The Spanish Flu

The Great War was grinding to an end. Nearly 20 million were dead over the past 4 years. Then a new killer arrived.

Spain was neutral in World War 1, and so had relatively freedom in a continent at war. The Spanish flu got its title when the king of Spain, Alfonso XIII, his prime minister, and several cabinet ministers came down with the disease. But this flu did not start in Spain.

The flu had struck other European countries months before King Alfonso died. But these combatant countries did not want to reveal their weakness, so they kept quiet about their outbreaks. Spain, not suppressing news, was the first nation to publicly report on the epidemic.

The flu’s origin remains uncertain. An epicenter was a major troop staging and hospital camp in Étaples, France, through which 100,000 soldiers passed through daily. The camp also housed a piggery, and poultry was regularly brought in.

The American epicenter was Fort Riley in Haskell County, Kansas, where a cook reported sick on 4 March 1918. Within days, 522 American men at the camp were ill.

By 11 March 1918 the virus had reached New York City. There was no attempted containment. President Woodrow Wilson refused to take any action which might compromise the war effort.

In early October, even as the disease was sweeping through military bases, killing soldiers and sailors by the thousands, U.S. Surgeon General Rupert Blue warned against rushing to see doctors with “mild cases of influenza.” “The present generation,” Blue said, “has been spoiled by having expert medical and nursing care readily available.”

The 1918 flu pandemic was caused by the H1N1 virus: a subtype of influenza A that had its reprise in the 2009 “swine” flu outbreak. Influenza A viruses sicken both mammals and birds.

China was one of the few regions of the world that was barely affected by the 1918 flu pandemic. This has led to speculation that the H1N1 viral strain originated in China, among a people who had acquired immunity to the virus from previous exposure.

Chinese laborers were imported to work behind British and French lines. A respiratory illness that struck northern China in November 1917 was identified by Chinese health officials a year later as identical to the Spanish flu.

Yet that does not prove that the 1918 virus was a Chinese import. Instead, evidence indicates that the virus had been circulating for months, possibly years, in Europe before the 1918 pandemic.

The Spanish flu hit in 3 waves. The 1st wave as not nearly as lethal as the 2nd, when people succumbed within hours. The 3rd wave was like an aftershock: smaller than the 2nd wave and larger than the 1st in terms of mortality.

Epidemiological modeling suggests that mass behavior patterns were significant in outbreaks. For example, schools reopened after the 2nd wave.

The young were brought down as readily as the old. This virus attacked the upper respiratory tract with ferocity, overwhelming the immune system.

Unusually, the most likely to die were pregnant women. Another oddity was that the flu was at its worst in the summer and autumn in the Northern Hemisphere – influenza is typically a winter malady.

The 1918 flu brought community life to a standstill in the US and other countries: schools, theaters, bars, and other congregating places were closed. Mothers were told to keep their children in their own yards. Many flu victims died of starvation in their homes, not from the disease – they were too weak to forage for food and no one dared bring it to them. American coffin makers couldn’t keep up with demand, so mass graves were dug. More American soldiers died from the 1918 flu than they did in the Great War.

All told, some 500 million people were infected worldwide: ~27% of the global population. Death toll estimates range between 20 and 100 million, centering at 50 million.

“In a lot of ways, we’re arguably as vulnerable, or more vulnerable, to another pandemic as we were in 1918, because there’s more economic interdependence,” notes American historian John Barry.


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Daihai He et al, “Inferring the causes of the three waves of the 1918 influenza pandemic in England and Wales,” Proceedings of the Royal Society B (7 September 2013).

G. Dennis Shanks, “No evidence of 1918 influenza pandemic origin in Chinese laborers/soldiers in France,” Journal of the Chinese Medical Association 79(1): 46-48 (January 2016).

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