History of Illness: The 1918 Pandemic | 5 Minute Flashback

General Manager: Juan Contreras

Producer: Nicole Maxhimer

Author: Rachael Sullivan

Imagine an illness, caused by a virus with symptoms such as cough, chills, fever, fatigue, and cough. Hospitals are overrun in some places and there aren’t enough medical professionals to go around. People are told to stay at home because everyone is susceptible to this virus and many could die. You probably thought I was talking about the SARS-CoV2 virus that causes COVID-19 but you would be wrong. I am actually talking about the H1N1 virus that caused the flu pandemic of 1918, also known as the Spanish Influenza. While many people feel like this pandemic is something completely new and foreign, the fact of the matter is about 100 years ago, Americans were dealing with the exact same thing. Today, I’m going to talk about the flu pandemic that infected a third of the world’s population.

What Did our World look like?

Before going into the history of this pandemic, let’s set the stage for what life was like back then. For most of the year “The Great War” or World War I raged on in the world. Almost all able-bodied young men were across the Atlantic, to help fight the war taking with them many skilled medical professionals. Woodrow Wilson was president and fighting to keep the world “safe for democracy”. Women known as suffragettes fought for women to be able to vote. People lived in cramped conditions with homes housing two or three generations housing. Men worked and women stayed home. Unless they were young and unmarried, then they could get a job as a secretary, nurse, or elementary school teaching. Children lived with their parents until marriage. Jobs were dangerous with many men dying on the job. People walked to work unless they lived in the city, where they could take the trolley. All of this was the background on which the flu pandemic raged.

Where it all Began.

It started in the solider camps. In March of 1918, there were outbreaks of a flu-like illness. At camp Funston in Fort Riley Kansas, more than 100 soldiers became ill with the flu. Within a week that number was 400. However, it wasn’t until September that the illness fully struck. At Camp Devins, a training camp outside of Boston, more than 14,000 cases were reported and 757 deaths had occurred all due to the flu.

Finally, in October the illness struck cities and it struck them hard. Hospitals overflowed with patients and the dead. Nurses did all they could to ease the pain of the ill but medicines quickly ran out and so did beds. There were so few medical professionals that nursing students worked as nurses, medical students worked as doctors, and 6-month long vocational nursing programs popped up all over the place.

Most people were cared for at home. Even when they didn’t get better and died, that’s where they stayed. Morgues were overrun and so bodies just stayed where they died. All of this was made worse by the fact that the illness struck quick and killed quicker. People would go from unwell with minor irritating symptoms, to struggling to breathe with blue fingers and toes in 12 hours. It wasn’t much longer after that that they died. Different cities handled the deadly disease differently. Cities like New York acted quickly and harshly enforcing mandatory quarantines and staggering business hours. They experienced the lowest death rate on the eastern seaboard. Cities like Philadelphia, on the other hand, didn’t enforce closures until the death rate was beginning to climb. That resulted in their city being hit the hardest out of all-American cities. Some cities enforced fines for anyone not wearing protective gear such as facemasks. In the end, though the cities that enforced social distancing very early and maintained it for longer periods of time did the best. Cities that lifted their interventions too quickly saw a large spike in cases and deaths.

The Second Wave.

All this death and disease occurred in October of 1918, also known as the second wave. This was the deadliest wave of the illness that resulted in most of the deaths from the disease. In January of 1919, there was a third and final wave that subsided in the summer. In the end, an estimated 500 million people or 1/3 of the world’s population had become ill with the disease and somewhere between 20 to 50 million people died due to the flu. This included about 675,000 Americans. This flu had a mortality rate of 2.5 compared to the normal <0.1% mortality rate in other flu pandemics. This flu was so severe that it actually depressed the average life expectancy in the united states by 10 years!

Still a Mystery.

There were many unique things about this pandemic, and the reasons behind these oddities are still not fully understood. The first is just why this virus was so deadly. While it is clear that people did not have an immunity to this particular virus, the fact that this flu pandemic had a higher mortality rate is very interesting. There has been some research and reconstruction of the virus to try and piece together that puzzle, however, even doing that has not fully explained the virus’s virulence. Another weird facet of this pandemic was the fact that it occurred in 3 waves within the same year. It is unclear what allowed the virus to generate three separate strains of illness in the same year, and why this didn’t occur with other flu pandemics. The final oddity of this pandemic was the age group that was hit the hardest. While generally children and the elderly are more susceptible to becoming infected with and dying from diseases, the age group that got hit the hardest was actually people between the ages of 25 and 34. People between the ages of 5 and 14 had a high infection rate but had an extremely low mortality rate. Finally, those 65 and older made up less than 1% of all infections. There is no explanation for this, but one theory is that a strain of virus similar to the 1918 H1N1 virus circulated in 1889, giving people over the age of 65 a partial immunity to deadly influenza. However, this is just a theory, and no one is certain why this trend occurred.

What is the flu?

To understand a bit more about influenza, in general, let's take a look at the disease from a medical level instead of a historical context. There are two influenza viruses that cause “the flu”. Those are influenza A and B. Influenza C causes a mild illness and influenza D cannot infect humans. Getting sick with the flu starts with a cough or a sneeze. This cough or sneeze releases droplets of the virus which gain entrance to the body through breathing, touching the face, or touching something with the viral particles on it and then touching the face. From there viruses invade both the upper and lower respiratory tract. The virus gains entry into the cells through little spikes on the cells surface that bind to sialic acid causing membrane fusion, essentially allowing the virus inside. From there, the virus hijacks the cell's machinery to begin producing viruses instead of proteins the body needs. The cells realize there is an issue and begin releasing cytokines that call for other immune cells to come to help fight the invasion. Various lymphocytes come in causing inflammation, fever, and muscle aches. If the virus isn’t eradicated in a timely manner people can develop pneumonia. Sometimes people can even develop secondary bacterial pneumonia due to the viral infection leaving the body in a weakened state.

This is what killed the majority of people that died from influenza in 1918. Some died of pulmonary edema (fluid buildup in the lungs) and nasal hemorrhaging essentially drowning in their own bodily fluids, however, most died from the secondary bacterial pneumonia that would occur after the virus. The bacteria that normally lived in the nose and throat would use the trail of damage the virus helped create to cause bacterial pneumonia in the lungs. Due to there being no antibiotics at the time, these patients soon died. According to history.com the damage to patients’ lungs was similar to the damage caused by the mustard gas troops endured during the war. Overall, the virus was deadly, striking down the young quickly and leaving patients gasping for breath in their last moments.

It seems that's all that we have for this 5 Minute Flashback, what did you find most interesting about the 1918 Pandemic? Did you see any similarities to what we're going through now in COVID-19? If you're looking to learn more history the best way is by subscribing to ZTV 5 Minute Flashback on YouTube, liking us on Facebook, following us on Twitter, and showing us some love on Instagram. This was Rachel Sullivan from Five Minute Flashback, and be sure to stay in, enjoy life, and stay curious!