The pandemics of 1918 and 2020: What have we learned?

By Page H. Gifford

It is new and frightening, and Americans today have never witnessed or experienced anything like this pandemic. Our grandparents or great grandparents may have lived through the horrific death toll and economic impact of the 1918-1919 pandemic. But what was different? What have we learned?

Tricia Johnson, director of the Fluvanna County Historical Society, said the impact of the 1918 pandemic was devastating on Fluvanna residents. There were 8,500 residents of Fluvanna at the time and an estimated that 2,833 people were infected or about a third of the population. All told, 46 people died. (With COVID-19, to date, Fluvanna has 207 cases and nine deaths.)

 Among the first fatalities in the 1918 pandemic were five Fork Union Military cadets all of whom died within four consecutive days. The fifth died later at home. Following this was the death of 72-year-old Sheriff Robert S. Campbell. The virus did not discriminate when it came to age.

Also, Alfred Lee Profitt of Shores, a W.W. I soldier discharged due to scrofula (a form of TB) died. His system was already compromised and along with complications of influenza, he died on December 10, 1918. He is buried in his family plot, which still exists today on private property off Shores Rd. not far from Caring for Creatures.

In Virginia in 1918, there were two million people and 326,000 were infected (15 percent) and 16,000 died. (With COVID-19, to date, Virginia’s 8.5 million in population has suffered 111,000 cases and 2,436 reported deaths.) By the end of the 1918 pandemic, 675,000 people lost their lives in the U.S. As of Aug. 23, deaths in this country has risen to slightly over 175,000.

In 1918, people had less contact than they do nowadays. Traveling meant walking, or riding on horseback; very few had cars though some traveled by train or ship. The most likely culprit in the spread of the 1918 pandemic was soldiers being discharged from overseas who had already contracted the disease. The FUMA cadets were not an isolated incident and not surprising when most of the infection rates were rampant among World War I soldiers returning home or in army camps.

There were three waves: the spring of 1918, the fall of 1918, and the spring of 1919. The second wave was most likely due to the Armistice Day (Veterans Day) celebration and the end of the war. That sounds familiar. In 2020, cases escalated due to Memorial Day and July 4th celebrations.

The public health response was swift and organized, but President Wilson, being preoccupied with a world war, never made a statement regarding the pandemic or its impact on the civilian population. The administration tried not to distract from the war effort which was responsible for the spread of the virus and increasing deaths. There were limited resources for the pandemic and unlimited resources given to the war effort.

There was a shortage of doctors with 30 percent serving in the armed services.

Not unlike where we are today, similar responses included uncertainty, fear, ignorance, and wishful thinking, influencing civilian and government behavior. In 2020, Americans are repeating some of the same behaviors.

Preventative measures were implemented by state and local governments, but officials were lacking transparency in communicating with the public, causing more widespread panic and fear and jeopardizing their credibility. In one example in 1918, in Chicago, when one hospital reached 40 percent capacity, the health commissioner announced, “Worry kills more people than the epidemic.” Experts agree that government transparency is key during a public health crisis. Denial may be a safer alternative but has been proven to make a situation worse.

Public Health Departments grew out of these advances and the belief in the ability of man to control nature. Sanitation, vaccination programs, and other public hygiene efforts in the late 19th century enabled public health officials to gain power and authority. However, the enormity of the 1918-1919 pandemic challenged the public health agencies. The massive death toll from the pandemic was puzzling and alarming. Many of the measures formerly known to work were ineffective. Lacking the organization and infrastructure and constrained by the war, they were unprepared for an event of this magnitude. Dr. Victor C. Vaughn, Dean of the University of Michigan School of Medicine, and adviser to the U.S Surgeon General during W.W. I, observing cramped hospital wards and flooded morgues, stated, “Bodies stacked like cordwood.”

Their aim was to reduce the transmission of the pathogen by preventing contact following the ancient guidelines of the past and like we do today. Back then, public health orders were based on scientific understanding of the microorganisms of influenza and how it is spread. Today, we do it the same way with scientific evidence. The conclusions are the same to prevent the spread of the disease.

The most frequently discussed and debated public health measure in the journals of the time was school closings.  In the United States, school closure was not as widely accepted as it was in Europe. One article in the Journal of American Medical Association in 1918, stated that “the desirability of closing schools in a large city in the presence of an epidemic is a measure of doubtful value.” The American Public Health Association (APHA) debated the effectiveness of closing schools against the loss of educational studies. They believed school closings were thought to be less effective in large urban rather than in rural areas where the school represented the point of exposure of the infectious agent — an ill-conceived idea considering spread was more prevalent among larger groups of people in closed areas in cities then isolated people in rural areas. The closing of schools and other public institutional to reduce the epidemic were not widely accepted. Many were in favor of herd immunity in Europe, believing, as we do today, that shutting everything down would cause greater unemployment and depression.

The more restrictive methods of infection control were quarantines and isolating those who were ill. Because of the strain on facilities, only severe cases were to be hospitalized while mild influenza patients were to remain at home. The APHA also supported institutional quarantines to protect people from the outside world in establishments like asylums and colleges, and military camps similar to our quarantine of long-term care facilities.

They set up hospital wards with social distancing, practiced good hygiene, and used disinfectants and sterilization methods. The JAMA describes in graphic detail the procedures for disinfecting areas from hospital beds to troop trains even to the placement of antiseptic hand solution in influenza wards. Today, it’s rubbing alcohol, Lysol, and Clorox. Nurses would wear special blouses inside the wards, removing them when the left to reduce transmission. A precursor of our PPE today in isolation wards.

There is little that separates us from the past in how we responded and proves history does repeat itself.

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