When the flu wiped out millions

Updated 2:49 PM EST, Sun November 9, 2014

Story highlights

Perri Klass: Before Ebola, there was Spanish flu, World War I-era pandemic

It killed tens of millions, more than died in war; mainly young adults; was similar to Ebola

One result: Cities modernized medical infrastructure, strategies to stop spread, she says

Klass: It taught us realities of stemming contagion: Wash hands, get your flu shot!

Editor’s Note: This is the 10th in a series on the legacies of World War I appearing on CNN.com/Opinion for the 100-year anniversary of the war’s outbreak. Ruth Ben-Ghiat is guest editor for the series. Perri Klass is a professor of journalism and pediatrics at New York University and director of the Arthur L. Carter Journalism Institute.

(CNN) —  

Before Ebola, there was the flu – the Spanish flu of 1918, which burned rapidly through army barracks, refugee camps, troop ships, all the crowded high-risk zones that World War I created.

Some people think it came out of Kansas. The first American cases developed there. Soldiers from army camps like Fort Riley, in eastern Kansas, carried the virus to other camps around the U.S., and over the sea to France.

Perri Klass
Courtesy Perri Klass
Perri Klass

The flu of 1918-1919 came toward the end of the First World War – which began a century ago this year – and it killed more people than died in that conflict, more people than the Black Death, back in the 14th century. In fact, nobody knows exactly how many people died around the world; the estimates go all the way up to 100 million, which would have been 5% of the world’s population.

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War's legacy

WAR'S LASTING LEGACY

  • The first World War began August 4, 1914, in the wake of the assassination of Archduke Franz Ferdinand of Austria-Hungary on June 28 of that year. In the next two months, CNN.com/Opinion will feature articles on the weapons of war, its language, the role of women, battlefield injuries and the rise of aerial surveillance.

If you lost a son in uniform in 1918, you were equally likely to lose him to the flu as to enemy bullets; half of the American servicemen who died were killed by the flu.

After the virus started spreading in Europe, infecting and killing people in a number of countries, it was thoroughly described in the Spanish press – because the King of Spain got sick, and because Spain was not in the war, and therefore not censoring news, while the French, British, and German papers were suppressing anything which might have an effect on wartime morale or suggest vulnerability. And thus, as a prize of peace, Spain became forever connected to the most deadly pandemic of all time.

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Influenza is a seasonal illness. Every year an influenza virus emerges, generally originating somewhere in Asia, and moves through the world, causing fever and chills, muscle pain and headache, cough and runny nose, and a certain number of deaths. That’s why you need to get a flu shot every fall – it’s available now and you should make sure that you get it, and doubly sure that your children do – because the flu virus is a particularly changeable microbe, and every year the virus is a slightly different genetic mix, and the vaccine has to be tailored to protect you.

Most years, most strains, influenza is especially deadly to the very young and the very old. In my pediatric clinic, we vaccinate every child starting at 6 months of age, but we take special trouble to make sure that the kids with medical problems, from asthma to congenital heart disease, get flu vaccine every year.

The 1918 flu virus was different. It was deadly to young adults. The elderly, who are often the victims in flu season, did relatively well, perhaps because they had lived through a related strain of flu 30 years earlier, and therefore had some protective immunity. But people in their 20s and 30s, healthy young people, got sick in record numbers – and many of them did not recover.

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That same 1918 flu was unusually virulent, so a very high percentage of the people who got sick went on to die. They died because their lungs filled with fluid. They drowned, it was sometimes said, inside their own useless lungs. There are stories about how fast this influenza killed; people got sick and died within 12 hours.

But the Spanish flu also looked more like a hemorrhagic fever – that is, people died because the infection affected their ability to form blood clots and stop bleeding –so there were people coughing up blood, or bleeding from their noses or their eyes. Some victims’ feet turned black from internal bleeding.

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In other words, the 1918 virus behaved a little like the Ebola virus, a hemorrhagic fever virus much in the news right now. This flu raced through classrooms and schools and theaters – and cities. In Philadelphia in October 1918, every hospital bed was filled, and hundreds of people were dying every day. The city ran out of coffins.

“The most terrifying aspect of the epidemic was the piling up of bodies,” John Barry writes in his book, “The Great Influenza.” “Undertakers, themselves sick, were overwhelmed. They had no place to put bodies. Gravediggers either were sick or refused to bury influenza victims.”

A doctor inoculates Boston Mayor Andrew James Peters against the Spanish flu in 1918.
Photo by Hulton Archive/Getty Images
A doctor inoculates Boston Mayor Andrew James Peters against the Spanish flu in 1918.

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All kinds of public health measures and quarantines were tried, as the epidemic raged. Campaigns promoted face masks and targeted spitting in public with misdemeanor ordinances and fines. St. Louis closed its schools, theaters, pool halls, churches and bars, in a strategy called “social distancing.” New York City required businesses to stagger their hours, so that people wouldn’t be squeezed together in rush hour commutes.

When the Boston schools were closed, teachers were recruited as nurses. Some towns attempted to keep the virus out altogether; Barry tells the story of Gunnison, Colorado, which blocked all incoming roads and warned railway passengers that if they stepped off the train onto the platform, they would be arrested.

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Cities also built their public health infrastructures; they opened emergency clinics, they strengthened reporting networks that tracked infectious diseases. In fact, the story of the 1918 influenza can be read – by those who have eyes to see – as the admittedly bloody beginning of the triumph of modern medicine, public health and scientific microbiology.