A Tale of Two Cities in a Pestilential World


by William Milam April 24, 2020

The 1918 Influenza Pandemic came in two waves. The first wave, which in the early months of 1918, struck a large American Army camp in Kansas and spread rapidly to other military camps across the country. Recruits moved between camps for various kinds of training as the government’s policy was focused on war fighting aims and had no regard for the basic principles of epidemic/pandemic mitigation—isolation and quarantine – which were well known to the medical and scientific community. The camps which housed thousands of young men in cheek by jowl conditions were giant petri dishes for transmission of the virus. Those troops going off to the trenches of France carried the infection to Europe in short order. The disease appeared in the French and British armies in early April, and then, probably from the contact with French and British POWs, had spread to the German army by late April. The infestation in the German army coincided with the beginning of the last great German offensive on the Western Front which looked in the beginning as if it might succeed in breaking through the entrenched French and British forces and changing the direction of the war. But influenza so affected the German army that the offensive stalled by summer.

And yet this first wave was a mild version of influenza which led a low fatality rate. Its only idiosyncrasy was that it seemed to prefer a younger segment of the population, men and women in their twenties and thirties, in the prime of their life. Soldiers and civilians became acutely ill for a few days, and then most recovered slowly but surely, but were too weak to resume normal activity during the recovery period. The German Commander later claimed that the offensive failed because his army was stripped of men by the influenza wave. But French, British, and American troops were also sick, and they managed to hold off the Germans, so that excuse may be a cover for bad military strategy.

The second wave of this influenza started in the late summer and early fall and was much more lethal than the first, but the young remained its preferred target. Certainly, the mild version that struck the army camps in the spring of 1918 and leaked into the civilian population was one reason—but far from the only one – that most countries were not prepared for the much increased lethality and virulence of the second wave that came in the fall of that year. There were other reasons too, which I shall discuss below.

Why it became so much more lethal points out why variations of viral epidemics can be so dangerous and why early mitigation is vital in defence. The virus that brought the first wave mutated sometime after the first wave had begun, either in Europe where it encountered other similar viruses, or on its own as it spread into the civilian population in the US. Mutation is the normal course for viruses, and probabilities would indicate that the mild influenza virus would mutate to one more virulent and dangerous. Had it been virulent and lethal in its first version, the probabilities would point to it mutating to a less virulent and lethal virus at some point. But it was that increase in lethality that overwhelmed both the army and the society, in an atmosphere of war fever, and led to the tragic results—30 million infections in the US, about 30 percent of the population, 500,000 to 850,000 killed; 500 million infected worldwide, as much as 33 percent of the world population, and estimates of the death toll ranging from 17 to 50 million killed, between one and six percent of the world population. In what is now Pakistan, India, and Bangladesh (British India and the Princely States) 12 to 17 million died, somewhere between three and five percent of the population.

Two of America’s greatest cities portray the difference between leaders listening to the experts and being as ready as possible for the onslaught of a pandemic and leaders who put politics above good sense. Philadelphia thrived on the war as it had become one of the great arsenals of that war, ship building, steel making, munitions industries had proliferated as the war effort quickly built up under federal government direction, and the demand for labour had expanded its population well beyond the means to house it in sanitary and safe conditions. Much of the new immigrant workers lived in unsanitary and unhealthy tenements. It was, of course, a patriotic city, supporting the war with large purchases of “Liberty Bonds.” The second wave of influenza was decimating military bases, yet transfers were not stopped; 300 sailors arrived from a Boston base riddled by influenza at the Philadelphia Naval Yard on September 7. Two weeks later, the military finally reacted to the decimation on those bases by cancelling the September call-up of many thousands more men. In those two weeks, 1,400 sailors at the Naval Yard came down with influenza. In very short order, civilian cases of influenza began to show up at Philadelphia hospitals; on September 27, 123 civilians were admitted with the disease.

In keeping with its central place in the war effort, the city fathers, all connected to the corrupt Vare political machine, had scheduled a Liberty Loan parade on September 28. As the influenza threat built up, the medical profession, doctors, public health experts, medical school experts, infectious disease experts, urged the city fathers to call off the parade. Wilmer Krusen, a politically appointed doctor with no public health experience, could have cancelled it, but he did not because the machine and the city’s elite wanted it. The newspapers refused to print articles which warned the public of the danger. So, on September 28, 100,000 people marched, watched by a crowd of over 200,000, and a public concert followed.

Two days later, Dr Krusen admitted that the epidemic was out of control. The description by John Barry of the carnage as the virulent influenza infection swept the city is grisly and is best summarised in the word “decimation.” In the second week of October, 2,600 people died; in the third week more than 5,000. In about two months, with most of the carnage in a five-week period over 500,000 cases of influenza were recorded, and 16,000 deaths. The deluge of corpses overwhelmed the cemeteries and the men who buried bodies. Corpses lay on the street rotting until they could be buried in mass graves.

In contrast to Philadelphia, our third largest city with almost 2 million inhabitants, in St Louis, our seventh largest city, with a little less than half Philadelphia’s population the influenza killed only 1,703 people (slightly more than 10 percent of the Philadelphia losses), out of 31,500 cases (about 11 percent of the Philadelphia cases). The difference was leaders who listened to the experts, the doctors, scientists, public health specialists, and infectious disease experts who called for strict mitigating measures immediately. Dr Max Starkloff, the St. Louis City Health commissioner listened and took immediate action. When the army barracks adjacent to St. Louis was hit by the influenza he basically shut down the city — closing all city schools, theaters, movie houses, and places of amusement; and he banned public gatherings of more than 20 people. A day later he closed churches, which in 1918 was a bold move. In fact, he closed every place where people might gather and restricted use of streetcars.

Much of the factual material above is distilled from John Barry’s book, “The Great influenza,” and also from The Missouri Historical Association and Missouri State Medical Association. The analysis is mine. But let me end this piece with John Barry’s description of how to best mitigate pandemics and epidemics, since we have no way to stop a new virus when it appears, “those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.” I would add that complete and full transparency and immediate action are necessary to save as many lives as possible and buy time until the virus has been defeated or run out of steam. Unfortunately, we have seen just the opposite here in the US.

The writer was a diplomat, and is Senior Policy Scholar at the Woodrow Wilson International Center for Scholars in Washington, D.C.

The article appeared in the Friday Times on 24 April 2020