Deadliest US pandemic killed hundreds in Jacksonville

1918 influenza pandemic (Spanish flu) killed 675,000 Americans, up to 40 million worldwide

Southern Bell Telephone and Telegraph operators in Jacksonville during the 1918 Spanish flu epidemic.
Southern Bell Telephone and Telegraph operators in Jacksonville during the 1918 Spanish flu epidemic. (State Archives of Florida, Florida Memory)

JACKSONVILLE, Fla. – Just over 100 years ago, America was shaken when an H1N1 flu, often called the “Spanish flu,” spread around the world, killing tens of millions. It killed an estimated 675,000 people in the United States that year and 400 people in Jacksonville in the month of October alone.

University of South Florida historian Gary Mormino said nearly one-third of Jacksonville’s residents -- estimated about 90,000 people at the time -- contracted the flu.

Between mid-October and late November 1918, Florida reported thousands of cases and hundreds of deaths from the Spanish flu, according to Mike Leavitt, secretary of Health and Human Services under President George W. Bush. He added that the exact numbers of Floridians affected by the flu will never be known because reports to the U.S. Public Health Service were never made.

Leavitt said Florida reacted to the flu as so many other states did: city ordinances mandated quarantines and the wearing of face masks in public, public gatherings were banned and schools and churches were closed.

The overall mortality rate of this 1918 pandemic was 2.5% -- 200 times the rate of seasonal flu. And while the “normal flu" disproportionately affects the very young and very old, the 1918 influenza was more deadly to healthy adults 15 to 34 years of age. Many of its victims were soldiers during World War I.

The 1918 pandemic took place during World War I and historians now realize that up to half of the American soldiers who died in Europe died of the flu, not enemy fire.

Oct. 18, 1918 edition of the Nassau News-Record featured this article at the top of its home page.

The U.S. Public Health Service sent out an article entitled “Uncle Sam’s Advice on Flu” that was published by many newspapers, including the Oct. 18, 1918 edition of Nassau County News-Record, gave some practical advice for those helping the sick, including that “no one but the nurse should be allowed in the room” and “care should be taken that all such discharges are collected on bits of gauze or rag or paper napkins and burned.”

Canadian scientist Kirsty Duncan, a Nobel Prize-winning expert on flu pandemics, found that many of the suggestions for avoiding disease transmission weren’t specific to the flu. As she noted, "in 1918, the medical profession did not know what caused Spanish flu. And because they did not know the cause, it did not know to prevent the disease.”

Duncan said medical practitioners of the time “rightly assumed that the disease could be spread through the air by coughing or sneezing."

This is a useful perspective as we watch the novel coronavirus spread about the world, our country and our state. Medical knowledge and understanding of disease, not to mention our ability to protect ourselves, is light years ahead of where it was in 1918. Plus, hand sanitizer and Lysol wipes didn’t exist a century ago.

So there’s every reason to believe that COVID-19 will not spread as widely or cause as much death and misery as the Spanish flu.

While the true mortality of COVID-19 will take some time to fully understand, World Health Organization data so far indicates that this virus will likely only be deadly to about 3% of the people who become infected and the vast majority of those deaths will be of those over 70 years of age with underlying medical conditions.

The Centers for Disease Control and Prevention has not yet classified the coronavirus disease 2019 a pandemic and it might never do so But the CDC does share guidance and tools developed for pandemic influenza as resources for health departments prepare for this coronavirus.

Since that information is being shared and if it is widely followed by the public, people will prepare rather than panic. That, and a little luck, coronavirus disease 2019 become a footnote in medical history and no repeat of the Great Flu of 1918.


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