In 1918, flu killed tens of millions

The flu arrived as a great war raged in Europe, a conflict that would leave about 20 million people dead over four years.

In 1918, the flu would kill more than twice that number — and perhaps five times as many — in just 15 months. Though mostly forgotten, it has been called “the greatest medical holocaust in history.”

Experts believe between 50 and 100 million people were killed. More than twothirds of them died in a single 10-week period in the autumn of 1918.

Never have so many died so swiftly from a single disease. In the United States alone, it killed about 675,000 in about a year — the same number who have died of AIDS in nearly 40 years.

As the country muddles through a particularly nasty flu season — one that the Centers for Disease Control says has killed 24 children in the first three weeks of January and 37 since the start of the flu season — the 1918 nightmare serves a reminder. If a virulent enough strain were to emerge again, a century of modern medicine might not save millions from dying.

“You think about how bad it was in 1918, and you think surely our modern medical technology will save us, but influenza is the Hollywood movie writer’s worst nightmare,” said Anne Schuchat, CDC’s deputy director, at a recent seminar on the 1918 pandemic. “We have many more tools than we had before, but they are imperfect tools.”

One hundred years ago, a third of the world’s population came down with what was dubbed the Spanish flu. (It got its name when the king of Spain, Alfonso XIII, his prime minister and several cabinet ministers came down with the disease.)

The flu brought life to a standstill, emptying city streets, closing churches, pool halls, saloons and theaters. Coffin makers couldn’t keep up with demand, so mass graves were dug to bury the dead. People cowered behind closed doors for fear they would be struck down.

In Philadelphia, news stories described priests driving carts through the streets, encouraging people to bring out the dead so that they might be buried.

In New York there were accounts of people feeling perfectly healthy when they boarded the subway in Coney Island and being taken off dead when they reached Columbus Circle. Entire families succumbed. In Tyler County, West Virginia, John Linza, his wife and two of their sons died on the same day. Two other sons died just days before them. The last Linza, an infant, died the day after his parents.

In the southwestern tip of Virginia, J.W. Trent, his wife and two sons fell ill. They were preceded in death by all four of their young daughters — Hattie, Mary, Ellen and Ruby.

In 10 weeks, the flu killed 20,000 in New York City and produced 31,000 orphans.

There is debate among historians about where the flu first surfaced — did it come from China or a British encampment in northern France or rural Kansas? But it spread worldwide practically overnight.

By the end of November, 50,000 had died in South Africa, where at its peak flu killed 600 people each day. In Egypt, the death count reached 41,000 in Cairo and Alexandria by January. In Tahiti, trucks roamed the streets of Papeete to collect the dead.

Normally the most vulnerable to influenza are infants, whose immune systems are not yet up to the test, and the elderly, whose ability to fight disease diminishes with age. In 1918, more than half the people it killed were in the prime of their lives.

Many died within hours, turning blue from lack of oxygen as they coughed foamy blood up from their lungs.

The Spanish flu infected the upper respiratory tract and then dove deep into the lungs with viral or bacterial pneumonia. How did it kill so many young healthy adults? Their immune systems attacked the influenza invader with such force that it killed them.

One Army doctor, quoted by historian John M. Barry, author of the bestseller, “The Great Influenza,” described the scene at a base hospital in Massachusetts:

“When brought to the (hospital) they very rapidly develop the most vicious type of pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see (the blueness) extending from their ears and spreading all over the face . ... It is only a matter of a few hours then until death comes . ... It is horrible.”

A century later, science has revolutionized the medical profession, producing miracle drugs and surgical procedures that no one could have imagined in 1918.

But when Thomas Frieden stepped down as head of the CDC last year he was asked in an interview what keeps him awake at night.

“We always worry about pandemic influenza because this has the potential to kill so many people,” he said.

Jeffery Taubenberger and Ann Reid were the first researchers to sequence the genome of the influenza virus that caused the 1918 pandemic.

“The most important thing to do is not just to understand 1918 as a historical phenomenon,” said Taubenberger, an NIAID virologist, “but as an example of what could happen in the future.”