How the U.S. Dealt with the Spanish Flu of 1918

2. Facemasks did little good against the Spanish flu

Across the United States, as municipalities battled to contain the flu in 1918 and 1919, some mandated the wearing of facemasks when out in public. Unfortunately, though the concept was sound, the masks were not. Constructed of gauze, they did little to prevent the spread of disease. The same applied to the medicines available at the time. Flu vaccines were still in the distant future in 1918. Neither were antibiotics to treat secondary infections available to healthcare workers. Patent medicines, touted as miracle cures, faced no government control, and conned thousands into a false sense of security.

Cities across the United States enacted emergency laws making it a crime to expectorate on streets and sidewalks. Public drinking fountains were shut down. The second wave of Spanish flu, far worse than the first, appeared in the United States in the late summer of 1918, at a time when railroads were crowded with troops moving from training camps to debarkation points to be sent to Europe and the trenches. By September city officials across the country recognized, in some cases, a growing health crisis. St. Louis was among the first to observe the spreading illness at nearby military bases. How it responded is proof that we have seen something like our current crisis demonstrably false.

3. US Public Health Service made recommendations, not mandates

By the late summer of 1918, officials at the national level recommended steps for communities to protect themselves from the formidable flu. Some did. Others did not. Philadelphia at first ignored the recommendations to limit social interactions. Instead, through its Director of Public Health, a political appointee the name of Wilmer Krusen, it reassured the public that the growing threat was merely seasonal flu, no more dangerous than any other. He suggested Philadelphians keep warm and dry and recommended the use of laxatives to “keep their bowels open”. Krusen was the official responsible for the city’s failure to cancel the parade, and thus the tragic aftermath which followed.

In St. Louis, an altogether different public official dictated the community’s response. When the first reports of the infection rates in Missouri army barracks arrived, Dr. Max Starkloff, the Commissioner of Health, wrote a column in the St. Louis Post-Dispatch telling citizens to avoid crowds and crowded areas. Following his recommendations, the city moved rapidly to close schools. The city banned public gatherings, closed its theaters and pool halls, and ordered many other businesses to close. Starkloff called for volunteers to treat the afflicted in their homes. The business community opposed most of his actions, but the city government backed their health commissioner.

4. Spanish Flu contributed to the causes of the Second World War

In December, 1918, President Woodrow Wilson sailed for France to participate in the treaty negotiations which formally ended the First World War. Wilson traveled with his famous Fourteen Points, determined to avoid harsh recriminations on the defeated Central Powers. He found the French, British, and Italians in opposition to his thinking. The Allies were determined to punish the Germans, inflicting terms which reduced their land boundaries and forced them to pay crippling reparations. They also reduced their military capability, seized most of their navy, and made further development of an air force illegal. Wilson argued for more lenient terms.

In the spring of 1919, the Spanish Flu afflicted the American President. Wilson, suffering from the effects of fever, became unstable. His mind wandered, and he frequently went into what aides described as “rages”. Unable to marshal his thoughts and too tired to respond forcefully to the arguments of the Allied leaders, he conceded points which he went to Europe determined to defend. He remained ill for several weeks. More than one biographer wrote his health never fully recovered from the illness in Paris. The resulting harshness of the Treaty of Versailles fed German nationalism and the rise of Adolf Hitler and the Nazi Party.

5. San Francisco ordered its citizens to wear masks

The Governor of California announced that wearing masks provided protection against the spread of Spanish Flu. The Governor, William Stephenson, described wearing masks as a “patriotic duty” though he took no steps to make them mandatory. San Francisco did. The city enacted an ordinance which made appearing in public without a mask “disturbing the peace” and liable to arrest and a fine of $5 (about $86 in 2020). San Francisco suffered considerably lower rates of infection during the early waves of the flu, though the masks offered little protection against the flu virus. Nonetheless, city officials touted their success.

Like St. Louis, San Francisco took early and aggressive action to control the spread of the virus by closing the schools, and banning large gatherings of people. Places are defined as “public amusements” closed by order of the city. The city also placed nearby military installations and ships in the bay under strict quarantine, with the cooperation of military authorities. During the second wave in the fall of 1918, San Francisco managed to control the rate of illness suffered by its citizens. On November 21, the city literally sounded the all-clear, alerting the citizens they could remove their masks and return to normal life by steam whistles. It proved to be premature, and the faith in masks was misplaced.

6. The sickness came in waves

The Spanish flu arrived in the United States in a series of waves, the first in the late winter and spring in 1918, the second in the late summer of that year, and the third wave in January, 1919. For most American cities and communities the worst wave was the second. Not so San Francisco. When the third wave hit the city its business leaders cited the government’s claims that masks had prevented the virus from spreading during the preceding event. Government and health care officials claimed the masks were 99% effective during the second wave. Business leaders argued against social distancing, and kept businesses and schools open during the crucial early days of the third wave. The result was devastating.

The third wave experienced by San Francisco erased the successes it achieved in combating the earlier attacks of Spanish flu. By the time it ended, the loss of life in the city had reached the levels of the hardest hit eastern cities. For the rest of the country, the third wave was comparatively light, with most areas reacting in accordance with the lessons learned during previous attacks. At the time of the Spanish flu attacks in the late summer and the ensuing winter, shortages of medical personnel caused by the war coupled with the false belief in the effectiveness of available masks. Driven by the desire of businesses to remain open, the third wave for San Francisco was the worst of the three.

7. October, 1918

During the month of October, 1918, news from the Western Front in Europe both exhilarated and concerned Americans. US troops heavily engaged the Germans in France, in many cases turning the tide of battle in favor of the Allies. But it was at a heavy cost. Wartime censorship could not completely quell the news of heavy loss of life in the trenches and skies above them. Until the late summer of 1918 American combat losses were light. The autumn months saw them rise during the late war offensives against the Germans. The month of October saw about 25,000 American troops killed during the Meuse-Argonne Offensive, which continued up to the day of the armistice, November 11, 1918.

During the same month of October, 200,000 Americans died of the Spanish Flu and the complications it caused in the United States. As of this writing, it remains the deadliest month in American history. Across the country, bans against public gathering meant no funerals. There were shortages of caskets, graves, and the diggers to excavate them. Bodies were held in storage; in some homes covered in ice and left in the bed in which they had died. In Philadelphia, a streetcar manufacturer was ordered by the city to build plain wooden boxes in which to bury the city’s deceased, and city employees were assigned to dig graves. During October, 1918, the rate in Philadelphia alone reached 1,000 per day, devastating families and overwhelming the city’s ability to cope with the crisis.

8. Spanish Flu did not originate in Spain

In the late 1990s and early 2000s, a theory emerged that the Spanish Flu originated in a military encampment in the United States in 1918. The theory did not take into account the existence of the virus in Europe before then. Wartime censorship prevented correspondents from reporting the virulence of the flu which struck military marshaling camps in northern France. Wartime censorship did not affect neutral Spain, where the flu appeared in late 1917, and reports of its rapid spread and formidable nature led to it being called the Spanish Flu. Although reports of the illness in Spain appeared around the world, the belligerents in the war kept the ravages of the disease a wartime secret.

With little in the way of acceptable treatment of the symptoms, doctors around the world turned to aspirin, a medicine-first marketed (and patented) by Bayer in 1899. In 1917 the patents expired, and other chemical companies were free to market the drug. In the United States, the Surgeon General recommended liberal doses of aspirin to treat the symptoms, and doctors throughout the country recommended doses of up to 30 grams per day. Today more than 4 grams per day is considered toxic. Aspirin poisoning causes the buildup of fluid in the lungs, one of the prime causes people would succumb to the illness during the crisis. Another common symptom of the Spanish Flu, hyperventilation, is also caused by aspirin poisoning.

9. Public misinformation and rumor was rampant

As the first wave of Spanish flu swept through the United States medical professionals considered it no worse than the usual seasonal flu which America dealt with every year. The second wave, which presented the unusual aspect of killing the young and healthy in their prime, changed America’s attitude. Rumors swept the country regarding the disease and its cause. One claimed that German U-Boats released clouds of gas carrying the virus off the American East Coast. The gas swept ashore, infecting cities, and was then carried inland by the railroads which carried American citizens and commerce.

Another rumor, which gained credence during the anti-German hysteria prevalent in America’s cities claimed the nation’s supply of aspirin was tainted. Aspirin was invented by Bayer, a German company, which held a monopoly on the drug until the patents expired in 1917. According to the rumor, the drugs manufactured and sold in America were deliberately poisoned by the company. Aspirin did contribute to the loss of life, due to it being taken at toxic levels at the recommendation of medical professionals. Still another rumor had the Germans using poison gas on the Western Front to distribute the virus among Allied troops.

10. New York took contradicting measures to combat the numbers

The City of New York was hard hit by the second and third waves of the virus in 1918 and 1919. The city responded in ways that appeared confused and contradictory. Public schools were told to remain open, with the argument presented that school nurses rendered them safer for children than isolation at home. New York’s Health Commissioner, Royal Copeland, ran a concerted campaign to inform the citizens of the city of the dangers posed by the flu, and the behavior which minimized risk. The citizens of the nation’s most densely packed city were told to avoid crowds. Copeland convinced the business community to stagger shifts, reducing the congestion on the subways and commuter trains.

Workdays were staggered by industry, with retail outlets ordered to open at 8 AM, offices, at 8.30, and so on, with closing times similarly adjusted. Copeland did not order the closing of New York’s theaters and public spaces, though he did distribute leaflets warning against the dangers inherent with attendance. He used the Boy Scouts to distribute them, as well as cards warning of violations of the health code, recently enacted, making spitting on the streets a crime punishable by fine. Copeland’s actions were in line with those of federal officials and experts, who widely regarded the flu as no different than other years’ until the immensity of the second wave overwhelmed the public health systems across the country.

11. Cincinnati took early steps to control the spread of the flu

Health officials in Cincinnati took note of the rapid spread of the flu down the East Coast from Boston in late September, 1918, and initiated steps to protect the citizens of the city. On October 3 its Health Commissioner, William Peters, banned non-essential hospital visits. The city closed schools, theaters, parks, churches, and initiated a ban on public and private meetings. Sunday schools were closed despite the protests of the large Catholic community in the city. The city allowed one major industry to remain open. Saloons, taverns, and brewery taprooms remained open for business, though alcohol purchased was carry-out only. On premises consumption was banned.

By October 15 the city’s fatality rate from the flu skyrocketed. Peters contracted the flu, though he recovered. At least 1,700 Cincinnati citizens were not so lucky. Resentment against the city’s large German population festered, and acts of violence against German businesses and churches occurred. On Armistice Day, Cincinnati reopened businesses and schools, and another sharp increase in cases struck the city’s children. The city banned children from stores, theaters, streetcars, and parks. The schools again closed, and remained so until just after Christmas, following a drop in new cases. By January, 1919, the worst was over in the city.

12. Camp Devens and Boston

On September 5, 1917, the US Army established Camp Devens, near Boston, to process and train American troops prior to their deployment to the Western Front in Europe. The site was selected due to its proximity to the Port of Boston. One year later the crowded camp was hit by the Spanish Flu, which arrived in Boston by ship. In September 1918, about 15,000 soldiers at the camp contracted the virus. A doctor testified to the tragic end of many flu patients as “simply a struggle for air until they suffocate. It is horrible”. In Boston, Chelsea Naval Hospital found itself overwhelmed by sailors, who likely contracted the disease in receiving barracks and ships.

The flu which first appeared in the military facilities in August spread to the city itself in September, overwhelming the unprepared health care system. More than 1,000 Bostonians died of the flu in September alone. From the city, it spread to other eastern ports, carried by ships and trains to Rhode Island, New York, Pennsylvania, New Jersey and Virginia. The city worked with the military to erect a tent hospital on Corey Hill. By the end of September, public schools were ordered closed, and the city recruited teachers to serve as temporary nurses. Boston shut down businesses and places of entertainment on September 26. On October 2, 1918, the Massachusetts Department of Health made influenza a reportable disease, making the Commonwealth one of the first in the nation to do so.

13. The business community largely opposed shutdowns

Across the nation in 1918, Americans relied on bakers for their daily bread, butchers for meat, and grocers for their food needs. Home refrigeration was scarce and primitive. There existed relatively little entertainment within the home compared to a later day. Limited knowledge of how contagion spread dominated, with the widespread belief that the illness was carried through the air, rather than it also being spread by contact with surfaces. The belief led the business community to push for protection through wearing masks, themselves primitive and of little use. The business communities found allies in the general public, which did not want to stay at home.

In communities where saloons and taverns were closed, men went to them anyway, hidden in backrooms or simply behind closed and locked doors. Barbers continued to give haircuts and shaves, at a time when sterilizing razors and scissors between customers was unknown. Bakers and butchers continued to serve customers using unwashed hands. People huddled together on crowded conveyances, carrying the flu to previously uninfected areas. Nurses visited hundreds of sick per day, then stopped at businesses on their way home to pick up what they needed. In cities where a crackdown on businesses violating closure orders occurred, police forces found their ranks depleted by officers contracting the virus as they attempted to force compliance.

14. Government response to the Spanish Flu was haphazard

In 1918 there existed no Centers for Disease Control; no National Institute of Health; no Department of Health and Human Services. The response to the spreading virus relied on state and local officials. In some cities, public health commissions were in the hands of doctors, while in others they were politically appointed sinecures. Few in the United States were prepared for the virulence of the Spanish flu. Flu was a common event in the United States, arriving in most of the country in the fall and declining the following spring. Some years presented outbreaks worse than others. In most states, flu was not a reportable illness, with doctors required to notify state authorities of diagnosed cases.

The Spanish Flu changed that for all time. State and federal health agencies tracked flu in the United States ever since, as a result of the three major waves of the Spanish Flu in 1918-19. The health agencies of the time had little in the way of fighting and tracking the virus as it spread, and at any rate, it spread too rapidly, and killed too quickly, for the efforts to have much effect. The overwhelming national response was to isolate those with symptoms from the rest of the population, either in their homes or in hospitals and temporary wards. Newspapers often scorned the efforts of health officials and local governments, siding with the business community which described the scourge as just another form of the flu.

15. The Armistice exposed the crisis in Europe

Following the Armistice on November 11, 1918, censorship of newspapers did not immediately cease. It did ease, however, and reporters who had written of the flu in Spain learned of its extent in France, Great Britain, and throughout the British Empire. Its extent in the German sides of the trenches exposed itself, from German prisoners and civilians. In the first and second waves, the flu ravaged the troops on the front lines, in the support trenches, and throughout the logistics trails. Railroads and other supply systems, disrupted by absences caused by the flu could no longer support the German Army in the last few weeks of the war.

The widespread nature of the disease in Europe was reported in America, though few Americans paid much attention, too concerned with their own plight to worry about the recently defeated enemy. In Great Britain and Canada, the disease spread faster than attempts to contain it could be established. Throughout the European continent, hunger and malnutrition made the survivors of the war more susceptible to the illness, and more likely to die from its symptoms. No person was immune. At the Versailles Conference, in addition to American President Woodrow Wilson, the British Prime Minister, David Lloyd George, contracted the flu. So did Georges Clemenceau of France, and Johannes Ball, who represented Germany.

16. Changes to American society

Prior to the outbreak of the Spanish Flu in the United States, urban decorative water fountains often served as drinking fountains, equipped with metal cups on chains. Those desirous of hydration shared the common cups. Following the Spanish flu, they vanished, never to be seen again in American cities. Ladles near wells and water pumps, once common, also faded from American life. American healthcare professionals were joined by their British and French counterparts informing their populations to avoid undue fatigue, and to wear adequate clothing to prevent becoming chilled. The role of nutrition in preventing illness was not yet known. The impact of the flu on communities prone to chronic hunger was observed and reported in the United States and Europe.

Flu epidemics before and after 1918, into the 21^st century, killed annually, though the victims who died were usually among the elderly, the very young, and those with pre-existing conditions. The Spanish flu claimed those among its victims, but it also killed a large number of healthy individuals between the ages of 20 and forty. More than half the American men who died in Europe during World War I were in that category, victims of the flu rather than German guns. Thousands more died in the mustering and training camps before being sent to Europe, and in the receiving ships and hospitals of the Navy and Coast Guard.

17. The American public erased the flu from its collective memory

After the Spanish Flu returned in late 1919, and in early 2020, it vanished. In the United States and across Europe, it became associated with the horrors of the Great War, and much like that horrid conflict, largely forgotten. Both were later surpassed by yet another horrid war, which erased the name Great War and designated it as World War I. The lessons of the outbreak of 1918-20 faded as well. The need for isolation of the sick was never part of the American psyche, whether the illness was flu or the common cold. Throughout the United States, the idea of missing work due to either became anathema. It simply wasn’t done.

Staying home when ill, and thus protecting the public from the transmission of whatever illness one was suffering, was frowned upon by employers. Employees without the protection of medical time off, which became known as sick days, often could not afford to miss work, the financial penalties were too stiff. One aspect of the Spanish flu which has proven difficult to study was the number of people who transmitted the virus without falling ill, or fell ill with comparatively mild symptoms. From the 1930s on, nostrums which eased the symptoms of flu and colds encouraged people to go on about their daily business while clearly still contagious, a habit ingrained in American life in the 21^st century.

18. The Spanish Flu killed the rich and famous

One of the enduring names of the American automobile industry – Dodge – was the surname of two brothers who founded the company, John and Horace Dodge. Both died of complications from Spanish Flu. Rose Cleveland, sister of former American President Grover Cleveland, died of the flu on November 22, 1918. Austrian artist Gustav Klimt succumbed during the third wave in 1919. Walt Disney contracted the illness and survived, as did the King of Spain, Alphonse XIII. Franklin Delano Roosevelt contracted the flu while serving as Assistant Secretary of the Navy.

General John J. Pershing was stricken by the flu, though he too survived. Another survivor of the second wave was Amelia Earhart, who served as a nurse among Canadian troops suffering from the flu near Toronto. Earhart was sickened, developed pneumonia, and nearly died. After she recovered she required surgery for sinus problems caused by the flu, which recurred for the rest of her life, causing her considerable discomfort on many of her famous flights. Yet another who contracted the flu and survived was the German Kaiser, Wilhelm II, who abdicated his throne at the end of the First World War.

19. The American government downplayed the flu

As the Spanish flu emerged in America, the federal government downplayed the danger. President Wilson and his administration stressed the need for Americans to support the war effort, especially during the first wave. Information regarding the dangers from the flu, already suppressed by wartime censorship, remained sketchy. State and local officials faced the rising numbers of ill and dying with little to no federal support. Even those already ill were urged to report to work, and those who chose to remain at home were belittled for their lack of patriotic duty. Woodrow Wilson, President of the United States, did not address the issue of the sickness ravaging the country. He simply said nothing.

His government, determined to maintain war production and the strength of the American economy, urged Americans to report to work. Across the country efforts to control the crisis by local authorities drew the disparagement of the federal government where it affected war production. The absence of national leadership gave rise to con men posing as medical experts, offering cures for the flu. One such huckster, Franklin Duane, who claimed to be a medical doctor, offered pills he called “Dr. Pierce’s Pleasant Pellets”. Along with the pills, Duane suggested a positive attitude offered protection against the flu. He was but one of many who profited from the tragedy, while the federal government did nothing to prevent the sale of placebos offered as “cures”.

20. The press downplayed the Spanish Flu

The most volatile period of the Spanish Flu, the second wave during the autumn of 1918, coincided with the peak of American combat involvement during the First World War. The press ignored the virus in favor of war coverage. On October 3, 1918 – a Thursday – 191 people died in Boston, according to the records of the Boston Globe. The total appeared on the newspaper’s front page the following morning, framed by two stories about the war, both of which featured much larger typeface, and both of which contained the inflammatory reference to the Germans popular at the time. They referred to them as “Huns”. The story about the casualties in Boston said that nearly 200 persons had died of the “grippe”.

The Boston newspapers printed Friday, October 4, 1918, reported little regarding the crisis beyond the existence of the seasonal flu. The Boston Post reported, “Health authorities are encouraged that the increase is but a small one”, in reference to the number of deceased the preceding day. Instead, several newspapers in the flu-stricken city-focused their attention on the Boston community’s failure to meet its goals in the sale of Liberty Bonds to support the war. Another story in the Boston Globe reported the governor of Massachusetts’ request to the federal government to cancel the ban on driving automobiles on Sunday (a wartime savings measure). In his plea, Governor Samuel McCall referenced the flu, and claimed driving in fresh air would help citizens, because “fresh air and sunshine will enable them to better fight the grippe”.

21. Average Americans didn’t know of the illness until it reached their community

The American people were less informed in 1918. Most of what they knew about world events and social situations came from the gossip of their neighbors and the content of their local newspapers. There was no 24-hour news cycle, no daily press conferences from national leaders, nor even local authorities. Philadelphia’s problems were of little concern to residents of Cleveland. The flu was a seasonal event, best handled locally by doctors and nurses. Locals had tried and true methods of combating it, which were used every flu season as they had been for generations.

When the flu struck it was a local event in the eyes of most Americans, not another step in a global battle. Its severity was stunning, and many communities experienced a backlash against the local authorities’ failure to contain it, but they were short-lived. One of the most memorable factors of the Spanish Influenza is that it was almost completely forgotten. Newspapers reported it as it occurred and ignored it after it was over in their area. The global impact of the Spanish Flu all but vanished from the record. It became a forgotten disaster, unworthy of mention as just another bout of the flu which occurred during wartime. The 50 million losses became part of the casualties of the First World War.

22. The US government made truth a victim

In 1917 the Wilson Administration created the Committee for Public Information. Its purpose was to monitor all information made available to the public regarding the conduct of the war, and the activities of the federal government. It was headed by George Creel, and became known as the Creel Committee. Creel believed that there existed little difference between telling the truth and outright lying to the public, as long as the desired ends were achieved. The Creel Committee decided what could and could not be reported to the American public about the war, both overseas and in the effort to support it at home. Under emergency measures rammed through Congress by the Wilson Administration, violating the strictures of the Creel Committee became sedition.

The federal government made a little comment regarding the flu, leaving its control to the several states, which for the most part allowed municipal and county governments to lead the fight against the silent threat. Wilson’s government did encourage Americans to continue to work, to increase production, and to participate in Liberty Bond drives and rallies. The government also supported recruiting rallies. It was aware of the high rate of infection at military bases and aboard ships, and deliberately censored the reporting of such information in the communities which supported them. For the federal government, this catastrophe was treated simply as a rendition of the seasonal flu.

23. The American economy recovered quickly

Because the shutdowns of businesses across the country were sporadic and staggered, the overall economy suffered little during the Spanish Flu, at least in the United States. The brief economic downturn which marked the beginning of the 1920s affected returning servicemen, but within a few months, American industry produced consumer goods at previously unforeseen levels. About 875,000 Americans died from the Spanish Flu, more than 12 times the fatalities suffered by the American military during the World War. The average life expectancy for Americans dropped by about ten years. The economy barely faltered.

Prior to these events of 1918, America suffered numerous epidemics of dangerous diseases, including other bouts with influenza. Following this tragedy, other diseases continued to claim American lives annually, including tuberculosis, polio, cholera, yellow fever, scarlet fever, measles, malaria, and others. The Spanish Flu rapidly became part of the past, to the point it earned the sobriquet of the forgotten flu. The manner in which it appeared and swept the country remained hidden to the general public until recent events brought it back to the forefront of public attention. A century after this grim chapter in history, Americans again find themselves urged to self-isolate and avoid crowds. At the same time, some Americans claim that we have never faced anything like the current situation before. They are wrong.

24. The lesson of the Spanish flu

The Spanish flu struck the United States as the nation was reaching its peak of mobilization during the First World War. Railroads teemed with relocating troops, harbors and ports were crowded with ships and sailors. Factories operated at full capacity. At the time flu was not known to be a virus, transmission by contact with contaminated surfaces had not been identified. In other words, it was a mysterious and previously unknown illness, which struck far more viciously than previously seen strands of seasonal flu. Americans at all levels were completely unprepared for its virulence, and watched with stunned helplessness as it killed seemingly at random.

Since these events, vaccines for flu and medicines to mitigate its symptoms appeared, both through prescriptions and over-the-counter compounds. Meanwhile, new strands of the flu continue to appear, as well as other viruses and illnesses which could easily reach these out of control proportions if the public is not informed of their existence and their propensity to spread. Medical knowledge advanced immensely in the century since the flu of 1918. That year and around the world into 1920, a respiratory illness caused by a novel virus claimed millions worldwide, while leaders suppressed knowledge of its existence. Some even opposed efforts to contain it out of financial and political concerns. Nothing more dramatically demonstrates the need to learn from history.

Where do we find this stuff? Here are our sources:

Aaron Kassraie, AARP. March 20, 2020. Online

“How U. S. Cities Tried to Halt the Spread of the 1918 Spanish Flu”. Dave Roos, History.com. March 11, 2020

Dr. Carol R. Byerly, Public Health Reports, National Institute of Health. 2010. Online

Article, US Centers for Disease Control. Online

Christopher Klein, History.com. October 5, 2018

“The Flu in San Francisco”. Article, The American Experience. PBS. Online

“2 cities handled this health crisis different. The results couldn’t have been more opposite”. Report, St. Louis. ClickOrlando Online

Dave Roos, History.com. March 3, 2020

Andrew Rettman, EU Observer. March 30, 2020

Mike Wallace, The New York Times. March 20, 2020

“Cincinnati, Ohio”. Article, Influenza Encyclopedia. Online

Jack Lepiarz, WBUR, Boston. March 11, 2020

Dr. Nancy Tomes, Public Health Reports, National Institutes of Health. Online

Paul Ratner, Big Think. March 7, 2020

Gary Finnegan, Vaccines Today. October 24, 2018

Martin Kettle, The Guardian. May 25, 2018

“Rampant Lies, Fake Cures and Not Enough Beds; What the Spanish Flu Debacle Can Teach Us About Coronavirus”. Joshua Zeitz, Politico. March 17, 2020

Walter Shapiro, New Republic. March 31, 2020

Gina Kolata. 1999