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“This pandemic has magnified every existing inequality in our society – like systemic racism, gender inequality, and poverty.”
-Melinda Gates
When Covid-19 was first recognized and began to spread in the U.S. and Europe, comparisons were made to the “Spanish Flu” outbreak after World War I. But many people, including prominent pundits, did not think that in our much more modern world the new pandemic would come anywhere close to the previous pandemic’s duration and death toll (which in the U.S. alone was 670,000). Well, it’s getting there. By the end of this week — with Thursday marking the 103rd anniversary of when the first case of Spanish flu was reported (in Kansas) — there will be close to 520,000 deaths from Covid-19 in the U.S., and we’re looking at at least 18 months before an “all clear.”
Back in 1918, no one could blame China. A 2018 study of tissue slides and medical reports found evidence that the virus likely had a North American origin, though it was not conclusive. In addition, details about the virus suggest that it originated long before 1918, perhaps as early as 1915. (Makes you wonder how long Covid-19 was around before it bloomed.) The major World War I troop staging and hospital camp in Étaples in France has been theorized as being at the center of the Spanish Flu. The overcrowded camp and hospital were an ideal environment for the spread of a respiratory virus. The hospital treated thousands of victims of poison gas attacks and other casualties of war, and 100,000 soldiers passed through the camp every day. It also was home to a piggery, and poultry was regularly brought in from surrounding villages to feed the camp. In late 1916 the camp was hit by the onset of a new disease with high mortality that caused symptoms similar to the flu. It was postulated that a precursor virus, harbored in birds, mutated and then migrated to pigs kept near the Western front.
One of the few regions of the world seemingly less affected by the Spanish Flu pandemic was China, where several studies have documented a comparatively mild flu season in 1918. A report published in 2016 in the Journal of the Chinese Medical Association found no evidence that the 1918 virus was imported to Europe via Chinese and Southeast Asian soldiers and workers, and instead found evidence of its circulation in Europe before the pandemic. The low flu mortality rate found among the Chinese and Southeast Asian workers in Europe meant that the deadly 1918 influenza pandemic could not have originated from those workers. Further evidence against the disease being spread by Chinese workers was that they entered Europe through other routes that did not result in a detectable spread, making them unlikely to have been the original hosts.
The pandemic is conventionally marked as having begun on March 4, 1918 with the case of Albert Gitchell, an army cook at Camp Funston in Kansas. Within days, 522 men at the camp had reported sick, and by March 11 the virus had reached New York City. With soldiers having been sent overseas to aid the Allies fighting Germany, the disease quickly spread to other U.S. Army camps in Europe while becoming an epidemic in the Midwest and East Coast. From ports in France it quickly spread to the rest of the country and Great Britain, Italy, and Spain and in May reached Breslau and Odessa. After the signing of the Treaty of Brest-Litovsk, Germany began releasing Russian prisoners of war, who then brought the disease to their country. It reached North Africa, India, and Japan in May, and soon after went around the rest of the world. In June, an outbreak was reported in China. After reaching Australia in July, the wave started to recede.
The first wave of the flu was relatively mild. Mortality rates were not appreciably above normal; in the United States 75,000 Spanish Flu-related deaths were reported in the first six months of 1918, compared to 63,000 deaths during the same time period in 1915 from “regular” flu. However, the first wave caused a significant disruption in the military operations of World War I, with three-quarters of French troops, half the British forces, and over 900,000 German soldiers sick.
The second wave began in August, probably spreading to Boston and Freetown, Sierra Leone, by ships from Brest, France, where it had likely arrived with American troops or French recruits for naval training. From the Boston Navy Yard and Camp Devens, about 30 miles west of Boston, other U.S. military sites were soon afflicted as were troops being transported to Europe. Helped by troop movements, it spread over the next two months to all of North America and then to Central and South America, also reaching Brazil and the Caribbean on ships. In July 1918, the Ottoman Empire saw its first cases in some soldiers. From Freetown, the pandemic continued to spread through West Africa while South Africa received it in September on ships bringing members of the South African Native Labour Corps returning from France. From there it spread around southern Africa and beyond the Zambezi, reaching Ethiopia in November. On September 15, New York City saw its first fatality. Thirteen days later, the Philadelphia Liberty Loans Parade, held to promote government bonds for World War I, resulted in 12,000 deaths after a major outbreak of the illness.
From Europe, the second wave swept through Russia and then spread via the Trans-Siberian railway throughout Asia, reaching Iran and then later India in September as well as China and Japan in October. The celebrations of the end of World War I on November 11, 1918 also caused outbreaks in Lima and Nairobi, but by December the wave was over.
But the second wave had been much more deadly. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. October 1918 was the month with the highest fatality rate of the whole pandemic. In the U.S., 292,000 deaths were reported between September–December, compared to 26,000 during the same time period in 1915. The Netherlands alone reported 40,000+ deaths from influenza and acute respiratory disease, and Bombay reported 15,000 deaths in a population of 1.1 million, a rate of nearly 1.4%.
In January 1919, a third wave of the Spanish Flu hit Australia, where it killed 12,000 following the lifting of a maritime quarantine. It then spread quickly back through Europe and the U.S., where it lingered into June. It primarily affected Spain, Serbia, Mexico, and Great Britain, and while it was less severe than the second wave, it was still much more deadly than the initial first wave. In the U.S., isolated outbreaks occurred in some cities including Los Angeles, New York City, Memphis, Nashville, San Francisco, and St. Louis, but overall American mortality rates dropped to the tens of thousands during the first six months of 1919.
But we weren’t out of the pandemic woods yet. In spring 1920, a fourth wave occurred in isolated areas including New York City, Switzerland, Scandinavia, and some South American islands. New York City alone reported 6374 deaths between December 1919 and April 1920. Other cities including Detroit, Milwaukee, Kansas City, Minneapolis, and St. Louis were hit particularly hard, with death rates higher than all of 1918. Peru experienced a late wave in early 1920, and Japan had one from late 1919 to 1920, with the last cases in March, and several countries in Europe recorded a late peak between January and April of 1920.
Yes, we’re all weary of the Covid-19 pandemic — masks, isolating, distancing, restrictions, remote working and learning, the naysayers and anti-vaxxers, and everything else. Very hopeful is three vaccines now being deployed. But is it too early to relax? Unhappily, that 670,000 mark appears within reach.
Tom Clavin is the bestselling author/co-author of 18 books, including, most recently, “Tombstone: The Earp Brothers, Doc Holliday, and the Vendetta Ride From Hell.” The next collaboration with Bob Drury, “Blood and Treasure: Daniel Boone and the Fight for America’s First Frontier,” will be published in April by St. Martin’s Press. Please go to your local bookstore or to Amazon/bn.com to pre-order.