Outbreak: Pandemic Strikes

By October 1918, the United States had been an active participant in World War I for more than a year. And while the declared enemy was overseas, there was a killer working stateside as well. Cities were gripped with fear: school was canceled; theaters, places of worship, and other places of “public amusement” had been shuttered. That month alone 195,000 Americans died, making it the deadliest month in American history; the killer was none other than influenza.

This year marks the 100th anniversary of the 1918 Influenza Pandemic, perhaps the second deadliest disease outbreak in human history. Though the pandemic lasted just 15 months, 500 million people worldwide fell sick and it killed between 3-5% of the world’s population.

Humble Beginnings

Though we’ll likely never be able to determine definitively the source of the 1918 Influenza Pandemic, one theory is that America’s Heartland played a critical role in its expansion.

In 1918 the flu was not a reportable disease, but in researching his book The Great Influenza, John M. Barry discovered that in January 1918, a doctor in Haskell County, Kansas reported unusual flu activity to the U.S. Public Health Service. By March, that had spread to nearby Fort Riley. On the morning of March 11, an Army private reported symptoms of fever, sore throat, and headache. By lunch that day, more than 100 soldiers on the base had fallen sick.

At the time, very little was known about viruses and their transmission. In fact, the very first virus–Tobacco mosaic virus–had only been discovered 26 years earlier in 1892. A News of the World report from November 1918 lists the following as recommended precautions against contracting the flu: “Wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply; do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge.”

Diet and exercise are, of course, essential components of our health, but a brisk walk isn’t going to do much when it comes to preventing a virus from hijacking a host’s cells and replicating itself.

From Fort Riley, soldiers carried the disease to other American military bases and, eventually, the battlefront in Europe.

Soldiers coalesce at a U.S. military hospital in France
Soldiers coalesce at a U.S. military hospital in France

Three-Day Fever

Initially, this new influenza strain was rarely fatal and set off few alarms. Across the battlefields of Europe, it was referred to as “three-day fever.” However, it did continue to spread and by the summer it had been seen on nearly every continent.

There was also its unique pathology. Most seasonal flu viruses bind only to the upper respiratory tract. While this makes them easily spread, it also seriously lowers the chances of a patient developing pneumonia. But this flu bound also to the lower respiratory tract which made it both easily spread and potentially far more deadly. Pathologists at the time did note lung tissue full of fluid and hemorrhages, but many of the fatalities early in the pandemic were misdiagnosed as other infectious diseases.

By July the medical community, and especially those along the warfront, had decided the threat was over. A British medical journal at the time wrote that influenza “has completely disappeared.”

It Had Not

While the first wave of flu in 1918 was relatively nonlethal, the second made up for it in spades.

In September, a soldier stationed at Camp Devens in Massachusetts was sent to the hospital and misdiagnosed with meningitis. The next day, more than a dozen more were sent to Devens’ hospital. At its worst point, 1,543 soldiers at Devens alone were diagnosed with the flu in a single day.

Camp Devens is just 35 miles from Boston which was, at the time, one of the nation’s five most populous cities. From there it spread into cities.

Red Cross volunteers assist a victim of the 1918 Influenza Pandemic
Red Cross volunteers assist a victim of the 1918 Influenza Pandemic

This time it worked fast. A physician at Camp Devens’ hospital reported that mere hours after a patient’s admittance, he began to turn blue from a loss of oxygen and concluded ominously “it is only a matter of a few hours then until death comes.”

The numbers were staggering. In a single day in Philadelphia, 759 people died from flu-related illnesses. Death spread so quickly that many were buried in mass graves. While the symptoms had been typical during the pandemic’s first wave, this time they were not. Many reported coughing up blood or bleeding from the ears, nose, and even eyes.

Streets were deserted. Cities looked like ghost towns. And eventually, the spread slowed. But that false sense of security, combined with the mass celebrations following Armistice Day in November 1918, led to a third wave beginning in January 1919. It, too, was gruesome, though not quite nearly so as the second.

The 1918 Influenza Pandemic left scars on nearly every part of the planet. Fourteen percent of Fiji’s population died in just 16 days. Entire villages were wiped off the planet forever by the virus.


The flu strain responsible for the 1918 pandemic was of avian origin. We will likely never know exactly how it spilled over into humans, but we do know that pigs can catch both avian and human flu viruses. We have seen that when this happens, that avian flu can develop the ability to infect humans. Not only does Kansas have more than a few pig farms, but southwestern Kansas–where Haskell County is located–sits along a major migratory path for more than a dozen bird species. Much has changed in the past 100 years, but the basic pathways of disease emergence have not. Presently 75% of emerging infectious diseases are of animal origin.

Each day we put ourselves in peril; commonplace practices like deforestation and urbanization place people and wild animals in closer contact than ever before. We are playing a high risk/low reward game of chicken with any number of new and emerging diseases lurking in the wild. EcoHealth Alliance is the only nonprofit attacking these complex issues with the doctrine of One Health: that the health of people, animals, and the environment are connected. We are prepared to stand between you and the next pandemic; our multidisciplinary team of scientists works at every intersection of disease transmission–from preventing illegal wildlife trade to advising policy to limit deforestation–to keep the globe healthy, to conserve wildlife, and to stop emerging diseases.

With your help, we can stop the next pandemic from emerging. We can save lives; we can save the environment at the same time.

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