The year the whole world got sick

A past epidemic could serve as a precautionary model for the SARS outbreak
Vicki Haddock, Insight Staff Writer
Sunday, April 13, 2003
c2003 San Francisco Chronicle |

URL: http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/04/13/IN99187.DTL

It was a warm spring when the potent germs, suspected of originating from Chinas Guangdong province, sickened the first Americans. The world was preoccupied by war and U.S. troops were fighting overseas, so the mysterious flulike malady attracted little attention. Summer approached, and the disease subsided. Americans, if they noticed at all, breathed a collective sigh of relief and moved on to their parties and parades.

Meanwhile the virus -- stealthily, relentlessly, mercilessly -- began to reassert itself in a more lethal configuration that would enable it, come fall,

to strike again with savage vengeance.

As masses grew sick and many died, a panicked populace suspected that the enemy had slipped in from overseas to unleash a germ warfare attack. States ordered theaters, dance halls, shooting ranges and Sunday schools shut down. Californians were threatened with jail if they ventured out without gauze masks. (Fashion-conscious San Franciscans preferred a chiffon harem-style mask because, as one observer noted, it has not such a disturbing and flattening effect upon certain types of female beauty.)

Within a year, the mystery virus would swing its scythe of death across the globe, sickening a fifth of the worlds population and killing 20 million, and perhaps as many as 100 million

All this may sound like a sensationalist prediction about todays enigmatic ailment, SARS (severe acute respiratory syndrome), but it was in fact the horrific reality of the flu pandemic of 1918.

The disease killed more Americans in a year than all U.S. combat deaths combined during World War I, World War II, the Korean War and the Vietnam War.

I think there are parallels to SARS, says Dr. Lucy Crain, a clinical professor of pediatrics at UCSF. People didnt know what caused it, there were no antibiotics or drugs to treat it, the modality of transmission was not well understood, so people tend to become increasingly anxious. But God forbid that todays SARS ever progresses to the magnitude of the influenza pandemic of 1918.

The trajectory of Crains family, like countless others, was altered by that fateful flu. Her father, age 12 at the time, watched in anguish as his 18- year-old brother and hero, Joseph, succumbed with the family doctor crying at his bedside because nothing could be done. It led her father to become a doctor, in turn propelling four of his five children into medical careers.

Experts today stress there is no reason for panic about SARS, which also is thought to have sprung from southern China. By last week, SARS had afflicted more than 3,000 people in 20 countries, killing more than 100.

LEAPING CONTINENTS IN HOURS
Researchers scramble to identify the cause of SARS and eventually concoct a vaccine against it, but modern treatments such as ventilators give doctors significant advantages over the physicians who vainly tried to heal flu victims in 1918. Progress cuts both ways: Today, unsuspecting carriers of the disease can board a commercial flight and traverse continents in hours. In 1918, when ships and railroads were the primary routes of transport, it took four months for the flu pandemic to spread from South Africa to Alaska.

Preventive measures havent changed much since then, when the healthy were encouraged to avoid the sick, wear gauze masks and frequently wash their hands.

In the spring of 1918, the flu made its first U.S. appearance in the cramped quarters of World War I troop camps such as Fort Devens in Massachusetts, Fort Lewis south of Seattle and prisons, including San Quentin in Marin County. Otherwise-healthy men contracted a flu that could, within days or hours, send a thermometers mercury rocketing, turn their faces mahogany and their feet black and literally drown the men as their lungs filled with bloody froth.

BODIES STACKED LIKE CORDWOOD
One colonel wrote of bodies stacked like cordwood; a doctor at Fort Devens observed, It is horrible. One can stand to see one, two or 20 men die, but to see these poor devils dropping like flies gets on your nerves. We have been averaging about 100 deaths a day.

Summer was a respite. Most people presumed the dangers had passed. Then in the fall an outbreak erupted from coast to coast.

Some people imagined that the enemy, via German drug manufacturer Bayer, was waging germ warfare by injecting the virus into its aspirin. Others circulated rumors that German agents had released vials of plague in crowded American cities.

25 TIMES MORE DEADLY

But the truth was more banal, and more terrifying. It was the flu -- but an uber-flu 25 times more deadly than usual. Typically, just a tenth of one percent of flu victims die. But in 1918, as science writer Gina Kolata notes in her book Flu, more than 1 in 50 sufferers succumbed. Oddly, it was particularly lethal to healthy people in the prime of life.

In many parts of California, funerals were legally limited to 15 minutes because of pressing demand.

In San Francisco, the Red Cross bought enough gauze to make a three-foot path of white from San Francisco to San Jose and enough tape to make a white line from Paris to Brussels. Factories converted to manufacturing masks.

Other American cities instituted quarantines, but newspaper accounts showed that the Bay Area chafed under restrictions. Locals complained about the order that streetcars keep their windows open, saying the drafts were causing colds. The masks, dubbed the highwaymans uniform, gave upstanding citizens the countenance of outlaws. The culinary workers union helped persuade San Francisco supervisors to end the mask mandate, saying its continuance would throw 2,000 restaurant workers out of work.

The epidemic hit San Francisco harder than any other city. New York had a higher death toll with 27,332, but the mortality rate was greatest in San Francisco: 29 deaths per every 1,000 residents.

The influenza of 1918 vanished as mysteriously as it appeared. It had been one of the greatest mass murderers of all time.

c2003 San Francisco Chronicle