The only study linking aspirine to increased mortality related to he Spanish Flu is a 2009 study by Karen Starko, MD. It is uncorroberated and applies only to the US. (See https://academic.oup.com/cid/article/50/8/1203/451446)
Continental European period newspaper articles describe an extreme quick progression from onset of symptoms to death. It went so fast, doctors had no time to do anything.
https://anderetijden.nl/aflevering/620/De-Spaanse-Griep
At that speed, the cause is the virus, not an opportunistic bacterial infection or other external factor. Doctors could do nothing.
The Spanish Flu was H1N1. The 2009 H1N1 outbreak was also more severe in young adults when compared to other age groups (with aspirine not being on the radar anymore.)
India serves as a useful vignette. Mortality in India was staggering, with estimates of 18.5 million persons dead [3] and higher [4]. Indeed, the Indian peasant population was so severely affected that economics Nobel laureate Theodore W. Schultz used the pandemic as a natural experiment in per capita agricultural output [5]. Given the huge number of deaths in India and the burden among subsistence agricultural workers, it is extremely implausible that salicylates played an exacerbating role in anything other than a trivial percentage of Indian mortality.
Thus, Starko's intriguing hypothesis fails the test of dose-response. That is to say, in countries such as the United States, where salicylates were more available, mortality was much lower compared with regions where salicylates were less readily available.
Continental European period newspaper articles describe an extreme quick progression from onset of symptoms to death. It went so fast, doctors had no time to do anything.
https://anderetijden.nl/aflevering/620/De-Spaanse-Griep
Aanvankelijk lijkt de ziekte op een gewone griep. Maar razendsnel ontwikkelen de patiënten een viskeuze longontsteking. Twee uur na opname hebben ze al roodbruine vlekken op hun jukbeenderen en een paar uur later zie je al hoe de blauwzucht zich vanaf de oren over het hele gezicht verspreidt….De dood laat dan nog slechts een paar uur op zich wachten
At onset, the disease resembles a common flu. But patients develop a viscuous pneumonia extremely quickly. Two hours after admission, they already have redbrown discoloration at the cheekbones and a couple of hours later you can observe cyanosis starting at the ears and covering the entire face... Death then arrives within a few hours
At that speed, the cause is the virus, not an opportunistic bacterial infection or other external factor. Doctors could do nothing.
The Spanish Flu was H1N1. The 2009 H1N1 outbreak was also more severe in young adults when compared to other age groups (with aspirine not being on the radar anymore.)