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January 9 - January 31, 2021
“The Federal public health service has been . . . unable to handle adequately the entire situation. . . . [They] have not been on the job.” It was October when he sent that wire. By then everyone needed nurses, or they were about to, and they knew it. By then everyone needed doctors, or they were about to, and they knew it. And they needed resources. The biggest task remained finding doctors, nurses, and resources. They needed all three.
Ten days, two weeks, sometimes even longer than two weeks after the initial attack by the virus, after victims had felt better, after recovery had seemed to begin, victims were suddenly getting seriously ill again. And they were dying. The virus was stripping their lungs all but naked of their immune system; recent research suggests that the virus made it easier for some kinds of bacteria to lodge in lung tissue as well. Bacteria were taking advantage, invading the lungs, and killing.
Surgeons developed new techniques during the epidemic that are still in use to drain empyemas, pockets of pus and infection that formed in the lung and poisoned the body. And doctors had drugs that alleviated some symptoms or stimulated the heart; major hospitals had X-rays that could aid in diagnosis and triage; and some hospitals had begun administering oxygen to help victims breathe—a practice neither widespread nor administered nearly as effectively as it would be, but worth something. Yet for a doctor to use these resources, any of them, that doctor had to have them—and also had to have
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The virus was penetrating everywhere, doctors were needed everywhere, and no responsible doctor would abandon his (or, in a few instances, her) own patients in need, in desperate need. In addition, the federal government was paying only $50 a week—no princely sum even in 1918.
What could help, more than doctors, were nurses.
Nursing could give a victim of the disease the best possible chance to survive. Nursing could save lives. But nurses were harder to find than doctors.
recruiters had a list of all nurses in the country, their jobs and locations. Those recruiters now pressured nurses to quit jobs and join the military, pressured doctors to let office nurses go, made wealthy patients who retained private nurses feel unpatriotic, pushed private hospitals to release nurses.
“The work at National Headquarters has never been so difficult and is now overwhelming us. . . . [We are searching] from one end of the United States to the other to rout out every possible nurse from her hiding place. . . . There will be no nurses left in civil life if we keep on at this rate.” The recruiter wrote that on September 5, three days before the virus exploded at Camp Devens.
The corpses had backed up at undertakers, filling every area of these establishments and pressing up into living quarters; in hospital morgues overflowing into corridors; in the city morgue overflowing into the street. And they had backed up in homes. They lay on porches, in closets, in corners of the floor, on beds. Children would sneak away from adults to stare at them, to touch them; a wife would lie next to a dead husband, unwilling to move him or leave him. The corpses, reminders of death and bringers of terror or grief, lay under ice at Indian-summer temperatures. Their presence was
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gravediggers would not work. The city’s official annual report notes that “undertakers found it impossible to hire persons willing to handle the bodies,
The families had to dig their own graves.
“They brought a steam shovel in to Holy Cross Cemetery and actually excavated. . . . They would begin bringing caskets in and doing the committal prayers right in the trench and they’d line them up right in, one right after another, this was their answer to helping the families get through things.”
the people who had died were wrapped in a sort of sackcloth and placed in the wagon. One was on top of the other, there were so many bodies.
People were already avoiding each other, turning their heads away if they had to talk, isolating themselves. The telephone company increased the isolation: with eighteen hundred telephone company employees out, the phone company allowed only emergency calls; operators listened to calls randomly and cut off phone service of those who made routine calls.
isolation increased the fear.
It now seemed as if there had never been life before the epidemic. The disease informed every action of every person in the city.
On the single day of October 10, the epidemic alone killed 759 people in Philadelphia. Prior to the outbreak, deaths from all causes—all illnesses, all accidents, all suicides, and all murders—averaged 485 a week.
The hundreds of thousands sick in the city became a great weight dragging upon it. And the city began to implode in chaos and fear.
without trust all human relations were breaking down.
Doctors died, and others kept working. Nurses died, and others kept working.
The police performed with heroism.
But citizens in general had largely stopped responding. Many women had reported to an emergency hospital for a single shift. They had never returned.
They have been told that there are families in which every member is ill, 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.”
“We didn’t work. Couldn’t go to work. Nobody came into work.” Even those who weren’t sick “stayed in. They were all afraid.”
The entire transportation system for the mid-Atlantic region staggered and trembled, putting in jeopardy most of the nation’s industrial output.
on the other side of the world, the same experiences—the deaths, the terror, the reluctance to help, the silence—were replicated.
The federal government was giving no guidance that a reasoning person could credit. Few local governments did better. They left a vacuum. Fear filled it.
“The first casualty when war comes is truth.”
newspapers insisted, “There is plenty of gasoline and oil for automobile use,” even while gas stations were ordered to close “voluntarily” at night and Sundays and a national campaign was being waged against driving on “gasless Sundays”—and police pulled over motorists who did not “voluntarily” comply.
Newspapers reported on the disease with the same mixture of truth and half-truth, truth and distortion, truth and lies with which they reported everything else.
People could not trust what they read.
military authorities of course assured both civilians nearby as well as the country at large that “the epidemic is on the wane.”
Fear, that was the enemy. Yes, fear. And the more officials tried to control it with half-truths and outright lies, the more the terror spread.
The Albuquerque Morning Journal issued instructions on “How to Dodge ‘Flu.’” The most prominent advice was the usual: “Don’t Get Scared.” Almost daily it repeated, “Don’t Let Flu Frighten You to Death,” “Don’t Panic.”
It may be surmised that the editors played down the severity of the problem to discourage the onset of general panic in the face of what was a thoroughly frightening situation.”
How could one not get panicky?
before people’s neighbors began to die, before bodies began to pile up in each new community, every piece of information except the newspapers told the truth.
But a Public Health Service warning to avoid crowds came too late to do much good, and the only advice of any real use remained the same: that those who felt sick should go to bed immediately and stay there several days after all symptoms disappeared.
The Journal of the American Medical Association knew better. It dismissed the public reassurances and warned, “The danger to life from influenza in this epidemic is so grave that it is imperative to secure from the individual patient the most complete isolation.” And it attacked “current advice and instructions to the public from the official and other sources”—Blue’s advice, the advice from local public health officials downplaying everything—as useless and dangerous.
In 2001 a terrorist attack with anthrax killed five people and transfixed America. In 2002 an outbreak of West Nile virus killed 284 people nationally in six months and sparked headlines for weeks, along with enough fear to change people’s behavior. In 2003 SARS killed over eight hundred people around the world, froze Asian economies, and frightened millions of people in Hong Kong, Singapore, and elsewhere into wearing masks on the streets. In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They
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others fomented terror, believing that blaming the enemy—Germany—could help the war effort, or perhaps actually believing that Germany was responsible. Doane himself charged that “German agents . . . from submarines” brought influenza to the United States. “The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle to America.”
Dr. M. G. Parsons, the U.S. Public Health Service officer for northeastern Mississippi, who proudly informed Blue that he had succeeded in getting local newspapers to run stories he made up that “aid in forming a proper frame of mind” in the public. That frame of mind was fear. Parsons wanted to create fear, believing it “prepared the public mind to receive and act on our suggestions.”
“The Germs Are Coming. An epidemic of influenza is spreading or being spread, (we wonder which).” Those and similar charges created enough public sentiment to force Public Health Service laboratories to waste valuable time and energy investigating such possible agents of germ warfare as Bayer aspirin.
banned customers from stores; the stores remained open, but customers shouted orders through doors, then waited outside for packages.
enforce anti-influenza ordinances, including requiring every person in public to wear a mask, arresting anyone who spit or coughed without covering his mouth, dictating that businesses (those that remained open) give twelve hundred cubic feet of air space to each customer, and halting all traffic into the city and allowing only those with “actual business here” to enter.
physicians attempted everything—everything—to save lives.
Homeopaths believed that the epidemic proved their superiority to “allopathic” physicians.
“Nothing should be done by the medical profession that may arouse unwarranted hope among the public and be followed by disappointment and distrust of medical science and the medical profession.” JAMA represented the American Medical Association. AMA leaders had worked for decades to bring scientific standards and professionalism to medicine. They had only recently succeeded. They did not want to destroy the trust only recently established. They did not want medicine to become the mockery it had been not so long before.
No medicine and none of the vaccines developed then could prevent influenza. The masks worn by millions were useless as designed and could not prevent influenza. Only preventing exposure to the virus could. Nothing today can cure influenza, although vaccines can provide significant—but nowhere near complete—protection, and several antiviral drugs can mitigate its severity.
the closing orders that most cities issued could not prevent exposure; they were not extreme enough.
