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The 1918 Spanish Flu and What It Cost Humanity: A Timeline

The 1918 Spanish Flu can teach us a lot about what to expect from today's new influenza outbreak.

It's shocking now to consider that 1918's Spanish Flu infected 500 million people worldwide, and killed between 50 and 100 million, which was 3% to 5% of the world's population at that time.

The particular hallmark of the Spanish Flu was that it disproportionally killed those between the ages of 20 and 40, rather than the aged or the young, as is common in other outbreaks. The Spanish Flu's mortality rate is estimated to have been between 10% and 20%, while the mortality rate of other flu epidemics is 0.1%.

The Spanish Flu was also marked by its extremely high infection rate of up to 50%, and its unusual symptoms, which included hemorrhages in the nose, stomach, and intestine, and both edema and hemorrhage in the lung. Edema is a buildup of fluid in the body's tissues.

Among those who were killed by the 1918 flu were the Austrian painter Egon Schiele, the French poet Guillaume Apollinaire, and a New York property developer named Frederick Trump, who is the current U.S. president's grandfather.

The 1918 flu virus is thought to have originated in birds, pigs or both. Viruses cannot replicate themselves, they must hijack living, replicating cells, and they then make tens of thousands of copies of themselves. While copying itself, the influenza virus makes numerous "mistakes", which means that it is always changing. This is why you need a new flu shot every year. If a bird virus and a human virus were to infect a pig cell, all their genes could swap, and create a new, possibly lethal, virus.

The 1918 flu across the world

In the U.S., 28% of the population was infected, and 675,000 people died. Native American tribes and Inuit and Alaskan Native tribes were particularly affected, with entire villages being wiped out. 50,000 Canadians died, while in Brazil, 300,000 died, including the country's president Rodrigues Alves.

In Great Britain, 250,000 died, while in France, over 400,000 died. Up to 17 million people died in India, which was about 5% of that country's total population. In Japan, 390,000 people died, and in Indonesia, it's estimated that 1.5 million people died.

Iran experienced a particularly high mortality rate, with between 902,400 and 2,431,000 people dying. This is between 8.0% and 21.7% of the country's total population at that time.

Even in places as isolated as Tahiti, Samoa, Australia, and New Zealand, the death toll was enormous. In Tahiti, 13% of the population died in just one month. In Samoa 38,000 died, which was 22% of the entire population. In Australia, 12,000 people died, while in New Zealand, the flu killed 6,400 Europeans and 2,500 indigenous Maori in just six weeks.

The origin of the Spanish Flu

The origin of the flu has long been debated. Claude Hannoun of France's Pasteur Institute has posited that the virus originated in China, then spread to Boston and Kansas, and from there, via troop movements, to Brest, France. Here is a timeline of how the Spanish Flu unfolded across the world.

April 1917 - the U.S. enters World War I with 378,000 men in the armed forces, this will rapidly swell to millions of men.

June 1917 - to increase the number of fighting men, a draft is established. The army creates 32 training centers, each housing 25,000 to 55,000 men.

March 1918 - over 100 servicemen at Camp Funston in Fort Riley, Kansas come down with the flu. A week later, that number has grown by 5 times. Sporadic cases of the flu begin appearing elsewhere in the U.S., and in Europe and Asia.

Soldiers at Fort Riley Kansas
Soldiers at Fort Riley Kansas, Source CDC

April 1918 - the first mention of the flu appears in an American public health report, describing 18 severe cases and three deaths in Kansas.

May 1918 - the U.S. begins shipping hundreds of thousands of soldiers to Europe. Because of the war, censors in Germany, England, France, and the U.S. are blocking news of the outbreak, leaving neutral Spain to report on the disease. This is how it got the name, the "Spanish Flu".

A U.S. hospital in France
A U.S. hospital in France, Source: U.S. Army/Wikimedia Commons

The virus spreads from Europe to North America, Asia, Africa, Brazil, islands in the South Pacific, and even native tribes living in the Arctic Circle.

September 1918 - a second wave of the virus emerges that has a much higher fatality rate than the first wave. It emerges at a Navy facility in Boston, and at an Army facility just outside the city.

Seattle policemen wearing masks
Seattle policemen wearing masks, Source: Wikimedia Commons

This wave is responsible for most of the deaths from the virus, with 12,000 people dying in the U.S. during September. The New York City Board of Health requires that all cases of flu be reported to them and that patients be isolated, either at home or in a hospital.

Flu patients at Walter Reed Army Hospital
Flu patients at Walter Reed Army Hospital, Source: Harris and Ewing/Wikimedia Commons

In Philadelphia, 200,000 people gather for a Liberty Bonds parade, and days later, 635 new cases of the flu are reported. The city orders schools, churches, and theaters closed.

October 1918 - 195,000 Americans die of the flu in this month alone. There is a severe shortage of nurses because many are serving overseas. The American Red Cross Chicago Chapter issues a call for volunteers to nurse the sick.

Nurses during the pandemic
Nurses during the pandemic, Source: CDC

Chicago authorities close movie theaters and schools, and they prohibit public gatherings. Crime in Chicago drops by 43%. Philadelphia, which records 289 deaths in a single day, is forced to store corpses in cold-storage facilities, and a trolley car manufacturer donates packing crates to be used as makeshift coffins.

San Francisco recommends that all its citizens wear face masks when out in public, and in New York City, shipbuilding is down by 40% due to absenteeism.

November 1918 - the end of the war brings soldiers back home, and more cases of the flu. Officials in Salt Lake City place quarantine signs on the doors of over 2,000 residents who have the flu.

WWI troops returning home
WWI troops returning home, Source: CDC

On November 11, 1918, the armistice is signed in France ending WWI. U.S. President Woodrow Wilson collapses after coming down with the flu.

January 1919 - a third wave of the virus emerges, killing many more people. Between January first and the fifth, San Francisco experiences 1,800 new flu cases, and 101 people die. New York City reports 706 new cases and 67 deaths.

New flu cases in San Francisco
New flu cases in San Francisco, Source: National Photo Company/Wikimedia Commons

August 1919 - the flu pandemic comes to an end because those who were infected either died or else developed immunity.

March 1997 - in a March 21, 1997 article in Science Magazine, researchers at the Armed Forces Institute of Pathology analyze lung tissue taken from a soldier who died in 1918 of the flu. They conclude that while the flu virus is unique, that, "The hemagglutinin gene matches closest to swine influenza viruses, showing that this virus came into humans from pigs."

February 2004 - researchers at the Scripps Institute in La Jolla, California and at England's Medical Research Council conclude that the 1918 virus may have jumped directly from birds to humans, bypassing pigs entirely. This could explain the virulence of the infection.

October 2005 - scientists at the Armed Forces Institute of Pathology sequence the complete genome of the virus by analyzing tissues taken from the body of a flu victim whose body has been preserved in permafrost since he was buried in 1918.

How to survive a new pandemic

Surviving a new influenza pandemic relies on several things, that:

  1. The World Health Organization scientists develop an effective vaccine quickly
  2. Stocks of antibiotics used to treat secondary bacterial infections don't run out
  3. The bacterial types of pneumonia aren't resistant to our current antibiotics
  4. Hospitals don't become overrun with patients, and deny entry to new patients

During 2009's swine flu pandemic, intensive care units in Australia reached capacity, and doctors there came to the conclusion that they would have to give precedence to pregnant women and children, while older patients would be treated last.

A pandemic would leave grocery store shelves empty and unable to be restocked,  schools would be forced to close, and other essential services would also be cut.

In her 2011 book Influenza Pandemics, author Lizabeth Hardman wrote, "An epidemic erodes social cohesiveness because the source of your danger is your fellow human beings ... if an epidemic goes on long enough ... morality does start to break down."

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