• Editorial - The Pandemic

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    People walking around in masks, keeping their social distance, compulsively washing and sanitizing their hands. The world living in fear as the death toll rises daily. Mixed messages from governments and even health authorities creating uncertainty about prudent behavior. A very familiar scenario for us today. But this was 100 years ago.

    One of the benefits of the imposed downtime in our current pandemic has been the chance to catch up on reading books that have been piling up. The first one I went to in my stack was John Barry’s, “The Great Influenza: The Story of the Deadliest Pandemic in History.” It seemed like a propitious time for such reading. There are similarities, as well as striking differences, between the 1918 flu pandemic and the current COVID-19, but like most pages of history, there are lessons to be learned.

    One of the striking differences, of course, is that our country was involved in World War I in 1918. It is not certain where the flu began, but the leading theory is a county (Haskell) in Kansas. From there it apparently spread to Camp Devens, an Army encampment in Massachusetts that was established in September 1917 to train soldiers who would soon be deployed around the country and the world. There was minimal concern at first because the symptoms were initially mild. But by March 1918, the flu had become virulent, with an alarming death rate. Approximately 850 soldiers, mostly privates, died at Camp Devens in 1918.

    It is often referred to as the “Spanish flu,” which illustrates how historical events can cloud the facts. Spain was neutral during World War I. Other countries, that were fighting on either side, were eager to maintain national morale for their war effort, and therefore minimized reports of the actual death rates (this was apparently true in the United States, where President Woodrow Wilson reportedly never even addressed the pandemic). Since Spain had no reason for such restrictions, they reported the actual numbers, making it look like the flu was worse there. Hence the name.

    As the year progressed, there was still limited civilian concern, because most cases were in the military. Numbers declined in the summer. But in September 1918, following a massive Liberty Loan Parade in Philadelphia against medical advice, the influenza spread rapidly throughout the public. Most cases were mild, with fever, cough, fatigue and conjunctivitis, but severe cases had extreme pain, constant coughing and bleeding from the nose, ears and eyes (approximately 23% had ocular involvement), often culminating in cyanosis, pneumonia and death.

    Although the federal government remained focused on the war, with little guidance regarding the pandemic, local governments instituted strict measures of social distancing, handwashing and wearing masks, with scenes that we would find familiar today. Following the second peak in the fall, the numbers began to decline after Armistice Day in November, although smaller peaks continued well into the 1920s. Factual numbers are hard to obtain, but total deaths worldwide are estimated at a minimum of 30 million, with approximately 700,000 in the United States (all the more staggering when we consider that the U.S. population then was less than a third of what it is today).

    The 1918 flu pandemic may have influenced history in several important ways. When Wilson went to Versailles to negotiate a surrender in 1919, he became ill with what most historians have called a stroke. Barry, however, believes he acquired the flu (it apparently can cause central nervous system manifestations, including stroke). In any case, in his weakened state, Wilson accepted the draconian demands of Clemenceau of France on Germany, a decision that likely helped set the stage for World War II 20 years later.

    A more positive outcome of the influenza was that it led to establishment of the National Institutes of Health in the late 1920s. Scientists continued their search for the etiology of the flu well into the 1920s and beyond. Failure to isolate the organism was assumed to be due to lack of proper tests, and investigators searched for better culture media. This is what Alexander Fleming was doing when his media became contaminated with penicillium.

    A final footnote on the 1918 flu pandemic is disheartening but may be instructive. Barry notes that, when health workers pleaded for volunteers to care for the sick, almost nobody answered. As a result, when it was over, people seemed reluctant to talk about it. We can’t sit in judgment on past generations — it was clearly a different time — but we can only hope that, when future generations read about COVID-19, they will have reason to think more favorably of us.