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| Makeshift hospital for Spanish Flu victims. Source: National Archives |
Yet the same virus
that devastated the world a century ago can also teach us the way we can—and
must—fight the current pandemic.
In America’s
head-long rush to war in early 1918, few paid much attention to the growing
number of soldiers reporting in sick with high fevers, body aches, and chills.
It was, after all, flu season, and wartime expediency would not allow common influenza to slow down military
training. Within a year, however, that flu would kill would vastly surpass the number of
soldiers and sailors who died in combat on all sides during all four years of
World War I.
So-Called Spanish Flu Death Toll
From August 1914 to the signing of the armistice in November 1918,
about 16 million military personnel and civilians were killed or died of
diseases associated with combat. From the spring of 1918 to the spring of 1919,
the Spanish Flu claimed the lives of at least 40 million people—far more, too,
than were lost in the Black Plague. Some estimates of the number of persons who
succumbed to the Spanish Flu reach as high as 100 million.
Just as health experts today are warning of subsequent waves of SARS-COVID-2,
the Spanish Flu came in three waves, with infection rates rising and ebbing,
then rising again. At its height in the fall of 1918, the Purple Death, as it
was also known, could kill a person in mere hours. Unlike most influenza variants,
this flu killed more than just the very young and the very old. It was
also particularly harsh for victims 20 to 40 years old—the very population that
was fighting at the front.
And like today, there was no cure, no vaccine, and little
support that medicine could provide other than prayer.
Flu Epidemic: Where Did It Come From?
Even today, no one absolutely is sure where such a virulent
avian H1N1 flu virus came from. Some researchers believe it may have started
in China. Others theorize the virus had been around for years, with minor
outbreaks occurring in France in 1916 and England in 1917.
What we do know is that in January and February 1918, flu swept through
rural Haskell County, Kansas. Between late February and early March, three
recruits from Haskell County reported for training at Fort Riley, Kansas. Many
historians believe one or more of these recruits carried the virus. By the end
of March, thousands of Fort Riley soldiers were ill. Soldiers transferring to
other military camps carried the virus with them, and soon 24 of the nation’s
36 largest military installations were suffering large outbreaks of influenza.
Though highly contagious, at this point the flu was still
relatively mild. Though the death rate from this was somewhat higher than the
normal rate of 0.1%, it wasn’t high enough to cause alarm. Infected and
uninfected soldiers were packed into cramp troop ships for the voyage to the
French port of Brest. By the time the ships arrived, even more of the soldiers
were infected. They, in turn, carried the virus into the trenches.
Once brought into the trenches, the virus quickly spread through
the British, French, and German forces. In wartime, however, casualty rates,
even for illness, are kept secret. Media censorship prevented journalists from
reporting on the large numbers of soldiers coming down ill in both the training
camps and trenches. The families of soldiers who died of the flu were simply notified that their love one
“died on the field of honor. “Whether on the battlefront or the home front, few
people knew there was a flu epidemic. And no one realized how quickly it
would become a global pandemic—or how deadly it would be.
By spring, the flu reached Spain, probably brought across the
border by returning Spanish laborers who had been working in France. Because
Spain was neutral in the war, there was no press censorship, and the Spanish
media reported freely on what the news service Agencia Fabra called a “strange
form of disease of epidemic character. “When the citizens of the
belligerent countries finally became aware of the epidemics in their own nations, the flu had a new name. “Under
the name of Spanish influenza, an epidemic is
sweeping the North American Continent,” reported the
Canadian Medical Association Journal. “It is said to have made its
appearance first in Spain, hence Spanish influenza.”
The Second Wave Arrives
The flu subsided during the summer months of 1918, so much so that
British military authorities declared the end to the Spanish Flu on August 10.
But that—just as we’re seeing today—was merely wishful thinking. The influenza virus was only
in waiting; changing itself, mutating into a more efficient predator.
Today, scientists understand that viruses can become more
virulent as they pass from one human to another, a process called “passage.”
The 1960 Nobel recipient Dr. Macfarlane Burnet estimated the relatively mild
virus seen in the first wave of Spanish Flu had gone through fifteen to twenty human passages,
emerging in the fall of 1918 a much more lethal disease than before. It would
be this mutation that would give the Spanish Flu the nickname Purple Death.
As American soldiers continued to arrive in France in late
August, French military authorities saw another eruption of influenza among their
troops. So many sick French and American soldiers were hospitalized that the
hospital had to turn away new victims.
And then, victims were dying in large numbers—20 times higher
than normal flu—and many only hours after first showing symptoms. It was not unusual for a
victim to wake up feeling fine, then collapse a few hours later. By dinner
they would be dead. In between, bloody fluid filled the lungs, preventing the exchange of CO2
for oxygen. Cyanosis turned the skin blue, then purple, and sometimes nearly
black, as the victim literally drowned in their own bodily fluids.
The current belief regarding today’s SARS-COVID-2 virus is it
damages the capillaries (small blood vessel) that line the lung and the alveoli
sacs, preventing proper gas exchange. Similarly, some victims of COVID-19 die
only a few hours after falling ill.
The Flu Comes Full
Circle
In September the virus came full circle, returning to the U.S.
with a vengeance aboard troop ships and warships returning from France. Once
again, wartime expediency help spread the disease. On September 25, 3,108
soldiers boarded a troop train at Camp Grant, Illinois. By the time they
reached their destination at Camp Hancock, Georgia, a 950-mile trek, 2,000 of
the soldiers had to be hospitalized with the flu. Dozens died.
On September 28 Philadelphia held a patriotic parade featuring
thousands of soldiers, sailors, Boy Scouts, and civic group members. Within
three days, every hospital room in the city was filled with flu victims. As many as a quarter of the victims
died every day, only to be replaced with new victims.
Similar results were seen in every large city in the nation. Like
today, public health officials ordered stores and theaters closed. Businesses
shut down. Public coughing and hand shaking were prohibited. Outside their
homes, people had to wear cloth masks over their faces. Field hospitals like
those normally seen on battlefields began popping up across the country to
take in the overflow of flu patients from brick and mortar hospitals.
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| Mandatory face masks helped prevent the spread of Spanish Flu. Source: National Archives |
Eventually, the country’s leaders realized the best way to stop
the flu was to stop feeding it. The military draft imposed to build up
America’s small peacetime army was halted, and by October almost all military
training was halted. The pipeline of fresh troops headed for the trenches of
France began to dry up. Fortunately, the war ended on November 11.
Historians estimate about 700,000 Americans died from the
Spanish Flu—more than all the American skilled in combat in WWI, WWII, the
Korean War, and the Vietnam War together.
A Pandemic of Global Devastation
But America was not alone in its suffering. This second wave of
influenza spread throughout Europe, Africa, and Asia. In Spain, which
gave the pandemic its name, Catholic Masses held to pray for deliverance only
helped spread the virus faster. Twelve hundred flu victims died daily in Barcelona alone;
eventually more than 260,000 Spaniards would perish. Churches and funeral homes
could not keep up with the dead.
When the killing stopped on the battlefields, the dying from influenza and secondary
infections continued. A week after the November 11 armistice, the number of flu-related deaths in
England soared to 19,000; eventually some 200,000 would die in the United
Kingdom. India lost 5 million to the flu. Between 30,000 and 50,000 Canadians died.
Many more perished in Africa, Latin America, Asia, and the Middle East. Then,
by the end of November, it was gone. The virus that arrived in the third wave
in December was a mere shadow of its former self. The virus had undergone an
antigenic shift, creating a less virulent mutation. The third wave swept over
New York City and San Francisco, California. It lingered throughout much of
1919, causing outbreaks here and there, but never the devastation the second
wave wrought.
Spanish Flu: Aftermath
Despite its devastation, the Spanish Flu was largely forgotten
until recently. Even the deadly outbreaks of the severe acute respiratory
syndrome (SARS) virus in 2003 and the Novel H1N1 “swine flu” virus in 2009
did little to prepare us for the novel corona virus that plagues us today. (I
survived the 2009 virus. Ironically, I contracted it while attending, as a U.S.
Navy analyst in military medical operations, a class on responding to pandemics
held aboard the hospital ship Mercy.)
Many factors tribute to the world’s slow response to the current
virus, but they weren’t new or unprecedented factors. First was China’s secrecy
about the virulence of the disease. That was exasperated by the leadership of
too many nations failing to recognize the health disaster looming before them—including
Donald Trump’s ongoing inability to deal with reality or to care about anyone or
anything except himself and his re-election.
But by understanding what worked and didn’t work to combat the
1918 flu, we can understand better what’s working—and not working— today. Today’s
politically-motivated demonstrations against stay-at-home orders forcing an
early reopening harkens back actions that help spur the virus in 1918. The
success of Gunnison to avoid any flu victims at all demonstrates isolation works.
In the end, public health should always trump politics.
