The Great Influenza: The Epic Story of the Deadliest Plague in History

by John M. Barry

The virus was too efficient, too explosive, too good at what it did.

It was as if the virus were a hunter. It was hunting mankind.

in those most distant corners of the earth, in those places so inhospitable that they barely allowed man to live, in those places where man was almost wholly innocent of civilization, man was not safer from the virus. He was more vulnerable.

In Nome, 176 of 300 Eskimos had died. But it would get worse. One doctor visited ten tiny villages and found “three wiped out entirely; others average 85% deaths. . . . Survivors generally children . . . probably 25% this number frozen to death before help arrived.”

The virus probably did not kill all of them directly. But it struck so suddenly, with such simultaneity, it left no one well enough to care for any others, no one to get food, no one to get water. And those who could have survived, surrounded by bodies, bodies of people they loved, might well have preferred to go where their family had gone, might well have wanted to no longer be alone. And then the dogs would have come.

In Labrador man clung to existence with tenacity but not much more permanency than seaweed drying on a rock, vulnerable to the crash of surf at high tide.

“sickness . . . has struck the place like a cyclone, two days after the Mail boat had left.” Gordon went from house to house. “Whole households lay inanimate on their kitchen floors, unable even to feed themselves or look after the fire.” Twenty-six of one hundred souls had died. Farther up the coast, it was worse.

In all of Labrador, at least one-third of the total population died.

And populations whose immune systems were naive, whose immune systems had seen few if any influenza viruses of any kind, were not just decimated but sometimes annihilated. This was true not only of Eskimos but of all Native Americans, of Pacific Islanders, of Africans.

Even when the virus mutated toward mildness, it still killed efficiently in those whose immune systems had rarely or never been exposed to influenza.

A very few—very few—isolated locations around the world, where it was possible to impose a rigid quarantine and where authorities did so ruthlessly, escaped the disease entirely. American Samoa was one such place. There not a single person died of influenza.

Yet India was not like elsewhere. There influenza would take on truly killing dimensions. A serious epidemic of bubonic plague had struck there in 1900, and it had struck Bombay especially hard. In 1918 the peak daily influenza mortality in Bombay almost doubled that of the 1900 bubonic plague, and the case mortality rate for influenza reached 10.3 percent. Throughout the Indian subcontinent, there was only death.

The supply of firewood was quickly exhausted, making cremation impossible, and the rivers became clogged with corpses.

In the Indian subcontinent alone, it is likely that close to twenty million died, and quite possibly the death toll exceeded that number.

“If the epidemic continues its mathematical rate of acceleration, civilization could easily,” he wrote in hand, “disappear . . . from the face of the earth within a matter of a few more weeks.”

Since birds provide a natural home for it, influenza does not depend upon civilization. In terms of its own survival, it did not matter if humans existed or not.

once it achieved near-maximum efficiency, two other natural processes came into play.

immunity. Once the virus passed through a population, that population developed at least some immunity to it. Victims were not likely to be reinfected by the same virus, not until it had undergone antigen drift.

cycle from first case to the end of a local epidemic in 1918 generally r...

The virus burned through available fuel. Then it quickly faded away.

second process occurred within the virus. It was only influenza. By nature the influenza virus is dangerous, considerably more dangerous than the common aches and fever lead people to believe, but it does not kill routinely as it did in 1918.

the 1918 virus, like all influenza viruses, like all viruses that form mutant swarms, mutated rapidly.

the virus mutated toward its mean, toward the behavior of most influenza viruses. As time went on, it became less lethal.

the only effective measure used against influenza in any of the camps had been to isolate both individual influenza victims and, if necessary, entire commands that became infected: these efforts “failed when and where they were carelessly applied” but “did some good. . . . when and where they were rigidly carried out.” He found no evidence that anything else worked, that anything else affected the course of the disease, that anything else changed except the virus itself. The later the disease attacked, the less vicious the blow.

Even as the virus mellowed, it still killed. It still killed often enough that in maturity it would have been, except for its own younger self, the most lethal influenza virus ever known.

Only weeks after the disease seemed to have dissipated, when town after town had congratulated itself on surviving it—and in some places where people had had the hubris to believe they had defeated it—after

a third wave broke over the earth.

The virus had mutated again. It had not become radically different. People who had gotten sick in the second wave had a fair amount of immunity to another attack, just as people sickened in the first wave had fared better than others in the second wave. But it mutated enough, its antigens drifted enough, to rekindle the epidemic.

this third wave was a lethal epidemic.

San Francisco had confronted the fall wave most honestly and efficiently.

quarantined all naval installations, even before any cases surfaced

mobilized the entire city in advance, recruiting hundreds of drivers and volunteers and dividing the city into districts, each with its own medical personnel, phones, transport and supply, and emergency hospitals in schools and churches.

closed public...

the mayor, Hassler, the Red Cross, the Chamber of Commerce, and the Labor Council jointly declared in a full-page newspaper ad, “Wear a mask and save your life!” claim...

local facilities geared up to pro...

In San Francisco, people felt a sense of control. Instead of the paralyzing fear found in too many other communities, it seemed to inspire.

shows citizens behaving with heroism, anxious and fearful but accepting their duty. When schools closed, teachers volunteered as nurses, orderlies, telephone operators.

San Francisco had—to that point—survived with far fewer deaths than had been feared, and citizens believed that the masks deserved the credit. But if anything helped, it would have been th...

They thought that they had controlled it, that they had stopped it. They were mistaken. The masks were useless. The vaccine was useless. The city had simply been lucky. Two weeks later, the third wave struck. Although at its peak it killed only half as many as did the second wave, it made the final death rates for the city the worst on the West Coast.

When it struck in January and February, the war had been over for more than two months. Censorship had ended with it. And so in Australia the newspapers were free to write what they wanted. And, more than in any other English-language newspaper, what they wrote of was terror.

All through the spring of 1919 a kind of rolling thunder moved above the earth, intermittent, unleashing sometimes a sudden localized storm, sometimes even a lightning bolt, and sometimes passing over with only a rumble of threatened violence in the distant and dark sky.

“There seems to be general agreement that influenza may act on the brain.

“World War I did not influence suicide; the Great Influenza Epidemic caused it to increase.”

“A wide spectrum of central nervous system involvement has been observed during influenza A virus infections in humans, ranging from irritability, drowsiness, boisterousness, and confusion to the more serious manifestations of psychosis, delirium, and coma.”

“These viruses do from time to time get across to central nervous systems and play hell.”

Wilson “lacked his old quickness of grasp, and tired easily.”

A president negotiating a major worldwide agreement while suffering mental challenges as a flu side effect. Horrifying

One thing was certain: he was never the same after this little spell of sickness.”

Four months later Wilson suffered a major and debilitating stroke. For months his wife and Grayson would control all access to him and become arguably the de facto most important policy makers in the country.

An epidemiological study published in 2004 demonstrates definite linkage between influenza and stroke.

It is of course impossible to say what Wilson would have done had he not become sick. Perhaps he would have made the concessions anyway, trading every principle away to save his League of Nations. Or perhaps he would have sailed home as he had threatened to do just as he was succumbing to the disease. Then either there would have been no treaty or his walkout would have forced Clemenceau to compromise.