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LEDGER IN-DEPTH

Are these unprecedented times? Not quite. The flu pandemic of 1918-19 killed at least 13,000 in N.C. and offers lessons for today

Several hundred soldiers at Camp Greene, a World War I military training facility off modern-day Wilkinson Boulevard, are believed to have died from influenza in 1918. (Photo courtesy of Charlotte Mecklenburg Library)

by Tony Mecia

Two years ago, Lauren Austin finished her public policy dissertation at UNC Charlotte, around the same time as she started a new job as an academic editor at an editing company.

She didn’t think that much about that dissertation again until early this year, when she started reading about the coronavirus and how it spread out of China and into Italy and Iran.

Then, friends started asking her about her dissertation. By February, Austin says, she felt as though she was living it.

Why? Her 285-page work is called: “Afraid to Breathe: Understanding North Carolina’s Experience of the 1918-1919 Influenza Pandemic at the State, Local, and Individual Levels.”

It’s an exhaustive examination of the effect of the last pandemic, the one that hit a century ago, when North Carolina was a much more rural state and Charlotte’s population was just 1/20th of what it is today.

Now, Austin is acknowledged as probably the top expert on how the previous pandemic affected the Charlotte region and the state. Well-known local historians point to her 2018 dissertation as the most comprehensive local source of information on the 1918-19 flu pandemic.

Pandemic parallels: In an interview with The Ledger this week, Austin said she sees many parallels between today and a century ago: the closed businesses and schools, the quarantines, the boredom that starts to set in and the desire to return to normal.

While many people were caught off guard by the coronavirus, she says she wasn’t really surprised, as pandemics seem to take hold every 100 years or so. As she warned in the conclusion of her dissertation: “We are at once both wholly unprepared and ideally situated for another influenza outbreak.”

Austin, 39, lives in the town of Aberdeen, near Pinehurst. Her remarks are edited for brevity and clarity. Portions of her dissertation are reprinted with her permission.

Q. A lot of people refer to what’s happening with the coronavirus as unprecedented. Is it?

It’s not. It’s very similar to the situation in 1918. Of course, the diseases are different, but from what I’ve seen, I think it’s different or unprecedented only in the era that we are in now, with everything being digital.

As far as the school closures, the business closures, everything like that, it’s very similar. From what I’ve seen, people are reacting very similarly.

Q. How so?

What I found in my research was that initially, when it popped up, it spread so quickly. It was a very new and odd virus. It targeted young adults. People were used to infants and the elderly population being targeted by disease. This was different, and it was scary for a large part of the population.

The immediate reaction was fear. Interestingly, within a couple of weeks, I was finding that the tone had changed. People were talking about how bored they were in quarantine. They almost stopped taking it seriously. They got used to the situation very quickly. A large part of that was due to the government response. The government was sending out mixed messages.

You had health officials saying, “Yes, take it seriously.” They were learning how to do better hand hygiene. They were saying, “Stay home. Don’t interact. Quarantine yourself.” But also, “Go out to vote. You’re safe if you go out to vote.”

They closed schools, but they said it was OK to send the children to the farms for work, because the farmers were all overseas [during World War I].

They got all these mixed messages, and it was hard to figure out which ones were correct.

They were telling people it was bad, but not nearly as bad as what your beloved soldiers are dealing with overseas, so suck it up.

Q. Has the response from people been the same?

A lot of people are taking it seriously, but a lot of people — it’s been not even two weeks since our “stay at home” order. People once again are bored. They’re starting to go out more. I had to go out for some essential stuff, and the stores were packed. People were buying clothes and movies. That sense of boredom has already kicked in, and I see that as being very similar.

Q. As far as the effect of the disease, how does it compare?

Overall, North Carolina’s mortality rate was about 325 per 100,000. For the nation, it was about 299 per 100,000. We were a little higher.

In North Carolina, the total dead that were recorded was about 13,700, just in North Carolina alone. Those numbers will always be rough, because reporting was just starting to become standardized. A lot of the rural counties, we’ll never know.

[As of Friday, state health officials said the coronavirus is responsible for 74 North Carolina deaths, a rate of less than 1 per 100,000 residents.]

Q. What are some of the differences?

The nature of the virus. I see people talking about how similar the viruses are. They’re not, really.

In 1918, it was more prevalent. That virus also carried with it lifelong changes in personality in some cases. Some people had it, and it was the regular flu. But if you had one of the strains, some people started getting sick in the morning and were dead by night. Others, like Woodrow Wilson, he got it during the Paris peace talks. His personality changed, and he was never the same.

A lot of people felt like they never fully recovered. We’re not seeing that yet.

Q. How quickly did society return to what it was before?

It seemed to snap back really quickly. Everybody had that sense of that bored attitude toward it and the government telling you to put it behind you and focus on the returning soldiers. Life tended to snap back fairly quickly. By early 1919, you had some businesses suing the local board of health for keeping them from making a profit.

Q. In the flu pandemic, what was closed?

It was similar to what they are doing today. They closed down most businesses. Movie theaters are the ones who came together to sue the board of health in Rock Hill. Grocery stores would stay open. They only allowed a certain number of people in at a time. With schools, everything closed down for the rest of they year, which was big, because starting in late September, schools across the state started shutting down. Some tried to open up but then would have to close again. After the third closure, they decided to stay closed.

Around here, they reopened in late December. The virus kept popping up. They had to keep closing school intermittently.

Most people stayed home. People were complaining that they couldn’t go out and get cold drinks and they couldn’t go out to do anything. Nobody was having parties. It seemed like they were taking the directions seriously.

What was interesting was that if you think about authors like Ernest Hemingway and F. Scott Fitzgerald, they all lived through it, and they all knew people who died from it, but it didn’t come through in any of their writing. It’s like they dealt with it and moved past it. I don’t know if I see that happening with this for a while.

Q. How will history remember this pandemic?

Because people don’t write as many letters anymore, one thing is we’re not going to have that record of what people were really thinking or feeling. We’re going to have a lot of opinions about “Tiger King,” but we’re not going to know how are people really thinking about this.

You read in all the letters in 1918 about fear. Fear was ever-present. When people look back on this episode, they’re not going to get the same thing. You’re missing that human record.

Q. What lessons can we learn from the 1918 flu pandemic?

Listen to your government as much as you can. They are trying to keep you safe, even though they may give mixed signals. Maintain the quarantine as much as possible.

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History lesson: The flu pandemic in North Carolina

The following are excerpts from Lauren Austin’s Ph.D. dissertation in public policy at UNC Charlotte: “Afraid to Breathe: Understanding North Carolina’s Experience of the 1918-1919 Influenza Pandemic at the State, Local, and Individual Levels.” It was published in 2018 and the following portions are reprinted with the author’s permission.

Read for yourself: The full dissertation is available on The Ledger’s website.

1918-19: Overflowing morgues, World War

It is not uncommon that bodies should be piled from floor to ceiling, morgues should be overflowing, and streets should be filled with corpses when a country is in the midst of fighting a world war. However, it is uncommon to see bodies spread everywhere when the country in question is thousands of miles away from the nearest battleground.

This sight was almost universal in the fall and winter of 1918-1919 when the pandemic commonly yet erroneously referred to as “Spanish Influenza” swept rapidly through the United States and across North Carolina, leaving more than 13,000 dead, the majority of whom had been healthy and vital young adults. Yet as quickly as it appeared on the red clay and sandy soil of North Carolina, it effectively disappeared; a pandemic, which killed between fifty and one-hundred million people worldwide in a remarkably short period, was seemingly forgotten.

North Carolina a century ago

By the end of the war, North Carolina housed three military training camps (two active: Greene in Mecklenburg County and Polk in Wake) and one in construction (Bragg in Cumberland County), which served as transportation hubs for thousands of American servicemen traveling to and from European fronts, and produced and shipped wartime textiles and armored material from factories throughout the state. The state’s workers gathered in large groups to produce Navy warships in Wilmington, airplane propellers in High Point, artillery shells in Raleigh, and Army-issued blankets, tents, and socks in textile mills in many towns and cities.

At this time, North Carolina also experienced substandard public health, health care, and health practices, largely due to its predominantly rural population. The combination of insufficient and poor-quality health care resources and the increased transportation of war goods meant that North Carolina’s citizens faced elevated risks during the 1918 epidemic as the disease swept largely unchecked throughout the state in a short time period.

Flu pandemic: by the numbers

The North Carolina State Board of Health reported that a total of 13,703 died in North Carolina from influenza between October 1, 1918 and March 1, 1919: it reported 6,561 influenza deaths in October, 2,083 in November, 1,920 in December, 2,266 in January, and 873 in February. However, this number is gleaned from the available spotty information reported at the time, not from extensive medical records and analysis. …

No comprehensive breakdown of mortality statistics exists for North Carolina during the period of the epidemic. There is no list of county statistics, no detailed age, sex, or race data for influenza victims. The only partial breakdown found is that of the 1918 Mortality Statistics published in 1920 by the Bureau of the Census. This report shows a national influenza mortality rate of 298.9 per 100,000 and a North Carolina total rate of 325.4 per 100,000. The report also breaks down the North Carolina death rate by race, reporting 285.9 per 100,000 for whites and 412.6 per 100,000 for [blacks].

‘A pestilence crept into N.C.’: How it arrived and spread

The influenza virus did not spread across the state westward via the railroad lines as previously thought, nor did influenza seem consistently prevalent in mill or factory areas as previously thought; at most, the disease was associated with population density and region and spread out from railway hubs which also functioned as busy urban areas. …

In the sultry early autumn days of mid-September 1918, a pestilence crept into North Carolina via the port city of Wilmington in New Hanover County and quickly took root there, spreading out its far-reaching tendrils of blue-tinted death across the state faster than anyone could have expected. While the state of North Carolina bustled with wartime commerce, manufacturing, and military training during those frantic days leading to the close of World War I, something far closer to home than the fighting front was threatening the lives of each North Carolinian resident. This mutated strain of influenza spread westward from the coast, enveloping the state in a blanket of fear, uncertainty, and impending death as the influenza epidemic of 1918-1919 took shape.

The flu pandemic of 1918-19 hit the state’s cities hardest, as well as counties in Eastern North Carolina. (Source: “Afraid to Breathe” dissertation)

North Carolina reacts: resignation, desensitization

This silent struggle with such a widespread disease caused a sense of acceptance, or at least resignation, in the population; within a short period of time, influenza became absorbed into the lifestyle of North Carolinians and they very soon ceased to be shocked by it and in some ways became blinded to it. This inurement to the epidemic differed from the death or war weariness that can often manifest in societies engaged in large-scale conflict.

The change in attitude was not only due to the fact that individuals resigned themselves to the horrors of the epidemic in their daily lives, it was more that they grew weary of the imposed quarantines and upheavals to their routines caused by the epidemic and began ignoring those changes. This desensitization was also encouraged by institutions that wished to suppress the presence of any weakness in society during wartime and keep the citizens focused on contributing to the war effort. In a society dealing with the absence of so many young men due to the horrors of war, North Carolina’s residents still at home were expected to buck up, deal with the epidemic as best they could, and remain thankful that they were not off fighting a war.

Advice from the governor

N.C. Gov. Thomas Bickett, in a statement on Oct. 3, 1918:

The disease is due to spit swapping. Spit is swapped or exchanged … by coughing or sneezing into the air instead of a handkerchief. In open coughing or sneezing into the air instead of into a handkerchief an invisible spray is thrown several yards into the air and floats from 30 to 60 minutes. The greater the spraying, as in psychic waves of coughing that pass through assemblages, moving picture shows, churches and other gatherings the denser and more potent to the infectious atmosphere … A great many soda fountains maintain a small collection of water practically hidden beneath the counter or slab where the spit germs of the town are pooled and re-distributed. … As for sterilized glasses, well how do you know they are sterilized? Take no chance. Demand a paper cup even if it costs you more. DON’TS Don’t associate with the impolite and careless, who spray you with their spit. Don’t go to unnecessary public gatherings while the epidemic is on. Put your moving picture show money in thrift stamps. Don’t use a roller towel. Don’t patronize a soda fountain that does not use paper cups. … Public officials can do little to protect you. You can do a great deal to protect yourself.

The influenza virus

This particular strain of influenza acted differently within its victims.

Approximately 20% of the infected victims contracted a mild case and recovered without much problem. However, the other 80% of victims experienced one of two terrifying illnesses. Some victims almost immediately became deathly ill, their lungs quickly filling with fluid as they struggled to breathe. These victims died in a matter of days, sometimes even hours, with bodies ravaged by a high fever — and gasping for breath — until they lapsed into unconsciousness and then death.

Advice from the N.C. State Board of Health, November 1918:

Keep away from crowds. Avoid people who cough, sneeze, and spit without... a handkerchief Do not use common drinking cups or towels, and keep away from the soda fountain that does not supply individual cups and sterilized spoons. Keep the bowels open. Snuff Vaseline up the nose three times a day. Gargle mouth and throat with warm salt water. Sleep and eat regularly. Keep in the open air and sunshine as much as possible and have good ventilation in the home and office. Sleep with your windows open. Wash your hands before eating, and never put your unwashed hands in your mouth. Do not give the disease to others — always bow the head and cover both nose and mouth with a handkerchief.

Flu arrives in Charlotte

The Charlotte News and Evening Chronicle’s … society column on October 1 noted that Miss Ellen Victor, daughter of Mr. and Mrs. H.M. Victor ... has a mild case of Spanish influenza. The very next day, the paper related that fifty new cases of influenza had been reported at the city health department between 8-11am that morning and that the Commissioner of Public Safety was meeting with the city health superintendent that afternoon to discuss the possibility of a city quarantine. However, it was acknowledged in the article that such a quarantine would hinder local businesses for weeks and was therefore to be the last alternative.

In the October 2 evening edition of the News, an article about the outcome of the meeting reported that no quarantine was necessary, an outcome which was very “gratifying to everybody interested in the operation of amusement places in Charlotte of which there are a dozen or more.”

[On] October 3, the paper reported that up to 175 cases of the flu had been reported by the city health department and that medical staff were already in short supply. However, schools were to remain open and no quarantine was being considered.

However, the last page of that day’s paper reported that Camp Greene, the military training camp located directly outside of the city of Charlotte, was under quarantine effective starting that day due to high levels of influenza being reported in the city, which camp officials desired to keep away from the camp. “The quarantine regulations forbid any soldier to leave the camp or to enter the city except upon important business, ‘and these cases will be few. Visits of civilians to the camp will also be discouraged,’” declared the camp. The last page of that day’s paper also carried the notification of the city’s first influenza death, Mrs. Rosa Stegall.

The Charlotte News declared on page seven of the October 5 newspaper that a quarantine had been “clapped on city at 6 o’clock last night by commissioners” and was to stay in place until at least October 15. … The formal proclamation … closed businesses, schools, churches, amusement centers, and all indoor gatherings.

Charlotte mayor’s statement

The mayor of Charlotte, F.R. McNinch, released a statement which read:

We greatly regret the necessity for putting on a strict quarantine against public gathering and crowds indoors in the city, as we fully appreciate the loss in a commercial way and the great inconvenience to the people which such a quarantine means. Even with the quarantine on, we are not led by the physicians to hope for the prompt eradication of this disease as it is so highly contagious; but the history of such epidemics does lead us to hope that through strict enforcement of the quarantine … physicians and nurses in the city may be able to properly minister to those who may be stricken.

Letters from Charlotte: ‘badly frightened’

On October 6, 1918, Robert Baxter Caldwell of Rosedale Plantation in Charlotte, NC wrote to his niece-in-law Louise Heagy Davidson, who was visiting her family in Jacksonville, Florida:

Dear Louise, The influenza is prevailing in Charlotte. A number have died. All the churches were closed yesterday. All the schools are suspended. The camp is quarantine [sic]. Large assembling of people are forbidden. Saturday the streets were deserted, Very few people in town. I will send you the Observer. Dr. Irwin says to keep the baby in Jacksonville two weeks. When get to town I will see Dr. Hudson, chief of the board, and send his opinion. Less children are all safe again. Yours truly, R.B. Caldwell

The next day, October 8, Caldwell again wrote to Louise, remarking on the influenza situation in Charlotte and conveying the sense of fear that everyone within the city felt:

Dear Louise, The influenza situation is about the same. I hear of deaths outside of Mecklenburg County. A sister of Skinner Allston died Saturday & his brother died yesterday. The people are badly frightened. It is the pneumonia that kills. When you walk up Tryon Street today, you soon notice the quiet when the movie picture is absent. The rail way coach is the most dangerous of all. Any kind of crowd seems to develop the sickness. The children of Less have all got well again. Leaves on the trees have turned brown and are rapidly falling off. Love to all, R.B.C.

Stationed at Came Greene

A similar pattern can be seen in the correspondence of Private Joseph B. Mathews, stationed at Camp Greene in Charlotte and assigned to work in the camp infirmary, to his girlfriend Eva La Flamme in Massachusetts. On September 29, 1918, he wrote to Eva, “About the Span. Inf. Officially we have none but in confidence I think there is about twenty cases in the Hos. That d--- pneumonia is the only thing on earth I am afraid of and I will admit I am scared to death of it. I’ll just close with best regards and hope you all escape that influenza.”

Photo from Camp Greene, December 1918. The military camp was placed under quarantine in the fall of that year because of the prevalence of the flu. (Photo courtesy of Charlotte Mecklenburg Library)

‘Afraid to breathe’

One Goldsboro, North Carolina resident recollected about the height of the epidemic that:

I felt like I was walking on eggshells. I was afraid to go out, to play with my playmates, my classmates, my neighbors. I was almost afraid to breathe. I remember I was actually afraid to breathe. People were afraid to talk to each other. It was like — don’t breathe in my face, don’t even look at me, because you might give me germs that will kill me. Farmers stopped farming, merchants stopped selling. The country more or less just shut down. Everyone was holding their breath, waiting for something to happen. So many people were dying, we could hardly count them. We never knew from one day to another who was going to be next on the death list.

Lessons for North Carolina

Perhaps the North Carolina experience in the fall of 1918 illustrates the adaptability of humanity: North Carolinians incorporated the epidemic into their daily existence so quickly that in letters they admitted that they failed to notice its consequences anymore. But perhaps the epidemic experience can be better seen as a cautionary tale against how quickly we can become inured to something that we need to continue to fight against.

The next pandemic

It is impossible to know from where the next pandemic will come but it is almost certain that, living in a world with four times the number of inhabitants than it did had 1918, with millions of people, pigs, and poultry living close together, every corner of the world easily accessible to any other point within hours, with American hospitals stocking no more than a few day’s supply of most lifesaving drugs at any given time, and the majority of those drugs being manufactured abroad, we are at once both wholly unprepared and ideally situated for another influenza outbreak.

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The Charlotte Ledger is an e-newsletter and web site publishing timely, informative, and interesting local business news and analysis Mondays, Wednesdays, Fridays and Saturdays, except holidays and as noted. We strive for fairness and accuracy and will correct all known errors. The content reflects the independent editorial judgment of The Charlotte Ledger. Any advertising, paid marketing, or sponsored content will be clearly labeled.

Executive editor: Tony Mecia; Managing editor: Cristina Bolling; Contributing editor: Tim Whitmire; Reporting intern: David Griffith