As news arrived in Columbia in late September 1918 that a deadly flu epidemic had struck cities on the East Coast and sickened hundreds at the Great Lakes Naval Training Station in Illinois, city leaders believed Columbia could be made safe.

Dr. Guy Noyes, in an statement issued Sept. 25, said there was no cause for worry in Columbia and that no passes were being issued to men in the Student Army Training Corps to prevent them from contracting it while out of town.

There were no cases yet in Columbia.

"The epidemic can be kept under control and this community made more safe than the average if everyone will carefully and intelligently co-operate in trying to observe the few rules that will prevent the spread of the contagion," Noyes said.

The flu of 1918, inaccurately called the Spanish flu, is believed to actually have originated at Fort Riley, Kansas, in the spring. It infected hundreds of soldiers, who carried it with them to France. That fall, it came roaring back, arriving first in Boston.

Of 45 Boone County men who died in uniform in World War I, 21 were killed by the flu. Some men were healthy when they boarded a ship for France in New York and died before the Atlantic crossing was completed.

On the day Noyes made his statement, Columbia newspapers carried accounts that 100 people had died in Boston.

Noyes went on to offer advice that has become familiar as the modern-day coronavirus pandemic has gripped the world. The disease was spread by coughing and sneezing, he wrote, and it was important to keep a distance from others by avoiding crowds. Each person should carry a handkerchief to cover their mouth and nose when they cough or sneeze.

"Everyone with a cold should be regarded and should regard themselves with suspicion," Noyes wrote.

Later, when the epidemic was raging, Dr. E.R. Clark warned students to be unsociable.

"The thing for them to do is to stay away from each other as much as possible," Clark said, the Columbia Evening Missourian reported. "Also, kissing is criminal now."

That was all good advice, said David McKinsey with Metro Infectious Disease Consultants of Kansas City. He was a co-author of two articles looking back on the 1918 flu, published in 2018 in the Journal of the Missouri State Medical Association.

"They were on target," he said. "That is applicable to today."

As the COVID-19 infection spreads — there were 154,000 cases worldwide as of Saturday morning with almost 5,800 deaths — major sporting leagues have canceled games, the University of Missouri system has gone to online-only coursework and Missouri is now under a state of emergency with four cases.

Throughout the region, exhibits, stage performances and gatherings of all kinds are canceled. Many businesses are directing employees to work from home.

Those actions can slow the spread of the disease, McKinsey said.

"I think the steps that have been taken over the last few days are proactive and should have a demonstrable impact on reducing the number of cases of COVID," he said.

Epidemic strikes

In 1918, despite the warnings of what was coming, Columbia did not take any steps to ban crowds or control large gatherings already scheduled.

With victory in sight on the battlefields, the city was in the midst of a national push to raise money through the sale of Liberty Bonds. The Student Army Training Corps paraded through town on Sept. 27, 1918 and all the churches held rallies the next day.

By Oct. 2, there were 12 cases of the flu. On Oct. 7, when the University of Missouri canceled classes until further notice, there were 70 cases among students.

After another week, the number of sick in Columbia had passed 400, and the city had taken over a downtown hotel for use as an emergency hospital. The students in military training camp were under quarantine, with pickets set to keep visitors out and the students in.

Schools, churches and theaters were ordered to close.

By the end of October, there were 43 deaths from what was called the Spanish flu, according to death certificates available online through the Missouri State Archives.

And after those steps, the epidemic seemed to be easing.

Classes resumed at MU on Oct. 28. The Columbia Public Library reopened Nov. 4. Schools reopened Nov. 11 and the ban on public meetings and gatherings was lifted Nov. 16.

The University Health Committee decided not to lift the quarantine of the campus. At first, the quarantine was intended to protect the community from the epidemic raging among students, the Evening Missourian reported

"Now that the ban in the city has been lifted, the Health Committee says that restrictions at the university must be applied, for a time at least, to protect the university community from the town," the newspaper stated.

Epidemic roars back

News of the armistice in France brought throngs of people into the streets on Nov. 11. The Student Army Training Corps was allowed to break its quarantine for the celebration.

The epidemic came roaring back. Within a week, there were 38 cases among high school students, for example.

On Nov. 27, all the previous restrictions — and some new ones — were re-imposed. Along with schools, churches and theaters, pool halls were closed. Retail stores were told that no more than six customers could enter at one time.

And the blame game began.

Ministers, in a statement, said they were being unfairly targeted. All they asked, W.W. Elwang wrote, was to be allowed to hold Sunday services.

"The next day the board met and threw the town wide open," W.W. Elwang wrote in a statement. "If any responsibility attaches to that action it must be laid at some other door than that of the Ministerial Alliance."

MU closed for a second time — ending the session two weeks early — on Dec. 6.

"It is the opinion of both the City Board of Health and the University Health committee that the continuing of the university exercises during next week would constitute a serious menace to the student body and the protection of the health of the citizens of Columbia and the university community demands that the university be closed at once."

Dr. Dan Stine, a member of the board and director of Parker Memorial Hospital, defended the quarantine.

"We now have reported to the board more than twice the number of cases per population that St. Louis has, and yet many of our townspeople view their situation as serious and belittle the situation here," he said. "The quarantine regulations of the board will stand criticism. It is only they who are ignorant of the nature of the contagion who would be moved to criticise. The epidemic is essentially one that it is impossible to stamp out as is smallpox or scarlet fever.

"It is a crowd disease. If there is no crowding of individuals within doors there will be no rapid-spread of the disease and means can be arranged for the care of the sick. If there is such crowding, it is possible that there will be a number of deaths due to the exhaustion of the means of extending aid to the sick."

Stine blamed the ministers for agitating against the restrictions.

"In bringing about the opening of the town, they did something they are sorry for, I am sure, but wouldn't it be more manly to acknowledge the mistake and pitch in and help us provide for the care of the sick?" Stine said.

After 37 deaths in November — mainly at the end of the month — there were 42 more in December.

Some restrictions were eased again on Dec. 9. Churches and theaters were allowed to reopen, but with a person in every other seat.

The epidemic left another 17 dead in January 1919, four died in February and the epidemic was over.

COVID-19

The coronavirus that originated in Wuhan, China, late last year is different from the flu. The 1918 flu, which was an H1N1 strain similar to the one that struck in 2009, was especially hard on people in their 20s and 30s, while those most at risk now appear to be older people, children and people with impaired health.

But the means of transmission are very similar.

"We have to be more careful," said Christelle Ilboudo, an assistant professor of clinical child health at MU. "Those people who have mild symptoms can pass them to others. If you have cold symptoms, cough into in your sleeve. Wash your hands frequently. All those things go a long way to protect people around you."

The first cases in Missouri are people who returned from disease hot spots. The epidemic will be here, she said, when cases unrelated to travel — known as community transmissions — are reported.

With the university transitioning to online classes through the end of the semester, it will mean fewer opportunities for that, she said.

"In crowds, in close quarters, you don't have any control of those individuals or how healthy they are," she said.

The disease could be spread quickly just in one setting.

"A sorority or fraternity party on campus could potentially lead to spreading" COVID-19, she said. "There are some people, especially some younger people, who have the disease, who have few or no symptoms. Some people are able to spread it before they get symptoms and some people never get sick enough to know they have it."

Early actions saved lives in 1918.

Like Columbia, Philadelphia did not cancel its late-September Liberty Loan parade. It was attended by 200,000 people and in 72 hours, all 31 hospitals in the city were full and by the end of the week, 2,600 people were dead.

St. Louis took proactive steps and canceled its parade and closed schools, theaters and pool halls and banned public gatherings. The death rate there was one-eighth that of Philadelphia.

But like Columbia, when the epidemic eased, St. Louis allowed an armistice parade. And it reopened schools, McKinsey noted.

Like Columbia, that sparked a resurgence in the epidemic.

The important thing during the current epidemic is to take what seem like harsh measures early, Ilboudo said.

In all, it appears that 143 people died of flu or pneumonia during the epidemic in Boone County. If the death rate attributed to the epidemic elsewhere was the same, that means there were more than 1,400 infections out of a county population of about 30,000.

However, one report from the time states 1,000 out of the MU student body of about 2,200 were ill at some point.

If the coronavirus hits in the same proportion as the 1918 flu, it would mean about 8,400 people in Boone County would be ill. If the death rate experienced for COVID-19 so far is unchanged, more than 300 of that number would die.

"The better thing to do is to take those drastic measures now instead of waiting," Ilboudo said. "There is a need to be little more aggressive action up front if we want to keep that from happening."

rkeller@columbiatribune.com

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