GLOBAL PAN­DEMIC

How a deadly in­fluenza virus in­fected a world still re­cov­er­ing from the Great War

All About History - - SPANISH FLU CENTENARY - Writ­ten by Char­lotte Evans

On a crisp morn­ing in spring 1918, dawn breaks over the small French town of Éta­ples. War wages on the Western Front. A young sol­dier lies in sweat-drenched linen, gasp­ing for air be­tween cough­ing fits as foam­ing bod­ily flu­ids stream from his nose and mouth. His face is ashen grey, mot­tled with deep red, and his body con­vulses in a fu­tile at­tempt to clear his lungs. Un­wit­tingly, he sprays half a mil­lion viruses into the cramped mil­i­tary hospi­tal. His body is un­der bi­o­log­i­cal siege and af­ter a short, ex­cru­ci­at­ing bat­tle, he draws his last breaths, suc­cumb­ing to a mys­tery dis­ease that will soon claim the lives of up to 100 mil­lion peo­ple world­wide.

Scenes rem­i­nis­cent of the Black Death would play out across Europe and the United States be­fore spread­ing across the globe. The sol­diers on the front­line of World War I were un­aware of the in­vis­i­ble in­vader thriv­ing deep in the rat-in­fested trenches that would cause the most dev­as­tat­ing epi­demic in mod­ern his­tory.

The first wave of Span­ish flu broke out in

France in 1918, sweep­ing across Europe while a si­mul­ta­ne­ous out­break cropped up in North Amer­ica. It spread fast, thriv­ing in the poor san­i­ta­tion of the bat­tle­front, trav­el­ling with the bat­tal­ions. When the guns fell silent af­ter Armistice Day, sol­diers re­turned home to their loved ones, un­wit­tingly car­ry­ing the deadly mi­crobe even fur­ther afield.

A sec­ond wave of the pan­demic spread across China, In­dia, Ja­pan and the rest of Asia be­fore mak­ing a re­turn ap­pear­ance in the United States. There was still more to mourn as the fi­nal wave of this great plague hit from Jan­uary to June 1919, fo­cus­ing its strengths on the ar­eas that had been hit by the first wave and rarely touch­ing the places af­flicted by the ag­gres­sive sec­ond wave.

The 1918 in­fluenza strain was un­like any other. It at­tacked the health­i­est and strong­est through a fa­tal chain re­ac­tion that trig­gered an un­fath­omable im­mune re­sponse. This flu sub­verted the im­mune sys­tem and used its strength to de­stroy the healthy tis­sue of vi­tal or­gans. In­di­vid­u­als with poorer im­mune sys­tems were spared by this over­re­ac­tion of the body, while ev­ery­one else was bom­barded with an at­tack from the virus and im­mune re­sponse in­stead.

In­fluenza can leave suf­fer­ers bedrid­den for weeks as the fever, joint pain and lethargy fore­shadow the nas­tier symp­toms yet to come.

The virus’ in­cred­i­ble suc­cess to plague our species comes from its re­mark­able abil­ity to reshuffle its genes into new pat­terns, so it can in­vade un­recog­nised by the hu­man body, mak­ing it vir­tu­ally un­stop­pable.

The flu be­comes more dan­ger­ous when it in­fects an­i­mals, where it can mu­tate to in­clude more deadly genes, and it is this sur­vival mech­a­nism that has caused large-scale pan­demics through­out his­tory, in­clud­ing the Asian flu of 1957 and the Hong Kong flu of 1986. Th­ese pan­demics have mostly arisen from dis­ease hot spots where an­i­mals and hu­mans live in close prox­im­ity, and sci­en­tists have lit­tle doubt the Span­ish flu be­gan in the same way.

At the time of the out­break, there was hys­te­ria as peo­ple blamed mus­tard gas and the squalor of the trenches, while bur­geon­ing sus­pi­cions were fos­tered against the Ger­man U-boats — had they de­ployed bi­o­log­i­cal war­fare? But as Span­ish flu pen­e­trated fur­ther into Europe, it be­came clear that it was a dev­as­tat­ing dis­ease, although there were few re­ports about it.

While the Bri­tish Em­pire and Al­lied na­tions had been placed un­der wartime cen­sor­ship, Spain’s neu­tral­ity al­lowed rel­a­tively free re­port­ing, lead­ing to the false un­der­stand­ing that it was hit first.

This led to the dis­ease’s nick­name, Span­ish flu. Though there is some con­tention sur­round­ing the out­break’s ori­gins, there is a con­sen­sus that it didn’t start in Spain. In­stead, there are two likely sources — France and the United States.

The site of the first con­firmed out­break was at Camp Fun­ston in Fort Ri­ley, Kansas, a US Army camp that was pre­par­ing Amer­i­can troops for bat­tle across the ocean in Europe. The first vic­tim was Pri­vate Al­bert Gitchell, who was di­ag­nosed on 11 March 1918, and within days, over 500 men at the camp had re­ported sick. This was con­sid­ered the source of the out­break for decades and it had been ex­pected that when the US be­came in­volved in the war, they brought the killer virus back home from Europe. But this hy­poth­e­sis changed when Dr John Ox­ford, a Bri­tish ex­pert on in­fluenza, iden­ti­fied the French mil­i­tary base in Éta­ples as the pan­demic’s source.

This over­crowded ma­jor troop stag­ing and hospi­tal camp on the Western Front pro­vided the per­fect breed­ing ground for a killer virus.

The sol­diers al­ter­nated ev­ery few weeks be­tween the fes­ter­ing trenches be­fore re­treat­ing to the mil­i­tary camps to rest in close con­tact with chick­ens and ducks. In late 1917, mil­i­tary pathol­o­gists re­ported the on­set of a new dis­ease with high mor­tal­ity — which would later be recog­nised as Span­ish flu — among the 100,000 sol­diers that who were fre­quently pass­ing through the en­camp­ment. Ad­di­tion­ally, Dr Ox­ford’s team re­vealed a part of the story that had been lost in the his­tor­i­cal nar­ra­tive of the Great War — even be­fore Amer­ica’s in­volve­ment, doc­tors and nurses from the US were en­listed and were free to visit home. It is this move­ment he at­tributes to the al­most si­mul­ta­ne­ous out­breaks at Fort Ri­ley and Éta­ples.

The con­flict had seen sol­diers drafted from ev­ery cor­ner of the Bri­tish Em­pire and as war waged in the trenches of the Western Front, they needed yet more man­power. Sol­diers an­swered the call for arms from Aus­tralia, the Caribbean, Pak­istan and be­yond. The dis­ease then swept through the world in a sec­ond dead­lier wave, fa­cil­i­tated by the ju­bi­lant ser­vice­men re­turn­ing home. It de­stroyed fam­i­lies and bought en­tire civil­i­sa­tions to their knees. Fu­neral homes were over­whelmed and bod­ies were pil­ing up out­side. Mass graves were be­ing dug and some corpses were thrown into the ocean. In Pun­jab, streets were lit­tered with un­col­lected bod­ies and trains were stopped to be cleared of the dead and dy­ing.

In des­per­a­tion, some Subarc­tic com­mu­ni­ties al­legedly had no other op­tion than to line the tops of the roofs of their houses with the bod­ies of loved ones as they were un­able to dig into the frozen ground and didn’t want wild an­i­mals to drag the car­casses into the wilder­ness. The Mo­ra­vian Mis­sion re­ported that in Okak, Labrador, where only about 50 peo­ple sur­vived from a pop­u­la­tion of roughly 266, huskies feast­ing on the bod­ies of the dead at­tacked an or­phan child, who had been left to fend for her­self.

Many who man­aged to sur­vive the virus per­ished from star­va­tion or hy­pother­mia in­stead, when they were too weak to get wa­ter or stoke their fires. The work­force be­came weak and busi­nesses, in­clud­ing postal and garbage dis­posal ser­vices, shut down. Al­most ev­ery na­tion had makeshift morgues with hun­dreds of corpses. Some cities marked their door­ways to show that some­one had died. In Toronto, they used a white sash for chil­dren, grey for the mid­dle-aged and pur­ple for se­nior citizens.

Hearses car­ry­ing bod­ies through the streets be­came fa­mil­iar sights, and anx­ious citizens stuffed cot­ton with cam­phor or adorned them­selves with moth ball neck­laces. Oth­ers sipped vi­o­let-leaf tea or warm milk and ginger, or would fu­mi­gate their houses with hot coals and sul­phur. The des­per­ate at­tempts to ward off the virus were fu­tile. By Novem­ber 1918, the out­break had reached the re­mote town of Bre­vig Mis­sion, Alaska, killing ev­ery adult. It only spared a few chil­dren and teenagers.

With no es­tab­lished cause for the dis­ease that was killing peo­ple overnight, and with med­i­cal pro­fes­sion­als con­tend­ing with only rudi­men­tary sci­en­tific knowl­edge on the pathogen they were con­fronting, coun­tries fran­ti­cally fought back against the virus in any way they could. New Zealand pur­port­edly be­gan ex­ter­mi­nat­ing ro­dents, while towns in Eng­land poured dis­in­fec­tant into the street gut­ters. The United States be­gan fu­mi­gat­ing ar­eas with po­tent con­coc­tions of coal, tar and formalde­hyde, and news­pa­pers printed warn­ings about breath­ing in fresh air and to avoid close con­tact with other peo­ple.

Peo­ple be­gan to com­mu­ni­cate more by phone and post but even let­ters may have been baked in a hot oven be­fore they were opened to kill the bac­te­ria. Tele­phone in­stall­ers took to dip­ping cheese­cloth in formalde­hyde to cover their nose and mouth. The Aus­tralian and Amer­i­can gov­ern­ments man­dated masks to pre­vent the spread but they did noth­ing against the virus. There was lit­tle the world could do other than to wait for it to run its course.

The deadly strain of in­fluenza dis­ap­peared as fast as it had started but sur­vivors were not left with­out scars. Many of those who re­cov­ered also suf­fered phys­i­cally crip­pling in­vol­un­tary jerks, spasms and cata­to­nia caused by brain in­flam­ma­tion. Sci­en­tists be­lieve that the so-called ‘Span­ish Lady’ had be­come a vic­tim of her own suc­cess, leav­ing only the im­mune or dead in the wake of her de­struc­tive path.

With few new hosts to in­fect, the virus evolved again into a much less deadly strain — an an­ces­tor of the flu we bat­tle to­day. Many de­tails of the great­est med­i­cal tragedy will be for­ever lost to his­tory, mis­placed in the shadow of the Great War, but we can only hope to pre­pare our­selves for the day pan­demic in­fluenza strikes again.

A poster of­fer­ing pub­lic health tips in Wash­ing­ton, DC A London dou­ble-decker bus is sprayed with dis­in­fec­tant

Ja­panese school­girls wear face masks in an at­tempt to stave off the in­fluenza

The flu that killed nearly 100 mil­lion peo­ple across the world

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