More People Died of the Spanish Flu Than in WWII


By Barry C. Fox, M.D.University of Wisconsin

Some of you may think of the flu season as just a regular annual occurrence. If you catch an infection, you have a 7 to 10-day bout of misery, and then it’s back to work. But, did you know that there have been four full-fledged worldwide outbreaks of influenza? In the spring of 1919, President Woodrow Wilson became seriously ill at the Paris Peace Conference. He had a fever of 103 degrees, with muscle aches and terrible coughing fits. He had survived a bout of the deadly Spanish flu.  

A black-and-white image of Woodrow Wilson throwing a ball with people in the background
Woodrow Wilson survived a bout of the Spanish flu while in Paris in 1919. (Image: Everett Collection/Shutterstock)

The Deadly Spanish Flu

Let’s take a closer look at one of the deadliest flu episodes ever—the Influenza Pandemic of 1918. The attacks of flu occurred in waves in mid-1918, then again in the spring of 1919. Between 30 and 50 million people died worldwide, including 43,000 US servicemen who, ironically, had survived the First World War but couldn’t fight off the flu. The 1918 influenza had a designation as a “swine flu” variety.

Why was it also called the Spanish flu? No one truly knows exactly where the flu started, but in Spain in 1918, the epidemic of influenza left the country’s population growth in a negative direction.

Although some people believe the Spanish outbreak was the beginning of the pandemic, the origin remains speculative among virologists. The Spanish Flu name prevailed—one of a handful of illnesses named after a country.

This is a transcript from the video series An Introduction to Infectious DiseasesWatch it now, on Wondrium.

Efforts to Control the Spread of Influenza

Most physicians at the time believed that influenza was caused by a bacterium, not a virus, but autopsies had continually failed to produce identification of a bacterial germ. They did, however, understand germ theory by then that influenza was spread through coughing, sneezing, and close personal contact. 

A long shot of the the graves of people who died due to the Spanish flu in Longyearbyen, Spitsbergen, Svalbard, Norway.
Efforts to control the Spanish flu failed because it spread too quickly. (Image: bmszealand/Shutterstock)

Unfortunately, there was no flu vaccine in those days, and efforts to develop one at the time failed. Instead, quarantines were put in place, and bans were placed on public gatherings as a deterrent to contagion. Public officials tried to limit the spread of influenza by banning spitting in public places and demanding that everyone cover their mouths and noses while sneezing. 

In addition, there was a shortage of physicians due to the First World War, so nurses and medical students often were left to staff emergency clinics. Health officials tried to control the spread of influenza by insisting that people wear masks. However, they didn’t realize that the masks were made from gauze, and they could not prevent the viruses from passing through because the holes in the mask were too large to halt a virus.

In other efforts to control influenza, the public health departments declared it one of the “reportable” diseases to track its spread; however, the rate of spread was so rapid, it was virtually impossible to keep accurate records.

Learn more about the toll infectious diseases take on populations during times of war and natural disasters.

Pandemic of Influenzas

So what exactly is the difference between an epidemic and a pandemic? An epidemic arises when a disease spreads rapidly to many people in a limited geographic region, so influenza in the U.S. on a yearly basis is an epidemic. A pandemic means there is a global spread of the disease.

Seasonal cases of flu are caused by influenza types A and B. Influenza A can affect both humans and animals. It has the highest pandemic potential due to the possibility of mixing animal and human genes, leading to surface protein mutations. 

Influenza B is a human virus only, has much less mutational capacity than type A, and has only one set of surface proteins, hence there is only one species. But, with influenza B, there are slight variations of the structure, similar to flavors of ice cream, that give influenza B strain various numbers. 

Influenza C is a human flu that causes a mild respiratory illness and is often not even recognized as a classical clinical influenza illness. Importantly, neither Flu B nor C is associated with pandemics.

Learn more about bioterrorism.

Profiting from a Pandemic

Returning to our pandemic, shysters trying to make a buck ran advertisements in the newspapers, claiming they had a cure—similar to selling snake oil to cure ailments. Others claimed influenza was cured by drinking alcohol, and there were runs on the liquor stores. 

Folk medicine practitioners recommended wearing a specific amulet or a small bag of camphor for protection. This practice was taken from the Middle Ages when people were trying to protect themselves from the plague. But, of course, none of these worked. Influenza started spreading worldwide, with no effective treatments.

Of all the health disasters over time, the Spanish flu ranks near the top of the list. It was one of the worst pandemics in history. Between 5 and 10 percent of the 500 million people who were infected died. No one knows the actual final death toll, but more people died from the flu than the total number of people killed in WWI.

Common Questions about the Deadly Spanish Flu

Q: Why was the 1918 Influenza outbreak named after a country?

Nobody knows where the deadly Spanish flu originated from, but since it left Spain with negative growth in its population, it was named after the country. But scientists still haven’t reached a consensus on the actual origins of the Spanish flu.

Q: What is the difference between a pandemic and an epidemic?

The difference is in the geographical scale of the disease’s spread. If the spread is limited to one geographical location, then it’s an epidemic. If it spreads worldwide as the deadly Spanish flu did, then it’s a pandemic.

Q: What were some alternative medicines people sold in the wake of the flu?

Many had the audacity to run advertisements and make claims of having a cure. A rumor was that the deadly Spanish flu could be cured by alcohol which wasn’t true. A practice borrowed from the Middle Ages was giving out amulets to protect people from the disease. The same was done in the Middle Ages in the wake of the plague.

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