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The 1918 Flu Pandemic: Why It Matters 100 Years Later

Posted on by Blog Administrator

Group photo of Red Cross nurses in Boston wearing personal protective equipment.

100 years ago, an influenza (flu) pandemic swept the globe, infecting an estimated one-third of the world’s population and killing at least 50 million people. The pandemic’s death tollAmerican soldiers returning home on the Agamemnon, Hoboken, New Jersey was greater than the total number of military and civilian deaths from World War I, which was happening simultaneously.  At the time, scientists had not yet discovered flu viruses, but we know today that the 1918 pandemic was caused by an influenza A (H1N1) virus. The pandemic is commonly believed to have occurred in three waves. Unusual flu-like activity was first identified in U.S. military personnel during the spring of 1918. Flu spread rapidly in military barracks where men shared close quarters. The second wave occurred during the fall of 1918 and was the most severe. A third wave of illness occurred during the winter and spring of 1919.

Here are 5 things you should know about the 1918 pandemic and why it matters 100 years later.

1. The 1918 Flu Virus Spread Quickly

500 million people were estimated to have been infected by the 1918 H1N1 flu virus. At least 50 million people were killed around the world including an estimated 675,000 Americans. In fact, the 1918 pandemic actually caused the average life expectancy in the United States to drop by about 12 years for both men and women.Flu patients in Iowa

In 1918, many people got very sick, very quickly. In March of that year, outbreaks of flu-like illness were first detected in the United States. More than 100 soldiers at Camp Funston in Fort Riley Kansas became ill with flu. Within a week, the number of flu cases quintupled. There were reports of some people dying within 24 hours or less. 1918 flu illness often progressed to organ failure and pneumonia, with pneumonia the cause of death for most of those who died.  Young adults were hit hard. The average age of those who died during the pandemic was 28 years old.

2. No Prevention and No Treatment for the 1918 Pandemic Virus

In 1918, as scientists had not yet discovered flu viruses, there were no laboratory tests to detect, or characterize these viruses. There were no vaccines to help prevent flu infection, noPolicemen patrol the streets in masks in Seattle to ensure public safety. antiviral drugs to treat flu illness, and no antibiotics to treat secondary bacterial infections that can be associated with flu infections. Available tools to control the spread of flu were largely limited to non-pharmaceutical interventions (NPI’s) such as isolation, quarantine, good personal hygiene, use of disinfectants, and limits on public gatherings, which were used in many cities. The science behind these was very young, and applied inconsistently. City residents were advised to avoid crowds, and instructed to pay particular attention to personal hygiene. In some cities, dance halls were closed. Some streetcar conductors were ordered to keep the windows of their cars open in all but rainy weather. Some municipalities moved court cases outside. Many physicians and nurses were instructed to wear gauze masks when with flu patients.

3. Illness Overburdened the Health Care System

An estimated 195,000 Americans died during October alone. In the fall of 1918, the United States experienced a severe shortage of professional nurses during the flu pandemic because large numbers of them were deployed to military camps in the United States and abroad.A black-and-white advertisement for the Chicago School of Nursing. This shortage was made worse by the failure to use trained African American nurses. The Chicago chapter of the American Red Cross issued an urgent call for volunteers to help nurse the ill. Philadelphia was hit hard by the pandemic with more than 500 corpses awaiting burial, some for more than a week. Many parts of the U.S. had been drained of physicians and nurses due to calls for military service, so there was a shortage of medical personnel to meet the civilian demand for health care during the 1918 flu pandemic. In Massachusetts, for example, Governor McCall asked every able-bodied person across the state with medical training to offer their aid in fighting the outbreak.

As the numbers of sick rose, the Red Cross put out desperate calls for trained nurses as well as untrained volunteers to help at emergency centers. In October of 1918, Congress approved a $1 million budget for the U. S. Public Health Service to recruit 1,000 medical doctors and more than 700 registered nurses.

At one point in Chicago, physicians were reporting a staggering number of new cases, reaching as high as 1,200 people each day. This in turn intensified the shortage of doctors and nurses.  Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

4. Major Advancements in Flu Prevention and Treatment since 1918

The science of influenza has come a long way in 100 years!A man dress in personal protective equipment in a laboratory. Developments since the 1918 pandemic include vaccines to help prevent flu, antiviral drugs to treat flu illness, antibiotics to treat secondary bacterial infections such as pneumonia, and a global influenza surveillance system with 114 World Health Organization member states that constantly monitors flu activity. There also is a much better understanding of non-pharmaceutical interventions–such as social distancing, respiratory and cough etiquette and hand hygiene–and how these measures help slow the spread of flu.

There is still much work to do to improve U.S. and global readiness for the next flu pandemic. More effective vaccines and antiviral drugs are needed in addition to better surveillance of influenza viruses in birds and pigs. CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.

5. Risk of a Flu Pandemic is Ever-Present, but CDC is on the Frontlines Preparing to Protect Americans

Four pandemics have occurred in the past century: 1918, 1957, 1968, and 2009. The 1918 pandemic was the worst of them. But the threat of a future flu pandemic remains. A pandemic flu virus could emerge anywhere and spread globally.A crowd of people with the Washington Monument in the distance.

CDC works tirelessly to protect Americans and the global community from the threat of a future flu pandemic. CDC works with domestic and global public health and animal health partners to monitor human and animal influenza viruses. This helps CDC know what viruses are spreading, where they are spreading, and what kind of illnesses they are causing. CDC also develops and distributes tests and materials to support influenza testing at state, local, territorial, and international laboratories so they can detect and characterize influenza viruses.  In addition, CDC assists global and domestic experts in selecting candidate viruses to include in each year’s seasonal flu vaccine and guides prioritization of pandemic vaccine development. CDC routinely develops vaccine viruses used by manufacturers to make flu vaccines. CDC also supports state and local governments in preparing for the next flu pandemic, including planning and leading pandemic exercises across all levels of government. An effective response will diminish the potential for a repeat of the widespread devastation of the 1918 pandemic.

Visit CDC’s 1918 commemoration website for more information on the 1918 pandemic and CDC’s pandemic flu preparedness work.

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19 comments on “The 1918 Flu Pandemic: Why It Matters 100 Years Later”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Thank you for this article. Very informative. Maybe the people that do not understand and do not accept the vaccination campaign will change their minds.

    Excellent historical perspective on the 1918 incident. We have come a long way in treatment protocols and diagnostic advancements with respect to infectious diseases. The major concern,at this time, is an unknown pathogen which will be quickly spread worldwide my international jet travel. A few sick people on an aircraft entering the US could easy spread the disease from one end of the Country to the other. Depending on the conditions’ incubation period many more people will be affected before public health officials begin to see a problem. I guess the only thing we can be sure of is something similar will occur again , it’s just a matter of the right conditions and time.

    This is a wonderful article on the influenza virus. I have extensively read about the pandemic, and its devastating effect on people. I must admit that I am appalled at the refusal to use trained nurses because they were Black Americans. That nonsense was part of the failure to help people in need of care at this crucial time . I must say it was hateful and ignorant of White Americans. White Americans are not reminded enough that they are immigrants to America just like any other race that came to this country from another country. America does not belong to white people. I don’t believe sick people care who is attending to them when they are on the brink of death.

    Well done article. However. You could include a list of historical accounts for
    Further reading materials.

    The possibility of another potential outbreak of any kind is a very scary and real test of how very little know. We indeed have come along way but still have a distance to go. .. Thank you for sharing this fascinating story.

    Two of my grandparents were killed in their 30s by this epidemic, leaving my 1 year-old mother, my aunt, and my uncle orphaned. This is important stuff; people need to take influenza seriously.

    My grandfather was a doctor in the Spokane Wa area and died from the flu in July of 1918 at age 46 . He was from the St Louis Missouri area and had been in the Spokane area for several years but could have visited or was visited by people from the St Louis area which is close to Kansas City to have caught the flu . Spokane was very isolated . This article gives no answer but gives some background to how he caught the flu in the middle of nowhere at the beginning of this pandemic

    Would the mortality rate be as bad as the flu pandemic in 1918 where 675,000 people were killed? How would our economy be affected? Any thoughts?

    The book “The Great Influenza” by John M. Barry has many historical references on this topic.

    Good summary of the 1918 flu pandemic. But the sentence “The average age of those who died during the pandemic was 28 years old” (end of the first section) is inaccurate. Twenty-eight was the age at which mortality peaked among young adults, who were the hardest hit, along the very young and the very old. As for the average, variations in infant or old adult mortality could easily tip the balance away from 28 years.

    I would agree with Tonya and Robert, there is an ever-present threat of a variant flu virus reeking havoc as many go unprepared for each flu season by not vaccinating, but also with a new, unknown pathogen. With the climate changing and the glacier ice melting to new low levels, bacteria, viruses and parasites previously encased in ice soon may be exposed to air, water, and humans. I am thankful for the diligent surveillance that the CDC and the WHO provides.

    Thank you for that summary. The pandemic took my grandmother in the Spring of 1919. My father and his two sisters were orphans then. Their father had died in France, November 1918. It is always so sad for me to read about this.

    Any plan to slow or stop a pandemic would include quickly identifying those who are contagious and minimizing their contact with others. However we do not have in place policies that would encourage that behavior, particularly in the low income and immigrant populations, including people who:
    * cannot afford to take time off work without pay
    * would lose their jobs if they did not show up
    * have no health insurance and can’t afford medical care
    * are afraid to seek care because of immigration status (their own or family member’s)
    And anyone who was quarantined would want to know that their basic needs would be met if they complied.
    I believe these issues would be best addressed in advance to overcome resistance. Once a potential pandemic starts, it will be difficult to get the necessary public and private buy-in, resources and authority until it is too late.

    It’s surprising that to see that the first three items listed would apply to any similar pandemic of unknown origin today. Today’s air travel would spread an illness at previously unheard of rates. Couple that with an unknown origin and our health care systems would be over run just as they were in 1918.

    Thank you so much for this article. I appreciate the information included and I pray that it convinces people with reservations to keep their own and their families health in mind for everyone’s sake but especially their own.

    My grandmother was 11 years old in 1918. The family was from Philadelphia. I remember her telling me that she had to help load dead bodies into wagons. They would yell in the neighborhoods, “throw out your dead!” She never got the flu, but it must have been horrible!
    That is why we were always told never to spit on the streets. It can carry diseases, etc.
    People—Don’t think this cannot happen again. We live in an age where we can prevent the worst from happening when it comes to flu and other diseases.
    Get your flu shots!

    Very educative write-up. A big lesson for us in Africa. The surveillance of influenza viruses must be sustained especially at animal-human interface to monitor possible new mutations. Thank you.

    My grandfather was 15 years old. His parents and his two siblings were very ill with the flu so he ran to get help. By the time he got back to the house they were all dead. I am lying in bed with the H1N1 right now. Probably the sickest I’ve ever been. I personally believe facemasks should be mandatory and all public transportation. What a tragedy all the way around.

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