Deja Virus: The 1918 Spanish Flu’s striking parallels to the COVID-19 pandemic

Douglas TowneJune 24, 2020
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The 1918 Spanish influenza hit Arizona in four waves, shut down Phoenix twice and had striking parallels to the COVID-19 pandemic.

An invisible global killer covertly arrived in Arizona in 1918, leaving numerous fatalities in its wake. The lethal assassin was a virus like COVID-19, and would ultimately claim more Arizonans than World War I, which was then raging in Europe. The disease, Spanish influenza, was a beast that could kill otherwise healthy young people within hours of exhibiting symptoms, turning their skin bluish-black and drowning them in their own body fluids.

Despite Spanish influenza’s horrid toll, the effects of the pandemic in Arizona were largely unexamined for a century. Recent studies have resulted in dramatic new conclusions about the outbreak. “Much of what we thought we knew about the 1918 Spanish influenza in Arizona is wrong,” says Jacqueline Wernimont, distinguished chair of digital humanities and social engagement at Dartmouth College.

Known as “the mother of all pandemics,” the Spanish flu virus is proving philosophically instructive for people today. Anyone frustrated, angered or bemused by the current information wars waging around COVID-19 can take heart in the fact that researchers are still ironing out the details of a pandemic that ended 100 years ago. All drafts of history retain some of their roughness, even from 1918.

Spanish influenza, by conservative estimates, infected one-third of the world’s population and killed at least 50 million people, including 675,000 in the U.S. alone. People had little natural immunity to this virulent new influenza strain that induced blistering fevers, nasal hemorrhaging and severe respiratory distress – a phenomenon known as a “cytokine explosion” in which a victim’s immune system overreacts, creating fluid in the lungs, which makes them susceptible to pneumonia.

Arizona Governor George W P. Hunt, right, and Tax Commissioner C.M. Zander in flu masks, Circa 1918; Photo courtesy Arizona State University Archives
Arizona Governor George W P. Hunt, right, and Tax Commissioner C.M. Zander in flu masks, Circa 1918; Photo courtesy Arizona State University Archives

“While pandemics typically affect the very young and elderly, Spanish influenza was characterized by atypical mortality among young adults,” says Sushma Dahal, a doctoral student at Georgia State University, who published her research on the disease in 2018. “Another unusual feature was the rapid succession of pandemic waves.”

Spanish influenza first appeared in Arizona in April 1918, a few months after it struck the northeastern U.S. in February. The initial outbreak, called the “herald” wave, killed relatively few people. Miners in Southern Arizona, however, were hit hard, which caused ore production to plummet. Conspiracy theories attributed the sickness to poisoning by German sympathizers or eating “war bread” containing wheat substitutes, according to the Arizona Daily Star.

A second, deadlier wave of Spanish influenza engulfed Europe in the summer of 1918. A few months later, it walloped the East Coast and rolled westward. By then, the disease had mutated into an efficient killer, weakening victims’ lung functions, resulting in pneumonia. The outbreak attracted scant mention in the media because of wartime government censorship, except in neutral Spain. The country’s unrestricted coverage resulted in the pestilence’s name, “Spanish influenza.”

American newspapers detailed Allied battles against Germany in World War I and downplayed the pandemic threat for fear of being unpatriotic. This suppression proved deadly to a nation focused on winning a war. “The most vicious enemy was the germ, not the German,” wrote Arizona State University history professor Bradford Luckingham in his 1984 study, Epidemic in the Southwest 1918-1919.

Local public health officials hoped Phoenix would escape the worst effects of the Spanish influenza’s lethal second wave, citing the therapeutic value of its mild climate and the cleansing power of fresh air that residents enjoyed on their sleeping porches. The city of 28,000 residents advertised itself as a health haven, but in fact had conditions ripe for the disease’s COVID-like spread, via respiratory droplets inhaled or conveyed to faces by hands that had come into contact with the virus on an object. “Phoenix had some of the worst slums in the country, and the city was located in a poor state with high rates of tuberculosis deaths and infant mortality,” Dahal says.

A public flier spells out Yuma Quarantine regulations; Photo courtesy National Archives Catalog
A public flier spells out Yuma Quarantine regulations; Photo courtesy National Archives Catalog

The second wave of Spanish influenza arrived in Arizona in late September. Public health officials promoted hand washing and avoiding symptomatic individuals and discouraged kissing, which “must not be indulged in either on the lips or the hand,” per The Arizona Republican. By early October, public gatherings in Phoenix were banned, and schools, theaters and dance halls were closed by municipal decree. Phoenix Union High School football games and the Arizona State Fair were postponed.

Roadblocks were erected on routes leading into Phoenix to limit visitors. Mail-order shopping was encouraged, and businesses were encouraged to provide 1,200 cubic feet of air space for each customer, considerably more than the recommended 6 feet of social distancing for COVID-19. Placards were posted on homes of those infected with the disease. Despite efforts to contain the public health crisis, infections spiked.

Patients filled St. Joseph’s Hospital and Arizona Deaconess Hospital, now called Banner-University Medical Center. Additional infected victims were taken to the Phoenix Women’s Club, which had been converted into an emergency hospital. The Women’s Club was staffed by Red Cross women led by Hattie Josephine Williams, Barry Goldwater’s mother. The emergency hospital became overrun with patients, and two tents were erected in an adjacent lot, adding 40 beds. But it still wasn’t enough. “Many died at home, and the doctors and mortuaries were under enormous stress due to volume at the peak,” Wernimont says.

Masked police in Seattle, underscoring the nationwide effect; Photo courtesy Douglas C. Towne
Masked police in Seattle, underscoring the nationwide effect; Photo courtesy Douglas C. Towne

By early November, 970 Phoenicians had contracted Spanish influenza during the second wave, with 54 deaths. Fear gripped residents, including Pancho Moreno, a patient at the Women’s Club hospital who fled in terror in his nightgown because of the deaths around him. Guards thought the farmworker was a hospitalized prisoner and fired several errant shots at him. Three days later, Moreno was found and readmitted to the hospital, only to die shortly afterward.

There was no cure for the virus, but this didn’t halt a desperate public from obtaining quack remedies. These ranged from receiving useless vaccines to drugstores selling dubious preventive measures, including Spanish influenza spray, atomizer and Germo concoctions.

The most popular treatment, however, was bootleg liquor that had been seized by the Maricopa County sheriff. Arizona had enacted Prohibition in 1914, six years before it became federal law, and 10,000 pints of confiscated whiskey were stored at the sheriff’s office. Some of this bootleg liquor may have been as toxic as the quack remedies suggested for COVID-19, including chloroquine phosphate, a popular fish tank additive that has the same active ingredient as an antimalarial drug, or household disinfectants such as bleach.

Dr. Orville Harry Brown, the state superintendent of public health, declared that liquor had medicinal properties in combating Spanish influenza, a proclamation that trumped Prohibition. “I will not hesitate in issuing it upon presentation of a doctor’s certificate,” Sheriff W.H. Wilky told The Phoenix Gazette. The sheriff, however, warned the reporter that he “hadn’t better write anything about that or we’ll be so swamped with inquiries and demands that it will take a small army to maintain order at our office.” Within a few weeks, “sick” residents claiming to be “almost dead from influenza,” had exhausted the sheriff’s liquor supply.

The armistice that ended World War I on November 11, 1918, resulted in “a parade a mile long” through Phoenix. The spontaneous patriotic gathering only fueled the contagion. A week later, Spanish influenza totals bumped up to 1,620 cases and 88 deaths.

As the second wave of the virus continued spreading in Phoenix, signs were posted that warned, “Coughs and Sneezes Spread Diseases as Dangerous as Poison Gas Shells.” An ordinance required city residents to wear masks in public starting on November 25. A local jingle publicized the difficulty of recognizing friends:

“Owing to the cussed ‘flu,’

If you want to know who’s who,

You will have to ask,

‘Who is that behind the mask?’”

Phoenix became “a city of masked faces, a city as grotesque as a masked carnival,” according to The Arizona Republican. Some masks were of dubious value, with holes made for cigarettes, cigars and pipes. Creative seamstresses personalized masks by adding a symbol of their notion of an influenza germ, such as a little red devil.

By mid-December, the outbreak was in decline in Phoenix, and the city attempted to return to normal for the holidays. “We are going to open, and we are going to open with a bang,” a theater owner told the Republican. “The people of Phoenix are hungry for amusement.” Capacity crowds turned out for opening nights at the movies. Churches threw open their doors, with clergymen reminding their faithful to “bring what you would have given these weeks, and we will recover from our financial loss much sooner.”

Phoenicians were still celebrating the end of the second wave of the pandemic when a third wave struck. The critics who believed reopening was premature were correct, as Christmas shopping and socializing added to the disease’s spread. On New Year’s Day, 1919, 101 new Spanish influenza cases were reported in Phoenix as the pandemic’s third wave hit. Five days later, Phoenix was again shut down, becoming one of the few American cities, including Denver and San Francisco, to require two closings. By January 10, active cases spiked to 712, breaking the previous single-day plateau of 634 infections set in October.

The infections were likely much higher, since more than one-third of the Valley’s population lived outside city limits, including poor neighborhoods south of Downtown where the disease was widespread due to the lack of potable water and crowded conditions in substandard housing. Patients filled hospitals once again. Despite the closure order, the Strand and Columbia theaters in Downtown Phoenix reopened, and their owners were arrested and fined. Fortunately, the third wave petered out in a few weeks. The fourth wave that occurred in the winter of 1920 was less lethal and of short duration.

As profound as the devastation was, Phoenix was spared the absolute worst that Spanish flu had to offer.

“Spanish influenza hit El Paso harder than any other major urban center in the region,” Luckingham wrote. These cities included Albuquerque, Tucson and Phoenix, which was the only one of the three cities hit twice.

Like the current pandemic, the Spanish flu exposed and exploited social divisions. During Phoenix’s second shutdown, for instance, cooperation between the public and private sectors declined, according to Luckingham, and there were fewer volunteers available to help fight the outbreak. Moreover, business owners resisted and challenged government regulations and were successful in getting some of them removed by court action. The disease eventually burned itself out because higher immunity levels created fewer hosts for the virus.

The Arizona State Board of Health reported 519 influenza-related deaths in 1918. Wernimont’s research, conducted when she was a professor at ASU in 2017, confirmed a much higher death toll. “Reviewing death certificates, we found there were 2,228 victims, but there were likely an estimated 6,000 Arizonans who died in the pandemic in 1918 alone,” she says. “The higher numbers are linked to the underreporting of Native American deaths, and to those who were listed as having pneumonia as the primary cause of death, with influenza secondary.”

She attributes the discrepancy to Arizona lacking the infrastructure to standardize reporting. Wernimont’s research also found mortality peaks associated with miners and farmworkers. According to census data, there were 334,000 people in Arizona in 1920, so 6,000 deaths meant an overall death rate of 1.7 percent, the equivalent of about 119,000 people today.

“Spanish influenza was more lethal in Arizona than most areas of the U.S.,” Dahal says. The epidemiologist indicates that the higher mortality was related to the state’s population, which included many inflicted with tuberculosis, crowded conditions in mines and Native Americans with limited access to health care. “The virus disproportionately affected lower socioeconomic groups,” she says.

But the most unnerving revelation Dahal uncovered about Spanish influenza? “It’s to realize how little we understand about this major pandemic,” she says. The contagion was overshadowed by or became an extension of the carnage of World War I. Future research was hindered by news censorship and poor record keeping. The most virulent infectious disease since the medieval Black Death became largely forgotten.

While local World War I heroes like Frank Luke Jr., an American fighter ace killed in France, were celebrated with monuments at the Arizona State Capitol, there are no memorials for the valiant medical workers or victims of Spanish influenza. “In the cities of the Southwest, most people preferred to remember World War I and victory, rather than the days of disease and defeat,” Luckingham writes.

The Spanish influenza, however, provided a legacy much more important than any statue or commemoration. The pandemic gave rise to Arizona’s modern public health and health care systems, both staffed by workers who are heroically holding the line during the current COVID-19 pandemic.

Photo courtesy Getty Images
Photo courtesy Getty Images
Other Arizona Disasters
1890: Walnut Grove Dam Failure

The dam was built by a private New York company on the Hassayampa River 60 miles upstream of Wickenburg in 1887. Three years later, heavy runoff caused the dam to fail. Its 2-mile-long lake emptied suddenly, creating 100-foot-high flood waters. There were 83 bodies recovered, some as far downstream as Yuma, but the death toll was likely higher. The dam was never rebuilt.

1956: Grand Canyon AirlineR Collision

A United Airlines Douglas DC-7 and a Trans World Airlines Lockheed L-1049 Super Constellation collided in partly cloudy skies over the Grand Canyon, killing all 128 onboard (rendered above). Both aircraft had departed from Los Angeles and were flying in uncontrolled airspace. The accident precipitated the creation of the Federal Aviation Agency in 1958 to modernize airspace control.

1970: Pioneer Hotel Fire

A fire on the Tucson hotel’s fourth floor quickly spread to the top of the 11-floor building, which was built in 1930 and lacked smoke detectors and sprinklers. The inferno killed 29 people, including three who leaped from windows. Louis Taylor served 42 years for arson before being released after the case was reopened in 2013. Offices and apartments now occupy the building.