‘The 1918 flu is still with us’: The deadliest pandemic ever is still causing problems today.
In 1918, a novel strand of influenza killed more people than the 14th century’s Black Plague. At least 50 million people died worldwide because of that H1N1 influenza outbreak. The dead were buried in mass graves. The pandemic spread across the world. In Philadelphia, one of the hardest-hit cities in the United States, priests collected bodies with horse-drawn carriages.
The pandemic killed far more people than there were deaths from combat casualties in World War One (1914-18). It may have killed between 3% and 6% of the global population. At the time, pandemic influenza was new to the world and only people exposed to milder forms of influenza in earlier flu seasons (usually winter) had partial protection against this more virulent form of the virus. And since it happened in the pre-antibiotic era, heavily infected patients were likely to die from viral pneumonia and complicating bacterial infections.
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The pandemic started in January 1918, overlapping with the war for nine months and persisting in its aftermath as people traveled back to their homes. The war played a major role in its spread and severity.
Prior to 1914, few people traversed long distances, limiting the spread of infectious diseases, such as influenza, from one place to another, and country to country. Indeed, some rural people could live for years without exposure to many of the infections that were frequent in cities.
The war saw the mobilization and movement of large numbers of troops and related personnel, both within and between continents; it also uprooted the lives of millions of non-combatants, especially in Europe. People from places far apart became more directly connected – and more liable than ever before to be exposed to any new form of the flu.
Those from previously isolated populations, such as Alaska or the Pacific Islands, were doubly vulnerable when first exposed to pandemic influenza. The outbreak in Western Samoa, for instance, killed 22% of the population, probably because it lacked protective immunity conferred by exposure to earlier forms of (seasonal) flu.
Regardless of background, mortality was lower for those who had been in the army for longer periods of time. This suggests that in the months and years after recruitment but before the arrival of the pandemic strain of the flu, soldiers became progressively immunized by exposures to seasonal flu. Or, to one or other of the bacterial infections that could cause fatal pneumonia as a complication of the flu.
From August 1918, the virus was spreading around the world in several waves, infecting almost everyone. It caused illness in 20% to 50% of infected people and death in 1% to 5%. It also played a crucial role in deciding the outcome of World War I as death rates among German and Austrian soldiers seemed to have been considerably higher than the death toll among allied soldiers.
It’s not clear exactly how or where the 1918 influenza outbreak began (It may have started in Kansas in January 1918), but, at some point, the novel H1N1 virus passed from birds to humans. From start to finish, the flu could burn through a town or city in a matter of weeks. Very few people had ever contended with a concoction of influenza like this before, which is why it was so potent, Reid said.
Even US President Woodrow Wilson contracted the virus while negotiating the end of World War I. Seasonal influenza tends to kill the oldest and youngest in society but in 1918, roughly half of those who died were men and women in their 20s and 30s. People were getting sick and dying in the prime of their lives.
The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The death rate for 15 to 34-year-olds of influenza and pneumonia was 20 times higher in 1918 than in previous years. People were struck with illness on the street and died rapid deaths. One anecdote shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza. Others told stories of people on their way to work suddenly developing the flu and dying within hours.
One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most vicious type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate." Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth." The physicians of the time were helpless against this powerful agent of influenza.
Over time, those who contracted the virus developed an immunity to the novel strand of influenza, and life returned to normal by the early 1920s, according to historians and medical experts. Reports at the time suggest the virus became less lethal as the pandemic carried on in waves.