Flu Pandemic Of 1918 Quotes

Me: Not happening. Him: How bout tmrw night? I’m free at eight. Me: Can’t. I have the Spanish Flu. Highly contagious. I just saved your life, dude. Him: Aw, I appreciate the concern. But I’m immune to pandemics that wiped out 40-mil ppl from 1918 to 1919. Me: How is it u know so much about pandemics? Him: I’m a history major, baby. I know tons of useless facts.

What the Spanish flu taught us, in essence, is that another flu pandemic is inevitable, but whether it kills 10 million or 100 million will be determined by the world into which it emerges.

However, as bad as things were, the worst was yet to come, for germs would kill more people than bullets. By the time that last fever broke and the last quarantine sign came down, the world had lost 3-5% of its population.

No other disease, no war, no natural disaster, no famine comes close to the great pandemic. In the space of eighteen months in 1918–1919, about 500 million people, one-third of the human race at the time, came down with influenza. The exact total of lives lost will never be known. An early estimate, made in 1920, claimed 21.5 million died worldwide. Since then, researchers have been continually raising the number as they find new information. Today, the best estimate of flu deaths in 1918–1919 is between 50 million and 100 million worldwide, and probably closer to the latter figure. 7

White Christians often explained the disaster in a time-honored way: it was God's punishment of humanity for its sings. To the seven deadly sins--anger, greed, lust, envy, pride, laziness, gluttony--they added an eighth sin: 'worshiping science.

In the United States, influenza death rates were so high that the average life span fell by twelve years, from fifty-one in 1917 to thirty-nine in 1918. If you were a “doughboy”—slang for an American soldier—you had a better chance of dying in bed from flu or flu-related complications than from enemy action.

He was utterly unnerved by the crowd. They were shaking hands, which even after all of his cultural-sensitivity training seemed like a bizarre thing to do in flu season, and kissing one another on the cheek. These people have no direct experience of pandemics, he reminded himself. None of them were old enough to remember the winter of 1918–1919; Ebola was a few years out and would mostly be confined to the other side of the Atlantic; Covid-19 would not arrive for another thirteen years

In August the flu returned transformed. This was the second and most lethal wave of the pandemic, and again by

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall.

First discovered in Kansas in March 1918, by the time the H1N1 pandemic, commonly known as the Spanish flu, burned out in 1919, it took the lives of as many as fifty million people worldwide.

Nowadays, the disease claims, on average, 36,000 Americans each year, out of a population of 320 million. Contrast this with another number: 35,092 Americans died in motor vehicle accidents in 2015.

Should we add the 40 to 50 million victims of the 1918 influenza pandemic to the 15 million who were killed in World War I, because the flu virus would not have evolved its virulence if the war hadn’t packed so many troops into trenches?

The Swiss-born architect known as Le Corbusier retreated to his rooms in Paris and sipped cognac and smoked through the worst of the pandemic, while cogitating on how to revolutionise the way people lived (though he hadn’t even a diploma in architecture).

In many ways, it is hard for modern people living in First World countries to conceive of a pandemic sweeping around the world and killing millions of people, and it is even harder to believe that something as common as influenza could cause such widespread illness and death.

But as the program got going, the smallest details became issues, even the very name of the disease. Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey

in a letter to the New York Times, Dr. Hans Neumann from the New Haven Department of Health noted that based on the projected scale of the immunizations, within two days of getting a flu shot, about 2,300 people would have a stroke and 7,000 would have a heart attack. “Why?” he asked. “Because that is the number statistically expected, flu shots or no flu shots.” Likewise, in the week following a flu vaccine, another 9,000 people would contract pneumonia, of whom 900 would die. These would certainly occur after a flu shot, but not as a consequence of it. “Yet,” wrote Neumann, “can one expect a person who received a flu shot at noon and who that same night had a stroke not to associate somehow the two in his mind?” Grandma got the flu vaccine in the morning, and she was dead in the afternoon. Although association does not equal causation, this thinking could lead to a public backlash against vaccinations that would threaten future programs.

In a strange twist on the concept of flu prevention, ‘vaudeville theaters were only allowed to be half full – members of the audience had to leave the seat on either side empty so that they would not breathe on one another. To further protect themselves many wore surgical masks, so that even when they laughed the sound was muffled.

Flu pandemics are nothing new. Medical historians think the first one struck in 1510, infecting Asia, Africa, Europe, and the New World. Between the years 1700 and 1900, there were at least sixteen pandemics, some of them killing up to one million people. Yet these were tame compared to the 1918 calamity. It was by far the worst thing that has ever happened to humankind; not even the Black Death of the Middle Ages comes close in the number of lives it took. A 1994 report by the World Health Organization pulled no punches. The 1918 pandemic, it said, “killed more people in less time than any other disease before or since.” It was the “most deadly disease event in the history of humanity.

Medical science had little to offer in the way of prevention or cure, apart from the process of disinfection, notification and isolation as recommended by Dr Niven. There was little consensus on treatment apart from the traditional recourse to bed rest, opiates and folk remedies, while to make matters worse, significant individuals refused to take the threat of Spanish flu seriously.

For propagandists, whatever promoted the Allied cause was true, whether factual or not. What counted was the noble end--victory--not the sordid means of achieving it. 'Truth and falsehood are arbitrary terms,' declared a CPI official. 'There is nothing in experience to tell us that one is always preferable to the other....There are lifeless truths and vital lies....The force of an idea lies in its inspirational value. It matters very little if it is true or false.

The relatively conservative WHO suggests “a relatively conservative estimate — from 2 million to 7.4 million deaths” if bird flu jumps to humans and becomes airborne (as swine flu — H1N1 — did). “This estimate,” they go on to explain, “is based on the comparatively mild 1957 pandemic. Estimates based on a more virulent virus, closer to the one seen in 1918, have been made and are much higher.” Mercifully, the WHO does not include these higher estimates on its “things you need to know” list.

Epidemiologists-scientists who study the spread of disease-use a special number to describe how contagious a virus is. It's called the basic reproduction number, or R0 for short. It's complicated to calculate but simple to understand-it counts how many people one sick person is expected to infect over the course of his or her illness. If I'm sick with a cold and I make two other people sick, the R0 of my virus is 2. Colds and seasonal flus typically have R0 values of around 1.5 to 2. The 1918 flu pandemic R0 was estimated to be 2 to 3, while diseases like polio and small pox have R0 values of around 5 to 7.

The world’s last great pandemic was the Spanish flu outbreak in 1918 that killed a hundred million people—about 5 percent of the world’s population. If a pandemic like that were to happen again, it would spread faster and might be impossible to contain. According to the Bill & Melinda Gates Foundation, in such a pandemic “the death toll could reach 360 million”—even with the full deployment of vaccines and powerful modern drugs. The Gates Foundation estimated that the pandemic would also devastate the world financially, precipitating a three-trillion-dollar economic collapse. This is not scaremongering: Most epidemiologists believe such a pandemic will eventually happen.

Since the body does a better job of fighting infection when it is a few degrees hotter, might reducing the fever lead to a worse outcome for the patient? A group from McMaster University in Canada looked at what happens in a large group of people when some of them—infected with, say, influenza—take medicine to reduce their fever. Once they feel better, patients with the flu get out of bed and start to socialize, spreading the virus. On a population level the effect is rather drastic. The McMaster group concluded that the practice of frequently treating fevers with medication enhances the transmission of influenza by at least 1 percent. I know that doesn’t sound like a lot, but remember that as many as 49,000 people die from the flu each year in the United States. If you plug the McMaster estimates into these flu numbers, almost 500 deaths per year in the U.S. (and perhaps many more elsewhere) could be prevented by avoiding fever medication during the treatment of influenza.

Today, such studies are illegal. Medical scientists cannot offer inducements like pardons to persuade prisoners to take part in their studies. Although they can award small cash payments to research subjects, they are forbidden from giving anyone so much money or such tempting favors that their compensations might constitute what ethicists term an inappropriate inducement, an irresistible temptation to join the study. Now, more than eighty years after the 1918 flu, people enter studies for several reasons—to get free medical care, to get an experimental drug that, they hope, might cure them of a disease like cancer or AIDS, or to help further scientific knowledge. In theory at least, study participants are supposed to be true volunteers, taking part in research of their own free will. But in 1918, such ethical arguments were rarely considered. Instead, the justification for a risky study with human beings was that it was better to subject a few to a great danger in order to save the many. Prisoners were thought to be the ideal study subjects. They could offer up their bodies for science and, if they survived, their pardons could be justified because they gave something back to society. The Navy inmates were perfect for another reason. Thirty-nine of them had never had influenza, as far as anyone knew. So they might be uniquely susceptible to the disease. If the doctors wanted to deliberately transmit the 1918 flu, what better subjects? Was influenza really so easily transmitted? the doctors asked. Why did some people get it and others not? Why did it kill the young and healthy? Could the wartime disruptions and movements of troops explain the spread of the flu? If it was as contagious as it seemed, how was it being spread? What kind of microorganism was causing the illness? The normal way to try to answer such questions would be to study the spread of the disease in animals. Give the disease to a few cages of laboratory rats, or perhaps to some white rabbits. Isolate whatever was causing the illness. Show how it spread and test ways to protect animals—and people—against the disease. But influenza, it seemed, was a uniquely human disease. No animal was known to be susceptible to it. Medical researchers felt they had no choice but to study influenza in people. Either the Navy doctors were uncommonly persuasive or the enticement of a pardon was overwhelmingly compelling. For whatever reason, the sixty-two men agreed to be subjects in the medical experiment. And so the study began. First the sailors were transferred to a quarantine station on Gallops Island in Boston Harbor. Then the Navy doctors did their best to give the men the flu. Influenza is a respiratory disease—it is spread from person to person, presumably carried on droplets of mucus sprayed in the air when sick people cough or sneeze, or carried on their hands and spread when the sick touch the healthy. Whatever was causing the flu should be present in mucus taken from the ill. The experiments, then, were straightforward. The Navy doctors collected mucus from men who were desperately ill with the flu, gathering thick viscous secretions from their noses and throats. They sprayed mucus from flu patients into the noses and throats of some men, and dropped it into other men’s eyes. In one attempt, they swabbed mucus from the back of the nose of a man with the flu and then directly swabbed that mucus into the back of a volunteer’s nose.

historian Alfred Crosby, who told the story of the flu in America, argued that democracy was unhelpful in a pandemic.

There’s a curious correlation between these sunspot peaks and flu epidemics. In the twentieth century, six of the nine sunspot peaks occurred in tandem with massive flu outbreaks. In fact, the worst outbreaks of the century, killing millions in 1918 and 1919, followed a sunspot peak in 1917. This might just be coincidence, of course. Or it might not. Outbreaks and pandemics are thought to be caused by antigenic drift, when a mutation occurs in the DNA of a virus, or antigenic shift, when a virus acquires new genes from a related strain. When the antigenic drift or shift in a virus is significant enough, our bodies don’t recognize it and have no antibodies to fight it—and that spells trouble. It’s like a criminal on the run taking on a whole new identity so his pursuers can’t recognize him. What causes antigenic drift? Mutations, which can be caused by radiation. Which is what the sun spews forth in significantly greater than normal amounts every eleven years.

The 1918 influenza pandemic (also known as the Spanish Flu) was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. It’s estimated that about 500 million people—one-third of the world’s population—became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide, with about 675,000 occurring in the United States. This virus is still with us today, and is the reason for our annual flu shots.

However, Hatchett and Mecher’s modeling, and the deep dive into the history of the Spanish flu, started to change minds inside the public health establishment, and especially the CDC. The findings on the NPIs from 1918 were so striking that they surprised the team. The nonpharmaceutical interventions had a profound effect on slowing spread, but they needed to be adopted early in the course of a pandemic. The best way to contain a pandemic would remain through vaccination. But it might be months, or longer, before a vaccine could be made available.

It belonged to that category of creature that, in a premonitory article written in 1903, Émile Roux had labelled étres de raison, or theoretical beings, organisms that can be deduced from their effects, though they have never been observed directly.

If anything like the 1918 flu occurred, the basic functions of the society would come to a halt, and no one in the federal government seemed to have worried about it.

The world’s last great pandemic was the Spanish flu outbreak in 1918 that killed a hundred million people—about 5 percent of the world’s population. If a pandemic like that were to happen again, it would spread faster and might be impossible to contain.

By the dawn of the twentieth century, for the first time since cities had come into existence 5,000 years before, infectious diseases were staunched to such an extent that cities were able to remain stable, and even grow, without depending on a constant stream of migrants from the countryside. It was a remarkable change.

The world’s last great pandemic was the Spanish flu outbreak in 1918 that killed a hundred million people—about 5 percent of the world’s population. If a pandemic like that were to happen again, it would spread faster and might be impossible to contain. According to the Bill & Melinda Gates Foundation, in such a pandemic “the death toll could reach 360 million”—even with the full deployment of vaccines and powerful modern drugs. The Gates Foundation estimated that the pandemic would also devastate the world financially, precipitating a three-trillion-dollar economic collapse. This is not scaremongering: Most epidemiologists believe such a pandemic will eventually happen. Archaeology

In 1918 and 1919 came the Great Influenza, the Spanish Flu.  The only global pandemic in modern times.  Fifty million to a hundred million dead.  How did Tibet fare this time, you ask?” McAlister’s face was stoic, immobile. Suddenly angry, Undertaker said, “No. You don’t ask, Dr. McAlister; you don’t ask because you already know.  Tibet was barely touched.  A few sick, no one reported dead.

Still, this particularly virulent and infectious strain of the flu virus is thought to have killed as many as 40 million people around the world between 1918 and 1919.

Instead, the dean had said, “Take a look at the person sitting to your left and to your right. Chances are that person will not be there four years from now.” Every

The 2009 “pandemic,” which was not really a pandemic at all, taught us that language is both a weapon and a handicap when waging a campaign against influenza.

On a very real level, germs concern us because the world has become a significantly more perilous place of late. In recent years, many normal activities, such as eating beef and chicken, travelling on public transit and being treated in a hospital, have turned out to be extremely dangerous in certain places. Arrogantly and ignorantly, we assumed that epidemics such as the Spanish flu of 1918 could not happen again. SARS proved us wrong, and now we dread bird flu or a yet unnamed pandemic.

The small town of Gunnison, Colorado, lies at the bottom of the valley carved by the Gunnison River into the Rocky Mountains. It is now crossed by the Colorado stretch of U.S. Highway 50, but in 1918, the town was mainly supplied by train and two at best mediocre roads. When the 1918–19 influenza pandemic reached Colorado as an unwelcome stowaway on a train carrying servicemen from Montana to Boulder, the town of Gunnison took decisive action. As the November 1, 1918, edition of the Gunnison News-Champion documents, a Dr. Rockefeller from the nearby town of Crested Butte was "given entire charge of both towns and county to enforce a quarantine against all the world". He instituted a strict reverse quarantine regime that almost entirely isolated Gunnison from the rest of the world. Gunnison became one of the few communities that largely escaped the ravages of the influenza pandemic, at least in the beginning – in an instructive example of the limited human patience for the social, psychological and economic disruption of quarantine, adherence eventually waned and the front page of the Gunnison News-Champion's March 14, 1919, issue reports that the influenza pandemic got to Gunnison, too. Nevertheless, Gunnison had a very lucky escape – of a population of over 6,900 (including the county), there were only a few cases and a single death.

I used to wonder why the 1918 Spanish Flu faded from public consciousness, why there were so few works of art depicting it or inspired by it, but now I understand. Who would want to remember the particular combination of grief, terror, and loneliness that a plague inspires—its senseless silent slaughter?

And the odds that a pandemic will strike are only going up. That’s partly because, with urbanization, humans are invading natural habitats at a growing rate, interacting with animals more often, and creating more opportunities for a disease to jump from them to us. It’s also because international travel is skyrocketing (or at least it was before COVID slowed its growth): In 2019, before COVID, tourists around the world made 1.4 billion international arrivals every year—up from just 25 million in 1950. The fact that the world had gone a century since a catastrophic pandemic—the most recent one, the flu of 1918, killed something like 50 million people—is largely a matter of luck.

A different narrative structure is needed, and a new language. Piqued by their humiliation, scientists went on to furnish us with a vocabulary of flu – with concepts such as immune memory, genetic susceptibility and post viral fatigue. Couched in this new language – not a poetic language, perhaps, but one that allowed tou to make predictions, and to test them against the historical reports – disparate events began to appear connected, with other, once obvious links atrophied and died (no, it wasn’t the punishment of an angry god; yes, it was at least partly responsible for the subsequent wave of melancholy). The pandemic took on a radically new shape: the one we recognize today.

In more recent history, we learn from other viruses, including Measles, Ebola, Rabies, Herpes, how important it is to respond immediately to prevent the spread of infection. I was shocked when I learned more about the influenza pandemic, otherwise known as the Spanish Flu of 1918–1919. It began in the US, swiftly traveled across the world, and killed more people than any disease before or since.

The National Institutes of Health in Maryland keeps samples of the 1918 flu virus in a freezer at an undisclosed location. It’s not easy to get anywhere near that locked freezer, let alone inside it. First, you have to get onto the campus of the NIH, which requires identification, a reason to be admitted, and a PhD, preferably in one of the life sciences. Once you get through and find the building, a guard has to buzz you in via an airlocked entrance with double doors. Inside, you will pass through a metal detector and then be firmly guided toward a locker, where your cell phone, thumb drive, computer, pager, and camera must be deposited. Then, and only then, will you be escorted farther into the building.

Not long ago, I read that a Federal Reserve Bank of New York study had found a correlation between Germany’s deaths from the 1918 flu pandemic and support for the Nazis during the 1932 and 1933 elections. Controlling for other possible influences like unemployment and city budgets, the researchers found that high death rates boosted a locality’s support for Adolf Hitler’s party. Preliminary evidence suggests extremist

Cases continued to surge. And yet many civic leaders would argue that the Spanish flu was driven by misguided fears and wasn’t that dangerous. In 1918, one of the most prominent of these individuals was Krusen, who would declare that the end of the pandemic was near and that the cases had reached a “crest.” Dr. John W. Croskey, president of the West Philadelphia Medical Association, similarly said that “the public should be educated to the fact that the disease is not as deadly as many believe it to be.” However, Croskey had grossly underestimated the severity of the flu, putting the case fatality rate—the percentage of people who developed symptoms of flu and would die from the disease—at about 0.5 percent, which was far less than its real fatality rate.

Today, we know that viruses are submicroscopic entities twenty times smaller than a bacterium. They contain a core of genetic material covered by a protein capsule, and they reproduce exclusively within living cells.

The most useful definition we have is that an epidemic is a severe local outbreak, while a pandemic is a global outbreak that makes people very sick, and spreads rapidly from a point of origin.

The history of the 1918 influenza pandemic is depressing reading. It’s like watching a horror movie that you have seen before. You know who the killer is, but you can’t jump in and save the victim.

Robert Graves, the poet and British Army officer, was in London, too, still shaky from the German metal he had received in his chest and thigh the year before. His mother-in-law contracted influenza, but deceived her physician in order to make the rounds of the latest London plays with her son, Tony, on leave from France. She died July 13: “her chief feeling was one of pleasure that Tony had got his leave prolonged on her account.” On the day she died, Grave’s friend and fellow poet, Sigfried Sassoon, who had been shot through the throat in 1917, was shot through the head while on patrol in No-Man’s-Land. He recovered. Tony was killed two months later.27 Yes, the war was much more engrossing than Spanish flu.

The pandemic of 1918–1919 was clearly one of influenza, except in two of its features. One, it killed more humans than any other disease in a period of similar duration in the history of the world. Two, it killed an unprecedentedly large proportion of the members of a group who, according to records before and since, should have survived it with no permanent injury. The year 1918 was an actuarial nightmare: the flu and pneumonia death rate of life insurance policy holders over 45 and 50, for whose deaths the insurance companies were at least partly prepared, did, of course, rise, but only slightly as compared to the rate of young adults, whose deaths in great numbers no insurance company anticipated.16

It seems that the returns of pandemic flu, every 30 or 40 years, are arbitrary. The return in 1918 happened to come in the midst of a world war, with all its crowds and migrations, and perhaps that coincidence created Spanish influenza. Perhaps, but can we be sure that crowds and migrations have much to do with increasing the virulency of flu? There is the annoying fact that two of the last three pandemics, those of 1889–1890 and 1957, appear to have originated not among the most cosmopolitan of the world—the citizens of New York or Panama City—but among the relatively isolated and static populations of the interior of Asia.24

The third explanation for 1918’s lethality is that the flu virus triggered an overreactive immune response that turned the body against itself.

Antigenic shift generated the deadly 1918 influenza virus and the swine flu outbreak of 2009.

We now think that the majority of deaths in the 1918 pandemic resulted from these secondary infections, not from the flu virus itself.

Today, influenza kills fewer than 0.1 percent of those who catch it. Nearly everyone recovers. In the 1918 pandemic most still recovered, but the death rate was twenty-five times greater. So many died in the U.S. that the average life expectancy in 1918 fell from fifty-one to thirty-nine years.

The Great Influenza, a book by the historian John Barry about the 1918 flu pandemic.

When did the pandemic end? That is more difficult to say, for while flu pandemics often begin abruptly, they normally disappear only after several renewals of virulency and then a long tailing off. The pandemic of Spanish influenza subsided and sank below the level of general and even scientific perception in the United States and almost everywhere else in the world in spring 1919.

In its first Spanish influenza pamphlet, issued in September, the USPHS recommended that those nursing flu patients wear gauze masks.37 Soon laymen decided that what was a sensible caution in the sickroom would be just as sensible in every situation. Gauze masks became a common sight in the streets and department stores of communities in the eastern United States. People could and did honestly believe that a few layers of gauze would keep out flu bugs, just as screens kept the flies off the front porch. The influenza virus itself is, of course, so infinitely tiny that it can pass through any cloth, no matter how tightly woven, but a mask can catch some of the motes of dust and droplettes of water on which the virus may be riding. However, to be even slightly effective during a flu epidemic masks must be worn at all times when people are together, at home and at work and in between, must be of a proper and probably uncomfortable thickness, must be tied firmly, and must be washed and dried at least once daily. Enforcement of such conditions is impossible and so the communities where masking was compulsory during the Spanish influenza pandemic almost always had health records the same as those of adjacent communities without masking.

All this tinkering was creating superviruses that did not exist outside the lab and that might be more easily transmissible between different species, or more virulent, or more resistant to any influenza vaccine. Most researchers were insistent that these “gain of function” studies were needed to better understand how the flu virus might evolve, but the federal government saw things differently. These experiments were a security risk.

Trust broke down between the two parties–or rather, was never built up. But trust is not something that can be built up quickly. If it is not in place when a pandemic declares itself, then however good the information being circulated, it probably won’t be heeded.

But maybe his father was right. Maybe what had happened in 1918 could never happen again. "U.S. Reveals Detailed Flu Disaster Plans." Cole decided to make this the topic for his research report. Plans for manufacturing and distributing vaccines and other medications. Plans to quarantine the sick and to call up extra doctors and nurses and to replace absent workers with retired workers so that businesses wouldn't have to shut down. Plans to keep public transportation and electricity and telecommunications and other vital services operating and food and water and other necessities from running out. Plans to mobilize troops (for Cole this was the only exciting part) in the event of mass panic or violence. One day he would ask Pastor Wyatt why, despite all these plans, everything had gone so wrong. "Son, that is just the thing. That is what people did not--and still do not--get. There is no way you can count on the government, even if it's a very good government. The government isn't going to save you, it isn't going to save anyone. There's no way you can count on other people in a situation like we had. People afraid of losing their lives--or, Lord knows, even just their toys--they'll panic. Even fine, decent Christian folk--you can never know for sure what they'll do next. So I say, love your neighbor, help your fellow man all you can, but don't ever count on any other human being. Count on God." What Cole didn't know was that most of the plans he read about that night would have been sufficient only for an emergency lasting a few weeks.

In the United States, heart disease has been the leading cause of death every year since 1900, with the exception of 1918 when pandemic flu ruled the roost.41 (In contrast, as I detail in How to Survive a Pandemic, COVID only made it to number three.42

If it is hot enough to barbecue,” a patient of mine once told me as I sutured the knife wounds on his chest, “it’s hot enough to stab someone.

Hopkirk, like many physicians of his day, also prescribed quinine to treat the flu. “In quinine,” he wrote with great certainty, “we have a drug that not only controls fever-producing processes allied to fermentations, but also exerts a definite anti-toxic action on the specific virus of influenza itself.

The cholera epidemic was a turning point marking the last time the disease would rage without simple precautions of public health.

knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our nation.” With that preamble, Ford announced that he was asking Congress to appropriate $135 million “for the production of sufficient vaccine to inoculate every man, woman, and child in the United States,” for a disease that no one could even prove to exist.

Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey flu.

The Spanish Flu pandemic of 1918 was a myxovirus. It killed twenty million people. Viruses mutate every few months. The antigens on their surface change so that they’re unrecognizable to the immune system. That’s why seasonals are necessary.

(There may be another reason why Ranger proposed a feminised history of the Spanish flu: it was generally women who nursed the ill. They were the ones who registered the sights and sounds of the sickroom, who laid out the dead and took in the orphans. They were the link between the personal and the collective.) At the root of every pandemic is an encounter between a disease-causing microorganism and a human being.

The first flu pandemic that experts agree was a pandemic–that is, an epidemic that encompassed several countries or continents

1700 and 1800 there were two flu pandemics. At

July the incidence of influenza in the AEF had reached its lowest point since early spring. Only 99 men died of flu and pneumonia that month, and the number was expected to be even lower

Then the influenza epidemic arrived. Unlike the plague of Athens, unlike the Black Death, unlike even the cholera epidemic that felled William Sproat and the other cholera epidemics to come in that century, the flu epidemic had no chronicler.

But the flu was expunged from newspapers, magazines, textbooks, and society’s collective memory. Crosby calls the 1918 flu “America’s forgotten pandemic,” noting:

In every conflict of the eighteenth and nineteenth centuries, more lives were lost to disease than to battlefield injuries. The nineteenth century saw two flu pandemics. The first, which erupted in 1830, is said to have ranked in severity–though not in scale–with the Spanish flu. The second, the so-called ‘Russian’ flu that began in 1889, was thought to have originated in Bokhara in Uzbekistan. It was the first to be measured, at least to some extent, since by then scientists had discovered what a powerful weapon statistics could be in the fight against disease.

This was the first wave of the pandemic, and it was relatively mild. Like seasonal flu, it caused disruption but no major panic. It did, however, create havoc in the European theatre of war, where it interfered significantly with military operations.

Experience has shown that people have a low tolerance for mandatory health measures, and that such measures are most effective when they are voluntary, when they respect and depend on individual choice, and when they avoid the use of police powers. In 2007, the CDC issued guidelines for how to ensure maximum compliance with public health measures in a pandemic. Based partly on lessons learned in 1918, these recommended that measures only be made mandatory when the proportion of the sick who die rises above 1 per cent (remember that this proportion was at least 2.5 per cent for the Spanish flu). Using 2016 numbers, that means that more than 3 million Americans would have to die before the CDC would advise such a step – a measure of how counterproductive that organisation believes compulsion to be.

I wish I knew. It’s almost like nature is trying to show us that she’s still more powerful than man. No matter how many of each other we kill in war, nature can still kill more of us. No matter how much we think we know about life, she still can make us look impotent.

Both sides had entered the war already weakened by the disease, and just as in 1918, armies propagated the contagion. Hospitals, already overfilled by flu victims, were unable to treat more than a fraction of the wounded. And yet the war raged on, pulling both countries and their neighbors back into the pre-industrial world. Little was left of modernity except for weapons.

Societies, especially in the developed world, were thought to be on the verge of becoming invulnerable to new plagues. Unfortunately, this expectation has proved to be spectacularly misplaced. Well into the twenty-first century smallpox remains the only disease to have been successfully eradicated. Worldwide, infectious diseases remain leading causes of death and serious impediments to economic growth and political stability. Newly emerging diseases such as Ebola, Lassa fever, West Nile virus, avian flu, Zika, and dengue present new challenges, while familiar afflictions such as tuberculosis and malaria have reemerged, often in menacing drug-resistant forms. Public health authorities have particularly targeted the persisting threat of a devastating new pandemic of influenza such as the “Spanish lady” that swept the world with such ferocity in 1918 and 1919.

Epidemics are local and occur in one place every 1 - 3 years, while Pandemics occur worldwide and happen at irregular intervals of several decades.

He estimates the number of deaths worldwide as 100 million, a larger number than the conventional estimate of 20 to 40 million. But, he said, 20 million people died in India alone, making it impossible for the 20 to 40 million figure to be correct.

The Purple Death was actually part of a great wave of influenza, a lethal virus that swept across America and around the world starting in the spring of 1918. A second, even deadlier wave of influenza appeared in late summer and autumn of 1918, and a third wave continued into 1919. This highly contagious disease, later widely known as Spanish flu, killed an estimated 675,000 Americans in one year, according to historian and professor Alfred Crosby. Consider this perspective: more Americans died from the flu in this short time than all the U.S. soldiers who died fighting in World War I, World War II, the Korean War, and the Vietnam War combined. Indeed, the Spanish flu killed as many Americans in about a year as did HIV/AIDS, the most notorious epidemic of modern times, in more than thirty years. According to the Centers for Disease Control and Prevention (CDC), the estimated number of deaths from diagnosed HIV infection classified as AIDS in the United States since the first reported death in 1981 through 2014 was 678,509—about the same number that died of Spanish flu from 1918 to 1919.

Two boys wearing masks, the most visible symbol of the epidemic

Luntz spoke in a hushed whisper. “My colleague, Scott Caan, and I have been working for years, trying to learn as much as possible about the origins of the 1918 flu pandemic. It killed at least twenty million people worldwide. I was part of the laboratory team, led by Dr. Jeffrey Taubenberg, who resurrected the killer flu.

How lethal was it? It was twenty-five times more deadly than ordinary influenzas. This flu killed 2.5 percent of its victims. Normally, just one-tenth of 1 percent of people who get the flu die. And since a fifth of the world’s population got the flu that year, including 28 percent of Americans, the number of deaths was stunning.

But in the rest of the world, the illness came to be called the Spanish flu, to Spain’s consternation. After all, the other countries of Europe, as well as the United States and countries in Asia, were hit too in that spring of 1918. Maybe the name stuck because Spain, still unaligned, did not censor its news reports, unlike other European countries. And so Spain’s flu was no secret, unlike the flu elsewhere.

Medical historians believe the sickness began in China in 1331. Along with a civil war, it halved the Chinese population. From there, the plague moved along trade routes of Asia and arrived in the Crimea fifteen years later, in 1346. Then it entered Europe, North Africa, and the Middle East. It disrupted society in ways eerily reminiscent of the Athens plague so long before. It emptied streets and public places like the flu epidemic that followed it. And its very name became emblematic of the horrors of epidemics. It was known as the Black Death. At the time the illness was as mysterious as the plague of Athens but now it is known that the Black Death bacteria, Yersinia pestis, were spread by fleas that lived on black rats. The rats, in turn, moved from port to port on ships, taking the illness with them. The fleas would bite people, infecting them with the bacteria. The plague would not have been so overwhelming if it could only spread through flea bites. It turned out that once the bacteria began infecting people, they found another way of spreading. They would infect the lungs and cause a pneumonia, whereupon sick people could infect the healthy simply by coughing or sneezing.

Giovanni Boccaccio wrote in his Decameron that people, afraid of contamination by the rotting corpses, would drag the dead outside their houses and leave them in front of their doors to be picked up, like so much garbage.

The victory over cholera was only a beginning. With the growing and profound knowledge that many diseases are caused by microscopic organisms and that the spread of disease can be prevented, the Western world was transformed. It took years for the change to be complete, but the result was a vigorous public health movement that emphasized simple but powerful measures like cleaning up water supplies and teaching people what now seem to be basic lessons of health and hygiene—keep flies away from food, wash your hands before handling food, give your babies milk, not beer, quarantine the sick. The results were dramatic. In large areas of the world, many of the killer diseases seemed tamed, or even vanquished, and deadly epidemics seemed to be relics of the past.

[T]he only epidemic disease that plagued the troops during the early years of World War I was syphilis.

In 2007, the CDC issued guidelines for how to ensure maximum compliance with public health measures in a pandemic. Based partly on lessons learned in 1918, these recommended that measures only be made mandatory when the proportion of the sick who die rises above 1 per cent (remember that this proportion was at least 2.5 per cent for the Spanish flu). Using 2016 numbers, that means that more than 3 million Americans would have to die before the CDC would advise such a step–a measure of how counterproductive that organisation believes compulsion to be.

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall. And it seemed that the two flu strains were closely related. Infection with the first strain protected against the second

pandemics are lethal. Antigen shift guarantees that the new virus will infect huge numbers of people, but it does not guarantee that it will kill large numbers. The twentieth century saw three pandemics. The most recent new virus attacked in 1968, when the H3N2 “Hong Kong flu” spread worldwide with high morbidity but very low mortality—that is, it made many sick, but killed few. The “Asian flu,” an H2N2 virus, came in 1957; while nothing like 1918, this was still a violent pandemic. Then of course there

In fact, Spanish flu infected so many in 1918 that it is the genetic Adam and Eve of nearly any modern pandemic flu strain.

In addition to antigenic drift, there is a larger change that the flu virus can undergo, antigenic shift, and that’s how we get our flu pandemics. During this shift, viral proteins assume an entirely new structure, and the virus is said to be “novel.” These novel viruses—which most often arise when animal and human viruses share and swap their genes—are like entirely new criminals, not old ones in disguise. This makes them sneakier, more prolific, and perhaps more deadly. Antigenic shift generated the deadly 1918 influenza virus and the swine flu outbreak of 2009.

Back in the disastrous flu pandemic of 1918 that killed upward of one hundred million people, there were stories of asymptomatic people getting on the subway in Brooklyn and being dead from viral pneumonia by the time they got to Manhattan. Whether such stories were apocryphal or not no one knows for sure, but I think they were true because of the virulence of that particular flu strain. What is believed now is that they died from their own immune systems going wild in what is called a cytokine storm.

The results were unequivocal. Both in London and in the United States, people who had survived the 1918 flu had antibodies that completely blocked Shope’s swine flu virus. People who were born after 1918 did not have those antibodies.