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With so much in the news these days about SARS, the Asian Avian flu and others it is always of interest to look back and see what has happened before. The last really big worldwide flu epidemic was the so-called Spanish Flu epidemic in 1918. It killed over 40 million people worldwide, with about 500,000 deaths in the US.
It was called the Spanish Flu because the first publicly recorded deaths from the disease were reported in newspapers in Spain. Their newspapers were not censored as many other countries were at the time due to World War I. When reporters wrote of a deadly new disease hitting that country during the late summer of 1918 most people assumed it had started there.
However, according to information I have read, the first actual cases were recorded at US Army bases. The first were reported at Camp Funston in Kansas on March 4, 1918 when scores of U.S. soldiers became ill. The U.S. troops spread the virus to Europe, but then the disease went into a slight dormancy for the summer. When it re-emerged in the fall, it became much more lethal.
Much of the problem, as with any other communicable disease, was the movement of people. In this instance it was soldiers being moved from place to place that fueled the spread. The disease spread easily in the crowded conditions of the barracks and troop ships and even more easily in the trenches where crowding was a factor and living conditions were horrible. From there it spread to civilians in Europe and came home with troops returning from the front. Travel of the disease was approximately the speed of travel of the time. It took months for it to move around the world because that was the fastest people could move back then via ship. If nothing else, any new disease will certainly spread much faster today. Due to travel via airlines, it could easily spread around the world in a few days if not a few hours.
In 1918 the disease began to take a serious toll in the US and Europe in August – when flu cases became abnormally high and continued until the following July when the number of cases dropped back to normal levels. During that time it is estimated that around 20 million Americans became sick and around 500,000 died. In October 1918, when the flu reached its peak in the US, it killed about 195,000 Americans in that month alone.
These numbers may not appear to be all that high until you remember that the population of the US was only about 100 million at the time. That means that 20% of the population became sick and 0.5% died of the disease. In a typical year – with a population of about 300 million today – the flu kills about 30,000 people or about 0.01% of the population. That means that the 1918 flu was about 50 times more deadly than a normal year! If a disease of the same virulence were to strike the US today the number of people who became sick would be around 60 million with about 1.5 million dead. Those are large numbers indeed.
Another unusual thing about the 1918 flu was the people it struck down. Normally the flu strikes the old and the young – those with weaker immune systems. However, this flu struck down those people and the young and strong. In fact, when graphed, disease tolls usually look like a U with the largest numbers of deaths at the high and low end of the age scale with only a few in the middle. The 1918-flu epidemic looked more like a W with a spike in the middle for young healthy people who normally do not die. In fact, of the 110,000 deaths our military suffered in Europe during that fall 57,000 of those died of the flu – “only” 53,000 died in battle!
Back in the US, after deaths from the disease began in earnest, people began to try to protect themselves. However, viruses were unknown at the time so the protections people attempted were ineffective. People began to wear masks in public, which do provide some level of protection against large airborne particles but airborne viruses are so small that to them the mask barely even exists. They pass with impunity. Also, many times the method of transmission can be through touch. A person touches an infected person or something that an infected person touched and then later touches themselves on a mucus membrane – the eyes, nose, mouth, etc. and the virus is transmitted.
The death rate became so scary that many local governing bodies closed down theaters, churches, and other public gatherings. For example during one day in October in New York City 851 people died of the flu! New York City hastily passed ordinances that made it illegal to spit, cough, or sneeze in public — with the threat of $500 fines. Five hundred dollars is a big fine today. Back then it was the price of the Model T Ford! Today that fine would be ten or twenty thousand dollars!! They were deadly serious about trying to control the spread of the flu . . .
Closer to home, at Syracuse University during October 1918 the campus was quarantined for two and a half weeks because of the epidemic. Twelve students died and emergency hospitals were erected in dormitories. At the time there were about 2000 students so this was very serious when people of college age would normally hardly be affected by the flu.
Now let’s move forward to today. The current death rate for people infected with the avian flu varies from between 30% and 60% depending on the exact strain and that is with the best of medical care, anti-viral drugs, etc. That is an appalling number. So far we are very lucky that the disease cannot be transmitted from human to human. All known cases so far come from contact with birds but that could change. If it does, we should all pray that the death rate becomes more along the lines of the 1918 flu or we are in for a very rough ride indeed. Imagine how our society would be affected and react if a disease suddenly appeared that killed 25% of those it infected? Even if it only infects 20% of the population, as the 1918 strain did, that would still mean 5% of the population dead – 15 million in the US alone. Imagine the disruptions that would occur with a significant number of people in our society dead in such a short period of time. Hospitals would be overwhelmed and our highly specialized society would be at serious risk of short-term collapse. That is not a very pleasant thought. How many of us are prepared spiritually, mentally and /or physically for that sort of collapse? If a nationwide quarantine had to be instituted it would likely be on the order of two to four weeks. How many of us have enough food, fuel, etc. to get through a period of that length? It is certainly something to think – and pray – about.
Finally, on a more personal note, in the summer of 2003 – during the SARS scare – I traveled on business to Taiwan. Since there were outbreaks in Asia my colleagues could not visit the US without spending a week in a US quarantine facility – not such a pleasant prospect. I was able to travel to Taiwan with no such requirement, so off I went. When I arrived I found there was an additional step to go through before one could get to the passport check and immigration control. All passengers had to pass through a health station. It didn’t really take much time at all but I found it interesting and it got me to thinking (dangerous!!). There were a number of Taiwanese health officers there and everyone had to pass through a control point single file where it was obvious that we were being visually examined. I was told later that there were infrared temperature sensors set to monitor people as they passed through. If you happened to have a body temperature outside of a pre-programmed range or – Lord help you – a fever, you would be taken aside for “further examination” and possible quarantine. Thankfully I had no such trouble. If the next flu pandemic breaks out during my lifetime, I hope that I am not traveling. I prefer to be at home during such an event, not stuck in some strange place . . .