Year: 2021

For instance, the U.S. military took roughly half of all physicians under 45—and most of the best ones.

What proved even more deadly was the government policy toward the truth. When the United States entered the war, Woodrow Wilson demanded that “the spirit of ruthless brutality…enter into the very fibre of national life.” So he created the Committee on Public Information, which was inspired by an adviser who wrote, “Truth and falsehood are arbitrary terms….The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

At Wilson’s urging, Congress passed the Sedition Act, making it punishable with 20 years in prison to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United State…or to urge, incite, or advocate any curtailment of production in this country of any thing or things…necessary or essential to the prosecution of the war.” Government posters and advertisements urged people to report to the Justice Department anyone “who spreads pessimistic stories…cries for peace, or belittles our effort to win the war.”

Against this background, while influenza bled into American life, public health officials, determined to keep morale up, began to lie.

Early in September, a Navy ship from Boston carried influenza to Philadelphia, where the disease erupted in the Navy Yard. The city’s public health director, Wilmer Krusen, declared that he would “confine this disease to its present limits, and in this we are sure to be successful. No fatalities have been recorded. No concern whatever is felt.”

The next day two sailors died of influenza. Krusen stated they died of “old-fashioned influenza or grip,” not Spanish flu. Another health official declared, “From now on the disease will decrease.”

The next day 14 sailors died—and the first civilian. Each day the disease accelerated. Each day newspapers assured readers that influenza posed no danger. Krusen assured the city he would “nip the epidemic in the bud.”

By September 26, influenza had spread across the country, and so many military training camps were beginning to look like Devens that the Army canceled its nationwide draft call.

Philadelphia had scheduled a big Liberty Loan parade for September 28. Doctors urged Krusen to cancel it, fearful that hundreds of thousands jamming the route, crushing against each other for a better view, would spread disease. They convinced reporters to write stories about the danger. But editors refused to run them, and refused to print letters from doctors. The largest parade in Philadelphia’s history proceeded on schedule.

The incubation period of influenza is two to three days. Two days after the parade, Krusen conceded that the epidemic “now present in the civilian population was…assuming the type found in” Army camps. Still, he cautioned not to be “panic stricken over exaggerated reports.”

He needn’t have worried about exaggeration; the newspapers were on his side. “Scientific Nursing Halting Epidemic,” an Inquirer headline blared. In truth, nurses had no impact because none were available: Out of 3,100 urgent requests for nurses submitted to one dispatcher, only 193 were provided. Krusen finally and belatedly ordered all schools closed and banned all public gatherings—yet a newspaper nonsensically said the order was not “a public health measure” and “there is no cause for panic or alarm.”

There was plenty of cause. At its worst, the epidemic in Philadelphia would kill 759 people…in one day. Priests drove horse-drawn carts down city streets, calling upon residents to bring out their dead; many were buried in mass graves. More than 12,000 Philadelphians died—nearly all of them in six weeks.

Across the country, public officials were lying. U.S. Surgeon General Rupert Blue said, “There is no cause for alarm if precautions are observed.” New York City’s public health director declared “other bronchial diseases and not the so-called Spanish influenza…[caused] the illness of the majority of persons who were reported ill with influenza.” The Los Angeles public health chief said, “If ordinary precautions are observed there is no cause for alarm.”

For an example of the press’s failure, consider Arkansas. Over a four-day period in October, the hospital at Camp Pike admitted 8,000 soldiers. Francis Blake, a member of the Army’s special pneumonia unit, described the scene: “Every corridor and there are miles of them with double rows of cots …with influenza patients…There is only death and destruction.” Yet seven miles away in Little Rock, a headline in the Gazette pretended yawns: “Spanish influenza is plain la grippe—same old fever and chills.”

People knew this was not the same old thing, though. They knew because the numbers were staggering—in San Antonio, 53 percent of the population got sick with influenza. They knew because victims could die within hours of the first symptoms—horrific symptoms, not just aches and cyanosis but also a foamy blood coughed up from the lungs, and bleeding from the nose, ears and even eyes. And people knew because towns and cities ran out of coffins.

People could believe nothing they were being told, so they feared everything, particularly the unknown. How long would it last? How many would it kill? Who would it kill? With the truth buried, morale collapsed. Society itself began to disintegrate.

In most disasters, people come together, help each other, as we saw recently with Hurricanes Harvey and Irma. But in 1918, without leadership, without the truth, trust evaporated. And people looked after only themselves.

In Philadelphia, the head of Emergency Aid pleaded, “All who are free from the care of the sick at home… report as early as possible…on emergency work.” But volunteers did not come. The Bureau of Child Hygiene begged people to take in—just temporarily—children whose parents were dying or dead; few replied. Emergency Aid again pleaded, “We simply must have more volunteer helpers….These people are almost all at the point of death. Won’t you…come to our help?” Still nothing. Finally, Emergency Aid’s director turned bitter and contemptuous: “Hundreds of women…had delightful dreams of themselves in the roles of angels of mercy…Nothing seems to rouse them now…There are families in which the children are actually starving because there is no one to give them food. The death rate is so high and they still hold back.”

Philadelphia’s misery was not unique. In Luce County, Michigan, a couple and three children were all sick together, but, a Red Cross worker reported, “Not one of the neighbors would come in and help. I …telephoned the woman’s sister. She came and tapped on the window, but refused to talk to me until she had gotten a safe distance away.” In New Haven, Connecticut, John Delano recalled, “Normally when someone was sick in those days [people] would bring food over to other families but…Nobody was coming in, nobody would bring food in, nobody came to visit.” In Perry County, Kentucky, the Red Cross chapter chairman begged for help, pleaded that there were “hundreds of cases…[of] people starving to death not from lack of food but because the well were panic stricken and would not go near the sick.”

[…]

Prompted by the re-emergence of avian influenza, governments, NGOs and major businesses around the world have poured resources into preparing for a pandemic. Because of my history of the 1918 pandemic, The Great Influenza, I was asked to participate in some of those efforts.

[…]

Then there are the less glamorous measures, known as nonpharmaceutical interventions: hand-washing, telecommuting, covering coughs, staying home when sick instead of going to work and, if the pandemic is severe enough, widespread school closings and possibly more extreme controls. The hope is that “layering” such actions one atop another will reduce the impact of an outbreak on public health and on resources in today’s just-in-time economy. But the effectiveness of such interventions will depend on public compliance, and the public will have to trust what it is being told.

That is why, in my view, the most important lesson from 1918 is to tell the truth. Though that idea is incorporated into every preparedness plan I know of, its actual implementation will depend on the character and leadership of the people in charge when a crisis erupts.

I recall participating in a pandemic “war game” in Los Angeles involving area public health officials. Before the exercise began, I gave a talk about what happened in 1918, how society broke down, and emphasized that to retain the public’s trust, authorities had to be candid. “You don’t manage the truth,” I said. “You tell the truth.” Everyone shook their heads in agreement.

Next, the people running the game revealed the day’s challenge to the participants: A severe pandemic influenza virus was spreading around the world. It had not officially reached California, but a suspected case—the severity of the symptoms made it seem so—had just surfaced in Los Angeles. The news media had learned of it and were demanding a press conference.

The participant with the first move was a top-ranking public health official. What did he do? He declined to hold a press conference, and instead just released a statement: More tests are required. The patient might not have pandemic influenza. There is no reason for concern.

I was stunned. This official had not actually told a lie, but he had deliberately minimized the danger; whether or not this particular patient had the disease, a pandemic was coming. The official’s unwillingness to answer questions from the press or even acknowledge the pandemic’s inevitability meant that citizens would look elsewhere for answers, and probably find a lot of bad ones. Instead of taking the lead in providing credible information he instantly fell behind the pace of events. He would find it almost impossible to get ahead of them again. He had, in short, shirked his duty to the public, risking countless lives.

And that was only a game.