The Great Influenza (55 page)

Of 220 people at Hebron, 150 died. The weather was already bitter cold. The dead lay in their beds, sweat having frozen their bedclothes to them. Gordon and some others from Cartwright made no effort to dig graves, consigning the bodies to the sea. He wrote, 'A feeling of intense resentment at the callousness of the authorities, who sent us the disease by mail-boat, and then left us to sink or swim, filled one's heart almost to the exclusion of all else' .'

Then there was Okak. Two hundred sixty-six people had lived in Okak, and many dogs, dogs nearly wild. When the virus came it struck so hard so fast people could not care for themselves or feed the dogs. The dogs grew hungry, crazed with hunger, devoured each other, and then wildly smashed through windows and doors, and fed. The Reverend Andrew Asboe survived with his rifle beside him; he personally killed over one hundred dogs.

When the Reverend Walter Perret arrived, only fifty-nine people out of 266 still lived. He and the survivors did the only work there was. 'The ground was frozen hard as iron, and the work of digging was as hard as ever work was. It took about two weeks to do it, and when it was finished it was 32 feet long, 10 feet wide, and eight feet deep.' Now began the task of dragging the corpses to the pit. They laid 114 bodies in the pit, each wrapped in calico, sprinkled disinfectants over them, and covered the trench, placing rocks on top to prevent the dogs from tearing it up.

In all of Labrador, at least one-third the total population died.

* 

The virus pierced the ice of the Arctic and climbed the roadless mountains of Kentucky. It also penetrated the jungle.

Among Westerners the heaviest blows fell upon young adults densely packed together, civilian or military. Metropolitan Life Insurance found that 6.21 percent of
all
coal miners (not just those with influenza) whom it insured between the ages of twenty-five and forty-five died; in that same age group, 3.26 percent of
all
industrial workers it insured died - comparable to the worst rates in the army camps.

In Frankfurt the mortality rate of all those hospitalized with influenza (not all those with pneumonia) was 27.3 percent. In Cologne the mayor, Konrad Adenauer, who would become one of Europe's great statesmen, said the disease left thousands 'too exhausted to hate.'

In Paris the government closed only schools, fearing that anything else would hurt morale. The death rate there was 10 percent of influenza victims and 50 percent of those who developed any complications. 'These cases,' noted one French physician, 'were remarkable for the severity of the symptoms and the rapidity with which certain forms progressed to death.' Although the symptoms in France were typical of the disease elsewhere, deep into the epidemic physicians seemed to purposely misdiagnose it as cholera or dysentery and rarely reported it.

And populations whose immune systems were naive, whose immune systems had seen few if any influenza viruses of any kind, were not just decimated but sometimes annihilated. This was true not only of Eskimos but of all Native Americans, of Pacific Islanders, of Africans.

In Gambia, 8 percent of the Europeans would die, but from the interior one British visitor reported, 'I found whole villages of 300 to 400 families completely wiped out, the houses having fallen in on the unburied dead, and the jungle having crept in within two months, obliterating whole settlements.'

Even when the virus mutated toward mildness, it still killed efficiently in those whose immune systems had rarely or never been exposed to influenza. The USS
Logan
reached Guam on October 26. Nearly 95 percent of American sailors ashore caught the disease, but only a single sailor died. The same virus killed almost 5 percent of the entire native population in a few weeks.

In Cape Town and several other cities in South Africa, influenza would kill 4 percent of the entire population within four weeks of the first reported cases. Thirty-two percent of white South Africans and 46 percent of the blacks would be attacked; 0.82 percent of white Europeans would die, along with at least 2.72 percent (likely a far, far higher percentage) of black Africans.

In Mexico the virus swarmed through the dense population centers and through the jungles, overwhelming occupants of mining camps, slum dwellers and slum landlords, and rural peasants alike. In the state of Chiapas, 10 percent of the entire population (not 10 percent of those with influenza) would die.

The virus ripped through Senegal, Sierra Leone, Spain, and Switzerland, leaving each devastated and keening with a death toll that in some areas exceeded 10 percent of the overall population.

In Brazil (where the virus was relatively mild, at least compared with Mexico or for that matter Chile) Rio de Janeiro suffered an attack rate of 33 percent.

In Buenos Aires, Argentina, the virus attacked nearly 55 percent of the population.

In Japan it attacked more than one-third of the population.

The virus would kill 7 percent of the entire population in much of Russia and Iran.

In Guam, 10 percent of the population would die.

Elsewhere the mortality exceeded even that. In the Fiji Islands, 14 percent of the population would die
in the sixteen days between November 25 and December 10
. It was impossible to bury the dead. Wrote one observer, 'day and night trucks rumbled through the streets, filled with bodies for the constantly burning pyres.'

A very few (very few) isolated locations around the world, where it was possible to impose a rigid quarantine and where authorities did so ruthlessly, escaped the disease entirely. American Samoa was one such place. There not a single person died of influenza.

Across a few miles of ocean lay Western Samoa, seized from Germany by New Zealand at the start of war. On September 30, 1918, its population was 38,302, before the steamer
Talune
brought the disease to the island. A few months later, the population was 29,802.
Twenty-two percent of the population died
.

Huge but unknown numbers died in China. In Chungking one-half the population of the city was ill.

And yet the most terrifying numbers would come from India. As elsewhere, India had suffered a spring wave. As elsewhere, this spring wave was relatively benign. In September influenza returned to Bombay. As elsewhere, it was no longer benign.

Yet India was not like elsewhere. There influenza would take on truly killing dimensions. A serious epidemic of bubonic plague had struck there in 1900, and it had struck Bombay especially hard. In 1918 the peak daily influenza mortality in Bombay almost doubled that of the 1900 bubonic plague, and the case mortality rate for influenza reached 10.3 percent.

Throughout the Indian subcontinent, there was only death. Trains left one station with the living. They arrived with the dead and dying, the corpses removed as the trains pulled into station. British troops, Caucasians, in India suffered a case mortality rate of 9.61 percent. For Indian troops, 21.69 percent of those who caught influenza died. One hospital in Delhi treated 13,190 influenza patients; 7,044 of those patients died.

The most devastated region was the Punjab. One physician reported that hospitals were so 'choked that it was impossible to remove the dead quickly enough to make room for the dying. The streets and lanes of the city were littered with dead and dying people' . Nearly every household was lamenting a death and everywhere terror reigned.'

Normally corpses there were cremated in burning ghats, level spaces at the top of the stepped riverbank, and the ashes given to the river. The supply of firewood was quickly exhausted, making cremation impossible, and the rivers became clogged with corpses.

In the Indian subcontinent alone, it is likely that close to twenty million died, and quite possibly the death toll exceeded that number.

Victor Vaughan, Welch's old ally, sitting in the office of the surgeon general of the army and head of the army's Division of Communicable Diseases, watched the virus move across the earth. 'If the epidemic continues its mathematical rate of acceleration, civilization could easily,' he wrote in hand, 'disappear' from the face of the earth within a matter of a few more weeks.'

Part IX

LINGERER

CHAPTER THIRTY-ONE

V
AUGHAN BELIEVED
that the influenza virus came close to threatening the existence of civilization. In fact, some diseases depend upon civilization for their own existence. Measles is one example. Since a single exposure to measles usually gives lifetime immunity, the measles virus cannot find enough susceptible individuals in small towns to survive; without a new human generation to infect, the virus dies out. Epidemiologists have computed that measles requires an unvaccinated population of at least half a million people living in fairly close contact to continue to exist.

The influenza virus is different. Since birds provide a natural home for it, influenza does not depend upon civilization. In terms of its own survival, it did not matter if humans existed or not.

* 

Twenty years before the great influenza pandemic, H. G. Wells published
War of the Worlds,
a novel in which Martians invaded the earth. They loosed upon the world their death ships, and they were indomitable. They began to feed upon humans, sucking the life force from them down to the marrow of the bone. Man, for all his triumphs of the nineteenth century, a century in which his achievements had reordered the world, had become suddenly impotent. No force known to mankind, no technology or strategy or effort or heroism that any nation or person on earth had developed, could stand against the invaders.

Wells wrote, 'I felt the first inkling of a thing that presently grew quite clear in my mind, that oppressed me for many days, a sense of dethronement, a persuasion that I was no longer a master, but an animal among the animals' . The fear and empire of man had passed away.'

But just as the destruction of the human race seemed inevitable, nature intervened. The invaders were themselves invaded; the earth's infectious pathogens killed them. Natural processes had done what science could not.

With the influenza virus, natural processes began to work as well.

At first those processes had made the virus more lethal. Whether it first jumped from an animal host to man in Kansas or in some other place, as it passed from person to person it adapted to its new host, became increasingly efficient in its ability to infect, and changed from the virus that caused a generally mild first wave of disease in the spring of 1918 to the lethal and explosive killer of the second wave in the fall.

But once this happened, once it achieved near-maximum efficiency, two other natural processes came into play.

One process involved immunity. Once the virus passed through a population, that population developed at least some immunity to it. Victims were not likely to be reinfected by the same virus, not until it had undergone antigen drift. In a city or town, the cycle from first case to the end of a local epidemic in 1918 generally ran six to eight weeks. In the army camps, with the men packed so densely, the cycle took usually three to four weeks.

Individual cases continued to occur after that, but the explosion of disease ended, and it ended abruptly. A graph of cases would look like a bell curve - but one chopped off almost like a cliff just after the peak, with new cases suddenly dropping to next to nothing. In Philadelphia, for example, in the week ending October 16 the disease killed 4,597 people. It was ripping the city apart, emptying the streets, sparking rumors of the Black Death. But new cases dropped so precipitously that only ten days later, on October 26, the order closing public places was lifted. By the armistice on November 11, influenza had almost entirely disappeared from that city. The virus burned through available fuel. Then it quickly faded away.

The second process occurred within the virus. It was only influenza. By nature the influenza virus is dangerous, considerably more dangerous than the common aches and fever lead people to believe, but it does not kill routinely as it did in 1918. The 1918 pandemic reached an extreme of virulence unknown in any other widespread influenza outbreak in history.

But the 1918 virus, like all influenza viruses, like all viruses that form mutant swarms, mutated rapidly. There is a mathematical concept called 'reversion to the mean' this states simply that an extreme event is likely to be followed by a less extreme event. This is not a law, only a probability. The 1918 virus stood at an extreme; any mutations were more likely to make it less lethal than more lethal. In general, that is what happened. So just as it seemed that the virus would bring civilization to its knees, would do what the plagues of the Middle Ages had done, would remake the world, the virus mutated toward its mean, toward the behavior of most influenza viruses. As time went on, it became less lethal.

This first became apparent in army cantonments in the United States. Of the army's twenty largest cantonments, the first five attacked saw roughly 20 percent of all soldiers who caught influenza develop pneumonia. And 37.3 percent of the soldiers who developed pneumonia died. The worst numbers came from Camp Sherman in Ohio, which suffered the highest percentage of soldiers killed and was one of the first camps hit: 35.7 percent of influenza cases at Sherman developed pneumonia. And 61.3 percent of those pneumonia victims died. Sherman doctors carried a stigma for this, and the army investigated but found them as competent as elsewhere. They did all that was being done elsewhere. They were simply struck by a particularly lethal strain of the virus.

In the last five camps attacked, hit on average three weeks later, only 7.1 percent of influenza victims developed pneumonia. And only 17.8 percent of the soldiers who developed pneumonia died.

One alternative explanation to this improvement is that army doctors simply got better at preventing and treating pneumonia. But people of scientific and epidemiological accomplishment looked hard for any evidence of that. They found none. The army's chief investigator was George Soper, later handpicked by Welch to oversee the nation's first effort to coordinate a comprehensive program of cancer research. Soper reviewed all written reports and interviewed many medical officers. He concluded that the only effective measure used against influenza in any of the camps had been to isolate both individual influenza victims and, if necessary, entire commands that became infected: these efforts 'failed when and where they were carelessly applied' but 'did some good' . when and where they were rigidly carried out.' He found no evidence that anything else worked, that anything else affected the course of the disease, that anything else changed except the virus itself. The later the disease attacked, the less vicious the blow.