
How the 1918 Flu Spread Across America (2017) - Anon84
https://www.smithsonianmag.com/history/journal-plague-year-180965222/#
======
js2
While doing ancestry research years ago, I learned I had a 2nd great uncle who
immigrated to America from Romania aboard the RMS Carpathia in 1904. (Eight
years later in 1912, this would be the first ship to come to the Titanic’s
rescue, and six years after that would itself be sunk by a U-Boat.) He had
left Romania likely to escape anti-semitism. He’d eventually find his way out
to Denver. Sadly, he’d die in 1918 (the same year the Carpathia was sunk) at
the age of 25, very probably from the flu.

This is a picture of him, along with his headstone and declaration of intent
to become a citizen:

\- [https://ibb.co/xggjjnJ](https://ibb.co/xggjjnJ) (Photo)

\- [https://ibb.co/vvnSqMg](https://ibb.co/vvnSqMg) (Headstone)

\- [https://ibb.co/zmNzdC9](https://ibb.co/zmNzdC9) (Declaration)

Google Maps for his Denver, CO address:

\-
[https://goo.gl/maps/CvmeCsUARnwXNnBu6](https://goo.gl/maps/CvmeCsUARnwXNnBu6)

~~~
nostromo
It's worth noting that the 1918 flu was unique in that it killed many young,
healthy people.

Corona virus is more typical in that it's primarily killing the very old or
otherwise ill.

[https://www.worldometers.info/coronavirus/coronavirus-age-
se...](https://www.worldometers.info/coronavirus/coronavirus-age-sex-
demographics/)

~~~
Macha
How much of that was down to the disease, compared to the conditions that
"young, healthy" people would have been subjected to during a world war?

~~~
certmd
From the article (as well as other places I've read similar things).

"Why did so many young adults die? As it happens, young adults have the
strongest immune systems, which attacked the virus with every weapon
possible—including chemicals called cytokines and other microbe-fighting
toxins—and the battlefield was the lung. These “cytokine storms” further
damaged the patient’s own tissue."

The more robust immune response was a large cause of the increased mortality.

~~~
dnautics
Iirc from my time as a biologist, we don't have any direct evidence that a
cytokine storm happened and there seem to be other possible explanations for
that distribution.

------
gradschool
A BBC documentary called "The Flu That Killed 50 Million" is informative. As
of time 130 million were infected and 200 thousand dead, Sir Arthur Newsholme,
senior medical officer at Whitehall, sent a message to his European
counterparts proposing a cease fire because an existential threat to humanity
transcends national rivalries. (Just kidding!) He actually decided against
even warning the public to take any precautions because it would not be
"expedient" for the munitions factories to slow down. My takeaway is never to
put it past those in power to decimate of the population if it suits their
ends.

~~~
technotony
To be fair, those in authority were doing a pretty good job decimating the
male working age population before flu came along. They could probably model
the daily death rate from flu in it's early days to be less than that on the
Western front... especially if they weren't very good at modelling exponential
growth.

~~~
stevenwoo
The SIR model for infectious disease growth was proposed in 1927,
[https://en.wikipedia.org/wiki/Mathematical_modelling_of_infe...](https://en.wikipedia.org/wiki/Mathematical_modelling_of_infectious_disease).
We got taught this in our undergrad calculus class and wrote programs to play
with the different parameters - it's kind of eye opening if one has never
thought too much about it - pretty much everyone gets infected within some
constraints.

------
jtdev
“ Philadelphia had scheduled a big Liberty Loan parade for September 28.
Doctors urged Krusen to cancel it, fearful that hundreds of thousands jamming
the route, crushing against each other for a better view, would spread
disease. They convinced reporters to write stories about the danger. But
editors refused to run them, and refused to print letters from doctors. The
largest parade in Philadelphia’s history proceeded on schedule.”

I see that Switzerland has imposed a ban on gathering of 1000 or more in
response to COVID19 - maybe other countries should consider doing the same?

~~~
wincy
For the USA at least, wouldn't imposing a ban rather than a recommendation be
a violation of the Constitutional right to freedom of assembly?

~~~
PopePompus
If the CDC merely urged that all large gatherings be cancelled, that would
probably result in the cancellation of 95% of them, with no constitutional
implications.

~~~
macintux
Can they at this point? It seems like their authority has been emasculated.

~~~
Loughla
I don't understand what you mean by this.

~~~
macintux
VP Pence has been given veto authority over all messaging, and the CDC’s
funding in this area was gutted early in the administration.

~~~
adventured
The CDC's funding was not gutted in that area, that's a false propaganda point
being shoveled by several prominent Democrats. Trump attempted to push cuts
through and failed, fortunately.

> AP FACT CHECK: Democrats distort coronavirus readiness

> Democratic presidential contenders are describing the federal infectious-
> disease bureaucracy as rudderless and ill-prepared for the coronavirus
> threat because of budget cuts and ham-handed leadership by President Donald
> Trump. That’s a distorted picture. For starters, Trump hasn’t succeeded in
> cutting the budget.

> He’s proposed cuts but Congress ignored him and increased financing instead.
> The National Institutes of Health and the Centers for Disease Control and
> Prevention aren’t suffering from budget cuts that never took effect.

[https://apnews.com/d36d6c4de29f4d04beda3db00cb46104](https://apnews.com/d36d6c4de29f4d04beda3db00cb46104)

~~~
macintux
You’re correct that funding wasn’t impacted. I was wrong about that.

However he did indeed cut the people tasked to deal with pandemics.

[https://foreignpolicy.com/2020/01/31/coronavirus-china-
trump...](https://foreignpolicy.com/2020/01/31/coronavirus-china-trump-united-
states-public-health-emergency-response/)

> But other White House efforts included reducing $15 billion in national
> health spending and cutting the global disease-fighting operational budgets
> of the CDC, NSC, DHS, and HHS. And the government’s $30 million Complex
> Crises Fund was eliminated.

> In May 2018, Trump ordered the NSC’s entire global health security unit shut
> down, calling for reassignment of Rear Adm. Timothy Ziemer and dissolution
> of his team inside the agency. The month before, then-White House National
> Security Advisor John Bolton pressured Ziemer’s DHS counterpart, Tom
> Bossert, to resign along with his team. Neither the NSC nor DHS epidemic
> teams have been replaced. The global health section of the CDC was so
> drastically cut in 2018 that much of its staff was laid off and the number
> of countries it was working in was reduced from 49 to merely 10.

------
danso
I read this article a few weeks ago when I fell down the rabbit hole of trying
to figure out why the Spanish Flu was called the "Spanish Flu". I knew it
didn't originate from Spain, but hadn't heard that the _traditional_ consensus
is that it likely started in Kansas, owing to the first detected case being in
Kansas.

The CDC has a variety of history pages [0] about the Spanish Flu. The main one
acknowledges that there isn't a "universal consensus" about the virus's
origin, but doesn't assert any of the other alternative explanations.

The theories that the Spanish Flu might have actually come from China seem to
be more recent. Such as this one in 2014 [1] that found reports from 1917 of
Chinese suffering Spanish Flu like symptoms. But his explanation for how the
first known case in the West was in Kansas – that thousands of Chinese workers
were sent to labor around the world – seems really speculative.

Given that there isn't compelling evidence to think the Spanish Flu started
elsewhere outside of Kansas, it is funny how not only did it get the name of
"Spanish Flu", but also that Kansas managed to not have a long-lasting
reputation for terrible disease, even though the Spanish Flu killed more
people than (IIRC) all the other 20th century pandemics combined.

[0] [https://www.cdc.gov/flu/pandemic-
resources/1918-commemoratio...](https://www.cdc.gov/flu/pandemic-
resources/1918-commemoration/1918-pandemic-history.htm)

[1] [https://www.history.com/news/china-epicenter-of-1918-flu-
pan...](https://www.history.com/news/china-epicenter-of-1918-flu-pandemic-
historian-says)

[https://en.wikipedia.org/wiki/Spanish_flu](https://en.wikipedia.org/wiki/Spanish_flu)

~~~
LeoTinnitus
I heard it was called it because the Spanish were the only ones reporting it
during the war.

~~~
smacktoward
Yes, that was the explanation I got in history class as well. The flu emerged
during World War I, and every combatant country had strict censorship of the
press in place, which suppressed news of its spread in those countries. But
Spain was neutral in that conflict and thus had an uncensored press, so
reports of the flu's impact quickly made it to print there. And those reports
got picked up worldwide as the first reporting on the influenza, leading
people to think of it as a disease that began in Spain.

------
smacktoward
It may be worth noting that while this piece presents it as settled that the
Spanish flu originated in Kansas, that's not really the case. The author of
this piece, John Barry, has long been an advocate for that position, but there
are other theories of origination as well supported by at least as much
evidence as the Kansas theory.

Wikipedia has a write-up on the various theories of origination here:
[https://en.wikipedia.org/wiki/Spanish_flu#Hypotheses_about_t...](https://en.wikipedia.org/wiki/Spanish_flu#Hypotheses_about_the_source)

------
dragontamer
> In 1918, medicine had barely become modern; some scientists still believed
> “miasma” accounted for influenza’s spread.

Does anyone know where I can learn more about the "miasma" model of disease?
Whenever I'm looking up old plagues / diseases / etc. etc., they bring up the
"miasma" model.

But what is the miasma theory (or pseudo-science?) that people used to believe
in? And how does it differ from our modern germ theory?

Ex: I know plague doctors wore airtight masks and waxxed leather to suit-up
and protect themselves from the "miasma" of the plague. As an early
sanitization model, it probably worked (at least, "worked" as much as modern
masks work on untrained laypeople). But where did the miasma model fall short
compared to germs?

~~~
NikolaeVarius
I dislike this idea of calling theories that ended up being wrong as "pseudo-
science". Not all wrong ideas were just random ramblings. Miasma Theory came
from imperfect knowledge and not understanding the mechanisms of some of their
observations.

If you read the debates on how miasma works, you can totally see reasonable
rational arguments if you strip away a few generations of scientific
knowledge.

~~~
vikramkr
I agree. It becomes pseudoscience when it contradicts existing scientific
knowledge without any rationale or explicitly comes from a a rejection of the
scientific method. There's a difference between being pseudoscientific and
being wrong. A lot of hypothesis about how the world works today, including
some seemingly strong beliefs backed by pots of evidence, will be found to be
wrong or incomplete as we move forward and develop better tools and science.

------
howmayiannoyyou
I fear we are going to regret not taking draconian measures right now.
Mandatory social distancing right now likely could buy additional time for the
healthcare system to advance preparations for a wide scale outbreak, including
stockpiling additional PPE and advancing triage procedures. It provides
valuable time for drug & medical device manufacturers to ramp up production of
needed supplies and drugs that should be proved effective in a few days or
weeks. A 14 - 30 hold would do disproportionate good over potential damage.

~~~
Loughla
Flip side of your argument, just for brevity's sake.

I fear many governments and leaders are going to use this as an excuse to take
full control and become the tin-pot dictators they want to be through those
same draconian measures.

So here we are.

------
kaonashi
The biggest thing I took away is that it wasn't the initial outbreak that was
abnormally lethal. It was the only after it had been incubating and mutating
in millions of human hosts that the second wave broke out.

------
devy
This article was from November 2017, can the mod put a year tag in the title?

~~~
mbreese
I agree and think that in this case, the (2017) year is an important
distinction. It helps to emphasize that this is not a story written with our
current fears in mind. But rather, it is an unbiased look at what happened
during the spread of the 1918 flu pandemic. And there are lessons to be
learned.

------
moultano
For those of you reading this from the bay area, we already have suspected
community transmission 50 miles away, in a town with a lot of people who
commute to the Bay. If it's easy for you to work from home, consider doing so,
giving explicit permission to your reports to do so, and asking your manager
to give permission to their reports to do so.

We're fortunate to be in an industry where WFH has relatively little cost, and
we can afford to get ahead of this in a way that other industries can't. We
don't have to wait for the government to give us guidance. For people doing
technical tasks, IMHO, the cost/benefit tipped in favor of WFH yesterday.

~~~
bcrosby95
I'm not sure why officials haven't come out suggesting things like this. And
to avoid non-mandatory travel.

It's probably a bit late for this stuff from a containment perspective. But it
would help reduce the r0.

Speaking personally, I have to decide by mid March if we should take our trip
to Legoland in San Diego. Right now I'm leaning towards "no". And I don't
imagine the outlook will be much better in just 2 weeks.

~~~
nostromo
Because they're balancing being extra-cautious with the serious risks of
overreacting.

The worst case scenario right now is that some people might lose their
grandparents a couple years early -- which is obviously incredibly sad, but
also not something worth crashing the world economy over.

~~~
tkahnoski
Ouch. I have this opinion of my dog. An extra year or two... not a big deal.

I do not have this opinion of my parents or any other immuno-compromised
individual. Your worst-case-scenario is absolutely the worst-case scenario in
many individual's minds.

If the greater good is not the extension of the life of those around us what
exactly are we trying to do here?

There are many things worth crashing the world-economy over. Slavery was one.
Climate change probably another.

Asking for a 90 day slow-down to prevent real-world deaths is probably one of
the more concrete and predictable things we could do compared to most other
altruistic choices facing us today.

~~~
nostromo
Please don’t put words in my mouth.

~~~
tkahnoski
I apologize if I misunderstood your intent. I can see other ways of
interpreting what you said.

I originally took your point to be that the current risks, although sad, are
acceptable and we face greater peril from slowing down economic activity.

Although I see trade-offs to everything I see economic activity fundamentally
as in service to the quality of life of a person and would rather take the
sadness of losing greater economic gains to the sadness losing significantly
more people.

There is always a balance to this and I could interpret what you said as
having a different perspective on what the current risks are but without
additional context, I took it as I did.

------
dang
A thread from last year:
[https://news.ycombinator.com/item?id=19237730](https://news.ycombinator.com/item?id=19237730)

------
lqet
> history’s worst epidemic

Come again?

~~~
phyzome
I suppose it depends on whether you look at total killed or percent killed.
The Black Death might have had a higher total body count, but smallpox hitting
the Americas had a massive mortality rate, something like 50% or higher.

------
generalpass
Was there ever a better example of why the government needs to be kept away
from news outlets?

~~~
war1025
I don't know that it's a correct reply for this comment, but it sparked in my
mind the memory of "All Quiet on the Western Front" [1]

The initial premise of which is that the townsfolk talk war up as a glamorous
and noble thing, so all the boys enlist at the outbreak of WWI, only to find
what absolute hell it is.

Actually makes me want to go back and read the book. Or maybe re-read? I don't
remember if we read it before we watched the film.

[1]
[https://www.goodreads.com/book/show/355697.All_Quiet_on_the_...](https://www.goodreads.com/book/show/355697.All_Quiet_on_the_Western_Front)

------
sadfev
Here comes the fear mongering. We are far better equipped to handle epidemics
and pandemics now than 100 years ago.

~~~
albroland
It's not even a matter of being equipped to handle it imo; all signs also
point to COVID19 not being as serious as initially thought and far more mild
than expected.

Administrating the test for it is both expensive, and time consuming, so the
gross number of known infections is likely to be substantially underreported
because of selection bias (why run expensive RNA analysis on a blood sample if
the person is having mild cold symptoms?). There are probably a bunch of other
confounding factors, such as most people getting it are probably asymptomatic
or just think they have a typical cold/flu. It also appears to be non-lethal
to children, as opposed to seasonal influenza.

In simple gross numbers, more people die in car accidents every day than the
current worldwide totality for this virus. Comparing against US CDC stats, it
isn't even remotely close to statistical estimates for flu deaths so far this
year in the US alone(~16k).

My suspicion is if you concede that gross numbers of COVID19 infections are
substantially underreported, the death rates fall into line with typical flu,
maybe marginally worse.

The reasonable response to this is what people should already be doing for
influenza: practice good hygiene, stay home if you're sick, take caution when
interacting with at risk populations to minimize their exposure, etc.

~~~
7952
What makes it different is that it is _new_. This could have made it avoidable
in comparison to other diseases that are common. Surely it is worth trying to
eradicate diseases before they get established? If we could irradicate flu we
would.

~~~
albroland
I'm not sure what I've said that would contradict anything you've suggested. I
agree with your question, obviously we should do everything reasonable to
contain and curtail a lethal disease. The best way to do that is to address it
in a sober, realistic manner and drive intervention and response on evidence -
not the conjecture of journalists who demonstrate little to no understanding
of the situation and disseminate unfounded paranoia.

~~~
7952
I think your comment is doing the opposite. It is using conjecture and false
comparisons to downplay the seriousness. And using those false comparisons as
a heuristic for justifying a continuation of common practice. You may well be
right. But you are not providing any evidence to justify that.

~~~
albroland
Could you detail what comparisons you think are unfair?

As for sources, if you look in the thread I respond citing WHO, NEJM, KCDC,
etc as evidence for my assertions/assumptions.

