Mild at First: A Brief History of The 1918 Bird Flu Pandemic

History doesn't repeat. It mutates.

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It started on farms in Kansas.

At first, it was severe.

Then it wasn't.

During the winter of 1917, a mystery flu started making locals sicker than doctors had ever seen. One of the doctors tried to sound the alarm, but the government ignored him. There was no national system for tracking or responding to flu infections. By springtime, the virus disappeared.

Everyone relaxed.

The flu resurfaced at an army base on the other side of the state. This time, it caused an outbreak among soldiers in overcrowded, unsanitary conditions. The military did nothing. They didn't care if their soldiers got sick, or even if some of them died. They did care about testing them for venereal diseases and limiting their access to alcohol and prostitutes. If a soldier came down with a venereal disease, they could be court-martialed.

Every Flu A in humans originated in birds and then made its way to us through an intermediary mammal host, usually pigs. In 1918, veterinarians were documenting regular flu infections in pigs and other mammals. They didn't know it at the time, but the virus (H1N1) was doing what H5N1 is now, jumping back and forth and trying to adapt to new hosts.

Compared to DNA viruses, RNA viruses like flu and Covid mutate hundreds or even thousands of times faster. Their antigens change. They don't evolve on a linear path. They shuffle back and forth between less or more contagious, and less or more pathogenic. When a virus finds the right environment, you get the worst of both. You get a virus that's highly contagious and extremely deadly.

That's what happened in 1918.

The flu hitched a ride with American soldiers to the trenches of Europe, but it wasn't the only virus to slam the army.

Measles struck first.

Even before deployment overseas, between Sept 1917 and March 1918, tens of thousands of soldiers fell ill with measles on American military bases due to overcrowding and unsanitary conditions.

Thousands died.

Military commanders didn't listen to their doctors about sanitation and disease prevention. In their rush to war, they also neglected key logistics. They didn't build out enough infrastructure, and it left troops huddled around tent stoves, sharing everything from spoons and forks to beds and blankets.

In the decades leading up to the Great War, disease killed 6-10 times as many soldiers as fighting did. For every soldier who died from combat wounds, as many as ten died from diseases unrelated to fighting.

Republicans held spectacle hearings on Woodrow Wilson's failure to mobilize the military effectively. Wilson responded with propaganda.

The American propaganda machine

At the time, Woodrow Wilson's administration didn't care about public health at all. They only cared about converting the entire country into a weapon. If you want a preview of fascism, look at the U.S. in 1918. They outlawed German language instruction. They crushed unions. They demanded "voluntary" sacrifices from every citizen, whether it meant foregoing meat or giving up weekends to make goods and equipment for the military. You couldn't go anywhere without hearing liberty songs and speeches. Someone was always trying to sell you a war bond. You could be arrested for sounding pessimistic. If you criticized the war effort, if you made a peep, you were a traitor.

Vigilante mobs called "citizens committees" beat and lynched anyone they suspected of treason, sometimes even wrapping their corpses in American flags. If someone refused to buy a war bond, they were either publicly shamed or even tied up and dragged to death. This was the brutal side of America you don't read about in textbooks, a brutality Woodrow Wilson himself made it his personal duty to nurture.

Newspapers ranging from The New York Times to The Washington Post were complicit in all of it, excusing mobs while describing unions as German agents. Imagine how talking about a deadly, highly contagious disease would've made someone sound.

Meanwhile...

Nothing to worry about

Full-blown flu outbreaks began in the military in March 1918. As John Barry writes in The Great Influenza, "At first it seemed like nothing to worry about, nothing like the measles outbreak with its pneumonic complications." The flu didn't look as severe as the first infections in Kansas.

It appeared mild.

Soldiers were falling ill, but they were recovering. Instead of doing anything proactive, military commanders let the flu spread and mutate in a population already ravaged by measles and secondary infections with pneumonia. Another fun fact: Infection with measles causes "immune amnesia." Your immune system forgets every disease it ever encountered.

If you were a virus looking for a place to mutate, the trenches of wartime Europe filled with immune amnesiacs was the perfect place.

By May 1918, the flu was spreading through the American, French, German, and British militaries. Tens of thousands were getting sick, but they were recovering. Then they were getting sick again.

Initially, the 1918 flu was so mild that when the first wave spread around the world, infecting up to 30 percent of the population, it was so short-lived that doctors didn't take it seriously. An article in The Lancet even declared, "It's not flu." By August 1918, doctors everywhere assumed it was over.

They were wrong.

Viral passage

The H1N1 flu spent the summer of 1918 mutating further and adapting to humans, becoming deadlier, not milder. It followed a process called passage, when a virus picks up lethality as it moves through more hosts of the same species.

When you pack living creatures together into close quarters, you remove any supposed evolutionary constraints on a virus to attenuate. So the idea of passage helps explain how a virus like the flu can become more deadly thanks to urbanization, globalization, and industrialization. It explains how a virus can go from being “mild” in people (or cows) to becoming fatal.

Our immune systems haven’t had sufficient time to adapt to these new conditions. Neither have the immune systems of our livestock.

Viruses evolve faster than we do.

Much faster.

In 1918 soldiers, immigrants, and travelers spread the more lethal flu strain to every corner of the world. Western governments were still censoring newspapers, so they rarely reported on outbreaks. Spain remained neutral. Because they didn't censor their press, they reported on the virus.

Hence the misnomer, "Spanish Flu."

In reality, it was the American Flu. Major outbreaks happened in the late summer and early fall. Doctors and scientists reported on the flu's pathogenic turn. Despite that, Woodrow Wilson's administration, including his public health officials, routinely dismissed the significance. The Surgeon General told the public there was "no cause for alarm." Wilson himself refused to direct any resources toward planning or preparation, even as more and more outbreaks gained attention from doctors and scientists. He was too focused on punishing Germany, ignoring their attempts to surrender. He didn't want to give up his propaganda machine or his spy network. In public or private, he almost never spoke about the flu.

Occasionally, newspapers did report on the seriousness of the blooming pandemic and tried to warn their citizens. When they did, the Army Morale Branch threatened them with criminal prosecution.

Chew your food to avoid flu

Woodrow Wilson did absolutely nothing about the flu. Men like Rupert Blue, the Surgeon General, demonstrated equally poor leadership. As Barry writes, he "became surgeon general simply by carrying out assigned tasks well, proving himself an adept and diplomatic maneuverer, and seizing his main chance." During much of the pandemic, he did "less than nothing," often blocking or sabotaging early efforts to get ahead of the virus.

Most doctors and scientists at the time considered Rupert Blue "a lightweight." He had done a barely competent job at managing an outbreak of plague in 1903, gaining cooperation from local businesses "who denied plague existed." Although he didn't stop the plague from becoming endemic in rodents, he managed to make friends among the elite.

As the flu started accelerating, Rupert Blue started publishing warnings in local newspapers advising citizens to:

1. Keep their clothes clean

2. Chew their food properly

3. Cover their face when sneezing

4. Breathe through their nose only

5. Wash their hands.

That would keep them healthy.

Doctors and even military officers were starting to discover the potential of gauze masks to slow or stop the spread of the flu. Unfortunately, they couldn't secure enough material. The first major outbreak of the new flu strain in a civilian population happened after a Liberty Loan parade in Philadelphia. You could think of it as the first superspreader event.

Three days later, flu exploded in the city. Hospitals filled up. People tried to bribe their way into hospital beds. It only took ten days for cases and deaths to go from a few hundred to hundreds of thousands of cases and hundreds of deaths a day. Similar outbreaks picked up speed in other cities, as well as more military bases. The flu brought a quick end to the war. Everyone was sick, dying, terrified, or trying desperately to keep the flu from spreading.

There was nobody left to fight.

It became physically impossible to train or equip new troops. Still, Wilson insisted on shipping soldiers overseas anyway.

The Surgeon General did finally realize his mistakes, but by the winter of 1918 it was far too late to do anything. Rupert Blue rounded up a ragtag team of underqualified doctors and nurses, sending them to towns and cities with no medical staff. There wasn't much they could offer except to advise flu patients to stay in bed and rest.

These flu symptoms were like something from a horror movie. As delirium took over, patients bled from their eyes and noses. A quarter of patients reported vision problems, even blindness. They suffered respiratory as well as neurological carnage second only to the pneumonic plague in severity. Autopsies revealed extensive heart, kidney, and brain damage. It presented with so many symptoms that even the best doctors misdiagnosed it as...

Dengue, plague, typhoid, cholera, and malaria.

The flu looked like everything.

From New York to Boston, cities ran out of coffins and gravediggers. Morgues and porches filled up with stacks of bodies. Families had to keep the dead in their bedrooms, even when they began to stink.

Even before dying, their bodies turned dark blue.

America's preoccupation with the war left everyone vulnerable and completely unprepared for the pandemic. Labs didn't have the equipment they needed to study this mystery contagion. A large portion of the country's doctors and nurses were halfway across the world. A handful of diehard scientists did their best, paving the way for future treatments and vaccines.

Cities like Philadelphia, hit first and hardest, were essentially abandoned by the government. There was no emergency or disaster response. If an event like an earthquake or a tornado brings out the best in us, a pandemic often brings out the worst. Residents didn't help each other because they were too afraid of catching the flu. Death entered every home.

Any sense of community evaporated.

An aura of dread descended.

As Barry writes, "No national official ever publicly acknowledged the danger of influenza." Federal and local governments "left a vacuum."

"Fear filled it."

And yet...

Public health officials across the country continued to downplay and minimize the virus. The head of public health in Illinois said, "Worry kills more people than the epidemic." A newspaper in New Mexico printed daily columns urging the public, "Don't let flu frighten you to death."

One newspaper in Phoenix even published an article stating that "The people during an epidemic who are most fearful are usually, on the testimony of physicians, the first ones to succumb to the disease."

Articles like these continued right until the middle of winter 1918, when there was no doubt about how wrong they'd been. That was when public health took an abrupt turn, with everyone from the Red Cross to red state governors publishing thousands of stories, pamphlets, and brochures urging people to avoid crowds, chew their food, and keep their bowels clean. Only a handful of organizations, like the American Medical Association, dared to contradict the narrative, urging strict quarantine and social distancing protocols.

By then, it was too late.

It was only somewhere in the middle of the second wave that cities started imposing strict public health mandates, and police started arresting anyone for sneezing without covering their face.

Even that didn't last.

The rush to normal

By the end of the second wave, there were signs the virus was attenuating, becoming milder again. The public started complaining about school and business closures, along with the discomfort of face masks.

As J. Alexander Navarro writes, "life after the pandemic seemed to be a headlong rush to normalcy." Except the pandemic wasn't over. Waves would hit through 1920. After that, the flu would become a regular menace.

In 1920, Warren Harding won the presidential election by campaigning hard on the idea of “normalcy.” He used the word frequently while promising Americans a return to business as usual, after a war and a pandemic. He also hitched the promise of normal to less progressive politics. In the new fixation on normal, eugenics began to take a firm root in American discourse. Instead of addressing the deep problems that brewed crisis, everyone tried to ignore them.

We know where the 1920s led.

The 1918 pandemic became a silent presence in art and literature. It's hardly mentioned in history textbooks. As many of us have speculated, the public was happy to forget that disturbing, dark period in history, where Americans beat traitors to death for nothing and ignored a tangible threat that wound up killing their friends and family. It must've been more than trauma. It must've been a deep coat of shame, regret, and guilt.

Experts estimate the 1918 pandemic killed 675,000 people in the U.S. Today, that would translate to roughly 2 million deaths. The mortality rate ranged anywhere from 1 to 20 percent in various parts of the world, depending on the quality and access to healthcare. Historically, the flu has posed a greater threat to humanity than any other virus, including the plague. In 1997, Hong Kong slaughtered every single one of its chickens to prevent an especially bad strain from adapting to humans. In 2003, Europe slaughtered 30 million poultry to stop H7N7.

There's one strain of flu that we haven't been able to eradicate, no matter how many birds we slaughter.

That's H5N1, now burning through the dairy industry.

As John Barry writes, H5N1 “threatened, and still threatens, to cause another pandemic. In total, hundreds of millions of poultry were slaughtered in an attempt to contain it. Nonetheless, it has become endemic worldwide."

Our minimizing friends and coworkers believe we've lived with disease for thousands of years. You hear it all the time.

That's not true.

Scientists have gone to extraordinary lengths to protect us from diseases like the flu. Once they find a home in humans, they cause catastrophic damage. They kill civilizations. They change the course of history. We don't have Liberty Loan parades anymore. Instead, we have Taylor Swift concerts and MAGA rallies. We live with an administration much like Woodrow Wilson's, more interested in war than public health, run by bureaucrats who are better at making powerful friends than controlling diseases. And all of them preach vibes over truth.

Even if H5N1 causes a mild first wave, there's no telling what will happen after that. If 1918 gives us any lessons, it's that "mild at first" offers no comfort or reassurance at all. It doesn't look like the world will get a century to bury the memory of the last pandemic. There's another one coming, and another, and another. We live in the age of pandemics now. As a society, we're either going to learn the value of masks and clean air, or we're going see more death, suffering, and denial.

History doesn't repeat.

It mutates.