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Lessons from the 1918 Flu Pandemic

Posted by Carolyn Carlson, M.D. on Oct 1, 2018 11:40:58 AM

It’s been 100 years since the 1918 flu pandemic swept across the globe, killing more than 50 million people, including an estimated 675,000 Americans. It was caused by an H1N1 virus with genes of avian (bird) origin, according to the Centers for Disease Control and Prevention (CDC). At the time, there was no vaccine to protect against influenza infection, and if the flu virus didn’t kill you, a secondary bacterial infection usually did as there also were no antibiotics. During this period, World War I was taking place. The conditions of World War I (overcrowding and troop movement) helped the 1918 flu spread. The vulnerability of healthy young adults, combined with the lack of vaccines and treatments, created a public health crisis. 

The CDC created a special website to commemorate the 100-year anniversary of the 1918 flu pandemic and the many public health advances since. I encourage you to browse the site, which includes a video, image gallery, pandemic timeline, a milestones infographic, and more. Here are some highlights:                

Three Waves

The first flu outbreak hit in the United States in March 1918 when it struck more than 100 soldiers at Fort Riley in Kansas. Within one week, the number of cases quintupled. 

The second wave of flu emerged in September 1918 at an Army training camp and at a naval facility, both located just outside of Boston. This second wave was highly fatal, and responsible for most of the deaths attributed to the pandemic. In Philadelphia, one of the areas hit hard by the flu, cold-storage plants were used as temporary morgues. 

A third wave of influenza hit in the winter and spring of 1919, claiming more lives before subsiding in the summer. 

It would take another 21 years before the first vaccine would be developed. 


Many People Died of Secondary Infections

Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. While the flu virus itself was deadly throughout the pandemic, many people fell victim to secondary bacterial infections – most commonly, bacterial pneumonia, which settled into their lungs as a result of the initial symptoms of the flu. Many otherwise healthy people between the ages of 20 and 40 fell victim to it, when typically this is the age group that fares well against the flu and other viruses. 

Efforts to control the spread of influenza and treat secondary bacterial infections were limited to supportive care and unproven remedies, such as aspirin, quinine, opium, ammonium, iodine, turpentine, and beef tea – some of which we now know can be harmful.


Close Quarters, Lack of Communication, and Poor Sanitation Practices

Wartime conditions played a big part in how the disease was spread. Soldiers in close quarters were especially vulnerable, and often times, civilian cases in America that were the first ones within their region could be traced back to friends or family in the military. With everyone living in such tight spaces, the virus was able to spread quickly and efficiently. 

Another issue was lack of communication. Because it was war time, governments were reticent to share news that could be viewed as negative or might embolden enemy forces to attack if it was perceived a region was weak. Because of this lack of communication, civilians weren’t notified of proper prevention techniques, such as staying away from large groups and using proper sanitation practices like hand washing, covering sneezes and coughs to avoid spreading the virus, and the importance of quarantining family members who might have the illness. 

2018 and Influenza

Medical advances since the 1918 flu pandemic include: vaccines to help prevent infection; drugs to treat illness; antibiotics to treat secondary bacterial infections; ventilators and intensive care units to treat severely ill patients; and modern gloves, gowns, and masks to protect caregivers.  We now have a global influenza surveillance system to monitor flu activity and more efficient ways to quickly share information about flu viruses with partners around the world. 

Flu viruses continue to pose one of the world’s greatest public health challenges, and the risk of a flu pandemic is always there. In fact, there have been four influenza pandemics in the last 100 years: 1918, 1957, 1968, and 2009 – caused by new viruses. While there have been many advancements since the 1918 flu pandemic, there is still much to do to improve our preparedness. 

As we head into the 2018-2019 flu season, get prepared by getting vaccinated by the end of October.  


Dr. Carlson is a board-certified pediatrician at Kelsey-Seybold’s Summer Creek Clinic. Her clinical interests include infectious diseases (both viral and bacterial), dermatologic diseases, development, and Adolescent Medicine. 


Topics: flu vaccination, flu, 1918 flu pandemic, seasonal flu

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