linnugripiblog

How did a person die with influenza in 1918?

The overwhelming majority of Westerners who got influenza in 1918 had exactly the same disease that you are familiar with today. You have a terrible three days, and a week later you are fine. But a minority, and it wasn’t a tiny minority, had an entirely different experience. Their symptoms were extraordinarily varied, and severe.

People could turn so dark blue from the lack of oxygen that physicians had reported they had difficulty distinguishing black patients from white patients. Some of the more horrific symptoms included bleeding from your nose and mouth, and from your ears and even your eyes. In some cases, literally, the floor would be covered in blood. It was an incredibly gruesome situation.

What did people in the communities do to protect themselves?

People isolated themselves. I think a lot of that was because we had two things going on. First, you had the government line. The Surgeon General of the United States said: “There is no cause for alarm.” There was cause for alarm, but his reassurances were repeated over and over by local officials practically everywhere. Meanwhile, people see their spouses die horribly, in less than 24 hours, and undertakers are not available, cemeteries are full.

People rapidly lost all faith in authority, and didn’t trust anything that they were told. This created a sense of alienation, and made it every person for himself, or herself. It spread terror and isolation.

The Red Cross reported that people were starving to death – not from lack of food, but because people were too frightened to go near the sick to bring them food. In most cases, you know, the communities began to fall apart.

What seemed to work that we could look at now?

Nothing really worked in 1918, nor would it really work today. Cities passed ordinances against shaking hands, against spitting. Washing your hands constantly could work. Limiting your contact with people could obviously limit your chance of infection.

The streets in many cities around the world virtually emptied in 1918. It just froze society once it got going. Absentee rates were 40, 50, 60 per cent in some of the war industries.

In the army camps, scientists reported that in the camps that used quarantine rigidly, they did seem to have some effect on the course of the virus. But if the quarantine was not rigidly enforced, if there were any exceptions made at all, it didn’t seem to have any effect whatsoever.

Who was at most risk to die in 1918?

If you were a healthy young adult, and you interacted with people, you were at the highest risk of dying. The one demographic subgroup was probably pregnant women – they are young adults already, and they have the additional burden and stresses of pregnancy on their body already. Pregnant women had the highest rates of mortality - sometimes extraordinary - mortality rates.

In 1918, how did they deal with the people dying so quickly in such a short period of time?

The ‘death system,’ the mortuaries, the cemeteries, and so forth, they were just overwhelmed. Bodies lay in homes for days at a time, sometimes more than a week. In Philadelphia, you literally had priests driving horse-drawn carts driving down city streets calling upon people to bring out their dead.

They were buried in mass graves, dug by steam shovels. It was a horrific circumstance. In some cases, where they had funerals, there were no coffins. They were, for each funeral, renting coffins. They would have a service with somebody in the coffin, and then the body would go to the cemetery without a coffin, and then that same coffin would be reused for another service 15 or 20 minutes later.

What were the biggest mistakes in 1918 that made things worse?

Not taking influenza seriously. The second biggest mistake was that governments did not tell the truth to the public.

I don’t think that would occur now. Since 2003, and even more recently, influenza has gotten an enormous amount of attention and governments are taking it seriously now. At least Western governments are.

The second problem, not telling the truth to the public, I’m not so confident that that would not repeat itself. It’s already been demonstrated that governments in Asia haven’t entirely told the truth.

In the end, what can 1918 teach us? So much has changed scientifically, the general health of people, is it really useful looking at something from that long ago?

1918 teaches us how lethal influenza could be. It teaches us certain things about the importance of telling the truth when there is a major event of any kind. Even when the population was totally panicked, people who were trained did their jobs. Not just nurses and doctors, who behaved with unbelievable heroism and went into the worst areas and died in large numbers, but the police and volunteers who removed the bodies from homes. The lesson is that these people, if they have a sense of what they are supposed to do, they will do their jobs. If people are actually trained and know what to expect, they will continue to function.

But if there is no leadership and no preparation, you run the risk of a disintegration of services. It’s very important not just to have plan but also to practice that plan, and to prepare people.

What would you personally do if H5N1 developed into a pandemic?

I think it’s important to recognize that any pandemic is a serious event. We are most worried right now about H5N1 because it’s been killing half of the people it infects. But, we don’t know that the next pandemic – and there will be another pandemic, the nature of the virus virtually guarantees it – we don’t know if it’ll come tomorrow, or if it’ll come in 20 years.

Our society has changed so much even since the last pandemic in 1968, which was so mild that most people who lived through it aren’t even aware that a pandemic occurred. Yet that mild virus, if it struck today, would today kill between 89,000 - 200,000 Americans. That’s a pretty severe blow.

And the impact on the economy would be even greater than it was in 1968, because our habits have changed. Businesses have become so much more efficient because there is no slack. You have just in time inventory, you more people more frequently eating out at restaurants, you have no excess hospital beds, you have all sort of things that mean even a mild pandemic would be more severe today than it was in 1968.

In terms of what I personally would do, frankly I would cut down on my contacts with people. I would sit at home as much as possible with my family. I certainly wouldn’t shake hands, and I would have a large store of canned goods and bottled water and hunker down.