During the Pandemic

The massive flu pandemic which struck the world following the end of World War I was devastating.  Lasting from 1918 to 1920, an estimated 50 to 100 million people died across the world making it the deadliest epidemic in history.  The pandemic spread to virtually every continent on Earth and was especially lethal to young adults rather than the juvenile or elderly victims of other epidemics.  Triggering a cytokine storm reaction in the human immune system, victims often ended up virtually drowning from the rapid buildup of fluid in their lungs.  Considering that the world population of the time was only 1.6 billion, the 500 million cases worldwide quickly overwhelmed hospitals, doctors, and nurses. 

The epidemic first struck at Fort Riley, Kansas in March, 1918, (possibly jumping to troops from the fort livestock). It quickly spread to France with the American Expeditionary Force before reaching Spain three months later.  By June 29 1918, Dr. Martin Salazar of the Spanish Health Department reported to the Royal Academy of Madrid that there was no available evidence of the epidemic in other countries and "Spanish influenza" became a common nickname.of the disease.  Although it was first viewed as a minor epidemic and news coverage in other countries focused on the war, newspapers in Spain widely reported on the closing of theatres and the suspension of postal and telegraph services.   The King, Prime Minister, and many senior government officials were stricken with the disease and the press became preoccupied with covering the spread of "the soldier from Naples" as the disease was commonly called at first (nobody in Spain liked the "Spanish influenza" label).  

The epidemic in Spain came in three separate waves and the thousands of temporary workers from Spain and Portugal helped carry the disease to other countries.  Despite the economic prosperity brought on by its neutrality during World War I, Spain still had one of the highest death rates in Europe at the time so there was little alarm in the beginning.  Religious festivals were still held and thousands of pilgrims were exposed in the heavy crowds that gathered at the events.  By late August of 1918 when the second wave hit however, the death toll rose to 250 percent above the average for the first part of the year.  Despite some effort at quarantining suspected cases, harvest festivals and feast days for patron saints were still held in villages across Spain.  Dr. Garcia Duran, chief health inspector of Valladolid, traced the beginning of the epidemic in that province to the religious celebration for St. Antolin at the beginning of September.  As he stated, "In the midst of an epidemic, with a seriously ill person in most of the houses, with many families in mourning because of deaths already occurred … and by a majority of votes, the villagers agreed not to suspend the bullfight!".  When it came time for a similar festival in Valladolid, Dr. Duran gave in to pressure and delayed the official start of the epidemic until late September so that the week-long festival could be held. 

As the death toll began to rise, doctors were initially uncertain about the exact nature of the disease and used whatever medical tools they had at their disposal.  Bloodletting was still popular in Spain and was widely practiced.  Doctors also tried treating patients with injections of colloidal solutions of silver and platinum as well as various antitoxins and vaccines for other, better known, diseases.  Regardless of the effectiveness of these different measures, patients and their families were often reassured that the doctors were doing everything possible in treating the epidemic. Security was set up at railway stations across the country with passengers showing symptoms of the flu put into quarantine (the healthy ones were sprayed with disinfectants before being sent on their way).  French and Portuguese borders were closed periodically but never for long. 

Due to the severe shortage of doctors and nurses to treat patients, family members were often left with the burden of caring for patients themselves.  Medical authorities had to battle against unsafe sanitary practices and Church hierarchy to try containing the epidemic.  Churches stayed open throughout the epidemic despite the risks involved in spreading the disease.  In one classic example, the bishop of Zamora blamed the epidemic on "our sins and ingratitude" and called for a week-long series of religious services in honour of the Virgin Mary.  While medical officials protested the dangers of large public gatherings during an epidemic, the bishop later announced that the high public turnout during the vigil was "one of the most significant victories Catholicism has obtained".   Zamora had the highest mortality of all Spanish cities during the epidemic.  In fairness, Church-sponsored institutions also worked diligently in treating patients throughout the crisis.

By the time the third wave of the epidemic hit in 1919, mortality was lower (due to fewer infectious hosts).  Although fatalities continued into 1920, the greatest loss of life occurred between 1918 and 1919 with an official death toll of 165,024.  The breakdown of public health systems across Spain led to drastically higher death rates for all diseases during the epidemic years compared to the non-epidemic years that had gone before,  If you add in non-influenza deaths that can be linked to the epidemic, the death toll rises to 257,082 (12 per thousand).  That death toll almost equals the number of deaths occurring during the Spanish Civil War from 1936 to 1939.  As in the rest of the world, the largest number of deaths occurred in young adults between the ages of 20 to 40 years.  Infants represented the next highest demographic group to show increased fatalities during the epidemic.  Spain already had one of the highest infant mortality rates in Europe at the time but the increased number of infant deaths still represented a 20 percent increase from non-epidemic years.

The economic and social consequences of losing so many young adults in a few short years can't be underestimated. Spain was particularly hard hit due to the loss of thousands of workers in their prime earning years.  The harsh lessons learned during the epidemic were put to use in later outbreaks in 1957-1958 and 1968-9 with far fewer casualties.  The spectre of the Spanish flu epidemic still haunts the world today and is often invoked as new flu strains emerge.  Whatever the future holds remains to be seen.