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The Spanish flu pandemic, a century on: 'Grief added to grief' in a world at war

Wikimedia/Otis Historical Archives National Museum of Health & Medicine | A hospital in Kansas during the Spanish flu epidemic in 1918.

A century ago this month, cataclysmic illness set upon a world already at war. Within months, the Spanish flu would claim at least 50 million lives. It remains today the most devastating pandemic in history.


In the spring of 1918, French newspapers relayed word of an epidemic in Spain. “The king is bedridden. He is believed to be suffering from an attack of the flu epidemic that has spread across the whole of Spain,” read the daily Le Figaro. “The flu epidemic continues to propagate. Today, around 120,000 are said to be ill in Madrid alone,” Le Matin reported. “All the Madrid newspapers provide great detail about a flu epidemic developing with incredible speed,” Le Gaulois added. The epidemic naturally took on the moniker “Spanish flu”.

Meanwhile, the scourge was taking hold, too, in France. The first cases were observed as early as April 1918, in particular among soldiers. But the French press kept mum. “We were in wartime. Information was censored in the warring countries,” recalls Anne Rasmussen, a scientific history professor at the University of Strasbourg. In Spain, however, a country neutral to the conflict, one could speak of the illness spreading. “So it was believed at first that the epidemic was in Spain alone and not elsewhere. In fact, the epidemic was Spanish in name alone,” the historian says.

50 to 100 million dead

Indeed, in March 1918, the very first sources of this flu – an H1N1 subtype of the influenza A virus, as in the 2009 epidemic – were observed an ocean away, in military training camps in the United States. In the space of a few weeks, the virus would spread and cross the Atlantic. It was disseminated in particular by the American Expeditionary Forces arriving to bolster the European front. “The war was a factor that favoured the spread of the virus because there was a lot of movement with troops, soldiers on leave and prisoners. The flu also affected populations that had been weakened by the conflict,” says Rasmussen. “But this epidemic also killed people in countries that were not at war.”

Within months, it had reached epidemic proportions. Beyond Europe, the rest of the world was impacted in three separate waves. “It went practically around the entire globe. Very few regions were spared. It even reached islands and remote zones. What characterised this flu was really its globalisation and its exceptional virulence,” Rasmussen says. The first assessments made after the war put deaths from flu at 21 million. That figure was later revised upward, to around 50 million. In the early 2000s, researchers Niall Johnson and Juergen Mueller even established a new toll of 100 million dead. “This last number appears exaggerated to me,” Rasmussen says. “It is difficult to count these dead since, while there were public health census systems in France and the United States at that time, that was not the case in Africa or Asia,” she explains.

A future pandemic?

The number of cases peaked in France in the autumn of 1918. French newspapers had begun relaying the news. “With the manifest and significant resurgence of flu cases among which some have grown serious due to bronchial-pulmonary complications, Monsieur Albert Favre, Undersecretary of the Interior, recently provided all prefects with instructions to effectively prevent or combat the illness of the day,” Le Temps reported in October.

France’s celebrities, too, were succumbing to the epidemic. The poet Guillaume Apollinaire was only 38 when he died on November 9. Edmond Rostand was 50 when flu claimed the Cyrano de Bergerac playwright on December 2. “An old cliché has it that the Spanish flu caused more deaths than the war. In France, that was not the case. There were an estimated 240,000 dead from the flu compared to 1.4 million killed during the conflict,” Rasmussen says. “But it is undeniable that with World War I ongoing, it was grief added to more grief.”

American soldiers suffering from Spanish Flu in a hospital in Aix-les-Bains, France, in 1918.
American soldiers suffering from Spanish Flu in a hospital in Aix-les-Bains, France, in 1918. Wikimedia/Uncredited US Army photographer

After the 1918 pandemic, unprecedented in scale, others would follow: one known as the Singapore flu in 1957; the Hong Kong flu in 1968; the so-called “swine flu” in 2009. The threat of a new virus as deadly as the Spanish flu still elicits a certain anxiety. “This fear of a new pandemic is nourished by the fact that populations are more and more mobile. We also know that the flu is a virus that is constantly mutating,” says Rasmussen. As a result, she explains, “There exists a fear about the arrival of a particularly virulent virus against which we wouldn’t have any real remedies.”

Today, however, monitoring tools are much more effective than they were a century ago, meaning public health authorities can take preventive measures to stem an epidemic’s sources. “We are also much better armed in terms of treatment,” Rasmussen adds. “We can fight flu-induced infections thanks to antibiotics, which was not the case in 1918.”

This article has been translated from the original in French.

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