Portland, Maine, fall, 1918. Five-year-old Tom Gillan has the flu. Feverish and weak, he falls asleep, and in a dream he stands watching a strange town in the distance — it’s a place he’s never seen before, but will never forget. The entire town is on fire.
When Tom wakes, his Irish-Canadian father gives him a hot toddy, heated brandy with water and honey. The old remedy seems to have done the trick. Tom Gillan, my grandfather, was one of the lucky ones who survived the Spanish flu pandemic a century ago. He grew up to become a lawyer and, as an Army sergeant during World War II, he participated in the D-Day Invasion of Normandy on Omaha Beach. While still in France, he and his infantry regiment came across a burning town. My grandfather swore for the rest of his long life that it was the same town he’d seen in the fever dream.
The First World War claimed an estimated 16 million lives. The flu pandemic that simultaneously swept the globe killed between 50 and 100 million. Half a billion people — roughly a third of the world’s population back then — contracted the deadly virus, which was often spread by troops living in close quarters and traveling to war and back.
A century has passed, and the planet is exponentially more interconnected. The conditions that breed deadly bird and swine flus — large groups of poultry or pigs living among humans; e.g., factory farms — have also increased exponentially. Public health officials say it’s not a question of if, but whenthe next devastating pandemic will emerge. Yet 100 years of medical science has not brought us much closer to preventing another catastrophe. In terms of body count, the next Great Flu could make the 1918 pandemic seem like the sniffles.
Although it became known as the “Spanish flu,” scientists now suspect the deadly strain of 1918-1919 may have originated in late 1917 in Kansas, where it later struck military encampments in the heartland. Spain was neutral during “The Great War,” so its press was free to report on the epidemic, news of which was often suppressed in warring nations. After reporters revealed that the King of Spain himself, Alfonso XIII, had nearly died of the flu, the name stuck.
By late August of 1918, the strain had mutated and become much more deadly. In mid-September, Portlanders began reading reports of an unusually high number of deaths in the Boston area from influenza and pneumonia, which attacks immune systems weakened by flu. For example, the strain killed 16 people within six hours one day. At Camp Devens — a military training facility, about 50 miles from Boston, where many Maine soldiers were quartered — a soldier died of flu on Sept. 7. One week later, the camp was grappling with an epidemic: 2,000 flu-sick soldiers and a roughly equal number of stricken Navy men.
On Sept. 11, fans packed into Fenway Park to cheer on Babe Ruth and his fellow Red Sox as they beat the Cubs to win the World Series almost certainly contracted and spread the illness. By Sept. 19, 75 Boston policemen were out of commission. By the end of the month, 1,000 Bostonians were dead. Some died within a few hours of showing the first symptoms, others within a few days. Unlike seasonal flu strains, this new plague was especially deadly for young and otherwise healthy adults. Common symptoms included fever, a persistent cough, and lameness. Blood ran from the ears and noses of some victims, and many suffocated to death on the fluid that swamped their lungs.
On Sept. 26, the papers reported that almost 11,000 people at Camp Devens had flu symptoms. Sixty-six people died there on a single day. Doctors and nurses became sick and many succumbed. Panic ensued as fatalities mounted. Nurses and doctors from Maine went to Massachusetts to alleviate the suffering. Some of them also perished, such as Frances Donovan of Bar Harbor, a nurse stationed at Fort Dix, in Trenton, New Jersey.
Among the military men from Maine taken by the pandemic was well-known Portland artist Thomas J. Clarity, an accomplished illustrator and cartoonist who’d visited his family here and then returned to the naval training camp on Bumpkin Island, in Boston Harbor. When he became violently ill, his family traveled to the island and were there at his bedside before “dissolution,” two days before his 27thbirthday. “One of the remarkable features of the disease,” a reporter observed, “appears to be the number of victims among children and young people between the ages of 18 and 35.” Thomas Clarity’s sister Gertrude died from the flu two months later.
Portland recorded its first death from Spanish flu on Sept. 19. On Sept. 27, a daylong conference was held at City Hall to try to stop the spread of both the virus and the panic it caused. City officials gathered with church and school leaders, theater owners and military personnel, and developed a host of precautions. All theaters and “movie houses” would be shuttered until further notice. Schools were also closed, effective immediately, but churches were allowed to remain open.
The Maine Department of Health had already ordered the closure of numerous public places and issued official warnings about how the virus spread — via sneezing, coughing, spitting, and the sharing of utensils, cups and towels. Portland Police Chief Daniel L. Bowen said anti-spitting laws would be strictly enforced, and the police arrested a few transgressors. Among the Portland cops felled by flu was “one of its best members,” Officer Timothy L. Murphy, who was ill for two weeks before dying of pneumonia on Oct. 27. A prominent athlete in his day, Murphy “won distinction as a fearless police officer and on two occasions plunged into the dock to rescue persons who had fallen overboard,” according to his obituary. He left behind a wife and seven children ages 12 and under.
On Oct. 4, Dr. Thomas Tetreau, head of Portland’s Board of Health, extended the closure order to include “all indoor gatherings at churches and other places of public worship, all lodge meetings, society meetings, club meetings, such parts of buildings as used for pool rooms, billiard rooms, bowling alleys, and to prohibit the serving of ice cream, soda or other soft drinks so called in other than individual paper containers that cannot be used a second time.”
Cumberland County Sheriff King F. Graham made it his mission to target the “hop beer joints” that had sprouted up all over town. Sheriff Graham was outraged that these bars stayed open on Sundays so crowds of customers could drink away the Sabbath. “It appears peculiar to me that board of health officials order even churches closed as well as places of amusement … and make no move against places where men congregate in large numbers for no other purpose than to fill up on hop beer and other cheap drinks,” he said.
Two deputy sheriffs conducted an inspection of local beer joints on Sunday, Oct. 6, and discovered there was little food to be had save “a plate or two of clam cakes or a few loaves of stale bread for sandwiches.” Neither was there “any menu of serving hot drinks such as tea or coffee.” Many of the proprietors lacked a license and their bars were in filthy condition. “A rather motley gathering was found in the majority of the places visited, including men from outlying districts in for a week end,” a local paper reported.
The following Sunday, four deputy sheriffs “went on the war path” and arrested nine hop-beer-joint operators. Others had reportedly seen “the hand writing on the wall” and were closed when the deputies commenced their crusade. Some bartenders were pouring draft beer into paper cones, but then using the cones to line beer glasses.
The men who were arraigned the next day in Municipal Court for “keeping open shop on the Lord’s day” were from the Italian, Irish and Jewish communities, ethnic neighborhoods that were among the hardest hit by the pandemic. “On account of the number of cases of influenza among people of the Italian quarter of the city,” the press reported, “the Italian church [now Saint Peter Parish] has been opened and several beds have been installed there for the use of persons who have been living in houses where the disease prevails.”
Portland’s Eastern Argus reported, “Several pathetic cases have become public, but none more so than that of the DeStefanio [or DeStafanis] family.” The father, Angelo, had immigrated from Lettomanoppello and worked in the granite quarries in Stonington before moving his family to a house on Washington Avenue. Angelo died from the grippe on Oct. 3, the day after the sickness claimed his wife and a son. Seven more of their children also had the flu. Six are known to have survived, including 11-year-old Carmela “Camilla” DeStefanis. Camilla grew up to become a teacher and eventually located five of her siblings, who were separated after their placement in an orphanage. She found one of them, her brother Joe, two decades after the pandemic. When Camilla died in 2003, at the age of 96, the Portland Press Herald chose hers as the “obituary of the day,” calling her “a childless matriarch for her family” who became a mother to her siblings, cousins, nieces and nephews.
Bishop Louis Sebastian Walsh, leader of Maine’s Roman Catholics, initially protested the order to close churches. He argued that it was an unconstitutional violation of freedom of worship and said 95 percent of Portland’s Catholics were against it. In early October, however, he relented and sent a declaration to the newspapers: Sunday Masses would be held in the school yards of St. Dominic’s Church and the Cathedral of the Immaculate Conception, as well on the grounds of Sacred Heart and St. Joseph’s churches. “The people will not be compelled to kneel, but may hear Mass standing with heads covered,” the bishop wrote.
Ominous black wreaths appeared on the doors of homes where someone had died of flu. At one point, even funerals in public places were prohibited. As was the case with police, the death toll was high among health-care workers. Four nurses in Portland died of flu or related causes at the end of September.
The Red Cross had a hospital on the corner of Free and Brown streets in downtown Portland, and its staff was quite active in the relief effort. Mrs. Grace Nash Hill, wife of attorney John Howard Hill, was “head of the home service of the civilian relief department” of the Red Cross. Many local physicians also made house calls on behalf of the organization.
One day in early October, a Portland doctor visiting a home in the Stroudwater neighborhood found a flu-stricken Canadian woman with a month-old infant, also sick, and two other children in a most precarious situation. Her husband was at Camp Devens, there was no fuel or food in the house, and the cellar was flooded. “A woman was secured to clean up the house, give the [sick] woman attention and care for the two older children who had not yet contracted the disease,” a newspaper reported.
Later that day on Tate Street, in the West End, this same doctor “found a Hebrew family of seven, all suffering from the disease.” The father, languishing in a room on the top floor, “was so weak that when he attempted to walk he fainted away.” He was sent to the Marine Hospital on Martin’s Point and the rest of the family was sent to the Red Cross hospital. Another Jewish family, across town on Hampshire Street, was also visited by this doctor, and all nine family members were sick. The mother was immobile, in bed with three children surrounding her and a fourth in a nearby cot. “This leaf from one physician’s experience in one afternoon will give some idea as to the great needs in some quarters,” the reporter wrote.
On Oct. 7, it was announced that Bishop Walsh had asked the Sisters of Mercy to volunteer as nurses. Sixty nuns immediately signed up. The next day the papers printed a letter from the bishop announcing the creation of a new hospital to be opened in the former home of Stephen H. Weeks, on the corner of Congress and State streets. Queen’s Hospital opened on Dec. 12, 1918. It was staffed by the Sisters of Mercy and open to all patients, regardless of religion.
“The present experience in our community with a contagious disease has shown the need of additional means for meeting such a contingency,” a newspaper declared, “and this philanthropic enterprise by Bishop Walsh will therefore be greatly appreciated by both the medical profession and the public.” Relocated a couple blocks down State Street and renamed Mercy Hospital in 1943, the institution celebrated its centennial last year.
October 1918 was a devastating month, the deadliest of the entire pandemic. The toll nationwide was 195,000 in October, including 2,554 Mainers. By Halloween, however, the plague seemed to have petered out, and churches and schools reopened. On Nov. 11, World War I officially ended. Veterans and survivors must have felt there was much to be grateful for that Thanksgiving.
Then, in December, the second deadly wave of the pandemic arrived and continued into the first months of 1919. Upwards of 675,000 Americans died before it ran its course, and the toll in Maine ultimately doubled.
The U.S. Public Health Service launched a nationwide information campaign during the epidemic. “If you feel sick and believe you have ‘Spanish’ influenza, go to bed and send for the doctor,” the Health Service warned. “This is important. Don’t get up too soon, your heart feels as tired as your legs and needs rest. In all health matters follow your doctor’s advice and obey the regulations of your local and state health officers.”
Other than the anachronistic directive to request a house call, the message from public health officials is basically the same today: If you think you have the flu, stay home and rest and await further instructions. They also advise people to get the seasonal flu shots. Though the effectiveness of those vaccines is often quite limited, and occasionally negligible, the reasoning is that some protection is better than none at all.
Some public health experts, such as epidemiologist Michael Osterholm, believe a “universal vaccine” could be developed that would protect against a wide variety of flu strains and remain effective for many years, unlike seasonal flu shots. In his 2017 book Deadliest Enemy, co-written with Mark Olshaker, Osterholm estimates it could take seven to 10 years, and just as many billions of dollars, to develop a universal vaccine that, once widely administered, “could save more lives in just a few months than all the emergency rooms in the United States have done in the last fifty years.”
Ten billion dollars isn’t a lot compared to, say, the Pentagon’s budget ($674 billion) or Jeff Bezos’ net worth ($140 billion, pre-divorce), but as was the case a century ago, our war-torn world lacks the political will (and the economic incentive) to devote sufficient resources to the effort. In a New York Times op-ed published last year, Osterholm noted that though the National Institutes of Health has declared the development of “game-changing” vaccines a priority, “there is no apparent effort to make these vaccines a priority in the current administration.”
Meanwhile, people keep dying in droves from influenza. According to the American Lung Association, over 80,000 Americans (including 85 Mainers) died due to flu during the 2017-2018 season — the highest national toll in decades, and about 24,000 fatalities above the previous recent high, set during the 2012-2013 season. The Centers for Disease Control and Prevention reported that the percentage of deaths from pneumonia and the flu last season “was at or above the epidemic threshold for 16 consecutive weeks,” also a recent high.
Pregnant women, young children, people over 50 and those already suffering ill health are in the most danger of dying from seasonal flu strains, but pandemic strains like the one that struck a century ago are “anti-Darwinian,” killing off the strongest and fittest young adults first — the result of an overreaction of the immune system known as a “cytokine storm.”
During a February 2018 appearance on the Ralph Nader Radio Hour, Osterholm said a modern pandemic could swiftly kill millions of Americans who don’t get the flu but do regularly take life-saving medicines — drugs predominately manufactured in China and India that are delivered daily to hospitals and pharmacies here on a “just in time” basis. Should a pandemic disrupt even one link in this complex global-supply chain (e.g., if large number of drug-factory or dock workers get sick), the delays would soon cause widespread mortality as scant stocks of crucial meds disappear.
We got a glimpse of this scenario in 2017, after Hurricane Maria wiped out a company in Puerto Rico that’s one of the mainland’s only sources of IV bags. This caused a critical shortage in the U.S., made worse by price-gouging of up to 600 percent, according to an article in The Guardian.
During a recent interview at Portland City Hall, Caity Hager, the city’s Emergency Management Coordinator, noted that the federal government’s Strategic National Stockpile has medical supplies and drugs that could be tapped in the event of a pandemic. But Hager acknowledged that the stockpile does not have sufficient amounts of commonly prescribed life-saving meds to make up for a sudden global shortage.
Portland did improve its pandemic preparedness following the Great Flu. For example, Maine General Hospital (now Maine Medical Center) built an isolation ward. Portland’s Board of Health hired more health and sanitation inspectors, as well as more nurses. Public and private health officials recognized the crucial need to share information about flu outbreaks early and often, and to keep the public informed.
Maine became one of the first states to make it mandatory to report cases of influenza. Dr. Tetreau, the head of Portland’s Board of Health, wrote, “One beneficial effect of the pandemic of 1918 was to vastly stimulate public interest in health matters generally.” In Portland, “the consideration of public health and welfare has risen to a position of prime importance in the public esteem,” he wrote.
“We have a pandemic plan,” said Dr. Kolawole Bankole, director of Portland’s Health and Human Services Department. Numerous emergency measures were put in place a decade ago in response to the threat of an anthrax or similar bioterrorism attack, and those protocols would be followed in the event of a deadly flu outbreak, said Hager and Dr. Bankole.
The Maine Cities Readiness Initiative includes a coordinated, statewide public-alert system and the provision of free medical care within 48 hours of an outbreak. Those suffering flu symptoms would be advised to stay home unless or until the severity of their condition necessitates medical intervention. Those who aren’t sick may be directed to a so-called Point of Dispensing (POD) in Portland, or one of the other 43 PODs in Maine, to get vaccinated, Hager and Dr. Bankole said.
Unfortunately, that would be way too late for those swept up in the first wave of the pandemic. It can take six to eight months to develop a vaccine designed for a specific flu strain, and then the inevitably contentious process of distribution would begin, replete with pitched political battles (Who gets vaccinated first?) and pushback from people who fear the sickness and the cure.
Maine has one of the lowest vaccination rates in the country and, not coincidentally, anti-vaccination sentiment is strong in our state. The 2014 incident involving Kaci Hickox, a nurse from Maine who traveled to Sierra Leone to fight Ebola, did not exactly win laurels for Gov. Paul LePage. Hickox said LePage chose fear-mongering and political gain over science and her rights when he ordered her to remain isolated for weeks, despite testing negative for the disease — an order she publicly defied.
The prospect of developing a universal vaccine elicited a hearty laugh from Dr. Bankole, who said there are other public health authorities who doubt such a vaccine would really be effective. Regardless of its viability, a major research initiative like that is far beyond the charge of municipal public health departments, though they do have a key role to play.
There are four flu clinics in Portland, Dr. Bankole and Hager noted, and weekly reports are generated during flu season that monitor the emergence of potentially virulent strains. In the case of a flu epidemic, the city would work closely with the Maine Center for Disease Control and Prevention to coordinate messages to the public, including alerts posted on social media. A new initiative to create a Virtual Operations Support Team has been implemented, and more pandemic-preparedness plans are in the works for implementation this summer, they said.
In the meantime, there’s little we can do but wait. In Deadliest Enemy, Osterholm and Olshaker quote Stewart Simonson, formerly a high-ranking official in the federal Department of Health of Human Services, who cautioned that another pandemic is “not a low probability. It is a high-probability, low-frequency threat. The variables are when and how severe; and, of course, how prepared mankind will be to respond.
“As you know,” he continued, “Mother Nature is the greatest bioterrorist of them all. … Our most dangerous adversary will not originate in the tribal areas of Afghanistan or some other remote place. It is everywhere man and animal live in close proximity. Just ask the chickens. As we used to say at HHS: If you’re a chicken, it’s already a pandemic.”
Efforts to remain vigilant for dangerous new flu strains are necessary, but that’s not where the battle will be fought. “We don’t know which, of all the influenza strains we’re watching, will emerge as a pandemic one,” Osterholm and Olshaker wrote. “What we do know is that when it happens, it will spread before we realize what is happening. And unless we are prepared, it would be like trying to contain the wind.”