutinin (HA) antigen and observe the adaptive immunity in 32 survivors of the 1918 flu pandemic, all of them presented seroreactivity and 7 of 8 further tested presented memory B cells able to produce antibodies that bound to the HA antigen highlighting the ability of the immunological memory many decades after.


title: Spanish flu

text: The high mortality rate of the influenza pandemic is one aspect that sets the pandemic apart from other disease outbreaks. Another factor is the higher mortality rate of men compared with women. Men with an underlying condition were at significantly more risk. Tuberculosis was one of the deadliest diseases in the 1900s, and killed more men than women. But with the spread of influenza disease, the cases of tuberculosis cases in men decreased. Many scholars have noted that tuberculosis increased the mortality rate of influenza in males, decreasing their life expectancy. During the 1900s tuberculosis was more common in males than females, but studies show that when influenza spread the tuberculosis mortality rate among females changed. The death rate of tuberculosis in females increased significantly and would continue to decline until post-pandemic.


title: Spanish flu

text: Death rates were particularly high in those aged 20–35. The only comparable disease to this was the black death, bubonic plague in the 1300s. As other studies have shown, tuberculosis and influenza had comorbidities and one affected the other. The ages of males dying of the flu show that tuberculosis was a factor, and as males primarily had this disease at the time of the pandemic, they had a higher mortality rate. Life expectancy dropped in males during the pandemic but then increased two years after the pandemic.


title: Spanish flu

text: One major cause of the spread of influenza was social behavior. Men had more social variation and were mobile more than women due to their work. Even though there was a higher mortality rate in males, each region showed different results, due to such factors as nutritional deficiency. In Newfoundland, the pandemic spread was highly variable. Influenza did not discriminate who was infected, indeed it attacked the socioeconomic status of people. Although social variability allowed the disease to move quickly geographically, it tended to spread faster and affect men more than women due to labor and social contact. Newfoundland's leading cause of death before the pandemic was tuberculosis and this is known to be a severe underlying condition for people and increases the |mortality rate when infected by the influenza disease. There was diverse labor in Newfoundland, men and women had various occupations that involved day-to-day interaction. But, fishing had a major role in the economy and so males were more mobile than females and had more contact with other parts of the world. The spread of the pandemic is known to have begun in the spring of 1918, but Newfoundland didn't see the deadly wave until June or July, which aligns with the high demand for employment in the fishery. The majority of men were working along the coast during the summer and it was typical for entire families to move to Newfoundland and work. Studies show a much higher mortality rate in males compared with females. But, during the first, second, and third waves of the pandemic, the mortality shifted. During the first wave, men had a higher mortality rate, but the mortality rate of females increased and was higher during the second and third waves. The female population was larger in certain regions of Newfoundland and therefore had a bigger impact on the death rate.


title: Spanish flu

text: 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 mobility of young men during 1918 was linked to the spread of influenza and the biggest wave of the epidemic. In late 1917 and throughout 1918, thousands of male troops gathered at the Halifax port before heading to Europe. Any soldier that was ill and could not depart was added to the population of Halifax, which increased the case rate of influenza among men during the war. 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 a record of those who died from 1917 to 1918. The movement of soldiers during this time and the transportation from United States between Canada likely had a significant effect on the spread of the pandemic.


title: Mission: Impossible – Fallout

text: Mission: Impossible – Fallout is a 2018 American action spy film written and directed by Christopher McQuarrie. It is the sequel to "" (2015) and is the sixth installment in the . The film stars Tom Cruise, Ving Rhames, Simon Pegg, Rebecca Ferguson, Henry Cavill, Sean Harris, Michelle Monaghan, and Alec Baldwin. In "Mission: Impossible – Fallout", Ethan Hunt (Cruise) and his Impossible Missions Force (IMF) team seek to prevent nuclear weapon technology from reaching the Apostles, a bioterrorist offshoot of the Syndicate.


title: Mission: Impossible – Fallout

text: Talks for a sixth "Mission: Impossible" film began before the release of its predecessor in 2015. "Mission: Impossible – Fallout" was officially announced in November 2015, with McQuarrie confirmed to write and direct, thus becoming the first director to return to the franchise. The returns of the cast were announced soon after; Jeremy Renner, who appeared in the previous two films, confirmed his absence at CinemaCon in March 2017, due to scheduling conflicts with "" (2019). Principal photography began in April 2017 and lasted until March 2018, with filming locations including Paris, New Zealand, London, Norway, and the United Arab Emirates. Production was notably put on hold for seven weeks following an injury to Cruise in August 2017.


title: Mission: Impossible – Fallout

text: "Mission: Impossible – Fallout" premiered in Paris on July 12, 2018, and was theatrically released in the United States in RealD 3D and IMAX (a first for the series) by Paramount Pictures on July 27. It received critical acclaim, with praise for its action sequences, McQuarrie's direction and screenplay, and the cast performances (particularly Cruise's); it is widely considered to be the best installment in the franchise. The film grossed $791 million worldwide, making it the highest-grossing film in the franchise, the eighth-highest-grossing film of 2018, and the then-highest-grossing film of Cruise's career (until 2022's ""). The sequel, "", is scheduled for release in July 2023.


title: Mission: Impossible – Fallout

text: Two years after , the remnants of the Syndicate have reorganized as a terrorist group known as the Apostles, having adopted the 'Terror for hire' policy. They are hired by an extremist known as John Lark, and are attempting to acquire three stolen plutonium cores for him to use in three nuclear bombs. IMF Agent Ethan Hunt is assigned to recover the plutonium, and arranges a meeting to purchase the cores, but the Apostles intervene and take fellow teammate Luther Stickell hostage. Ethan chooses to save Stickell, allowing the Apostles to steal the cores. The IMF team later captures Norwegian nuclear weapons expert Nils Delbruuk, whom the CIA believes is building weapons for Lark. Using a fake broadcast of teammate Benji Dunn posing as CNN's Wolf Blitzer, they trick Delbruuk into unlocking a phone he used to communicate with Lark.


title: Mission: Impossible – Fallout

text: Furious at the IMF's failure to secure the plutonium, CIA Director Erika Sloane instructs Special Activities Division Agent August Walker to accompany Hunt on a mission to retrieve it. Hunt and Walker infiltrate a Paris nightclub where Lark is supposed to purchase the plutonium from the Apostles, with arms dealer Alanna Mitsopolis acting as broker. They track a man they suspect to be Lark, but after an intense fight in the men's restroom, the man is killed by MI6 Agent Ilsa Faust. Hunt assumes the identity of Lark and meets with Mitsopolis, but the meeting is cut short when hitmen attack them. In exchange for the plutonium, Mitsopolis tasks Hunt with extracting Lane from an armored convoy moving through Paris, and provides one of the cores as a down payment.


title: Mission: Impossible – Fallout

text: Hunt and Walker preemptively attack the convoy to prevent Mitsopolis’ brother Zola and their men from killing local police. Ramming Lane's vehicle into water, they lead police and Mitsopolis's men on a chase while Dunn and Stickell secure Lane. Faust reappears and attempts to kill Lane under orders direct from MI6, but Hunt escapes with Lane. Mitsopolis then instructs Hunt to deliver Lane to London. At a London safe house, IMF Secretary Hunley orders Hunt to stop the mission and turn himself in after receiving doctored evidence implicating Hunt as Lark. The team trick Walker into admitting he is the real Lark and inform Sloane, who sends a CIA unit to take everyone into custody. Unbeknownst to Sloane, the unit has been infiltrated by the Apostles and Walker signals them to attack.


title: Mission: Impossible – Fallout

text: Walker kills Hunley and Hunt pursues him to an elevator, where Walker tells him that he must turn himself in and admit he's Lark or he will kill his former wife, Julia. The team track Lane and Walker to a medical camp over the Siachen Glacier. Faust deduces that Lane is planning to detonate the nuclear bombs at the medical camp, contaminating the water supply of India, Pakistan, and China. The bombs are linked by a failsafe; any attempt to defuse one bomb without also disarming the detonator will automatically trigger the other. At the camp, Hunt discovers Julia and her new husband Erik. Lane programs the bombs' detonator with a 15-minute countdown and gives it to Walker, choosing to remain with the bombs.


title: Mission: Impossible – Fallout

text: Walker takes off in a helicopter secretly pursued by Hunt while Dunn, Stickell, and Faust try to find and defuse the nuclear weapons. Julia helps Stickell disarm the first bomb, but they are unable to defuse it without the detonator. Faust finds the second bomb but is ambushed and subdued by Lane; Dunn and Faust eventually overpower him. Following an aerial chase, Hunt uses a hijacked helicopter to ram Walker's helicopter out of the sky. The two men fight on the edge of a cliff before Hunt kills Walker by dropping a hook attached to a helicopter on him. Hunt secures the detonator, allowing the team to deactivate the bombs. In the aftermath, Sloane hands Lane over to MI6 through Mitsopolis, with Faust earning her exoneration. Julia tells Hunt that he has given her the best life, despite his commitment to the IMF. Sloane praises Hunt for his actions.


title: Mission: Impossible – Fallout

text: On May 23, 2015, "The Tracking Board" reported that Paramount Pictures was developing a sixth "Mission: Impossible" film, with Tom Cruise, J. J. Abrams, David Ellison, and Dana Goldberg returning to produce, along with Don Granger and Matt Grimm as executive producers, and Elizabeth Raposo overseeing development. On July 28, 2015, Cruise confirmed on "The Daily Show" that a sixth film was already being developed, and told its host Jon Stewart that the filming would "probably" commence in summer 2016. On August 2, 2015, Paramount executive Rob Moore told "Variety" that the sequel was already in the works, stating that they were "very happy to be developing this movie with Tom," and "there has to be another movie." On November 19, 2015, it was announced that Paramount had again hired Christopher McQuarrie to write the film, while it was possible that he would also direct again. The studio was moving fast, with plans to begin shooting in August 2016. On November 30, 2015, McQuarrie confirmed through his Twitter account that he would be back for directing duty as well, and also produce the film along with Cruise.


title: Mission: Impossible – Fallout

text: On August 19, 2016, "The Hollywood Reporter" wrote that Paramount had halted pre-production on the film for a dispute over salary between Cruise and the studio, as Cruise wanted to be paid equal to or more than his fee for the Universal Pictures film "The Mummy". On September 16, "The Hollywood Reporter" confirmed that Cruise's dispute with the studio had been resolved. Production would now begin in spring 2017. In November, Jeremy Renner—who portrayed William Brandt in the and films—stated that he was unsure if he would be part of the sixth film because of scheduling conflicts with his role as Hawkeye in Marvel Studios' "" (2019). In March 2017, it was confirmed at CinemaCon that he would not return for the sixth film.


title: Mission: Impossible – Fallout

text: In February, McQuarrie revealed that the film would include more backstory to Ethan Hunt's personal life. On June 13, 2017, Michelle Monaghan was announced to return as Ethan Hunt's wife Julia Meade-Hunt.


title: Mission: Impossible – Fallout

text: Filming was slated to start in Paris on April 10, 2017. Other locations included London, New Zealand and Norway. Filming officially began on April 8. Some of the filming also took place in New Zealand in July 2017. The municipality of Forsand in Norway allowed the closing of Preikestolen ('Pulpit Rock') for a time in autumn for the film's shoot; only crew members and cast were allowed to approach the mountain for nine consecutive days. They also were allowed up to 50 helicopter landings per day. The scenes set in the Indian-administered territory of Jammu and Kashmir were shot in New Zealand. Director Christopher McQuarrie said that he wanted the climax of the film to be set in a more "politically complex" location than New Zealand, so he chose to set this sequence in Kashmir.


title: Mission: Impossible – Fallout

text: In August 2017, Cruise injured his right leg on the London set during filming. Following the accident, the studio announced it would halt production for at least nine weeks for Cruise's broken ankle and other injuries to heal, but released a statement saying that they would be keeping the July 2018 release date for the film. The injury resulted in a cost of around $80 million for the studio because they had to pay the cast and crew for the eight-week hiatus so they would not take another job. However, the injury and subsequent costs were offset by insurance. They did not count against the film's final budget. Filming resumed in early October 2017, with Cruise spotted on the set seven weeks after his initial injury and two weeks earlier than initially planned.


title: Mission: Impossible – Fallout

text: Reshoots for Cavill's "Justice League" coincided with the schedule for "Fallout", for which he had grown a mustache which he was contracted to keep while filming. While McQuarrie initially gave the producers of "Justice League" permission to have Cavill shave the mustache in exchange for the $3 million it would cost to shut down production on "Fallout" and then digitally fill the mustache in, executives from Paramount rejected the idea, forcing "Justice League"s VFX team to use special effects to digitally remove the mustache in post-production.


title: Mission: Impossible – Fallout

text: On January 25, 2018, the title was revealed to be "Mission: Impossible – Fallout". Filming wrapped in the United Arab Emirates (UAE) on March 25, 2018. Production in the UAE included filming of a High Altitude Low Opening (HALO) jump scene with Cruise. The scene required Cruise and the crew to train on a ground-based vertical wind tunnel, and then use a C-17 military aircraft to make over one hundred jumps from around to end up with three takes that McQuarrie wanted for the film. As the scene was to be set near sunset, they could only make one jump a day to try to get each shot. One of the biggest challenges for the visual effects team was replacing the Abu Dhabi desert with Paris, which is where the jump takes place in the film. Artists re-created the Grand Palais des Champs-Élysées using reference imagery, Lidar scans, and photogrammetry from drone footage that was taken above the building.


title: Mission: Impossible – Fallout

text: The visual effects were provided by DNEG and Blind LTD and supervised by Huw Evans, Andrew Booth, and Jody Johnson with the help of One of Us and The Third Floor.


title: Mission: Impossible – Fallout

text: The musical score for "Mission: Impossible – Fallout" was composed by Lorne Balfe. McQuarrie confirmed Balfe to be the composer for the film in April 2018, replacing the previous composer and longtime collaborator Joe Kraemer. Balfe was given eight months to score the film and had a very collaborative process.


title: Mission: Impossible – Fallout

text: The score has been praised by many critics, calling it an epic and inspiring score, with some powerful themes which are balanced with softer, more sentimental ones; some also considered it being too "Nolan-esque," comparing it to scores by Hans Zimmer (particularly "The Dark Knight Rises"). The score implements the use of percussion, snares, and bongos to create a jaunty staccato momentum.


title: Mission: Impossible – Fallout

text: The digital album was released through Paramount Music on July 14, 2018. The physical soundtrack was released later in the month by La-La Land Records.


title: Mission: Impossible – Fallout

text: The first trailer was released on February 4, 2018, during Super Bowl LII, and a second one on May 16, 2018. Marketing spent a total of $140 million on global promotion and advertisements.


title: Mission: Impossible – Fallout

text: "Mission: Impossible – Fallout" was released in the United States and Canada on July 27, 2018, by Paramount in RealD 3D, IMAX, and IMAX 3D, and August 31, 2018, in China. The film premiered in Paris on July 12, 2018.


title: Mission: Impossible – Fallout

text: The film was released in India with some edits to exclude any mention of the Indian state of Jammu and Kashmir. It was the last film in the franchise to be produced by Bad Robot Productions, which ended its partnership with Paramount in 2018.


title: Mission: Impossible – Fallout

text: "Mission: Impossible – Fallout" was released for digital download on November 20, 2018, and was released on DVD, Blu-ray, and Ultra HD Blu-ray on December 4, 2018. The digital and Blu-ray releases include behind-the-scenes featurettes, a deleted scenes montage, an isolated score, and three commentary tracks. The film is also available in 3D on certain VOD services around the world.


title: Mission: Impossible – Fallout

text: "Mission: Impossible – Fallout" grossed $220.2 million in the United States and Canada, and $571 million in other territories, for a total worldwide gross of $791.1 million, against a production budget of $178 million, becoming the highest-grossing film.


title: Mission: Impossible – Fallout

text: In the United States and Canada, "Fallout" was released alongside "Teen Titans Go! To the Movies", and was projected to gross $48–65 million in its opening weekend, with some estimates going as high as $75 million. It opened in 4,386 theaters, the most ever for the franchise and the seventh-widest release of all time. The film made $6 million from Thursday night previews (including $1 million from IMAX screenings), the highest of the series, a record for Cruise, and a 50% increase from "Rogue Nation"s $4 million. It went on to debut to $61.2 million, the best of the series and the second-highest of Cruise's career. It made $35.3 million in its second weekend to remain in first and marked the best sophomore frame of the franchise. The film made $19.4 million in its third weekend, finishing second behind newcomer "The Meg".


title: Mission: Impossible – Fallout

text: In other territories, the film was projected to debut to $75–80 million from 36 countries, for an estimated total global opening of around $135 million. It made $15 million on its first day, including $2.8 million in South Korea. The film ended up overperforming, debuting at $92 million overseas for a worldwide total of $153.5 million. Its largest markets were China ($181 million), South Korea ($24.9 million), the United Kingdom ($9.5 million), and India ($8.2 million). By its third weekend of release, the most significant markets outside the US were: South Korea ($46.4 million), the UK ($22.4 million), India ($13.5 million), Taiwan ($11.9 million), Mexico ($10.8 million), Brazil ($9.6 million) and UAE ($6.4 million).


title: Mission: Impossible – Fallout

text: On review aggregator Rotten Tomatoes, the film holds an approval rating of based on reviews, with an average rating of . The website's critical consensus reads, "Fast, sleek, and fun, "Mission: Impossible – Fallout" lives up to the 'impossible' part of its name by setting yet another high mark for insane set pieces in a franchise full of them." On Metacritic, the film has a weighted average score of 86 out of 100, based on 60 critics, indicating "universal acclaim." Audiences polled by PostTrak gave the film an 84% overall positive score and a 65% "definite recommend," while CinemaScore reported filmgoers gave it an average grade of "A" on an A+ to F scale, the highest ever for the series.