Top 10 Facts About the 1918 Flu Pandemic

The Influenza pandemic of 1918 caused more deaths than the four years of the Bubonic Plague. Not only did the pandemic kill more people than died in World War I, but it killed more people than all the wars of the 20th century combined. It is believed that the influenza pandemic of 1918 killed 25 million in its first 25 weeks, while AIDS killed 25 million over a course of 25 years.

Why has this disease been so overlooked in history? No one knows. Perhaps it’s because of the horror it caused to cities and the efficiency with which it killed. When undertakers ran out of coffins, bodies lined the streets. One of the things that made the illness so deadly was that it killed more healthy young adults than it did children or elderly. In some especially deadly cases, the person afflicted with the disease died only hours after feeling the first symptoms.

Children used to jump rope while singing:

I had a little bird,

Its name was Enza.

I opened the window,

And in-flu-enza.

1.  Struck Down In The Prime Of Their Lives

The 1918 Influenza killed a disproportionately high number of healthy young adults. Historically, the flu creates a U-shaped graph of fatalities. The very young and very old are most likely to die from influenza while those in the prime of their lives (between age 20 and 40) are not as vulnerable. The 1918 flu created a W-shaped fatality graph. Individuals between the ages of 20-40 accounted for nearly half of the fatalities. This was a phenomenon unique to this pandemic and has never been seen before or since. Another statistic unique to the 1918 pandemic is that individuals below the age of 65 had a much higher rate of death than individuals over the age of 65. The demographic under age 65 accounted for over 99% of all excess influenza related deaths.

This abnormal result is believed to have been caused by the immune systems of healthy young adults over responding to the threat of infection. It is speculated that the disease induced a massive immune system response of cytokines and immune cells, or a ‘cytokine storm,’ that caused the individual to die from an overreaction of their own immune system.  The individuals with the strongest immune systems were killed when their own immune systems ravaged their bodies.

One theory to explain the elderly portion of the population’s immunity is a previous influenza strain that circulated in the population born before 1889. During that year, the ‘Russian flu’ circled the globe and killed about one million worldwide. Some epidemiologists hypothesize that the individuals that survived this pandemic had a higher rate of immunity to the influenza of 1918. This claim is disputed by the fact that for this to occur, the virus would have to have appeared suddenly before 1889, then disappeared for three decades before violently surfacing again in 1918.

9. What You Don’t Know Can Kill You

Wartime press censorship between 1914 and 1918 stopped the dissemination of information regarding the spread of the epidemic. News of the highly infectious disease was deemed as detrimental to the war effort, and was stifled by the government. When newspapers did report on the spread of the disease, it was too late. The disease was already running its course throughout the population and the information that was distributed was largely ineffective in stopping the spread of the epidemic.

The federal government delegated all tasks of responding to the epidemic to state governments. The first case was reported to Army officials in Kansas during March of 1918. The first public health report that was filed regarding the ‘Spanish flu’ occurred in July in Philadelphia. The U.S. Public Health Service, which should have coordinated a national plan to disrupt the spread of the disease, lacked the resources to carry out an effective policy. When the U.S. Public Health Service finally did receive the first reports of the disease, they offered no advice to the public or even acted on the information they were given.

Within U.S. Army camps thousands of men became infected. The Army did not report these cases to the U.S. Public Health service. They Army also failed to carry out effective quarantines within its camp. When it came to tracking the disease and quarantining affected areas, the government was slow to act; if they acted at all. The government was focusing on the war effort, while it should have been focusing on the war on influenza at home. During the year of 1918, when influenza was at the peak of its killing efficiency, the federal government assigned 180 public officials and 44 quarantine stations in an effort to combat the disease.

Public health departments of the individual states were unable to effectively react to the massive amounts of sick and dying citizens. Public officials such as city mayors were reluctant to admit there was a problem because they thought it would harm wartime morale and production. The New York Times reported that the government was able to evoke press censorship under “Title 1, section 1, 2, and 3 of Title 12 of the Espionage Act.” This executive power was signed by President Woodrow Wilson on June 13, 1917. This gave the government the ability to shut down any press that printed information harmful to the war effort.

The government and U.S. Public Health officials did save lives by ordering the temporary closure of public places such as theatres, taverns and shops in order to stop the spread of the virus in areas where large groups of people gathered.

8.  A Legacy of Death

The strain of influenza that devastated the world in 1918 has fostered nearly every major influenza A outbreak since. Influenza A is just one type of Influenza; the two other types being B and C. The scientific nomenclature of the virus, H1N1, has resurfaced multiple times over the course of the 20^th century, most recently in the first decade of the 21^st century. The scientific name H1N1 refers to the chemical structure of protein markers on the outer shell of the virus’ coat. Nearly all cases of influenza A worldwide are direct descendants of the 1918 strain, which killed tens of millions of people within a few weeks.

The H1N1 strain underwent genetic drift to create the H2N2 strain and also the H3N2 strain. These mutated strains have surfaced in the 20^th century and caused other well known influenza pandemics.  The only exceptions to the lineage of the 1918 strain are the avian viruses H5N1 and H7N7, which have a separate genealogy.

The Asian Flu outbreak (H2N2) of 1957 was a descendent of the 1918 strain. The strain killed about 70,000 people in the United States and two million people worldwide according to the World Health Organization.

The H3N2 influenza outbreak in Hong Kong in 1968 was also direct relative of the 1918 strain. This strain killed roughly one million people worldwide. These are just two of the many influenza outbreaks that are claim the 1918 pandemic as their ancestor.

The weakening of influenza’s severity over time can be attributed to advances in the laboratory and preventive efforts. The WHO is an active agent in preventing the spread of dangerous infectious diseases before they can take hold of a population.  Lab test results have shown that the strain of influenza in 1918 would have been treatable using FDA approved antiinfluenzal drugs rimantadine and oseltamivir that are available today.

7. Mysterious Origins

A mystery remains as to the absolute origin of the influenza strain that devastated the world. The first outbreak in a military camp was reported at Camp Funston (now Fort Riley) in Kansas. The first civilian outbreak can be traced back even further than that. The local newspaper of Haskell Country, the Santa Fe Monitor, issued reports saying “everybody in the county has lagrippe or pneumonia” on February 21^st, 1918.  When troops from Camp Funston came to Haskell county to visit their families while on leave, they contracted the disease. When they returned to the military camp, they carried the infectious disease with them and unknowingly spread it amongst their fellow soldiers. Camp Funston was home to 56,222 troops in close quarters and unsanitary living conditions.

On March 4, 1918, the first soldier reported sick in Camp Funston. In the course of a few hours, hundreds were sick. Within a period of three weeks, the disease had infected more than one thousand soldiers. The soldiers then began to move to other army bases, and the disease spread with them. The disease’s movements across the globe can be traced to the movements of these soldiers. The most lethal virulent wave of the disease struck Camp Devens, near Boston in September of 1918. As they moved from base to base, and eventually to Europe, they brought the disease with them.

Another theory that has originated recently is that the disease started in a British Army post in France. British scientist J.S. Oxford theorized that the pandemic of 1918 first arose two years earlier in the form of a disease that British physicians referred to as “purulent bronchitis.”Autopsies of soldiers killed by the outbreak there share a striking resemblance to those killed by influenza in 1918.

This theory cannot account for the further spread of the disease. The theory that can be traced back to the origin is the Haskell County/Camp Funston theory. Neither of these theories are settled indisputably and speculation abounds as to other possible sites of origin. While the theory that the disease originated in Kansas is highly plausible, it undermines that fact that most influenza outbreaks before and after 1918 originated in Asia.

6. Malignant Misnomer

The “Spanish Flu” is the colloquial name most often associated with the 1918 influenza pandemic. This gives the impression that the disease originated in Spain. It did not. The reason that the disease became known as the Spanish flu was because Spain was neutral during World War I and the press was not subject to wartime censorship. Therefore, the press in Spain was free to print whatever news about the disease they saw fit. The surrounding countries began gathering diseased related news from Spain, as it was uncensored and the most reliable. Thus, they dubbed the disease the “Spanish flu.”

In other countries, such as Britain and the United States, the intense levels of press censorship stopped the distribution of information detrimental to the war effort (such as news of an impending pandemic). In all likelihood, the disease originated in Kansas; yet it was never given the moniker the Kansas flu. The disease was likely carried to Spain by American troops.

Another reason the most accurate information regarding the flu came from Spain is because the king of Spain at the time, Alfonso XIII, contracted the illness and became the illness’ most high profile victim. News organizations in Spain frequently released reports on the state of the king’s health.

5. Not Your Average ‘Flu’

The CDC estimates that influenza and influenza related complications cause about 36,000 fatalities in the United States every year. This number is taken from a study during the period between 1990 and 1999. A study done over the 23 year period between 1976 and 1999 concluded an average of 25,000 deaths per year. These numbers can be used in comparison to the 1918 influenza pandemic to give a picture of just how severe and deadly the disease was.

About 675,000 Americans died from influenza and influenza related complications out of a population of 105 million during the 1918 pandemic. The extreme virulence of that year’s influenza strain has not been seen before or since. Along with the highly infectious nature of the flu, many deaths can be attributed to lack of information available to the public, rudimentary medicine, and the cramped and unsanitary conditions that soldiers lived in. Today, with our increased knowledge of influenza and of other infectious diseases, these numbers would be lower.

The World Health Organization estimates that the seasonal flu kills between 250,000 and 500,000 people every year, while conservative death tolls of the 1918 pandemic are between 20 and 30 million. Some estimates are as high as 50 and 100 million. It’s impossible to know the exact number because hospitals stopped keeping track of their patients as the bodies began to pile up in hallways and outside doorway. These numbers, in comparison to the averages, are astoundingly higher.

During the average flu season, between 5-20% of individuals get the flu and kill less than .01% During the epidemic, it is estimated that 28% of the world’s population contracted the illness. All in all, between 2.8-3% of the world’s population died from the disease.

4. Bad Medicine

Medieval techniques were often employed to fight the disease. Treatments for the disease varied all across the world. In some places, treatment methods ranged from oils and herbs, to aspirin, bleeding, and taking hot baths. One treatment was cinnamon in powder or oil form; to reduce temperature. Many of the treatments were tried on a trial-and-error basis.

Many flu victims simply had their symptoms treated, as there was no known remedy for the disease itself. Hot and cold packs were given as needed, and patients were given plenty of water to prevent dehydration from sweating. Oxygen masks were given to patients that were suffering from cyanosis, a condition that occurs when the lungs cannot properly oxygenate the blood, and the heart pumps unoxygenated blood through the body. Victims of cyanosis would often turn very dark from lack of oxygenated blood. The cyanosis was caused by hemorrhaging of the lungs and cytokine storm invasions of lung tissues. After the hemorrhaging and cytokine storms had taken their toll, most victims were unable to breathe and choked on their own blood.  98% of victims that developed cyanosis died. Because a disease as deadly and as rapid as the 1918 influenza had never been seen before, many doctors misdiagnosed the disease as dengue, cholera, and typhoid. Oftentimes, the body’s weakened immune system left victims vulnerable to secondary infections such as pneumonia.

As desperation spread, people began trying everything in search of a remedy. Superstitious remedies became commonplace in some areas. Some people hung balls of camphor around their necks in an effort to ward off the flu. Others ate lumps of sugar that had been soaked in kerosene. One treatment was to ‘tie a ribbon around your right arm.

3. Killer Speed

One astonishing trend of the 1918 plague was the virulence and quickness with which it claimed its victims. The disease came in three waves. The second wave was the deadliest. It occurred during the winter of 1918. Most deaths occurred in a sixteen week period, from mid-September to mid-December of 1918. One of the reasons the second wave was the worst is because the soldiers returning from the war brought the pandemic back with them. The virus had mutated into a much more virulent strain while in Europe. It arrived in a Boston port in the fall of 1918. The massive number of returning troops gave the virus an incubator for when it reached the mainland.

When people celebrated Armistice Day on November 11, of 1918, throngs of people took to the streets to participate in parades, rallies, and parties. For public health officials, this was disastrous. The large numbers of people being in close contact with one another caused a resurgence of the epidemic in some cities that were beginning to get it under control.  In the month of October alone, the virus killed almost 200,000; or a third of the total United States death toll.

The speed with which the epidemic struck overwhelmed hospitals. Nurses and doctors were in constant short supply. As the hospitals filled up and the disease spread everywhere, doctors and nurses began to die from the illness. The supply of coffins could not keep up with the incredibly sudden onset of the virus. The virus killed the majority of its victims in less than one hundred days; between the months of September, October, and December. An infectious disease with the killing power and speed of this virus has never been seen before or since.

The massive amount of deaths caused the United States average life expectancy to fall by ten years.

2. Triple Threat

The Influenza epidemic did occur in one single wave, it occurred in three. It surfaced first in the spring of 1918, albeit in a milder form than the fall wave. The illness began in March and spread throughout the United States and Europe over the course of the next few months. The rate of infection among communities for this first wave was higher than normal, but the fatality rates were low. This first wave of the illness was not unusual, other than the higher rate of infection. It affected young children and elderly the most, which is a trademark of the milder seasonal flu. The initial wave of 1918 was nothing compared to the wave that occurred during the fall months.

The fall wave that occurred between the months of September, October, and November of 1918 was by far the most deadly wave. This wave killed millions of people all over the world in just a few weeks. The second wave proved to be the most deadly, but the terror was not over yet.

A third wave occurred in the winter of 1919 and in some places stretched into 1920.

One of the reasons scientists classify the disease as occurring in three waves rather than just one is the noticeable differences between the fatality rates of each successive wave. The second and third waves, which occurred during the fall and winter, had a considerably higher rate of complication, severity, and fatality. In some places, the transition between waves was too slight to even be noticeable.

Scientists are uncertain as to what gave the influenza of 1918 the ability to mutate with such incredible speed and to strike with such virulence.

1. GLOBAL TERROR

Despite the disease’s likely origin in the United States, the rest of the world was quickly infected. The pandemic of 1918 killed the majority of its victims overseas, specifically in Southeast Asia.  About 675,000 Americans were killed by the disease (about ten times the amount of American soldiers that died in World War I) while the rest of the tens of millions of deaths occurred all over the world. The disease, which became known as La Grippe, was seen in North America, Europe, Africa, Asia, Brazil, and the South Pacific. Because the virus mutated rapidly among troops in Europe, especially in Germany, the allied forces blamed Germany for using biological weapons.

The battlegrounds of Europe had their fair share of pandemic victims. The death tolls of the Great War were compounded by the civilian deaths caused by influenza. The death toll from the virus in Britain was 228,000. 400,000 citizens of Germany died in 1918 alone.

By Jacob Mc Hugh

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