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Rampant Lies, Fake Cures and Not Enough Beds: 

What the Spanish Flu Debacle Can Teach Us About Coronavirus








Emergency hospital during influenza epidemic, Camp Funston, Kansas, circa 1918. | National Museum of Health and Medicine

1918 USA

In March 1918, with the United States fully mobilized for World War I, soldiers at Camp Funston in Fort Riley, Kansas, began reporting acute flu-like symptoms, including aches, respiratory distress, chills, coughing and high fever. Just a month later, over 1,100 men had come down with the disease; 46 of them (roughly four percent) had died. It was the start of the infamous “Spanish Flu”—a misnomer for the scourge that likely began in the U.S. but, as troops fanned out across Europe, claimed 21 million lives globally, including over 600,000 Americans.

What began in Army camps, where 25 percent of soldiers developed the flu, spread by fall to the civilian population. In Boston, 202 people died on just one day—October 1. Philadelphia later topped that record, with 700 deaths in one 24-hour period. The disease wasn’t discriminatory. It devastated urban populations like Pittsburgh and New York City but also hit vulnerable rural areas like Arkansas, where the public health infrastructure was essentially nonexistent.

Lasting just over a year, the 1918-1919 influenza pandemic stands as a lasting reminder of what happens when governments and their citizens fail to meet a crisis head on. From our perch today, as we brace for the coronavirus’ inevitable spread, the missteps of 1918 seem eerily prescient: A lack of leadership from Washington, with the gaps filled unevenly at the state and local levels. Public officials who either lied, dissembled or made up facts. Hucksters who used popular media to misinform the public and make a quick buck in the process. Public health infrastructure that was inadequate to the challenge. And ordinary citizens who often refused to heed the warning of experts.




To be sure, science a century ago was light years from present day. The influenza outbreak was far more lethal in our great grandparents’ time than in our own because treatments were nowhere near as advanced. But even back in 1918, developments in medicine and public health had rendered diseases like cholera, typhoid and diphtheria—in recent memory, sure killers—manageable or even preventable. America’s cities and its military had extensive experience with quarantines and other social measures to stop vectors of transmission. And still, government bungling and a general lack of preparedness helped the pandemic spread like wildfire.

History repeats

Professional historians usually recoil from the old adage that “history is bound to repeat itself” (it really isn’t). And yet, sometimes it does. The lesson is pretty simple. Look at what went wrong in 1918. Then do the opposite.

Lots went wrong in 1918. Start with the worst example, Philadelphia, where the local government failed abjectly to meet the public health crisis. The problem silently took root on September 7 when 300 sailors, some of whom were already infected, docked in the Navy Yard. Boston had already been hard hit by the epidemic, so city officials were well aware of its deadly potential. The city, whose infrastructure had buckled even before the war, was now teeming with new workers and migrants who stretched the housing stock, streets and transportation to capacity. It took but 10 days before over 600 servicemen and civilians were sick enough to require hospitalization, including several doctors and nurses who had been treating sick patients.




Philadelphia’s director of Public Health and Charities, a political appointment that was, like most other positions, a sinecure of the city’s political machine, was Dr. Wilmer Krusen, a gynecologist who lacked training in epidemiology. From the start, he downplayed the severity of the threat, assuring the public that his office could “confine this disease to its present limits, and in this we are sure to be successful. No fatalities have been recorded. No concern whatever is felt.” When fatalities began to mount, he insisted there was nothing to worry about—it wasn’t the “Spanish flu,” but rather, just a few cases of the “old-fashioned influenza or grippe. … From now the disease will decrease.” True to his word, Krusden took no steps to assemble supplies or to identify doctors and nurses who could be made available in the event of mass hospitalizations. He resisted calls by other medical professionals that the city quarantine the Navy Yard.

And then, on September 18, the city held a monster parade to support the Fourth Liberty Loan Drive.

These were the high water mark days of America’s involvement in World War I. The federal government compelled, shamed and goaded citizens into conforming: From the Sedition Act, which forbade interference in the sale of war bonds, to the legions of Four Minute Men who delivered patriotic speeches in movie theaters as the reels were being changed—to say nothing of horrific acts of popular violence against German Americans—public spirit demanded that the parade go on. Tens of thousands of Philadelphians lined the streets to cheer the procession, providing the disease a tragic opportunity to spread.

Within 10 days, over 1,000 Philadelphians lay dead, with another 200,000 estimated ill, and the state government in Harrisburg ordered the city’s public amusements and gathering places closed down, a ban that shuttered saloons, theaters, ice cream parlors and movie theaters. It was too little, too late: As the body count continued to climb, the Catholic archbishop assigned three thousand nuns and seminarians to staff makeshift hospitals and dig mass graves. By March 1919, when the threat of influenza lifted, Philadelphia had lost over 15,000 of its citizens.


In Pittsburgh, local officials ignored the price of inaction to the east. They failed to line up hospital space and medical professionals, despite “harrowing stories that had come from other sections of the country of multitudes of dead,” the local Red Cross chapter later observed. When the governor ordered all cities to close most places of public accommodation, the mayor objected that “the whole thing seemed wrong,” echoing the city’s public health chief, who waved off calls to prepare for an onslaught of patients with the bloodless observation that “the disease was not affecting Pittsburgh to any great extent.” Of course, it soon did. Mortality rates (though not hard numbers) ultimately exceeded those of Philadelphia, though the city’s delayed and begrudging compliance with the state ban, as well as aggressive action by the Red Cross and other voluntary organizations, may have slowed the pace of infection in a way that spared funeral homes the same appalling over-capacity that hit other places.

Failed Govt

The failure of Philadelphia’s government to respond quickly and forcefully should have alerted other elected officials to the crisis. In some cases, it did, as in San Diego, where city officials took heed of the carnage that had overrun eastern cities like Philadelphia, Boston and New York and acted quickly to close churches, dance halls, gymnasiums, libraries, swimming pools and all public meetings—except, of course, outside war bond drives. Police enforced these measures aggressively. When the number of infected citizens did not immediately drop, municipal officials worked with the Red Cross to produce and distribute thousands of gauze masks, which many citizens balked at wearing, despite the entreaties of public health officials. The San Diego Union dismissed the very idea out of hand, observing that “modern civilization has abolished the mask as part of the human wearing apparel … only highwaymen, burglars, and hold-up men wear masks professionally.” Still, the city’s early and active efforts contributed to smaller mortality numbers than other municipalities.

The Lies

But the broader pattern that emerged was dismissal, dissemblance and outright deception on the part of public officials who either did not perceive the severity of the threat or who would not acknowledge it, for fear of political consequence. What mayor or governor, after all, wanted to go to war with local businesses, which in every city vocally opposed forced shutdowns? What health official wanted to run afoul of the coercive spirit encouraging war bond drives and other acts of solidarity with the men in uniform? In Denver and Cheyenne, officials caved to business pressure and lifted restrictions, only to reimpose them after the rates of infection and fatality climbed again.

Even as his city reeled with the onset of disease, New York City’s public health director waved away calls for greater vigilance, finding that “other bronchial diseases and not the so-called Spanish influenza ... [caused] the illness of the majority of persons who were reported ill with influenza.” Though the federal Public Health Service encouraged cities and states to adopt best practices, in the earliest days when quarantines and shutdowns might have flatten the curve (to borrow from contemporary parlance), the U.S. Surgeon General, Rupert Blue, assured Americans that “there is no cause for alarm if precautions are observed”—a nonchalant remark that newspapers widely reported, and which imparted a false sense of calm. Even when the body count manifestly demonstrated otherwise, Colonel Philipp Doane, who led health and safety at the military shipyards where the disease first spread, dismissed the “so-called Spanish influenza” as “nothing more or less than the old-fashioned grippe.”

Woodrow Wilson, who mobilized a formidable public relations effort to generate populate support for the war, said nothing. This was a time before presidents routinely stepped in to counsel, console or calm the nation through a pandemic.

It wasn’t only that many elected and appointed officials failed to meet the moment. In many ways, Americans were ill-prepared to confront a pandemic. The state of the country’s health care system was primitive by modern standards. In Pittsburgh, a city teeming with factories and industrial workers, the poor quality of air contributed to widespread, devastating respiratory problems. Even before the influenza set in, rates of pneumonia reached heights of 253 deaths per 100,000—appalling figures that outstripped every city except New York. In 1923 the Mellon Foundation found that unregulated soot and ash from factories was destroying the health of workers and their families, a condition that many other communities also faced. As well, Pittsburgh had no health infrastructure of which to speak: just 20 community hospitals, some staffed by only one nurse, with an acute shortage of beds. The housing stock was also poor, with most working-class residents crammed into tenements that, under the right circumstances, were petri dishes for disease. They were better off than the 50,000 residents who lived in rooming houses, where they not only shared rooms with perfect strangers but also beds, which they occupied in shifts.




Rural America was hardly better equipped to weather the storm than big cities. In the 1920s and early 1930s, researchers would discover the scourge of Southern poverty that left large swaths of the population poorly nourished and afflicted with common parasites and disease. No less than their urban counterparts, the residents of small towns and country communities were physically compromised even before the influenza took hold.

In the absence of calm and steady leadership from the top, there was no shortage of hucksters standing by, ready to profit from fear. One Dr. Franklin Duane gave interviews and ran advertisements for a fake home remedy (“Dr. Pierce’s Pleasant Pellets”), arguing that “the more you fear the disease, the surer you are to get it.” Dr. Bell’s Pine Tar Honey, Schenck’s Mandrake Pills, Beecham’s Pills and Miller’s Antiseptic Snake Oil also promised protection or relief from the flu. “When [Vick’s] VapoRub is applied over the throat and chest,” one wide-circulation ad informed readers, “the medicated vapors loosen the phlegm, open the air passages and stimulate the mucus membrane to throw off the germs.”

Gullible citizens

Ordinary people could be forgiven a certain level of gullibility, notwithstanding very real advances in medicine and science that rendered such snake oil ads suspect. But in many localities, they resisted closures and quarantines with as much gusto as the owners of stores, saloons, theaters and restaurants. Neither did they segregate themselves at first indication of infection. In Seattle, according to a local newspaper, “every worker who sniffles is shot with [a] serum … they blow their noses and return to work,” despite entreaties from city health officials that they stay home. After the mayor unwisely suggested that if people observed the quarantine and closure rules, “the epidemic would be ended in five days,” residents began flouting the restrictions entirely. After all, if the mayor wasn’t concerned, why should they be?On one afternoon, when a “trophy train” packed with memorabilia parked itself downtown, thousands of Seattle citizens congregated for nine hours to inspect its wares.

Mitigation 1918 Army   - Fail!The need for early intervention was well known in 1918. The Army surgeon general demanded “influenza be kept out” of the basic-training camps, where new soldiers were being prepared to fight in World War I. “Epidemics of the disease can often be prevented,” he said, “but once established they cannot well be stopped.” He barred civilians from the camps and ordered that soldiers entering them be quarantined, soldiers showing symptoms be isolated and whole units quarantined if several soldiers were ill. Of 120 camps, 99 imposed those measures.

But an Army study found no difference in morbidity and mortality between camps

 History Repeats