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History sends a warning about pandemic second waves

In his thoroughly researched and masterfully written book, “The Great Influenza: The Story of the Deadliest Pandemic in History,” John Barry argues that although it can never be proved conclusively, evidence suggests the 1918 pandemic (Spanish Flu) started between Feb. 28 and March 2 of that year when several young men from Haskell County, Kansas — where a “severe influenza” was raging — traveled to Camp Funston, a part of Fort Riley, Kansas. 

There is no doubt the movement of millions of military-age men and women during World War I significantly contributed to the pandemic that claimed between 50 million and 100 million lives worldwide when global population was between 1.8 and 1.9 billion. (7.8 billion today).

Barry notes that a “river of soldiers” moved from Camp Funston to other military bases in the U.S. and then to France. Two weeks after the first soldier fell ill in Kansas, the influenza surfaced at two Army bases in Georgia, where 10% of the personnel at those camps would become sick. From these two installations the influenza spread rapidly and was soon reported at 24 of the 36 largest military bases in the country, as well as 30 of the nation’s 50 largest cities, most of them adjacent to those military bases. 

There were localized reports of influenza in France (where some scholars are of the opinion the pandemic may have started) in early 1918, but the cases were mild. The first significant outbreak began in Brest in early April, shortly after American troops arrived in France, and was reported in Paris in late April. By May, the disease had exploded, and the First British Army suffered over 36,000 hospital admissions and tens of thousands of less serious infections. The German army also experienced an influenza, and the malady may have been a factor in canceling a third phase of a major and, up to then, successful military offensive. Over the next few months the virus would spread across Europe, then worldwide. 

Through the first half of 1918, the overwhelming majority of cases were not severe and bore little resemblance to the virulent disease that killed people in Haskell County, Kansas, leading many physicians to wonder if the sickness was influenza. However, there were sporadic lethal exceptions. A U.S. Army report noted the virus often led to “fulminating pneumonia with hemorrhagic lungs” that killed a soldier in 24 to 48 hours.

By mid August the disease seemed to disappear, and the British military command declared the epidemic over. Phase one had ended, but a much more deadly second phase of the pandemic was about to begin. 

Why was the second phase of the 1918 pandemic, which claimed the majority of the 675,000 lives lost in the U.S., so much more lethal than the first and third waves? John Barry states the virus adapted to humankind via a phenomenon known as “passage.” When a pathogen (an organism such as bacterium or virus that can make people sick) “passes from living animal to living animal, it reproduces more proficiently, growing and spreading more efficiently.” This process often increases the virulence or severity of the pathogen as “it becomes a better and more efficient killer.” 

Barry notes that passage is a complex phenomenon, as the killing capacity of the virus does not increase and continue indefinitely. If a pathogen is too efficient a killer, it will run out of hosts and die. “Eventually its virulence stabilizes and eventually recedes.” In some instances of “passage” a pathogen can become “less dangerous instead of more dangerous,” as it did in the 2014-16 ebola epidemic in West Africa.

According to the National Institutes of Health, the majority of deaths in 1918 were not caused by the influenza virus alone, as most victims died of bacterial pneumonia following the influenza infection. (Antibiotics would not be widely used to treat bacterial infections until the early 1940s.) It was a horrible death, as described by U.S. Army physician Roy Grist in 1918. In a letter to a colleague about the influenza outbreak at Camp Devens (near Boston), Grist stated, “These men start with what appears to be an ordinary attack of LaGrippe or Influenza and when brought to the Hospital they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have Mahogany spots over their cheek bones, and a few hours later you begin to see Cyanosis extending from their ears and spreading all over their faces, until it is hard to distinguish colored men from the white.”

Cyanosis occurs when victims turn blue as their lungs are unable to transfer oxygen into the blood. In 1918 cyanosis was so extreme that victims often turned dark blue, triggering rumors the murderous disease was not influenza but the Black Death. Grist wrote that “It is only a matter of a few hours before death comes … it is horrible.”

On Sept. 28, 1918, the city of Philadelphia held an enormous Liberty Loan war bonds parade that attracted an estimated 200,000 spectators, even though influenza had been spreading in the city for at least 10 days and health officials urged the mayor to cancel the event. The outbreak exploded on Oct. 3, and 12,000 people would die over the next five weeks. When there were no more caskets to inter the staggering number of influenza victims, bodies were wrapped in white cloth and buried in mass graves.

John Barry states “there was terror afoot in 1918 … the randomness of death brought that terror home. So did its speed.” Children at play sang variations of the following ditty: “I had a little bird, its name was Enza. I opened the window, and in-flew-Enza.”

According to Barry, the virus was like a hunter — stalking and killing people not only in cities but in the most remote places on earth. A physician in Alaska visited 10 Eskimo villages and found “three wiped out entirely; others averaged 85% deaths. … Survivors, generally children … frozen to death before help arrived.”

When the second wave appeared to have dissipated in this country, some people “had the hubris to believe they had defeated it.” After local health boards and “emergency councils had cancelled orders to close theaters, schools, and churches and to wear masks, a third wave broke over the earth. … The virus had mutated again.”

As was the case with the 1918 “Spanish Flu,” pandemics often occur in multiple waves. Will a nation grown weary of social distancing, eager to reopen an economy that has left millions of people unemployed, trigger a second wave? Are we about to begin a new phase of the coronavirus pandemic that will be significantly more deadly than the first wave?

P.S. Canadian historian Mark Humphreys argues the 1918 pandemic began in northern China in 1917 and spread to Europe via 94,000 Chinese laborers sent to southern England and France to free up young men to fight in World War I. Humphreys cites medical records indicating that as many as 3,000 of the 25,000 Chinese Labor Corps workers who arrived in Vancouver — then transported across Canada by train before leaving for Europe by ship — were quarantined with “Spanish Flu”-like symptoms. According to Humphreys, this was the origin of the pandemic in North America. In a recent interview, John Barry states “the leading hypotheses” where the pandemic began “are China, the US, France and Vietnam, but it could have started somewhere else.”

George J. Bryjak lives in Bloomingdale and is retired after 24 years of teaching sociology at the University of San Diego.

Sources:

“Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic” (Aug. 19, 2008) National Institute of Health, www.nih.gov 

Barry, D. and C. Dickerson (April 4, 2020) “The Killer Flu of 1918: A Philadelphia Story,” New York Times, www.nytimes.com 

Barry, J. (2018) “The Story of the Deadliest Pandemic in History,” Penguin Random House LLC: New York 

Chodosh, S. (2020) “What the 1918 flu pandemic can teach us about COVID-19 in four charts,” Popular Science, www.popsci.com 

Harden, R. and L. Ivers (March 29, 2020) “Anticipating the next waves of COVID-19” The Hill, https://thehill.com 

Humphries, M. (Jan. 8, 2014) “Paths of infection: The First World War and the origins of the 1918 Influenza Pandemic,” War and History, https://journals.sagepub.com

Klein, C. (March 7,  2019) “China Epicenter of the 1918 Flu Pandemic, Historian Says,”

History, www.history.com 

MacKinnon, L. (April 1, 2020) “What if COVID-19 comes in waves, as other pandemics have?” Politics Canada, www.politics.ca,

Shetty, M. (2020) “Penn and the 1918 Influenza Epidemic,” Penn University Archives & Records Center, http://archives.upenn.edu

Tapper, J. (March 27, 2020) “What the author of ‘The Great Influenza: The Story of the Greatest Pandemic in History” can teach us about coronavirus,” CNN. www.cnn.com 

“The Influenza Epidemic of 1918” (accessed 2020) Stanford University. www.stanford.edu 

Worobey, J. and J. Cox (2019) “The Origins of the Great Pandemic,” Evolution, Medicine and Public Health, Volume 2019, Issue 1, www.academic.oup.com 

“1918 Pandemic Influenza: Three Waves” (accessed 2020) Centers for Disease Control, www.cdc.gov 

“2014-2016 Ebola Outbreak in West Africa” (accessed 2020) Centers for Disease Control, www.cdc.gov

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