In the late summer of 1918, the second devastating wave of Spanish influenza arrived on the American coast. Carried by First World War doughboys returning from Europe, the newly virulent virus first spread from Boston to New York and Philadelphia before traveling west to infect panicked populations from Saint Louis to San Francisco.
Without a vaccine or even a known cause of the epidemic, mayors and city health officials had to improvise. Should they close schools and ban all public gatherings? Should they force every citizen to wear a gauze face mask? Or would closing major financial centers in wartime be unpatriotic?
When it was all over, the Spanish flu has killed an estimated 675,000 Americans among the 20 to 50 million people worldwide. Some American cities are doing much worse than others, and looking back over a century later, there is evidence that the earliest and best organized responses have slowed the spread of the disease – at least temporarily – while cities that dragged their feet or let their guard down paid a heavier price.
Philidelphia parade
The Liberty Loan Parade in Philadelphia, which brought together about 200,000 people, has contributed to the widespread spread of Spanish flu in this city.
Everett Collection
In mid-September, the Spanish flu was spreading like wildfire through military and naval facilities in Philadelphia, but Wilmer Krusen, director of public health in Philadelphia, assured the public that the stricken soldiers suffered only from the old-fashioned seasonal flu and that it would be confined before infecting the civilian population.
When the first civilian cases were reported on September 21, local doctors feared this would be the start of an epidemic, but Krusen and his medical counsel said that Philadelphians could reduce their risk of getting the flu by staying at warm, keeping their feet dry and their guts open, writes John M. Barry in The big flu: the story of the deadliest pandemic in history.
As civilian infection rates increased day by day, Krusen refused to cancel the next Liberty Loan parade scheduled for September 28. Barry writes that infectious disease experts have warned Krusen that the parade, which was to attract several hundred thousand Philadelphians, would be “a flammable mass ready for use in a conflagration.”
Krusen insisted that the parade continue, as this would raise millions of dollars in war bonds, and he minimized the danger of the disease spreading. On September 28, a patriotic procession of soldiers, boy scouts, marching bands and local dignitaries spanned three kilometers through downtown Philadelphia with sidewalks filled with spectators.
Just 72 hours after the parade, the 31 hospitals in Philadelphia were full and 2,600 people died at the end of the week.
George Dehner, author of The Global Flu and You: A History of the Flu, says that if Krusen’s decision to hold the parade was absolutely a “bad idea”, the rate of infection in Philadelphia was already picking up in late September.
“The Liberty Loan parade probably threw gas on the fire,” says Dehner, “but he was already preparing quite well.”
St. Louis flattened the infection curve
St. Louis Red Cross Motor Corps in service during the 1918 flu epidemic.
Universal History Archives / UIG / Getty Images
Public health’s response to Saint-Louis could not have been more different. Even before the first case of Spanish influenza was reported in the city, the health commissioner, Dr. Max Starkloff, had alerted local doctors and written an editorial in the Saint-Louis after the expedition on the importance of avoiding crowds.
When an influenza epidemic in a nearby military barracks first spread to the civilian population of Saint-Louis, Starkloff wasted no time in closing schools, closing cinemas and billiard halls and ban all public gatherings. There has been a decline in business owners, but Starkloff and the mayor have held on. When the infections multiplied as expected, thousands of sick residents were treated at home by a network of volunteer nurses.
Dehner says that because of these precautions, St. Louis public health officials have been able to “flatten the curve” and keep the flu epidemic from exploding overnight like in Philadelphia.
“It’s the crushing of new cases in such a short time that completely overwhelms a city’s capacity,” said Dehner. “It magnifies all the problems you are already having.”
According to a In 2007, analysis of death cases due to the Spanish flu, the maximum death rate in St. Louis was only the eighth of the mortality rate in Philadelphia at worst. This does not mean that Saint-Louis survived the epidemic unscathed. Dehner says the Midwestern city was particularly affected by the third wave of Spanish flu which returned in late winter and spring 1919.
San Francisco imposes the wearing of masks
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In San Francisco, health officials have put all their trust behind the gauze masks. California Governor William Stephens said it was the “patriotic duty of every American citizen” to wear a mask and San Francisco finally made the law. Citizens caught in public without masks or who were not wearing them properly were arrested, accused of “disturbing the peace” and fined $ 5.
In his book, Jacobs says that the gauze masks that city officials claimed to be “99% flu-proof” were actually not very effective. San Francisco’s relatively low infection rates in October were likely due to well-organized campaigns to quarantine all naval facilities before the flu hit, as well as early efforts to close schools, ban rallies and close all places of “public entertainment”.
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On November 21, a whistle signaled that the San Franciscans could finally take off their masks and San Francisco Chronicle describes “sidewalks and tunnels … strewn with relics of a tortuous month”.
But San Francisco’s luck ran out when the third wave of the Spanish flu hit in January 1919. Believing masks were what saved them the first time, companies and theater owners fought back against orders public gathering. As a result, San Francisco ended up suffering from some of the highest Spanish flu death rates nationwide. The 2007 analysis found that if San Francisco had kept all of its flu protections in the spring of 1919, it could have reduced deaths by 90%.
Read more:
Why the second wave of the Spanish flu in 1918 was so deadly
Spanish Flu – Symptoms, Start and End
In the midst of the 1918 flu pandemic, America struggled to bury the dead
Why October 1918 was America’s deadliest month
Pandemics That Changed History: Chronology
