Looking back on the influenza pandemic of 1918

Click to enlarge. Source: Our World in Data.

I managed to acquire a copy of THE GREAT INFLUENZA: The Story of the Deadliest Pandemic in History by John M. Barry before the libraries and bookstores closed.

It tells the story of the 1918 influenza pandemic, the deadliest in history in terms of absolute numbers.

Nobody knows for sure how many died.  The old consensus estimate was 20 million; the new one is 50 million.  Barry believes that the virus killed at least 35 million and probably between 50 and 100 million people.

In the USA, the estimated pandemic death toll was 675,000—more Americans that were killed in battle or died of wounds in all the wars of the 20th century..

One of the worst things about the pandemic is that its highest death rate was among people in their 20s and 30s, the young and healthy whose immune systems over-reacted to the ‘flu virus.

If the highest estimate of the death toll is correct, from one in 10 to one in 12 of the world’s young adults may have died, according to Barry.

The influenza pandemic arose in a world at war, and spread because of the war, just as the coronavirus pandemic spread because of a globalized world economy.

Barry said the first cases of the new influenza were reported rural Haskell County, Kansas, and then in Camp Funston at Fort Riley, Kansas, in March, 1918, where draftees were being trained and readied to be shipped overseas.

A short time later it appeared in Camps Forrest and Greenleaf in Georgia, and rhino in 24 of the 36 U.S. Army camps.  It was reported in Brest, France, a short time after American troops arrived there.  Soon it spread to all the nations and colonies that participated in the war. and then over the whole world.

At first, it was no worse than ordinary influenza—the “grippe,” as people called it.  But a second, deadlier wave arose during the summer, a mutant form of the first.

It killed in frightening ways.  Some turned blue or black, because of lack of oxygen in the blood.  Some spurted blood from their noses and even eyes and ears, for reasons nobody yet understands.

There were some who had air migrate from congested lungs to air pockets under the skin, which made a crackling sound when bodies were turned over.  One nurse said she could never eat Rice Krispies again.

The United States in which the influenza arose was more of a police state that it has ever been, before or since.  When war was declared on April 6, 1917, every American and every American institution was expected to be fully committed to the war effort.

There was a spy network, a propaganda network and a war bond-selling network, all reaching into every American town and neighborhood.

A Food Administration, Fuel Administration, Railroad Administration and War Industries Board had absolute power to carry out their missions.

But there was no Health Administration, only a relatively powerless U.S. Public Health Service.  No federal or state agency had responsibility for fighting the pandemic.  A volunteer organization, the American Red Cross, filled that vacuum, along with municipal health departments, private physicians and a few dedicated scientists.

What federal authority did do was try to protect civilian morale by suppressing news of how bad the pandemic was.

The seriousness of the pandemic was only acknowledged in the last month or two of the war, and that was in the context of charging Germany with waging germ warfare.

Censorship also suppressed news of the pandemic in Britain, France and Germany.  The first news accounts came from Spain, a neutral country.  From this people got the idea that the ‘flu originated in Spain

In Philadelphia, one of the worst-hit cities in the second phase, drivers of horse-drawn carts went through the city crying, “Bring out your bodies”—a scene that might have taken place during the Black Death of the European Middle Ages.  Many Philadelphians were in fact too sick themselves to bring out their dead.

Deaths from the disease shot up after a Liberty Loan parade on Sept. 28,.  It was the biggest parade in Philadelphia’s history. The war ended just six weeks later, on Nov. 11.

Municipal authorities had misgivings about holding it, but their patriotism would have been questioned if the city failed to meet its quota of war bond sales.

During the last weeks of the war, the U.S. Army temporarily suspended the military draft.  The number of sick recruits in training camps made training impossible, and there was no point in bringing in more draftees until the pandemic could be brought under control.

Conditions on troop ships were worse.  Troops were distributed among sealed compartments, but they had to come out to eat.  Soon the compartments were filled with the dead and dying, with blood and filth covering the floor.  The healthy tracked blood all through the ships.

Dr. Cary Grayson, the President’s personal physician, informed Wilson of the situation and pleaded with him to freeze the troop movements.  Wilson brought in General Peyton March, the Army chief of staff, to answer Grayson.

March said the troops could not be spared, and those who died of sickness were honorable and necessary casualties, just like those who died on the battlefield.

Wilson, according to Barry, looked out the window, sighed and said nothing.  The troop movements continued until the end of the war.

In the 1919 Peace Conference in Paris, Wilson sought to establish the conditions for a lasting peace that would justify the horrors of the war.

He argued for a “peace without victory” that would make it possible for Germany to rejoin the family of nations.  He threatened to return to the United States without signing the Treaty of Versailles unless punitive reparations and other measures were removed.

Then he was suddenly taken sick.  As he recovered, he seemed liked a changed man.  He agreed to everything that his French allies wanted in return for agreeing to a League of Nations.

 Nobody knows how history would have turned out if he had not given in.   Barry thinks Wilson was one of the last victims of the ‘flu.

Although the pandemic was worldwide, The Great Influenza concentrates on the American experience.  I would be interested to know how the pandemic was experienced in Britain, France and especially Germany, since Germany had the reputation of being the most scientifically advanced nation of that era.

The deadliest effects of the pandemic, according to Barry, were in parts of the world remote from the war and the war effort—Eskimo villages in Alaska, outports in Labrador, rural India and China, tropical Africa and South America.

A few places escaped.  The town of Gunnison, Colorado, cut itself off from the world.  Motorists were turned away by armed deputies as they reached the outskirts of town.  Train passengers were forbidden to disembark at the railroad station.

Gunnison escaped completely.  So did a couple of boarding schools who isolated themselves completely, to the extent not accepting deliveries of packages.

So did American Samoa.  In neighboring Western Samoa, 22 percent of the population died.  The continent of Australia escaped the worst of the pandemic, until some servicemen came home from the war.  They were put in quarantine, but the virus escaped anyway.

∞∞∞

The Great Influenza was first published in 2004 and republished in 2018.  In the new edition, Barry was asked his opinion on what would happen if another equally deadly pandemic occurred.

He thought the death toll of a new pandemic would be great—but only half as great as in 1918.  We now know that influenza is caused by a virus and we know something of the structure of the virus.

We know how to make vaccines for influenza, but they have to be tailored to the particular strain of the disease, and this can take months.  Scientists are working on a universal vaccine, but they’re not there yet.

We do have cures for pneumonia and other follow-on diseases that killed patients who survived the influenza itself.

But Barry noted that most vaccines used in the United States are manufactured abroad.  In the event of a pandemic, the foreign government would be likely to stop exports until its own people were taken care of.

The most obvious thing to do about infectious disease, he said, is to send sick children home from school, as is generally done, and sick adults home from work, as is almost never done.

Quarantine almost never works, he said, because it is almost never enforced rigorously.  Masks don’t help.  Closing borders doesn’t help.  Closing theaters, bars and sports events might help.  He didn’t consider shutting down “non-essential” business.  He thought social distancing can help, but not much.

I only report his opinion about these matters.  I don’t know enough to either endorse it or oppose it.

The great advantage we have over 1918 is that the World Health Organization monitors the emergence of disease worldwide, although this is imperfect.  He said the world was imperiled by the SARS (severe acute respiratory syndrome) outbreak in China in 2003, because the Chinese initially lied and hid the disease.  But overall, we have better information than was available a century ago.

The most terrifying thing about the 1918 pandemic was that public officials lied about it and the people didn’t know what to believe, Barry said.  Fear, not the disease itself, was what threatened to break the society apart.

LINKS

The Spanish flu (1918-1920): The global impact of the greatest influenza pandemic in history by Max Roser for Our World in Data.

How Generals Fueled 1918 Flu Pandemic to Win Their World War by Gareth Porter for The American Conservative.

How they flattened the curve during the 1918 Spanish flu by Nina Strochlic and Riley D. Champlain for National Geographic.

What the 1918 flu pandemic can teach us about COVID-19 by Sara Chodosh for Popular Science.

The Lasting Effects of the 1918 Influenza Pandemic by Alex Tabarrok for Marginal Revolution.

Tags: Infectious Disease, John M. Barry, The Great Influenza