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Podcast Transcript
In 1918, as the world was nearing the end of the First World War, another disaster was spreading across the globe.
It was so lethal that someone could be dead within a single day after seeing the first symptoms.
It moved through army camps, cities, ships, and villages, infecting hundreds of millions and killing more people than the war itself.
Despite the best efforts at the time, no one knew how to stop it.
Learn more about the Spanish Flu and its terrible impact on this episode of Everything Everywhere Daily.
The Spanish flu pandemic of 1918 to 1920 was one of the deadliest disease outbreaks in human history.
It first appeared in Camp Funston in Kansas, where the first cases were reported in late February of 1918. By early March, the virus had hospitalized more than 1,000 soldiers.
The outbreak completely befuddled camp doctors; epidemic diseases rarely forced healthy young adults into hospital beds. The doctors’ explanation reflected their confusion.
The camp housed hundreds of horses, and the staff typically disposed of their waste by fire. On March 9th, a fierce dust storm ravaged Haskell County, Kansas, the same day soldiers planned to burn the horse manure.
The first soldiers fell ill on March 11th, reporting flu-like symptoms and intense respiratory distress. By mid-March, nearly 1,100 had succumbed to the illness.
The original transmission into human hosts probably occurred when wild waterfowl, such as ducks and geese, transmitted an avian virus to domestic hogs, likely through droppings.
Within swine as hosts, the virus reassorted its genetic material, mutating into a form capable of jumping to humans, who then passed it to one another through respiratory droplets.
Scientists speculate that Kansas became the cradle of this global pandemic precisely because it lies directly along the Central Flyway, one of North America’s four major migratory corridors for waterfowl.
The seasonal movement of millions of wild birds over the Midwest’s livestock farms created a perfect mixing vessel for the avian virus, bringing it one fatal step closer to humanity.
If proper naming conventions had been used at the time, it should have been called the Kansas Flu, not the Spanish Flu.
The doctors reached one conclusion: the dust storm picked up the foul horse manure smoke and distributed it among the soldiers.
While not a typical “miasma” explanation of bad odors, like what was used during the Black Death, the doctors concluded that the toxic cloud contained particulates that caused the soldier’s illness.
Despite a century of breakthroughs, including the development of germ theory and the smallpox vaccine, the medical community remained ill-prepared for a disease this devastating
A doctor at Camp Devens, a US Army Base in Massachusetts, reported that their base was averaging 100 deaths per day. The breakneck pace of the deaths reflected the sheer virulence of the disease.
It was common for people to wake up feeling well, show symptoms by noon, and be dead by nightfall. Those who died so quickly often turned a horrifying shade of blue.
These young, healthy victims fell to a cytokine storm, a violent immune response that triggers massive inflammation and causes the body to overwhelm its own organs.
Author Sara Francis Fujimura described the disease’s impact on the lungs: Sometimes, within hours, patients succumbed to complete respiratory failure. Autopsies showed hard, red lungs drenched in fluid. A microscopic look at diseased lung tissue revealed that the alveoli, the lungs’ normally air-filled cells, were so full of fluid that victims literally drowned.
Hospitals eventually learned to triage patients by examining their feet. Staff left any patients with black feet, a telltale sign of cyanosis, or oxygen deprivation, to die, as they were beyond the reach of medical care.
World War I accelerated the spread of the Spanish Flu, prompting three distinct waves between 1918 and the spring of 1920. Wars demand communal activities, and the virus surged in large gatherings.
During wartime, communities gathered in celebration and sorrow. On army bases, thousands of men crowded into barracks as they trained and prepared for war.
When the men left for the front lines, they traveled in packs on large ships and in cramped, crowded train cars. When they reported to the front, they gathered in mess halls, barracks, and in the wet trenches of the Western Front.
The world at war functioned as a series of super-spreader events.
The Great War hampered the international community’s response to the pandemic. As war raged across the trenches of Western Europe, nations kept their data secret. There was a war to win, and they had more important priorities than dealing with what they thought was a seasonal flu.
They were learning, albeit slowly, that this was not your typical seasonal flu outbreak.
Warring nations reported the disease so infrequently that only neutral nations, like Spain, provided consistent updates. Because Spain did not censor its news, the world associated the outbreak with them, forever branding the pandemic the “Spanish Flu.”
While the international medical community stood largely unprepared, they did attempt to offer solutions. They were strategies that may sound strikingly familiar today.
Masking and shelter-in-place initiatives were often cast as patriotic sacrifices, even though they were unpopular. Mask mandates in urban areas of Europe and North America were rare and, when enacted, were often denounced and met with stiff resistance.
Across the colonial world, officials provided masks to European settlers but did not do so universally. India’s experience with the Spanish flu serves as a prime example.
British colonial authorities provided little information, and Indians largely rejected what they did offer. Consequently, people continued to travel in crowded train cars and to gather for large festivals, such as the Kumbh Mela.
As a result, India suffered the world’s highest death toll, losing an estimated 20 million lives. This catastrophe fueled Indian Nationalism and exposed the cruelty of British dominion. In rural India, where news traveled slowly, many attributed the pestilence to Hindu deities, further diminishing the success of interventions like masking.
An editorial in an Indian newspaper characterized the impact: India perhaps never saw such hard times before. There is wailing on all sides. … There is neither village nor town throughout the length and breadth of the country which has not paid a heavy toll.
In North America and Western Europe, nations sought to limit the virus’s spread by banning public gatherings, including festivals, holidays, and funerals. Some ordinances even limited Sunday sermons to just five minutes to reduce contact time.
However, when officials implemented these programs in Sub-Saharan Africa, they often did so suddenly and at gunpoint. This approach failed to win converts as most people resisted, viewing the measures as yet another colonial affront.
A report from the Nigerian Pioneer captures the reaction of the indigenous population: The people are in a state of terror… They view health officers as a fresh source of danger. Many believe that the doctors visit to mark houses for destruction, or to take the sick to the hospital, which to them is but the portal of the grave. Consequently, families hide their sick, and the disease spreads unchecked.”
The impact on global populations was profound. Life expectancy in the United States, which, by most accounts, fared far better than other parts of the world, declined by 10 years during the pandemic. The flu had a mortality rate of 2.5%, up from the typical flu virus rate of 0.01%, but still far lower than the 6% mortality rate in India.
This dramatic increase explains the chaos in the international medical community. The virus had changed dramatically from the previous season, and there didn’t seem to be anything public health officials could do.
While scientists raced to develop a cure, a vaccine, or even a treatment, it seemed there was nothing they could do. Scientists developed multiple ineffective vaccines during the Spanish Flu pandemic. The fundamental problem scientists encountered was their belief that bacteria caused the pestilence.
Virology was still a young science and researchers would not finally glimpse a virus until the invention of the electron microscope in 1939.
Scientists derived their vaccines from bacteria harvested from the lungs of previous victims. Laboratories across the developed world created these formulas in strict scientific isolation, and doctors ultimately administered them without a single success.
The failure of the vaccine created vaccine hesitancy in the United States, which persisted until the development of the polio vaccine in 1955.
One of the great mysteries of the Spanish Flu period was the disproportionate death rate amongst people aged 18-35. This demographic is normally the healthiest, yet during the Spanish Flu, they experienced a rate of morbidity that approached 40%.
In a normal disease environment, communicable respiratory diseases will have the greatest effect on the very young or the very old. World War I soldiers were a prime example; most of the soldiers were between 20 and 30, and they were falling ill and dying at an alarming rate.
The common explanation for why young healthy people were stricken down so severely is that they elicited a much stronger immune response, sending the immune system into overdrive.
Ultimately, the body produces so many white blood cells that the system floods the lungs with white blood cell fluid, causing the victim to literally drown from within.
Traditionally, vulnerable populations, such as the very young and very old, did not produce such a vigorous response, leaving their lungs with far less discharge.
Treatments of the time were largely ineffective. As scientists floundered about, unable to explain the difference between a virus and a bacterium, they often repurposed other medical treatments and applied them to the Spanish Flu.
In Italy, hospitals began experimenting with quinine as a potential treatment which was used against malaria. The treatment was effective at keeping people alive, although it did not appear to slow transmission. Other hospitals tried using over-the-counter remedies such as aspirin and camphor, with no success.
The disruption caused by the Spanish Flu was profound. In addition to the massive disruptions in North America and Western Europe, there was also significant upheaval in Africa, East Asia, and Latin America.
In Africa, the Spanish Flu outbreak was a catastrophe. The virus returned to Africa with troops who fought on the side of Britain and France, and it spread across Africa’s expanding network of railroad lines.
Africa was particularly vulnerable due to its lack of health infrastructure. Sub-Saharan Africa, under European control, created little to no health infrastructure and largely depended on foreign missionaries, whose work came to a screeching halt during the pandemic.
Historical estimates suggest that Africa suffered as many as 3 million casualties in 1918 to 1919.
East Asia has similar losses. While well-resourced cities managed to blunt the blow, the complete absence of healthcare infrastructure devastated the rural areas.
Latin America suffered horrendously as well. A lack of political clarity on the continent, coupled with poor health care, left the impoverished highly vulnerable. Some statistics suggest that the death toll in Latin America reached as many as 500,000.
The Spanish Flu was a global catastrophe; it affected nearly every aspect of life for nearly 2 years. While most of its outcomes are decidedly negative, the outbreak did spur scientific inquiry that would pay dividends in the late 1920s and 1930s.
Among these innovations were the electron microscope, the development of penicillin, and an increased awareness of antiseptic procedures. Vital breakthroughs in vaccine design ultimately guided scientists like Jonas Salk in developing the polio vaccine.
Since 1918, the Spanish flu virus has not disappeared so much as evolved and branched. Its direct human descendants circulated as seasonal H1N1 flu until 1957, while related strains also became established in pigs as swine flu.
Later pandemic strains, including the 1957 Asian flu, the 1968 Hong Kong flu, the reemergent H1N1 “Russian flu” of 1977, and the 2009 swine flu, were not simply the original Spanish flu returning, but they were connected to it through descent or long-running swine influenza lineages.
The pandemic’s global death toll is difficult to calculate because record-keeping varied widely, many deaths occurred outside formal medical systems, and wartime censorship distorted reporting. A commonly cited estimate is about 50 million deaths worldwide, but scholars have proposed ranges from roughly 20 million to more than 100 million.
Even the lower estimates place it among the deadliest pandemics in world history.
The Spanish Flu was unlike any pandemic that came before it. There had been massive losses of life from disease in the past, but nothing ever spread as fast while being so lethal. Humanity learned the hard way the dangers and downsides of an interconnected world.
