Friday, October 24, 2014

The Influenza Pandemic of 1918

This rhyme was popular in 1918

Ninety-six years ago, in 1918, the United States faced a pandemic so lethal that 195,000 people died from it just during the month of October. At the time it was called the Spanish Flu, but it didn’t originate in Spain.  It was a quick killer, hitting young adults, many dying within a day or two of showing symptoms.  Nobody knows how many people died of the flu in 1918-1919, but it is estimated that as many as one-third of the world’s population at the time was infected, and as many as 50 million died, more than three times the number of deaths in World War One. It is believed that more people died in a year from the flu pandemic than the bubonic plague, the Black Death of the Middle Ages, killed in a century. When the Flu Pandemic ended in 1919, 28% of the American population had been infected and between 500,000 and 675,000 people died.

It reached its height in October of 1918, just before the end of World War I.  The War, with its concentration of troops probably helped its spread and made it a pandemic.  It was deadly, killed quickly, sometimes within hours.  Schools, theaters and other public places in the United States were closed to keep the flu from spreading.  Deaths were so numerous, that funeral homes and cemeteries couldn't handle the numbers. People were buried in mass graves, and the size of funerals were limited and often held outdoors in order to curtail the spread of the disease. There was no treatment, quarantine was about the only preventative measure that was effective.

There are several theories about the origin of the Flu in 1918, one points to the town of Etaples in France, which was a major troop staging area, and the location of a military hospital.  Other theories point to the East, specifically China, which experienced an outbreak of respiratory illness in November 1917, which was identical to Spanish flu.  How did the flu get from China to Europe?  China wasn’t involved in World War One, but the link may have been Chinese workers brought to the Western Front, in Europe, to labor behind the front lines.  Travel, now worldwide due to the war, helped the flu virus spread from Europe to the rest of the world.  Soldiers in close quarters were easily infected due to physical proximity, weakened immune systems because of poor nutrition, exposure to chemical weapons, and stress.

There were three waves of flu in 1918.  The first, which hit in the spring and early summer, was mild, and most of the people who contracted it survived. In the United States, it was first reported in Haskell County, Kansas, in early January 1918.  By March 11, it had spread to Queens, New York.  People who were sickened by flu in the first wave were lucky, since having the flu-developed immunity to the virus.  A second more dangerous strain appeared in August 1918, in three places at almost the same time: Brest, France, Freetown, Sierra Leone in West Africa, and Boston Massachusetts.  Between January and August, the virus had mutated and became deadly. The third wave continued through the spring of 1919.

This map views the earth from the top--the North Pole, showing the spread of the virus from China to the rest of the world.

In May 1918, young soldiers in Europe came down with the flu, most recovered, but some developed a virulent form of pneumonia.  Within two months, the flu spread from the military to the civilian populations of European cities.  It continued its spread into Asia, Africa, and South America and back to North America.

During the last week of August, dockworkers in Boston, Massachusetts developed flu symptoms of high fevers, severe muscle and joint pain.  Between five and ten percent of the men with flu developed pneumonia.   The flu spread quickly to the city of Boston.  By mid-September it had spread to California, North Dakota, Florida and Texas.

It was a young person’s pandemic.  In 1918-1919, ninety-nine percent of Spanish Flu deaths were people under the age of 65. In people between the ages of twenty and 40 years old, the rate was fifty percent.  It differed from previous flu outbreaks in that its symptoms were so severe.  Most people died of bacterial pneumonia, a secondary infection.  It also killed directly, causing massive hemorrhages and edema of the lungs.  Nurses noted fevers as high as 105 degrees and unusually severe bloody noses. Often the affected person turned blue, and spit bloody mucus.  It was not usual for a person to die with a day or two of contracting the disease.

People did not know how to stop the disease.  One common solution was to require that everybody wear a face mask. Posters appeared asking people to cover their mouths and noses when the sneezed or coughed. Another prevention method was to encourage men to stop spitting.  Drinking alcohol was another idea that became popular, so popular that it caused liquor shortages.  Closing places where people gathered like churches and theaters was common.

There were so many cases that accurate records could not be kept.  There was also a shortage of doctors and nurses, and those who were available often came down with the flu themselves.  Undertakers ran out of caskets, and there was a shortage of gravediggers. Schools, theaters and businesses closed. Telegraph and telephone service stopped because the operators were sick.  Garbage went uncollected and mail was not delivered.  Since there was no known cause or treatment, people tried other remedies like carrying a potato in a pocket, or carrying a bag of camphor. Wearing a special amulet around the neck.  By November of 1918, the number of new cases started to decline.

People were willing to try anything to prevent the flu, and there were business people willing to capitalize on that.
The flu disappeared almost a quickly as it appeared.  People wanted to forget about it.  Most people didn’t realize how dangerous it was.  When the Spanish flu pandemic began, it was believed that bacteria caused the disease.  Late in 1918, scientists and doctors realized that the cause was a virus. Although the existence of viruses had been known for about 20 years, was not until 1933 that the type A flu virus was isolated, and not until 1944 that a vaccine for type A flu was available.  
Although there have been several flu pandemics since 1919, none have been as severe. The flu pandemic of 1958-1959, (the Asian Flu), killed two million people worldwide and 70,000 in the United States.  Another pandemic in 1968-1969 (Hong Kong Flu) killed one million people worldwide and 33,000 in the United States. In the swine flu pandemic of 2009-2010 (Swine Flu), 12,000 Americans died. Influenza is still a dangerous disease, but now there are eeffective vaccines and treatments for it, and a flu pandemic has never been as lethal as the one in 1918.