Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It

by Gina Kolata

At the same time, Shope’s brilliant work, through no fault of its own, was to spark one of the greatest product liability fiascoes in U.S history. In 1976, because of his theories about swine influenza, the United States government ended up trying to immunize all Americans against swine flu. The decision was made by President Gerald Ford on advice from the nation’s most eminent scientists. A young soldier had died of a swine flu, igniting a fear that a deadly flu like the one from 1918 might be spreading to humans. It turned out that there was no swine flu epidemic—although no one could have known that at the time. Meanwhile, thousands of people became convinced that the swine flu vaccine caused medical problems ranging from paralysis to fatigue to nearly any chronic disease, initiating hundreds of thousands of legal claims. By the time it was called to a halt, the swine flu immunization campaign had generated a legacy of mistrust of flu vaccines and a mistrust of scientists, who were harshly criticized—unfairly, they say—for crying wolf. It became an object lesson for scientists on the dangers of taking the 1918 flu too seriously,

After the swine flu disaster, the 1918 flu “became something to avoid,” if you were a virologist, Crosby added.

In the years since Richard Shope had made the connection between swine flu and the influenza virus of 1918, scientists had made steady progress in understanding influenza viruses, but had not come close to figuring out what made one virus a killer and another a dud.

In 1944, Americans were the first in history to be immunized against influenza, with flu shots made of viruses that had been grown in eggs, then killed so that they could not cause an infection. That meant that if scientists knew in advance that a new flu epidemic was brewing, they might be able to stop it with a vaccine.

In 1947, the newly formed World Health Organization created a worldwide surveillance system to provide an early warning of flu epidemics.

Then Hale made an offhand remark about the 1918 influenza epidemic.

“Everything has been done to elucidate the cause of that epidemic. But we just don’t know what caused that flu. The only thing that remains is for someone to go to the northern part of the world and find bodies in the permafrost that are well preserved and that just might contain the influenza virus.”

Hale was saying that if someone could find bodies of flu victims that had been frozen since the day they died, the intact virus that had killed them might be chilled to a state of suspended animation. If those corpses had remained buried in permanently frozen ground in the northern...

The Hultins were the original naive visitors. When their friend showed them a sign that said “coin laundry,” Hultin recalls, “I never asked him what it was—I knew it. Americans are so worried about germs that they have their coins cleaned.”

And try to find dry ice in Alaska. It’s tough.”

The scientists were on the verge of cutting out snippets of tissue from frozen bodies that might be infected with the most dangerous virus ever known. They faced a real possibility of unleashing a new pandemic upon the world. They had no idea whether the virus would be alive, but the whole point of their expedition was to try to revive it.

When they dug into the part of the grave where bodies were lying, the four men wore gloves and surgical masks to cover their noses and mouths and they sterilized their equipment to keep from sullying the tissue samples they were removing. They asked the Eskimos to stay away while they removed tissue from the corpses. But that was the extent of their protective measures.

“In 1951, I was a graduate student,” Hultin explained. “I just didn’t have enough knowledge of how things spread. That’s why I felt comfortable having a professor of virology with us, because he would protect us. We took precautions that were standard at the time, but we were not afraid of getting infected.

Even though the protective measures that the scientists used in 1951 look primitive now, “at that time it was the best effort.” But, looking back, Hultin can’t help but shiver. “We should have been more concerned about not starting this pandemic again.”

flew home on a small plane, a DC-3. “We had the containers in the passenger compartment—no one knew what it was. It looked like camping gear,” Hultin said. “That was fifty years ago and you can imagine how many times a DC-3 airplane had to stop to refuel. Every time it stopped, we would go behind the building with our fire extinguisher and put some more dry ice in the containers.”

Hultin thought about taking precautions, just in case the flu virus was alive, as he hoped it would be. He and Whitney wore masks and sterile gowns; they worked under negative-pressure hoods, like those over kitchen stoves, where the air is swept up and under the hood into an exhaust duct rather than into the room. Those were the same precautions that McKee had established for working with highly dangerous bacteria that cause tularemia, Hultin noted. They were state-of-the-art at the time.

He dreaded returning to the rigid class system and what he describes as “an extraordinarily punitive taxation system and a life full of limiting boundaries”

It is those two viral proteins, the hemagglutinin and the neuraminidase, that define a flu strain, and scientists began naming strains by their hemagglutinin and neuraminidase proteins. A strain that swept the world in 1946, for example, was H1N1. The next time the flu virus underwent a major genetic change, creating a pandemic, was in 1956, with strain H2N2. The pandemic that arrived in 1968 involved a virus whose hemagglutinin had changed from the 1956 virus but whose neuraminidase had not. It was named H3N2.

There had been the pandemic of 1946, the first year a flu vaccine had been available. But that vaccine had been made against the previous year’s flu strain—the abrupt change in the virus’s genes took scientists by surprise, making their vaccine ineffective by the time people got their flu shots.

“I thought maybe I should go back up and see if I could find more bodies,” Hultin suggested. But nothing came of his inquiries and so he bided his time, waiting for science to advance to a state where it would be worthwhile for him to return to Brevig and try to find the virus that caused the 1918 flu. “I knew that sooner or later something would come up.”

Thus began, with a casual bet and one dead soldier, what can be viewed as either a dress rehearsal for a public health crisis that never was or one of the greatest public health disasters in medical history.

It was an affair that showed how scant knowledge and real fears can be magnified in a political arena, transmogrifying into certainties that no scientist could defend and pronouncements that were based more on hype than on fact. It eventually demonstrated the unerring ability of the press to ratchet coincidences into causal relationships and spark a panic. And from its start in New Jersey to its dwindling end in the nation’s courtrooms, the story was a graphic illustration of the power of an image, the haunting memory of the 1918 flu that was rising like a specter from its grave.

It took a week for the lab at the Centers for Disease Control to discover the virus’s identity. It was a swine flu virus, one that was closely related to, if not identical to, the virus that, through the sleuthing in the 1930s by people like Richard Shope, was thought to have caused the 1918 influenza pandemic.

An antibody test was not a definite proof that the Fort Dix virus was identical to the 1918 virus. After all, no one had ever isolated the 1918 virus and the only evidence that it was a swine flu virus came from the curious appearance of swine flu antibodies in people who had survived that flu—but not in people who were born after 1918.

On Thursday, February 12, eight days after David Lewis’s death, Dr. Walter Dowdle, the laboratory chief at the Centers for Disease Control, looked down at the written laboratory reports from the Centers’ virologists telling him that one man had perished from swine flu at Fort Dix and four others were infected. He knew that this was an extraordinary moment.

It was a bit too much like the 1918 flu for comfort—a young man, healthy and strong, dying mysteriously within days of falling ill. Moreover, the men at Fort Dix were the perfect age to be infected with a flu like the one that caused the disastrous pandemic of 1918. Only people well over age fifty would have lived through the 1918 flu and could have built up antibodies that could protect them from the virus. That meant that young men, indeed most of the population, would be vulnerable if the virus came again.

How could they ignore the possibility that the Fort Dix flu outbreak was a first sounding of another disastrous occurrence of the 1918 flu? If it was, they had no time to waste. In the years since 1918, medical researchers had learned to isolate and identify flu viruses and they had learned to make vaccines. Yes, it took months to make a flu vaccine. But perhaps the Fort Dix incident was a godsend, a warning that came early enough so that a 1918-type disaster might be averted. If a flu virus was going to burn through the population, leaving huge swathes of dead young people behind, it should show up as an epidemic the next fall, when new flu strains, having emerged the year before, would take over. That meant that if an unprecedented effort was made, companies might be able to manufacture enough vaccine to protect all Americans against the new swine flu. There were a few obvious problems, including a logistical one: No one had ever attempted to vaccinate an entire population against the flu and it was hard to even imagine making so much vaccine. The other problem was scientific: The data thus far were so paltry that they could hardly justify making such a major decision.

That evening, he called Sencer at his home, giving him the grim news. Of course, it could be a false alarm, the lab may have made a mistake, and so Sencer demanded that the virologists repeat their tests the next day. On February 13, the virologists began to redo the tests, but it would take days to get an answer. In view of the gravity of the finding, Sencer decided not to wait. He called a meeting of federal officials for the next day, Saturday, February 14. It meant asking busy public health leaders to fly immediately to Atlanta. All agreed to come.

Dr. Edwin D. Kilbourne, who was then chairman of the microbiology department at Mount Sinai School of Medicine in New York, proposed that influenza pandemics came at approximately eleven-year intervals. The virus, Kilbourne argued, periodically mutated into a new creation that few could fight off. The last pandemic was in 1968, which meant, he had predicted, that the world in 1976 was almost due for a new influenza strain. In fact, by coincidence, the same day that the virologists at the Centers for Disease Control identified the Fort Dix viruses as swine flu, The New York Times published an op-ed piece by Kilbourne describing the periodic nature of influenza pandemics and warning that a new pandemic was likely to strike. It appeared with a headline that said, “Flu to the Starboard! Man the Harpoon. Fill ’em with Vaccine! Get the Captain!” and it was illustrated with what Kilbourne described was a “hyperbolic cartoon,” showing a man overboard grasping for a life preserver.

History seemed to bear him out. The Asian flu virus of 1957 was thought to resemble a virus that spread through the world in 1889. The Hong Kong flu virus of 1968 was thought to resemble the virus that caused the influenza pandemic of 1898. In 1979, Kilbourne reasoned, it should not be surprising to see a flu that resembled that of 1918.

In his op-ed piece, Kilbourne stated his case succinctly, writing that influenza pandemics “have marked the end of nearly every decade since the 1940’s—at intervals of exactly 11 years—1946, 1957, 1968. A perhaps simplistic reading of this immediate past tells us that 11 plus 1968 is 1979, and urgently suggests that those concerned with public health had best plan without delay for an imminent natural disaster.”

Whenever pandemic influenza next appears, we must improve upon our well-intentioned but uncoordinated efforts of the past that have resulted in ambiguous advice to the public and inadequate production and maldistribution of vaccine.”

“I was extremely interested,” Kilbourne said. He realized that his op-ed piece with the cartoon that seemed so exaggerated at the time now looked prescient. “I thought, ‘Maybe I was more right than I thought I’d be,’”

Of course, everyone had one burning question: Were four cases of swine flu the first signs of a new pandemic?

Many of the decisions they reached that day showed that they were preparing for the worst, for the return of the 1918 flu.

The group decided to make swine flu antibodies for use in laboratory tests, just in case.

The group meeting with Sencer also agreed that they needed to start preparing a vaccine.

Finally, they knew they had to do scientific studies to see whether the swine flu virus was spreading within and beyond Fort Dix and, if so, how far and how fast it was moving.

Presumably, unless the people had been sick with this flu before or unless they had been around in 1918, their blood would be bereft of swine flu antibodies. But if the patients had been infected with a swine flu, their blood samples taken a few weeks after they were ill would be brimming with antibodies to this influenza strain.

The group also knew that they had no method to answer the most crucial question: Was the swine flu virus found in the Fort Dix soldiers the first sign of a recurrence of the 1918 pandemic or something totally insignificant—a feeble virus, perhaps, that could barely spread from person to person and that, even on those rare occasions when it does spread, is not harmful?

On February 17, the virology lab at the Centers for Disease Control reported that it had completed its retesting of the virus, confirming that the men at Fort Dix were infected with a swine flu.

Kilbourne worried about the danger of working with what might be a deadly flu strain. He decided that just he and his lab technician, Barbara Pokorny, would work with the viruses and that they would work in a closed room. The sort of high-tech containment facilities used today for work with deadly viruses were not available in 1976. He told no one except Pokorny what they were doing or the nature of the new viruses. Pokorny told New York Times science reporter Harold Schmeck months later that she kept the pact of silence. “I wouldn’t let anybody in the laboratory,” she said. “They really thought I had flipped out.”

Meanwhile, government officials decided that the time had come to tell the public about the swine flu at Fort Dix. As much as they wanted to study the situation further and see whether a deadly flu strain was loose, they were afraid that there would be leaks to the press—the worst possible scenario.

His intention was to keep the discussion low-key and to not even mention 1918. The analogy, however, came out in the question-and-answer period that followed the official statement. A few reporters, astutely, seized upon it.

NBC news said much the same and showed pictures from 1918 of people wearing masks in an effort to protect themselves against the killer flu.

One reason the flu is less apparent in summer is that the virus dies quickly in high humidity. It needs dry winter air to spread and flourish, which is why flu epidemics seem to disappear when spring arrives.

“I was fearful that the virus was overwintering some place and would pop up in the fall,” he says. With a vaccine program, he adds, “for the first time in history, we had a chance to forestall a pandemic.”

was clear that we could not say the virus would spread. But it was clear that there had been human-to-human spread at Fort Dix. It was also clear that there was not any immunity in the population to this virus, not if you were under 50 (or maybe 62).” That meant, he said, that “most people were at risk, especially young adults. An epidemic spreading into a pandemic had to be considered as a possibility.”

If the government decided to go ahead with a national swine flu immunization campaign, there literally was no time to waste. It would take months to make the vaccine and eight to ten weeks to distribute it nationally, the first time ever that so many people would be receiving a vaccine. It takes two weeks for a vaccinated person to become immune to the flu. And so the time from the manufacture of a swine flu vaccine to the successful immunization of most of the nation was going to be at least three months.

“There was nothing in this for the CDC except trouble. Here we were at the end of one flu season with time to try to do something before the next flu season. The obvious thing to do was to immunize everybody. But if we tried to do that, guide it, help it along, we might have to interrupt a hell of a lot of work on other diseases.” Suppose there was an influenza pandemic, the meeting participant said. An immunization program was an almost certain invitation to disaster. Those who had been unable to get the flu shots in time would be angry because they would be vulnerable. Those who were immunized but who caught another virus that they thought was the flu would be annoyed because they would assume that the vaccine did not work. All in all, millions of people would be upset.