alternatehistory.com

The 1918 flu pandemic infected a third of the world's population, a full 500 million people, and killed between 50 and 100 million people, about 5% of the worlds population, then at about 1.6 billion.

So what if the flu had a higher fatality rate? Surely that would curb rates of infection, so maybe it lasts a little bit longer. Let's say the pandemic lasts 45 months instead of 27, from March 1918 to May 1922 instead of June 1920. Maybe only a quarter of the world's population gets infected... but a fifth dies. 320 million people. Some places get hit harder than others, some less. For example, in Tonga a quarter of the population is killed, in Nauru a third, and in Western Samoa only a quarter of the population is left, becoming one of the worst hit locations. Australia and Japan does better than everyone with only 15% of the population dead by the end of the pandemic, thanks to appropriate quarantine measures. American Samoa and New Caledonia do not lose a single person thanks to effective quarantines.

Elsewhere, the rule of 20% of the population killed is followed pretty closely. In the trenches of the Western Front, there is the worse depopulation yet, with 90% dead. For some reason the influenza is especially effective against those between 20 and 40, and that's exactly who is in the trenches. It was stated that half of the deaths in OTL were from that age demographic, and, here, that would amount to 160 million healthy adults, many, many more than are in the trenches, so 90% is a reasonable estimate.

What could be the repercussions of such a devastating disease? I'm thinking that massive American reinforcement on the Western Europe would stop somewhere in the summer of 1918. But the Germans are just as devastated... in any case I think both would come to the negotiation table.
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