The Worst Outbreaks in U.S. History
Inside The Swift, Deadly History Of The Spanish Flu Pandemic
Scientist Johan Hultin traveled to Brevig Mission, Alaska, a town of a few hundred souls in the summer of 1997. He was searching for buried bodies, and Alaska's frozen ground was the perfect place to find them. Digging through the permafrost—with permission from the town's authorities—he eventually uncovered a woman who died almost 80 years previously and was in a state of excellent preservation. Hultin then extracted samples of the woman's lung before reinterring her. He intended to use this to decode the genetic sequence of the virus that had killed this Inuit woman along with 90 percent of the town's population.
Brevig Mission was just one place that was part of a global tragedy, one of the worst ever to befall humanity: the influenza pandemic of 1918-19. The outbreak of this influenza virus, also known as Spanish flu, spread with astonishing speed around the world, overwhelming India, and reaching Australia and the remote Pacific islands. In just 18 months at least a third of the world's population was infected. Estimates on the exact number of fatalities vary wildly, from 20 million to 50 million to 100 million deaths. If the upper end of that estimate is accurate, the 1918 pandemic killed more people than both World Wars put together. (Get the facts on influenza.)
The first official cases of the 1918 Spanish flu pandemic were recorded at the U.S. Army's Camp Funston, Kansas, where this emergency influenza ward held treated patients.
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War and pestilenceSeveral closely related viruses cause influenza, but one strain (type A) is linked to deadly epidemics. The 1918-19 pandemic was caused by an influenza A virus known as H1N1. Despite becoming known as the Spanish flu, the first recorded cases were in the United States in the final year of World War I. (Explore the memorials of World War I.)
A magnified view of the H1N1 virus responsible for the 1918 pandemic.
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By March 1918 the United States had been at war with Germany and the Central Powers for 11 months. During that time America's small, prewar army had grown into a vast fighting force that would eventually send more than two million men to Europe. (How the United States entered World War I.)
American forts experienced a massive expansion as the entire nation mobilized for war. One of these was Fort Riley, Kansas, where a new training facility, Camp Funston, was built to house some of the 50,000 men who would be inducted into the Army. It was here in early March that a feverish soldier reported to the infirmary. Within a few hours more than a hundred other soldiers had come down with a similar condition, and more would fall ill over the following weeks. In April more American troops arrived in Europe and brought the virus with them. The first wave of the pandemic had arrived. (What is the difference between an epidemic and a pandemic?)
Deadly speedThe Spanish flu strain killed its victims with a swiftness never seen before. In the United States stories abounded of people waking up sick and dying on their way to work. The symptoms were gruesome: Sufferers would develop a fever and become short of breath. Lack of oxygen meant their faces appeared tinged with blue. Hemorrhages filled the lungs with blood and caused catastrophic vomiting and nosebleeds, with victims drowning in their own fluids. Unlike so many strains of influenza before it, Spanish flu attacked not only the very young and the very old, but also healthy adults between the ages of 20 and 40.
Biologists at St. Bartholomew's Hospital in London are analyzing brain and lung tissue from victims of the 1918 pandemic as part of global efforts to understand the virus. Here, wax-mounted tissue samples sit on a list of children's names who fell victims to influenza in 1918.
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The principal factor in the virus's spread was, of course, the international conflict then in its last phase. Epidemiologists still dispute the exact origins of the virus, but there is some consensus it was the result of a genetic mutation that perhaps took place in China. But what is clear is that the new strain went global thanks to the massive and rapid movement of troops around the world.
The drama of the war also served to obscure the unusually high mortality rates of the new virus. At this early stage, the illness was not well understood and deaths were often attributed to pneumonia. Strict wartime censorship meant that the European and North American press were unable to report outbreaks. Only in neutral Spain could the press speak freely about what was happening, and it was from this media coverage that the disease took its nickname.
Deadly Contact
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Native Americans treat patients infected by European diseases in this 1591 engraving by Theodor de Bry.
GRANGER/ALBUMEpidemics are as old as civilization: Signs of smallpox appear on 12th-century B.C. Egyptian mummies. Increased contact led to the spread of disease. In the sixth century A.D. The Plague of Justinian moved along trade routes, killing 25 million people across Asia, Africa, Arabia, and Europe. Eight centuries later, the Black Death wiped out 60 percent of Europe's population. When Europeans settled in the Americas in the 16th and 17th centuries, they introduced smallpox, influenza, and measles to the native peoples, killing an estimated 90 percent of the population. Here, Native Americans treat patients infected by European diseases in a 1591 engraving by Theodor de Bry.
The second waveThe overcrowded trenches and encampments of the First World War became the perfect hosts for the disease. As troops moved, so the infection traveled with them. The wave that had first appeared in Kansas abated after a few weeks, but this was only a temporary reprieve. By September 1918 the epidemic was ready to enter its most lethal phase.
It has been calculated that the 13 weeks between September and December 1918 constituted the most intense period, taking the greatest number of lives. At least 195,000 Americans died in October alone. In comparison, total American military casualties for the whole of World War I came in at just over 116,000. Once again, it was the crowded military encampments where the second wave initially gained a hold. In September an outbreak of 6,674 cases was reported at Camp Devens, a military base in Massachusetts.
As the crisis reached its zenith, the medical services began to be overwhelmed. Morticians and gravediggers struggled, and conducting individual funerals became impossible. Many of the dead ended up in mass graves. The end of 1918 brought a hiatus in the spread of the illness and January 1919 saw the beginning of the third and final phase. By then the disease was a much diminished force. The ferocity of the autumn and winter of the previous year was not repeated and mortality rates fell.
Although the final wave was much less lethal than its predecessors, it was still able to wreak considerable damage. Australia, which had quickly enacted quarantine restrictions, managed to escape the worst of the flu until the beginning of 1919, when the disease finally arrived and took the lives of several thousand Australians.
The Spanish flu did not strike in Australia until 1919. Quarantine camps like this one, in Wallangarra, Queensland, were set up to treat and contain the illness.
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The general trend of mortality, however, was downward. There were cases of deaths from influenza—possibly a different strain—as late as 1920, but by the summer of 1919 health care policies and the natural genetic mutation of the virus brought the epidemic to a close. Even so, its effects, for those left bereaved or suffering long-term health complications, were to last decades.
Lasting impactThe pandemic left almost no part of the world untouched. In Great Britain 228,000 people died. The United States lost as many as 675,000 people, Japan some 400,000. The south Pacific island of Western Samoa (modern-day Samoa) lost one-fifth of its population. Researchers estimate that in India alone, fatalities totaled between 12 and 17 million. Exact data in the number of deaths is elusive, but global mortality figures are estimated to have been between 10 and 20 percent of those who were infected.
In 1997 the samples taken by Johan Hultin from the woman found in the frozen mass grave in Brevig Mission added to scientists' knowledge as to how flu viruses mutate and spread. Drugs and improved public hygiene—in conjunction with international institutions such as the World Health Organization and national bodies such as the Centers for Disease Control and Prevention in the United States—put the international community in a much better position to meet the challenges of a new outbreak. However, scientists know a lethal mutation could occur at any time, and a century on from the mother of all pandemics, its effects on a crowded, interconnected world would be devastating.
Flu Fears Bring To Mind Deadly Horror Of 1918
They called it the Spanish flu, and in October 1918 one of the most dangerous viruses in world history established a foothold in Lawrence.
The city practically shut down.
In the Oct. 8 issue of the Lawrence Daily Journal-World, page one headlines alternated between World War I news of the "Yanks" taking on the "Huns" at Cambrai and city and state health officials ordering the closure of schools and theaters while banning church services, lodge meetings and public assemblies.
As battles raged in Europe, Lawrence was preparing to fight a different war of its own.
"Obviously we had flu in the 1800s and we had flu many times before that, but nothing like this," said Dr. Chien Liu, professor emeritus who served as director of infectious diseases at Kansas University Medical Center from 1963 to 1991.
Today, medical and health officials are concerned about a possible avian or bird flu pandemic that could sweep through the world, leaving a trail of illness and death in its wake. They need only look at the 1918 pandemic to envision a possible worst-case scenario. The 1918 flu also was a bird flu, modern researchers say.
In this 1918 photograph provided by the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Spanish flu victims crowd into an emergency hospital at Camp Funston, a subdivision of Fort Riley. Most historical accounts say the flu, which killed about 600,000 Americans and millions worldwide, originated in Kansas.
It isn't clear how many people died in Lawrence because of the flu. There is little information available about what happened here except from reading newspaper stories now stored on microfilm. And most of the stories and information about deaths came from KU sources. By the time the flu had run its course in early November, 23 KU students and one staff member had died. The flu had infected about 1,000, mostly KU students and members of the Student Army Training Center and some staff. There were 3,000 students enrolled at the time.
"There was just no sense of anything they could do to prevent the illness and the dying," said Kathy Tuttle, a KU associate vice provost and one of the university's historians. "I think that must have made it a horrible feeling for all the people involved."
Flu starts in Kansas
The 1918 flu obtained its Spanish nickname because Spain was the first European nation to highly publicize the outbreak in that country. Other European nations also had outbreaks, but because of the war, newspapers were giving little, if any, publicity to bad news.
Most historical accounts, however, say the flu originated in Kansas, at Fort Riley's Camp Funston. The first reports of soldiers getting sick occurred in March. Historians also think American soldiers sent to Europe were the main carriers of the disease to that continent.
According to the 2004 book "The Great Influenza" by John M. Barry, the origin of the flu may have been January or February in Haskell County in southwest Kansas. It then spread to Camp Funston.
By October, the flu had spread dramatically throughout the United States. On Oct. 2 in Boston, 202 people died in a single day. In Philadelphia, 289 people died on Oct. 6. New York reported 851 deaths in one day.
Outbreak ends quickly
In Lawrence on Oct. 8, it was reported there were 92 cases of flu at KU. Chancellor Frank Strong ordered the university closed. The outbreak also led to Lawrence Mayor W.W. Holyfield issuing a proclamation closing theaters and forbidding public gatherings of more than 20 people in one place. Kansas Gov. Arthur Capper issued a similar statewide order.
To prevent the spread of flu in Lawrence, the commander of KU's Student Army Training Corps, or SATC, moved to shut down local theaters and movie houses and stationed uniformed troops at the entrances. In addition, KU students were prohibited from gathering in large groups, for fear the airborne disease would spread more quickly.
Strong also ordered KU students not to leave town and thus carry the disease to other parts of the state. Nevertheless, up to 500 students violated the order and left anyway, according to newspaper accounts.
KU football games also were called off, including a game with Missouri.
The magnitude of the flu outbreak in the city remained murky, according to a statement from then city health officer A.W. Clark.
"The reason for this is that the physicians have been so busy that they have not taken the time to make reports to the health offices," Clark said in the Journal-World.
At KU, 151 male students were under observation at the Student Army Training Center. A new barracks was used to house the extremely sick patients.
By Nov. 2, the number of flu cases had dropped dramatically and on Nov. 8, city flu bans were lifted.
The Spanish flu killed more than 600,000 Americans by the time it had mostly run its course at the end of November 1918. Worldwide there were 25 million to 37 million deaths.
Worldwide: 25 million to 37 million peopleIn the United States: about 600,000In Lawrence: no records existAt Kansas University: 24
How likely is a bird flu pandemic today? Though there have been a few human bird flu cases in Southeast Asia, it has still primarily been spread among chickens, Liu said.
The concern is that the bird flu virus might mix with the human flu virus and exchange genes, causing a new super flu that could be transmitted more easily among humans. There is no true vaccine for such a flu.
"There is an experimental vaccine that has been developed, but it takes time to mass produce it," Liu said.
A national expert recently told officials here that a new flu pandemic would likely leave hundreds dead in Douglas County and hospitalize up to 11,000 people.
U.S. Death Toll From COVID-19 Surpasses 1918 Spanish Flu Pandemic
U.S. Death toll from COVID-19 surpasses 1918 Spanish flu pandemic - CBS NewsWatch CBS News
The number of reported deaths in the U.S. Linked to COVID-19 has surpassed 676,000, according to Johns Hopkins University. The death toll now exceeds the number of Americans believed to have died during the Spanish flu pandemic in 1918. Infectious disease expert Dr. Amesh Adalja joined CBSN to discuss.
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