The 1918 pandemic's savage second wave

An influenza ward at Walter Reed Hospital in Washington, D.C., November 1918. Image: Library of Congress.
An influenza ward at Walter Reed Hospital in Washington, D.C., November 1918. Image: Library of Congress.

A century ago, people around the world fought to survive a deadly illness: the influenza pandemic of 1918.

     Much has changed since then. Modern doctors, nurses and respiratory therapists can rely upon medicine and technology that didn't exist in 1918. But like the 1918 pandemic, health officials warn that we could see a second, deadlier wave of the COVID-19 virus alongside the next flu season. So, what caused the second wave in 1918? Here is the rundown:

Chart: CDC.

The first wave: The virus was detected in the U.S. in March 1918 when more than 100 cases were reported at Camp Funston in Fort Riley, Kansas, according to the Centers for Disease Control and Prevention.

The second wave: A perfect storm of factors produced deadly consequences. 
    To begin with, the virus mutated. "It is possible that a mutation or reassortment occurred in the late summer of 1918, resulting in significantly enhanced virulence," wrote Jeffery K. Taubenberger of the National Institute of Allergy and Infectious Diseases in a 2006 article. The second wave of the pandemic occurred in September–November 1918.
    The mutated strain "had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection," recounts the History Channel website.
     To make matters worse, the country was in the process of sending young men overseas to fight in World War I.
    "From Camp Funston soldiers departed by the thousands for assignment to military camps across the United States and eventually on to Europe, quite obviously carrying the flu virus with them. Influenza reached the port of Brest, France, with American soldiers in April," wrote Frederick Holmes, professor of medicine emeritus and of the history of medicine at the University of Kansas School of Medicine. "In retrospect a more efficient incubator and disseminator of an infectious disease to pandemic proportions could not be imagined, young non-immune persons concentrated in close quarters for weeks and then dispersed throughout the world."

A final insult: The third wave -- less severe than the second -- occurred during the winter and spring of 1919, according to the CDC. It subsided during the summer of 1919.

The damage: Worldwide, 30 million to 50 million people died in the 1918 pandemic, including an estimated 675,000 Americans. By contrast, an estimated 16 million lives were lost in World War I -- and thousands of soldiers died of influenza, according to the U.S. Archives

Postscript: As noted, this flu was first documented at the military base in Kansas. But it is often called the Spanish flu. Why?  "Spain was neutral during World War I and unlike its European neighbors, it didn’t impose wartime censorship on its press," explains the History Channel article. "Since Spanish journalists were some of the only ones reporting on a widespread flu outbreak in the spring of 1918, the pandemic became known as the 'Spanish flu.'"



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