by Margaret Dedloff
Each year, between 10 and 40 million people in the United States get sick with influenza, or more commonly known as the flu. The flu is a respiratory illness caused by the very contagious influenza virus that can be spread by droplets from coughing and sneezing. The virus can also survive on surfaces, which is why one of the best ways to prevent getting the flu is to wash your hands! Additionally, getting the flu shot each year can help to protect against infection from the virus.
Infection with the flu is characterized by fever, cough, sore throat, body aches, and fatigue. In a typical year, influenza results in anywhere between 290 to 650 thousand deaths globally. While the virus has an important impact on the population each year, the 1918 flu pandemic is the most severe outbreak of the flu in recent memory. The 1918 flu is also referred to as the Spanish flu due to World War I (WWI) wartime censorship. To maintain public confidence and support of their government and to keep damaging information out of enemy hands, many warring countries chose not to report on the flu pandemic. As a neutral country in WWI, Spain decided to report on the illness, resulting in it being referred to as the Spanish flu, despite the outbreak likely starting in the United States.
The first recorded cases of the 1918 flu happened in March 1918 at Camp Funston in Fort Riley, Kansas. Initially around 100 soldiers were sick with a respiratory illness, but within a week, 500 soldiers were ill.
In May of 1918, United States soldiers began to head to Europe to fight in WWI and they brought the flu with them. Fortunately, the first wave of the 1918 flu was relatively mild. Many people caught it, but the symptoms were similar to those experienced with typical flu infection nowadays, resulting in few deaths. There was a second wave of flu infections, however, in the fall of 1918 that was much more serious. This wave likely began at Fort Devens outside of Boston, Massachusetts. Significantly more deadly than the first, this wave resulted in 195 thousand Americans dying in October 1918 alone. A final wave of the pandemic came in 1919. The 1918 influenza pandemic resulted in 500 million people infected, approximately one third of the world’s population at that time, and 50 million deaths worldwide.
As mentioned above, the symptoms of the 1918 flu were generally similar to those experienced with flu infections today: fever, cough, sore throat, and headache. A major difference that made this incidence of flu so deadly was that victims experienced extreme lung damage, with the alveoli (air sacks) of the lungs filled with so much liquid that victims drowned. The 1918 flu, much like today’s flu, was most dangerous for young children and the elderly (65+), but there was another age group that suffered a higher mortality rate: 20-40 year olds.
Much like we have experienced over the last few years with the COVID-19 pandemic, government officials created public health campaigns to try to limit the spread of the 1918 flu. For example, in October 1918, officials in San Francisco, California mandated mask wearing for anyone who worked with the public and encouraged everyone else to wear masks as well.
There were also public health campaigns that encouraged covering your mouth while you cough and sneeze, as well as leaving windows open to let in fresh air. Unfortunately, there were also people who railed against public health measures encouraged by the government, like the Anti-Mask League in San Francisco.
The 1918 influenza pandemic had a huge impact on the world with widespread infections and death. The United States had more people die due to the 1918 flu pandemic than to World War I, World War II, the Korean War, and the Vietnam War combined. While the 1918 influenza pandemic occurred more than a century ago, it can still teach us many lessons about pandemic response. For example, one reason the pandemic may have had such a large death toll was because of the lack of cohesive public health measures, with some cities requiring masks and limiting gatherings and others not. This same phenomenon has been an issue during the COVID-19 pandemic as well. In the future, it would be beneficial to study the historical response to pandemics, and their failures, to influence the next pandemic response.
