This flu is based on the Spanish Flu of 1918, Nicotero said as much on the Talking Dead. He didn't say Spanish flu explicitly, but said it was based on a flu in the early 1900s that, unlike most flus, killed young, in their prime people. The Spanish flu killed a lot of people and quickly. 500 million were infected and 50 to 100 million of them died.
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This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. 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 majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung
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Spanish Flu Pandemic