U.S. Library of Congress

Looking back at the 'worst infectious pandemic in history' and what it taught us

By Carter Williams, KSL.com | Posted - Feb. 7, 2020 at 8:23 a.m.


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Editor's note: This article is a part of a series reviewing Utah and U.S. history for KSL.com's Historic section.

SALT LAKE CITY — The coronavirus that began in China and has slowly spread globally has infected thousands and even led to a few hundred deaths over the past few weeks. The World Health Organization declared it a global health emergency last week.

With the outbreak grabbing news headlines and people’s attention it’s a reminder that coronaviruses aren’t new, and neither are global viral outbreaks. That’s especially true as the world has become increasingly connected over time. However, no outbreak has created more chaos than when a particular flu strain began ravaging the world a little more than a century ago.

It’s not entirely clear how the 1918 influenza pandemic originated, but it came as World War I was nearing an end. It was referred to as the “Spanish flu” at the time because it was first noticed in Spain. But the illness likely started in the United States and traveled with soldiers as they went overseas to fight, historian Leonard Arrington wrote in a paper for the spring 1990 edition of Utah Historical Quarterly.

The H1N1 virus spread quickly and viciously. By the time the pandemic ended in 1919, it was believed to have infected some 500 million people worldwide, or about one-third of the world’s population at the time, according to the U.S. Centers for Disease Control and Prevention. The virus was believed to have killed more than 50 million people worldwide — claiming more lives than four years of fighting.

A research paper on the disease, which appeared in the Proceeding of the National Academy of Sciences of the U.S. in 1998, stated it was “the worst infectious pandemic in history.”

How it was initially reported in Utah

Scrolling through newspaper archives, the 1918 pandemic was reported in Utah as early as July 1918. A wire story with the headline “Epidemic of influenza threatens whole world” appeared in the July 13, 1918, edition of the Salt Lake Telegram.

“The obnoxious disease first became epidemic in Spain a few months ago. Even King Alfonso fell victim to it. Hardly a city or town in Spain escaped,” the article read. “Then it spread to Germany and the German army became infected. So widespread was the epidemic in Hunland that the delay in resuming the German drive on the western front has been ascribed to it.”

The report noted that it then spread to England, where schools were closed and, at the time the article was published, businesses were at risk of also closing to stop the spread of the virus. The article pondered whether the U.S. would also face the crippling effects that European countries were facing at the time.

In this 1918 photograph, influenza victims crowd into an emergency hospital at Camp Funston, a subdivision of Fort Riley in Kansas. The flu, which is believed to have originated in Kansas, killed at least tens of millions of people worldwide. (National Museum of Health and Medicine, Armed Forces Institute of Pathology via AP Photo)

Flash forward to Sept. 19, 1918, when the Salt Lake Herald-Republican published an apparent message from state health officials. They warned Utahns about the virus. At that point, they feared an outbreak would be similar to one from 1890 that killed about 1 million people worldwide.

“State authorities fear a repetition of the influenza epidemic of 1890 when the disease spread throughout the country,” the paper reported. “Should the dreaded ‘Spanish’ influenza ramify into Utah, the state will promptly announce measures to prevent it from developing into a serious epidemic.”

How the pandemic affected Utah

Utah wasn't spared as the outbreak turned to the U.S. Once it first reached the state on Oct. 3, 1918, Utah State Health officer Dr. T.B. Beatty "was sufficiently concerned to issue a directive banning all public gatherings, including church meetings and theater performances," Arrington wrote.

"He warned school districts and universities that they should give serious consideration to closing schools and colleges," he added. "They did so two days later and most of them remained closed until early in January 1919."

More than 1,500 cases and 117 deaths were reported in Utah within four weeks of the virus reaching the state. Arrington pointed out that on Oct. 15, 1918, 161 news cases and six deaths were reported on that day alone.

About the same time, the State Board of Health recommended standard procedures of the time, such as bed rest, eating healthy food and seeing a doctor; however, the board also suggested people keep a window open and wear a gauze mask that covered their nose and mouth when entering a sick room, which wasn't standard practice at the time, historian Robert McPherson wrote in another paper for the 1988 edition of Utah Historical Quarterly.

This photo taken in 1918 or 1919, shows precautions taken in Seattle, Washington during the influenza pandemic. The city would not permit anyone to ride on its streetcars without wearing a mask. 260,000 of these were made by the Seattle Chapter of the Red Cross, which consisted of 120 workers. Reports from the time indicate Utah had similar public precaution measures once the flu reached the state in October 1918. (Photo: U.S. Library of Congress)

What made it alarming is it seemed to affect younger, healthy adults just as much as infants or elderly people. It was bad enough that Salt Lake City officials would quarantine homes where the flu appeared. They'd placard those homes with "influenza" in large letters and there was "rigid" enforcement against public assembly at one point, Arrington wrote.

"To make the point clear, the police arrested the proprietor and seven card-playing customers of a soft drink establishment and card room at 547 W. Second South," he added. "The city also reminded citizens of the requirement that gauze masks be worn in public places."

In all, about one-fifth of the people living in the state at the time would be infected by the outbreak, Utah State History noted. Nearly 3,000 Utahns and about 675,000 Americans died from it. In comparison, 665 soldiers from Utah died during World War I — and most Utah soldiers died from disease or illness.

What the pandemic taught us

Looking back at it now, the CDC points at several reasons why the 1918-1919 H1N1 strain was so deadly.

"With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly," the agency wrote.

Advances have been made since the 1918 pandemic. In a study published in the American Journal of Epidemiology, researchers who looked back at the pandemic wrote: "We now have advanced capabilities in prevention, surveillance, diagnostics, and treatments that were unknown 100 years ago, as well as a myriad of tools for pandemic response planners."

However, as the number of those infected by the coronavirus continues to grow, the 1918 pandemic and other virus or coronavirus outbreaks over the past century are a reminder of how quickly these viruses can spread. The 1918 pandemic is just an example of how devastating the diseases can get.

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