Unusually Deadly: The 1918 Influenza Pandemic

I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.

Flu pandemics are part of our collective consciousness. There have been four major episodes since the great pandemic of 1918, and each carried their own deadly characteristics. The 1918 influenza pandemic, known by many as the “Spanish Flu,” had a stark and unique feature: mortality rates were highest among healthy young adults. The unusual pattern of morbidity was most deadly for people between ages 20 to 40, rather than previous strains with higher infection rates in children and the elderly.

Illness arrived quickly; some of those infected woke up to his or her normal routine but died by nightfall. Those who did not die from the virus itself often died of complications caused by bacteria, like pneumonia. Nearly 500 million people became ill, 20% to 40% of the population. An estimated 50 million people died worldwide. In 1918-1919, influenza killed more people than died in World War I and more people than the Bubonic Plague or “Black Death” over four years in 1347-1351. 

In 1918 the flu affected everyone, with origins unknown, influenza reached Asia, Africa, North America, South America, Europe, and the South Pacific. Physicians were in short supply and in unprecedented high demand. Postal workers and teachers became health education volunteers, distributing posters and bulletins with critical public health information. Even for those who avoided infection, life was drastically altered. Public health ordinances were crucial to slow the spread. For a time in the United States, public gatherings were forbidden in many cities, gauze masks were required in public spaces (however they were ultimately ineffective), funerals were limited to 15 minutes, and stores could not hold sales or use tactics to attract the public. 

The 1918 Flu Pandemic proved the need for public health emergency preparedness and paved the way for programs like C.D.C.’s Crisis and Emergency Risk Communication course, CERC. Public health pandemic plans are now updated annually with current scientific data to create effective vaccines, community information, and organized leadership in times of health crisis.

Barbara Reynolds recounts her family’s tragedy in the Pandemic Influenza Storybook

My grandfather Thomas Langan was born in 1893 in Cedar Rapids, Nebraska. Cedar Rapids was a small farming community which in 1910 had a population of 576. The main sources of income were farming and working at the flour mill near the river. Thomas married his wife Carrie at the age of 16 in 1909, and by 1918 the couple had five children. In December of 1918, Thomas (25 years) and his three brothers, William (22 years), Edward (20 years), and David (16 years) all became ill with the pandemic flu. Thomas was the first to become ill, and William was known to have taken a home remedy to Thomas’ home. We do not know what the home remedy consisted of, but local media talked about Vicks® vapor rub and garlic as remedies for the illness. 

Tragedy struck on December 16, 1918, when Edward died. Three days later, William died. And, the very next day, David died. Though still ill, Thomas attended the funerals of William and David, which were held on the same day. Thomas survived and he and Carrie went on to have four more children, including my mother, Dorothy Langan. To this day, a large monument stands in the Cedar Rapids cemetery, erected by my great grandfather, marking the loss of his three sons and his wife who also died in January 1918. 

The personal tragedy of the 1918 pandemic flu within my family was not discussed until I became involved in a project for HHS/CDC to develop a crisis and emergency risk communication course for pandemic influenza. While writing the course book, I happened to discuss it with my mother who then shared the family story with me. She said that her parents, Thomas and Carrie, seldom mentioned the pandemic events from their early years of marriage and, when they did, it was always in hushed tones.

Today, I teach the pandemic influenza crisis communication course across the nation and tell my family’s story as a reminder that our preparations for the next influenza pandemic is about people, families, communities, and their legacy. The community mitigation measures recommended by CDC can help reduce illness and deaths from pandemic influenza. Our efforts in public health are about saving people, not about numbers.

Want to learn more about the 1918 Influenza Pandemic? Check out PBS documentary Influenza 1918.