COVID-19 overtakes 1918 flu as deadliest pandemic in U.S. history

COVID-19 is now the deadliest disease in American history, surpassing the death toll from the devastating 1918 influenza pandemic. More than 676,000 people in the United States have lost their lives to the disease over the course of in the last year and a half since the World Health Organization first declared a pandemic on March 11, 2020.

For more than a century, the influenza epidemic of 1918 held this grim distinction. In three separate waves, the virus infected more than a quarter of the American population and caused the average life expectancy to drop by 12 years. Here’s a look at the catastrophic damage it has caused by spreading rapidly across the world – and the implications for modern pandemics.

The first wave

Even though it is colloquially known as the Spanish Flu, the first recorded cases of the 1918 flu epidemic occurred in the United States, not Spain. In early March 1918, the last year of World War I, a soldier presented to the infirmary at an army training camp in Fort Riley, Kansas with a fever and other flu-like symptoms. According to National geographic history magazine, more than a hundred other soldiers fell with similar symptoms within hours.

(Here’s why some historians believe the virus originated in China.)

The disease quickly swept the world as hundreds of thousands of American soldiers deployed to the European front lines in World War I. Censorship during wartime meant that the American and European media were not allowed to report on epidemics. Spain, however, was neutral in the conflict. Newspapers across the country covered the disease so extensively that it quickly became the Spanish flu.

However, this early outbreak was not particularly severe. Most people recovered within a few days, and some doctors wondered if it was really the flu. As a Spanish news agency wrote in a cable to London at the time, “A strange form of epidemic disease has emerged in Madrid. The outbreak is mild in nature, no deaths have been reported.

The second wave

Everything changed this fall. In September 1918, a much deadlier second wave of the pandemic emerged at another US Army training camp outside of Boston, Massachusetts. In October alone, the Second Wave killed an estimated 195,000 Americans, more than the total US military casualties in World War I. Historian Pete Davies described the scene at a U.S. Army camp in his book The Devil’s Flu: Stranded and their bodies were starved of oxygen, the men turned blue, purple, or gray-black. The bodies were stacked like logs in the hallways leading to the morgue.

The symptoms of the second wave were also different. In addition to the typical flu-like symptoms of the first wave, doctors in this fall have reported unusual symptoms ranging from bleeding from the nose and stomach to paralysis. The second wave also targeted young people, with most of the deaths among those aged 20 to 40.

As flu cases increased across the country, cities have taken different approaches to flatten the curve, as Nina Strochlic and Riley Champine reported for National Geographic in 2020. St. Louis quickly closed public gatherings and put in place quarantines when its first cases were reported, while Philadelphia held a parade with some 200,000 people in attendance. By the end of the pandemic, Philadelphia had recorded a rate of 748 deaths per 100,000 population, more than double that of St. Louis.

The third wave

By the end of 1918, many American cities, including Philadelphia, were able to suppress the second wave of the pandemic using social distancing measures. But in January 1919, the third and final wave of the influenza pandemic struck.

Although the ferocity of the disease lessened in its third wave, it still managed to do considerable damage. Eager to get back to normal after months of quarantine, few American cities have reinstated their restrictions, writes historian John M. Barry. They continued to see epidemics and deaths until the spring of 1919.

The third wave also coincided with the end of World War I and some historians believe it may have affected peace treaty negotiations. In April 1919, President Woodrow Wilson contracted the Spanish flu while in Paris discussing the conditions for an end to the war. Some historians believe that although Wilson sought to defuse tensions, he was so exhausted from the flu that he gave in to the harsher conditions of the French prime minister.

(These US presidents battled serious illnesses during their tenure.)

Modern implications

Estimates suggest that the Spanish flu killed as many as 675,000 Americans from September 1918 through June 1919, and somewhere between 60 and 100 million people worldwide. But historians warn that the U.S. estimates are not precise but rather are an extrapolation from a population sample disproportionately made up of whites who lived in cities.

More than a hundred years later, as the world grapples with yet another deadly disease, historians and scientists have pointed to the 1918 influenza pandemic for evidence on how to fight COVID-19. In particular, they cite the importance of public health measures like social distancing and masking. But these lessons have their limits.

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“Looking back to the last century, we can see that the ‘war to end all wars’ did not, in fact, end wars, and that the deadliest pandemic did not end to deadly pandemics, “write Anthony Fauci and two other officials of the National Institute of Allergy and Infectious Diseases in an article published in the American Journal of Public Health. “A century later, tragic wars and tragic pandemics are still happening, and we are still struggling to deal with them. “