Moreover, Taiwan is located in the tropical-subtropical zone with similar excess influenza deaths to those observed in temperate zone during periods of previously recognized influenza epidemics in Taiwan [11, 12] , and has been known to be one of the evolutionarily leading regions for global circulation of influenza [13] . Therefore, the island population in Taiwan could serve as a good model for studying spatial and temporal spread of influenza outbreak in a confined region during distinct waves of a pandemic. In this study, we will make use of the healthcare records from 1918-1920 in Taiwan to examine the level of excess healthcare burden under which healthcare system was extended in the years immediately following the initial wave of the pandemic in 1918, and to ascertain the possible post-pandemic demands on a modern healthcare system, such as we might face in the coming influenza seasons.