The Cautionary Tale of 1918

—Carol R. Byerly

We pandemic scholars have long said that it is not “If,” but “When” another plague will strike.  Now here it is.  News that hospitals are suffering from severe personnel and supply shortages and putting up temporary structures, or “surge tents” to house Covid-19 patients evokes the deadly fall of 1918 when the influenza swept the globe in the worst pandemic in human history, killing at least 50 million people in just 18 months—more than three times the death toll of World War I. 

The influenza epidemic of 1918 offers a cautionary tale of the power of a virus to prey on humans in war and peace and to challenge our ability to control its spread and lethality.

Borne out of the trenches of World War I the influenza virus, now known as H1N1, sickened one quarter of the four million soldiers in the U.S. army and killed more service personnel—55,000—than did enemy fire, 50,000.  Striking the American Expeditionary Forces during the United States’ greatest battle of the war at the Meuse Argonne, influenza rendered thousands of men helpless, clogged hospitals, and caused General Pershing to halt the offensive for three days.  In the civilian world influenza struck virtually every family in the United States, with 20 to 40 percent sickness rates closing schools and shops, and overwhelming hospitals for weeks.  Most victims recovered within days, but those who developed pneumonia were bedridden for weeks.  Graves of the estimated 675,000 Americans who died that fall are found in cemeteries across the country.  That was in a U.S. population of 100 million.  A similar toll today would be more than 2 million deaths.

We like to believe that a century of medical advances means that such a catastrophe could not happen again, but the 1918 influenza shows us that such confidence is misplaced. 

First, because death rates for influenza and viruses like this one may be low at 5 or 10 percent, the morbidity or sickness rates can be so high during a pandemic that 30 to 40 percent or more of the population will sicken, including medical personnel, teachers, government officials, factory and transportation workers, and military populations, bringing society to its knees.

Second, while today, unlike in 1918, we have powerful antibiotics, respirators, and intensive care units that can save lives, a pandemic of even 10 to 20 percent sickness rates will overwhelm these resources, putting patients and their care providers in competition for them.  In addition, while many Americans may have better housing and nutrition than in 1918, millions today live with chronic illnesses that can render them vulnerable to viral complications.

Third, scientists in 1918 could not see viruses through microscopes like we can today, but they knew they were transmitted through the air and were almost impossible to quarantine against.  A yearly flu vaccine now helps protect us from that disease, but there will be no such protective vaccine for ovid-19 for at least a year.  We fight pandemics through global surveillance, informed calculations as to what kind of control measures to provide, and continued surveillance to see how it’s working.  But because viruses evolve continually, they often outsmart the experts and modern technology.    

Finally, the virus of 1918 was global killer that traveled with troop ships from Europe to the Americas, Africa, Asia and Australia.  Today viruses can span the globe within a day or two, using jet travel to invade denser urban populations.  The epidemiological curves we are watching daily as Covid-19 circles the globe and claims thousands of lives are to us pandemic scholars no longer academic.

Fever of WarCarol R. Byerly worked for the United States Congress and the American Red Cross, taught history at the University of Colorado, and was a research scholar of military medical history for the Office of the Surgeon General of the United States Army. She is the author of Fever of War: The Influenza Epidemic in the U.S. Army during World War I, available from NYU Press. 


Feature image: Walter Reed Hospital Flu Ward by Harris & Ewing photographers. Public Domain via Wikimedia Commons.

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