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Have Americans forgotten the history of this deadly flu?

In autumn of 1918, the largest military offensive in American history was raging on Europe’s Western Front. The battle concluded on Nov. 11, 1918, when the Armistice with Germany was signed, ending what was known as the Great War.

But more U.S. soldiers died of disease (63,114), primarily from the Spanish flu, than in combat (53,402).

Overall, 675,000 Americans were killed by the Spanish flu. This number surpasses the total of U.S. soldiers killed in World War I, World War II, the Korean War and Vietnam War combined. Current day estimates put the death toll from the 1918-1919 outbreak of the Spanish flu between 80 to 100 million worldwide.

This “twin catastrophe” was not coincidental, author Kenneth C. Davis writes in his book, “More Deadly Than War: The Hidden History of the Spanish Flu and the First World War.

“Refugees crowding cities, malnutrition, and shortages of doctors, nurses, and effective medications all contributed to the pandemic’s rapid spread and high rates of death,” Davis writes. “But it was the movement of troops — with men crowded together in barracks, tents, and trenches and jammed onto railroad trains and ocean-going troop transports — that was most responsible for the spread of the Spanish flu.”

In an interview with the PBS NewsHour, Davis, author of the ”Don’t Know Much About” series, discussed the importance of knowing this history. The conversation has been edited for length.

You write in your book, “While many schoolbooks and historians tend to focus on great battles and the military decisions of kings and generals, history’s greatest killers have been the tiniest foes.” What made the Spanish flu so deadly 100 years ago?

Because military men were sent overseas, or sailors were sent from one port to another, the flu quickly spread across the U.S., after the first outbreak at Fort Riley in Kansas.

Even as the last 100 days of the war were being fought, in eventually what became the greatest military offensive in American military history — the Meuse-Argonne Offensive of September into November of 1918 — the flu continued to strike.

It was sudden, it was violent. It was virulent. It was very deadly. And what was most unusual about it was that it seemed to strike healthy young people, young soldiers in particular.

A French trench at Verdun in 1916. The Spanish flu was able to spread quickly due to trench warfare used in World War I. Trenches were often cold, rat-infested, filled with lice and muddy.

Why do more Americans not know this part of our history?

In World War I, we talk about the battles and the peace treaties and the numbers lost, but the Spanish flu aspect of it has really been buried and hidden in history. I think that’s not only dangerous, it’s sad, because it’s such a fascinating and compelling story, and one that we can really learn lessons from.

It’s particularly complicated by the fact that so many people who lived through the Spanish flu didn’t want to talk about it or remember it — even some of the doctors who were on the front lines of trying to figure out this medical mystery of what was killing so many people, so quickly and so violently. The fact that it was really concentrated in troops is what underpins this idea that the war and the flu are inseparable.

I’ve heard historians say that Americans don’t like to focus on events where there’s not a clear enemy. It’s easier to come together to fight Germans in World War I than to battle a bacterium. Do you agree?

I think it makes it all the more human and fascinating to connect things like disease to history and the fact that, for instance, during the American Revolution more people died of smallpox than died fighting the American Revolution. But we don’t think about it. You know that that was a factor, not only in the war, but certainly in some senses in George Washington’s own decision-making — who, by the way, suffered from smallpox as a teenager and fortunately survived it.

The building of the Panama Canal couldn’t have happened without understanding what yellow fever was, which really came out of the Spanish-American War. A man named William Gorgas oversaw the end of yellow fever essentially in Cuba and did the same thing in the building of the Panama Canal. Gorgas’ name comes up in my book, because he was the surgeon general during World War I and during the Spanish flu epidemic. So, he saw first-hand how deadly disease could be to troops in the field.

A sign warning about Spanish Influenza at the Naval Aircraft Factory in Philadelphia, Pennsylvania, on Oct. 19, 1918. Photo courtesy of the U.S. Naval Historical Center

An interesting aspect you explore is how African-American soldiers were somewhat spared the flu in part because of Jim Crow and segregated hospitals. How did race factor into the story?

The Spanish flu affected every community on Earth without question. Some groups fared much worse than others. We know, for instance, the death rate in Alaska was much much higher. A small village of 78 people lost 70 people within three or four days of the flu’s arrival. That’s an astonishing mortality rate, of course. India lost perhaps 18 to 20 million people. We’re talking about a virus that killed perhaps 100 million people worldwide in the space of about a year — 5 percent of the world’s population at the time. It’s an extraordinary number. It’s an unthinkable number to us today.

In the United States, there’s a little difficulty in tracking the effect on African-American communities because record-keeping was poor in some cases. Jim Crow was not just something that happened south of the Mason Dixon line. Jim Crow was an American institution. So African Americans in 1918 received substandard care, and had fewer choices in terms of being cared for in a hospital. Where they were admitted into hospitals they were often put into segregated wards; sometimes a segregated ward meant a basement or a closet somewhere. So that’s part of our history as well.

Aileen Cole, at far left, and the other eight nurses outside their quarters at Camp Sherman, 1918. During World War I, about 90 African-American nurses were certified by the Red Cross and then recruited for duty with the military. Cole made history as one of the first black nurses in the military’s Army Nursing Corps once she transferred to military service. Photo courtesy Armed Forces Institute of Pathology

Another wonderful example of that is a story I tell of a group of African-American nurses. The Army did not want their services … until they needed them. And then they were allowed to treat soldiers and civilians, but they were still segregated in their own barracks.

To be honest, we can’t really talk about history without talking about race, because it has affected every aspect of our history from the beginning of the republic and well before it. The hundreds of years of slavery and the institution of slavery and what it wrought in this country in terms of racism factor into almost every discussion we have of American history. It’s just that simple. And so I could not write a book about the American Spanish flu experience without discussing the fact that race entered into it.

Did you think a lot about whether this could happen today, a pandemic like the Spanish flu?

Could this happen again? The answer is, of course. And I’m sure there are people at the CDC who probably have nightmares about this. But we are much better prepared than we were 100 years ago. We would possibly have a vaccine that would work against such a virus, if it were identified and produced in massive numbers quickly enough.

Overcrowded hospital cots at Camp Funston in Fort Riley, Kansas, where the Spanish flu epidemic began in 1918.

We have erected enormous guardrails around the world through international cooperation, the World Health Organization, perhaps one of the most effective parts of the United Nations. Those guardrails are weakened when we deny science, when we ignore sound medical advice for short-term political considerations.

Those things all factored into the spread of the Spanish flu 100 years ago, and those are things that could happen again today, if we weaken our defenses at the CDC, if we weaken our defenses in terms of cooperating with foreign governments about sharing information about viruses. So, I’m not an alarmist, but I think one should be seriously concerned that an outbreak of a virus on the scale of the Spanish flu virus would be far more devastating than a terrorist attack.

Alaska Native children from the remote village of Nushagak survived the 1918–1919 influenza pandemic. Most of their parents and grandparents died of the virus, likely because they had not been exposed to an earlier H1-like influenza virus as a result of their geographic isolation. Photo courtesy of Alaska State Library

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