Bestselling Costa Rica History in 2020
The Costa Rica Reader: History, Culture, Politics (The Latin America Readers)
DK Eyewitness Travel Guide Costa Rica
The History of Costa Rica: Second Edition Revised
The Ticos: Culture and Social Change in Costa Rica
- Used Book in Good Condition
Costa Rica Wildlife: A Folding Pocket Guide to Familiar Animals (Pocket Naturalist Guides)
- Used Book in Good Condition
The Mammals of Costa Rica: A Natural History and Field Guide (Zona Tropical Publications)
Costa Rica History, Travel and Tourism: People and Tradition, Economy, Government and Politics
Monkeys Are Made of Chocolate
History of the Discovery and Conquest of Costa Rica
The History of Costa Rica (The Greenwood Histories of the Modern Nations)
The Green Republic: A Conservation History of Costa Rica
- University of Texas Press
Costa Rica: A Journey through Nature (Zona Tropical Publications)
- Comstock Publishing Associates
Cut the Crap & Move To Costa Rica: A How to Guide Based on These Gringos' Experience
- International relocation
- Costa Rica
- Bestselling Book
- New York times bestseller
Pandemic - An Exploration of the Spread of Influenza in 1918
The Influenza Pandemic of 1918 was among the most deadly outbreaks in world history. One of the reasons that this pandemic should remain in discussion today is that it may have much to tell us about current influenza, and prepare us for a possible future outbreak.
Even in the spotlight of medical science, disease often remains shrouded in mystery. Disease is frightening; the billions of dollars spent annually around the globe seeking prevention and cure is a testament to society's fear of it. Widespread disease is technically defined in several different ways. "Outbreak is used when a disease suddenly infects many people within a small geographic area. Epidemic signifies that a great proportion of people in a certain geographic area have contracted the disease within a short period of time. Pandemic refers to an epidemic that has infected many areas of the world nearly simultaneously" (Peters ix). In 1918 the world experienced a pandemic whose death toll exceeded 20 million people. Some estimates place the death toll between 20 and 40 million people (Altman 86). In little more than a year, this disease infected 2 billion people worldwide, before disappearing as mysteriously as it had arrived. In the US alone, "more than 600,000 people - 2% of the 1918 population - died" (Peters 8). This pandemic was caused by a strain of influenza, a virus that earned its name in the early fourteenth century. Italian scientists began calling it "influenza," or the "influence" because it was widely believed that human health was influenced by the heavens (Getz 10). Influenza, or the flu, has been a long-time companion of humankind. During the 1918 pandemic, also referred to as the "Spanish flu", the majority of the victims experienced familiar flu-like symptoms and got well. "But in a minority of cases, and not just in a tiny minority, the virus...did not follow normal patterns...was unlike any influenza ever reported" (Barry 251).
The impact of WWI on the Spread of Influenza
Parallel to the disease, the world also faced mechanized warfare on a scale never before experienced. This was the first truly modern war, in which rifles, machine guns, and large field guns that fired shells were used. Chlorine and mustard gas also caused many casualties. World War I began in 1914, and US involvement began in April 1917. Preparing for US overseas operations led to circumstances ripe for the spread of disease. Men poured into military camps and bases all over the US, where overcrowding and poor hygiene contributed to weakened immune systems. Author, professor, and historian, Alfred Crosby, states "too many men, especially from rural areas, with too few of the immunities normally acquired in urban childhood, [were] jammed into poorly ventilated quarters" (20). Perpetual travel between US military bases and later, to France, increased the probability of contact with infected individuals. French and American troops mingled with troops from all over the world in Brest, France. As these troops dispersed, they carried the disease with them to their next location, and it spread like wildfire. The war would impact the spread of the disease not just on the frontlines, but in US cities as well. The vast majority of qualified doctors and nurses were sent overseas to the war front, leaving few behind to care for the mounting number of sick and dying patients. And the disease would impact the war, in turn. "Of the American soldiers who died during World War I, 85 out of every 100 were killed not in battle but in their beds by the flu" (Getz 56).
The Three Waves
The devastating final result of the virus could not have been guessed at during the early months of 1918. Studies conducted within the past decade show that the virus appeared in waves. The first wave, which was the mildest strain, occurred in the spring. This first wave affected military personnel at 24 of the 36 largest army camps in the US, and 30 out of 50 major cities that were near military facilities (Barry 169). In April it appeared in France, where it affected soldiers as well as civilian populations. In May it reached England, impacting the war effort by postponing offensive tactics. It crested in June, and then appeared in China and Japan. While much of the world experienced this first wave, there were large areas that were unaffected. Most of Africa, South America and Canada did not experience an epidemic at that time (Kolata 11-12). This wave is referred to as mild, because although it infected many people, the mortality rate was not nearly as high as the second wave.
The second wave began in late July to mid August. It erupted violently and nearly simultaneously in several different areas of the world. In Brest, France, so many French sailors were hospitalized with influenza and pneumonia that by August 10th the naval hospital was overwhelmed and forced to close (Barry 182). In Freetown, Sierra Leone, a ship contaminated with the virus stopped to receive a load of coal on August 15. 200 crewmembers were sick with influenza. The following day, out of 600 laborers for the coal company, 500 could not go to work due to illness. "Officials estimated that influenza killed 3 percent of the entire African population, nearly all of them dying within the next few weeks" (Barry 183). By the end of August, a Naval barracks at Commonwealth Pier in Boston was overwhelmed with influenza patients and had to send some of them to a nearby Naval hospital. This barracks was called a "receiving ship" and housed up to 7,000 men while they were in transit. The "grossly overcrowded" quarters allowed the disease to spread rapidly (qtd. in Barry 183). By early September, contamination spread to civilians. Camp Devens was a military facility about 35 miles northwest of Boston. It was intended to hold 36,000 men, but in September, it was bursting at the seams with 45,000 men. (Barry 187). An army report from that time states, "...the influenza...occurred as an explosion". The base hospital, equipped for 1,200 patients, overflowed with 6,000 patients (Qtd. in Barry 187).
For the next three months, the second wave washed over the world, leaving death, fear, and sorrow in its wake. By late November, most cities were beginning to believe that the worst was over. But again, as after the first wave, the virus had mutated. "Viruses are masters of mutation, and the influenza virus is one of the most changeable" (DeSalle, 106). "It had not become radically different. People who had gotten sick in the second wave had a fair amount of immunity to another attack, just as people sickened in the first wave had fared better than others in the second wave" (Barry 373). Some places were not impacted by the third wave, but most were. Many locations that had not previously experienced the horrific death tolls of port cities and military bases were impacted in the third wave. California, Washington, Iowa, Kentucky, and West Virginia, among others, saw a sharp increase in the number of influenza cases (Barry 374). In fact, only one place had escaped completely thus far: Australia. "Australia had established a strict maritime quarantine against Spanish influenza before the wave of the fall of 1918 reached its shores, a quarantine which proved impenetrable until winter 1919, giving time another two months or so to dull the edge of the disease's virulence" (Crosby 234). The influenza death rates in Australia were far less than any other Westernized nation, barely one-third that of the United States (Barry 376).
By the end of the third wave near the beginning of 1919, it is estimated that 5% of the world's 1.8 billion population died from influenza. Most deaths occurred within a twelve-week period in the fall of 1918. (Barry 397). "Today's world population is 6.3 billion. To give a sense of the impact in today's world of the 1918 pandemic, one has to adjust for population. If one uses the lowest estimate of deaths - the 21 million figure - that means a comparable figure today would be 73 million dead. The higher estimates translate into between 175 and 350 million dead" (Barry 397).
Philadelphia versus St. Louis
Perhaps the comparison of Philadelphia and St. Louis is not a particularly fair one, speaking strictly in terms of the number of those who died. Estimates place the death toll in Philadelphia at nearly 16,000, while St. Louis had a mortality rate approximately one-eighth that number ("Rapid Response" par.8). Because of their geographic locations, these cities came into contact with the disease at different times. Based on a scientific review of statistics worldwide, performed ten years after the pandemic, it was found that "a correlation does exist between the timing of the outbreak in a region and lethality. The correlations are not perfect. The virus was unstable and always different" (Barry 373).
Philadelphia was booming in 1918. Due to the combination of the war effort and continuing industrialization and urbanization of the Northeast, its population had soared to nearly 2 million people (Crosby, 70). Living conditions were very poor as far as cleanliness and hygiene were concerned. Many tenements still used outhouses to service dozens of families, and "blacks endured even more squalid conditions...Philadelphia had the largest African American population of any northern city, including New York or Chicago" (Barry, 198). Social programs and services were limited to a hospital, a poorhouse, and an asylum. The city did not have an orphanage, and little money was spent on education. "Muckraker Lincoln Steffens called Philadelphia 'the worst-governed city in America'. He may well have been right" (Barry 198). The boss of Philadelphia's political machine was Edwin Vare. He amassed enormous wealth through political corruption, ensuring that all city workers kicked back a portion of their salary by forcing them go to the Republican Party headquarters to pick up their pay. Vare also held large city contracts, the largest a street-cleaning contract, and in 1917 was paid more than $5,000,000. "Yet the streets were notoriously filthy, especially in South Philadelphia - where the need was greatest, where everything but raw sewage, and sometimes even that, ran through the gutters, and where the machine was strongest" (Barry 199). According to Barry, the lack of city services actually served to keep the public voting for the machine, because it provided what the city didn't, in food baskets, help with jobs and favors, and help with the police (199). Corruption, inefficiency, and foul living conditions made the spread of disease inevitable.
Despite warnings in July, Philadelphia's Bureau of Health did not make influenza a reportable disease until September 21. Exactly a week later, the city proceeded with a Liberty Loan drive to promote the sale of bonds to raise money for the war effort. 200,000 citizens gathered for a parade. "In the days immediately following the Liberty Loan parade, the pandemic exploded in Philadelphia" (Crosby, 73). Five days after the parade, on October 3rd, the director of the Department of Health banned all public meetings and closed all churches, schools, and theaters (Barry 221). But by then it was too late. "...Within a month, nearly 11,000 Philadelphians died of influenza" (Kolata, par. 11).
Contrasting the methods employed by health officials in St. Louis with those in Philadelphia does reveal a marked difference in strategy and response time. "Social distancing" was the "brainchild of the city's health commissioner, Dr. Max C. Starkloff. Working with Mayor Henry Kiel, Starkloff closed schools, barred public gatherings and shut or limited businesses" (Levins par. 3). These measures were adopted within 2 days of the first reported case of influenza in St. Louis. As a result, the city's flu death rate for each 1,000 residents was 3.0 - the lowest big-city figure. Philadelphia's rate was 7.3, and that was only third-worst among big cities. San Francisco's rate ran to 7.6. In Pittsburgh, the figure hit 8.0 (Levins par. 3). "In contrast to St. Louis, Philadelphia imposed bans on public gatherings more than two weeks after the first infections were reported" ("Rapid Response" par. 8). The ban on public gathering, however, did not apply to saloons, taverns, and other drinking establishments in either city.
The population of St. Louis in 1918 was less than 800,000 (Levins par.38). St. Louis had less population density than Philadelphia, fewer slums, and less political corruption. The city government was more organized, and had the benefit of time to prepare. It is not at all surprising that their quick methods of containment, including the ban on public interaction, helped to slow the spread of the disease. "In St. Louis, the toll for 1918 rose to just shy of 3,000. That's a heavy loss, about the same as the fatalities in the terror attacks of Sept. 11, 2001. But among America's big cities, those 3,000 flu deaths were remarkably low" (Levins par. 2).
In the second, most deadly wave, Philadelphia was among the first cities to be infected, while St. Louis was among the last. Comparing the total number of deaths in Philadelphia and St. Louis, without taking into consideration the timing of the disease and the location of each, may lead to an inaccurate conclusion. Many believe that Philadelphia's Health Department was completely remiss in its public service, while in St. Louis, quick action led to a lower death toll. This is largely true, but the fact that St. Louis experienced a later, milder form of the virus could partially account for fewer deaths. It is an important point that early and thorough "social distancing" can dramatically reduce the number of new infections, but the same effect is achieved among people who have more space in their living arrangements, which was a luxury many in Philadelphia did not have.
"The Forgotten Pandemic"
One of the aspects of the 1918 Influenza Pandemic that seems inexplicable is the fact that it was almost entirely dismissed from public awareness. Up until the 1990s, when medical scientists and virologists began their investigative work, there was virtually no public mention of the disease. Crosby calls the 1918 flu "America's forgotten pandemic," noting: "The important and almost incomprehensible fact about the Spanish flu is that it killed millions upon millions of people in a year or less. Nothing else - no infection, no war, no famine - has ever killed so many in as short a period. And yet it has never inspired awe, not in 1918 and not since, not among the citizens of any particular land and not among the citizens of the United States" (qtd. in Kolata 53).
In her book, Epidemic! The 1918 Influenza Pandemic, Stephanie True Peters discusses several reasons why this may be the case. Her introduction, "The Forgotten Pandemic", briefly discusses the significant fact that "...this flu is hardly ever mentioned anywhere. Few history textbooks discuss it. People who lived through it were close-mouthed about it for years. News publications printed after the pandemic relegated it to their back pages, if they included it at all" (Peters ix). "The final estimate of Americans who died of the flu comes close to 650,000 [including both domestic and overseas numbers]. That figure is greater than the number of American soldiers killed in World War I, World War II, the Korean War, and the Vietnam War combined" (Peters 8).
Fear would be a normal reaction to an event so devastating, especially when coupled with warfare. But is fear, or even emotional upheaval in mourning lost loved ones, enough of a motivation to abandon discussions of the event entirely? Peters believes this was a considerable factor. "It seems most likely that people simply didn't want to remember. Nightmarish scenes of dead bodies stacked like piles of wood, of young men and women turning blue and gasping for breath, of frustrated doctors and nurses helpless to provide comfort and care - these memories were too painful to recall, and so were pushed away" (Peters 43).
Certain qualities of human behavior are universal. Competition, perhaps the most ancient drive in each of us, rewards the victor. Most people don't like to recall situations in which they've lost. This thought process provides another two reasons why this particular event has been purged from our collective consciousness. First, the fact that the disease dwindled of its own accord, and not due to medical intervention, probably contributed to the medical community's desire to "forget the flu" (Peters 44). The medical professionals of the early 20th century worked tirelessly to discover the cause of, and a cure for, this disease. The fact that they failed to discover either was not due to a lack of effort, or improper methods. However, many people must have felt betrayed by the medical community. Advances in medical science just prior to the outbreak had potentially caused people to be overconfident in their doctor's ability to cure them (Peters 45). Had a successful vaccine been created, doctors and nurses of the time would have been hailed as heroes. Instead, the public must have viewed them as failures. The second reason that the competitive thought process may have led to national amnesia is that, of the two striking world events that occurred at the same time, the survivors of the pandemic may have chosen to recall the war, "which at least provided the victors with feelings of pride and patriotism" (Peters 43). Altman points out, "In spite of its ferocity, the pandemic was quickly forgotten once it passed. World War I, not Spanish Influenza, defined those years. Even medical histories tend to pass over the subject. Books tend to focus on medieval death carts heaped with corpses, on smallpox and leprosy, and on tragic individuals wasting away with tuberculosis. Somehow, the flu doesn't seem very dramatic" (86).
While obviously this disease has not been completely forgotten, and there are valid emotional and psychological reasons for the avoidance of the topic, I feel that another possibility may be closer to the truth of the matter. During the war, US media were strongly discouraged from printing articles or making public statements that hinted at the seriousness of the disease. It was feared that the truth would hinder the war effort and reduce the country's morale (Barry 333). Indeed, the pandemic became known as the "Spanish Flu", most likely because Spain was the only country accurately reporting the spread of the disease and its frightening consequences. This occurred in the late summer of 1918, well after the same strain of the flu had struck other areas (Peters 7). I believe that the censorship imposed by the US government lasted long after the end of the war, and after the end of the disease itself. As Barry points out, "...the more officials tried to control it [fear] with half-truths and outright lies, the more the terror spread" (336). Also, "...the more the officials and newspapers reassured, the more they said, There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death" (Barry 340).
In 1918, the fastest mode of transportation was by car or by ship. Even with such limited transportation, this virulent form of influenza circled the globe in a year. In today's society, when US domestic flights alone are numbered in the thousands, and international flights follow nearly as closely in numbers, how long would it take for a current pandemic to circle the globe? Not long at all. I believe there are two important messages that should be gained from the tragic events of 1918 and early 1919. The first is that this type of pandemic can, and most likely will, happen again. Most public health organizations agree that early nonpharmaceutical intervention, in the form of "social distancing" can do much to prevent the spread of disease - or at least buy a little time ("Rapid Response" par.7). It's important for all of us to remain vigilant and prepared. Planning for an emergency, by stocking up on food and other necessities, greatly reduces the amount of individual and family stress. Such preparation would make it easier to comply with bans on public gathering.
The second message is one of simple remembrance. Many people who were in the prime of their lives were struck down by an illness that was completely familiar to them. Most probably expected to recover. Many did recover - but many others did not. These people were sons and daughters, aunts, uncles, and grandparents. They made dinners, they made friends, they made love, they made babies. They were loved; they existed. We should all endeavor to do justice to their memory.
Altman,Linda Jacobs. Plague and Pestilence: A History of Infectious Disease. Springfield, NJ: Enslow, 1998.
Barry,John M. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Viking, 2004.
Crosby, Alfred W. America's Forgotten Pandemic: The Influenza of 1918. Cambridge, UK:Cambridge, 1989.
DeSalle, Rob., ed. Epidemic! The World of Infectious Disease. New York: New Press, 1999.
Getz, David. Purple Death: The Mysterious Flu of 1918. New York: Henry Holt, 2000.
Kolata, Gina. The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York: Farrar, Straus and Giroux, 1999.
Kolata, Gina. "The 1918 Flu Killed Millions. Does It Hold Clues for Today?" New York Times 28 Mar. 2020. 14 Mar. 2020.
Levins, Harry. "What he knew in 1918 could save millions of lives." St. Louis Post-Dispatch. 9 Jul. 2020. 14 Mar. 2020.
Peters, Stephanie True. Epidemic! The 1918 Influenza Pandemic. New York: Benchmark, 2005.
"Rapid Response Was Crucial To Containing The 1918 Flu Pandemic." Science Daily. 3 Apr. 2020.
NIH / National Institute of Allergy and Infectious Diseases. 7 Apr. 2020.