More Than Just a Flu: The Devastating Impact of the Spanish Flu

Treating_an_Influenza_patient_at_Navl_Hospital_New_Orleans,_1918

A century ago, the world faced a silent enemy more devastating than Covid-19, the Spanish Flu.  The pandemic’s death toll was greater than the total number of military and civilian deaths from World War I, which was happening simultaneously. The pandemic swept across the globe, infecting an estimated 500 million people. It took the lives of anywhere between 20 to 50 million, making it the deadliest pandemic in human history. Although this colossal tragedy has long passed, its lessons still resonate with us today, urging us to learn, remember, and prepare for future pandemics.

A World at War, a Virus on the March:

Although it’s named the Spanish Flu, researchers now believe it most likely originated in the United States in 1918. During this time, the world was in the midst of the First World War, and its nations were depleted of resources and exhausted. Amidst the chaos, an unassuming influenza virus emerged, likely from animals. The virus found fertile ground in overcrowded military camps and trenches. Soldiers, weakened by war and poor living conditions, became unwitting carriers, unknowingly transporting the virus across continents.

spanish flu hospital
Beds with patients in an emergency hospital in Camp Funston, Kansas, 1918. courtesy of Wikipedia.

One of the first recorded cases was on March 11, 1918, at Fort Riley in Kansas. Overcrowding and unsanitary conditions created a fertile breeding ground for the virus. The pandemic broke out near the end of World War I when wartime censors in the belligerent countries suppressed bad news to maintain morale. However, in neutral Spain, newspapers freely reported the outbreak. This created a false impression of Spain as the epicentre leading to the “Spanish flu” misnomer.

From Pandemic to Panic:

Unlike previous influenza outbreaks, the Spanish Flu had an exceptionally aggressive mutation that was highly contagious and lethal. It didn’t just affect the elderly and infirm but also healthy young adults who succumbed to pneumonia and respiratory failure within a few days. The world was gripped with fear and panic. Many cities implemented lockdowns, banned public gatherings and made masks mandatory to prevent the spread of the invisible threat.

seattle police officers
Spanish flu in 1918, Police officers in masks, Seattle Police Department

During the autumn of 1918, Seattle’s health commissioner implemented various measures, such as banning dances and shutting down theatres, churches, and schools. During the peak of the epidemic, it was mandatory by law for anyone venturing out in public to wear a mask consisting of six layers of gauze to ensure that the flu germs did not spread.

spanish flu in seattle
Tram operator refuses entry to non-mask-wearing man
Australian Impact

The impact of the Spanish Flu in Australia, though not as severe as in other parts of the world, was still significant. Starting in October 1918, the Australian Quarantine Service began inspecting all ships that arrived in Australia. The first infected ship to enter Australian waters was the Mataram, from Singapore, which arrived in Darwin on 18 October 1918. Over the next six months, the quarantine service intercepted 323 vessels, 174 of which carried the infection. Of the 81,510 people who were checked for influenza, 1,102 were infected. Individuals suspected of having the flu were required to remain in quarantine.

Despite these precautions, the flu managed to spread into the community. The first instance of the flu was reported in Melbourne in early January 1919, and the disease quickly made its way to New South Wales (NSW) and South Australia (SA). However, it didn’t reach Western Australia (WA)until June of that same year.

prevent influenza

Dr Frank Macfarlane Burnet, a young Australian pathologist, witnessed the devastating effects of the flu firsthand. Fueled by this experience, he dedicated his life to virology, eventually contributing to the development of polio and influenza vaccines and illustrating the long-term impact of individual experiences on shaping scientific pursuits.

Quarantine

Ships that arrived from infected countries had to quarantine for 7 days, with patients subject to ‘daily thermometer parades inhalation with steam plus two per cent zinc sulphate solution along recognised lines. Queensland closed its border on February 1st, stranding 700 Queenslanders at Tenterfield Sation in NSW. This led to a temporary quarantine camp being set up in the showgrounds. Some passengers accepted rail passes back to Sydney, while the rest spent 7 days in a tent before they were allowed to enter Queensland. Months later, Spanish flu was detected in Qld, and the government reopened the border to NSW.

In NSW, the government closed schools, theatres, and bars. Sporting events and church services were prohibited, and individuals were mandated to wear face masks while using public transport, walking on the streets, and inside public buildings.

spanish flu quarantine camp
WALLANGARRA QUARANTINE CAMP NO.2 on the border between NSW and Qld. Soldiers changed trains here when returning home from the war. The rope marks the border between Qld and NSW

Despite the implementation of quarantine measures, the virus persisted and spread due to population movements and gatherings. There is still ongoing debate over the precise transmission route. As the outbreak progressed, major cities, including Sydney and Melbourne, became epicentres, and rural areas followed suit. In Victoria, all cases were required to be reported to health authorities and then transferred to the hospital. However, with limited beds available, the Exhibition Building in Melbourne was repurposed as a makeshift hospital. By August 1919, it had provided care for over 4,000 patients.

Impact on Health and Mortality:

Estimates suggest that around 5 million people, approximately 40% of Australia’s population, contracted the flu during a particular outbreak. The death toll from the flu was between 12,000 and 15,000 people, which is a significant loss for a population of 5 million. 

  • During this outbreak, young adults, primarily men in their 20s and 30s, were more affected than other age groups. This phenomenon, known as “cytokine storm,” triggered an exaggerated immune response, leading to severe respiratory complications and, in many cases, death. This is uncommon compared to other regions where older populations typically suffer more. The likely reason for this is their higher mobility and interaction during the war effort. 
  • The healthcare systems were overwhelmed during this outbreak due to the surge in patients, with limited resources and personnel struggling to cope. 
  • Indigenous communities were particularly vulnerable during this outbreak, as they suffered disproportionately high mortality rates due to pre-existing health disparities and limited access to care.
Spanish Flu vs Covid-19

The Spanish flu infected approximately 500 million people, about one-third of the world’s population at the time. The estimated death toll from the Spanish flu varies, with figures ranging from 17 million to 100 million. In comparison, COVID-19 has infected nearly 55 million people to date, with 1.3 million deaths.

Some famous people who survived the Spanish flu include:

  1. Walt Disney – American entrepreneur, animator, and film producer
  2. Edvard Munch – Norwegian painter
  3. Katherine Anne Porter – American journalist and author
  4. David Lloyd George – British Prime Minister
  5. Woodrow Wilson – 28th President of the United States
  6. Franklin D. Roosevelt – 32nd President of the United States
  7. General John J. Pershing – American general
  8. Haile Selassie I – Emperor of Ethiopia
  9. Mahatma Gandhi – Leader of the Indian independence movement
  10. Greta Garbo – Swedish actress
Social and Economic Impacts:

The pandemic caused widespread panic and disruption. Public gatherings were banned, schools closed, and businesses faced significant challenges. The war efforts were also impacted, as labour shortages and reduced productivity hindered recovery. The economic toll was significant, with the flu exacerbating existing wartime difficulties. Businesses struggled, unemployment rose, and the government faced a strain on its resources to manage the crisis and support affected communities.

spanish flu medical teams
Nurses leaving Blackfriars Depot, Chippendale NSW

The social tensions increased, with anxieties and scapegoating targeting specific groups, particularly immigrants and marginalized communities. Focusing on public health measures like mandatory quarantines also raised concerns about individual rights and government authority.

Long-Term Legacy

By late 1919 the pandemic was over. The global impact of the Spanish Flu was staggering. Estimates suggest that one-third of the world’s population was infected, with death tolls ranging from 50 to 100 million people. Entire communities were decimated, and the societal and economic repercussions were profound. The Spanish Flu outbreak had a significant and long-lasting impact on Australia’s public health approach. It highlighted the significance of being prepared, working together, and having effective healthcare systems in managing pandemics.

Not Just a Medical Crisis:

The estimated mortality rate of the Spanish flu was approximately 0.28%–0.4%, making it one of the deadliest pandemics in history. However, the impact of the pandemic went beyond the medical field. It led to social unrest, worsened inequalities, and influenced political landscapes. There was a surge in anti-immigrant sentiment, which was fueled by misinformation and the search for scapegoats. Economic difficulties worsened, placing further strain on war-torn nations. The Spanish Flu left a lasting impact on the 20th century, with its consequences rippling out long after the last case was reported.

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