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2018 - The 100th Anniversary of the World's Deadliest Flu Outbreak



Last week, I walked into my office and was met with a chorus of sneezes, coughs and nose blowing from the staff. A few days later, I joined the their not so exclusive club with tissues flying faster than snowflakes in a blizzard. Yes, the flu had hit Connelly Law Offices and it seemed no one was spared. Some had it worse than others and it appeared that those who did receive the flu shot were spared the worst of the symptoms.

A few days later, as I was making my routine calls to nursing facilities and senior living centers to check in and chat with our clients, more than one nursing home reported similar illnesses with one medical professional telling me that the whole facility was being treating prophylactically with Tamiflu due to an outbreak on one of the floors.

As the New Year rolled around, I heard as many honks from the noses of friends and colleagues as I did from the Times Square party horns. As the cacophony of coughs echoed in stores, restaurants and even courtrooms, I realized that this year was the 100th Anniversary of the flu pandemic of 1918, the deadliest outbreak of its kind in modern history.

It was 1918 and World War I was coming to an end. The world, which was caught up


in battle for nearly half a decade, saw servicemen returning home from foreign soil. Families across the globe were relieved to have their loved ones back home only to see them succumb to an enemy they could not see. People fell by the thousands, not to bullets or bombs, but to the unseen germs that were spread unknowingly from person to person and country to country.

The first wave of the flu began in the spring of 1918 and by all accounts was nothing spectacular. Those who got sick reported relatively minor symptoms such as fever and fatigue and they usually recovered quickly. However, that fall, things took a much different and darker turn.

As the leaves turned and the crisp weather of autumn arrived, the flu hit people hard and spread around the world with a vengeance. Victims who became ill died within days or sometimes within hours as their lungs filled with fluid, essentially drowning them. By the end of 1918, the average life span in the United States plunged by nearly 12 years.

Today’s flu types can usually be pinpointed as to where it came from but in 1918, it was observed simultaneously in the United States, Europe and Asia and then spread throughout the world in a matter of months.

What was so sinister about this virus is that it struck down normally healthy people, many of them young and strong returning servicemen. Government records state that 40 percent of naval veterans and 36 percent of army vets were hit with the sickness. By the time it all ended in 1919, the death toll worldwide was said to be between 20 and 50 million people with over 500 million infected by the virus.


The flu pandemic of 1918 killed over 750,000 Americans and sickened nearly 25% of our population. Although several factors conspired to fuel this deadly outbreak, it is not out of the realm of possibility that such a public health emergency could occur again. And with an aging society, we may be more at risk than ever.

The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years. Those struck with illness on the street often died rapid deaths, some before they could even return home for their next meal. One story shared of 1918 was of four women playing bridge together late into the night. Before morning, three of the women had died from influenza.

Others told stories of people on their way to work suddenly developing the flu and dying before the end of their shift. One physician wrote that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate."

Another physician recalled that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth".


In the United States, over one-quarter of our population became sick with three-quarter of a million succumbing to the illness. American citizens conducted their business, such as shopping and going to work, wearing masks and avoiding contact with others in order to elude the deadly germs. Sources of entertainment, such as movie theaters, diners and even sporting events, were shut down to contain the illness.

Today, the flu season generally runs from the late fall into the early spring with an average of 200,000 people being hospitalized due to complications of the illness. Over the last thirty years, upwards of 49,000 flu related deaths are reported annually, according to the Centers for Disease Control.

Interesting enough, there are many people who do not know what the flu is. Those I have spoken with often confuse the flu with a stomach virus, often chalking up vomiting and diarrhea as the flu. However, this is not the case.

The flu is a virus that attacks a person’s respiratory system and is highly contagious. A person with this illness can easily spread it thorough coughs, sneezes and even talking as small respiratory droplets are released into the air and inhaled by all those nearby. In addition, a person who may touch an object with the virus on it and then touches his or her mouth, eyes or nose can become infected.

Young children and those over the age of 65 with accompanying medical conditions such as asthma, diabetes or heart disease are at a higher risk of complications than those without these conditions. These complications can include pneumonia, ear and sinus infections and bronchitis.


The flu pandemic of 1918 occurred because of a virulent new strain, which some say originated in China, appeared for which there was little or no immunity among people worldwide. It is thought to have traveled quickly due to the movement of troops and refugees as the war came to an end.

Since 1918, there have been several other flu pandemics but none as deadly as that year's illness. In 1957-58, some 2 million people died worldwide including over 70,000 here in the United States. The flu of 1968-1969 saw over 30,000 people die here while nearly a million succumbed worldwide. In 2010, the swine flu, also called the H1N1 virus, killed more than 12,000 of our citizens.

If nothing else, the true stories of flu pandemics should be reason enough to get your annual flu shot. This is especially true for our seniors, who are prone to serious complications from the illness, for a specific reason.


Seniors are more likely to become sicker even without pre-existing conditions because their immune systems become weaker as they age. In recent years, the CDC estimates that between 71 and 85 percent of flu-related deaths occur in people ages 65 and older and 54 to 70 percent of hospitalizations occur in that group. So you can see the seriousness of being vaccinated for our seniors.

Besides the flu shot, seniors also should make sure they are up to date with the pneumococcal vaccination which prevents against diseases such as pneumonia, meningitis and bloodstream infections.

Of course, when I urge our clients to make sure they are up to date with their immunizations, I often hear the argument that when they get the shot, they come down with the flu a few days later.

Could this be true?


Dr. Andrew Pekosz, a professor of immunology at John Hopkins University School of Public Health said that getting the virus from such a shot is impossible.

“The flu shot is a killed virus that consists of only half of the virus – the part you need to make an immune response to. It’s also administered in the arm muscle which is not a place the flu virus normally goes to. So, there is no possibility you can get the flu from the flu shot,” he states.

So, does this mean that people who report some symptoms after the shot are imagining it?

“Most people have a little redness and soreness at the site of the inoculation. These are normal symptoms and due in part to your body’s immune system reacting to the vaccine,” says Dr. Pekosz. “Usually these don’t last for more than a day or two.”

The Centers for Disease Control goes a bit further with the possible symptoms of

the flu vaccine. Medical professionals working there state that a low-grade fever and body aches are indeed possible after receiving the shot but not because you have contracted the flu, but because your body’s immune system is reacting to the introduction of a foreign substance into the body.

In any case, influenza pandemics are still a real possibility even with vaccines and other medications used to lessen the severity and increase the recovery time of those who get sick. This winter appears to be colder than average which means we will be spending more time indoors and exposed to those who may be sick. Taking the precautions necessary to stay healthy, including getting the flu shot, is the best way to avoid getting sick and suffering complications.

Even though the great flu pandemic of 1918 occurred one hundred years ago, we must always remember that this can happen again.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.

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