The United States and the 1918-1919 Pandemic: A Comparative Essay

The influenza pandemic of 1918-1919 was one of the most significant events in human history. The pandemic likely altered the course of the twentieth century. The pandemic is estimated to have killed 50 million people worldwide. The disease spread throughout the entire world and may have infected one-third of the worldwide population. The disease had four devastating waves, the second wave being the most lethal. The responses to the virus varied from country to country and sometimes from city to city. The United States had one of the highest death tolls of any country at 600,000 people and was one of the most documented countries on the response to the virus and the effects the pandemic had. This essay will make a historical comparative analysis of the way in which the United States was affected by and responded to the pandemic by comparing a broad perspective of the United States and China and a narrow perspective of Oakland, California and Victoria, Australia. 

To begin, let us compare the United States’ and China’s pandemic responses and the effects the pandemic had on the population. In 1918, China’s population was circa 395.2 million[1] and dwarfed the United States population of 103.2 million. Even with almost a quarter of the population of China, the United States suffered far worse than China. As stated earlier, the United States suffered about 675,000 deaths to the virus. In China, documents related to the pandemic are sparse, but, according to K.F Cheng and P.C. Leung from the International Society for Infectious Diseases, 2,457 people died to influenza in 1918-20.[2] Historians are still unsure why China was spared from the disease as the rest of the world was getting hit very hard. On either side of China, India and Japan had many infections and death during the pandemic in the hundreds of thousands, it is almost as if the virus skipped over China. Historians are still debating the cause of this. National Geographic reported in 2014 that “Historians say”[3] the virus originated in China. If this were true it is possible that “many people in China had had some previous exposure to the virus and so had obtained some degree of immunity.”[4] There is some evidence to back up this claim, however it is still disputed where the H1N1 influenza virus originated. It is important to remember that the United States was involved in many world affairs at the time, including World War I. China, meanwhile, was relatively contained with the exception of migrant workers that left the country to work in Canada and the United States. 

The way the two nations focused their efforts to stop the pandemic are quite different. Research on the response by the Chinese government is difficult because there is not a lot of literature on the matter. Additionally, Chinese cities such as Hong Kong were heavily influenced with Western culture. The Chinese did not keep a lot of records on the pandemic, especially in rural areas. The death toll previously mentioned was the combination of Shanghai and Hong Kong of the course of three years. Some scholars, such as Cheng and Leung, have theorized that traditional Chinese medicine may have played a significant role in the low morality rate in China. In other words, perhaps the infection rate in China was significant but the death rate was not as high as other countries such as the United States. Traditional Chinese medicine was widely used during the 1918 pandemic, even in Shanghai and Hong Kong. Chinese medicine such as mahuang xingren shigao had been used to fight off epidemics since the Han Dynasty (206 B.C. to 220 A.D.).[5]-[6] In other words, this theory may not be too hard to imagine. Western powers such as the United States attacked the virus with Western medicine and practices such as social distancing and mask wearing, but the United States had a haphazard response to the pandemic. Although, literature from local, state, and federal agencies echoed each other on the importance of masks, social distancing, and the sick staying home, there was resistance from the populace, and it was difficult for the government to enforce mandates. Additionally, the United States had many different responses to the virus—there was no single large-scale national response. State governments and local municipalities controlled their own responses to the virus. For example, Columbus, Ohio closed their schools for 11 weeks while New York City and Chicago never closed their schools.[7] Many cities around the United States implemented mask mandates, but there was a lot of resistance to the mandates such as the Anti-mask League in California. The lack of a nationwide response in the United States may have been a factor that continued the spread of the virus. While it is a stretch to call traditional Chinese medicine China’s national response, China had a more uniform response than the United States. Comparing the United States’ and China’s response to the pandemic is difficult because of the lack of sources from China. Comparing Oakland, California of the United States to another Western power such as Victoria, Australia will highlight some of the successes and failures will shed light on the effectiveness of at least one American city.

Oakland, California and Victoria, Australia had very similar effects and responses to the pandemic; the differences between the two will be discussed shortly. Oakland’s and Victoria’s local governments issued proclamations after their cities became plagued with the virus. Both proclamations were disseminated by their respective health departments. Both cities were slow to respond to the virus. Victoria issued its public health proclamation on November 23, 1918. Oakland issued its proclamation in late 1918. Both cities issued mask mandates when handling patients. The two proclamations had similar language regarding patients being kept in rooms with open windows. The Victorian bulletin says, “Air and light should freely enter the room.”[8] The Oakland directive states, “Open your windows at night.”[9] This was important because the ill needed fresh air due to their lungs being damaged from the virus. One of the most important directives from both cities was to stay away from crowds and to walk everywhere if possible. Oakland addressed workers directly stating, “Walk to work if possible. Avoid the person who coughs or sneezes.”[10] Victoria’s directive informed people to “avoid crowds; be in the open air as much as possible.”[11] An additional similarity is both documents inform the reader of the symptoms that are experienced due to influenza. Victoria’s Board of Public Health and California’s State Board of Health state symptoms such as a “sudden chill,” body aches, weakness of the body, and fever.[12] Victoria, however, lists other symptoms that the Oakland proclamation does not such as vomiting and diarrhea, symptoms of acute mania, and delirium tremens.[13] Next, we will explore some of the differences between the two proclamations.

Victoria and Oakland differed in the language used in the proclamations. For example, Victoria’s Secretary of Public Health, T.W.H. Holmes “issued a detailed set of directives to the public informing them of the symptoms, treatment, spread, and prevention of influenza.”[14] This is different than Oakland’s that focuses on “What to Do until the Doctor Comes!”[15] Oakland’s directive at the beginning details what a person should do if they or a person related to them comes down with the flu. Then, the directive gives prevention methods to householders, workers and nurses. Compare that to Victoria’s directive that speaks more broadly to the entire population. California attempted to guilt people into taking care of themselves and other people by saying, “If you follow the dictates of this official bulletin, you will be doing your duty to your fellow man and to yourself.”[16] Victoria’s mandate was a legal document. Under the “legal obligation” section of Victoria’s mandate it states, “any person who fails to comply with the foregoing regulations, or is guilty of any neglect or disobedience thereof, is liable to a penalty of” twenty pounds.[17] Where Victoria’s directive was more legal binding it did not give a directive on what to do with soiled masks and garments. Oakland’s directive was very specific in saying that after handling the sick the masks “must be boiled five minutes and thoroughly dried every time they are taken off.”[18] We see the initial response the pandemic had some similarities and differences. Let us now examine the results of the pandemic on the two cities. 

Although most of the practices and measure taken by both cities were similar the results of the pandemic were quite different. The population of Oakland and Victoria in 1918 were 216,000[19] and 1,430,667[20] and the death toll was greater than 140019 and 3561[21] respectively.  Per capita, Victoria had far few deaths than Oakland. While Victoria’s number of total deaths was higher the population was far greater. Oakland’s deaths per capita was 648 compared to Victoria’s 248 per capita death rate. There are many reasons why this could be the case. It is possible that the legal mandates in Victoria’s proclamation were enforced and people respected the law. Oakland’s proclamation was not legally binding. It is possible that people did not walk to work as the directive instructed or that the use of handkerchiefs was not as widespread as it was in Victoria. It is possible that the information in the order from Holmes in Victoria was more detailed about how the virus spread thus leading to a more informed public. Victoria’s government ordered “no person suffering from symptoms of influenza shall enter any public building or place where persons are congregated.”[22]Oakland did not give such a direct order, but instead gave recommendations. In the total number of deaths, Victoria suffered greater losses, but taking into account the population of both cities, Oakland faired much worse. 

The 1918-1919 pandemic was one of the worst events in human history. The international death toll is estimated to be 50 million people. The disease infected more than one-third of the global population. The responses to the pandemic varied widely from country to country. The United States was one of hardest hit countries with more than 600,000 deaths. This paper sought to examine broad perspective by exploring the differences between China and the United States (the East and the West) and a narrower perspective by exploring two Western cities, Oakland and Victoria. Traditional Chinese medicine was widely used but cannot be said to be the reason China did not suffer as greatly as the United States. The United States implemented Western medicinal measures that were not used in China such as mask mandates. Oakland faired much worse than Victoria in the number of deaths per capita. The measures taken to control the spread of the virus were similar in ways, but the rhetoric was different. Victoria’s health department sought to educate the reader while implementing legal mandates the populace was to follow. Oakland did not give legal requirements but sought to inform the public and certain groups of people such as workers, householders, and nurses. By comparing the United States and China and Oakland and Victoria, we see that United States did not respond well to the pandemic in relation to other countries and cities around the world. 

‌Footnotes

[1] Yi Xu, Bas van Leeuwen, and Jan Luiten van Zanden, “Urbanization in China, ca. 1100–1900,” Frontiers of Economics in China 13, no. 3 (2018): 322–68, https://doi.org/DOI 10.3868/s060-007-018-0018-9.

[2] K. F. Cheng and P. C. Leung, “What Happened in China during the 1918 Influenza Pandemic?,” International Journal of Infectious Diseases 11, no. 4 (July 1, 2007): 360–364, https://doi.org/10.1016/j.ijid.2006.07.009.

[3] Dan Vergano, “1918 Flu Pandemic That Killed 50 Million Originated in China, Historians Say,” National Geographic News, January 24, 2014, https://www.nationalgeographic.com/news/2014/1/140123-spanish-flu-1918-china-origins-pandemic-science-health/#close.

[4] K. F. Cheng and P. C. Leung, “What Happened in China during the 1918 Influenza Pandemic?,” International Journal of Infectious Diseases 11, no. 4 (July 1, 2007): 360–364, https://doi.org/10.1016/j.ijid.2006.07.009.

[5] K. F. Cheng and P. C. Leung, “What Happened in China during the 1918 Influenza Pandemic?,”

[6] History.com Editors, “Han Dynasty,” HISTORY, August 21, 2018, https://www.history.com/topics/ancient-china/han-dynasty.

[7] Alexandra M. Stern, Martin S. Cetron, and Howard Markel, “Closing The Schools: Lessons From The 1918–19 U.S. Influenza Pandemic,” Health Affairs 28, no. Supplement 1 (January 2009): w1066–78, https://doi.org/10.1377/hlthaff.28.6.w1066.

[8] Susan Kingsley Kent, The Influenza Pandemic of 1918-1919 : A Brief History with Documents (Boston: Bedford/St. Martin’s, 2013) 69.

[9] Susan Kingsley Kent, The Influenza Pandemic of 1918-1919, 75.

[10] Kent, 76.

[11] Kent, 69.

[12] Kent, 68 and 75.

[13] Kent, 68-69. 

[14] Kent, 68.

[15] Kent, 75.

[16] Kent, 75.

[17] Kent, 70.

[18] Kent, 75-77.

[19] “1918 Flu Pandemic - Oakland - LocalWiki,” localwiki.org, accessed November 22, 2020, https://localwiki.org/oakland/1918_Flu_Pandemic.

[20] “Fast Facts,” Anzac Centenary Victorian Government, accessed November 22, 2020, http://anzaccentenary.vic.gov.au/history/fast-facts/index.html.

[21] “Parliament of Victoria - Epidemics and Pandemics in Victoria: Historical Perspectives,” www.parliament.vic.gov.au, accessed November 22, 2020, https://www.parliament.vic.gov.au/publications/research-papers/download/36-research-papers/13957-epidemics-and-pandemics-in-victoria-historical-perspectives.

[22]  Susan Kingsley Kent, The Influenza Pandemic of 1918-1919 : A Brief History with Documents (Boston: Bedford/St. Martin’s, 2013) 70.

Bibliography

“1918 Flu Pandemic - Oakland - LocalWiki.” localwiki.org. Accessed November 22, 2020. https://localwiki.org/oakland/1918_Flu_Pandemic.

Cheng, K. F., and P. C. Leung. “What Happened in China during the 1918 Influenza Pandemic?” International Journal of Infectious Diseases 11, no. 4 (July 1, 2007): 360–364. https://doi.org/10.1016/j.ijid.2006.07.009.

“Fast Facts.” Anzac Centenary Victorian Government. Accessed November 22, 2020. http://anzaccentenary.vic.gov.au/history/fast-facts/index.html.

History.com Editors. “Han Dynasty.” HISTORY, August 21, 2018. https://www.history.com/topics/ancient-china/han-dynasty.

“Parliament of Victoria - Epidemics and Pandemics in Victoria: Historical Perspectives.” www.parliament.vic.gov.au. Accessed November 22, 2020. https://www.parliament.vic.gov.au/publications/research-papers/download/36-research-papers/13957-epidemics-and-pandemics-in-victoria-historical-perspectives.

Stern, Alexandra M., Martin S. Cetron, and Howard Markel. “Closing The Schools: Lessons From The 1918–19 U.S. Influenza Pandemic.” Health Affairs 28, no. Supplement 1 (January 2009): w1066–78. https://doi.org/10.1377/hlthaff.28.6.w1066.

Susan Kingsley Kent. The Influenza Pandemic of 1918-1919 : A Brief History with Documents. Boston: Bedford/St. Martin’s, 2013.

Vergano, Dan. “1918 Flu Pandemic That Killed 50 Million Originated in China, Historians Say.” National Geographic News, January 24, 2014. https://www.nationalgeographic.com/news/2014/1/140123-spanish-flu-1918-china-origins-pandemic-science-health/#close.

Xu, Yi, Bas van Leeuwen, and Jan Luiten van Zanden. “Urbanization in China, ca. 1100–1900.” Frontiers of Economics in China 13, no. 3 (2018): 322–68. https://doi.org/DOI 10.3868/s060-007-018-0018-9.