Prologue

Gina Kolata opens Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It with a riddle: Why is her knowledge of the deadly 1918 “Spanish Flu” sketchy, even though she studied microbiology and virology in college and has written on science and medicine for publications such as the New York Times? Kolata’s puzzlement deepens when she considers that the 1918 pandemic killed more people in the US in a single year than World War I, World War II, the Korean War, and the Vietnam War combined.

Kolata states that she is not alone in her ignorance of the 1918 pandemic. Despite its deathly sweep, the disease has been overlooked by history for some reason. Kolata’s own interest in the pandemic is piqued when she comes across an article in Science that explores the first attempts to resurrect the virus’s genetic code. Written by scientist Dr. Jeffery Taubenberger, the paper sends Kolata on the heels of “one of the worst killers known” in history: the 1918 influenza virus.

Chapter 1: The Plague Year

The flu that arrived suddenly in the US in the fall of 1918 sickened many, especially the young and the healthy. It started with a headache and shivering, and soon wore down the patient. Within a few days, some began to cough up blood; many died gasping for breath. An autopsy almost always revealed lungs “lying heavy and sodden” in the chest, full of fluid. By 1919, the plague had left between twenty and one hundred million dead globally.

One of the most unusual aspects of the disease is that it particularly targeted the young and healthy, those between twenty and forty years of age. Yet despite its devastating effect, the pandemic has been tucked away in memory. Perhaps this is because people conflated it with the horrors of World War I and wanted to forget about it, according to Alfred W. Crosby, a historian of the 1918 flu.

The flu struck in two waves. The first wave, initially noted in the spring of 1918 in the Spanish seaside resort of San Sebastian (hence the name “Spanish flu”) was benign and vanished with the summer. But soon, it was “back with a vengeance.” In the US, the second wave arrived in August 1918, with sailors docked at the Commonwealth Pier in Boston. On August 28, eight of the sailors had the flu. The next day, fifty-eight did. Soon, the flu entered the civilian population, and the first three deaths occurred on September 3. On the same day, the flu also reared its head in Fort Devens, Massachusetts, thirty miles from Boston. Soon, it had spread like wildfire across the United States.

Death from the flu was observed in meticulous detail by the novelist Tom Wolfe, who watched Ben, his twenty-six-year-old brother, struggle from the disease. In a fictionalized account of the event, Wolfe described the characteristic red spots on his brother’s cheeks—a sign of oxygen deprivation—and his “rapid, unbelievable” gasps for breath. As Ben’s condition worsened, his breathing eased, and delirium set in. He finally sunk into unconsciousness, his eyes almost closed. As Wolfe prayed for him, Ben drew his last, feeble breath.

In 1918, nothing much could be done for patients like Ben. No one knew how to treat the flu or pump oxygen into sodden lungs. The influenza virus had not yet been isolated. Although scientists knew about viruses in 1918, no one had ever seen one, as the electron microscope had yet to be discovered. Even now, influenza is largely untreatable, though scientists have known for decades that the flu virus is made of eight simple strands of RNA. Scientists may be able to recognize the egg-shaped appearance of the flu virus, but they still cannot eliminate it.

The best way to tackle an influenza pandemic is through vaccines. For a long time, there was no headway on the vaccine front, because the 1918 flu virus was assumed to have disappeared with its victims. Since lung tissue, where the virus lodges, is soft, chances of the virus surviving in corpses was thought to be extremely low.

However, “nothing about the 1918 flu was ordinary.” As it turns out, three people among the millions of victims held the secrets of the virus in their lungs; these secrets were to be discovered eighty years later. The three are twenty-one-year-old Army Private Roscoe Vaughan, who died of the flu in Camp Jackson, South Carolina; thirty-year-old Private Downs, who passed away in Camp Upton, New York; and a woman from a remote Eskimo village near Brevig, Alaska. But before unraveling the story that connects the three, Kolata takes a detour into the history of pandemics.

Chapter 2: A History of Disease and Death

Infectious diseases are inextricably linked with human history. In 431 BCE, the philosopher Thucydides chronicled an unprecedented sickness that ravaged Athens. Unlike any other illness, this epidemic raged for over a year, killing so many it seemed “truly a work of wrathful gods.”

Until the twentieth century, periodic epidemics—such as the one that struck Athens in 431 BCE—had been the norm, periodically diminishing entire populations. With diseases such as tuberculosis rampant in cities, it was not until 1900 that a large city like London could maintain its population “without large influxes of migrants.”

However, no plague in history had been as devastating as the one that occurred a millennium after the Athenian epidemic. Called the Black Death, historians say that it began in China in 1331 and landed in Europe by 1346. Its sufferers at the time did not know this, but the Black Death was caused by the bacteria Yersinia pestis, which is found in fleas living in the fur of rats. As rats moved from port to port, so did the fleas, biting and infecting people. What made the Black Death so widespread, though, is that fleas were not the only mode of infection. Once infected, a person could infect others with their cough and other bodily secretions. Between 1347 and 1351, the Black Death wiped out as much as a third of the population of Europe. The plague disappeared four years after it began, perhaps having killed all it could.

In 1831, cholera swept England, the first of six waves of cholera that left 140,000 dead. When the epidemic finally waned, it was almost immediately committed to public amnesia. The only lasting effect the 1831 cholera epidemic had, according to British historian R. J. Morris, is that it spurred public health researchers to take drastic measures, such as cleaning up a city’s water supply, to improve health and living conditions.

In 1833, Robert Koch, one of the founders of the germ theory of disease, visited Egypt to investigate a raging cholera epidemic set to spill over into Europe. There, he identified the lozenge-shaped Vibrio cholerae. As the knowledge that many diseases are spread from microorganisms spread, “the Western world was transformed.” A vigorous public health movement was soon underway. With these measures, deadly diseases (such as cholera and tuberculosis) that had plagued Europe for centuries began to lose their bite. People in the early years of the twentieth century started to view epidemics as a “thing of the past.”

Tragically, it was at this juncture that the 1918 flu arrived. According to Crosby, this may be one reason why the 1918 flu is left out of history textbooks of the time. Since the flu disturbed the feeling of invincibility that pervaded the early twentieth century, public memory was keen to return to that idyllic state.

The world may forget, but one group of people remain “haunted by the flu”: the scientists and medical researchers who wanted to know where the plague came from—and how to stop it if it comes again.