1918 “Spanish Flu” Vs. 2020 CoVid-19, a Chicago Comparison

1918 “Spanish Flu” Vs. 2020 CoVid-19, a Chicago Comparison
Over 22,000 Dead from Spanish Flu in Illinois, Decatur Herald, December 1, 1918.

Since I love Chicago history so much and we can learn so much about our current and future condition from studying the past, I thought it would be interesting to do a comparison of the 1918 worldwide influenza pandemic and our current CoVid-19 pandemic through the Chicago looking glass.

To be fair, a true side by side comparison is difficult because we are talking about two different diseases and 102 years of separation but there are still a great many similarities and luckily a great many differences.

We have to keep in mind that at the time of the 1918 pandemic the term virus was not even in use.  The medical community referred to the disease as the “Influenza Germ” known as Pfeiffer’s Bacillus.  There were no antibiotics to treat secondary pneumonia infections because penicillin was not discovered until 1928.  There were no anti-viral drugs to slow it down and no ventilators so doctors were limited to supportive treatments.

 

Population

Curiously, the population of Chicago today is virtually the same as it was 102 years ago.  Chicago currently has a population of 2.7 million which is what it was in 1918.  The population of the United States as a whole was about 103 million which is about 1/3 of what it is today.

 

The Start and Spread of both Diseases

1918

The first mention of the 1918 flu in the U.S. was in the spring of 1918 within the military.  There is some disagreement among scholars because the flu was so mild.   The flu that hit in the fall (whether mutated or new) in the U.S. was much deadlier.  The world was at war and the censoring of information coming from other countries made it nearly impossible to determine the geographic start of the virus but the first reports came out of Spain since they were neutral during the war and it thus became known as the “Spanish Flu”.

The first accounts I could find in newspapers of the time referred to a steamer from France being quarantined at the port of New York with 25 people suspected of having the “Spanish Influenza”.  The article came out on September 11th so the steamer had more than likely docked a few days before then.

The first case in the vicinity of Chicago was at Great Lakes Naval Base.  It was reported that the epidemic started on September 9th and by September 23rd there were 7,000 cases and 100 deaths at the Naval Base.

Chicago Tribune, September 16, 1918

Chicago Tribune, September 16, 1918

In 1918 the worldwide spread was caused mainly by the thousands of soldiers moving by ship from place to place.

2020

The first patient to present in the U.S. with what is now called CoVid-19 was a 35-year-old male in Snohomish County, Washington on January 19, 2020.

The first person in the Chicago area was discovered almost simultaneously due to the fact that this Chicago resident had returned from Wuhan, China (The supposed geographic start of the virus) on January 13th.  She and her husband have since made a full recovery.

One would assume, given the ease of travel internationally as compared to 1918 that the geographic spread of the virus would seem almost instantaneous.  In researching both eras the disease seemed to have spread extremely rapidly and almost simultaneously in different geographic regions.

 

Similarities in Reaction and Recommendations

Recommendations

While our medical knowledge today is well beyond that of 1918 the initial reactions and recommendations were eerily similar even with 100 years of distance.

Some of the recommendations in 1918 seem very familiar

  • Avoid crowded areas like movie theaters and trains.
  • Avoid people who are sick.
  • Isolate yourself if you feel ill.
  • Wash your hands frequently

Some may not seem all that familiar and some even humorous by today’s standards.

  • Make sure to take laxatives and keep the bowels moving freely.
  • Avoid getting your feet wet.
  • Sleep with the windows open at night.
  • Keep children warm and dry at all times.
  • Eat eggs and milk every four hours.
  • Wear a gauze mask and boil it often.
  • Cough into a handkerchief and burn it.
  • Get as much sunlight as possible (actually, sunlight tends to kill viruses so maybe not such a bad idea)

Once both the 1918 and 2020 viruses started to spread, the governments of both time periods enacted ordinances that closed non-essential businesses and large gatherings and actually threatened arrest of those who would violate the orders.

 

 

 

Misinformation and rumor

Human psychology really has not changed much in 100 years and probably for much longer than that.   Just as in today’s viral crisis, the people of 1918 also had to contend with misinformation, rumor and bogus cures.

Listerine advertised to prevent the flu, The Pantagraph, October 18, 1918.

Listerine advertised to prevent the flu, The Pantagraph, October 18, 1918.

It is somewhat human nature to want to cling to whatever hope we can.  We have to be cautious, however, and make sure that the “cure” is backed up by science and is not worse than the disease itself.

In 2020 we have seen things appear on social media such as the rumor that snorting cocaine and bleach can cure the coronavirus and we have even seen people die from eating fish tank cleaner because they recognized an ingredient in the cleaner that sounded similar to a malaria treatment that has been mentioned as showing promise as a possible therapeutic for CoVid-19. (chloroquine)

During the 1918 virus,  many “patent medicines” were touting their ability to cure the flu.  This resulted in many sales and few positive results.  It wasn’t as if the government didn’t warn people back then.  They did.  Unfortunately,  panic and desperation can cause people to act in desperate ways.

Chicago doctors in 1918 started prescribing oranges as a cure. The prescriptions caused the price of oranges to skyrocket to .60 cents per pound. (huge by 1918 standards)

It was later learned (in January, 1919) that Chicago physicians had written over 400,000 prescriptions for medication for the flu with 25% or roughly 100,000 prescriptions for opium, morphine, codeine, heroin, and cocaine.

Vick’s Vapo-Rub, that many of us remember being slathered with as kids, touted its ability to help with the flu as well as Listerine.

There were car dealers that claimed their cars contained the cure for the flu because they brought your spirits up.

Sulzer’s Bran Bread was advertising that it could help with the flu by keeping your intestines clear of waste matter.

Kolynos Dental Cream out of New Haven CT claimed that it stood sentry at your mouth preventing the entrance of the flu and that the country of Spain had tripled its demand for their product.

However, The 1918 Darwin award goes to French Lick Springs Hotel Co. in French Lick, Indiana that advertised during the height of the flu in Chicago for people who had the flu to get a room at their hotel where they could recuperate in luxury!  Wonder how that worked out for them?

French Lick Hotel advertises for Spanish Flu Victims, Chicago Tribune, October 30, 1918

French Lick Hotel advertises for Spanish Flu Victims, Chicago Tribune, October 30, 1918

The Deadly Differences

While we have been dealing with coronaviruses for some time, we are still learning more every day about this new coronavirus.

According to the CDC, 95% of those exposed to CoVid-19 have an incubation period of roughly 5 days although 1% can have an incubation period of two weeks. (Hence the two-week quarantine recommendations) with symptoms coming on slowly.  A March 10th investigation by the American College of Physicians agrees. 

Most cases of flu, including the 1918 flu, have an incubation on average between 2 to 4 days with intense symptoms coming on very quickly.

We have the luxury of 100 years of hindsight with the 1918 flu.

The 1918 influenza was extremely deadly.  Estimates of lethality worldwide are somewhere around 2.5 to upwards of 10%.  That means that of the people infected 2.5% to 10% died of the disease.  Most people died within four days of contracting the 1918 flu with quite a few dying the same day that symptoms showed up.  There were many reports of people waking up more or less healthy and dying the same day.

It was also different in that your average flu is worse for the very young and the very old.  The 1918 flu was actually deadlier for those between the ages of 20 and 35!  The reason for this is that the 1918 flu caused such an extreme immune response in those with healthy immune systems that it flooded the lungs.  People who had healthy immune systems literally drowned in their own mucous.  Victims would cough up a blood-stained foam from their lungs and lack of oxygen would turn their faces and hands blue earning it the nickname, “The Blue Death”.

October 1918 was the single deadliest month of all in Chicago.  Roughly 6,700 Chicagoans died in the month of October alone!  The estimates of death in the two months of October and November of 1918 was over 10,000.  Some of the speculations are because death certificates didn’t usually state that the cause was Spanish Flu.  The cause of death was listed usually as pneumonia or bronchial pneumonia.

Chicago had over 625,000 cases from September through November of 1918 which was about 25% of its total population.  Ten thousand deaths during that period would put the lethality rate for Chicago at roughly 6.25%

Historically the average influenza death rate is about .1% and an average of 8% of the population is affected.  Of course, this is taking into consideration the fact that we also have vaccines for the flu.

Right now the numbers on CoVid-19 vary greatly because we are still in the midst of the pandemic and actual statistics will need time to shake out.  These numbers will be different based on age group, geography, and other factors.  Most medical experts agree that CoVid-19 will end up being a more lethal disease than your average flu but many are anticipating a final number somewhere around .2% compared to .1% with the flu but again these numbers are still being compiled.

One thing that could hurt our medical system is that while people generally recover fairly quickly or die fairly quickly from influenza the length of time of recovery with CoVid-19 can be quite a bit longer which results in longer hospital stays and less turnaround which is a big reason that the country is trying to flatten the curve as to try not to overwhelm our medical systems.

There is some consolation if we look at CoVid-19 numbers from the perspective of 2019 – 2020 seasonal flu numbers as compiled by the CDC.

According to the most recent estimates as of the date of this article, there have been between 38 million to 54 million cases of the flu, 18 million to 26 million flu medical visits, 400,000 to 730,000 flu hospitalizations, and 24,000 to 62,000 influenza deaths.

If there is something positive to say at this point (albeit the jury is still out) the current numbers after roughly 10 weeks or approximately 2.5 months of dealing with the onset of U.S. cases the number of cases and deaths are still relatively low as compared with the seasonal flu and if we continue to listen to the medical professionals we may have gotten ahead of it.   As of the date of this article, the number of total U.S. confirmed cases is 85,356 with 1,246 deaths.  (Let’s keep our fingers crossed that this article ages well.)

You can see the daily totals on the CDC’s website here.

 

Why was this 1918 influenza so much more deadly than others?

The research conducted to come up with this answer is so fascinating and yet terrifying at the same time.  I could not do it justice so you can read the whole story on the CDC’s website here.

In a nutshell, researchers brought the old 1918 flu back to life using frozen samples of tissue from victims.  They recreated the pandemic using mice in a secure facility at the CDC.  The injected some mice with the 1918 flu and others with various other strains of flu.

The researchers found that the 1918 flu went directly and aggressively to the victim’s lungs.  In fact after fours day of infection they found that the amount of virus in the lungs of the mice exposed to the 1918 flu was 39,000 times that of those infected with other strains of the flu!   That is not a typo.  39,000 times!

 

How did it all come to an end?

 In 1918 Chicago the flu epidemic came in quickly and violently and left just as quickly.  The first case was reported in Great Lakes on September 9th.  The peak of infections took place toward the end of October and early November.   Levels of disease returned to baseline by the end of November.  From beginning to relative end was about a 3 month period.

One thing that I found very interesting about the treatment of the sick today was something that was touched upon by our leaders in this crisis.  Currently, they are using antibody-rich blood plasma from CoVid-19 survivors in hopes that the antibodies will help fight off the virus.

In 1918 they did almost the same thing.  They didn’t call it plasma but rather a serum made from the blood of Spanish Flu survivors.  I don’t know if this was plasma or direct transfusion but there were personal ads run in the newspapers looking for donors.

Personal Ad for blood of recovered flu victims, Chicago Tribune, October 20, 1918

Personal Ad for blood of recovered flu victims, Chicago Tribune, October 20, 1918

The final numbers for the 1918 flu are staggering.  The estimates are that over 500 million people or one-third of the population of the world at the time were infected with the virus with the number of deaths being at least 50 million.  675.000 of those deaths were in the United States.  27,000 deaths reported for CoVid-19, as of the date of this article, still sounds much better than 50 million for the 1918 flu. (Let’s hope it doesn’t get to be much more)

We don’t yet know what the final numbers will be in the battle against CoVid-19 but we do know that what we do as individuals can make a huge difference with not only CoVid-19 but will the other respiratory viruses including the flu which can be just as deadly to the most vulnerable.  We know by looking at historical data and listening to the medical professionals that while this is a very serious threat we are probably not looking at an apocalyptic outcome or not even anything close.

By using proper hygiene, avoiding crowds, social distancing and staying home if sick when possible and taking care of those most vulnerable we will make it through this as well.

In addition to the CDC website, there is also a very nifty website put together by the University of Michigan that is specific to the 1918 pandemic.  It is called the Influenza Encyclopedia and I highly recommend it.

 

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