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In 1918, as the world was nearing the end of the First World War, another disaster was spreading across the globe. It was so lethal that someone could be dead within a single day after seeing the first symptoms, it moved through army camps, cities, ships, villages, infesting hundreds of millions and killing more people than the war itself. Despite the best efforts of the time, no one knew how to stop it. Learn more about the Spanish Flu and its terrible impact on this episode of Everything Everywhere Daily. This episode is sponsored by Quince. I recently moved into a new, larger place and I face the challenge of decorating it. I of course, am turning to Quince to help get the job done. In addition to clothes, Quince offers stylish home furnishings that makes my place look great at affordable prices. And I've also recently picked up a second cashmere sweater that I've talked about before just because I like it so much. The great thing about Quint's is that their prices are 50 to 60% lower than those of similar brands. How Quint's works directly with ethical factories and cuts out the middleman so you're paying for quality, not brand markup. Everything is designed to last and makes getting dressed and decorating your home easy. Refresh your everyday with luxury you'll actually use. Head to Quince.com Daily for free shipping on your order and 365 day returns. Now available in Canada too. That's Q-U-I-N-C-E.com Daily for free shipping and 365 day returns. Quince.com Daily this episode is sponsored by Newspapers.com as a history buff, you know that while textbooks record the dates of our nation's conflicts, they often lose the voices of the individuals who served. This Memorial Day as we honor those who made the ultimate sacrifice, Newspapers.com invites you to go beyond the monument and discover the personal stories of the people we remember. Think of it as a bridge to the past, giving you access to over a billion pages of primary source history. This is your chance to move past the generalities of war and find the specific local heartbeat of that era. Newspapers.com provides a vibrant, unfiltered view of the past, letting you see the nuance, the sacrifice and the everyday lives that shape the world that we live in today. It's more than an archive, it's a way to ensure these stories are never forgotten. This Memorial Day, give a voice to the names in your family tree. Visit newspapers.com today and use promo code everything everywhere at checkout for 20% off your subscription. Newspapers.com honor the past by uncovering its stories. The Spanish flu pandemic of 1918-1920 was one of the deadliest disease outbreaks in human history. It first appeared in Camp Funston, Kansas, where the first cases were reported in late February of 1918. By early March, the virus had hospitalized more than 1,000 soldiers. The outbreak completely befuddled camp doctors. Epidemic diseases rarely forced healthy young adults into hospital beds. The doctor's explanation reflected their confusion. The camp housed hundreds of horses, and the staff typically disposed of their waste by fire. On March 9, a fierce dust storm ravaged Haskell County, Kansas. The same day soldiers planned to burn the horse manure. The first soldiers fell ill on March 11, reporting flu like symptoms and intense respiratory distress. By mid March, nearly 1,100 had succumbed to the illness. The original transmission into human hosts probably occurred when wild waterfowls such as ducks and geese transmitted an avian virus to domestic pigs, likely through droppings. With swine as host, the virus reassorted its genetic material, mutating into a form capable of jumping to humans, who then passed it to one another through respiratory droplets. Scientists speculated that Kansas became the cradle of this global pandemic precisely because it lies along the Central Flyway, one of North America's four major migratory corridors for waterfowl. The seasonal movement of millions of wild birds over the Midwest's livestock farms created a perfect mixing vessel for the avian virus, bringing it one fatal step closer to humanity. If proper naming conventions had been used at the time, it should have been called the Kansas flu known, not the Spanish Flu. The doctors all reached the same conclusion. The dust storm must have picked up the foul horse manure smoke and distributed it amongst the soldiers. While not a typical miasma explanation of bad odors like what was used during the Black Death, the doctors concluded that the toxic cloud contained particulates that caused the soldiers illnesses. Despite a century of breakthroughs, including the development of germ theory and the smallpox vaccine, the medical community remained ill prepared for a disease this devastating. A doctor at Camp Devens, a US army base in Massachusetts, reported that their base was averaging 100 deaths per day. The breakneck pace of the deaths reflected the sheer virulence of the disease. It was common for people to wake up feeling well, show symptoms by noon, and be dead by nightfall. Those who died so quickly often turned a horrifying shade of blue. These young, healthy victims fell to what's known as a cytokine storm, a violent immune response that triggers massive inflammation and causes the body to overwhelm its own organs. Author Sarah Frances Fujimura described the disease's impact on the lungs by noting, sometimes within hours, patients succumbed to complete respiratory failure. Autopsies showed hard red lungs drenched in fluid. A microscopic look at diseased lung tissue revealed that the alveoli, the lungs, normally air filled cells, were so full of fluid that the victims literally drowned. End quote. Hospitals eventually learned to triage patients by examining their feet. Staff left any patients with black feet, a telltale sign of cyanosis or oxygen deprivation, to die as they were beyond the reach of medical care. World War I accelerated the spread of the Spanish flu, prompting three distinct waves between 1918 and the spring of 1920. Wars demand communal activities and the virus surged in these large gatherings. During wartime, communities gathered in celebration and sorrow. On army bases, thousands of men crowded into barracks as they trained and prepared for war. When men left for the front lines, they traveled in packs, on large ships, and in cramped, crowded train cars. When they reported to the front, they gathered in mess halls, barracks, and in the wet trenches of the Western Front. The world at war functioned as a series of super spreader events. The Great War hampered the international community's response to the pandemic. As the war raged across the trenches of Western Europe, nations kept their data secret. There was a war to win, and they had more important priorities than dealing with what they thought was a seasonal flu. But they were learning, albeit slowly, that this was not your typical seasonal flu outbreak. Warring nations reported the disease so infrequently that only neutral nations like Spain provided consistent updates. Because Spain did not censor its news, the world associated the outbreak with them, forever branding the pandemic the Spanish Flu. While the international medical community stood largely unprepared, they did attempt to offer some solutions. And they were strategies that may sound strikingly familiar today. Masking and shelter in place Initiatives were often cast as patriotic sacrifices, even though they were very unpopular. Mask mandates in urban areas of Europe and North America were rare and when enacted, were often denounced and met with stiff resistance. Across the colonial world, officials provided masks to European settlers but didn't do so universally. India's experience with the Spanish flu serves as a prime example. British colonial authorities provided little information, and Indians largely rejected what they did offer. Consequently, people continued to travel in crowded train cars and gather for large festivals. As a result, India suffered the world's highest death toll, losing an estimated 20 million lives. The catastrophe fueled Indian nationalism and exposed the cruelty of British dominion. In rural India, where news traveled slowly, many attributed the pestilence to Hindu deities. Further Diminishing the success of interventions like masking. An editorial in an Indian newspaper characterized the impact by noting India perhaps never saw such hard times before. There is whaling on all sides. There is neither village nor town throughout the length and breadth of the country, which has not paid a heavy toll. In North America and Western Europe, nations sought to limit the virus's spread by banning public gatherings, including festivals, holidays and funerals. Some ordinances even limited Sunday sermons to just five minutes to reduce contact time. However, when officials implemented these programs in places like sub Saharan Africa, they often did so suddenly and at gunpoint. The approach failed to win converts as most people resisted viewing the measures as yet another colonial affront. A report from the Nigerian Pioneer newspaper captured the reaction of the indigenous population by noting the people are in a state of terror. They view health officers as a fresh source of danger. Many believe the doctors visit to mark houses for destruction or to take the sick to hospitals, which to them is but the portal to the grave. Consequently, families hide their sick and the disease spreads unchecked. End quote. The impact on global populations was profound. Life expectancy in the United States, which by most accounts found fared far better than other parts of the world, declined by 10 years. During the pandemic, the flu had a mortality rate of 2.5%, up from the typical flu virus rate of 0.01%, but still far lower than the 6% mortality rate in India. This dramatic increase in mortality explains the chaos in the international medical community. The virus had changed dramatically from previous seasons, and there didn't seem to be anything public health officials could do. While scientists raced to develop a cure, a vaccine, or even a treatment, it seemed that there was nothing that could be done. Scientists developed multiple ineffective vaccines during the Spanish flu pandemic. The fundamental problem scientists encountered was their belief that a bacteria had caused the pestilence. Virology was still a young science, and researchers would not finally glimpse a virus until the invention of the electron microscope in 1939. Scientists delivered their vaccines from bacteria harvested from the lungs of previous victims. Laboratories across the developed world created these formulas in strict scientific isolation, and doctors ultimately administered them without a single success. The failure of the vaccines created vaccine hesitancy in the United States, which persisted until the development of the polio vaccine in 1955. One of the great mysteries of the Spanish flu period was the disproportionate death rate amongst people aged 18 to 35. This demographic is normally the healthiest. Yet during the Spanish flu, they experienced a rate of morbidity that approached 40%. In a normal disease environment, communicable respiratory diseases will have the greatest effect on the very young or the very old. World War I soldiers were a prime example. Most of the soldiers were between 20 and 30 and they were falling ill and dying at an alarming rate. The common explanation for why young healthy people were stricken down so severely is that they elicited a much stronger immune response, sending the immune system into overdrive. Ultimately, the body produces so many white blood cells that the system floods the lungs with white blood cell fluid, causing the victim to literally drown from within. Traditionally vulnerable populations, such as the very young and very old, did not produce such a vigorous response, leaving their lungs with far less fluid. Treatments of the time were largely ineffective. As scientists floundered about, unable to explain the differences between a virus and a bacteria. They often repurposed other medical treatments and applied them to the Spanish flu. In Italy, hospitals began experimenting with quinine as a potential treatment, which was used against malaria. The treatment was somewhat effective at keeping people alive, although it didn't appear to slow transmission. Other hospitals tried using over the counter remedies such as aspirin and camphor, with no success. The disruption caused by the Spanish flu was profound. In addition to the massive disruptions found in North America and Western Europe, there was also significant upheaval in Africa, East Asia and Latin America. In Africa, the Spanish flu outbreak was a catastrophe. The virus returned to Africa with troops who had fought in the side of the British and the French, and it spread across Africa's expanding network of railroad lines. Africa was particularly vulnerable due to its lack of health infrastructure. Sub Saharan Africa, under European control, created little to no health infrastructure and largely depended upon foreign missionaries who work came to a screeching halt during the pandemic. Historical estimates suggest that Africa suffered as many as 3 million casualties in just 1918 and 1919. East Asia had similar losses. While well resourced cities managed to blunt the blow of the pandemic, the complete absence of health care infrastructure devastated rural areas. Latin America suffered horrendously as well. A lack of political clarity on the continent, coupled with poor health care left the impoverished highly vulnerable. Some statistics suggest that the death toll in Latin America reached as many as 500,000. The Spanish flu was a global catastrophe and it affected nearly every aspect of life for nearly two years. While most of its outcomes are decidedly negative, the outbreak did spur scientific inquiry that would pay dividends in the late 20s and 30s. Among these innovations were the electron microscope, the development of penicillin and an increased awareness of antiseptic procedures. Vital breakthroughs in vaccine design ultimately guided scientists like Jonas Salk in developing the polio vaccine. Since 1918, the Spanish flu virus has not disappeared so much as evolved and branched. Its direct human descendants circulated as seasonal H1N1 flu until 1957, while related strains also became established in pigs as swine flu. Later pandemic strains including the 1957 Asia flu, the 1968 Hong Kong flu, the re emergence of of H1N1 Russian flu in 1977 and the 2009 swine flu were not simply the original Spanish flu returning, but they were connected to it through descent or long running swine influenza lineages. The pandemic's global death toll is difficult to calculate because record keeping varied widely. Many deaths occurred outside of formal medical systems and wartime censorship, distorted reporting, but a commonly cited estimate is about 50 million deaths worldwide. But some scholars have proposed ranges from roughly 20 million to more than 100 million. But even the lowest estimates place it among the deadliest pandemics in world history. The Spanish flu was unlike any pandemic that ever came before it. There had been massive losses of life from disease in the past, but nothing ever spread as fast while being so lethal, and humanity learned the hard way the dangers and downsides of an increasingly interconnected world. The executive producer of Everything Everywhere Daily is Charles Daniel. The associate producers are Austin Otkin and Cameron Kiefer. Research and writing for this episode was provided by Joel Hermanson. My big thanks go to everyone who supports the show over on Patreon. Your support helps make this podcast possible. I also want to remind everyone about the community groups on Facebook and Discord, as this is where everything happens outside of the podcast. As always, if you leave a review on any of the major podcast apps, you too can have it right on the show.