Spanish flu - Flu
1918 Spanish influenza ward at Camp Funston, Kansas. Photo: US Army Photograph, WikiCommons

JACKSON, Wyo. — If anyone was still alive today that lived through the 1918 Spanish Influenza pandemic, they might recognize a lot of similarities with this day’s COVID-19 outbreak.

Like the current coronavirus, the deadly flu of 1918-19 moved slowly to the U.S., beginning in major metropolitan areas and spreading, slowly and eventually, to Jackson Hole even as local news media here in 1918 said there was little chance it would get to such an isolated valley.

As the Great War in the Europe began winding down a far deadlier scourge was to claim more lives—10 times as many—than WWI.

The dreaded “La Grippe” infected 28% of all Americans, with an estimated 675,000 succumbing to the Spanish Flu during the pandemic. Of the U.S. soldiers who died in the European theatre, half of them fell to the influenza virus and not to the enemy.

The 1918-19 influenza pandemic would go on to kill more people in absolute numbers than any other disease outbreak in history. Contemporary estimates put the death toll at 21 million, worldwide, but some epidemiologists have revised that number in recent years to be as high as 50, to perhaps 100 million deaths.

Okay, enough with the scary numbers. Point taken. Spanish Influenza was bad; like Black Plague bad, smallpox deadly.

A regular purge of humankind?

Pandemics are nothing new in history, and their long record across the ages and continents has much to teach us about how best to handle the current outbreak. The pandemic of 1918-19 was hardly the world’s first influenza pandemic. Throughout history, there have been others—the Africa outbreak of 1510, Asia flu of 1580, Yellow Fever gripped the United States in 1647, England/Ireland epidemic of 1688, the London outbreaks in 1847-48 and again in 1889-90.

But 1918 topped them all.

It began mildly, with a spring wave in March and April. In fact, it was so mild that some physicians wondered at the time if this disease actually was influenza. Early cases in Kansas and in military camps spread throughout the U.S. were all but ignored.

Until the second wave. Fall of 1918, the flu hit hard.

Soldiers returning from the war brought it back to the U.S. with them. It first arrived in Boston in September of 1918. The virus killed almost 200,00 in October alone. In November, as people celebrated Armistice Day with parades and parties, a more fearsome enemy was taking hold on American shores.

The ‘Black Death.’ Watercolor by Monro Orr. Photo: Creative Commons

What was La Grippe and how does it compare to COVID-19?

Dubbed “Spanish Influenza” because Spain was reportedly hit particularly hard early (8 million deaths in that country), the disease likely originated elsewhere. Maybe China, France, Britain—even the U.S have been considered in myriad studies. What is known is a rare genetic shift of a strain of H1N1 avian influenza virus started the whole thing. The recombination of its surface proteins created a virus novel to almost everyone on the planet, capitalizing on a lack of herd immunity.

Recent molecular studies attempting to reverse-engineer the virus from the frozen tissues of a dead soldier may shed more light on exactly what Spanish Flu was but for now what scientists have learned is characterization of five of the eight RNA segments of the 1918 influenza virus indicates that it was the common ancestor of both subsequent human and swine H1N1 lineages. Since the appearance of H5N1 in 1997, pathologists have noticed a lot of similarities there as well.

Jackson’s Hole Courier 1918. Image: Wyoming Newspaper Project

And the 1918 flu targeted young adults. Those between ages 20-40 accounted for most of all deaths. The over 50 age group was far less affected. Perhaps more disturbing is the fact that the actual flu disease was not responsible for the majority of deaths associated with the influenza in 1918-19, it was secondary bacterial pneumonia so nasty pathologists conducting autopsies found the lungs in such a devastated condition the only thing they could compare it to was victims of poison gas.

Military doctors called it “atypical pneumonia” back then. Today it’s referred to as Acute Respiratory Distress Syndrome (ARDS). The Army’s pneumonia board judged that “more than half” of all the deaths among soldiers came from this atypical pneumonia.

According to California State University professor Ibrahim Al-Marashi, who wrote an enlightening treatise in the Bulletin of the Atomic Scientists titled, Black plague, Spanish flu, smallpox: All hold lessons for coronavirus, the recent COVID is just another instance in the long history of so-called zoonoses—diseases that jump from animals to humans.

The domestication of the horse led to the virus responsible for the common cold in humans, while the domestication of chickens gave humans chickenpox, shingles, and various strains of the bird flu. Pigs were the source of influenza, and measles, smallpox; and tuberculosis emerged from cattle.

When a virus successfully jumps species from an animal to a human (“patient zero”), and that version of the virus, in turn, succeeds in making the jump to a second human, those two people become the first two human vectors of human-to-human virus transmission.

Three-quarters of infectious diseases are the result of zoonotic spillovers, and the novel coronavirus is no exception. The term “coronavirus” refers to a family of viruses shaped like a crown, and it accounts for about 10 percent of common colds in humans. (Rhinoviruses are the predominant cause of the common cold.)

Novel coronaviruses have made the jump into the human population on three occasions in the 21st century, each time causing a deadly pandemic: SARS (severe acute respiratory syndrome) in late 2002, MERS (Middle East respiratory syndrome) in 2012, and COVID-19 (coronavirus disease 2019) at the start of this winter.

Interestingly, as early as 2007, the world was put on notice by an American Society for Microbiology journal article, Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging InfectionIn it, researchers warned, “The presence of a large reservoir of SARS/CoV-like viruses in horseshoe bats, together with the culture of eating exotic mammals in southern China, is a time bomb. The possibility of the reemergence of SARS and other novel viruses from animals or laboratories, and therefore the need for preparedness, should not be ignored.”

But ignored it was.

Influenza patients getting sunlight at the Camp Brooks emergency open-air hospital in Boston. Medical staff were not supposed to remove their masks. Photo: National Archives

Ignore at your peril

What we are experiencing now around the world must look an awful lot like 101 years ago.

The flu that winter of 1918 was beyond imagination. Millions were infected, thousands died. No one escaped. The pandemic affected everyone. With one-quarter of the U.S. and one-fifth of the world infected with the influenza, it was impossible to hide from the sickness.

The strain was not only virulent and lethal but extraordinarily violent. It presented a suite of symptoms rarely seen with influenza—symptoms so unusual it was sometimes misdiagnosed as dengue, cholera, or typhoid. Patients exhibited a range of complications including hemorrhage from mucous membranes in the nose, stomach, and intestine. Flu sufferers sometimes bled from their ears and eyes, or even right through unbroken skin.

“Intense and protracted prostration led to hysteria, melancholia, and insanity with suicidal intent,” reported New York City Health Department’s chief pathologist on patients bedridden for so long if the disease didn’t kill them they were often driven mad with depression.

Physicians tried everything they knew, everything they had ever heard of; from the ancient art of bleeding patients to administering oxygen, to developing new vaccines and sera. Home remedies weren’t much better, either, though there was some anecdotal indication that fresh air and sunshine eased symptoms better than most anything else.

Doctors today are noting various possible home precautions that have been observed—at least in this early going—to have optimistic results. A blast of Vitamin C, and Vitamin D, as well as zinc, are thought to help in boosting the immune system and fighting off illness. Lately, malaria pills with
hydroxychloroquine and chloroquine are being explored as a possible preventative for the current coronavirus.

One curious development noted by doctors of the early 20th Century is the later in the pandemic someone got sick, the milder the symptoms and less likely they would die from it.

Survivors of the first wave enjoyed significant resistance to the second and third waves, offering compelling evidence that all were caused by the same virus. Compare that to the 1889-90 pandemic, which also came in waves, where it was the third wave that was the most lethal.

In the Spanish Influenza outbreak, even if isolation only slowed the virus, it had some value. One of the more interesting epidemiologic findings in 1918 was that the later in the second wave someone got sick, the less likely he or she was to die, and the milder the illness was likely to be.

This was true in terms of how late in the second wave the virus struck a given area, and, more curiously, it was also true within an area. For instance, cities struck later tended to suffer less, and individuals in a given city sickened later also tended to suffer less.

West coast American cities, hit later in the spread, had lower death rates than east coast cities; and Australia, which was did not experience the second wave until 1919, had the lowest death rate of any developed country.

Further, in the 1918-19 pandemic, someone who got sick four days into an outbreak in one place was more likely to develop a viral pneumonia that progressed to ARDS than someone who got sick four weeks into the outbreak in the same place. The earlier patients were also more likely to develop secondary bacterial pneumonia, and to die from it.

Late in the winter of 1919-20, the third wave of the plague swung through the U.S. to clean up anyone missed in 1918. The world’s deadliest disease, in terms of mortality in a set amount of time, finally fizzled in summer 1920.

As we are just beginning to experience today, those lucky enough to avoid infection back then had to deal with public health ordinances to restrain the spread of the disease.

Public health departments distributed gauze masks to be worn in public. Stores were forbidden from holding sales. Funerals were limited to 15 minutes. Some towns required a signed certificate to enter, and railroads would not accept passengers without them. And yes, there were guards posted on some roads and train depots in and out of valleys in western Wyoming.

Bodies piled up as the death toll climbed. Besides the lack of healthcare workers and medical supplies, there was a shortage of coffins, morticians, and gravediggers. Conditions in 1918-19 were not so far removed from what was experienced in the Black Death era of the bubonic plague of the Middle Ages.

Jackson’s Hole Courier 1918. Image Wyoming Newspaper Project

How Spanish Flu affected Jackson Hole

Hindsight is 20/20, and looking back on old newspaper articles during the outbreak of flu in 1918-19 plays out like a frightening vision—a monster movie with the reading audience knowing what the players don’t.

“Don’t go there,” you want to warn. “Be overly cautious. Do everything to prepare!”

An October 10, 1918 article in the Jackson’s Hole Courier observed the influenza spread as something happening “out there” in the world and “not yet in the valley.” The paper printed an advisory on precautions to take to stay healthy. Headlines noted the advance of the virus had brought it to neighboring states Utah and Nevada but “no occasion for hysteria exists,” the Courier wrote.

Precautions in late September, early October were almost nil. Dances were held. People came and went and congregated. Life went on in Jackson Hole.

Casper Daily Press 1918. Image: Wyoming Newspaper Project

“Spanish Influenza, which recently ravaged the German army and later spread into France and England, with such discomforting effects on the civil population, has been brought to some of the American Atlantic coast cities, officials fear, but they are awaiting further investigation and develops before forming definite opinions,” wrote the Courier on September 19, devoting barely a column inch to the story buried behind news the Boston Red Sox had won the 1918 World Series.

A month later, the Casper Daily Press ran a small article on Thursday, October 10, 1918, sharing the news that “medical men had gathered in Chicago” to discuss the year’s influenza strain which they agreed might be something akin to 1890 when the U.S. was rocked by the virus. Follow simple rules and the death rate would be cut down, they assured.

These rules included advice like: “Keep warm,” “do not kiss anyone,” and “avoid expectorating in public.”

A week later, on October 18, the Kemmerer Republic reported 400 cases of Spanish influenza with 23 already dead. Cokeville had eight cases, Star Valley had 30 with three deaths—one being the only doctor in Afton.

In that same newspaper, Kemmerer was reported having its first case despite establishing a quarantine on October 11, a measure the newspaper called the “most extreme precautions in the United States.” But three Japanese men had arrived just before the borders to Kemmerer/Diamondville were closed. They brought death with them.

By October 17, as the plague began its killing spree in earnest, the Courier suddenly reflected a more serious tone as local authorities began taking measures to slow the spread of the disease in the valley.

“Miss Tressie Royer arrived to Jackson from Ogden after the school she was attending was closed due to flu. She was placed in quarantine,” the paper wrote. “Miss Loletta Thomas [also recently] arrived to teach at Kelly and was quarantined.”

Schools were ordered closed, chairs and tables removed from hotel lobbies to discourage congregating, and public gatherings of any kind were banned.

“Spanish Influenza is traveling through the country like wildfire, and the community is rare, where it has not put in its appearance. Jackson is, so far, fortunate and every possible precaution will be taken to prevent the malady from gaining a foothold here,” the Courier exclaimed.

It was too late. For everyone.

The Worland Grit reported on October 24 that the flu there was “on the decline” and “seems to have been checked.”

Dr. WO Gray, Washakie County health officer, told the Grit, “Worland…seems to have been very fortunate in the small number of cases, especially serious ones, that have developed in the community. There is probably no town in the state at the present time more free than our little city from the ‘Spanish Flu’ and with proper precautions taken by the public and reasonable care in the treatment of the cases which develop, there is no reason why this should not continue to exist.”

They relaxed, and paid the price.

By December, Grit headlines screamed, “Worland Under Strict Quarantine from Epidemic.” More than a hundred new cases swamped the town’s two doctors who “were busy night and day and nearly work out completely” from battling the plague. The Masonic Hall was converted into a makeshift hospital to deal with the growing numbers of infected.

Dr. Charles Huff. Photo: Courtesy TOJ

Meanwhile, in Jackson, the first deaths were being reported by early November. Joseph Novack, who had recently moved to San Francisco for his work, died along with his wife and year-old son, Edward.

Just before Christmas, in December 1918, the valley was full in the grip of the disease.

Dr. Charles Huff reported five new cases of flu on December 5. “Mr. and Mrs. Lloyd, two children, and a nephew all ill. He hopes to keep them isolated to stop any spread,” the Courier reported.

The December 12 edition reported “quite a number of cases in South Park country” including SJ Callahan, James Boyle, Charles Wort, and GV Long.

Three more deaths reported on January 9, 1919—Mrs. Doris Topping (Fred Topping’s first wife before Eva), Fred Karns, and Mrs. Fred Shinkle—brought the death toll to 11 in Jackson Hole.

Advertisements for local businesses like Wm. Mercill’s and the Jackson Mercantile Co. went from hawking fresh vegetables and fruits for the holidays on Dec. 19, to announcing quarantine regulations prohibited anyone from entering the store. “Come to the back door,” they advised.

Even that failed to work as Mable Hood, manager of the Mercill Store, came down ill and was reported convalescing at the Reed Hotel in January.

Late in January, the Courier announced: “Present conditions in the valley are pretty good evidence that the flu epidemic has run its course.”

It hadn’t.

A March 13, 1919 article reported: “Influenza returns, 15-16 new cases in and around Wilson. RC Lundy, John Powell family, Warren Edmiston family, all ill.”

A week later, “WC Deloney and the girls were stricken with flu.”

On March 27, 1919, the Kemmerer Republic, so boastful it had dodged significant trouble the previous year due to “strict enforcement of rigid quarantine,” admitted the flu made a rebound and the city was in the midst of a “serious outbreak.”

It wasn’t until July 31 of 1919 that Dr. Huff pronounced a Wilson outbreak all but cleared up, and the valley fairly safe, even as he, himself, took ill and was “bedridden with exhaustion and effects of the flu.” Doctor W. Ackley came from Ashton, Idaho to assist Dr. Huff in late August 1919. At that time, St. John’s was reporting 38 people hospitalized with the flu, all but two of those would recover.

But back it came for one last wave in 1920.

On February 5, 1920, Jackson Hole again had enough cases of the Spanish Flu that the Baptist Church canceled services and the valley again braced for the worst. JP Cunningham took ill, reportedly down for six weeks with the flu in Idaho Falls through March.

By the summer of 1920, reports of any flu epidemic had disappeared from Wyoming newspapers. But the resulting numbers were staggering.

Thirteen million jars of Vicks VapoRub were distributed in the U.S. during the height of the pandemic from October 1918 to March 1919. The Wyoming Board of Health estimated flu deaths at around 700 at a time when the state population was a mere 180,000. Hundreds in Jackson Hole were eventually down with the flu; nearly the entire population of the valley at the time.

Dec. 26, 1918 edition of Jackson’s Hole Courier. Image: Wyoming Newspaper Project

New flu, same as the old flu

History repeats itself. We’ve all heard the phrase. Or variations of it.

“Those who do not learn [from] history are doomed to repeat it.” That’s a quote often attributed to writer and philosopher George Santayana, an aphorism of what he actually wrote: “Those who cannot remember the past are condemned to repeat it.”

Close enough.

How about this one? “What has been will be again, what has been done will be done again; there is nothing new under the sun.” King Solomon wrote that in the Old Testament book Ecclesiastes. It’s been there for decades, available and ignored in every motel nightstand in America.

George Bernard Shaw’s quip cuts to the quick. “If history repeats itself, and the unexpected always happens, how incapable must Man be of learning from experience.”

How given we all are to forget or dismiss. Hollywood has warned again and again mankind’s demise might not manifest in a Godzilla suit breathing fire. Our blindsided vulnerability will more realistically be a bug we can’t see without a microscope. Something so small as to be dismissed as insignificant.

In many ways, we are no smarter or stronger or better prepared as a species now than we were in the Middle Ages or the Roaring Twenties. We are still the same flawed men and women who beat our chests then succumb to a sniffle.

But we’ve always been resilient as a race. You don’t climb to the top of the food chain by chance.

And we are learning with this new syndrome. Pathologists, scientists, doctors—they’re all putting to use a century of JAMA journals, new lab findings, and real-time life-or-death clinical trials in China and Italy to come up with a cure, a vaccination, a hope.

Never before has it been easier to share information. To collaborate with colleagues, and commiserate with friends and family around the globe. We are all connected like no other time in history. That’s one edge of the sword.

The flipside is we are all connected like no other time in history. What happens to an old man in China, ripples to an Italian mother of five, ripples to a Seattle day-trader who had not a care in the world yesterday.

We’re in this together. There is a map called history. Let’s learn and live.