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  • Writer's pictureWilliam Miller, MD

The 1918 Influenza Pandemic - Part 2

Updated: Jul 14, 2021

In Part 1, we examined one theory of how the 1918 influenza virus hopped from horses to chickens to humans and then how the dynamics of troop transport during World War I helped spread it around the globe. In this second of our 3-part series, we look at some public health actions or inactions and the public’s responses. Similarities to COVID today may be apparent.

Viruses all have the potential to mutate over time. Influenza is somewhat unique among viruses in that it has developed a strategy that actively promotes rapid mutation as a means of continually evading our immune system, which is part of the reason we have to get a new flu shot every year. The strain that left America on the troop transport ships in the Spring of 1918 was not the same as that which returned six months later in the Fall. The strain that returned was much more virulent and more contagious. This led to a second global wave of the pandemic that was far more deadly than the first.

As news of the pandemic first spread, authorities in ports began to enact strict rules that sick passengers from ships and their contacts had to be quarantined. Australia exacted some of the earliest and strictest of such rules and as a result had the lowest rates of influenza during the entire two years of the pandemic. In June 1918, the steam ship City of Exeter arrived in Philadelphia from Liverpool with 28 sick passengers. All were quarantined and an outbreak avoided, at least for the moment. However, in August, a similar ship arrived and many of the sick were allowed to disembark without quarantine, pointing to a problem of inconsistency in following rules perhaps due “pandemic fatigue” causing apathy as the pandemic continued.

By August, reports were flying around that the pandemic seemed to be over. Some elected officials began accusing public health workers of “fear mongering”. Even a few medical professionals claimed that concerns had been blown out of proportion and that this was no worse than “old fashion influenza”. One such skeptic was the public health officer of Philadelphia, Dr. Wilmer Krusen. He ignored reports of a new, quickly spreading outbreak in Boston that seemed to be more deadly. Also, on September 19th, the Philadelphia shipyard reported that almost 200 sick sailors had arrived from Europe, a fact that was also ignored.

The City of Philadelphia was preparing for the “Liberty Loan Parade” to promote the sale of war bonds and to boost public moral. It was to be the largest parade in the city’s history. Despite urgings to cancel the parade, Dr. Krusen allowed it to proceed and on September 28th, over 200,000 onlookers crowded the streets for several hours. Within days, hospitals began to fill with seriously ill people. The parade is attributed to 47,000 cases of influenza and about 12,000 deaths within six weeks, leading to it be called the deadliest parade in American history.

Realizing his mistake, on October 3rd, Dr. Kruzen ordered that all schools, churches, bars and theaters in Philadelphia be closed and all public gatherings were banned, but it was too late. At the peak of the outbreak in mid-October, every hospital in the Philadelphia area was full and five emergency hospitals were set up in auditoriums. Many health care workers became ill and 43% of the city’s nurses and many of its doctors were too sick to work. Philadelphia’s medical schools released their third- and fourth-year medical students to work as junior doctors in the overwhelmed hospitals. The number of dead grew so rapidly that there were not enough grave diggers and unburied bodies began to pose an additional health threat.

Meanwhile, on the West Coast, the pandemic was just beginning. The first case was reported in San Francisco in September 1918, and by mid-October there were over 2,000 confirmed cases. The city’s Board of Health responded by ordering schools and theaters to close and banned public gatherings. On October 25th, the San Francisco Board of Supervisors passed an ordinance requiring all persons to wear a mask in public. Failure to do so would result in a warning and subsequent violations resulted in fines or jail. Due to public resistance, the mask ordinance was repealed one month later, but then cases dramatically rose and the ordinance was re-instated at the urging of Mayor James Rolph, Jr, on January 17th, 1919. By then, the matter of the ordinance had become highly politicized.

Rolph, who later became the 27th Governor of California, was the wealthy owner of a shipping company. Mrs. E. C. Harrington, a San Francisco attorney and labor rights activist, was a fierce critic of Rolph. She formed the Anti-Mask League of San Francisco, serving as its president, and organized between 4,000 and 5,000 residents to join against the Mayor and the masking ordinance. The group included some prominent physicians, civil libertarians and one member of the Board of Supervisors. They argued that the ordinance was not based on sound scientific reasoning and infringed on civil liberties. The movement became a major headline for newspapers the world over and on February 1st, the ordinance was lifted.

It has been said that the 1918 Influenza Pandemic brought out the best and worst examples of humanity. Overall, however, many people rose to the occasion to help. The Red Cross played a big role in many large American cities as did the recently founded Boy Scouts of America. Nurses in particular played a significant role. With no effective treatment available at the time, it was good nursing care that was the most important. Hospital staff were primarily nurses, either licensed or in training. Some cities also had “visiting nurse societies” who made house calls to attend to the ill at home. Standing up with courage to what must have been a truly horrific scene, nurses then as today, were some of the unsung heroes providing care and comfort to the sick.

Seattle police in masks during 1918 Flu Pandemic (source Wikipedia).

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