The Great Influenza Pandemic of 1918-1919
As World War I war rages on, Philadelphia throws a spectacular parade to promote the latest “Liberty Loan” bonds. Some 200,000 patriotic citizens jam the downtown sidewalks – “packed in like sardines,” one commentator says – to cheer two miles of marching bands, floats, and waves of uniformed troops. Within 72 hours of that event on September 18, 1918 every bed in Philadelphia hospitals is filled. A week later, 2600 people in the city succumb to the flu. Fatalities rise to 4500 the following week. In a month and half the death toll climbs to a staggering 16,000. It will be one of the hardest hit American cities. The Great Pandemic has “officially” begun in the U.S.
“I love a parade” Philadelphia style, 1918
That dramatic flu explosion isn’t exactly a sneak attack. There is a little-noticed deadly outbreak at an army base in Ft. Riley, Kansas six months earlier that spreads to surrounding areas, but it dies down. More significantly, a few weeks before the Philadelphia parade a Boston “Win The War for Freedom” parade features sailors from the Commonwealth Pier base located across the Boston Bay. Some of those troops are already suffering a nasty and sometimes fatal influenza-like illness. The Massachusetts Department of Heath warns after the parade that “unless precautions are taken the disease in all probability will spread to the civilian population of the city.” By the end of October, more than 1000 Boston citizens are dead.
The aftermath of the September 3rd Boston parade does ring alarm bells in Philadelphia. There are some officials and medical experts who advise a cancellation, noting reports of a virus taking lives at nearby military bases. But what about a much needed wartime boost to moral? Not to mention the pressure to meet Liberty Loan quotas. And what if a cancellation precipitates a mass panic? The Philadelphia Inquirer worries about spooking the public, and advises to green light the event. The city Director of Public Health, a political appointee, is on the hot seat. Adding to the heat, he knows that two days before the Philadelphia parade, the nation’s draft call-up has been suspended because nearby army camps, including Fort Dix in New Jersey and Camp Meade in Maryland, are overwhelmed with contagion. The Health Director publically denies the influenza is a major a public threat, proclaiming that those military deaths are “old fashioned influenza or grippe.” He does, however, promise an educational campaign against coughing, spitting, and sneezing in public.
With the hindsight of the Boston and Philadelphia experiences, St. Louis quickly cancels its Liberty Loan military parade scheduled for early October. The death toll in St. Louis does not rise above 770. It posts the lowest per capita death rate for the top ten cities.
At the end of the first week in October 1918, all three cities introduce a series of measures designed to promote social distancing, which generally include targeted quarantines, mask requirements, cleaning regimens, and a ban or regulation of public gatherings – specifically movie theatres, saloons, dance halls, large banquets, fraternal lodges, pool halls, sporting events, and funerals. Church gatherings are more sensitive but often restricted in some manner. Similar measures are enacted in New York, Cleveland, Chicago, San Francisco and other large cities. None of these hard-hit metro areas, however, ever impose any general ban on retail and department stores, offices, and small restaurants. Various laws do mandate an opening/closing “stagger” schedule for businesses in an effort to reduce commuter crowding. Most particularly, there is no interference with factories, mines, and shipyards; it is wartime and most manufacturing is regarded as “essential.”
Schools in some cities remain open. There is a pervasive government belief that children would be better off in public schools than at home. At time when large cities are packed with recently arrived immigrants, officials often echo the patrician sentiments of the New York City Health Commissioner: “New York is a great cosmopolitan city and in some homes there is careless disregard for modern sanitation. In school the children are under the constant guardianship of medical inspection…. If the schools are closed at least 1,000,000 would be sent to their homes and become 1,000,000 possibilities for the disease. Furthermore, there would be nobody to take notice of their condition.”
There are two major waves of influenza in the United States – the first from August through October of 1918 and then again from January to March 1919. The first wave is the most deadly. In all major cities hit by the disease, various restrictions are relaxed, then reinstated, and relaxed again in response to waves or ebbs and flows within waves. In the next installment, we will look in detail at how this played out in San Francisco.
The federal government does not get directly involved in the pandemic response. At that point in our history, state and local leadership on many issues is more prevalent than central authority in Washington. President Woodrow Wilson’s attention is consumed with fighting the World War and then personally leading the peace talks. He never releases any statement about the pandemic. Wilson becomes ill on April 3, 1919 in Paris during the peace negotiations and does not fully recover from what is likely influenza. Individual state governments do intervene with guidelines, mandates, resources and other assistance, but it is the cities that burden the decision-making and implementation.
By early spring of 1919, the Great Pandemic has largely run its course here but rages on in Europe for a few more months. Why does it eventually die out in the United States?
> Social/business restrictive measures contain the spread.
> It is a military-born and spread infection. As the troops are dispersed after the Armistice of November 11, 1918, the overall effect is to mitigate the disease, at least in regard to its concentration in large metro areas where it most contagious.
> Doctors become more knowledgeable and effective in treating the pneumonia that accompanies the disease.
> The virus rapidly mutates to a less lethal strain, which fits a general model for pathogenic viruses to decline in strength.
> So many people contract the flu in a benign (asymptomatic) or at least in a not-deadly form that a “herd immunity” develops.
How and where does the flu begin?
It is widely known as the “Spanish flu.” Spain gets a “bad rap.” To maintain morale, World War I censors usually minimize early reports of illness and mortality in Germany, the United Kingdom, France, and the United States. But newspapers are free to report the epidemic’s effects in neutral Spain, which include the grave illness of King Alfonso XIII. This gives the false impression that the flu originates in Spain and then spreads to France. There is no epidemiological basis for this conclusion. The best evidence is that British troops carry it to France as early as 1916. From there, the back and forth of soldier life across the continent and oceans provides an ideal conduit for worldwide transmission.
How many Pandemic fatalities?
Estimates of worldwide deaths vary, but most historians agree on some 50 million. The U.S. absorbs approximately 675,000 fatalities. For comparison, in 2020 we currently have about 90,000 COID-19 deaths in the U.S. and 320,000 globally. The Pandemic over two years kills more people than the total of World War I in five years. 500 million are infected—one third of the planet. The population of the world and the U.S. were smaller a century ago, so the percentage of deaths are significantly higher than today.
Why so many fatalities then compared to now?
> The Pandemic flu of 1918 is medically more infectious and deadly than COVID-19.
> There are considerably less government efforts to control or contain the disease. In part, this is due to the lack of knowledge that asymptotic carriers can transmit disease. More significantly, the war effort demands that virtually all manufacturing sectors remain open and producing. Although impossible to measure the actual impact of that decision, it undoubtedly adds to the death toll.
> The medicine of the era to treat the disease was far less advanced than today.
> Because it is a military born and raised disease, the concentration of troops for World War I at U.S bases in large cities accentuates the spread. For Europe, where all the fighting occurs, the situation is even graver.
Who is most vulnerable to the flu?
Influenza typically attacks the very young and very old the hardest. The 1918 Pandemic flu targets strong adults, those in the prime of life – like soldiers. The explanation is complex. Some researchers suggest that for this particular 1918 stain, a strong immune system may have stimulated an overreaction to the invading virus and actually emboldened the virus. Others point to the very crowded conditions of military life, which promote contagion.
Cures for the disease?
This unfolded a century earlier. A few vaccines to prevent other diseases are available or in experimental phases at the time – smallpox, rabies, diphtheria, cholera, and typhoid fever. In terms of knowledge of influenza as an infectious diseases, not much is understood then. No vaccine is developed for this influenza or even seriously attempted. Antibiotics do not exist – we knew it was transmitted person to person by respiratory droplets, but viruses will not be discovered until the 1930’s when more powerful microscopes are developed. As a result, testing for the disease is not possible. You wait for symptoms, isolate, and hope for “herd immunity.”
What is the economic impact of the Pandemic in the U.S.?
Perhaps the most significant economic difference between then and now is that in 1918 substantial federal government war spending prop ups and sustains manufacturing across the country. There is no effort to close factories, shipyards, and mines. Many offices either on their own or under orders from the health department require masks and extra cleaning, but the large majority continue to operate. Undoubtedly, entertainment businesses suffer. The data on retail stores, most of which stay open, is more difficult to ascertain, but the evidence points to significant drops in revenue as many customers voluntarily curtail their shopping.
It appears that aggregate economic damage to the U.S economy is modest and temporary. But such resilience is not even; many areas both urban and rural (some 50% of the U.S. is regarded as rural then) suffer more and revive slowly. The stock market recovers well in 1919 and according to most estimates the Gross National Product actually increases slightly in that year.
Why is it called “the forgotten pandemic?”
Despite the high mortality rates, the Spanish flu fades from public awareness until the arrival of news about bird flu and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu the “forgotten pandemic.”
There are various theories of why the Spanish flu is “forgotten.” Media is dramatically less constant and pervasive than today. Americans are familiar with patterns of pandemic disease in the late 19th and early 20th centuries: typhoid, yellow fever, diphtheria, and cholera; the influenza is sometimes regarded as just another, albeit more deadly, malady. In some areas, the disease is hardly felt or reported. The outbreak coincides with media focus on the First World War. The number of war-related fatalities often overshadows and overlaps the deaths caused by flu.
Next: San Francisco in the Great 1918 Pandemic: Unmasking the Real Story
Terry Hamburg, Director, Cypress Lawn Heritage Foundation