The Spanish Flu

A recent article authored by Douglas Jordan and published by the Centers for Disease Control and Prevention (CDC) provided some sobering news, quoted here: “The 1918 H1N1 flu pandemic, sometimes referred to as the “Spanish flu,” killed an estimated 50 million people worldwide, including an estimated 675,000 people in the United States. An unusual characteristic of this virus was the high death rate it caused among healthy adults 15 to 34 years of age. The pandemic lowered the average life expectancy in the United States by more than 12 years. A comparable death rate has not been observed during any of the known flu seasons or pandemics that have occurred either prior to or following the 1918 pandemic.” The virus infected an estimated 500 million people worldwide, then a full third of the global population.

The article continued: “The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918.” That the virus was so widespread and so lethal is not surprising. Men were at war or returning from war; there were no vaccines, nor were there antibiotics to manage the secondary bacterial infections; nor were there mechanical medical supports such as ventilators. Management of the infection consisted primarily of isolation, quarantine, the use of disinfectants and good personal hygiene.

But let’s shift for a few minutes to a gentleman named Johan Hultin. Dr. Hultin was born in 1924 in Sweden, later migrating to the U.S. where he obtained a Master’s degree and graduated medical school at the University of Iowa. Dr. Hultin, is now a retired pathologist, and during his medical career was described as the “Indiana Jones of the science set.”

As a graduate student in 1951, Dr. Hultin ventured north to Alaska, with a plan to find in the permafrost, ice-bound corpses that would yield tissue – tissue that could help scientists reconstruct the genetic underpinnings of the Spanish flu virus. In 1918, the village of Brevig Mission, Alaska, had 80 residents. Over a period of 5 days, 72 had died of the virus. Very carefully, conscious that the virus might be unleashed, Dr. Hultin was able to recover lung tissue from four Inupiaq Eskimos, having received permission for his “archeological dig.” That’s Dr. Hultin (left) and his colleagues above. Alas, the venture was for nought, as the virus would not replicate. Brevig Mission, by the way, is not far from Nome.

Dr. Hultin lived with his disappointment for almost 5 decades (although keeping quite busy: more on that later). In 1997 he learned of some research being conducted by Dr. Jeffrey Taubenberger, a molecular pathologist with the Armed Forces Institute of Pathology. He was attempting to create a genetic map of the virus from small specimens that had been stored in wax in 1918. Asking Dr. Taubenberger if he would like some tissue if Hultin “could dig it up,” the response was “yes,” and Dr. Hultin was off to Brevig Mission again, on his own, at age 72, on a venture that ultimately cost $3,200 – which he covered. Dr. Hultin below, circa 1997.

In the same time frame, a much more elaborate expedition, headed by Dr. Kirsty Duncan, and including leading scientists from England, the U.S. and Canada, headed to Longyearbyen, a small Norwegian settlement on Spitsbergen, the largest island of the archipelago of Svalbard. They were in search of tissue from 7 miners who had perished from the Spanish flu in 1918. Unfortunately, the bodies were buried in ground subject to alternate freezing and melting; leaving no hope in finding the virus, which dies quickly when exposed to temperature changes.

Kirsty Duncan, pictured below, received her Ph.D. in geography (which presumably might have helped her locate Longyearbyen). She did say that she undertook a “crash course” in virology to prepare for the expedition. Dr. Duncan currently sits as a Liberal member of parliament in Canada.

Back to Dr. Hultin. He was able to provide Dr. Taubenberger with lung tissue from the remains of a woman he named “Lucy.” With fragments of RNA from Lucy, together with those from American army soldiers whose specimens had been stored in 1918, Dr. Taubenberger and his colleague, Dr. Ann Reid, analyzed the genome of the Spanish flu, discovering that most of the genes were very similar to a bird flu virus.

With solid evidence that the Spanish flu had avian origins, it had yet to be determined where the outbreak began. One theory is that the flu had it beginnings in an army camp in Kansas. The camp was one supplying soldiers for the American Expeditionary Force. A second theory involved another military camp, one housing some 100,000 British soldiers in France. In late 1917 hundreds of the soldiers in that camp fell ill, with more than 150 deaths. To this day however, there is no solid evidence as to the geographic source of the outbreak.

There were three waves of the Spanish flu. The first in early 1918 seemed much like the flu we experience today, with fever, chills, fatigue, and relatively quick recovery. The second wave, beginning in the autumn of 1918, produced much more severe symptoms – cyanosis, lungs filled with pus, and a high fatality rate. A third wave came with the end of The Great War. Celebrations threw cautions aside, and although not as deadly as the second wave, still millions were infected.

The Spanish flu had pretty much its course by the middle of 1919. Immunity had built up among those in the surviving population, and then of course, there were already millions who had perished.

You might ask, “How would the Spanish flu be managed today?” Seasonal flu vaccines might provide some immunity, as these vaccines target H1N1 viruses. similar to the Spanish flu. Furthermore, at least one anti-viral agent, oseltamivir, has been shown to be effective against H1N1 viruses. And of course, we now have available a raft of antibiotics to take on the bacterial lung infections that often follow a viral infection.

Dr. Johan Hultin, turning 95 in 2020, has packed much into his life. His interest in auto safety resulted in an auto safety award, and in 1968 he was commissioned to establish an automobile safety engineering unit at Stanford University Research Institute.

He was known as an accomplished mountain climber. In 1982 at age 57, he became the oldest person to scale Mustagh Ata, a 25,000 foot peak in China. At age 60, his final ascent took him to Pakistan and to the summit of Karakoram, which had never before been climbed successfully.
And lastly, Dr. Hultin long has warned of contagions being used to further bio-terrorism. It is not difficult to imagine a rogue state or terrorist organization producing a virus such as Covid-19 (or worse) to wage war that could decimate populations, cultures and economies.

With that bit of good news, there remains the question: “Why was this called the Spanish flu?” Spain was neutral during The Great War, and as a result there were few restrictions on media; whereas strict censorship was standard operating procedure among the allied and axis powers. In mid-1918 influenza hit Spain particularly hard (with King Alfonso XIII gravely ill), and as the news came out, the rest of the world labelled the viral infection the “Spanish flu.”
The Spanish, however, called it the “French flu,” believing that migrant workers crossing from France into Spain brought the disease with them. But “Spanish flu” stuck. Alfonso XIII below, looking debonair, and yes, he did recover from the flu.