One issue with the influenza outbreak was that it didn't look like others that practitioners had experience with. Barry explains:

Miner had seen influenza often. He diagnosed the disease as influenza. But he had never seen influenza like this. This was violent, rapid in its progress through the body, and sometimes lethal. This influenza killed. Soon dozens of his patients—the strongest, the healthiest, the most robust people in the county—were being struck down as suddenly as if they had been shot.

The doctor redirected his work to researching the disease that was killing his patients. He did everything he could to make progress but hadn't made much when the disease just went away. He reported it to a public health journal and his county, to this day, remains "the first outbreak in 1918 suggesting that a new influenza virus was adapting, violently, to man."

Later, Barry posits that someone from Haskell County, where Dr. Miner worked, brought the "influenza virus to Camp Fusion." He says that more than one thousand people were hospitalized at the camp within three weeks. The spread was being tracked to some extent but it still wasn't seen as a worldwide crisis.

The epidemic got so bad that people were dying in droves. Barry discusses how the medical personnel dealt with the situation, saying:

One nurse at Great Lakes would later be haunted by nightmares. The wards had forty-two beds; boys lying on the floor on stretchers waited for the boy on the bed to die. Every morning the ambulances arrived and stretcher bearers carried sick sailors in and bodies out. She remembered that at the peak of the epidemic the nurses wrapped more than one living patient in winding sheets and put toe tags on the boys’ left big toe. It saved time, and the nurses were utterly exhausted. The toe tags were shipping tags, listing the sailor’s name, rank, and hometown. She remembered bodies “stacked in the morgue from floor to ceiling like cord wood.” In her nightmares she wondered “what it would feel like to be that boy who was at the bottom of the cord wood in the morgue.”

It spread worse in crowded places like military bases or populated cities. Even as some officials tried to downplay it, the influenza virus took one life after another. Barry says that "the virus sickened tens of millions of people in the United States—in many cities more than half of all families had at least one victim ill with influenza; in San Antonio the virus made more than half the entire population ill—and hundreds of millions across the world."

Since officials wanted to ignore and minimize what was happening, steps that might have helped save people's lives weren't taken. For example, "any interruption in influenza’s spread could have had significant impact. For the virus was growing weaker over time. Simply delaying its arrival in a community or slowing its spread once there—just such minor successes—would have saved many, many thousands of lives." But the virus wasn't slowed in many cases—though future medical professionals and public health workers took cues from what happened with the influenza virus to help contain other strains and different diseases.