Unprecedented: Our generation, our disease
The 1918 flu pandemic offers lessons for days of COVID-19
NOV. 9, 1918 — The prediction made by health officer G. N. Simpson and other members of the Emergency Relief Committee that Thursday night’s jollification was bound to reflect itself in the new flu cases reported in the city bore fruit today, when the reports of new cases numbered 45, the highest mark of the epidemic in any one day. This makes a total of 387 cases to date.
“It makes my heart sick to think that responsible citizens of the city, in a time of quarantine, would so far forget themselves to pull off a celebration of the kind, even the good news, and what the harvest may finally be, can’t be told, but one thing is certain that there will be more green rounds in the cemetery than would otherwise have been the case,” was how Simpson expressed his opinion.
“I can’t attribute the increase of new cases to any other cause. Prior to that time things were going along nicely, and had precaution not been thrown to the winds, the ban might have been raised the middle of the coming week, but now no one knows when it can be raised, for we are facing a condition fully as bad as any time during the past three weeks.”
— Tribune Chronicle archives
The word “unprecedented” has been used to describe the seemingly unusual time in which we are living, when
schools and businesses are closed, medical masks are worn by the general public, and family and friends are being told to keep their distance — all in the hope of curbing the spread of COVID-19. The truth is, though this is event is unprecedented in our life time, it is not the first pandemic to seize the globe.
“One thing we’ve missed out in the last few generations here is the notion of incurable or rampant diseases. That was literally a part of life 100 years ago,” said Bill Lawson, Mahoning Valley Historical Society executive director.
Little more than 100 years ago, the 1918 influenza pandemic, often referred to as the “Spanish flu”— though there is not consensus among experts as to whether it emerged in Spain — killed an estimated 50 million worldwide, with 675,000 of those in the United States.
Compare that to COVID-19, which so far has killed approximately 65,000 worldwide and 8,396 in the United States, according to the most recent reports.
Though the globe’s current novel coronavirus pandemic is not a flu virus, parallels can be drawn between today and the 1918 event — showing that in some ways, history really does repeat itself.
THE 1918 FLU
The 1918 pandemic was caused by the H1N1 flu virus; the most recent outbreak of the strain was in 2009, which resulted in fewer than 300,000 deaths, according to information from the Centers for Disease Control and Prevention.
The 1918 flu coincided with the end of World War I, during which people were traveling frequently from and around Europe, contributing to the virus spread. Medical professionals were also in short supply because of the war effort, with as many as one-third of physicians deployed to military service, according to the CDC.
“It was a global phenomenon,” Lawson said. “It’s very clear globalization for World War I played a part in spreading it across this country.”
Vaccines did not exist, and no antiviral drugs were available. Intensive care measures, such as mechanical ventilators that have been critical in treating COVID-19 patients, also were not available — leaving doctors with few avenues beyond “supportive care.”
This flu hit the young and apparently healthy especially hard. Lawson said he’s visited Calvary Cemetery in Youngstown, where there is a section of hundreds of graves of victims of the 1918 pandemic, with markers showing a large number were young adults.
A Tribune Chronicle story on Oct. 22, 1918, reads: “A rapidly spreading pandemic disease was first recognized at the U.S. Naval Hospital in Chelsea, Mass., Aug. 28, 1918, the first patients coming from the receiving ship at Commonwealth Pier Boston, … it proposes to spread rapidly over the entire country, attacking between 30 and 40 percent of the population and running an acute course from four to six weeks in each community.”
That article, excerpted from a “an extensive study of the influenza plague” by Dr. J. J. Keegan in the Journal of the American Medical Association, states 5 to 10 percent of those infected developed fatal cases of pneumonia — which is also a complication of severe cases of COVID-19.
“Every century has had its attacks. Beginning with 1831, this country has had five epidemics,” another article reads. It prescribes bed rest and eating nourishing foods as treatment — and recommends avoiding “persons having colds, which means avoiding crowds.”
NILES, Oct. 18 — Five new cases of Spanish Influenza were reported to the health officers yesterday, and cards of quarantine were placed on the homes of Mr. and Mrs. McKenzie of Warren Avenue, Mr. and Mrs. Jordan of Franklin Avenue, Mr. and Mrs. Bruce McIntyre of Arlington Street and Mrs. Allen of Neal Street and Mr. and Mrs. Osbourne of Kelly Street.
Every precaution is being taken to prevent the spread of the disease, but a great deal of alarm has been felt on account of the number of cases reported yesterday. Three of the cases reported yesterday are acute, and pneumonia is feared.
All meetings of lodges and dancing parties which were announced tonight have been called off and it is expected that a special meeting of the board of health will be held on Monday evening.
Tribune Chronicle news from October to December 1918 paints a picture of communities scrambling to stop the spread of influenza. Buried among news from the front lines of the world war are lists of closings, reported flu cases and deaths.
On Oct. 21, 1918, schools in Braceville were closed for two weeks after a couple came down with the flu. Meetings, lectures, and conventions across Trumbull County were postponed out of fear of the virus, and quarantines were placed on cities and homes.
“A lot of it was just what we’re doing now, which is common sense: avoiding contact, staying home unless absolutely necessary, and closing up businesses like ours here,” Lawson said.
Emergency hospitals were flooded with patients, and pleas went out to any volunteer with medical background. Some schools were converted to hospitals.
A Nov. 14 article states an “urgent call” was made to the surgical dressings department of the Red Cross for pneumonia jackets for the emergency hospital.
“Help Wage War on Influenza,” proclaims a Dec. 6 headline. “Spanish influenza has killed more Americans than the German bullets have according to health authorities. The armistice has silenced the German guns, but there is yet no peace with the flu.”
“If there was a confirmed case in a household or family, there would be a sign on the door. They were expected or legally required to stay inside,” said Lawson, who added neighbors or officials might drop off food for the quarantined family. “It really came down to how individual cities took preventive measures.”
The mitigation was done on a community level. There was no coordinated national, state, and local pandemic planning in 1918, according to the CDC.
The lack of coordination came down, in part, to inefficient communication.
“Really, communication was a lot harder because very few people had telephones at that point,” said Lawson. “There’s no radio and television to get things out. All people had were newspapers and word of mouth on the street.”
A CDC article, “The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus,” traces the rediscovery of the 1918 virus through the pandemic’s 100th anniversary in 2018.
The CDC has since established a pandemic framework and procedures to handle a large-scale crisis — we are seeing much of this in play today.
Still, there are gaps in pandemic planning.
“If a severe pandemic, such as occurred in 1918 happened today, it would still likely overwhelm health care infrastructure, both in the United States and across the world,” reads the CDC article.
In the 2009 outbreak of H1N1, the first doses of vaccine became available 26 weeks after the decision to manufacture.
Generally, it has taken about 20 weeks to manufacture a new flu vaccine — though the White House Homeland Security Pandemic Influenza Plan sets a challenging goal of reducing the time frame to 12 weeks. The Pandemic Influenza Plan is designed to also respond to other types of infectious diseases, such as COVID-19.
Today we have the advantage of instantaneous communication, including frequent and sometimes daily updates from the state and federal governments. Medicine has also advanced significantly, giving doctors more resources to treat patients and curbing the mortality rate.
When it comes to COVID-19, though, we also have disadvantages.
“Well I think obviously we’re more globally oriented,” Lawson said. “There’s air travel throughout the world. I think that has been one of the factors that has allowed it to spread between continents pretty quickly.”
Of course, the world has seen many other highly contagious diseases — typhoid fever, dysentery, polio, whooping cough and diphtheria — all of which have been committed to history.