The deadly flu pandemic of 1918, which began in the United States and ended up killing upwards of 60 million people and infecting about 500 million – about a third of the world’s population — caught the world off guard and set off a literally life-and-death struggle to stop it.

In 1918, much of the world – particularly, the United States – was ignorant of the importance of basic science, although Europeans had made better progress. Even simple “observation of facts,” the basis of “positive knowledge,” was, in the words of the German scientist Rudolf Virchow, only rudimentary from a procedural standpoint but not widely followed.

The few American medical schools in existence at the time were light years away from the advanced coursework and residencies required to license doctors today; some schools barely required any coursework at all. Ideas promulgated 2,000 years earlier by Hippocrates and Galen, such as treating disease by bleeding the patient, were still in use.

Even inoculation was resisted for centuries in the United States, despite encouraging progress in Europe. Here again, unfounded religious objections played a key role.

John M. Barry provides a good example of this resistance to facts in his granular history of the 1918 epidemic, “The Great Influenza”: “First introduced in America during the Boston small pox epidemic of 1721, the practice of inoculation was legally restricted in New England (based on) uncertainties and a theological conviction, as the historian Elizabeth A. Fenn would write, that it displayed ‘a distrust of God’s overruling care.’ ” That reliance on a deity persists to this very day, particularly in some religious quarters, attesting to the difficulty of uprooting and eliminating fantasy.

The great irony of the current viral crisis is that, in 1918, we were still hobbled by non-science-based concepts in medicine and now most of us aren’t, and yet the disease is only spreading in the world’s most advanced nation.     

Today, among evangelical and some other groups, resistance to scientific advancement and scientific knowledge in general continues and has an ostensible friend in the White House. Among these groups is QAnon, which, through its widespread internet presence, promotes beliefs that, as reported by Adrienne LaFrance in an lengthy analysis in The Atlantic magazine, “the coronavirus might not be real; that if it was, it had been created by the ‘deep state,’ the (alleged) star chamber of government officials and other elite figures who secretly run the world; that the hysteria surrounding the pandemic was part of a plot to hurt Trump’s reelection chances; and that media elites were cheering the death toll.

“Some of these ideas would make their way onto Fox News and into the president’s public utterances. As of late last year, according to The New York Times, Trump had retweeted accounts often focused on conspiracy theories, including those of QAnon, on at least 145 occasions,” LaFrance writes.

The president exploits these bogus theories and unproven, usually disputed medical claims to justify his non-interference in the pandemic.

The 1918 flu pandemic began in the same month – March – as the 2020 pandemic. Some people, as now, were slow to acknowledge it, largely due to World War I.

“Indeed, by then, the bodies of more than five million soldiers had already been fed into what was called ‘the sausage factory’ by generals whose stupidity was only exceeded by their brutality,” Barry recounts.

The war, ironically, proved to be both bane and blessing for the scientific community.

Its previously unknown levels of cruelty, death, and seemingly mindless killings led to a prediction by the English physician, journalist, and sci-fi author H.G. Wells – known today mainly for the cinematic versions of “War of the Worlds,” “The Invisible Man,” and “The Time Machine” – that it “would be ‘the war that will end wars.’ “

At the same time, this plentiful bounty of death became, Barry writes, “the first truly scientific war, the first war that matched engineers and their abilities to build not just artillery but submarines and airplanes and tanks, the first war that matched laboratories of chemists and physiologists devising or trying to counteract the most lethal poison gas.”

To reach this new knowledge plateau, widespread ignorance, political opposition in the United States, and what LaFrance calls a “mass rejection of reason, objectivity, and other Enlightenment values” had to be overcome.

The surgeon general of the Army, William Crawford Gorgas, son of a former Confederate officer, played a key role here. But first he had to overcome not just resistance in general society, especially among religious organizations and their political supporters, but also within the Army. “On no subject where he had only science behind him, science without political weight, could he get even a hearing from army superiors,” Barry writes.

When the pandemic fizzled out, despite the number of deaths, society seemed simply relieved that it was over and proved very slow to deal with it.    The first history would not be published for almost three-quarters of a century. The arts, a mostly irreplaceable store of memory, set it aside.

Why? Barry writes: “People write about war. They write about the Holocaust. They write about horrors that people inflict on people. Apparently, they forget the horrors that nature inflicts on people, the horrors that make humans least significant.”

Some of the most prominent authors of the time – Ernest Hemingway, F. Scott Fitzgerald, John Dos Passos, and Mary McCarthy, among others – never mentioned it in their writings. Flappers and old fishermen got better treatment.

The president of the United States, Democrat Woodrow Wilson, was pretty much a non-factor in the reaction to the virus, except that a year later, in 1919, Wilson, a political scientist and former president of Princeton University, caught the flu while negotiating the terms of German surrender in Paris. One theory — never proven — holds that he was exhausted by the illness and did not, therefore, press for a better settlement that might have helped prevent the recurrence of world war 10 years later.

One positive current development is the internet, which has made everyone an author, so no shortage of commentary or analysis, which the next generation can use when another pandemic erupts, has occurred.

Today’s pandemic repeats much of what occurred in 1918, when, for example, it occurred in waves beginning in the same month of the year. “The first spring wave killed few, but the second wave would be lethal,” Barry writes.

Progress in stopping the flu pandemic was, in addition to religiously-based opposition to treatments, also based on incorrect diagnoses – specifically, the confusion among flu, pneumonia, and other conditions that may have somewhat similar symptoms. The situation required some serious scientific thinking, free of irrelevant and unfounded religious and political objections.

Today, a similar contest is afoot between Trump and scientific experts, such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, whose name now adorns t-shirts and coffee mugs. Another commentator called the parallels between the 1918 and 2020 pandemics “eerie.”

“Clearly, we have not succeeded in getting the public as a whole uniformly to respond in a way that is a sound scientific [response to a] public health and medical situation,” Dr. Anthony Fauci told CBS News. “I mean it is clear because right now, you’re seeing people throughout the country [contracting the virus]. And it’s unfortunate. And it’s frustrating. …

“It’s the kind of mistrust of science because science is viewed as authority,” Fauci said. “And there’s a lot of anti-authority feeling. I think that’s the kind of thing that drives the anti-vaxxers, the people who don’t believe the science of vaccination and don’t want to get their children vaccinated. It’s all part of that trend, which is very disturbing.”

Transmission of the flu in 1918 occurred via similar forms of transportation. Steamships were a common carrier, especially those carrying U.S. troops to Europe. Today, airplanes and ships of various kinds, including naval vessels and cruise ships, provide similar transmission methods. This seems to have been one of the few lessons learned, resulting in restrictions in air and sea travel.

“Nearly 40 percent of the two million Americans troops who arrived in France (in 1918) – 791,000 men – disembarked at Brest, a deepwater (French) port capable of handling dozens of ships simultaneously.” Many of these men carried the flu virus with them.

In France, by July, the first outbreak occurred in a detachment brought from Camp Pike in Arkansas. “By August 10, the same day the British army declared the influenza epidemic over, so many French sailors stationed at Brest were hospitalized with influenza and pneumonia that they overwhelmed the naval hospital there – forcing it to close.”

Just as in 1918, some people reject the idea that COVID-19 can kill, despite repeated, informed, science-based assertions to that effect by experts in infectious diseases and by the record itself. By July 2020, the disease had killed more than 450,000 people worldwide, including 130,000 Americans, a significant number of which were people under the age of 40. As of this writing, with some states trying to “reopen” their economies – allowing bars and restaurants, for example, to accept indoor customers – the number of infected young people is rising.

As we await the opening of schools in the fall of 2020, it should be remembered that the second wave of the 1918 flu pandemic, already similar to the current pandemic in many respects, struck with previously unfelt force in September, when students usually return to classrooms. Barry called it an “explosion.”

Irresponsible thinking and leadership worsened the impact.

Physicians and public health experts, for example, urged Philadelphia to cancel a huge patriotic parade because “influenza was a disease,” like COVID-19, that is “spread in crowds.” The parade, stretching two miles through the city, was allowed to proceed anyway, with “bands, flags, Boy Scouts, women’s auxiliaries, marines, sailors, and soldiers” and “several hundred thousand” onlookers, Barry writes.

Shortly after the incubation period of 24 to 72 hours, officials were forced to admit the virus, previously confined mostly to military personnel, was “now present in the civilian population” and that the flu “was indeed exploding in the city,” Barry writes. This was despite the presence of five medical schools and the early pre-graduation assignment of aspiring physicians to the anti-flu effort. New York took similar steps earlier this year.

Then, as today, city life almost ground to a half.

“Federal, municipal, and state courts closed. Giant placards everywhere warned the public to avoid crowds and use handkerchiefs when sneezing or coughing. Other placards read, ‘Spitting equals death.’ ”

Then, just as now, front-line workers bore the brunt of the disease. “Undertakers, themselves sick, were overwhelmed. They had no place to put bodies. Grave diggers either were sick or refused to bury influenza victims. … Then undertakers ran short of coffins.” They had to hire guards to protect their caskets from thieves.

“The symptoms terrified a Boy Scout delivering food to an incapacitated family; they terrified a policeman who entered an apartment to find a tenant dead or dying; they terrified a man who volunteered his car as an ambulance,” Barry writes.

At the same time, Army camps and their medical facilities were already “overwhelmed” by the flu. The Army cancelled a scheduled draft call. Governors then, just as now, pleaded for doctors and nurses to come help them.

Undeterred by religious and political foolishness, a small but dedicated band of physicians and researchers persisted. One of them came up with a novel but effective idea: have respiratory patients wear masks. William Henry Welch, a leader in this effort, called them “an important contribution to the prevention of spray infections” and should be adopted as a “routine measure” — just as Americans are being constantly reminded today.

Despite this, and numerous other efforts to break the flu pandemic, the death toll kept rising – just as it continues to increase today as states like Texas and Georgia, irresponsibly reopened their economies. Some, like Texas, have been forced to reverse course.

By September 1918, “the virus had spanned the country, establishing itself on the Atlantic, in the Gulf, on the Pacific, on the Great Lakes,” Barry writes. It “followed rail and river into the interior of the continent, from New Orleans up the Mississippi River into the body of the nation, from Seattle to the East, from the Great Lakes (naval) training station to Chicago and from there along the railroad lines in many directions.”

Ultimately, the pandemic accounted for nearly half of all deaths in the United States. While the elderly were especially vulnerable, just as they are to COVID-19 today, the flu also killed “the young and strong.” The corona death count among individuals under 40 has, in recent days, been rising.

“In the American military alone, influenza-related deaths totaled just over the number of Americans killed in combat in Vietnam,” Barry writes. “One in every 67 soldiers in the army died of influenza and its complications.” The current increasing death toll from coronavirus is almost three times American casualties in Vietnam and well over U.S. losses in World War I.

By October 1918, the epidemic began to fall “to manageable proportions” in the United States. A national commission was formed to study it. The next month, the American Public Health Association created a Committee on Statistical Study of the Influenza Epidemic. That was nine months into the epidemic. The American Medical Association, American Public Health Association, army, navy, Public Health Service and Metropolitan Life Insurance Company all launched studies.

Today, a task force appointed by Trump under the leadership of Vice President Mike Pence seems to have largely waived its responsibilities by not taking any serious national steps, although Fauci has urged individuals and groups to take steps such as isolation, washing hands, and wearing masks; some states have even dropped the accumulation of statistical data.

The 1918 studies, however, did give us useful information. They told us flu is transmitted via air, surfaces, or large congregations of people. “The only way to avoid it is to completely isolate oneself from society for the six to ten weeks it takes an outbreak to burn through a community, including not accepting deliveries, not going out, and so forth,” Barry writes.

In the face of an epidemic, then, we are left with limited choices as individuals, including hand-washing, wearing masks, keeping sick children home, and closing schools. “Discipline matters,” Barry writes.

The state of New York has demonstrated that these simple, commonsense steps work. But, on a broader level, knowledge and leadership also matter.

“The biggest problem lies in the relationship between governments and the truth,” Barry writes. “Part of that relationship requires political leaders to understand the truth – and to be able to handle the truth.”

Clearly, this is Trump’s chief failing, and not just in this particular policy area. “The political leadership factor is the weakness in any plan,” Barry writes.

“In times of crisis, citizens look at their leader: presidents and mayors, local politicians and elected administrators, public managers and top civil servants,” write political scientists Boin, t’ Hart, and Sundelius. “We expect these policy makers to avert the threat or at least minimize the damage of the crisis at hand.”

Historic and even recent examples are numerous. Reactions to the current viral crisis in New Zealand, South Korea, and Japan show what positive leadership can achieve in this respect.

The steps taken by Prime Minister Jacinda Ardem of New Zealand, which claims to have eliminated the corona virus, are a good example. These include, as reported by Nadeem Khan of Counter Currents, the following: recognition, decisiveness, communication, visible action, and an apolitical approach.

Now, as the death toll from coronavirus continues to rise – and rise much more rapidly than it did when the crisis began in March in the United States – polls show a substantial majority of U.S. citizens, uncertain as to where all of this is leading, believe the Trump administration has failed to act responsibly.

In the end, Barry writes, “the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself.”

ADDITIONAL SOURCES DRAWN ON FOR THIS ESSAY

The Great Influenza: The Story of the Deadliest Pandemic in History

John M. Barry

Penguin Books (2004)

Pandemics

Jeffrey Brown

PBS Newshour (June 22, 2020)

“We Are The Mighty”

Eric Milzarski

Wearethemighty.com (Nov. 5, 2018)

“History of Influenza”

Centers for Disease Control and Prevention (cdc.gov)

“Fauci: Americans ignoring science during pandemic is ‘frustrating’ ”

Grace Segers

CBS News (June 19, 2020)

The Politics of Crisis Management: Public Leadership Under Pressure

Arjen Boin, Paul ‘t Hart, Eric Stern and Bengt Sudelius

Cambridge University Press (2017)

“Covid-19: What makes a good leader during a crisis?”

David Robson

British Broadcasting Corporation (March 27, 2020)

“Jacindaism: The New Doctrine of Political Leadership During Crisis”

Nadeem Khan

Counter Currents (May 24, 2020)

“Nothing Can Stop What Is Coming”

Adrienne LaFrance

The Atlantic (June 2020)

“Woodrow Wilson’s Case of the Flu and How Pandemics Change History”

Steve Coll

The New Yorker (April 17, 2020)

Michael E. Norris, PhD, is the founder and editor of Between the Coasts. Contact him at mikenorris2013@hotmail.com.