“Although it’s been more than a century, there are lessons from the influenza outbreak that are important and relevant today when facing new pandemics.”

By George Yagi Jr.

WHEN THE Influenza Pandemic of 1918 struck, it ravaged a global population already caught in the midst of a world war. In fact, the H1N1 outbreak would go on to become one of the deadliest pandemics in history.

While the Great War claimed the lives of 40 million soldiers and civilians, the influenza outbreak of 1918 to 1919 killed between 50 to 100 million people and also infected as many as 500 million worldwide.

It was dubbed the Spanish Flu by contemporaries. Neutral Spain, unlike the Allied and Central powers, had no wartime censorship. As such, newspapers in the country were among the first to report on the seriousness of the outbreak, leading many to wrongly believe that it originated on the Iberian Peninsula.

However, even a century later, the true origins of the illness remain elusive.

Some have argued that poor sanitation on the Western Front and the close living quarters in the trenches created the ideal breeding ground for the pathogen. Others point out that the virus first appeared at Camp Funston in Kansas. Even China has been cited; Shanxi province had experienced an outbreak of a lethal respiratory disease one year earlier.

Influenza struck in three waves: the first, which occurred in early 1918, was mild with few fatalities. The second wave, which spread across the Western Front in the autumn of 1918, was far deadlier and primarily targeted the young and healthy between the ages of 20 to 40 years old. In fact, the virus’ lethality during this second wave was so severe that some died within 12 hours of getting sick. By the third and final wave, which appeared in early 1919, herd immunity began to have impact on the disease, and it eventually faded into historical memory by 1920. Although it’s been more than a century, there are lessons from the influenza outbreak that are important and relevant today when facing new pandemics.

Travel is dangerous

Following the outbreak of influenza at Camp Funston in March 1918, the disease quickly spread to other crowded U.S. Army outposts. Ultimately, 24 out of 36 major military installations became hotbeds of infection as new recruits prepared for their journey overseas. Until penicillin made its appearance on the battlefields during the Second World War, it was quite common for armies to lose more men to disease than in combat.

Little attention was paid to sick troops en route to Europe and soon after their arrival in the spring of 1918, they began to infect French soldiers. The illness quickly spread to the British army, who then passed it to the enemy during General Erich Ludendorff’s Spring Offensive. As many as half a million Germans were put out of action, and operations momentarily stalled. As the disease ravaged the armies in the field, it also spread to nearby civilian populations.

The rapid advance of the H1N1 virus around the globe was greatly aided by shipping and railroads, allowing infections to reach even the most remote areas on earth. American Samoa was one of the few regions spared. The governor of the distant Pacific territory closed the island to all outside vessels, saving the inhabitants from the deadly plague.

Quarantines can be effective

When carried out properly, quarantines can be effective in halting the advance of a disease.  However, in the case of the 1918 influenza outbreak, such measures were often applied poorly and too late.

With the war in Europe hitting a critical phase in mid-to-late 1918, calls to quarantine American soldiers destined for overseas service were ignored.

Acting Army Surgeon General Charles Richard soon found himself at odds against Army Chief of Staff Peyton March after recommending a quarantine of American troops for at least one week before embarkation for France. As the soldiers were needed on the Western Front, March ignored the advice in favor of conducting physicals as troops boarded their transports. President Woodrow Wilson approved the decision.

Modified quarantines were also enacted by the navy to assist in the movement of troops across the Atlantic, but many vessels became plague ships with burials at sea regularly taking place.

Only a strict following of procedure could ensure a quarantine would be effective.

At Camp Upton, the ranking surgeon ordered the men to remain in their assigned areas of the base.  Soldiers belonging to the remount station followed the orders and not a man was infected. In contrast, the 3^rd Development Battalion allowed its soldiers to wander about camp with lethal results.

For those in quarantine, temperature-taking, face masks, isolation, and proper ventilation were all a regular part of the process to combat the H1N1 virus. Yet despite its best efforts, the Army Medical Department admitted that these measures would probably only slow the spread of the disease.

Crowds are deadly

During a pandemic, large gatherings spread infection. In the case of the Liberty Loan Parade in Philadelphia, which took place on Sept. 28, 1918, an estimated 200,000 people gathered for what was supposed to be a celebratory event. A week later, 45,000 were ill and more than 1,000 were dead. A shortage of medical personnel in the city due to the war effort made the crisis worse.

A dearth of nurses was only overcome when a group of Catholic nuns came forward to attend to the sick and dying. The outbreak took the city by storm, with casualties quickly filling the morgue, and cemeteries unable to cope with the numerous dead.

Faced with further public health dangers from the number of bodies scattered throughout the city, the Catholic Church intervened again and ensured a decent burial for the deceased in mass graves, with priests even conducting services well into the night.

In the end, the Liberty Loan Parade led to the deaths of 12,000 people in Philadelphia, making it one of the hardest hit areas during the influenza outbreak of 1918. The situation might have been different if the parade had been cancelled.

ABOUT THE AUTHOR: Dr. George Yagi Jr. is an award winning author and historian at the University of the Pacific.  Follow him on Twitter @gyagi_jr