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

by Gina Kolata

The epidemic affected the course of history and was a terrifying presence at the end of World War I, killing more Americans in a single year than died in battle in World War I, World War II, the Korean War, and the Vietnam War.

The plague took off in September of that year, and when it was over, half a million Americans would lie dead. The illness spread to the most remote parts of the globe. Some Eskimo villages were decimated, nearly eliminated from the face of the earth. Twenty percent of Western Samoans perished. And no matter where it struck, the virus went after an unusual group—young adults who generally are spared the ravages of infectious diseases. The death curves were W-shaped, with peaks for the babies and toddlers under age 5, the elderly who were aged 70 to 74, and people aged 20 to 40.

How many became ill? More than 25 percent of the U.S. population. What about servicemen, the very young and healthy who were the virus’s favorite targets? The Navy said that 40 percent of its members got the flu in 1918. The Army estimated that about 36 percent of its members were stricken. How many died worldwide? Estimates range from 20 million to more than 100 million, but the true number can never be known. Many places that were bludgeoned by the flu did not keep mortality statistics, and even in countries such as the United States, efforts at tabulating flu deaths were complicated by the fact that there was no definitive test in those days to show that a person actually had the flu. But still, the low end of the mortality estimates is stunning. In comparison, AIDS had killed 11.7 million people through 1997. World War I was responsible for 9.2 million combat deaths and around 15 million total deaths. World War II for 15.9 combat deaths. Historian Crosby remarks that whatever the exact number felled by the 1918 flu, one thing is indisputable: the virus “killed more humans than any other disease in a period of similar duration in the history of the world.”

So many died, in fact, that the average life span in the United States fell by twelve years in 1918.

On a whim, he picked up an almanac from 1917 and looked up the U.S. life expectancy. It was, he recalls, about fifty-one years. He then turned to the almanac from 1919. The life expectancy was about the same. Then he looked at the 1918 almanac. The life expectancy was thirty-nine years, he says. “What the hell happened? The life expectancy had dropped to what it had been fifty years before.”

But in the rest of the world, the illness came to be called the Spanish flu, to Spain’s consternation. After all, the other countries of Europe, as well as the United States and countries in Asia, were hit too in that spring of 1918. Maybe the name stuck because Spain, still unaligned, did not censor its news reports, unlike other European countries. And so Spain’s flu was no secret, unlike the flu elsewhere.

At the other extreme were those who fled to lives of wild abandon. They “maintained that an infallible way of warding off this appalling evil was to drink heavily, enjoy life to the full, go round singing and merrymaking, and gratify all of one’s cravings whenever the opportunity offered, and shrug the whole thing off as one enormous joke.”

And it was a time when death became separate from everyday life. The Ladies’ Home Journal proudly declared that the parlor, where the dead had been laid out for viewing, was now to be called the “living room,” a room for the living, not the dead.

Hultin never wrote up his results, never published a scientific paper on his failed attempt to resurrect the 1918 flu virus. “I thought, ‘I have it all, I can always write it up later,’” he said. By then, his six-month stay had been extended to two years and he was expected to finish his master’s degree—imminently. “I was busy with my master’s degree project and it was a negative finding,” Hultin said. “If it had been positive it would be tremendous, but it was negative.”

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.

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.

Neustadt and Ernest R. May, a historian at Harvard University, later analyzed what they saw as crucial moments in the swine flu vaccine decision. It shared features, they said, with several other crucial moments in history, the Bay of Pigs and the Vietnam War. In each instance, they say, “the individuals who made the key decisions, or at least some of them, looked back and asked, ‘How in God’s name did we come to do that?’”

But this time Earl Butz, the Secretary of Agriculture, was also present, telling Ford that although an unprecedented number of eggs would be needed to grow the flu virus in order to make the vaccine, “the roosters of America are ready to do their duty.”

vaccines? Or was there something peculiar about this

But, at a time when ironies and mistaken assumptions were making a shambles of the swine flu vaccine, the secret irony of the Guillain-Barré link was perhaps the wryest one. The whole alarm came about because the Minnesota doctor who first reported a flu shot patient who got the disease had misheard an audiotape. He thought the tape warned that Guillain-Barré syndrome might follow flu shots. In fact it said just the opposite. It had used the disease as an example of how a faulty association could be drawn between a disease and the vaccine if, by chance, a person who had had the vaccine happened to become ill for reasons having nothing to do with the vaccine.