For many of us, the flu is a seasonal nuisance that emerges each year as the days grow shorter and people huddle indoors — annoying but not truly threatening.
A century ago, however, the flu was much more than a minor inconvenience. This year marks the 100th anniversary of the deadly 1918 influenza pandemic, also known as the Spanish flu, which infected half a billion people (one-third of the world's population at the time) and killed at least 50 million.
This pandemic was so lethal that it took more lives than all the combined military deaths of World War I and World War II, and life expectancy in the United States fell by about 12 years from 1917 to 1918.
Where did the Spanish flu come from?
A century later, we know much more about influenza pathology and prevention. But scientists are still trying to pin down exactly where the 1918 flu pandemic started and why mortality rates were so high.
Although it was called the Spanish flu, experts believe it didn't start in Spain. This nickname was likely a side effect of World War I, which was also afflicting the globe at the time. Most major countries engaged in battle suppressed reports of influenza's devastation to avoid appearing as weakened targets to their enemies.
But neutral Spain had no reason to hide the effects of the virus, creating the false impression that its population suffered from the pandemic earlier and more intensely than the rest of the world.
In reality, the pandemic ravaged nearly every area on Earth — from Japan to Australia to South Africa — though some countries fared better than others. China, while affected, experienced significantly lower mortality rates than the United States and Britain. Yet an estimated 17 million died in India while 14 percent of the population died in the Fiji Islands in only 16 days.
Experts don't yet agree where the first outbreak occurred. Many studies point to an origin in the United States, yet other scientists suggest China and some France. But there is general consensus that the H1N1 virus that caused the pandemic likely emerged from a bird virus.
Spanish flu in Utah
Like the rest of the world, Utah could not escape the 1918 influenza. Globally, the pandemic occurred in three major waves during the spring, fall and winter of 1918, with the third wave finally subsiding by the summer of 1919. The first signs of outbreak in Utah were reported in the beginning of October 1918.
According to historian Leonard Arrington, Utah state health officer Dr. T.B. Beatty acted quickly on Oct. 10, issuing a ban on all public gatherings, including church meetings and theater shows, and directing schools to close (which they did, with most remaining closed until January 1919).
Despite these measures, the virus tore through Salt Lake City, likely due to its larger population and frequent visitors, Arrington notes. By early November, more than 1,500 cases were documented there and 117 people had died.
Most other communities throughout Utah also felt the pandemic's impact. In Ogden, 2,626 influenza cases and 73 deaths were reported by Oct. 26. An Oct. 30 Desert Evening News headline stated that "Every county now reports influenza," though the article insisted health officials remained optimistic so long as Utahns adhered to the board of health's guidelines.
Prevention and treatment
In addition to Beatty's ban on public gatherings, the Utah State Board of Health took out an advertisement in the Deseret News urging Utahns to avoid public transportation, crowded places and "common towels." They also advised frequent handwashing, plenty of rest and staying home as soon as any illness struck, no matter how slight.
Utahns were also instructed to wear gauze masks in public and around those who were sick. Homes with influenza victims had to display quarantine signs. Park City and Ogden tried to keep the disease out by requiring people who entered the cities to present signed doctor's certificates indicating they weren't infected.
Moreover, stores weren't allowed to hold sales and funeral services were limited to a half hour (and later 15 minutes). The November 1918 funeral of Joseph Fielding Smith, Latter-day Saint church president, was restricted to only a few close family members.
At this time, very little was known about what caused the influenza virus and how it spread.
"There were no vaccines to protect against flu virus infection, no antiviral drugs to treat flu illness, and no antibiotics to treat secondary bacterial infections like pneumonia," according to the Centers of Disease Control and Prevention.
Scientists and doctors also had very little understanding about what made the 1918 virus so virulent. Not only did it spread quickly, it also — quite alarmingly — often killed otherwise healthy young adults. Typically, small children and older adults are the groups most likely to die from influenza.
Today, scientists theorize that the inflammatory immune response the Spanish flu triggered in the lungs was likely more robust in healthy young people, leading to more fluid buildup and a higher likelihood of deadly pneumonia for this age group.
Because the virus affected both the upper respiratory tract and deep within the lungs, coughing and congestion were common side effects, along with more severe (and often fatal) symptoms. These included blue-tinged faces from lack of oxygen accompanied by lung hemorrhages and infections that literally caused victims to drown in their own fluids.
Lacking modern medicine, doctors prescribed liquids, hot compresses to ease chest congestion and alcohol (even in dry Utah). With so many infected, hospitals quickly filled and staff ran short. To keep up with growing demand, impromptu infirmaries were set up in Utah church buildings and teachers whose schools were closed served as volunteer nurses.
A sobering toll
After many long months, the number of reported influenza cases eventually began to ease up. Though a massive Salt Lake City Armistice Day celebration on Nov. 11, 1918, led to a predictable outbreak, by December many public spaces in the state began reopening. The epidemic greatly diminished in the spring and summer of 1919 and by the spring of 1920, the last of the Spanish flu finally left Utah.
After the pandemic had run its course, at least 91,799 Utahns had been infected and 2,915 had died, though Arrington points out that these reported numbers likely grossly underestimate the true breadth of the disease.
Experts aren't sure what caused the Spanish flu's end, though many speculate the virus eventually mutated into a less lethal strain.
Could a deadly influenza pandemic happen again? It's certainly possible, scientists say. A new influenza virus could emerge that humans have no previous resistance to, which is likely what happened in 1918.
Fortunately, we are better equipped to face a deadly virus than we were 100 years ago and could possibly develop a vaccine quickly enough to stave off a pandemic. But there is still so much about the 1918 flu and influenza in general we don't yet understand.
As Anne Schuchat, deputy director of the Centers for Disease Control and Prevention, said at a seminar on the Spanish flu, "We have many more tools than we had before, but they are imperfect tools."