The current pandemic has rekindled a lot of interest in the 1918 pandemic where the misleadingly labeled Spanish flu killed anywhere between 50 and 100 million people.

As the pandemic reached epic proportions in the fall of 1918, it became commonly known as the “Spanish Flu” or the “Spanish Lady” in the United States and Europe. Many assumed this was because the sickness had originated on the Iberian Peninsula, but the nickname was actually the result of a widespread misunderstanding.

Spain was one of only a few major European countries to remain neutral during World War I. Unlike in the Allied and Central Powers nations, where wartime censors suppressed news of the flu to avoid affecting morale, the Spanish media was free to report on it in gory detail. News of the sickness first made headlines in Madrid in late-May 1918, and coverage only increased after the Spanish King Alfonso XIII came down with a nasty case a week later. Since nations undergoing a media blackout could only read in depth accounts from Spanish news sources, they naturally assumed that the country was the pandemic’s ground zero. The Spanish, meanwhile, believed the virus had spread to them from France, so they took to calling it the “French Flu.”

While it’s unlikely that the “Spanish Flu” originated in Spain, scientists are still unsure of its source. France, China and Britain have all been suggested as the potential birthplace of the virus, as has the United States, where the first known case was reported at a military base in Kansas on March 11, 1918. Researchers have also conducted extensive studies on the remains of victims of the pandemic, but they have yet to discover why the strain that ravaged the world in 1918 was so lethal.

One thing that I had not known is that the first wave of the flu hit in the beginning of 1918, then abated during the middle of the year, and then came back much greater vengeance towards the end of 1918 and continued into 1919, and that most of the deaths occurred during this second phase. Given what we are seeing with the current resurgence following a lull, the possibility of that pattern repeating this time should be very concerning for all of us.

The program Radiolab looked at the question of what happened during and after the 1918 flu. Interestingly, they found that while the flu was raging, the coverage of it in the New York Times was relegated to small items buried in the inner or back pages the paper. Most of the paper was devoted to coverage of World War I. While that was undoubtedly a major event, it must be remembered that the flu was killing people in numbers about five times as many as those dying in the war, so this extreme relegation was surprising. Speculation is that the US government and the media were also deliberately downplaying reporting on the flu in order to keep up enthusiasm for the war effort.

The 71-minute program had five segments.

(You can read the transcript here.)

In the first segment that lasts 23 minutes, it reported on how US president Woodrow Wilson went to Paris in January 1919 to determine the details of the treaty that the allies led by the US, France, and the UK would impose on the surrendering Germany. Wilson wanted to not be too harsh on Germany but France’s leader Georges Clemenceau wanted to severely punish that country. The arguments between the two went on for months (it was interesting to me that Wilson could be away from the country he was the leader of for so long) while the flu raged through Paris, until Wilson became very ill and delirious for about a week. In those days it could not be conclusively determined if it was the flu or not but Wilson had all the symptoms. After he recovered, he was a shadow of his former feisty self and he capitulated to pretty much all of Clemenceau’s demands, causing some of his own aides to resign in protest. What resulted was the Treaty of Versailles that imposed Draconian measures on Germany and is widely blamed for fueling the deep resentment that led to the rise of the Nazis, Adolf Hitler, and World War II.

The second segment that lasts for the next 11 minutes deals with how the flu affected Mohandas (he was later given the honorific of Mahatma) Gandhi’s thinking. India was then a colony of the British and had sent a million soldiers to Europe to fight on behalf of the UK in the war. I had not known that this famous advocate of non-violence had actively recruited Indians to fight in that war, thinking that it would prove to the British that Indians were fighters and give them greater leverage after the war to claim more autonomy and eventually their independence.

But in May 1918, a ship carrying Indian troops returning from fighting in Europe and the Middle East arrived in Mumbai (then Bombay) and they brought with them the flu that quickly began spreading all over India, eventually killing anywhere between 10 and 20 million people in just a few months, with corpses piling up everywhere. This was more than had died globally due to the fighting in World War I and the British colonial government’s response was utterly inadequate.

In August 1918, Gandhi gets sick with all the symptoms of the flu, though again we cannot be absolutely sure, and it lasts for months on end. He gets so sick that by October he thinks he is going to die and this makes him contemplative and philosophical about life and he begins to think that his efforts to get Indians to fight in the war were misguided. After he recovers, he begins his campaign of non-violent resistance to get the British out of India. So in a sense, the Spanish flu laid the seeds of Gandhi’s strategy for how to wage his independence struggle.

The third segment deals with an avante garde artist in Vienna named Egon Schiele who, along with his pregnant wife died of the flu in late 1918. The fourth segment deals with an engineer in Pittsburgh who in late 1919, when the effects of flu and the war were on the decline, used vacuum tubes to transmit voice and music wirelessly. This led people looking for signs of hope after so much death, upon hearing these ethereal voices coming out of the air to think that this could possibly signal that dead people were trying to communicate with them from the afterlife, and led to an explosion of séances and other attempts to speak to the dead.

The last segment begins at the 55-minute mark and goes to the end of the program at the 71-minute mark and was the one I found most fascinating. It dealt with the question: What happened to the 1918 flu virus?

The story begins in 1997 when researchers went to a town in Alaska where large numbers of people had died due to the 1918 flu and been buried in a mass grave. They dug up some bodies that had been preserved in the permafrost and analyzed them using modern technology that can identify the structure of the virus, the same method that enables us now to see the image of the spiky ball that is the current virus. Back in 1918, they had no idea what the virus looked like.

What they found was that the 1918 flu virus was an RNA molecular string made up of eight different segments (genes) that each had a separate function. Even though the pandemic eventually petered out around April 1920, the virus stayed around as a regular seasonal flu, changing a little bit each year. But because people had developed some immunity to it, it was no longer was the vicious killer it had been before. That situation lasted until 1957 when there was a convergence between the descendant of the 1918 flu virus and a new bird virus that also had eight segments. Because of the structural similarity, this enabled mutation by mixing and matching of genes between the two viruses and this process resulted in a new strain of the 1918 flu that had three new genes, two of which made important proteins. These two gene names are abbreviated to H and N so the original 1918 virus is now called the H1N1 virus and the new 1957 one was called H2N2.

In 1968, this virus interacted in a similar manner with another bird virus with a similar structure to create the H3N2 virus. But then in 1977, the H1N1 virus also returned and competed with the H3N2 virus each flu season. The H3N2 virus is still the dominant flu strain that we have. Meanwhile the original H1N1 virus from 1918 had infected pigs and created a different lineage of the virus that caused swine influenza and that virus too evolved similarly through the decades. This combined with the other viruses to create a new strain in 2009. So the current annual flu viruses are built on the backbone of the 1918 virus.

This segment ends with an interview with Anthony Fauci about how the current virus relates to the earlier ones. He says that the virus that causes covid-19 has a fundamentally different structure from the H1N1 strain and does not have the eight different gene segments that allow the mix and match capability of the other flu viruses. So what does he think might happen to this one in the future?

“So I guess the question people are asking, is it conceivable that with this particular coronavirus that we’re gonna see versions of this as the years go by? You can never predict with certainty, but what I think we’ll see over the years is that we will either control it very well with a vaccine, which I do hope is the most likely option, or it will go through a couple of cycles of seasons and then will take its place at a low-level threat. Something that’s present that can be dealt with, that it doesn’t, you know, impact us in a way that it’s impacted now.”

But when asked what he thinks might be the worst-case scenario, he says that we are now living through it.

“Well, I have to tell you the worst-case scenario that keeps me up at night I’m living through right now. A brand new virus that jumps species, infects humans, and has the combined capability of spreading extremely rapidly from human to human at the same time as it has a relatively high degree of morbidity and mortality. And that’s exactly what we’re in right now. Literally, the perfect storm of a pandemic, which is the reason why unlike other pandemics of different years, with the exception of 1918 which has some serious significant similarities, we have an epidemic that has essentially gripped the planet. So this is indeed an unprecedented situation. We’ve not been here before, certainly no one in our generations.”

A fascinating program, especially the first, second, and last segments.