1918 flu pandemic offers lessons for future
By
Susan Spencer
Telegram & Gazette Staff
Posted Sep 8, 2018 at 5:31 AM
Updated Sep 8, 2018 at 5:31 AM
One hundred years ago this month, what’s considered the deadliest
disease outbreak in human history, the influenza pandemic of 1918,
roared into Central Massachusetts.
The pandemic came in three waves and lasted 15 months. The second wave, which took off in Massachusetts in September, when a massive outbreak occurred at Fort Devens, was the worst.
Overall, the “Spanish flu,” as it was termed, caused more deaths than AIDS did in 40 years or the bubonic plague did in a century, according to historian John M. Barry, who wrote the book, “The Great Influenza.”
An estimated 25 million to 150 million people died worldwide, including 675,000 in the United States. Many cases weren’t reported and death certificates often only listed the secondary cause of death, usually pneumonia.
A digital encyclopedia of the 1918 American influenza epidemic produced by the University of Michigan Center for the History of Medicine and Michigan Publishing pegged the number of flu-related deaths in Worcester, as of January 1919, at 1,294, while others say it was likely less.
Medical science, public health and emergency response systems have changed in the past 100 years, yet researchers and health officials still fear a new type of virus could cause another global pandemic.
That virus is not going to be Ebola, which caused more than 11,300 deaths in West Africa, and one in the United States, between 2014 and 2016.
A more likely culprit will again be the flu, when a deadly variant arises from genetic re-combinations of strains that can be transmitted across species, including humans, mammals (swine) and birds.
Already there have been avian flu strains transmitted to humans directly from birds, such as in China in the past few years, with a mortality rate of up to 60 percent, according to the World Health Organization.
“What’s different about influenza is its ability to cause pandemics.
Most viruses just can’t do that,” said Dr. Robert W. Finberg, chairman
of the Department of Medicine at University of Massachusetts Medical
School.
Plus, the flu spreads in the air, making every cough or sneeze a potential transmission vehicle.
“Do I think it’s a worry? Yes, it’s a worry. Much more than Ebola. Because we don’t know how to contain it.”
Preparations for the next pandemic - and how to prevent it - are taking place on multiple fronts, from science labs to health care organizations, to government centers.
At UMass Medical School, researchers are working on therapies that will remain effective despite the rapid mutation of flu viruses.
Unlike other viruses, one type of flu virus, type A, which includes the swine flu, contains eight strands of genetic material that can share information and recombine with flu strains from other species to make a brand new strain.
Influenza B doesn’t combine with other species, but is a factor in seasonal flu outbreaks, according to Dr. Finberg.
In a typical flu epidemic year, roughly 25,000 people in the U.S. die
over the course of the season, from fall to spring. Usually deaths
occur among older people or the very young.
The 1918 pandemic, now thought to be the avian flu, killed primarily young adults between ages 14 and 45, as many as 10 percent of that age group, and started months ahead of normal flu season.
One theory why is that the strong immune systems of young adults sent out super-strong defense substances called cytokines to combat the invading virus, and the “cytokine storm” ended up destroying healthy host cells.
Also, World War I played a role in contributing to so many deaths, particularly among young adults. Soldiers were camped in close quarters, where the virus quickly spread.
And some researchers have attributed delays in taking action such as closing public gathering places to the reluctance of health officials and newspaper publishers to alert the public to the severity of the outbreak. The reticence was perhaps out of fear of prosecution under the Sedition Act of 1918, as Mr. Barry wrote in Smithsonian magazine in November. The Sedition Act made it a crime to express views that cast the government or the war effort in a negative light.
Worcester historian Donald W. Chamberlayne, in a report he wrote in December about the 1918 influenza pandemic in Worcester, noted the optimism of headlines in newspapers such as the Sept. 26 Gazette headline: “Influenza not causing scare in Worcester.”
He wrote that on Sept. 20, superintendent of City Hospital Dr. Charles A. Drew said there were a large number of cases in the hospital and city, but “he does not see any reason for the people to become unduly excited.”
“The government kept lying about it,” Dr. Finberg said. Parades would be held and more would die.
Dr. Finberg said that flu vaccines now are modeled based on what’s circulating in the Southern Hemisphere, which is six months ahead of the flu season in the north.
With the shape-shifting nature of the flu virus, scientists are always racing to catch up with what mutations might arrive when the flu season hits in full force. That’s why three or four strains are typically included in the flu vaccine.
Vaccines can be made much more quickly than they were in the past, particularly with DNA sequencing, but the DNA sequence has to be known, according to Dr. Finberg.
The 1918 pandemic can still offer important lessons on public health response.
The first wave is thought to have started at Fort Riley, Kansas, in March 1918. It spread quickly among soldiers training for and returning from battle overseas. It died down by mid-summer.
On Aug. 27, 1918, several sailors on Commonwealth Pier in Boston were reported to have the disease, the New England Historical Society wrote on its website. The sailors were sent to Chelsea Naval Hospital, from which the disease spread to Boston and the rest of Massachusetts, in particular, Fort Devens.
Albert B. Southwick wrote in the Sunday Telegram Nov. 5, 2006, by the end of September more than 8,000 sick and dying men clogged its hospital, which was built for 2,000.
Newspaper accounts by mid-September told of 125 cases in Leicester; eight died in Millbury in one day; Westboro and Holden closed their schools; and Leominster Hospital had to turn away people who were dying, Mr. Southwick wrote.
Worcester’s first influenza-related death was Sept. 19, according to the University of Michigan researchers. The victim, James W. Roche, 25, was home from the Newport Naval Training School on furlough to visit his parents at 142 West St. His parents succumbed a few days later.
The Michigan analysis and Mr. Chamberlayne’s report are critical of the slow response by Worcester city officials to close schools, theaters, saloons and churches to contain the spread of the disease.
As a result, the Worcester public health response time from when officials became aware of the outbreak to when it adopted first control measures was 15 days, the longest of Massachusetts’ major cities.
Worcester did, however, put in place in about a week an isolation hospital in a converted dance hall at the fairgrounds on West Boylston Street.
Mr. Chamberlayne estimated that between 1,000 and 1,200 people in Worcester died, or about half a percent of the city’s population, as a result of the influenza pandemic. Approximately 3 percent of households lost at least one member.
Mr. Barry wrote that in the developed world, the mortality rate was around 2 percent of the population. It was higher elsewhere.
“Part of the tremendous spread of the 1918 pandemic was a unique set of circumstances,” including World War I, said Dr. Michael P. Hirsh, medical director for the Worcester Division of Public Health.
Dr. Hirsh is also surgeon-in-chief and chief of pediatric surgery and trauma at UMass Memorial Children’s Medical Center.
Departments of public health have gotten smarter about working with local medical communities to identify early warning signs and coordinate control measures, he continued.
Locally, UMass Memorial Medical Center and St. Vincent Hospital medical staff check with each other regularly, on the same shift, if they see an unusual number of certain types of cases, or anything out of the ordinary.
“That kind of communication wasn’t available in real time (in 1918),” Dr. Hirsh said.
The state DPH also set up six regional Health and Medical Coordinating Coalitions, or HMCCs, which integrate planning and resources across acute care hospitals, community health centers and large ambulatory care organizations, emergency medical services, local public health, and long term care.
Alissa Errede is the program manager for the Central Massachusetts HMCC, which serves 74 cities and towns, and is also the emergency preparedness chief at Worcester DPH.
Ms. Errede said that emergency dispensing sites have been
strategically identified across the city and region, where the public
would go for vaccinations and other front-line services.
And on the regional and state level, emergency coordination plans are set up to gather data quickly and coordinate response.
Medical reserve corps in Worcester, Grafton and Wachusett Regional, mobilize volunteers who train regularly to respond to medical emergencies in their community. Volunteers with health care or medical support experience are encouraged to sign up on the HMCC regional website www.ARCHEcoalition.org.
“The best way to really help is to do this in advance,” Ms. Errede said.
Dr. Hirsh said preparing for a pandemic or other emergency, such as a natural disaster or terrorist attack, can be scary, but necessary.
“We can’t be ostriches about it,” he said.
The pandemic came in three waves and lasted 15 months. The second wave, which took off in Massachusetts in September, when a massive outbreak occurred at Fort Devens, was the worst.
Overall, the “Spanish flu,” as it was termed, caused more deaths than AIDS did in 40 years or the bubonic plague did in a century, according to historian John M. Barry, who wrote the book, “The Great Influenza.”
An estimated 25 million to 150 million people died worldwide, including 675,000 in the United States. Many cases weren’t reported and death certificates often only listed the secondary cause of death, usually pneumonia.
A digital encyclopedia of the 1918 American influenza epidemic produced by the University of Michigan Center for the History of Medicine and Michigan Publishing pegged the number of flu-related deaths in Worcester, as of January 1919, at 1,294, while others say it was likely less.
Medical science, public health and emergency response systems have changed in the past 100 years, yet researchers and health officials still fear a new type of virus could cause another global pandemic.
That virus is not going to be Ebola, which caused more than 11,300 deaths in West Africa, and one in the United States, between 2014 and 2016.
A more likely culprit will again be the flu, when a deadly variant arises from genetic re-combinations of strains that can be transmitted across species, including humans, mammals (swine) and birds.
Already there have been avian flu strains transmitted to humans directly from birds, such as in China in the past few years, with a mortality rate of up to 60 percent, according to the World Health Organization.
Plus, the flu spreads in the air, making every cough or sneeze a potential transmission vehicle.
“Do I think it’s a worry? Yes, it’s a worry. Much more than Ebola. Because we don’t know how to contain it.”
Preparations for the next pandemic - and how to prevent it - are taking place on multiple fronts, from science labs to health care organizations, to government centers.
At UMass Medical School, researchers are working on therapies that will remain effective despite the rapid mutation of flu viruses.
Unlike other viruses, one type of flu virus, type A, which includes the swine flu, contains eight strands of genetic material that can share information and recombine with flu strains from other species to make a brand new strain.
Influenza B doesn’t combine with other species, but is a factor in seasonal flu outbreaks, according to Dr. Finberg.
The 1918 pandemic, now thought to be the avian flu, killed primarily young adults between ages 14 and 45, as many as 10 percent of that age group, and started months ahead of normal flu season.
One theory why is that the strong immune systems of young adults sent out super-strong defense substances called cytokines to combat the invading virus, and the “cytokine storm” ended up destroying healthy host cells.
Also, World War I played a role in contributing to so many deaths, particularly among young adults. Soldiers were camped in close quarters, where the virus quickly spread.
And some researchers have attributed delays in taking action such as closing public gathering places to the reluctance of health officials and newspaper publishers to alert the public to the severity of the outbreak. The reticence was perhaps out of fear of prosecution under the Sedition Act of 1918, as Mr. Barry wrote in Smithsonian magazine in November. The Sedition Act made it a crime to express views that cast the government or the war effort in a negative light.
Worcester historian Donald W. Chamberlayne, in a report he wrote in December about the 1918 influenza pandemic in Worcester, noted the optimism of headlines in newspapers such as the Sept. 26 Gazette headline: “Influenza not causing scare in Worcester.”
He wrote that on Sept. 20, superintendent of City Hospital Dr. Charles A. Drew said there were a large number of cases in the hospital and city, but “he does not see any reason for the people to become unduly excited.”
Dr. Finberg said that flu vaccines now are modeled based on what’s circulating in the Southern Hemisphere, which is six months ahead of the flu season in the north.
With the shape-shifting nature of the flu virus, scientists are always racing to catch up with what mutations might arrive when the flu season hits in full force. That’s why three or four strains are typically included in the flu vaccine.
Vaccines can be made much more quickly than they were in the past, particularly with DNA sequencing, but the DNA sequence has to be known, according to Dr. Finberg.
The 1918 pandemic can still offer important lessons on public health response.
The first wave is thought to have started at Fort Riley, Kansas, in March 1918. It spread quickly among soldiers training for and returning from battle overseas. It died down by mid-summer.
On Aug. 27, 1918, several sailors on Commonwealth Pier in Boston were reported to have the disease, the New England Historical Society wrote on its website. The sailors were sent to Chelsea Naval Hospital, from which the disease spread to Boston and the rest of Massachusetts, in particular, Fort Devens.
Newspaper accounts by mid-September told of 125 cases in Leicester; eight died in Millbury in one day; Westboro and Holden closed their schools; and Leominster Hospital had to turn away people who were dying, Mr. Southwick wrote.
Worcester’s first influenza-related death was Sept. 19, according to the University of Michigan researchers. The victim, James W. Roche, 25, was home from the Newport Naval Training School on furlough to visit his parents at 142 West St. His parents succumbed a few days later.
The Michigan analysis and Mr. Chamberlayne’s report are critical of the slow response by Worcester city officials to close schools, theaters, saloons and churches to contain the spread of the disease.
As a result, the Worcester public health response time from when officials became aware of the outbreak to when it adopted first control measures was 15 days, the longest of Massachusetts’ major cities.
Worcester did, however, put in place in about a week an isolation hospital in a converted dance hall at the fairgrounds on West Boylston Street.
Mr. Chamberlayne estimated that between 1,000 and 1,200 people in Worcester died, or about half a percent of the city’s population, as a result of the influenza pandemic. Approximately 3 percent of households lost at least one member.
“Part of the tremendous spread of the 1918 pandemic was a unique set of circumstances,” including World War I, said Dr. Michael P. Hirsh, medical director for the Worcester Division of Public Health.
Dr. Hirsh is also surgeon-in-chief and chief of pediatric surgery and trauma at UMass Memorial Children’s Medical Center.
Departments of public health have gotten smarter about working with local medical communities to identify early warning signs and coordinate control measures, he continued.
Locally, UMass Memorial Medical Center and St. Vincent Hospital medical staff check with each other regularly, on the same shift, if they see an unusual number of certain types of cases, or anything out of the ordinary.
“That kind of communication wasn’t available in real time (in 1918),” Dr. Hirsh said.
The state DPH also set up six regional Health and Medical Coordinating Coalitions, or HMCCs, which integrate planning and resources across acute care hospitals, community health centers and large ambulatory care organizations, emergency medical services, local public health, and long term care.
Alissa Errede is the program manager for the Central Massachusetts HMCC, which serves 74 cities and towns, and is also the emergency preparedness chief at Worcester DPH.
And on the regional and state level, emergency coordination plans are set up to gather data quickly and coordinate response.
Medical reserve corps in Worcester, Grafton and Wachusett Regional, mobilize volunteers who train regularly to respond to medical emergencies in their community. Volunteers with health care or medical support experience are encouraged to sign up on the HMCC regional website www.ARCHEcoalition.org.
“The best way to really help is to do this in advance,” Ms. Errede said.
Dr. Hirsh said preparing for a pandemic or other emergency, such as a natural disaster or terrorist attack, can be scary, but necessary.
“We can’t be ostriches about it,” he said.
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