Spanish Flu Pandemic – 1918

One of the characters in my novel, explains that he was raised by his grandpa because his parents died in New York City from the Spanish flu. According to my own family history, my grandmother lost her oldest daughter, a child of ten, when the Spanish flu spread to their tiny village in northern Italy. Here’s what I discovered when I researched this terrible illness.

Some historians have called Spanish flu—which swept around the world in 1918—the “forgotten pandemic.” Why forgotten? Some say it was overshadowed by the events of World War I. Others note that epidemiologists of the time were unaware of the true number of disease victims.

Ward in Kansas handling Spanish flu victims in 1918.
Flu victims in a makeshift ward in Kansas

But it was a true pandemic, one of the worst in recorded history. More people died of influenza in a single year than in four years of the Bubonic Plague (“the Black Death”) which occurred in the 1300s. World War I killed approximately 9 million combatants. By most estimates the Spanish flu killed approximately 50 million people worldwide. In New York City, the setting for much of my novel, 20,000 to 24,000 deaths—out of a 1918 population of 6,000,000—were attributable to the flu.

The effect of the Spanish flu was so severe that the average life span in the US fell by more than 10 years. The virus had a mortality rate of approximately 20 percent, much higher than previous strains of the flu. Another striking thing about Spanish flu was that its victims were primarily healthy young adults rather than children or the elderly. The death rates for 15 to 34-year-olds of influenza and pneumonia (often brought on by the flu) were 20 times higher in 1918 than in previous years.

People struck with the illness often died rapid deaths. One physician wrote that patients with seemingly ordinary influenza would quickly develop pneumonia and struggle for air until they died. An anecdote shared in 1918 was of four women playing bridge together late into the night. They all felt fine. Overnight, three of the women died from influenza. Other stories told of people on their way to work suddenly developing the flu and dying within hours.

The unusual severity of the strain of virus that became known as Spanish flu contributed to the huge number of deaths. And the time period did as well. There were no flu vaccines and no antibiotics to treat secondary infections. This meant the flu had to be fought in other ways. In many communities, police officers, mail carriers, and other workers began wearing masks in public in an effort to avoid infection. In some cities, street car passengers were required to wear masks. Boy Scouts reminded people not to spit. Cartoon drawings told people to use handkerchiefs. Posters warning about the disease were placed in public areas. Schools, gyms, and military tents were used for extra hospital space. In New York City, the health commissioner established shifts for different types of businesses in order to avoid overcrowding on the subways. Fear of the flu affected all aspects of life. Children would jump rope to the following rhyme: I had a little bird, its name was Enza, I opened the window, and in-flu-enza.

By the summer of 1919, the Spanish flu pandemic had ended. An interesting—and chilling—article on the Spanish flu may be found on the website of the Center for Disease Control and Prevention at https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html.  In 2018, The Atlantic published an amazing collection of photos documenting the Spanish flu’s effect. It can be found at https://www.theatlantic.com/photo/2018/04/photos-the-1918-flu-pandemic/557663/.  In 2009, The New York Times published an article on the city’s health commissioner who oversaw efforts to prevent spread of the flu. It’s available at https://www.nytimes.com/2009/05/01/nyregion/01bigcity.html