Scenes From the Pandemic Summer of 1918

While there are some obvious parallels between now and the terrible Spanish Flu of a century ago, the most important thing to remember is that we live in a very different world today

After so many weeks of social confinement, it’s the little details of life that start to get to you. For some, it might be a loved one’s innocuous mannerism that’s needled its way under your skin, or perhaps a distracting lava lamp in the background of a co-worker’s video calls. For me, the thing that’s evolved from micro-annoyance to pet peeve to daily irrational rage trigger is the phrase, “in these unprecedented times,” a stock insertion that’s been getting an awful lot of mileage in marketing emails, news reports and public information bulletins as the lockdown wears on. 

Now, in no way am I blaming anyone for using this in a professional context. It’s a polite, benign catch-all for communicating the sense of dislocation and disorientation we’re all trying our best to deal with. But, in group-selecting this as the platitude of the moment, didn’t anyone think the word-choice was a little off? These are uncertain times, yes; they’re scary times, absolutely; they’re difficult, fraught, extraordinary and terribly sad times too, but one thing they are not is unprecedented.

The world, we all know, has been here before with deadly respiratory disease. Pandemics sweep the planet at fairly regular intervals, and in the past century, there have been three that have been officially acknowledged as such by the WHO: The weirdly forgotten “swine flu” in 2009 (thought to have caused up to 400,000 deaths worldwide); “Hong Kong flu” in 1968 (responsible for something like 4 million); and the “Asian flu” of 1957 (around 2 million dead). But it’s the one from 102 years ago, the gargantuan, globe-swallowing “Spanish influenza” pandemic of 1918, that has drawn the most frequent and direct comparisons with the current COVID-19 crisis.

On the surface, at least, that’s fair enough — there are a number of striking similarities. Spanish flu mirrors coronavirus in the course it tore through populations one after another, and also in a great deal of the measures the authorities took in attempting to manage it. There are also clear echoes in the deep disruptions the 1918 virus inflicted on societies, economies, health-care provision and the way people went about their daily lives. Back then, masks were suddenly seen on faces in public and became a flashpoint for controversy; mass gatherings were banned in many places, physical distancing was recommended and the decisions of public officials came under intense scrutiny.

Odd resonances bring all of that home, like the fact that the British Prime Minister of the day, David Lloyd George, was struck down with flu for a number of weeks at the height of the crisis in October 1918, and, just like Boris Johnson in April 2020, was lucky to survive. Then, as now, quack remedies and rumored preventatives were recklessly thrown out into panicked public discourse — among them, writes Laura Spinney in her fantastic 2017 history of the disease, Pale Rider, “various drugs derived from iodine for ‘internal disinfection.’”

By the tips of its fingernails, the earlier episode is also within living memory. On March 28th, the poignant death was reported of Hilda Churchill, a 108-year-old woman from Manchester, U.K., who succumbed to coronavirus having survived the Spanish flu pandemic (which infected her family and killed her baby sister) when she was seven years old. Before she died, Churchill had told her grandson how similar she thought the current crisis was to that of 1918, aside from the fact that “there were no planes, and somehow it still managed to spread everywhere.”

There was also a war on, of course. The fact that Spanish influenza is overshadowed in our collective memory by a conflict whose worldwide death toll it utterly dwarfed (World War I claimed somewhere between 15 and 22 million lives over four years; the pandemic killed between 50 and 100 million in less than a year) has always been an oddity highlighted by historians of the period — and duly ignored by the rest of us. There are a number of other cognitive barriers between us, living through today’s digital-age disease crisis, and the world that Spanish flu turned upside-down — some of which should perhaps flag up a warning against drawing too many parallels between our own response to a devastating illness and that of people who were caught up in a hurricane of social, industrial and political change — events that genuinely were unprecedented — at a full century’s distance.

‘Fearful Toll of Death’

In trying to imagine what it was really like to live through Spanish flu, the first psychological hurdle we hit is the enduring problem we have as a species with historical empathy. We struggle to see ourselves in the people of the past, and with the first part of the 20th century that’s aggravated by our tendency to picture it in the half-light of flickering, silent-era black and white — we make the mistake of assuming life was somehow just like the sped-up action in hand-cranked movies of the era (like the big-hearted comedy Mickey, which lit up audiences while the pandemic raged).

The Biggest Movie in America During the 1918 Flu Pandemic Is More Worth Watching Than Ever

An instant fix for this is to immerse yourself in one of the stops-you-in-your-tracks colorization projects of recent years — watch Peter Jackson’s incredible rendering of archive footage of troops fighting the First World War, They Shall Not Grow Old, and all that historical separation suddenly snaps down into faces and environments we can instantly relate to.

Strangely, though, the most sympathetic way to visualize the experience of Spanish influenza might be in that sepia-tone haze of a world without color. A symptom of the flu widely reported at the time was an uncanny draining of vivacity from color vision, so that sufferers’ surroundings seemed eerily washed out and muted.

That might sound reminiscent of the loss of taste and smell experienced by many who’ve gone through COVID-19, and though the two diseases are caused by viruses from completely different biological families, sensory suppression isn’t the only feature they share. Just like with coronavirus, the majority of those who contracted Spanish flu would survive — onset symptoms included headaches, sore throats, fever and exhaustion. Unlike today, those most at risk of contracting a severe case included the very young (under the age of five) and otherwise healthy adults (mainly men) in their 20s and 30s, as well as people in old age.

For those who succumbed, as with COVID-19, death would often involve a secondary bacterial infection, and patients would usually die from pneumonia, with severe inflammation of the lungs brought on by the body’s own overly aggressive immune response to the virus. Some of the features of the 1918 illness when it turned lethal were more grotesque, perhaps — sufferers’ skin often darkened dramatically, lips turned blue, many died coughing up blood — and its pace was swifter (incubation was two to three days; death would sometimes come just as soon after that), but in many ways its pathology seems all too familiar.

Another point of contact between then and now is the extent to which the virus colonized people’s consciousness. In North America at least, the media of the time (which is to say newspapers) were awash with headlines about the pandemic for months on end. Some of the local coverage reveals how every detail of daily life was being filtered through the prisms of both war and infection — like Pennsylvania’s New Castle News, whose December 13th edition sought to dispel rumors among younger readers that Santa Claus had been drafted for the war effort and/or been struck down with Spanish flu. “They are writing to the post office … and inquiring after his health, and whether he is still in red and white or whether he has donned the khaki,” went the report, concluding, “You can’t make children think … that the ‘flu’ can keep old Santa out of the running.”

Another, more macabre story ran in the paper in October under the headline “Flu Doesn’t Worry County Jail Pair,” which a bit too gleefully reported on two convicted murderers who’d been overheard arguing over the relative merits of death by influenza or their impending executions. One of them thought a demise by due process might give him a free pass to heaven, while the other, according to the story, perhaps sensibly “was inclined to believe that he would rather take his chances with the ‘Flu’ route than by the electric chair.”

Zooming out from the more ditzy and sensationalist headlines, some of the more responsible national reporting captures a sense of the visceral fear people were simultaneously living with. One update in Winnipeg’s Manitoba Free Press, on November 27, 1918, announced that theaters and places of worship were to soon be re-opened in Edmonton, with schools following in the New Year. But it also warned Canadians: “Some harrowing tales are coming from isolated rural points in connection with the ravages of the flu epidemic. At Witchekan Lake, a party of seven threshermen were all found dead in a caboose, two in bunks and five on the floor.” 

It then goes on to relate a series of further gruesome discoveries made on the same day, including a couple found dead in their store by a customer and a youth who was encountered while “digging four graves into which he intended placing the bodies of his father, mother, brother and sister. From every direction,” the article brooded, “most distressing stories are arriving of the fearful toll of death which follows in the wake of the epidemic in places far removed from medical attention.”

The scale of the 1918 pandemic is difficult to comprehend, even from our current informed vantage point. But one anecdote related in Spinney’s book helps put it into an apocalyptic kind of perspective. Illustrating a coffin shortage in New York City during the fall, she describes a backlog of 200 unburied caskets at Calvary Cemetery in Queens, along with the tragedy of a recent Italian immigrant who was unable to find a “suitable box” in which to bury his one-year-old baby. His family had to share their living space with the body for several days, she writes, before the grieving father “finally bought some wood and, in despair, fashioned a coffin with his own hands.”

A World Optimized for Contagion

There are competing theories over exactly where Spanish influenza originated. A strain of what’s now categorized as the flu subtype H1N1, it first made the jump from a virus hosted by birds (or possibly pigs) to one transmissible between humans at some point between late 1916 and early 1918. Some have suggested it first emerged in northern China; others have pointed to the human battery-farm hospitals behind the Allied lines on the Western Front. But recent analyses that measure the frequency of a virus’ genetic alteration over time place its most likely ground zero in Kansas, near to the U.S. Army camp where the first confirmable cases of the 1918 epidemic were recorded, on March 4th.

Hundreds of the troops at Camp Funston, who were being hurriedly trained for combat duty in Europe, were treated for a notably savage form of flu in a makeshift hospital that month; by April, it had spread throughout the Midwest, and two weeks later, some of those recruits had transported it across the Atlantic to the Western Front. From there, it went everywhere. (Except Australia, which managed to muster full continental quarantine before any infected crews could dock.)

During the first 100 days since that inciting outbreak in Kansas, Spanish flu is thought to have infected 130 million people and killed 300,000 across the globe. By comparison, by April 8th of  this year, 100 days after Chinese authorities shut down the Wuhan seafood market, having become aware of COVID-19’s existence, it’s been estimated that the new virus had infected 1.3 million, with around 75,000 dead.

There are sizable caveats with both those sets of numbers (the 1918 estimate is historical extrapolation; the 2020 figure is hampered by the fact that total numbers of coronavirus cases aren’t yet known for sure), but if they’re anything like ballpark, it suggests there were something like 100 times the number of cases in the first months of the 1918 pandemic, but that it also had a much lower mortality rate — just over 0.2 percent. That would be double the typical death rate for seasonal flu in the U.S., but nothing like the global killer we’ve come to associate with the time.

By this point, in mid-June, the disease had gained its spectacularly inaccurate name — it was “Spanish” simply because Spain’s newspapers, free of wartime censors in a neutral nation, were atwitter with news of King Alfonso XIII, who had contracted the disease along with half his cabinet — and it had already begun to recede.

But in late August, as the Allies took the war into its final phase with their Hundred Days Offensive, and audiences in American movie theaters were being stunned by the spectacle of the longest cartoon to date — a sublime 12-minute animated recreation of the 1915 atrocity The Sinking of the Lusitania — the virus re-emerged, having mutated into a far more deadly iteration. It reappeared in Freetown, Sierra Leone; in Boston, Massachusetts; and in the French naval port of Brest at around the same time.

The lethal second wave engulfed most of the world, lasted through the fall into December, and was followed by a third wave, which this time caught Australia off-guard, where it remained for months, killing an estimated 13,000 people. Elsewhere it peaked in late January 1919, spreading among the delegates to the Versailles Peace Conference (including U.S. President Woodrow Wilson, who was subdued by flu at a sensitive point in the negotiations), and then infection rates tailed off as 1919 wore on; by April 1920, it had gone.  

If that recurring trajectory sounds ominous in relation to the world’s present situation (and perhaps, at least in this respect, the events of 1918 really should give us pause for thought), it bears repeating that direct comparisons can be misleading. And when it comes to demographics, the gulf between then and now is much wider than it first appears.

In 1918, the global population stood at 1.6 billion people, less than a quarter of its current size — but in certain areas, the areas that mattered epidemiologically, it was far more densely populated than it is now. In New York City, for example, the tenements of the Lower East Side packed in 500 people per acre, rivaling the slums of Bombay. The giant ships ferrying servicemen and Army auxiliary staff to Europe, such as the U.S.S. Leviathan, were vastly overcrowded incubators for influenza. The factory hives of Europe’s industrial towns were breeding grounds for contagion. And the damp, unhygienic conditions of the trenches, camps and hospitals of the front itself were almost custom designed to accelerate the disease’s spread and severity; when the troops were demobilized in late 1918 and the first half of 1919, many would bring the virus home with them.

These were the crucial pockets of compressed humanity that propelled the pandemic, along with one agonizingly tragic moment: After the armistice was signed on November 11th, mass street-party celebrations, filled with hugging and kissing — and, lamentably, viral transmission — broke out for days in cities around the world, precisely as the disease was hitting its destructive peak in many of those places. 

‘Ostracize the Sneezer’

On a global scale, then, the social-distancing measures of 1918 were nothing like those in place today. But that’s not to say self-isolation wasn’t recognized as an effective strategy in containing an epidemic — the “curve” characteristic of a disease’s spread, which we’ve become so familiar with of late, and the equations of contagion had already been identified, just a few years previously, by the British malaria scientist Ronald Ross.

In July 1918 the British government’s senior medical officer, Sir Arthur Newsholme, prepared a “public memorandum” advising citizens to protect themselves in language that prefigured the current U.K. administration’s, telling them to stay home and avoid public gatherings. Such a demoralizing announcement didn’t go down well with a war cabinet that was regularly censoring coverage of the epidemic in the press, however, and the official advice was suppressed — a fateful decision Newsholme later said he regretted but stood by, writing in a report the following year: “There are national circumstances in which the major duty is to ‘carry on,’ even when risk to health and life is involved.”

That didn’t prevent other, less authoritative recommendations from circulating. In November 1918, the popular News of the World paper informed the British people they should “wash inside your nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply. Do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge.”

And in Manchester, a dynamic local health administrator, James Niven, took matters into his own hands. He saw the importance of tracking the disease’s early spread in his city and conducted painstaking statistical analyses, accurately predicting the second wave’s approach. He shut down a number of schools and cinemas and kept citizens well informed, via posters across the city, a column in the Manchester Guardian and the distribution of 150,000 handbills in which he precisely laid out the flu’s symptoms, treatment and effective isolation precautions. In these leaflets, ahead of his time, he correctly acknowledged the invisible danger of asymptomatic carriers: “It will be advisable for the healthy to avoid crowded gatherings, since their neighbors may quite well have a slight attack of influenza without being aware of the fact.”

For the theaters that remained open, Niven also procured from the central health board one of the first public-health information films, fronted by the marvelously Dickensian “Dr. Wise”:

In the U.S., meanwhile, although Woodrow Wilson remained strangely quiet on the disease he’d later contract, censorship wasn’t as much of an issue. The Public Health Service printed millions of leaflets aimed at educating the nation in basic hygienic matters, such as how to wash their hands and the importance of shielding others from coughs and sneezes. The federal government correctly informed the public that influenza was “spread by droplets sprayed from nose and throat.”

But then, as now, efforts to limit its spread were largely managed at the state and local levels, with a wide variety of approaches and mixed results. New York, having been proactively targeting tuberculosis for a decade when the virus hit, saw relative success in containment after an initial spike; Philadelphia, meanwhile, was slow to enact quarantine orders, shelter-in-place measures and closures on businesses and schools, and the city endured one of the highest death rates in the U.S. 

How obediently the public complied with the protection strategies was another matter altogether. “Unless the local health department receives the hearty cooperation of the public, the closing ban may be placed again on this city,” ran the Daily Northwestern’s warning to the citizens of Neenah, Wisconsin on December 12th under the finger-wagging headline “Neenah Must Be Careful.”

That same day’s paper carried a report that the Surgeon General was ordering the immediate release of as many military doctors as could be spared to treat the stricken in their local communities, accompanied by the following advice from a meeting of the American Public Health Association in Chicago: “Avoid crowds, breathe clean air, ostracize the sneezer and keep calm if you would fool the flu germ.”

In San Francisco, one of many U.S. cities that imposed compulsory mask orders for people in the streets, an “Anti-Mask League” was organized and attracted strong support — some 4,500 of its members staged a protest in January 1919, many perhaps still outraged by a city health officer’s shooting and wounding of three people after one had refused to wear a face mask back in October.

As might be expected, there was also widespread agitation in favor of business shutdowns and shelter-in-place ordinances. Shaming those who were seen to be putting their communities at risk was a national pastime, according to Spinney: “In America, it wasn’t just conscientious objectors who were denigrated as ‘slackers’ in the autumn of 1918, but those who refused to comply with anti-contagion measures too.” 

Nothing More Than Old-Fashioned Grip’

The Northwestern’s piece on the medics convening in Chicago also paints a picture of a profession in confusion over how to respond to the crisis. While they were all in agreement in exhorting the public to avoid “quackery,” the report wryly notes that “every one of the 800 assembled physicians had an idea of the cause and cure of influenza. But not all ideas coincided.” Some were blaming the spread on public water fountains, à la cholera; some declared sterilizing restaurants’ knives and forks was the key to control; others attributed the disease to “improper living conditions among the working classes.”

The article continued, “‘Don’t try amateur doctoring,’ advised Dr. G. C. Craig, director of the bureau of preventable diseases at Rock Island, Ill. ‘The public sadly misconstrues directions and treatments. Coal-tar medicines in particular should be avoided.’”

The citizenry might be forgiven for resorting to the 1910s version of Googling for a diagnosis, though, considering how much misinformation and junk science (even for the time) was being fed to them, from both the media and the rumor mill. Spinney recounts one canard doing the rounds that claimed doctors and nurses found guilty of spreading flu germs among soldiers were being shot at dawn, as well as a story circulated by the New York Italian newspaper Il Progresso about a sinister figure handing out literature to schoolchildren in Long Island. Owing to their “Made in Germany” imprint, the books were seized and sent off to be investigated for signs of deliberate infection, the 5G cell phone towers of their day.

More dangerous, perhaps, were the volleys of wayward medical speculation and red herrings that were fired indiscriminately into the newspapers every day. “Cure Is Very Simple With Proper Treatment,” promised the lead story in the October 9th edition of the Iowa Recorder. “This Spanish influenza is nothing more than old-fashioned grip,” it reported one forthright Dr. Grimes as declaring. “‘It was discovered at the army camps,’ he said, ‘that if a soldier came down with influenza he would always recover if he went to bed at once and stayed there.”

Anxious readers might have also been duped by businesses seeking to cash in on their willingness to try anything to protect themselves. Only when you read to the end of one apparently well-informed guide to treatment, published in Ohio’s Sandusky Star-Journal on October 12th, does it become clear that it’s really an advert, disguised as editorial, for Vicks VapoRub, whose vapors “carry the medication direct to the parts affected.” A full-page ad taken out in the Syracuse Herald on October 23rd, which publicized the names of eight city liquor stores, was less subtle: “Wines and liquors used with medicinal intent will repel the influenza bacillus,” it hustled. “Don’t wait for the ‘Flu’ to come to you — guard against this plague in time.”    

On December 20th, meanwhile, a story that ran in a number of L.A.-area papers advised readers that it was their own fear of flu that made them most susceptible to it: “Anybody who allows himself to become panic stricken at the approach or the thought of this or any other epidemic is … lowering his vitality and thus inviting the disease into his system.” A fearful moment of weakness was when, the story explained, “the ‘flu bugs’ jump onto him.” Its jingoistic prescription for survival was this: “Take reasonable precautions … and cultivate a serene conviction that the epidemic will not get you. Then, chances are, germs to Germans, that it won’t.”

What’s really scary is that, while this claim came with zero medical authority, it wasn’t a million miles away from what the scientific consensus of the day actually was. And this is perhaps the most significant difference between the experience of 1918 and today’s pandemic, where the full distance of 10 decades’ progress in understanding can really be felt. For all that their ideas about behavioral control and social distancing might echo the wisdom of current practice, and for all the astute public servants like James Niven, who paid attention to the evidence and saved lives as a result, the scientists confronting Spanish flu ultimately had no idea what they were dealing with.

Since the 1880s it had been mooted that pathogens much smaller than bacteria might exist, but in terms of 1918 germ theory, viruses were still hypothetical fringe-science. The leading theory on what was causing the pandemic blamed an organism known as Pfeiffer’s bacillus, after the German scientist who had wrongly identified it as the culprit behind a previous global influenza episode, in 1889. It wasn’t until the 1930s that the nature of viruses as biological agents wholly distinct from bacteria and other microorganisms began to be properly grasped and the first vaccines developed. In the decades since, virology has got to the point where scientists have the understanding to artificially synthesize the influenza A(H1N1) strain that infected a third of the world’s population between 1918 and 1920 and killed at least one in every 10 people it inhabited.

Unnervingly, they have done just that — Spanish flu was resuscitated in 2005 and currently resides in a biosecure containment facility at the Centers for Disease Control and Prevention’s headquarters in Atlanta. “The decision to reconstruct the deadliest pandemic flu virus of the 20th century,” they say, “was made with considerable care and attention to safety.” 

Let’s hope. 

In any case, the upshot is that for 15 years, researchers have had access to one of the most potent pathogens in recent history, interrogating it for “important insights into the basis of virulence.” It was a very different disease, inflicted on a very different world, but it’s very possible that it will be the lessons learned from Spanish flu that ultimately prevent this, and future pandemics, from taking us back there.