A World of Pandemics: Part I


Of all the horrors of World War I, it wasn’t the bombs, bullets, or even the mustard gas that ended up as the greatest killer. In reality, the act of moving that many people around the world turned out to be the most deadly fruit of war. The last year of the war, 1918, saw the most deadly pandemic the world has ever known. With all those millions of soldiers being shipped around the globe, it spread like wildfire.

This was the Spanish influenza pandemic. In terms of sheer numbers killed, the Spanish influenza beats out the Black Death as the king of historical epidemics. The statistics of the Spanish flu are just brutal, and the disease touched every corner of the globe. Survivors tell of heartbreaking scenes of misery and quarantine, and today the flu ranks as one of the worst diseases in history, a reminder of how deadly influenza can really be.

The Pandemic Killed 5% Of The World’s Population

Photo: Stevan Aleksić/Wikimedia Commons/Public Domain

The Spanish influenza pandemic killed people on the scale of the fourth rider of the Apocalypse. It is estimated to have killed between 50 and 100 million people worldwide between 1918 and 1919 alone. To put that into perspective, the four years of WWI only killed 17 million people total. Just in the US, over half a million people were killed by the flu, five times as many Americans as were killed in the war.

The flu infected (but didn’t necessarily kill) even more: about 1/3 of the world’s population was believed to have been infected by some form of the Spanish flu. That’s 500 million people at a time when there were only about 1.5 billion people on the entire planet.

The Disease Targeted Young Adults

Photo: CDC/Wikimedia Commons/Public Domain

The normal victims of the flu are typically babies and really, really old people – like, spare hip, dinner at 4:00 pm kind of old. When a 50 year old dies of the flu, it’s a pretty big deal. And a 25-year-old gym rat might think of the flu as a crummy week or two in bed, but the term “life threatening” wouldn’t even come to mind. The Spanish flu turned all that on its head. Young, healthy guys would get home from work one day feeling a little sluggish, and then get carried off in a body bag the next morning. Suffice it to say, that freaked a lot of people out.

Unlike normal flu viruses, Spanish influenza seemed to target those between 20 and 35. The reason for this is that people born after 1889 had no exposure to anything similar to the 1918 virus strain. Those born before that date had some exposure to a similar flu strain; therefore, they had some immunity. That discovery didn’t come until 2014, though, so people at the time were left guessing why Johnny-six-pack next door just dropped dead while Aunt Gertrude was still going strong.

The First Recorded Outbreak Occured In Kansas

Photo: U.S. Army photographer/Wikimedia Commons/Public Domain

Like college basketball champions and the world’s supply of corn, the Spanish flu seems to have come from unassuming Kansas. While the state boasts many fine and comfortable establishments, Fort Riley was not one of them. In 1918, the army camp housed 26,000 men and was described as bone-chilling in the winter and sweltering in the summer. Oh yeah, and they burned tons of manure from the many horses and donkeys on the base, so it probably always smelled like a paper mill.

On March 9, conditions at the base got a lot worse. The cook, Albert Gitchell, reported to the infirmary with a bad cold. By noon, there were over 100 soldiers in the infirmary, apparently suffering from the same malady. In total, 1,127 soldiers came down with the flu, 46 of whom died.

The condition spread to other camps but, given that war was declared, the brass kept a tight grip on the information. Besides, an outbreak of illness among a bunch of men closely quartered in less than ideal living conditions was hardly that unusual.

The Flu Traveled To Europe With American Soldiers

Photo: U.S. Army/Wikimedia Commons/Public Domain

In March of 1918, 84,000 American soldiers were shipped off to Europe. In April, another 118,000 crossed the pond. Along with them, the soldiers brought a chance at victory for the Allied Powers. That, and also the deadly influenza virus.

Imagine that you’ve been living in a muddy trench for the past three years, dodging bullets, ducking artillery, and chasing off rats. Somehow, you are still alive. Finally, some serious reinforcements are coming in, and things are looking up. Then, out of the blue, you catch the worst flu you could possibly imagine. Before you know it, you are lying on an army cot jammed next to a bunch of fellow flu victims, dying in a state of complete delirium because of your high-grade fever.

In the month of June, 31,000 influenza cases were reported in Great Britain. The virus rapidly spread across enemy lines and beyond into Russia, India, and North Africa. By July, the disease had spread across the Pacific to China, Japan, the Philippines, and New Zealand.

Spain Was The First Country To Announce The Epidemic

Photo: Gerardo Chowell, Anton Erkoreka, Cécile Viboud and Beatriz Echeverri-Dávila/Wikimedia Commons/CC BY 4.0

Though Spain was not the first place to be stricken with the illness, it was the first country to openly report it. That is because it was the first country that was not actively involved in WWI to experience the flu’s incredibly high mortality rate. Where other countries (including the US) censored the news for fear of damaging “public morale,” Spain reported on the outbreak freely, which is how the infamous influenza gained the name Spanish flu.

Even Remote Villages Were Not Immune To The Disease

Photo: Internet Archive Book Images/Wikimedia Commons/Public Domain

It wasn’t only the large population centers that suffered from outbreaks of the Spanish flu. Even Inuit villages in Alaska suffered from outbreaks of the disease. In some cases, entire villages were completely wiped out from the disease. In other cases, all the adults were killed, leaving only orphans behind to fend for themselves.

One such infected village was the small, Inuit town of Brevig Mission, Alaska. The disease claimed the lives of 90% of the town’s Inuit population. It was so bad that the Alaskan Territorial government had to pay gold miners from Nome to go up and bury the bodies. When the miners arrived, they tossed the bodies into a pit two meters deep and covered it with permafrost.

The Second Wave Of The Flu Was Much Deadlier Than The First


By the end of the summer, the first wave of the flu was starting to die down. People who hadn’t been tagged by the disease undoubtedly felt pretty good about themselves, having dodged that bullet. Then the second wave of the pandemic hit.

It began at a naval facility in Boston in September of 1918, and it pretty much wrecked everyone. Around this same time, the flu hit the port towns of Brest, France, and Freetown, Sierra Leone. It was at this point that the situation escalated from standard pandemic to full-blown crisis of biblical proportions.

In the month of October, 195,000 Americans died from the flu. The death rate during the second wave was a full five-times higher than that of the first. The “lucky” ones who escaped the first wave were much more likely to catch the second wave and subsequently die from it. With such high communicability and mortality rates, things quickly got out of hand.

Symptoms Included Turning Blue And Bleeding Internally

Photo: National Photo Company/Wikimedia Commons/Public Domain

Catching Spanish influenza was not fun. Initial symptoms were similar to normal influenza (fatigue, fever, and headache) but more severe. When the coughing and sneezing set in, things started to get really nasty. People would cough with such force that their abdominal muscles tore.

The flu was so virulent that it would cause internal bleeding around the lungs. People would bleed from their mouths, noses, and sometimes ears. People’s skin would actually turn blue, to the point where it was hard to identify their initial skin color. With all that damage to the lungs, pneumonia set in pretty quickly. People would usually die within a day or two of developing their first symptoms, sometimes mere hours after figuring out they were sick.

They Couldn’t Bury The Bodies Fast Enough

Photo: Unknown/Wikimedia Commons/Public Domain

The world’s worst day is the undertaker’s best day, but the booming coffin industry simply could not keep up with the staggering rate of death caused by the Spanish influenza. We’re talking tens of thousands of people dying in a matter of a month or two…  in just about every big city around the world. To prevent the infectious bodies that were slowly rotting in the morgue corridors from causing secondary infections, many places restored to digging mass graves.

In 2015, a mass grave was rediscovered in Pennsylvania. Located around 100 miles northwest of Philadelphia, the bodies were uncovered after a heavy rain washed away the topsoil near a highway embankment. There were no coffins, just human bones jutting up from the soil.

The War Had Created A Shortage Of Medical Staff

Photo: St. Louis Post Dispatch/Wikimedia Commons/Public Domain

Many of the trained medical personnel at the time the Spanish influenza struck had already joined up with the military to help the war effort. Even before America entered the war, many doctors and nurses volunteered to serve in field hospitals through the Red Cross. So when the flu hit, a great deal of those medical resources were tied up in the trenches of Europe.

As a result, many of those tending for the sick at home were volunteers. They had varying degrees of experience in medicine, from retired doctors pulled back into service to medical students who were still in training.

In some cases, women whose only medical experience was tending to their families found themselves nursing for entire communities. These volunteers risked and sometimes gave their lives caring for the infectious sick. In many cases, their care was the difference between life and death for flu victims.

In The US, Philadelphia Had The Highest Rate Of Sickness And Death

Photo: National Museum of Health and Medicine/Wikimedia Commons/Public Domain

Philadelphia really dropped the ball on this one. City officials knew about the second-wave outbreak of the flu in Boston; they had even issued a bulletin about the dangers of Spanish influenza as early as July, but they still figured that it was no big deal in late September of 1918. They didn’t even have it listed as a reportable disease. Sh*t was about to get real.

In late September, the public was getting mixed signals about the influenza problem. Assurances were made that the disease was contained to military personnel. Dr. Paul Lewis, director of the Philips Institute of Philadelphia announced that they had identified the cause of influenza (incorrectly of course). Then on September 28, the city threw a massive parade, of all things, where 200,000 people gathered to support the war effort. Within days, hundreds of new influenza cases were being reported. The city was forced to admit that they had a problem. Churches, schools, and theaters were all closed.

Unfortunately, about 75% of the city’s medical personnel were unavailable due to the war. Hospitals quickly became overcrowded, necessitating churches and state armories to double as shelters for the sick. The corpses started piling up, posing a real public health problem. The city appealed to the federal government to send embalmers, and individuals were being conscripted to dig graves for $15 a pop. By the time the epidemic abated in early November, almost 13,000 people were dead.

Public Spitting And Coughing Were Banned

Photo: Wikimedia Commons/Public Domain

In some cities, schools, churches, and other public places were closed, and additional quarantine measures were also put into place. The medical community knew enough to realize that public gatherings and bodily fluids contributed to the spread of the disease. Aggressive public information campaigns were disseminated akin to the hand-washing and “cover your cough” campaigns in circulation today.

Perhaps the most hilarious of the public health measures, though, was an ordinance adopted in several locations that banned spitting. In New Castle, Pennsylvania, spitting in public was met with a $1 fine and possible jail time. In all fairness, though, spitting isn’t just bad manners. Apparently, it actually does kill people.

Like The Bubonic Plague, Children Created A Nursery Rhyme About It

Photo: Hans Thoma/Wikimedia Commons/Public Domain

As the Black Death had “Ring Around the Rosey” to commemorate it’s destruction, so too did the Spanish Flu develop a cute diddy.

   I had a little bird
   And its name was Enza.
   I opened the door
   And in-flew-Enza.

The Medical Community Didn’t Understand What Caused The Flu

Photo: Board of Public Health, Victoria/Wikimedia Commons/Public Domain

The Spanish flu came around before penicillin and viruses were even discovered. No viral vaccines even existed, let alone one for the flu. The vaccinations that did exist were bacteria-based, and, at the time, people actually thought that influenza was caused by a bacterium called Bacillus Influenzae. Though they may have helped prevent secondary infections in some cases, they had no hope in stopping the viral influenza.

It wasn’t until 1933 that scientists discovered that influenza was caused by a virus. The first vaccine was developed in 1938, but due to the countless strains and mutations of the ever adapting influenza viruses, the vaccine remains a hit-or-miss proposition to this day. Influenza simply mutates too quickly for a vaccine with broad universality to effectively eradicate it.

It Is Literally The Mother Of All Modern Pandemics

Photo: CDC/Wikimedia Commons/Public Domain

Almost all modern strains of the Influenza A virus descend in some way from the Spanish flu. The 1918 strain was of the H1N1 variety, with its genetic descendants still alive and infectious to this day. Pretty much any flu you get is a mutated version of the 1918 H1N1 virus. The 1918 outbreak, though, was much more infectious and virulent than any other H1N1 strain to date. Part of this has been attributed to a lack of immunity to the strain in the human population of the time.

The Spanish flu taught people at the time a very important lesson that is still applicable today. That is, at any given point, influenza is pretty much just a mutation or two away from a massive blight of death that humans are powerless to stop. That’s something to chew on the next time your employer asks you to come in because, “it’s just a cough.”

Like All Influenza Viruses, It Ultimately Came From Birds

Photo: Shpernik088/Wikimedia Commons/CC BY-SA 4.0

Ultimately, all human borne influenza originated as avian influenza. Yes, those cute, chirping, balls of feathers are really disease-ridden harbingers of the apocalypse. Sometimes the virus hangs out in some pigs before jumping to humans, giving us the swine flu. There are two key factors that make an influenza strain hit with the pandemic force of the 1918 variety: infectivity and virulence.

In order for a disease to pose the danger of a pandemic, it really needs to be readily transmissible from human to human. While bird flu can sometimes be transferred from birds to humans (or swine flu from pigs to humans), that danger is generally limited to those who work in the food industry. It is only after the influenza strain develops the ability to be transmitted easily between humans that a real pandemic breaks out.

The second factor, virulence, is basically how bad the virus is (how likely is it to kill you). A global pandemic of the sniffles might be inconvenient, but it is hardly something to stay up at night about. A flu that kills over 50% of the people infected by it… well, that’s another story.

These two aspects combined in the Spanish flu in a way that has not been seen since. Certainly, there have been more virulent and more infectious pandemics, but no other pandemic had both these qualities in such a high degree. For example, the H5N1 virus has had periodic outbreaks where the fatality rate is over 50%. That virus, however virulent, is not very infectious as it has not become easily transmittable from human to human. All it takes, though, is a few small mutations.


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