I apologize for the absence of a post on Sunday. It’s the end of semester, so everything’s getting a bit hairy.
Part I: The Spanish Flu
I had a little bird
Its name was Enza,
I opened the window,
On March 4th, 1918, an unnamed soldier stationed at Camp Funston, a US army training camp in Kansas, woke up feeling sick. Achy and feverish, he reported to the sick tent where the doctor diagnosed him with influenza – the common flu. The soldier was quarantined in a tent reserved for victims of contagious diseases, and the camp went about its business, preparing to send soldiers to Europe to fight in the final throes of World War I. A week later, Private Albert Gitchell woke up with the same symptoms. His throat burned, and his body was wracked by alternating waves of fever and chills. The medic on duty recognized flu symptoms, and had him immediately quarantined, joining the unnamed soldier.
Unfortunately for the population of Camp Funston, and eventually for the world, Private Albert Gitchell had been a camp cook, and up until the previous night had played a role in serving food to 56,000 men who would soon be sent to fight, and die, in France. By the following week over one hundred men had come down with the flu. By the end of the month, it was over a thousand. 46 died. The outbreak, compared to what would come, was minor: Camp Funston recovered, and its soldiers were sent to other camps for further training.
In April, influenza infection rates spiked, first in military bases, and then in the cities around them. Army doctors reported disturbing findings: this new flu killed rapidly, in only 24 to 48 hours, causing massive hemorrhaging of the lungs. But as April turned to May new cases were reported less frequently, bringing a faint hope that the outbreak had run its course.
That hope was false: the virus was only getting started.
In May, 1918, the virus arrived in Spain – carried, mostly likely, by an American soldier on furlough from the fighting in France. By the end of May, eight million Spaniards had died and the king, Alfonso XIII, had only barely survived. Spain was a neutral country during the war, and as a consequence its press was free to speak about the flu. In America, during the minor spring outbreak, both government and press had conspired together to suppress discussion of the outbreak and the looming threat of pandemic. So what should’ve been the American Flu became the Spanish Flu, and people that should’ve been talking about it and preparing for another outbreak instead stayed quiet in the name of patriotism, hoping that they had already seen the worst.
A bit silly, in hindsight, because as most epidemiologists knew, outbreaks come in waves.
Influenza is normally a winter disease – arriving annually in September or October, it disappears again in February or March. In late summer, 1918, Spanish flu returned to American shores with a vengeance. America’s borders are never as secure as rednecks might like them to be, and 1918 was no different: possible ports-of-entry abounded. On August 18th, the Norwegian liner Bergensfjord arrived in New York harbour with a hold full of 200 sick passengers; a few weeks before that, the Somali had docked in Canada, coming from India with 89 sick crew members. Port towns and military bases were under siege – harbours and navy yards up and down the East coast reported outbreaks. In Philadelphia, the City of Exeter arrived from Liverpool with 28 sick crew members. Philadelphia’s government responded rapidly and effectively: the ship was designated a plague-ship and quarantined offshore, anchored in the harbour. This spared the City of Brotherly Love the brunt of the flu, but not for long.
In September 1918, the growing bubble of infection burst, and America was awash in flu virus. First Boston, then Chicago and New York – America’s major cities were devastated by flu outbreaks. The streets were deserted, people huddled inside darkened rooms, peering fearfully out of windows, wondering if they would be infected next. Coughing or sneezing was tantamount to an 8th deadly sin. A newspaper from Ottawa reported:
“Streetcars rattled down Banks Street with windows open and plenty of room inside. Schools, vaudeville theatres, movie palaces are dark; pool halls and bowling alleys deserted.”
Owing to its early quarantine of the City of Exeter, Philadelphia was mostly spared through September. There was an outbreak of cases in the naval yard, home to the world’s largest shipyard, but the city had remained mostly unscathed. At least until September 28th, when Philadelphia decided to tempt fate. The press and governments joint refusal to print anything that might lower wartime morale meant that information about the nature of the influenza outbreak was scarce, and even medical journals were reporting that the flu was nothing to panic about – only a mild outbreak, nothing out of the ordinary.
This was plainly wrong to any doctor on the ground, but the bureaucratic machine successfully steamrolled their protests.
So there was no one with a loud enough voice able to say “maybe this is a bad idea” when, on September 28th, the city of Philadelphia put on the Liberty Loan Parade. Designed to sell war-bonds, it was the biggest parade in the city’s history. Several hundred thousand people crowded together, standing for hours on a two mile stretch of sidewalk in the late September sunshine – coughing and shuffling and sneezing and spitting and laughing and shaking hands.
Two days later, several hundred people fell ill.
The city opened 12 emergency hospitals and closed its four medical schools, ushering their students from the classrooms to the hospital ward in a dangerous and stressful introduction to practical medicine. As in most epidemics, healthcare workers bore the force of the storm: half of Philadelphia’s nurses became patients, and 20% of them died.
The city closed churches, schools, and theatres – people became isolated and afraid in their own homes. Most stores closed of their own accord, and food and goods became difficult to find. Chaos descended. All the while, the municipal government continued to lie and say it wasn’t that bad (the “Ostrich Approach” to governing). In early October, the government-appointed head of public health told the newspapers that they had reached the worst point of the epidemic, and that mortality rates would decline. The next day, 430 people died.
The next week, 5000 died.
And then it was over. The flu disappeared. By the end of October businesses had reopened, the survivors had returned to work, and arrests for being drunk-in-public were back to their normal pre-flu high (you know everything is going to be fine when the bars reopen). In its wake, influenza left 13,000 dead in Philadelphia, and 500,000 infected. In New York alone, 21,000 children were orphaned.
Around the world, 50 million people died (a conservative estimate) and 500 million were infected. That is 3% of the world’s population succumbing to the disease, and 27% infected, or, adjusted for 2012: 210 million dead, the population of the UK, France, Germany, and Spain combined, and 1.9 billion people infected – all of China, with room to spare.
The aftermath of the Spanish Influenza pandemic left whole populations on their knees, and cities, states, and countries struggling to know what to do with survivors, as they also coped with the end of WW1. In all of the confusion and upheaval, one thing got lost: just what the hell was the Spanish Flu? Where did it come from? Where did it go? And, could it come back?
Find out in Part 2, on Thursday.