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Today is Armistice Day Armistice Day which marks the armistice signed on the eleventh hour of the eleventh day of the eleventh month in 1918 between the Allies of World War I and Germany to end World War I – the “war to end all wars.” It is also known as Remembrance Day and Veterans Day.

But 1918 was also the year of another kind of worldwide war against the Spanish influenza pandemic. There is no special day to mark this and I doubt that many Americans today know about it or think about it. You may have gone last month for your flu shot, but never thought about the fact that October 1918 was the deadliest month in United States history. 195,000 Americans died in that one month as a result of influenza.

Influenza ward at Walter Reed Hospital in Washington DC, 1918

By the time the pandemic had run its course, an estimated 500,000 Americans had died of the flu. It is hard to grasp that number. It is more deaths than the American combat fatalities in all the wars of the 20th century combined. And worldwide, the flu may have claimed as many as 100 million lives.

My mother was born in December of that year and it was feared that she or her mother might get the flu. The start of that flu season was in March with the first recorded case being a mess cook in Fort Riley, Kansas. There are still several hypotheses about how and where the flu pandemic began and no conclusive answer.

Though it became known as the “Spanish flu,” it did not originate in Spain. Spain seemed at the time to be particularly hard hit by the virus. I say “seemed” because the Spanish media covered it extensively, but the United States, the UK, France, and Germany deliberately underplayed the virus’ effect in hopes of keeping up wartime morale. Many Americans thought, as with many military wars, that it was something happening far from our shores.

Recent studies of the incomplete medical records from the time seem to show that this viral infection itself was not more aggressive than any previous influenza. Oddly, it seemed to affect healthy people more than would have been expected. Rather, factors such as malnourishment, overcrowded medical camps and hospitals and poor hygiene promoted bacterial superinfection which killed most of the victims after a prolonged period.

There was what was called a “second wave” that year of the same virus. We know it was the same strain because those who had survived a first infection had immunity in a second exposure. But after the lethal second wave struck in late 1918, new cases mysteriously dropped abruptly.

In Philadelphia, 4,597 people died in the week ending October 16, but by Armistice day influenza had almost disappeared from the city. No one is certain why. Did doctors get better at preventing and treating the pneumonia that developed after the victims had contracted the virus? Did the virus mutate extremely rapidly to a less lethal strain?

Could it happen again? That is the stuff of movies, like Outbreak, Contagion and World War Z, all of which make reference to the 1918 pandemic. Certainly our medical knowledge and treatments are much better today. Research done in 2007 reported that monkeys infected with the recreated flu strain has the same symptoms of the 1918 pandemic. They died from what is called a cytokine storm, which is when there is an overreaction of the immune system. That may explain why is may explain why the 1918 flu had a surprising powerful effect on younger, healthier people. A person with a stronger immune system would ironically have a potentially stronger overreaction than a less healthy person.

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