Alfred Russell died of influenza on November 8, 1918. He was just 5 years old.
Russell, who lived in Davenport, was the youngest of seven children. But his funeral was lonely: His mom, four sisters and two brothers were stuck in the hospital, battling the same virus that killed Alfred, according to newspaper reports.
The 1918 outbreak of influenza, known then as “Spanish flu,” was one of the deadliest pandemics in world history, killing somewhere between 20 and 75 million people worldwide.
In the U.S., an estimated 675,000 died from the flu — more than 12 times the number of American combat deaths in World War I.
In the Quad-Cities, 5-year-old Alfred Russell was hardly alone. From the first reported flu death in early October 1918 to the epidemic’s wane in the summer of 1919, thousands were infected across eastern Iowa and western Illinois, and hundreds died.
Overwhelmed by illness and mortality, the local newspapers began running a regular column, “Influenza Deaths,” which became as routine as weather reports.
One-hundred-and-two years later, at a moment of heightened alarm about COVID-19, the new coronavirus sweeping the globe and upending daily life, Americans are confronting what many have called an “unprecedented situation.”
But the coronavirus crisis has a useful if imperfect precedent in the 1918 flu outbreak.
That flu was different in several key respects from the new coronavirus. By the best evidence, the 1918 flu was deadlier than COVID-19. Whereas the coronavirus targets the elderly, the 1918 flu ruthlessly killed not just the very old and very young but also healthy young adults. Public health was also less widely understood and practiced a century ago by the general public.
Still, themes emerge over time. Then, as now, people complained that officials were "overreacting." Extreme action — including the closure of whole towns — began before many people had died.
The pandemic of 1918 is not a perfect guide to the 2020 pandemic. But a review of how the Quad-Cities handled the "Spanish flu" offers some valuable lessons about the unfolding crisis of the new coronavirus.
"An epidemic,” an editorial in the Moline Dispatch opined in November 1918, "may take as many lives in a month as fierce war would take in two years, and there is no return for it — except the things regarding it which medical science may be able to find out in order to combat its next recurrence."
Lesson 1: Things can change fast
There are different hypotheses about whether the so-called Spanish flu originated in China, Britain or the United States. The first domestic case appeared in Kansas, in January 1918.
By April, news reports began reaching the Quad-Cities that influenza was circulating among soldiers. On July 4, 1918, an editorial in the Rock Island Argus decried the "epidemic of Spanish influenza threatening to invade this country." The problem, it was believed, was mostly limited to military camps and bases.
A local outbreak began to be taken seriously in late September, when more than 2,000 men fell sick at the Great Lakes naval training station, near North Chicago. Camp Grant, outside Rockford, was hit next. By early October, 234 men at Camp Grant were dead.
It wasn’t until October 4 — nine months after the first case in the U.S. — that the Davenport Daily Times reported the first non-military fatality in the Quad-Cities: a 60-year-old pharmacist and former Moline Board of Education member.
To some at the time, the death was tragic but isolated. “Influenza Is Not Spreading," read the headline in the Daily Times. Rock Island had only eight cases, which some local authorities interpreted to be "evident that the disease is not spreading to any extent in Rock Island, as there was that number of cases here a week ago.”
On Oct. 7, the Daily Times reported, "Davenport is practically free from influenza, and there is no reason for alarm." The next day, it was reported Moline was “lucky” because “the disease has not appeared in epidemic form.”
At the same time, the papers carried advice on how to stay well. The preventative measures would seem familiar to a modern person: "Be cool and calm, but careful. Keep away from people with colds. Cover or smother every cough or sneeze. Keep out of crowds. Avoid poorly ventilated places,” read one bulletin from a local committee of the Red Cross. “Above all things, panic should be avoided."
Almost exactly one month later, the city of Rock Island alone had 1,403 total cases and about 50 deaths. Moline averaged 30 new cases a day for more than a month.
In Davenport, the totals were higher. One particularly somber day logged 202 new flu cases in a 24-hour period. Physicians emphasized the total case counts were likely underestimated, as mild symptoms went unreported.
Within weeks, the Quad-Cities had shifted dramatically from life-as-usual to full-blown contagion.
Lesson 2: Drastic interventions can work
By the second week of October 1918, the epidemic had reached more than 800 cities and towns across Illinois. In the Quad-Cities, there were only a handful of cases. But disaster signs were mounting. Reports poured in of widespread death at military facilities in Iowa and Illinois. Several people died in Iowa City, and in Dubuque and Geneseo, where outbreaks were more advanced, schools and churches were closed indefinitely.
So health officials of the “Tri-City area” proclaimed what the Daily Times called "the most drastic order that has ever been issued": a near-total shutdown of urban life. All libraries, movie houses, theatres, churches, pool rooms, bowling alleys, sports venues, colleges and most schools were closed. Public gatherings were prohibited, and even funerals were limited to immediate family.
In Rock Island and Moline, businesses had a 6:30 p.m. curfew. In Davenport, most businesses had to close at 5 p.m. The Davenport mayor instructed police to arrest anyone violating orders.
The decision was severe and without precedent. It was also popular. Local boards of health supported the society-wide closure almost unanimously. Elected officials in Davenport, Rock Island, Moline, East Moline and Silvis supported it. The leaders of the Rock Island Arsenal backed it, too.
"I know every picture exhibitor and theater manager in Davenport will suffer as a result," said the manager of one local theater. "But it is our duty to safeguard the public health of the community, and for this reason I believe we should close."
The rules were followed. After a week of quarantine, the Rock Island Argus reported no violations citywide. "Protection of the public health just now is a patriotic duty, as well as a personal safeguard,” read an editorial in the Argus.
And public health officials were mostly satisfied. Containment appeared to be mitigating the transmission of disease. Three weeks after the closure orders, Moline had seen fewer than 1,000 total flu cases, and Rock Island only about 1,400 — high figures, but better than what many other cities endured.
Lesson 3: It ain’t over till it’s over
Almost immediately, officials faced pressure to lift the closure orders. Some locals believed the response was an “overreaction.” Others thought it stifled the very soul of the local area. One Rock Island reverend was irate at the prohibition on Sunday services. “My God and my church come first,” he thundered to local leaders.
Thanks to the “drastic actions,” the number of new cases was dropping every day during the city-wide closures. By the first week in November, Moline and Rock Island were averaging about 25 new cases each day, East Moline about 15 and Davenport about 70, according to newspaper reports. Health officials were content that containment was working.
The Moline Dispatch reported “Moline, Rock Island and East Moline adopted the most stringent quarantine orders of all Illinois cities,” winning the praise of the director of the Illinois health department. “That there were so few cases and comparatively few deaths was due in large part, according to state health officials, to the wise and timely preventive measures adopted by the health officials.”
Severe action was lauded for yielding impressive results. “The number of cases of the disease and the percentage of deaths have been lower in the Tri-Cities than in other parts of Iowa or Illinois where any epidemic existed,” reported the Argus.
The success led locals to believe the problem was passing. On Nov. 13, after four weeks of quarantines, most of the closure orders were lifted across the area. The optimism was palpable: "The epidemic is about over,” reported the Dispatch.
But the celebrations came too soon. Days after the closures ended, the number of new cases began ticking upward. Moline logged a record 64 cases in a single day. The makeshift flu hospital was closed, only to reopen hours later out of emergency.
"There is a deplorable tendency on the part of the public to let down the safeguards as soon as quarantine in any particular locality is removed,” said the Illinois state health director. "Only eternal vigilance can stamp out influenza.”
But the relapse didn’t lead everyone to call for a re-closure. Local health authorities "apparently are convinced that the influenza situation is not sufficiently serious to warrant issuing new closing or restricting orders,” the Dispatch reported. Local business owners agreed, arguing strenuously against new restrictions on their income.
In Moline, the mayor was reportedly perturbed about a new epidemic. Prompted to act, he decided to spare businesses but re-canceled schools and many public gatherings over the objections of the city health commissioner, who believed the "public only has itself to blame.” Residents were ordered to wear masks in public, a rule that was flagrantly ignored. In Davenport, strict closing orders were re-implemented to shut down businesses and most social gatherings. The new prohibitions lasted two weeks and were lifted by Christmas.
By the end of the year, Davenport had reported 4,475 cases of flu, with 270 deaths. Rock Island had 3,167 cases and 114 deaths. (Physicians emphasized those totals were likely underestimated.)
In just three months, pandemic flu had transformed the Quad-Cities.
Lesson 4: Good information can save lives. Bad information can be deadly.
The first step in battling an epidemic is to know where there is one. After the first cases appeared during the 1918 influenza epidemic, physicians in Iowa became required to report flu cases to city health officials, per order from the state board of health. "This is absolutely essential in order that some idea may be had of the extent of the disease, whether it is on the increase or decrease,” reported the Daily Times.
Unlike with COVID-19, which requires special testing to confirm a diagnosis, no diagnostic testing existed at the time for the “Spanish flu.” Doctors had discretion to diagnose cases, which could exhibit vague symptoms.
Still, even in the early 20th-century medical professionals had an impressive understanding of flu transmission. As early as September 1918, Quad-Cities newspapers were running long columns from local physicians dwelling on the seriousness and deadliness of the flu epidemic. Local doctors advised that flu spreads through direct contact to sneezes, coughs and bodily fluids and that it can be curtailed through basic hygiene and through what today is called social distancing, or what one local doctor called the “five-foot barrage.”
An April 1918 Dispatch editorial compared the destruction of disease to the deadliness of “a Prussian air-raider bombing a defenseless city.”
“The germs, like the Germans, celebrate the coming of spring with a tremendous assault,” the editorial warned. “It would be literally equivalent to a great military victory, or the raising of a great army, if we'd all stop the nasty practice of coughing and sneezing into other people's faces and spitting germs all over the neighborhood.”
By October 1918, with flu cases first appearing in the Quad-Cities, local officials printed 100,000 circulars with info on preventative measures and what to do if someone becomes sick. The pamphlets were sent to local schools, factories and homes, with 50,000 circulated in Davenport alone.
Yet amid pain and illness, good information can be difficult to come by. The Daily Times reported in mid-October 1918 that physicians estimated 30% of the Davenport population was probably suffering from a mild form of the flu and wasn’t being reported. “It is these cases which will cause the disease to spread and cause the epidemic,” the Daily Times wrote.
Bad information, meanwhile, was legion. Newspaper ads promised flu treatment or cures. “Spanish Influenza Yields to Old-Fashioned Remedy,” read one headline from the time. The remedy, called MenThoEze, involved inhaling fumes from “goose-grease and turpentine” mixed with “healing oils” and purportedly brought “relief in twenty minutes.” One Pittsburgh doctor made international news when he announced the discovery of a “cure” for the flu involving a combination of creosote and iodine.
“Spanish influenza should have no terrors for anyone,” wrote a misleading editorial in the Daily Times. “A glance through the paper reveals the heartening information that no less than 145 patent medicines will aid one in battle the flu. Keep cool.”
Lesson 5: Individual decisions matter.
Pandemics are scary, destabilizing and anxiety-ridden. Information is hazy, and people feel helpless.
But individuals can make a difference to improve public health and protect themselves. During the local epidemic of the “Spanish flu,” in 1918, leaders meaningfully changed the course of the public health response, such as the Moline mayor who re-instituted the shutdown public gatherings after an uptick of cases.
Everyday citizens can also make a difference. Amid the COVID-19 outbreak, health experts are urging Americans to stay home and practice “social distancing” to slow the spread of disease.
In 1918, the failure to follow social distancing practices was deadly. The city of Philadelphia, for instance, threw a parade for the WWI effort that drew 200,000 spectators. Days later, flu infections spiked in the city, resulting in thousands of deaths.
In St. Louis, where city officials aggressively shut down public gatherings days after detecting flu, per capita flu-related deaths were around 50% lower than Philadelphia.
The Quad-Cities had its own experiment with the failure of social distancing. On Nov. 7, 1918, the United Press wired news to outlets across the country: “WAR OVER.” It was a faulty report based on a miscommunication. But millions took to the streets all over the U.S. in celebration, four days before the eventual armistice was signed.
In Davenport, “hundreds of people, when the whistles started to blow, yesterday afternoon, rushed into the streets, many bareheaded and without wraps,” the Daily Times reported. “Many rode about the streets on auto trucks without hats or coats, or tramped the streets in the rain. Everywhere there was congestion.”
Health officials were thrilled at the news — and aghast at the public gatherings amid the pandemic. One physician said that "all precautions, which the board urged the public to take, had apparently been forgotten in the excitement which resulted from the fake message that peace was at hand and that hostilities had ceased."
Unlike in 1918, the United States of 2020 is not anticipating the imminent end of a global war. Parades have been canceled, and big events called off.
And the upside of social distancing means more time at home to read up on history if one chooses. Sometimes it contains valuable lessons.
Graham Ambrose is the Iowa politics reporter for the Quad-City Times.