The 1918 flu pandemic

Makeshift hospital in a gymnasium to care for flu patients 1918.

To borrow the opening lines of Charles Dickens' classic, "The Tale of Two Cities", 1918 was the best of times -- it was the worst of times. On the plus side, 1918 marked the end of World War I, the first of the world-wide wars, which had raged in Europe since 1914. That was good. But, on the minus side, 1918 marked the beginning of the outbreak of a flu epidemic, which by 1920 had become a flu pandemic, circling the globe, and reaching even to the Arctic and remote Pacific Islands.

Though the 1918 flu, a strain of the H1N1 virus, was called "The Spanish Flu," it is not known just where the flu originated -- probably someplace in Europe. Since it seemed to hit the German forces before it hit the allies, some have suggested that it might have been a factor in tipping the war advantage to the allied forces of Britain, France and the U.S. The fact that so many troops, both German and Allies, were in such close contact with one another (in those days of trench warfare) made the disease spread to large numbers in a very short space of time. Many of the soldiers had weakened immune systems because of malnourishment and the stress of battle and gas attacks, so were particularly susceptible to any new disease. The flu epidemic became pandemic (world-wide) when all those soldiers took the flu bug back to their homes.

Before the pandemic was over, in 1920, 50 to 100 million people world-wide had been killed by the flu, and it was thought that more than 1 billion people had been afflicted with the virus -- more than half the world's total population at the time. What was unique about the 1918 flu virus was that for some reason it set off a "cytokine storm" in a person who was infected with the virus. The flu virus reacted with the immune system of the victim in such a way as to cause an over-reaction of the immune system, resulting in an attack by the immune system on the victim's own body. Since the immune systems of young, healthy individuals were strongest, they suffered most from the flu. Unlike most flu outbreaks, in which the elderly, infirm, and infants (0-2 years) suffer the most, the 1918 flu most often killed young and heretofore healthy individuals, from 20-40.

The 1918 influenza scourge was different in another aspect. Most flu seasons take place in late fall and winter months. The 1918 flu was worst during the summer months. The virus worked unusually fast in its victims, attacking the lungs, and death was most often attributed to some form of pneumonia. Often, when the flu did not kill its victim it attacked the brain, resulting in some form of mental retardation.

The first wave of the flu hit in March of 1918, and mainly affected the young men who were fighting the war in Europe. That strain of the virus acted like a normal flu virus, in that those mildly infected with the virus recovered quickly, and were immune to the disease after that. But in France the severely stricken were evacuated to crowded field hospitals, and then sent home. This led to a second wave of the disease, a mutated version of the virus, which was much more deadly than the first, and spread quickly to the civilian population in Germany, France, Great Britain, and the United States.

In some places, particularly the Pacific Islands, where the flu had been virtually unknown, and immunity was especially low, the devastation was especially severe. Some areas were so hard hit that steam shovels were called in to bury the dead in mass graves. Stores, schools, and public areas were closed, but sometimes so many people were stricken that there was no one to care for the sick. Western Samoa was crippled when 90 percent of the population was stricken with the disease. On nearby American Samoa the Commander of Naval Forces immediately imposed a blockade of that island and prevented an influx of the disease. American Samoa did not suffer a single flu death.

It is estimated that 28 percent of the population of the U.S. in 1918 was touched by the Spanish Flu, and some 675,000 people (2 ½ percent) died from the disease. This was 10 times the number of war casualties from World War I. Of the U.S. servicemen serving in France, fully half of all wartime casualties were attributed to effects of the flu.

In our own family, we lost an uncle who served in France during World War I, to the flu. He had been a very active, strong and athletic young man. Furthermore he had fought in three major battles in France and came through without a scratch. It was after he returned home to the US that he was taken ill with the flu. The progress of the disease was very swift, and he was dead within just a few days, leaving a wife and two little boys. Cause of death was pneumonia, effects of the Spanish Flu.

Today, it is natural to wonder about the 2009 flu as compared to 1918. There are similarities between the 1918 flu and the 2009 variety. Both bear components of bird, swine and human strains of the virus. Both started off as mild diseases, and both flourished in densely populated centers -- the battlegrounds of France in 1918, Mexico City in 2009. In 1918 there was a second wave -- a resurgence of the disease -- a few months later, which was much deadlier than the first wave. It is too soon to tell if the 2009 version will have a second wave of the flu outbreak.

But there are certainly differences between 1918 and 2009. In 1918 there was more mystery to the disease than today. Communications were primitive compared to 2009. Most nations were reluctant to talk much about the disease, lest they alarm their citizens unduly. Spain, which was more open than most countries about reporting the extent of the flu in their land, was rewarded by having the flu virus strain called "Spanish Flu," even though there is no evidence that the flu originated in that country.

Today, countries are much more open in reporting sensitive health issues. One cannot turn on a newscast or open a newspaper without getting the latest news on the flu pandemic. On a recent CNN newscast 43 percent of the time was spent on various aspects of the Flu Pandemic, a similar statistic to other news programs.

In 2009 we are fairly certain that the Public Health authorities have a better handle on how to cope with the disease -- to isolate victims of the flu, to treat those who have the flu, and especially the secondary effects, such as pneumonia, caused by the disease, and to educate the population in the prevention and treatment of the disease.

And statistics are on our side. Even in 1918 a person only had a 3 out of 10 chance of contracting the flu, and of those who did catch the flu, only 2 ½ out of 100 died from it. Hopefully, by this fall, when the new vaccine is ready to protect us all from this latest version of the flu virus, we can look back on the 2009 flu season as a grossly overblown calamity.

Source: The Influenza Pandemic of 1918 at the Stanford Press

The 1918 Flu Pandemic in Wikepedia