Lentis/The U.S. Pandemic Response: Influenza, 1918-1919

The origins of the influenza of 1918-1919 are unknown. The Avian flu, infected one third of the world’s population. It killed 50 million worldwide, more than all the soldiers and civilians killed during WW1. The Influenza pandemic is known as the deadliest pandemic of the modern world. No country was safe from it, and with the lack of knowledge and technological advances, the US was at the mercy of the unification of its people. The influenza pandemic came in three separate waves. The first wave was the least deadly, starting in the spring of 1918. Two subsequent waves occurred in the fall of 1918 and the winter/spring of 1919.

Background

The influenza of 1918 had an unusually a high mortality rate among the young. People ages 15-31, who typically are more resistant to illness, were the most susceptible to dying from the influenza. Symptoms of the first wave included typical flu symptoms such as sore throats, headaches, and fevers. The first wave occurred during the first quarter of 1918 and was the least deadly. In 1918, roughly 75,000 flu deaths were recorded. Compare this to the 63,000 flu deaths that occurred during the same time period three years prior.

The second wave was much more deadly than the first. In the United States approximately 292,000 flu deaths were recorded in the fall of 1918. Only 26,000 deaths were recorded during the fall of 1915. The flu would cause patients faces to turn blue and blacken limbs and torsos. Nose and mouth bleeds, coughing fits, and muscle aches were also common. The cause of death was usually bacterial pneumonia, an infection of the lungs. A few hours to days after infection, the patient would pass due to fluid filling the lungs.

History

Emergency hospital in Kansas - 1918.

The first recorded case of the influenza in the United States was in Kansas, 1918. In the spring of 1918, the US was in the middle of WWI World War 1, (World war 1 ended November 11, 1918) Historians say the war allowed the 1918 flu to spread faster. Constant movement of troops allowed the virus to spread worldwide (troops were being moved from camp to camp, as well as country to country, during battle and as prisoners of war). Furthermore, there was mass malnourishment, overcrowded medical camps, and hospitals had poor hygiene, all of which promoted bacterial superinfection.

Response

1918 public service notice recomending mask wearing.

US Government Response

Different cities throughout the United States had different responses to the 1918 influenza pandemic. Some of the most restrictive regulations were in places like San Francisco. Citizens caught not wearing a mask in public would be arrested for disturbing the peace and fined five dollars or up to two hundred dollars (five dollars is around 100 dollars today). Other regulations in San Francisco included banning social gatherings, closing places of recreation, and closing schools. Other areas of the country waited before going into lockdown. The city of Philadelphia hosted a 200,000 person parade for World War I. Three days later the hospital beds were filled to capacity. Fifteen days later and more than 3,000 people died in a single week.

US Public Response

Originally there was small scale noncompliance with masking laws, but trolley drivers and store owners refused to turn away unmasked customers. Those who opposed mask mandates during the 1918-1919 pandemic were known as “Mask-Slackers” and were prevalent during the influenza of 1918-1919. On October 22, 1918, Mayor James Rolph signed “The Mask Ordinance”, making San Francisco the first United States city to mandate masks. Gradually, support of the anti-mask movement grew and became organized. This culminated with the Anti-Mask rally at Dreamland Rink in San Francisco, organized by the "Anti-Mask League" of San Francisco, where around 2000 people met to discuss ways to defeat the mask mandate. The league held many of the same values anti-maskers do today, such as not trusting the scientific data and claiming an overreach of their civil liberties. Protests against mask mandates led to civil unrest, and many who did not comply with the rules were arrested.

Preventative Response

Social campaigns were established to reduce the spread of the influenza virus and to manage the outbreak. Isolation and quarantine of the ill was one strategy used to prevent further spread. Hospitals created additional wards to separate flu patients from other hospital patients. Periodic disinfectant was used to clean hospital rooms between uses. Ambulances were also sanitized with antiseptic. Public health campaigns were started to inform the public of healthy habits and dangerous habits. The American Public Health Association (APHA) campaigned for legislation to prevent the use of common cups for drinking and used posters to communicate the importance of hand washing and the danger of spit. “Spit Spreads Death” was a common phrase used on signs. Masks made from gauze were introduced with the intention to prevent virus particles from escaping the mouth and nose and vice versa. Organizations like the Red Cross made official statements on mask wearing “Wear A Mask and Save Your Life” while also addressing those noncompliant with “The man or woman or child who will not wear a mask is now a dangerous slacker.” Antiseptic solutions were also created to be used on the hands like modern hand sanitizer.  

Parallelism with Covid-19

“Both the Influenza, and the new Covid19 share many similarities. Both spread between people who are in close contact through respiratory droplets released through talking, sneezing or coughing. These droplets can be inhaled. These viruses also spread if a person touches a surface with the viruses on it and then touches his or her mouth, nose, or eyes”. As the Covid19 pandemic reaches its 2 years anniversary, how exactly has the US, learning from the influenza, reacted?

With Influenza, the US lacked the technology for diagnosis and treatment. So, the country took a well-known approach: Enclosure. “Communities across the country did what they could, closing their schools, churches, theaters, shops and salons”. Personal hygiene, use of disinfectants and use of masks in public were demanded. With a one century of difference, the same tactic was applied for COVID19, with different results.

Roughly 675,000 Americans died from the 2 years of Influenza. With Covid, as for October 12th 2021, roughly 715K deaths have been reported in the US. Why, with better technology for diagnosis and cleaning, and previous pandemic experiences, is the US struggling to keep the pandemic at bay?

One theory argues that it is due to the influence of young adults. The 1918 influenza killed a disproportionate number of 25–40-year-old, which accounted for 40% of deaths from the 1918 influenza; COVID-19 mostly affects those over the age of 65. Affecting the largest section of the population, the theory argues that young-adults took the pandemic seriously. The problem with this theory is that the Influenza happened during WW1, where young adults were obligated to be on the field in close proximity to each other and in poor hygienic conditions, explaining its mortality rate.

Another theory argues that it comes from the effects of social media, with one side promoting the tactics of Lockdown and social distancing, while the other side undermining the effects of the virus.

Conclusion and Further Research

The influenza came to an end by the summer of 1919. Historians believe the end of the pandemic was because partial herd immunity was reached. The virus infected or killed enough people that the world population no longer had enough susceptible people for the strain to become a pandemic once again. The 1918-1919  flu was one of the first of three flu pandemics caused by the H1N1 influenza, with the most recent being the 2009 swine flu.

Social conditions and events of the time (Red Summer, Progressive Era, First Red Scare) and their relation to the pandemic and sentiment in the United States at the time would be a good source of expansion of the chapter. The chapter could also be expanded to include interactions with other countries at time in addition to World War I. Different repsonses in cities throughout the United States and the lack of response from the White House could be included.