Survivors Remember 1918 FluPlague could teach lessons about how to prepare for future flu outbreak

The Associated PressDec 17, 2006

CHEVY CHASE, Md. - At the height of the flu pandemic in 1918, William H. Sardo Jr. remembers the pine caskets stacked in the living room of his family’s house, a funeral home in Washington, D.C. The city had slowed to a near halt. Schools were closed. Church services were banned. The federal government limited its hours of operation. People were dying — some who took ill in the morning were dead by night. “That’s how quickly it happened,” said Sardo, 94, who lives in an assisted living facility just outside the nation’s capital. “They disappeared from the face of the earth.”

Sardo is among the last survivors of the 1918 flu pandemic. Their stories offer a glimpse at the forgotten history of one of the world’s worst plagues, when the virus killed at least 50 million people and perhaps as many as 100 million. More than 600,000 people in the United States died of what was then called “Spanish Influenza.” The flu seemed to be particularly lethal for otherwise healthy young adults, many of whom suffocated from the buildup of liquids in their lungs.

In the United States, the first reported cases surfaced at an Army camp in Kansas as World War I began winding down. The virus quickly spread among soldiers at U.S. camps and in the trenches of Europe. It paralyzed many communities as it circled the world. In the District of Columbia, the first recorded influenza death came on Sept. 21, 1918. The victim, a 24-year-old railroad worker, had been exposed in New York four days earlier. The flu swept through the nation’s capital, which had attracted thousands of soldiers and war workers. By the time the pandemic had subsided, at least 30,000 people had become ill and 3,000 had died in the city.

Flu 'made everybody afraid'
Among the infected was Sardo, who was 6 years old at the time. He remembers little of his illness but recalls that his mother was terrified. “They kept me well separated from everybody,” said Sardo, who lived with his parents, two brothers and three other family members. His family quarantined him in the bedroom he had shared with his brother. Everyone in the family wore masks. The city began shutting down. The federal government staggered its hours to limit crowding on the streets and on streetcars. Commissioners overseeing the district closed schools in early October, along with playgrounds, theaters, vaudeville houses and “all places of amusement.” Dances and other social gatherings were banned.

The commissioners asked clergy to cancel church services because the pandemic was threatening the “machinery of the federal government,” The Washington Star newspaper reported at the time. Pastors protested. “There was a feeling that they couldn’t turn to God, other than in prayer,” Sardo said. “They liked the feeling of going to church, and they were forbidden.” The flu’s spread and the ensuing restrictions “made everybody afraid to go see anybody,” he said. “It changed a lot of society,” Sardo said. “We became more individualistic.” At the time, rumors swirled that the Germans had spread the disease — which Sardo did not believe.

In a list of 12 rules to prevent the disease’s spread, the Army’s surgeon general wrote that people should “avoid needless crowding,” open windows and “breathe deeply” when the air is “pure” and “wash your hands before eating.” One slogan was, “Cover up each cough and sneeze. If you don’t, you’ll spread the disease.”

Those who were healthy wore masks when venturing outside. People who were known to be infected were threatened with a $50 fine if they were seen in public. Sardo remembers people throwing buckets of water with disinfectant on their sidewalks to wash away germs from people spitting on the street. These days, government health officials are trying to build their case for school closings and similar steps during a future flu pandemic by showcasing new research that suggests such measures seemed to work during the deadly Spanish flu of 1918. Researchers found that cities like St. Louis, which instituted “social distancing” at least two weeks before flu cases peaked in their communities, had flu-related death rates less than half that of Philadelphia, which didn’t act until later.

The whirlwind historical research project — which started in August and was unveiled this month — involved a team of researchers from the University of Michigan and the U.S. Centers for Disease Control and Prevention, who combed through health records, newspaper clippings and other documents from 45 cities.

Another finding: The more social distancing measures were used and the longer they were in place, the less severe was the pandemic’s effect on a particular city. Wearing masks in public, restricting door-to-door sales, canceling church and quarantining sick people were among the layers of measures that appeared beneficial.

But the researchers acknowledged they’ve only just begun their analysis, and haven’t teased out which measures were most effective. And they stopped short of saying those steps were the clear-cut reason some cities had lower death rates.

'A lot of prayers'
Another survivor of the 1918 flu pandemic, 99-year-old Ruth Marshall, says she, her two sisters and a brother came down with what they thought was a cold. Then the fever struck and the illness became severe, she said. Marshall, who lived just steps from the Capitol at the time, said the influenza deaths reported in the newspapers came as a surprise. “We never thought we were going to die. We did pretty good — a lot of prayers,” she said.

Others were not so fortunate. As the death toll started to mount, there was a shortage of coffins. Funeral homes could not keep up. Sardo’s father, who owned William H. Sardo & Co., and other funeral-home directors turned to soldiers for help embalming and digging thousands of graves. Talk of the threat of another pandemic brings back memories for Sardo, who says he has gotten a flu shot every year they are available. “It scares the hell out of me,” Sardo said. “It does.”

Answer the following questions:

  1. As a result of the 1918 Flu Pandemic: How many people died in the U.S.? World-wide?
  2. Name three measures cities and the government took to control the outbreak.
  3. What measures seemed to work best?
  4. What is “Social Distancing”?
  5. How could these measures be applied today in the event of a pandemic?