Spanish Influenza: We Still Aren’t Sure What Hit Us in 1918


By Walter Donway

Even the name, “Spanish Flu,” is a head fake.

The pandemic first identified 100 years ago, on March 11, when mess cook Private Albert Gitchell, reported sick at Camp Funston, Fort Riley, Kansas, had no special connection with Spain. In fact, where it did begin, and first publicly appear, are debated a century later. Recent research has argued for a troop staging camp/hospital in France — or China.

The biological origin and genetic evolution of the incredibly contagious and virulent strain of virus are debated, too. How it spread explosively throughout the world is debated. Why, unlike other strains of flu, it struck hardest at young, healthy adults is debated. Why it abruptly, drastically abated—and has never returned—is debated.

The disease infected half a billion people. It killed at least 20 million, but serious more recent estimates are as high as 100 million. That would be as much as five percent of the entire population of the planet. Three-quarters of a million Americans died. If not the worst disaster in the history of mankind, it was close. The list of notables who died ranges from Randolph Bourne and Max Weber to both Dodge brothers (co-founders of the car company) to Frederick Trump, the grandfather of President Donald Trump.

The world noticed, of course! And yet, the apparently limited scar the pandemic left on collective human memory — the memory of a disaster greater than the Black Death (spread over an entire century) — is one of the questions. Appearing in 1918, just as the Great War (WWI) was ending, with its toll of 18 million dead and 23 million wounded — making it among the most lethal conflicts in history — did the flu get lost in the shuffle? One line of argument is that people at home, reading the columns of daily death notices in their town or city, did not adequately distinguish the war casualties from the flu deaths. It has been labeled “the forgotten pandemic.”

If that seems speculative, well, so is everything about the pandemic. For example, the deadly toll the flu took in Germany versus Great Britain and France was viewed as “sensitive” war information that could affect morale. Therefore, in many countries, the toll taken by the flu was censored. Spain, less involved in war, did not censor reporting of the horrendous impact of the virus. Attention thus turned to horrendous (honest) reports from Spain. And the name “Spanish flu” stuck.

Did the virus pop to the surface that day in Kansas and sweep around the world? There were hens and pigs at the fort to feed the soldiers and forms of avian (bird) flu typically spread to swine and then humans (An early mutation probably let the virus jump from birds to pigs). Certainly, the affliction swept through the base. Photos show rows and rows of cots of GIs sick with flu. Soldiers regularly shipped out from Fort Riley to the European battle theater, and, whatever the origin of the illness, the battlefield was ideal for its transmission. Soldiers from many countries, sick and wounded, were shipped on crowded trains back from crowded field hospitals to their countries of origin.

Keeping straight the death toll became impossible because about one-in-four American soldiers and sailors was infected. In many places, no medical records were kept. But we know that hospitals and clinics filled and overflowed; doctors and nurses succumbed to the disease.

It has been a century since the pandemic felled tens of millions, but scientific investigations keep appearing. If we do not understand how this catastrophe arose in the biology of humans and other species, why it spread so rapidly, why it disproportionately affected the young and healthy, and how it abated, then aren’t we as vulnerable to catastrophe today as we were a century ago?

Not really. Back then, there was no vaccine to prevent it. Americans were advised to wears masks at school, at work, and on public transportation. New York City tried staggering work shifts to keep the subways less crowded. Spitting became a serious offense and Boy Scouts helped to enforce the ban. People stopped shaking hands, library books stopped circulating. Today, a flu vaccine is created annually based upon the expected strains. U.S. Army, Department of Agriculture, and academic scientists in 2005 reported they had sequenced the DNA of the Spanish flu virus. Tested in animals, the virus caused the disease. The flu vaccine developed for 2010, although not intended to do so, would have provided some protection again Spanish flu.

The flu did not kill everyone. Much depended upon when you got sick. The virus came in three waves. The first, beginning in 1918 with the outbreak at Fort Riley, was mild. Scientists now think it arose at about the same time in parts of America, Europe and Asia. In the end, the disease reached even the Artic and remote Pacific islands.

But then, less than a year later, the virus struck again, racing around the world with terrifying speed and virulence. Now, some people died within hours of the appearance of their first symptoms. Still, this was not a new virus; Spanish flu had mutated into new strain. We know it was the same virus because those infected in the first wave who survived were immune to the second wave. After its killing spree, the virus mutated, yet again — this time into a less virulent strain — this is typical of viruses — and the pandemic ended. In less than two years, a population great than the United Kingdom’s today had perished.

One mystery has been why the illness proved most lethal to healthy young adults. Strains of the virus we know today put the very young, elderly, already ill, and otherwise debilitated at high risk. The reigning scientific hypothesis is that Spanish flu killed by over-stimulating the human immune system. It detonated a “cytokine explosion,” an overreaction of our biological defenses that can kill us. Maybe. That is still debated. For example, why did the illness take 27 percent of Iran’s population? And 22 percent of Samoa’s? And, in a single month, 13 percent of Tahiti’s population?

In 1997, infection of humans with avian flu virus in China and other parts of Asia sent a wave of fear through the medical world. The mortality rate of infected birds is 50 percent or more. When humans contracted the new strain of flu, their mortality rate, too, was sky high. The avian strain of flu had mutated to jump to the human population and, of course, that is speculated to be the path taken by the Spanish flu in 1918. So far, human deaths from avian flu have been very limited — dozens, not millions. Yet, the virus can wipe out millions of hens and other poultry.

The Spanish flu epidemic was an authentic “black swan,” predicted by no one (even science fiction writers), taking the world by surprise. A century after its eruption among us, pandemic’s nature — its lethal trajectory of viral mutation, where it began and how it flashed around the world, how it killed so large a percentage of those infected — is investigated and debated. A recent, widely quoted paper posed an entirely new theory that it all began in China and spread to the West with 100,000 Chinese laborers sent to dig trenches on the WWI battle front.

The term “influenza” can be translated as “influence.” But deriving from Medieval Latin, influenzia, it meant more. From the root for “flow,” it referred to a fluid or emanation given off by certain stars that shaped human affairs. The term was applied first to the 1743 outbreak of the illness. Our term “disaster” derives from the same belief.

No, the Spanish flu is not shrouded in that kind of mystery. But we still do not know for sure what hit us 100 years ago, why it did, and if it could happen again.