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Laboratory Leaders

For our Laboratory Leaders feature, we’re taking a break from the Power Teams
series we started in Q3 2018 to bring you a story from the 1918/1919 influenza
pandemic that killed more people in the United States than all the wars of the
20th century combined. This is the tale of two cities that had very different
outcomes because of their use of --and failure to use --social distancing:
St. Louis, Missouri and Philadelphia, Pennsylvania.

O ften cited as the most devastating epidemic in recorded world history, the 1918/1919 influenza pandemic killed more people

than World War I. By many estimates, the death toll varies widely between a staggering 20 and 40 million people—and perhaps
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even as high as 50 million . During this pandemic, more people died of influenza in a single year than in four years of the Bubonic
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Plague from 1347 to 1351. Also known as the Spanish Flu , the 1918/1919 influenza pandemic was a global disaster.
Caused by an H1N1 virus with genes of avian origin, the true source of this pandemic remains a mystery. Although we still don’t have
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universal consensus regarding where the virus originated , it spread around the globe in three separate waves from 1918 to 1919 as
WWI was winding down. In the United States, it was first identified in military personnel at Fort Riley, Kansas, in the spring of 1918.
It’s estimated that approximately 500 million people (one-third of the world’s population at that time) became infected with this virus.
The actual worldwide death toll is still unknown; however, about 675,000 occurred in the United States alone—many times the number
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of Americans who died in WWI and more than were killed in all of the wars of the 20th century, combined .
A tale of two cities

The ways in which city officials responded to this pandemic Despite dire warnings from local physicians and infectious
played a major role in the death toll. The devastating second disease experts, when the first few civilian cases were reported
wave of the pandemic arrived on America’s shores in late summer on September 21, Krusen and his medical board responded that
1918 carried by military personnel returning home from Europe, Philadelphians could lower their risk of infection simply by staying
spreading first from the Atlantic coast in Boston to New York City warm and keeping their feet dry. Civilian infection rates continued
and Philadelphia before making a westward migration to infect to climb exponentially daily, but Krusen refused to cancel the
terrified citizens from the heartland in St. Louis, to the Pacific Liberty Loan parade that was scheduled for September 28.
coast in San Francisco. There was no vaccine, and there was He downplayed the danger of spreading the disease, insisting
little to no guidance, so mayors and city health officials had to that the parade must go on because it would raise millions of
figure out what to do—from requiring citizens to wear gauze face dollars in war bonds.
masks, to deciding whether to close schools and ban all public
gatherings, to risking the shutdown of the country’s financial On September 28, a patriotic procession of soldiers, Boy Scouts,
centers during the final days of the war. marching bands, and local dignitaries stretched two miles through
downtown Philadelphia, the sidewalks packed with spectators.
Many U.S. cities fared far worse than others, and looking at Approximately 200,000 people attended the parade.
the evidence through the clear eyes of history shows that the Although the city’s infection rate was already climbing by late
earliest and most well-organized responses played a crucial September, Krusen’s decision to not cancel or postpone the
role in slowing the disease spread—at least temporarily— parade, was like throwing gasoline on a fire. Just 72 hours after
while cities that were slow to act paid a heavier price. the parade, all 31 of Philadelphia’s hospitals were full and 2,600
Nowhere is this disparity clearer than in the stories of two people had died by the end of the week.
cities: Philadelphia, Pennsylvania and St. Louis, Missouri.
St. Louis flattens the infection curve
Philadelphia’s Liberty Loan Parade In October 1918, the public health response in St. Louis
By mid-September 1918, the pandemic was spreading like was completely different—thanks to Health Commissioner,
wildfire through army and naval installations in Philadelphia; Max Starkloff, M.D., whose actions are credited as being
however, the city’s public health director, Wilmer Krusen, an early instance in the modern medical practice of
assured the public that the soldiers were only suffering social distancing.
from the seasonal flu that would be contained before
infecting the civilian population.

SCC Quarterly | Volume 6 • Issue 1 | Laboratory Leaders