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February 18, 2008

The Deadliest Flu Ever

After a slow start, flu season is now in full swing across the United States. What’s worse, flu experts at the Centers for Disease Control and Prevention (CDC) are reporting that this year’s flu vaccine is not a good match for two of the
main strains of flu that are going around.

“Slightly more than half of the viruses that we are looking at in our lab are viruses that are different than the vaccine strain,” said the CDC’s flu chief. “So, they may not be well covered by the vaccine.” In other words, that flu shot you got may not protect you against this year’s bugs.

Of course, most cases of flu aren’t serious. But
complications from the disease still claim around 36,000 lives each year in the United States alone. Worldwide, the number is ten times that. And some strains are far worse than others. Just how bad can flu get? Today, let’s turn the clock back 90 years and see the flu at its all-time worst.

Swift and Fatal

In 1918 and 1919, more than a fifth of the world’s
population caught the flu. And not just any flu–the deadliest flu ever, which caused one of the worst pandemics in history. Before it was over, between 1 and 3 percent of the world’s people had perished. That’s at least 20 million
people worldwide.

Military bases served as incubators for the virus, in America and Europe especially. In fact, a huge number of casualties in World War I came from the flu, rather than from enemy fire. Within months, following troop movements and trade routes, the virus had traveled around the world.

The illness was so fast and so deadly that doctors couldn’t believe it was influenza. It wasn’t like any flu they had ever seen before. A patient who started to feel under the weather on Monday was often dead by Wednesday. Many patients turned a blue-gray hue, as fluid built up in their
lungs. “It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate,” reported a doctor at a military base near Boston. “It is horrible.”

Even worse, this virus devastated people for whom flu is normally just an inconvenience. Healthy men and women in their twenties, thirties, and forties were dropping dead on the street on their way to work or the market. How could this be the flu? Some even speculated it was a plot by the Germans, or a side effect of the mustard gas used during
World War I.

Dramatic Mutation

But it was the flu–a horrible new strain, but just the flu. Every few decades, the flu virus, which mutates at least a little bit every year, undergoes a dramatic change. This new virus is especially dangerous because no one has built up an immunity to it. The virus of 1918-19, from the
time it likely got started in Asia, was of this sort: different enough from previous strains that few people were immune.

Because flu spreads through the air, it was also
frighteningly easy to get infected. All you had to do was breathe the air that a sick person had just coughed or sneezed into. The most dangerous place you could be was in a crowd.

Unfortunately, it was hard to avoid crowds in 1918. Hundreds of thousands of soldiers were being packed into barracks and onto troop ships. And huge military parades and war-bond rallies helped the virus make the leap from soldiers to the civilian population.

Flu Crosses the Nation

By autumn of 1918, life in big cities had become
nightmarish. In one month–October 1918–nearly 200,000 Americans died from flu. Medical care was hard to come by, because so many doctors and nurses had been dispatched to Europe to care for the troops (and because many of those who stayed got sick, too). Churches, theaters, and taverns
closed. In some cities, even funerals were limited to 15 minutes.

When one person in a family got sick, the flu usually spread to everyone else in the house. Volunteer nurses, arriving with broth and clean sheets, were seen as saviors by people too ill or too poor to get to a doctor. “In some cases,” a New York City nurse wrote, “the nurses were even
locked in the house by the patient’s friends, or kidnapped on their rounds, so panic-stricken had people become.”

The East Coast was ravaged in September 1918, and it took only a few weeks for the epidemic to spread to the West. In San Francisco and Seattle, wearing gauze masks was required by law. In Prescott, Arizona, the town council made it
illegal to shake hands. Other towns quarantined themselves, forbidding trains from stopping, only to fall ill when they welcomed the postman. On the playground, children had a new jump-rope rhyme:

I had a little bird, and its name was Enza
I opened the window, and in-flew-Enza.

It’s a Small World

By the time it had run its course, the 1918-19 flu had killed more than half a million Americans. Beyond the United States, the death toll was even more appalling. What Americans called the “Spanish flu” (incorrectly thinking that was where it started) cropped up all over the world.

Germany, France, and the United Kingdom each lost at least 200,000 civilians between June 1918 and May 1919. More than half a million Italians died. In poorer and more densely populated areas, the death toll was catastrophic. In parts of Mexico, more than 10 percent of the population perished.
On South Pacific islands, more than 20 percent did. In India, at least 12 million people died from flu.

The death toll for the whole world is difficult to know, but the most conservative estimate is that 20 million people died. Many researchers double that number, and some go so far as to say that the death toll could have reached 50 million.

The 1918-19 pandemic was extreme, but not unprecedented. The World Health Organization has records showing that there have been 31 documented influenza pandemics since 1580, most recently in 1968-69. And medical experts say we’re overdue for another devastating flu.

–Colleen Kelly
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