Hospital patients at Camp Funston, an Army base in Kansas, where some experts think the 1918 flu originated

National Museum of Health and Medicine

Pandemic

More than 100 years before the coronavirus pandemic, a powerful flu killed tens of millions of people worldwide and brought life in many U.S. cities to a standstill 

When Violet Harris, a 15-year-old junior at Lincoln High School in Seattle, learned on October 5, 1918, that officials were shutting down schools to halt the spread of a deadly disease known then as the Spanish flu, she responded like many students: with excitement.

“It was announced in the papers tonight that all churches, shows, and schools would be closed until further notice, to prevent Spanish influenza from spreading,” she wrote in her diary. “Good idea? I’ll say it is! So will every other school kid, I calculate.”

But those initial good feelings didn’t last. They soon turned to worry as the flu spread throughout her community, forcing everyone to wear masks whenever they went outside and even infecting her best friend, Rena.

On October 5, 1918, Violet Harris, a 15-year-old junior at Lincoln High School in Seattle, learned the news. Officials were shutting down schools to halt the spread of a deadly disease known then as the Spanish flu. She responded like many students: with excitement.

“It was announced in the papers tonight that all churches, shows, and schools would be closed until further notice, to prevent Spanish influenza from spreading,” she wrote in her diary. “Good idea? I’ll say it is! So will every other school kid, I calculate.”

But those good feelings didn’t last. They soon turned to worry as the flu spread throughout her community. Everyone had to wear masks whenever they went outside. And her best friend, Rena, even got infected.

“I stayed in all day and didn’t even go to Rena’s,” Violet wrote about a month later. “The flu seems to be spreading, and Mama doesn’t want us to go around more than we need to.”

If Violet’s experience sounds familiar, that’s because more than 100 years before Covid-19, the world faced another deadly pandemic. It’s estimated that by the time the flu subsided in 1919, it had infected one in every three people worldwide and killed at least 50 million—making it the worst pandemic since the bubonic plague in the 14th century.

“I stayed in all day and didn’t even go to Rena’s,” Violet wrote about a month later. “The flu seems to be spreading, and Mama doesn’t want us to go around more than we need to.”

Violet’s experience probably sounds familiar. That’s because more than 100 years before Covid-19, the world faced another deadly pandemic. The flu died down in 1919. By that time, it had infected about one in every three people worldwide and killed at least 50 million. That makes it the worst pandemic since the bubonic plague in the 14th century.

Though the Covid-19 death toll has been far lower than that of the 1918 flu, many historians see similarities between the two pandemics. Just as today, officials back then were forced to make difficult decisions about closing schools and implementing social distancing.

“I’m often struck by how ancient this [current] pandemic feels,” says Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World. “We don’t have a vaccine yet, so the only way we can slow the spread of the disease is to use these social distancing measures, and they are not new. They were used in 1918 and in previous pandemics.”

The Covid-19 death toll has been far lower than that of the 1918 flu. Still, many historians see similarities between the two pandemics. Just as today, officials back then were forced to make difficult decisions. They dealt with closing schools and putting social distancing in place.

“I’m often struck by how ancient this [current] pandemic feels,” says Laura Spinney, author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World. “We don’t have a vaccine yet, so the only way we can slow the spread of the disease is to use these social distancing measures, and they are not new. They were used in 1918 and in previous pandemics.”

Coyne family/Raymond Coyne/Mill Valley Public Library

During the 1918 flu pandemic, not wearing a mask was illegal in parts of the U.S.

World War I & the Flu

Though it was dubbed the Spanish flu, some experts think it originated in the U.S. However, nobody knows for certain.

What is known is that on March 4, 1918, a young man showed up with the flu at the hospital at Camp Funston, an Army base in Kansas where soldiers were training for combat in World War I (1914-18). Over the next few weeks, more than 1,000 men reported to the camp hospital with the same symptoms, and 38 died.

As thousands of Americans were sent to Europe to fight in the war that spring, they took the flu with them. It spread rapidly, hitting every country hard. The U.S., Britain, and other countries censored their press during wartime, making it illegal to publish anything that might hinder war efforts, including that a deadly disease was spreading among troops. But Spain, not a combatant in the war, had no censorship and its press reported extensively on the disease, so it became known as Spanish influenza.

Though it was dubbed the Spanish flu, some experts think it started in the U.S. But nobody knows for certain.

What is known is that on March 4, 1918, a young man showed up with the flu at the hospital at Camp Funston, an Army base in Kansas. Soldiers at the base were training for combat in World War I (1914-18). Over the next few weeks, more than 1,000 men reported to the camp hospital with the same symptoms, and 38 died.

Thousands of Americans were sent to Europe to fight in the war that spring. They took the flu with them. It spread rapidly, hitting every country hard. The U.S., Britain, and other countries censored their press during wartime. That made it illegal to publish anything that might hinder war efforts, including that a deadly disease was spreading among troops. But Spain wasn’t fighting in the war. As a result, it had no censorship and its press reported about the disease so much that it became known as Spanish influenza.

Officials urged social distancing to stop the spread of the 1918 flu.

At first, the disease was no worse than the seasonal flu, so health officials did little to prepare for a major outbreak. But as the virus mutated and became stronger, a second, more lethal wave of influenza began to sweep around the globe in August. Returning soldiers brought this new superflu back to the crowded Army bases that were now all over the U.S.

Most flus especially endanger the very old and very young, but this flu was different. The majority of its victims were between the ages of 20 and 40. They would turn blue in the face, have trouble breathing, and even bleed from the nose and mouth.

“These men start with what appears to be an attack of . . . influenza, and when brought to the hospital they very rapidly develop the most viscous type of pneumonia that has ever been seen,” an Army doctor stationed near Boston wrote to his friend on September 29, 1918. “It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. . . . We have been averaging about 100 deaths per day, and still keeping it up.”

At first, the disease was no worse than the seasonal flu. That’s why health officials did little to prepare for a major outbreak. But the virus mutated and became stronger. That led to a second, more lethal wave of influenza that began to sweep around the globe in August. Returning soldiers brought this new superflu back to the crowded Army bases that were now all over the U.S.

Most flus especially endanger the very old and very young, but this flu was different. The majority of its victims were between the ages of 20 and 40. They would turn blue in the face, have trouble breathing, and even bleed from the nose and mouth.

“These men start with what appears to be an attack of . . . influenza, and when brought to the hospital they very rapidly develop the most vicious type of pneumonia that has ever been seen,” an Army doctor stationed near Boston wrote to his friend on September 29, 1918. “It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. . . . We have been averaging about 100 deaths per day, and still keeping it up.”

George Rinhart/Corbis via Getty Images

Pro baseball players wore masks during a game in 1919.

‘Garages Full of Caskets’

The U.S.—and the world—was ill-prepared to stop such a deadly disease. Scientists didn’t yet know that the flu was caused by a virus, and their vaccines, aimed at bacteria, proved useless. Plus, with so many American nurses and doctors over in Europe because of the war, hospitals in the U.S. were understaffed.

At the same time, the demands of the war created the perfect conditions for a contagious virus to spread. Factories were jam-packed with workers producing ships and ammunition, and barracks were crowded with young men training for combat, placing large numbers of people in close contact. 

The U.S.—and the world—was ill-prepared to stop such a deadly disease. Scientists didn’t yet know that the flu was caused by a virus. Their vaccines were aimed at bacteria, so they proved to be useless. Plus, so many American nurses and doctors were over in Europe because of the war. That left hospitals in the U.S. understaffed.

At the same time, the demands of the war created the perfect conditions for a contagious virus to spread. Factories were jam-packed with workers producing ships and ammunition. Barracks were crowded with young men training for combat. So, large numbers of people were in close contact at the time.

Making the situation worse, many public officials downplayed the threat of the virus or spread misinformation. President Woodrow Wilson never mentioned the flu in a public address (even though it’s believed he contracted the disease in 1919). The U.S. Surgeon General assured Americans that “there is no cause for alarm if precautions are observed.” New York City’s public health director claimed that “other bronchial diseases and not the so-called Spanish influenza” were causing the illness. And rumors ran rampant that Germany, which opposed the U.S. in the war, had planted the disease to infect American soldiers and their allies. 

“Because of the war, there was a concerted effort to keep morale up,” says John M. Barry, author of The Great Influenza, “which turned out to be counterproductive.”

Indeed, the refusal to acknowledge the severity of the crisis proved deadly—most notably in Philadelphia. On September 28, 1918, about 200,000 people packed downtown for a Liberty Loan parade to promote the government bonds that were being issued to pay for the war. Although doctors had urged city officials to cancel the parade, the patriotic event went on. As the crowd cheered the floats and troops, the virus silently spread. About 4,500 Philadelphians died in the next week—too many to bury.

Many public officials downplayed the threat of the virus or spread misinformation. That made the situation worse. President Woodrow Wilson never mentioned the flu in a public address (even though it’s believed he contracted the disease in 1919). The U.S. Surgeon General assured Americans that “there is no cause for alarm if precautions are observed.” New York City’s public health director claimed that “other bronchial diseases and not the so-called Spanish influenza” were causing the illness. And there were many rumors that got out of hand. One rumor claimed that Germany, which opposed the U.S. in the war, had planted the disease to infect American soldiers and their allies.

“Because of the war, there was a concerted effort to keep morale up,” says John M. Barry, author of The Great Influenza, “which turned out to be counterproductive.”

Indeed, the refusal to acknowledge the seriousness of the crisis proved deadly. That was definitely the case in Philadelphia. On September 28, 1918, about 200,000 people packed downtown for a Liberty Loan parade to promote the government bonds that were being issued to pay for the war. Doctors had urged city officials to cancel the parade. Still, the patriotic event went on. As the crowd cheered the floats and troops, the virus silently spread. About 4,500 Philadelphians died in the next week. There were too many people to bury.

‘It is only a matter of a few hours then until death comes.’

“They had so many died that they keep putting them in garages,” Ann Van Dyke, a Philadelphia resident, later recalled in an oral history, “garages full of caskets.” 

Philadelphia was far from the only city hit hard by the virus. In October, the death toll in the U.S. skyrocketed; 195,000 Americans died from the flu in that month alone. Hospitals across the country were overrun with patients. Tents serving as emergency relief centers sprang up in parks and fields.

As the deaths mounted, many U.S. cities shut down schools, theaters, restaurants, and churches; banned public events; and urged social distancing. Society seemed to grind to a halt.

“They had so many died that they keep putting them in garages,” Ann Van Dyke, a Philadelphia resident, later recalled in an oral history, “garages full of caskets.”

Philadelphia was far from the only city hit hard by the virus. In October, the death toll in the U.S. skyrocketed; 195,000 Americans died from the flu in that month alone. Hospitals across the country were overrun with patients. Tents serving as emergency relief centers sprang up in parks and fields.

As the deaths mounted, many U.S. cities shut down schools, theaters, restaurants, and churches. These cities also banned public events and urged social distancing. Society seemed to grind to a halt.

“That was the roughest time ever,” Glenn Holler, who lived in Conover, North Carolina, during the pandemic, later recalled. “People would come up and look in your window and holler and see if you was still alive, is about all. They wouldn’t come in.”

Then, almost as fast as it had spread, the flu disappeared. That was partly because so many people had already been infected by the virus that they’d developed immunity to it. Life in many cities returned to normal—and Violet, the Seattle high school student, went back to school on November 14, after a month and a half of lockdown.

“Our teachers were pretty lenient today,” she wrote in her diary. “Except Miss Streator [her Latin teacher]. She gave out the words just the same as if we hadn’t had six weeks to forget them in.”

“That was the roughest time ever,” Glenn Holler, who lived in Conover, North Carolina, during the pandemic, later recalled. “People would come up and look in your window and holler and see if you was still alive, is about all. They wouldn’t come in.”

Then, almost as fast as it had spread, the flu disappeared. That was partly because so many people had already been infected by the virus that they’d developed immunity to it. Life in many cities returned to normal. Violet, the Seattle high school student, went back to school on November 14, after a month and a half of lockdown.

“Our teachers were pretty lenient today,” she wrote in her diary. “Except Miss Streator [her Latin teacher]. She gave out the words just the same as if we hadn’t had six weeks to forget them in.”

Jessica Rinaldi/The Boston Globe via Getty Images

Today: Students hang out while social distancing at Revere High School in Massachusetts.

Back to Normal?

A third wave of the flu followed in the winter and spring of 1919, but it wasn’t quite as lethal, eventually morphing into a common flu. In May of that year, the flu mostly burned itself out—but not before leaving a staggering amount of death in its wake. In all, 675,000 Americans died during the pandemic—more than the total number of U.S. soldiers killed in all the wars of the 20th century combined.

Yet the 1918 pandemic was long relegated to the back pages of history, overshadowed by World War I. That is, until Covid-19 exploded into a pandemic earlier this year. Now many people are re-examining the 1918 pandemic—and its aftermath—for a preview of how Covid-19 might change society.

For example, a recent study by the Federal Reserve Bank of New York found that the flu may have helped give rise to the Nazi Party and other extremists. The study notes that “the disease may have fostered a hatred of ‘others,’ as it was perceived to come from abroad.”

A third wave of the flu followed in the winter and spring of 1919. It wasn’t quite as lethal, eventually morphing into a common flu. In May of that year, the flu mostly burned itself out. But, in the end, it left a staggering amount of death in its wake. In all, 675,000 Americans died during the pandemic. That’s more than the total number of U.S. soldiers killed in all the wars of the 20th century combined.

Yet the 1918 pandemic was long dismissed and put on the back pages of history. Essentially, it got overshadowed by World War I. That is, until Covid-19 exploded into a pandemic earlier this year. Now many people are re-examining the 1918 pandemic and its aftermath. By doing so, they hope to get a preview of how Covid-19 might change society.

For example, a recent study by the Federal Reserve Bank of New York found that the flu may have helped give rise to the Nazi Party and other extremists. The study notes that “the disease may have fostered a hatred of ‘others,’ as it was perceived to come from abroad.”

What lessons can we learn from the 1918 flu pandemic?

But there were also some positives to come out of the 1918 pandemic. For instance, our knowledge of science and medicine became much more sophisticated (see “How the 1918 Flu Changed Health Care,” below). That has given doctors and researchers many advantages in the fight against Covid-19 that they didn’t have back then.

Ultimately, historians say, we can take some solace in knowing that after the 1918 flu, life eventually returned to normal for many people—even if the pain of the pandemic was long-lasting.

“The evidence suggests that societies do bounce back quite quickly from pandemics, even from the 1918 flu,” Spinney says. “The trouble is that at the individual level, the price paid was huge amounts of misery and suffering.”

But some positive things also came out of the 1918 pandemic. For instance, our knowledge of science and medicine became much more advanced (see “How the 1918 Flu Changed Health Care,” below). That has given doctors and researchers many advantages in the fight against Covid-19 that they didn’t have back then.

The pain of the pandemic was long-lasting. Ultimately, historians say, we can find hope in knowing that after the 1918 flu, life eventually returned to normal for many people.

“The evidence suggests that societies do bounce back quite quickly from pandemics, even from the 1918 flu,” Spinney says. “The trouble is that at the individual level, the price paid was huge amounts of misery and suffering.”

How the 1918 Flu Changed Health Care

The world altered its approach to health and medicine after the pandemic

The 1918 flu led to big changes in health and medicine. Before then, many wealthy white people believed that immigrants and the working class were more susceptible to diseases because of something inherent to them, rather than because of their poor living conditions. But the 1918 flu proved that nobody is immune to illness.

As a result, world leaders started placing a greater emphasis on health care. Many nations embraced the idea of a national health care system, and public health worldwide began to look more like it does today.

An international bureau for fighting epidemics—a forerunner of today’s World Health Organization—was also formed in 1919. And scientists began placing a greater emphasis on the study of infectious diseases, eventually leading to the creation of the first flu vaccine in the 1940s.

Says John M. Barry, author of The Great Influenza: “All sorts of great science came out of the pandemic.”

The 1918 flu led to big changes in health and medicine. Before then, many wealthy white people believed that immigrants and the working class were more susceptible to diseases because of something inherent to them, rather than because of their poor living conditions. But the 1918 flu proved that nobody is immune to illness. 

As a result, world leaders started placing a greater emphasis on health care. Many nations embraced the idea of a national health care system, and public health worldwide began to look more like it does today.

An international bureau for fighting epidemics—a forerunner of today’s World Health Organization—was also formed in 1919. And scientists began placing a greater emphasis on the study of infectious diseases, eventually leading to the creation of the first flu vaccine in the 1940s. 

Says John M. Barry, author of The Great Influenza: “All sorts of great science came out of the pandemic.”

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