A comparative study of the 1918–1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning,10.1017/S0950268

• ...to propose that the most important determinant of fatal outcome during the 1918 pandemic was associated to greater proximity or repeated exposure to infectious patients, possibly through greater infective dose of the virus, resulting in higher viral burden with “cytokine storm” and death. As in previous examples other factors such as economic level that could determine the nutrition status and access to health care services among persons living in smaller and crowding apartments cannot be excluded ...

A. Cristina Paulo, et al. Influenza Infectious Dose May Explain the High Mortality of the Second...