1918 Pandemic Second Wave

This show is coming out on July 7th, 2020. Of course, we don’t yet know what the immediate (or even the long-term) effects of the COVID-19 pandemic in the United States and worldwide will be. Protests against having to wear masks and living with other restrictions are getting lots of media attention. Many anti-maskers are posting, frankly, bizarre claims on social media about health restrictions being un-American, comparing mask requirements to communism, and yelling that health officials are Marxists.

Social media being social media, however, there are lots of other posts claiming different things. As far as we at the Buzzkill Institute can tell, most of these are relatively normal and do not use faulty historical references to Marxism or totalitarianism or whether health restrictions are “un-American.”

And one of the most common threads I see contain lots of misunderstandings about the chronology of the 1918 influenza pandemic, and whether government and societal action (or inaction) was responsible for that flu returning for a second and third wave, and lasting till, roughly, April 1920.

So today I want to talk about the second wave of the 1918 Pandemic. But first let me establish a couple of ground rules for comparison. In the first place, although commentators and medical experts have warned about a second wave of COVID-19 hitting the world in the fall of 2020, it’s not at all clear when that’s going to happen. At least not in terms of starting in a specific month, or the infection curve starting to go up again once it hits a certain number at the bottom of that curve. It does seem, however, that, again, in the United States at least, that we are _not_ seeing the start of a second wave of the pandemic. The rise in cases and deaths recently seems to be still part of the first wave. So we can’t place a chronological template from the 1918 pandemic over the year 2020, and chart when things will happen.

The second ground rule is that, naturally, the world was very different a hundred years ago. Medical science was different, and the treatments of wide-spread illnesses were different. Most importantly, though, the major difference between then and now was the fact that World War I was still raging when the influenza broke out in 1918, and that governments, especially the United States government, often privileged wartime concerns over public health concerns. It might seem unwise to us now, but in 1918, the First World War seemed to be of much greater concern in terms of human mortality than an influenza outbreak. Many medical scientists at the time did not assume that the flu would last so long or be so deadly. So maybe it’s understandable that the US government heeded military concerns more than medical concerns. That’s certainly what most other countries did as well.

Before I go too far down the road of explaining the 1918 Influenza Pandemic’s second wave, let me briefly tell you the experts who I have relied on for this show. Naturally, John Barry’s book, The Great Influenza, is considered the best medical history of the pandemic (and, of course, is on the Buzzkill Bookshelf). So has the work of Dr. James Harris at Ohio State University, and, perhaps most importantly, Dr. J. Alexander Navarro, at the University of Michigan’s Center for the History of Medicine. Please note that this Dr. Navarro is not to be confused with Dr. Anthony Navarro, the economic and trade advisor to the Trump administration who is now one of President Trump’s most advisors on the response to COVID 19. Peter Navarro’s advice to the President and his public comments on the pandemic and how to handle it have, to put it mildly, been controversial. The scholarly work of Dr. J. Alexander Navarro is, on the other hand, highly regarded, and based on years of serious historical and archival work. So please don’t confuse th the two Navarros.

OK, now, what happened? As all of you know, the 1918 Influenza Pandemic broke out in March of that year. Historians of medicine are not completely certain, but the consensus opinion is that it started at a US Army camp in Kansas. The virus went through the camp quickly, and since troops were being trained in one area, and then moved around the country rapidly, the virus spread quickly to the east coast of the United States, and then to the Western Front in France, where American troops joined the other Allied troops. Once there, it moved through almost all of Europe, including through the forces of Germany and Austria-Hungary.

Most countries kept the news of the virus under wraps, so as not to hurt national morale during the war. But Spain was neutral during the war, and their newspapers reported the outbreak in that country. Those reports went to the foreign press, and the influenza was reported, therefore, as the Spanish Flu (which is why it is still lumbered with that incorrect attribution of its origin).

Reports of the influenza seemed to lessen near the end of the summer of 1918, and it looked as if this epidemic might not turn into a devastating world-wide pandemic. But by August, a new strain of the virus appeared. And the more or less constant movement of troops to and from Europe (and other places involved in the war) spread that new strain. Crowded conditions of military transportation also meant that naval troop transports and troop trains were almost perfect incubators and transmitters of each strain of the virus. It could have hardly been a more efficient way to spread the disease

This was the 1918 influenza pandemic’s “second wave,” and it proved far more deadly than the first. September and October were particularly bad months for mortality, especially in the United States. Nearly 200,000 Americans died in October alone. This new strain killed millions, and the manner of the deaths was particularly gruesome because the virus caused the body’s immune system to kick into overdrive and end up killing the person while trying to kill the virus.

The massive death of the second wave very quickly surpassed the death-toll of the initial outbreak. Historians of medicine and specialists in the 1918 pandemic are fairly certain that several non-medical factors were responsible for the increased deadliness of the second wave. Essentially, a combination of governmental preoccupation with military needs, a press muzzled by government censorship, and health-care systems overwhelmed by the severity of the pandemic created the perfect conditions for massive death.

Medical science couldn’t develop a vaccine for the virus. Even things like the microscopes of the time weren’t sophisticated enough to detect the details of this new virus and its evolving strains. By the late summer of 1918, severe nursing shortages ravaged the countries at war because the supply of nurses kept being split between “ordinary” war service and the need for nurses to care for the exploding number of domestic influenza cases in each country.

Press restrictions imposed by wartime governments made it very difficult for affected societies to mount “nation-wide” responses to the pandemic in each country. All too often, it seemed that the outbreaks of influenza were local or regional problems. It’s not that the public literally didn’t know about outbreaks in other cities and towns, but, essentially, they didn’t know enough. If they had, they might have put considerable pressure on their governments to react more comprehensively and in a more-coordinated manner.

And that brings me to what is probably the main reason why the 1918 second wave was so bad — the ways in which government preoccupation with pressing military concerns affected how they attempted to fight the pandemic within their own countries. And maybe this will provide us with glimpses of what we need to do to try to lessen the severity of the almost-inevitable second wave of the COVID-19 virus. In other words, the second wave of the 1918 flu might have been less severe if what we now call social distancing and quarantining had been more strictly and extensively followed.

Let’s take just two countries — Britain and the United States — as examples.

The British government had figured out by late summer 1918 that the only effective way to fight the mortality rate of the virus was a severe quarantining of their domestic population. They had seen what limited local quarantining in schools and other aspects of civilian life had done to lessen the pandemic’s impact. This led them to conclude that quarantining people would be the most efficient way of stopping the spread of the virus. So it’s not as if the British government (or any other modern government) hadn’t seen and understood the effects of a shutdown.

No, the problem was that a shutdown meant the halt of troop movements throughout the country and to the battlefields. World War I soldiers were often rotated to the distant rear of battle areas in order to give them time to rest and recover from the stresses of trench warfare. Some British soldiers were routinely sent back to Britain itself at set intervals for rest, and then returned to the front. Further, there was a constant demand for fresh troops, so new recruits had to travel to embarkation points in Britain to go to France and other areas of conflict. The flow was constant.

A shutdown also meant that civil workers in munitions and war production would have to stay home. Even though crowded factories were excellent environments to keep the influenza spreading, war production was considered so important that the government couldn’t risk halting it, or even slowing it down. The British government ultimately decided that both major aspects of the war (troop movements and the production of war material) was more important than trying to halt the pandemic.

A similar sort of thing happened in the United States, but reaction came from state and city governments, not so much from Washington DC. So there was great variation across the country.

Where state and local governments imposed school closings, prevented large social gatherings, closed nonessential businesses, and forced people to wear masks, the rates of infection and death were kept relatively low. Localities that did not do this sort of thing often saw devastating tragedies. The most famous of these was in the city of Philadelphia in late September 1918. The city had planned a major parade to encourage people to contribute to the Liberty Loan campaign to fund wartime needs. Cities and towns across the country were urged to raise as much money as they could, and some of them built civic pride by competing with other cities and towns to see who could raise the most money.

Health officials urged Philadelphia politicians to cancel the parade because of the overcrowding it would cause, which would lead to increased transmission of the virus. The politicians, however, were afraid of the city appearing un-patriotic and not raising enough money for the war effort if they cancelled the parade, so it went ahead. Perhaps even more deadly than the city’s insistence on the parade happening was the sentiment of a great many Philadelphians, especially immigrants and German-Americans, who believed that they would be tarred as traitors if they didn’t attend the parade and show their American patriotism.

And as you know from other 1918 shows we’ve done, Philadelphia became the hardest hit city in terms of influenza mortality. 1,000 people died in just the ten days following the Liberty Loan parade in late September.

In San Francisco, resistance to mandatory mask orders and social distancing erupted, much like we’ve seen these last few months. The Anti-Mask League of San Francisco was formed in January of 1918 in direct response to a new city ordinance requiring people to wear masks in public. Nearly 5,000 people attended the first meeting of the Anti-Mask League on January 25th, and the group fought against these new city laws throughout most of the rest of 1918. Despite the fact that health officials had shown that masks and social distancing worked, the Anti-Mask League argued that masks were not necessary, that they trapped the virus and re-infected the wearers, and that forcing people to wear masks and to social distance violated their civil liberties. Sound familiar?

San Francisco was still able to keep its infection rate relatively low because of the mask regulations, however.

At least, that is, until November 11th, 1918. Yes, Armistice Day, when the fighting of World War I stopped. Some cities and towns in the United States ended their influenza restrictions in response to the end of the war, and allowed large gatherings to celebrate the Armistice. City centers filled with revelers, restaurants and bars opened to crowds of customers, movie-houses opened, and live theatre started up again. Everything from the local cinema holding an audience of hundreds, to the local coffee shop with a handful-sized crowd became popular again in mid-November 1918.

And you know what I’m gonna say, Buzzkillers — the influenza death toll spiked in places where this sort of reopening happened.

Now, it’s very difficult to apply a single cause to the appearance of the second wave of the 1918 influenza. In fact, it’s impossible to find a single cause and a single group or system of thought to blame. Throughout this episode, you’ve noticed several reasons for the horrific second wave: governmental preoccupation with military needs, a press muzzled by government censorship, health-care systems overwhelmed by the severity of the pandemic; and the celebrations after the November 11th Armistice.

Apart from not having a World War to fight, you’ve no doubt noticed a great many parallels between 1918 and how the COVID-19 pandemic has been handled this year, at least in the United States. (And one might argue that pressures to “re-open” the American economy sound an awful lot like the 1918 emphasis on the War as the nation’s pre-occupation.)

I do not wish to rush to blame, and I don’t want to rely too much on that old saw about not learning the lessons of the past. But it seems to me that there are two ways in which we’re repeating the mistakes of 1918 during the increase in death rates in the last month (which is, after all, still within the first wave of this pandemic). First, the dramatic differences between the way states and localities are toying with their ideas of “re-opening” their economies. And, second, the shocking level of willful-ignorance about, and childish obstinance against, simple and common sense health rules and practices among (admittedly, a minority) of Americans, we are seeing history being repeated.

I hope that all decent and sane people will realize that we may very well be setting ourselves up for a 2020 Influenza Pandemic second wave that will be deadlier than the first. I would have hoped that some of the similarities with mid-to-late 1918 would be more obvious and better-understood by our culture. Many people (some of the more sensible state governors, the actual scientists on various government health panels) are responsible, and seem to be at least arguing for our national government and our populace to listen to reason, to listen to science, and to follow best medical practice.

I just worry that warnings are not being heeded as closely as they should be. And, because of some of the things that happened during 1918, we’ve been told this lesson before.

Talk to you next week.

Buzzkill Bookshelf

John M. Barry, The Great Influenza: The Story of the Deadliest Pandemic in History

Magisterial in its breadth of perspective and depth of research, The Great Influenza weaves together multiple narratives, with characters ranging from William Welch, founder of the Johns Hopkins Medical School, to John D. Rockefeller and Woodrow Wilson. Ultimately a tale of triumph amid tragedy, this crisis provides us with a precise and sobering model as we confront the epidemics looming on our own horizon.


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