Covid 19 -- We Have Seen Worse

Reprising "Stories from the Flu Pandemic," an Idiosyncratist post from 2014

from flu.gov

In the fall of 1918, a flu pandemic swept the world.  In the United States, an estimated 25 percent of the population fell sick and 675,000 people died.

Curiously, the youngest were among the most vulnerable, particularly young adults.  Older Americans seemed to have acquired a certain immunity during an earlier flu season before the turn of the century.

In 1918, doctors believed the flu was a bacterial infection.  In fact, it was a virus, but viruses were little understood at the time.  The distinction made no difference: There were no medicines in 1918 to treat infections of either kind.  Treatment consisted of rest, aspirin and patent medicines.

People retreated to their homes.  Public gatherings were cancelled, many schools were closed and church attendance stopped for several months.  Cities including San Francisco required everyone to wear gauze masks in public and jailed those who did not wear such masks.  In retrospect it was revealed that gauze masks offered little if any protection.

A New York mailman, from archives.gov

Family Stories

There are a few oral history sources of people's memories of the 1918 flu.  I culled the quotes below from flu.gov and historymatters.gmu.edu.  They are lightly edited but intact in substance.

From Pennsylvania:

     -- "My grandmother had a separate room curtained off when seven of their children got sick with the pandemic flu.  When she entered the room, she wore gauze over her nose and mouth.  Of the seven children that got sick, four of them died . . . . My aunt said that she knew when one of them was not going to live because her mother would sit with the child in the family's rocking chair and sing to him/her.  The rocking chair would creak and when it stopped, she knew they were gone."

From Missouri:

     -- A younger daughter stayed home in December 1918 when her parents and older siblings went for a sleigh ride.  Afterward, "all four children caught the flu; all four died within one week.  It was so cold they put the bodies outside.  Before he died, one of the boys said to 'just put me outside, I will join the others in a few days.'"


From South Carolina

     -- "My grandfather William, a merchant, met his wife Lily at a church gathering.  They had five children, three boys and two girls.  William registered for the draft but was not called to serve.  His business was very prosperous and became more so when the flu epidemic began -- due to increased demands for his livery (taxi) service.  As soldiers returned home with the flu, William picked them up from the train station.  As the numbers of flu stricken soldiers grew, he stopped charging for this service.
         "Sadly William contracted the flu and died in January 1919 at the age of 38.  Lily never remarried and life was very hard for the widowed mother and their children."

From Kentucky, a 95-year-old coal miner's memories:

     "And every, nearly every porch that I'd look at had -- would have a casket box sittin' on it.  Men were a diggin' graves just as hard as they could and the mines had to shut down there wasn't nary a man, there wasn't a mine arunnin' a lump of coal or runnin' no work.  Stayed that way for about six weeks."

From Colorado:

      -- Above is the burial site of an entire family lost:  two parents and their children aged 19, 16, 10, 8 and 4 years old.  (The family name was misspelled on the tombstone.)


A Nurse's Story

Nurse Carla R. Morrisey wrote an article, "The Influenza Epidemic of 1918," that is part of the Navy Department Library.  In it, she recalls what she was told by her great aunt, also a nurse, of caring for sick sailors at the Great Lakes Naval Training Center in Illinois.  Here are some excerpts:

"With a room of 42 beds and twice that many sick sailors, Josie often worked 18 hours a day. 'As the boys were brought in we would put winding sheets on them even if they weren't dead.  You would always leave the left big toe exposed and tag it with the boy's name, rank and next of kin.' As one boy lay dying in bed, one waited on a stretcher on the floor for the bed to empty.  Each morning as the ambulance drivers would bring in more sick boys they would carry the dead bodies out.   Josie often said she felt sorry for the poor boy on the bottom. . . . As the weeks dragged on the truck loads of caskets left daily for the train station to destinations listed on the 'tag' as next of kin.

"Nursing was nine-tenths of the battle in recovering from influenza.  Since there were only palliatives for the flu and pneumonia it developed into, doctors were not the essential ingredient in fighting the disease . . . . Josie would work endless hours trying to relieve the high fevers and nosebleeds before the lungs filled with blood and face turned blue."


Conclusion

There have been many advances in medical treatment since 1918.  Vaccines and retroviral medicines have taken most of the sting out the flu.  Polio vaccinations, developed in the early 1950s, eradicated a childhood disease that killed thousands and paralyzed many thousands more in the United States, including an American president.  Worldwide, polio has been defeated almost everywhere.

On the whole, we are much healthier than people in 1918, but other challenges -- malaria, chikungunya, Ebola, Lyme disease -- are with us.  With time, new diseases are sure to arise.


Note  

A description of the spread of the 1918 flu, which is believed to have arisen in the U.S.  From 1914 on, World War I had occasioned movements and interactions of soldiers from many continents -- more than any previous event in human history.  An unexpected result was the international spread of a deadly flu virus.

The Pandemic That Started Here

The most frightening diseases humans have faced have come from many places.

The Black Plague, which reduced the population of Europe by one-third in the 14th century, is believed to have been transmitted to humans by fleas from Central Asia.

The SARS (Severe Acute Respiratory Syndrome) epidemic that killed 8,100 in 2002 was passed to humans by small mammals in the Guangdong Province of China.

Ebola, which was first traced to fruit bats and then other animals, has arisen several times in Africa since 1976.

Interestingly, the most deadly pandemic of modern times, the misnamed Spanish Flu of 1918, is now believed to have originated in a rural county in the American Midwest.


The Spanish Flu in Context

The world rejoiced in November 1918 when World War I ended.  In its four years, more than 20 people, military and civilian, lost their lives.  But an even worse killer was still on the loose.

During 16 weeks at the end of 1918, a vicious flu spread across oceans, among combatants and ordinary citizens, through cities and and countries worldwide.  After four scant months, between 50 million and 100 million people -- no one can say for sure -- died and the virus went to ground and disappeared.


Where the Flu Began

Camp Funston Flu Patients, 1918, from the U.S. National Archives

For decades after the pandemic, health researchers tried to establish where it began.  In a 2004 article in the open-access Journal of Translation Medicine, John M. Barry revisited the theories:

        -- A British scientist suggested the origin was WWI British Army post in France where
            doctors treated "purulent bronchitis" in 1916, but this theory was dismissed because
            the disease had not rapidly or broadly as the flu had done.

        -- Another flu outbreak in early 1918 in China was studied but seemed unlikely because
            it stopped early and did not spread far.

        -- Several other outbreaks of disease in early 1918 in France and India also were ruled out
            for similar reasons.

All the signs pointed to origination in the United States where, Barry wrote, "One could see influenza jumping from Army camp to camp, then into cities, and traveling with the troops to Europe."

Gene sequencing of preserved tissue suggested that the outbreak was very rapid.  Epidemiological studies and oral histories narrowed the focus to Haskell County, Kansas, a rural area with a population of 1,720 and an economy based on farming grains and raising poultry, cattle and hogs.

In early 1918, the local doctor observed many cases of influenza.  Barry's article noted the following:

        "Soon, dozens of his patients -- the strongest, the healthiest, the most robust people in
          the county -- were being struck down as suddenly as if they had been shot.  Then one
          patient progressed to pneumonia.  Then another.  And they began to die . . . . The
          epidemic got worse.  Then, as abruptly as it came, it disappeared.  Men and women
          returned to work.  Children returned to school.  And the war regained its hold on people's                     thoughts."

The doctor's warning, sent to national public health officials, was the first alarm sounded anywhere in the world.  By that point, the end of March, the flu had run its course in Haskell County but just begun its spread.

At the time, the U.S. Army was preparing recruits for service in Europe.  Haskell County soldiers were trained at Camp Funston, home to more than 56,000 troops.  Starting on March 4, soldiers at the camp started coming down with the flu; 1,100 were hospitalized and many others were treated at infirmaries.

The soldiers transferred from Camp Funston to other Army bases and then to France.  According to Barry, "by the end of April twenty-four of the thirty-six main Army camps suffered an influenza outbreak.  Thirty of the fifty largest cities in the country also had an April spike in excess mortality from influenza and pneumonia."

The flu proceeded from there.  Its second wave, later that year, was far more deadly.

Barry's conclusion:

"The fact that the 1918 pandemic likely began in the United States matters because it tells investigators where to look for a new virus.  They must look everywhere."