Pandemics: Different Eras, Different Reactions

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Patti Mulhearn Lydon, 68, doesn’t have rose-colored memories of attending Woodstock in August 1969. The rock festival, which took place over four days in Bethel, NY, mostly reminds her of being covered in mud and daydreaming about a hot shower.

She was a 17-year-old high-school student from Bethlehem, Pennsylvania, when she made the trek to Max Yasgur’s farm with her boyfriend Rod. For three nights, she shared an outdoor bedroom with 300,000 other rock fans from around the country, most of whom were probably not washing their hands for the length of “Happy Birthday” — or at all.

“There was no food or water, but one of our guys cut an apple into twenty-seven slices and we all shared it,” she said. At some point, a garden hose from one of the farm’s neighbors was passed around and strangers used it as a communal source for bathing and drinking, she said.

And all of this happened during a global pandemic in which over one million people died.

H3N2 (or the “Hong Kong flu,” as it was more popularly known) was an influenza strain that the New York Times described as “one of the worst in the nation’s history.” The first case of H3N2, which evolved from the H2N2 influenza strain that caused the 1957 pandemic, was reported in mid-July 1968 in Hong Kong. By September, it had infected Marines returning to the States from the Vietnam War. By mid-December, the Hong Kong flu had arrived in all fifty states.

But schools were not shut down nationwide, other than a few dozen because of too many sick teachers. Face masks weren’t required or even common. Though Woodstock was not held during the peak months of the H3N2 pandemic (the first wave ended by early March 1969, and it didn’t flare up again until November of that year), the festival went ahead when the virus was still active and had no known cure.

“I wish they had social distancing at Woodstock,” jokes Lydon, who now lives in Delray Beach, Florida, and works as a purchasing manager for MDVIP, a network of primary care doctors. “You had to climb over people to get anywhere.”

“Life continued as normal,” said Jeffrey Tucker, the editorial director for the American Institute for Economic Research. “But as with now, no one knew for certain how deadly [the pandemic] would turn out to be. Regardless, people went on with their lives.”

Which, he said, isn’t all that surprising. “That generation approached viruses with calm, rationality and intelligence,” he said. “We left disease mitigation to medical professionals, individuals and families, rather than politics, politicians and government.”

While it’s way too soon to compare the numbers, H3N2 has so far proved deadlier than COVID-19. Between 1968 and 1970, the Hong Kong flu killed between an estimated one and four million, according to the CDC and Encyclopaedia Britannica, with US deaths exceeding 100,000. As of this writing, COVID-19 has killed more than 295,000 globally and around 83,000 in the United States, according to Johns Hopkins University. But by all projections, the coronavirus will surpass H3N2’s body count even with a global shutdown.

Aside from the different reactions to H3N2 and COVID-19, the similarities between them are striking. Both viruses spread quickly and cause upper respiratory symptoms including fever, cough and shortness of breath. They infect mostly adults over 65 or those with underlying medical conditions, but could strike people of any age.

Both pandemics didn’t spare the rich and famous — Hitchcock actress Tallulah Bankhead and former CIA director Allen Dulles succumbed to H3N2, while COVID-19 has taken the lives of singer-songwriter John Prine and playwright Terrence McNally, among others. President Lyndon Johnson and Vice President Humphrey both fell ill from H3N2 and recovered, as did UK Prime Minister Boris Johnson from COVID-19 last month.

Both viruses infected animals — a 4-year-old Malayan tiger at the Bronx Zoo tested positive for the coronavirus in early April, and in January 1969, the original Shamu at San Diego’s SeaWorld, along with two other killer whales named Ramu and Kilroy, contracted the Hong Kong flu.

Both pandemics brought drama to outer space: During an Apollo 8 mission in December 1968, commander Frank Borman came down with the Hong Kong flu while in orbit. And in early April, three NASA astronauts returned to Earth after seven months aboard the International Space Station, with astronaut Jessica Meir remarking that it felt like coming home “to a different planet.”

During both pandemics, horror stories abounded — from the bodies stored in refrigerated trucks in New York last month to corpses stored in subway tunnels in Germany during the H3N2 outbreak.

Those who had H3N2 and survived describe a health battle that sounds eerily familiar to COVID. “The coughing and difficulty breathing were the worst but it was the lethargy that kept me in bed,” said Jim Poling Sr., the author of “Killer Flu: The World on the Brink of a Pandemic,” who caught the virus while studying at Columbia University. “X-rays after recovery showed scarring at the bottom of my left lung.”

Renee Ward, 53, remembers her entire family contracting the virus in Greenville, NC, during Christmas of 1968. “My father got sick first, quickly followed by me and my mother,” she said. But their symptoms were mild, for the most part. “Christmas morning, I was trying to play with my new kitchen set from Santa, while my mother watched from the couch and cried because we couldn’t travel to be with my grandparents.”

Linda Murray Bullard, 60, from Chattanooga, Tenn., remembers visiting a “super” grocery store with her mom just before Thanksgiving in 1968. Days later, her mother was in bed with a fever, chills and dry cough.

“I turned 9 years old on December 5th, but because she was so ill we didn’t celebrate,” said Bullard. “I just wanted her to feel better.” Days before Christmas Eve, her 33-year-old mother went to an ER and was diagnosed with the Hong Kong flu. She died shortly after.

The global fight to stop (or at least slow down) COVID-19 has brought heavy restrictions on all aspects of public life, including restaurants, bars, weddings, funerals, churches, movie theaters and gyms. Schools have reverted to remote learning and most business now happens via Zoom. The Grand Canyon is closed, as are all Disney parks and Las Vegas casinos. Professional sports are on indefinite hold, including Wimbledon, which canceled for the first time since World War II.

How does this compare to the Hong Kong flu? Nathaniel Moir, a postdoctoral fellow at Harvard University’s Kennedy School of Government, said there were few precautions taken during the H3N2 pandemic other than washing hands and staying home when sick.

“It was like the pandemic hadn’t even happened if you look for it in history books,” he said. “I am still shocked at how differently people addressed — or maybe even ignored it — in 1968 compared to 2020.”

The virus rarely made front-page news. A 1968 story in the Associated Press warned that deaths caused by the Hong Kong flu “more than doubled across the nation in the third week of December.” But the story was buried on page 24. The New York Post didn’t publish any stories about the pandemic in 1968, and in 1969, coverage was mostly minor, like reports of newly married couples delaying honeymoons because of the virus and the Yonkers police force calling in sick with the Hong Kong flu during wage negotiations.

A vaccine was soon developed — in August 1969, not long after Woodstock — but the news of a cure didn’t get much media attention either.

It may seem like the world responded to the 1968 pandemic with a shrug of indifference, but the different approaches may be down to a generational divide, said Poling. In 1968, “we were confident with all the advances in medicine. Measles, mumps, chickenpox, scarlet fever and polio all had been brought under control,” he said.

Tucker remembers being taught as a child of the ’60s that “getting viruses ultimately strengthened one’s immune system. One of my most vivid memories is of a chickenpox party. The idea was that you should get it and get it over with when you are young.”

Even with those relaxed ideas about viruses, the Hong Kong flu caught the world by surprise. It was different from previous pandemics because of how fast it spread, thanks largely to increased international air travel.

Much of our current thinking about infectious diseases in the modern era changed because of the SARS outbreak of 2003, which “scared the hell out of many people,” said Poling. “It’s the first time I recall people wearing masks and trying to distance themselves from others, particularly in situations where someone might cough or sneeze.”

The idea that a pandemic could be controlled with social distancing and public lockdowns is a relatively new one, said Tucker. It was first suggested in a 2006 study by New Mexico scientist Robert J. Glass, who got the idea from his 14-year-old daughter’s science project.

Two government doctors, not even epidemiologists” — Richard Hatchett and Carter Mecher, who worked for the Bush administration — “hatched the idea [of using government-enforced social distancing] and hoped to try it out on the next virus.” We are in effect, Tucker said, part of a grand social experiment.

But the differences between how the world responded to two pandemics, separated by 50 years, is more complicated than any single explanation.

“If I were 48 in 1968, I would have most likely served in World War II,” said Moir. “I would have had a little brother who served in Korea, and possibly might have a son or daughter fighting in Vietnam.” Death, he said, was a bigger and in some ways more accepted part of American life.

The Hong Kong flu also arrived in a particularly volatile moment in history. There was the race to land a man on the moon and political assassinations and sexual liberation and the civil-rights movement. Without 24/7 news coverage and social media vying for our attention, a new strain of flu could hardly compete for the public’s attention.

But, even if people in 1968 had been told to stay home, it’s unlikely they would’ve protested, Moir said. Dining out, for instance, was a rare indulgence for most American families then. Today, “we spend as much eating out as we do preparing food at home,” Moir said. A 2013 study by market research firm NPD Group found that between the mid-1960s to the late 2000s, middle-income households went from eating at home 92 percent of the time to 69 percent of the time.

In 2020, we feel that being denied music festivals and restaurants is an egregious attack on our liberty. “A big part of our freakout over COVID-19 is a reaction to everything in this country that we’ve taken for granted,” Moir said. “When it’s taken away, we lose our minds.”

It’s a point echoed by Lydon. Her best memories of that wild weekend aren’t the sweaty crowds or the music — Jimi Hendrix’s electric guitar scared the “begeebers” out of her, she said — but the quiet moments afterwards back at a parent’s house in New Jersey.

“I ate the best grilled-cheese sandwich and drank the best lemonade,” she said. And “I took the best shower I ever remember.”

[equote="magz"]
By the way, you were born the same year my mother was.

Correction 2: Reuters Fact Check team initially rated this claim as True, and later revised that to Partly True. After listening carefully to feedback from readers and reviewing the timeline of the Hong Kong flu pandemic that started in 1968, we are correcting this verdict to Misleading.

(Note – this fact check does not aim to compare the responses to the Hong Kong flu and the current COVID-19 outbreaks. It is strictly assessing the primary claim shared in social media posts that “Woodstock occurred in the middle of a pandemic”. It does not attempt to verify or disprove the entire content of an article with that headline that was published on the website of the American Institute for Economic Research here )

Here is our updated fact check, which replaces the earlier versions and includes a response from one of the organisers of the Woodstock festival.

Social media users have been sharing an image online that claims the popular music festival Woodstock, which took place in August 1969, happened in the middle of a pandemic. This claim is misleading.

The claims state: “The Hong Kong Flu (H3N2) of 1968, killed 1 million worldwide, and 100,000 in the US, most excess deaths being in people 65+ (via the CDC). Nothing changed economically, nothing closed, no social distancing, no masks. No one was considered selfish then.”

The U.S. Centers for Disease Control and Prevention (CDC) confirms those figures on its website, where it says that the disease was first noted in the United States in September 1968. (here)

The pandemic lasted until 1970.

It is true that the Woodstock festival fell between those dates – it took place in August 1969 at a dairy farm in upstate New York. However, a closer look at the timeline of the disease shows why it is misleading to suggest that Woodstock happened “in the middle of a pandemic”. The peak for most U.S. states was December 1968 and January 1969 (Dec 28, 1968 in New York state)

The first season of the pandemic had ended in the U.S. by early March 1969 and it did not flare up again until November of that year, several months after Woodstock

In other words, Woodstock happened between the first and second waves in the United States of the H3N2 Hong Kong flu that emerged in 1968, but not during a peak in infections and months after the first season of the flu had ended in the U.S.

Joel Rosenman, co-producer of Woodstock, told Reuters via email:

“Woodstock was not partying in defiance of pandemic containment measures, because at the time of Woodstock, there was no pandemic, and there were no containment measures to defy. In the months following the December-January peak of the pandemic, the flu all but disappeared. By mid-‘69, any preoccupation with the virus had given way to widespread unconcern. Media coverage had dwindled to virtually zero. As far as the nation was concerned, the pandemic was in the rear-view mirror. It was during this time, not during the pandemic months of the previous winter, that my co-producers, John Roberts, Artie Kornfeld, Mike Lang and I created Woodstock—without so much as a thought about ‘pandemic.’ It wasn’t until the next flu season, several months after Woodstock, that we all found ourselves in a horrifying déjà flu.”

A New York Times article from August 17, 1969 reported that another Woodstock producer, Michael Lang, said a dozen doctors came to the festival not because of “widespread illnesses” but because of “the potential threat of a virus cold or pneumonia epidemic among such a large gathering.” ( here ) He did not mention the Hong Kong flu.

Rosenman told Reuters the doctors were there to cope with routine medical issues, given the size of the crowd. “The reality is we needed those extra doctors to deal with the increased numbers of medical issues that predictably come with an unpredictably huge turnout of half a million kids.”

VERDICT
Misleading. The Woodstock music festival took place months after the first season of the Hong Kong flu had ended in the United States. Although there was to be a second wave in the U.S. the following winter, it is misleading to say it happened “in the middle of a pandemic”.

It’s not clear what the death rate is for Covid-19 but it seems to be substantially higher, probably around 1-1.5% but possibly as high as 3.5%. If that ended up infecting everyone in a short space of time then we would have tens of millions of deaths.

1968: global diffusion
On 11 July 1968, the Hong Kong Chinese-language newspaper Ming Pao reported the outbreak of an influenza-like illness in Guangdong province. Subsequent news stories noted flu epidemics in Szechuan, Gansu, and Shaanxi provinces. The cities of Shanghai and Wuhan were apparently affected before the infection spread south to Guangdong. There was no official announcement from the PRC confirming the epidemic, however; the PRC was not at that time a member of either the United Nations or the WHO.

According to the Ming Pao, the flu had sparked panic buying of medicines in Guangdong. The situation was exacerbated by the ongoing Cultural Revolution launched by Mao. In the anti-Maoist Hong Kong press, the coverage was hardly neutral, dwelling at length on the political chaos that was fuelling the epidemic. The situation in Hong Kong, a British crown colony, remained tense. To escape the political turmoil in China, thousands of immigrants had crossed the border, swelling the population of the territory to just under four million, with approximately one million people living in resettlement housing provided by the government. It was in these circumstances that anti-colonial riots broke out in 1967, leading to clashes between police and pro-Communist sympathizers in which fifty-one people were killed, either by police or as a result of bomb attacks. Hong Kong’s crowded conditions also ensured that new viruses could seed rapidly and develop into ‘explosive outbreaks’ ‘When China sneezes,’ an editorial in the South China Morning Post declared, ‘Hong Kong catches a cold.’

Alarmed by information filtered from the mainland, the Hong Kong Medical and Health Department stepped up border surveillance, although there was no testing and quarantine measures were not introduced. On 13 July 1968, officials recorded a surge in patients suffering from influenza-like symptoms at government clinics. A heat wave was initially blamed for the spike in flu. To deal with the growing number of patients, clinics were kept open over the holidays and, where possible, people were advised to stay at home and ‘take aspirin, tea, lemon drinks, whisky or brandy according to taste’.

Although the death rate was low, over the next two weeks an estimated 15% of the population was infected, or some 500,000 people. The Hong Kong press dubbed the infection the ‘killer flu’ as opposed to the ‘Hong Kong flu’, the name by which it was becoming known in the international news. A Hong Kong city councillor complained that the sobriquet Hong Kong flu ‘was giving Hong Kong a bad name. Why don’t they call it by its proper name – China flu?’ News stories emphasized the impact that the flu was having on the territory’s economy, with the worst hit public utilities being the Hongkong Telephone Company and China Light & Power. There was some irritation among the colony’s residents that, although the flu had likely come from the PRC, it would damage Hong Kong’s reputation and economy. An editorial in the South China Morning Post noted that ‘Fingers of scorn will be pointing at us from many countries in a few weeks time but all we can plead is that this particular export carries no Hongkong Certificate of Origin. We have acted, unwillingly, in our old role as an entrepot for a sneeze by person or persons unknown.’

In the United Kingdom, experts warned of the ‘inadequate medical services and a shortage of vaccine’. The Financial Times announced in September 1968 that

The world’s epidemiologists have joined the sinologists in keeping a very close watch on events in the Far East from whence another pandemic of influenza seems likely to sweep. The commercial and social disruption that can result from even a mild form of this virus infection, when whole blocks of the community – from football teams to Cabinets – succumb simultaneously, can be considerable.

The influenza virus could now ‘move with the speed of a jet airliner’, according to David J. Sencer, director of the NCDC; it has been estimated that between 1968 and 1969 more than 160 million people travelled overseas by air. By August 1968, the flu had reached Vietnam and Singapore and the following month it was reported in the Philippines, India, Australia, and the United States. The first US cases occurred in San Diego, carried by US marines returning from the Vietnam War. The flu virus was isolated on 2 September in Atlanta, from a sample taken from a marine who had shared accommodation with a friend from Hong Kong.

US public health experts had anticipated a mild flu for the winter of 1968–69 and were taken off-guard by news of the novel strain of influenza from Hong Kong that ‘showed a marked antigenic change’ from the earlier subtype A2 1957 influenza. In mid May, the Advisory Committee of the PHS had announced that ‘little or no influenza A2 is expected to occur in the United States during the 1968–69 season, except possibly on the Pacific Coast’. As the first cases were reported in the United States at the beginning of September, however, an emergency meeting of the committee was held. The US surgeon general declared that an epidemic was imminent, and a letter was sent out to state health officers, epidemiologists, and laboratory directors, eliciting their cooperation in ‘monitoring the importation of the virus and in conducting surveillance for influenza’. As the PHS Advisory Committee declared: ‘It is only through intensive surveillance that the true extent of the disease will be determined.’

The town of Needles in eastern San Bernardino County, California, was the first flu outbreak among a US civilian population. By October, some 40% of the town was reported ill. In Milwaukee, 43% of the population was ill, with an absenteeism rate of over 50% in adults. New York declared a state of emergency, although schools and businesses remained open. Despite government concerns, containment measures were not implemented. In the lull between pandemic waves, Woodstock went ahead in August 1969, attracting 400,000 people, as did the ‘Moratorium March’ against the Vietnam War in Washington, DC, which attracted half a million protesters.

While an editorial in the New York Times in December 1968 declared the epidemic to be ‘one of the worst in the nation’s history’, for the most part flu stories were buried in the inside pages of newspapers. Often the news coverage was politically tinged. In declaring the disease a virus from ‘Red China’, discussions of the flu could be ideologically loaded. In Des Moines a billboard went up that read: ‘Hong Kong Flu is Unamerican! Catch something made in the U.S.A.’

In December 1968, NASA astronauts on the Apollo 8 mission – the first crewed spacecraft to leave earth’s orbit – along with 1,200 personnel at Cape Kennedy, received flu shots. According to a NASA doctor, this was part of an effort ‘for “limited exposure” of the astronauts to cold germs before the flight’. In the event, Colonel Frank Borman came down with ‘intestinal flu’ while in orbit, experiencing diarrhoea and nausea. It was claimed that the astronauts had caught the illness from President Lyndon B. Johnson, whom they had met before embarking on their space mission (although the flu symptoms are more likely to have been the effects of space adaptation syndrome).

President Johnson was admitted to the Bethesda Naval Hospital suffering from a fever and an ‘upper respiratory infection with a slight bronchial irritation’ on 19 December. It was only with reluctance that the White House conceded that the president was suffering from the Hong Kong flu. Meanwhile, Vice-President Hubert Humphrey was recuperating from the flu in Phoenix, Arizona. Other well-known flu victims included the Hollywood actress Tallulah Bankhead, who succumbed to pneumonia in December 1968, and Allen Dulles, director of the CIA, who died in January 1969. The eighty-four-year-old former President Truman was admitted to hospital in Kansas City. By February 1969, when the epidemic was declared over, it had killed an estimated 100,000 people in the United States.

The moniker ‘Mao’s flu’ was widely used in the media. In January 1969, the British secretary of state for social services, David Ennals, responded to a question by a confused member of parliament who wondered ‘in what way the characteristics of Mao flu can be distinguished from those of Hong Kong flu’. An Associated Press news report noted that 200,000 people were ill from ‘Mao-Tse-tung flu’ in Rome, explaining that ‘the influenza virus got its nickname because it is believed to have originated in China and to have spread through Asia toward Europe via Hong Kong.

In Europe the highest mortality occurred in December 1969. An estimated 13–17 million were infected in Italy, including the prime minister, Mariano Rumor. In France, it was claimed that some 25% of the population was ill, with half the workforce bedridden in some areas. French manufacturing suffered major disruptions from flu-induced absenteeism.The health services in both East and West Germany were also hit hard.

The first reported case of Hong Kong flu in the United Kingdom came at the beginning of September 1968, when the young daughter of a house officer was diagnosed with the flu. It was not until January 1969, however, that cases were being widely reported across the United Kingdom, with the epidemic peaking in the winter of 1969–70. According to the Economist, the flu sparked hysteria. An angry general practitioner wrote to the British Medical Journal berating the newspapers and the BBC for creating confusion in the public with their ‘hysterical outbursts’. It was reported that the pandemic threatened to overwhelm hospital services. The flu also disrupted sports activities, raised the cost of basic foods (including Christmas turkeys), and even caused delays to the Automobile Association’s breakdown service. The cumulative effect of absenteeism led to a dip in productivity, with the closing of docks and car plants, and the postal and train services affected.

Pandemic preparedness and response
Although there was far less lead time than in 1957, the prompt identification of the virus led to the relatively swift development of a flu vaccine. It took just over a month from the WHO’s announcement of the new strain of Hong Kong influenza in August to the production phase of the first vaccine in September 1968, following the recommendation for a monovalent vaccine containing the new A2 Hong Kong strain by the National Institute of Health (NIH)’s Division of Biologics Standards. The first million doses of the vaccine were made available in the United States in November 1968, with the pharmaceutical company Merck, Sharp & Dohme pledging a further eight million doses before the end of January 1969. In New York City, a limited batch of vaccines was first made available in December 1968 to those over sixty-five at a Board of Health clinic on 25th Street and First Avenue. As the New York Times reported: ‘The elderly came from all parts of the city. Some hobbled on two canes. Others were supported by younger relatives. Before 8 in the morning they were on the phone, asking if were true that inoculations would be given at the clinic. The little switchboard was swamped.’ However, even this was too little, too late. While the US microbiologist Maurice Hilleman ascribed the successful production of a flu vaccine to the virus’s early detection by the WHO, he also recognized that the vaccine came ‘too little and too late’ to be helpful in the United States.

Christmas 1918 was not Christmas 2020. The pandemic had already peaked in the U.S. in the fall of 1918 as part of the disease’s second wave. Meanwhile, this week the deaths attributed to Covid-19 in the U.S. are the highest they’ve ever been, showing no signs of waning as the holiday approaches. But the flu also killed far more people (675,000) than Covid-19 has to date, in a country that was much smaller, population-wise, at the time. And it wasn’t over by any means. In some cities, a third wave was already starting as Christmas approached, says Kenneth C. Davis, author of More Deadly than War, a history of the pandemic and World War I aimed at young readers.

“There was an uptick, and it was a serious uptick in some,” he says.

A century ago, the federal government held much less authority and power than it does today; the CDC, for instance, wouldn’t get its start until 1946. Decisions about how seriously to take the disease fell to states and, especially, municipalities.

Davis says San Francisco took it quite seriously, implementing a strong mask mandate in the fall as well as measures that’d be described today as social distancing. After cases rose sharply in mid-October, the city locked down harshly; the measures worked to keep the flu at bay and, a month later, the city reopened and dropped the mask mandate. But the flu was not done with the city yet. Come Christmastime, Davis says, the cases were again on the rise, and residents, having finally escaped from the pandemic shutdown, were not eager to go back.

“San Francisco wanted to institute the mask rule again but people resisted,” he says.

Davis said some anti-maskers of the day felt their rights were infringed on. Some Christian Scientists cited religious objections. And other people simply found masks too much trouble. It didn’t help that masks at the time were generally homemade, using several layers of cheesecloth and were supposed to be boiled for ten minutes every day to keep them clean.

While it’s hard to tease out whether Christmas gatherings or shopping contributed, influenza case numbers did indeed rise again in San Francisco in early January.

Lendol Calder, a historian at Augustana College in Illinois and author of Financing the American Dream: A Cultural History of Consumer Credit, says it wasn’t just the debate over masks that seems familiar today. In some places, residents complained that officials shut down churches but left saloons open. The closing of churches was a major issue in Milwaukee, a city that took the pandemic especially seriously—and that was also home to deeply observant German and Norwegian immigrant communities.

But, Calder adds, even Milwaukee allowed churches to hold services on Christmas Day.

Of course, Christmas is also a shopping season, and that was already true in 1918.

Despite the anti-maskers, Howard Markel, director of the Center for the History of Medicine at the University of Michigan Medical School, says the question of how to guard against the flu was not politicized in the way that anti-Covid measures are today.

“Most people did comply because they had greater faith in their public officials, and they had greater faith in the science of medicine, even though it was much more rudimentary than today,” he says.

Markel notes that epidemic disease was very familiar to the early 20th century public. Families, many of which had lost a child to diphtheria or watched a loved one suffer from polio, were generally willing to comply with some limitations on their activities. Most public health departments wore badges and had police powers, and this was generally uncontroversial.

“They could forcibly quarantine you or put you on a quarantine station on an island,” Markel says.

Markel, who is also editor of the Influenza Encyclopedia, a digital archive of materials from the pandemic, says one advantage people of 1918 had in terms of making holiday plans is that family gatherings were generally not the treasured once- or twice-a-year events they are for many people now.

“Extended families often lived together or right near each other, next door or upstairs,” he says. “Getting together for a holiday meal was much less of an event than it is today, when many people don’t live in their hometown.”

At the same time, Americans longed to see each other during the holiday season of 1918 for a reasons beyond the Christmas spirit: Young men were returning from the battlefields of Europe and military bases following the official end of the First World War on November 11.

For the families of more than 100,000 men lost in the war, many dying from the flu, in the course of less than a year—and for those who had lost someone to the flu at home—it must have been a somber Christmas. But, for many others, the relief of the war’s end and the apparent decline of the pandemic encouraged many Americans to come together.

“The mood was absolutely euphoric for most of the country,” Davis says. “There’s a pent-up desire to get out—that existed back then as well. The mood of the country was, ‘We’ve come through something terrible. We have something to be thankful for.’”

To whatever extent that joy encouraged people to gather in public or hold Christmas parties at home, it certainly contributed to some of the infections and deaths in the third wave of the flu.

And Fnord

The 1957–1958 Asian flu pandemic was a global pandemic of influenza A virus subtype H2N2 that originated in Guizhou, China.  The number of deaths caused by the 1957–1958 pandemic is estimated between 1–4 million worldwide.

The 1955 arrival of Jonas Salk’s polio vaccine is still hailed as one of modern medicine’s crowning achievements, a lifesaving intervention that some deemed nothing short of miraculous.

For those of a certain age, the mass distribution of a safe vaccine signaled the end of a dark and disturbing period, one of locked school buildings and swimming pools, iron lungs and lifelong paralysis. Many of those who went through the process of being inoculated still recall the sense of elation the vaccine brought, even if the reality wasn’t as smooth as memory might suggest.

“It’s sort of assumed this mythological status as a hugely successful campaign,” said James Colgrove, a public health professor at Columbia University. “But there was a lot of confusion, there was a lot of chaos, and the federal government was actually widely criticized for its failure to anticipate the public demand for the vaccine — and to make plans for rolling it out.”

Perhaps the closest contemporary comparison to today’s effort is the administering of the polio vaccine in the 1950s and 1960s.

Much like COVID-19, the polio virus, which would infect 57,879 and kill 3,145 in 1952 alone, sent the country into a panic. Public spaces closed, and many people were afraid to leave their homes, as those who contracted the virus often ended up hospitalized or permanently paralyzed.

“People were afraid,” said Rahul Gupta, chief medical and health officer at the March of Dimes. “People were afraid to go out because of this disease.”

Americans who had expected a coordinated federal distribution effort were frustrated to learn that there wasn’t one. With the Centers for Disease Control and Prevention still in its infancy, the federal government turned to an array of pharmaceutical companies for help.

“What the government did was simply to hand the formula over to [six] companies, with virtually no oversight, and say, ‘Go produce it for everybody who wants it,’ ” said David Oshinsky, author of the Pulitzer Prize-winning book “Polio: An American Story.” “And it turned out to be a disaster.”

Confusion over how to get the vaccine abounded, said Colgrove of Columbia University. Private physicians were unsure when they would receive doses and when they’d be able to deliver them to patients. There were rumors, too, of black-market sales.

In a particularly tragic episode, one of the companies enlisted by the federal government to manufacture the vaccine — California-based Cutter Laboratories — produced a defective batch that effectively resulted in tens of thousands being injected with the polio virus, a fiasco that led to a reported 40,000 cases, 50 children suffering paralysis, and five deaths.

The contamination temporarily halted the vaccine distribution, though it eventually returned and, along with a second vaccine from scientist Albert Sabin, resulted in a sharp decline of polio cases across the country. The disease was eventually eliminated in the United States.

The country would see its distribution system tested again just two decades later in 1976, when an influenza reminiscent of the 1918 influenza pandemic emerged.

Even with the lessons of the mass polio vaccination still relatively fresh in the national consciousness, things quickly went awry, as the government rushed out a vaccine and more than 400 people who received it went on to develop Guillain-Barré syndrome, a rare neurological disorder that can result in paralysis.

Some of the effects of the 1976 debacle still linger today, said Dr. Howard Markel, a professor and medical historian at the University of Michigan School of Public Health. They are often seized upon by the antivaccination movement as evidence of the government’s inability to safely inoculate its citizens.

There have also been occasional success stories in campaigns to vaccinate large numbers of people quickly.

In 1947, for instance, a middle-aged businessman arrived in New York City feeling under the weather. The man had previously received the smallpox vaccine, which had first been developed in the late 1700s. But when he died days later, and smallpox was determined to be the cause, it led to a successful campaign to vaccinate — or re-vaccinate — a vast majority of the city’s population.

“In the span of less than two months, they vaccinated close to 5 million people,” Oshinsky said, who noted that the city’s compact area aided in the campaign’s effectiveness.

It's not that high, at least not with medical treatment. Death-confirmed cases in the U.S. is 2.1% Source: https://www.scribd.com/document/4846025 ... from_embed

Confirmed cases is a lower bound on true cases, and death reporting in the U.S. should be pretty reliable. The U.S. has a lot of cases and relative to other developed nations an unhealthy population. So the true rate is definitely less than 2.1%. No one knows what the true case count is, for a long time the CDC was using a rule of thumb of 10x confirmed cases but that's probably out of date.

In August the WHO estimates it at 0.5-1%: https://www.who.int/news-room/commentar ... m-covid-19

In October Ioaniddis puts the median infection fatality rate at 0.27%. https://www.who.int/bulletin/online_fir ... 265892.pdf

On April 17, 1957, the first news of a flu outbreak in Hong Kong reached an American audience, when a single column of news appeared in the New York Times on the international page. Amidst dispatches from Turkey, the UK, Greece, and Sweden, and ads for men’s tropical worsted suits and women’s silk blouses, was the headline “Hong Kong Battling Influenza Epidemic.”

Epidemiologists around the world looked at Hong Kong with a sense of dread. The outbreak had happened unnervingly fast, indicating that this flu virus was unusually infectious.

From our vantage point in the midst of the COVID-19 pandemic, the response to the 1957 flu is illuminating of the critical turning points that determine how a disease spreads and how it ultimately impacts society. It forced officials to make hard decisions balancing public health and potential disruption to daily life. It was the first test of a new early warning system for global outbreaks, and the first pandemic that was battled in real time with a newly developed vaccine.

The seeds of that response were planted during World War II, when the U.S. military formed a Commission on Influenzae, recruiting leading researchers from universities and hospitals. Out of that effort came the first flu vaccine, developed by Thomas Francis and Jonas Salk (Salk famously went on to develop the polio vaccine in 1952). Soldiers got the first flu shots.

In 1948, the World Health Organization established the Worldwide Influenza Centre in London at the National Institute for Medical Research—where the flu virus was first identified, in 1933—and four years later launched the Global Influenza Surveillance and Response System (GISRS), a network of 26 laboratories around the world tasked with monitoring flu evolution.

The 1957 pandemic has largely faded from public memory. One reason may be that while many died, its mortality rate was low. It’s classified as a Category 2 pandemic—one step more severe than the seasonal flu and swine flu. (The 1918 pandemic is a Category 5. Based on its mortality rate so far, COVID-19 would be a Category 3 or 4.)

Another reason that the pandemic is forgotten may be that it struck a society more accustomed to contagious disease than we are; antibiotics and vaccines were only beginning to become more widely available as tools of public health. Moreover, even as millions became ill and thousands died, travel, school, shopping and sporting events mostly went on as normal.

In spring 1957, as the novel H2N2 virus spread through eastern Asia, American sailors in the Pacific began to get sick. The virus spread through the close quarters of ships and then military bases in Japan and Korea. Doctors had sailors gargle with a throat-wash and took samples of their blood, some of which they bottled and sent to the U.S.

While researchers were relieved to realize that they weren’t facing the same strain as the one that caused the 1918 pandemic, they were also alarmed that they had a novel strain on their hands.

Hilleman ignored federal regulations and called six vaccine manufacturers directly, advising them, “Don’t kill your roosters.” Vaccines were produced in fertilized eggs; with millions of doses to be developed, they were going to need a lot of eggs. He shipped viral samples to all six so they could get started. They promised to provide 60 million doses by February 1, 1958.

He also issued a press release from Walter Reed, warning that a flu pandemic would hit in the fall just as the new school year started.

But the flu didn’t wait for fall. By June, it had spread to 20 countries, including the U.S., where it landed on military bases first. An aircraft vessel parked at a port in southern California saw 157 crew admitted to sick bay in just two weeks. And at a naval base in San Diego, 70% of the recruits got sick. Soon there were 10,000 cases on West Coast bases alone.

In early June, hundreds of teenage girls attended a Girls State government event at the campus of the University of California, Davis. Soon enough, more than 200 of them began to shiver and burn in their dorm rooms.

“The girls feel rough for about a day as their temperatures go up to 103 and 104 but after that they snap right out of it,” the Girls State program director told a local paper. The young attendees were fine—but a 57-year-old advisor died.

One of the girls didn’t show any flu symptoms until she was on a train to Iowa with about a hundred other Californians. They were headed to an international church conference at a college in Ames with about 1,700 participants. The group was split up and housed all over campus, and soon other conference attendees fell ill. So many people were infected that the organizers cancelled the conference and sent everyone home—where they subsequently passed on the virus to others.

By mid-July, the virus’s spread in the U.S. was pretty well known by both the public and by health authorities. The CDC had created an Influenza Surveillance Unit in response, and were receiving weekly health reports from counties across the country.

And yet the 1957 outbreak hadn’t proved to be particularly fatal. “Most of the deaths have occurred among persons already weakened by chronic disease, old age, or hunger,” the United Press reported in late June. “The great majority of patients recover after three or four days of fever and malaise.”

They developed a “voluntary allocation” plan with vaccine manufacturers that would distribute the shots through the free market. There would be no central federal management. In theory, it was to be an equitable distribution. But as historian George Dehner writes in Influenza: A Century of Science and Public Health Response, pharmaceutical companies had already taken vaccine preorders from corporate clients such as Ford and AT&T. One pharma executive said the companies “would need to be considered in any allocation plan.”

The military had claimed the first 2.6 million doses; sailors and soldiers began to receive inoculations in August. Vulnerable populations, healthcare workers, and essential transportation, communications, and utility employees were next on the list; they needed 12 million doses. Officials launched a promotional campaign to encourage all Americans to get the vaccine once it became more widely available.

When schools opened in early September, flu cases exploded across the country. Schools were often the source. Kids were more susceptible than adults to H2N2; unlike COVID, the virus was less likely to infect people over age 60. Student absentee rates ranged from 30 to 60% in many communities. In New York City, tens of thousands of kids were out sick at once. But schools remained open. A health commissioner in Nassau County, New York, explained the rationale: “Children would get sick just as easily out of school.” Adults missed work at a much lower rate, but some stayed home. In hard-hit New York City, the subway system lost $1 million in revenue as sick riders skipped the commute.

By late September, few vaccine doses were available compared to the size of the outbreak. The American Medical Association charged that doses were going to corporate executives rather than doctors’ patients.

Public health officials monitored the outbreak but believed that “efforts to contain it were futile,” scholars at the Center for Biosecurity of the University of Pittsburgh Medical Center wrote in a 2009 paper. Rather than quarantining the infected, cancelling large events, or limiting travel, they stressed keeping the sick at home. Sick people inundated clinics, doctors’ offices and emergency rooms, but few of them needed to be hospitalized.

So normal life continued—and people got ill. By October, more than half of the counties in the U.S. had an outbreak. College football games across the country—Western Michigan vs. Colorado State, Lehigh vs. Rutgers, Navy vs. Yale, and many others—were cancelled because too many players were sick.

The cancellations coincided with the pandemic’s peak. That’s also when vaccines started to become more broadly available. But they were less than 60% effective, and they took two weeks to have a protective effect. Moreover, skeptics claimed the vaccine was worse than the disease, and some critics said the government’s vaccine promotion was a scheme to increase sales, Dehner writes.

In November, infection rates began to drop all over the country. By then, 53 million vaccine doses had been released, but the demand was low. Vaccine manufacturers sold some of it overseas, but as much as half of it was eventually returned to them, unused, according to Hillman.

At sea, it was a different story. The Pacific ships that had been struck down in the summer suffered another round of infection in November, even though their crews had been vaccinated. Sailors on two naval vessels became ill after visiting ports in Japan, which was having a major outbreak. Two more ships were stricken after visiting ports in the Philippines.

Back in the U.S., the worst of the pandemic was over. But Christmas spending was muted. A nationwide poll found that nearly half of people said they had less money because of the pandemic.

By spring, the pandemic was largely over. It’s not quite accurate to say that life returned to normal in 1958, because life had remained mostly normal.

On Aug. 30, 1954, Bernice E. Eddy, a veteran scientist at the National Institutes of Health in Bethesda, Md., was checking a batch of a new polio vaccine for safety.

Created by Jonas Salk, the vaccine was hailed as the miracle drug that would conquer the dreaded illness that killed and paralyzed children. Eddy’s job was to examine samples submitted by the companies planning to make it.

As she checked a sample from Cutter Laboratories in Berkeley, Calif., she noticed that the vaccine designed to protect against the disease had instead given polio to a test monkey. Rather than containing killed virus to create immunity, the sample from Cutter contained live, infectious virus.

Something was wrong. “There’s going to be a disaster,” she told a friend.
As scientists and politicians desperately search for medicines to slow the deadly coronavirus, and as President Trump touts a malaria drug as a remedy, a look back to the 1955 polio vaccine tragedy shows how hazardous such a search can be, especially under intense public pressure.

Despite Eddy’s warnings, an estimated 120,000 children that year were injected with the Cutter vaccine, according to Paul A. Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

Roughly 40,000 got “abortive” polio, with fever, sore throat, headache, vomiting and muscle pain. Fifty-one were paralyzed, and five died, Offit wrote in his 2005 book, “The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis.”
It was “one of the worst biological disasters in American history: a man-made polio epidemic,” Offit wrote.

In those days, polio, or infantile paralysis, was a terror.
“A national poll … found that polio was second only to the atomic bomb as the thing that Americans feared most,” Offit wrote.

“People weren’t sure how you got it,” he said in an interview last week. “Therefore, they were scared of everything. They didn’t want to buy a piece of fruit at the grocery store. It’s the same now. … Everybody’s walking around with gloves on, with masks on, scared to shake anybody’s hand.”

Many survivors had to wear painful metal braces on their paralyzed legs or had to be placed in so-called iron lungs, which helped them breathe. There was no vaccine and few treatments. (One bogus approach was to spray acid into the noses of children to block the virus. All it did was ruin the sense of smell.)

Salk’s vaccine was given to 420,000 children. A placebo was given to 200,000. And 1.2 million were given nothing.

The study found that children who did not get the vaccine were three times more likely to be paralyzed with polio than those who received the vaccine.

A year later, on April 12, 1955, when officials announced the results at a news conference at the University of Michigan, there was jubilation. Reporters hollered: “It works! It works!” Offit wrote.

The news made front-page headlines across the country. “People wept,” Offit said. “There were parades in Jonas Salk’s honor. … That’s what contributed to the tragedy of Cutter more than anything else … the irony.”

That same day, licenses were hurriedly granted to several drug companies, including Cutter Laboratories, to make the vaccine.
But the officials granting the licenses were never told of Eddy’s findings, Offit wrote.

The year before, Eddy’s scrutiny of the Cutter vaccine had continued through the summer and fall.

Eddy was born in 1903 in Glen Dale, W.Va., a small town on the Ohio River, south of Wheeling, according to a 1985 biographical sketch by Elizabeth Moot O’Hern. Her father was a doctor.

She had started at NIH in 1937, had headed testing of vaccines for influenza, and in 1954 was asked to help test the Salk polio vaccine. The pressure was intense. “For weeks she and her staff worked around-the-clock, seven days a week,” O’Hern wrote.

This was a product that had never been made before, and they were going to use it right away,” Eddy had said.
She began testing Cutter’s samples in August 1954 and continued through November, according to a later report in the Congressional Record. She found that three of the six samples paralyzed test monkeys.
“What do you think is wrong with these monkeys?” she asked a colleague, Offit recounted.
“They were given polio,” the colleague replied.
“No,” Eddy said. “They were given the … vaccine.”
Eddy’s discovery suggested that Cutter’s manufacturing process was flawed. Its vaccine should have contained only killed virus.

She reported her findings to William Workman, head of the NIH Laboratory of Biologics Control.

But amid the scientific and bureaucratic chaos, Workman never told the licensing committee, Offit wrote.

Starting on the evening of April 12, 1955, batches of the Salk vaccine made by five drug firms were shipped out in boxes marked “POLIO VACCINE: RUSH.”
About 165,000 doses of Cutter’s went out.

Within weeks, reports of mysterious polio infections started coming in.

On April 27, 7-year-old Susan Pierce, of Pocatello, Idaho, died of polio days after getting the Cutter vaccine. She had been placed in an iron lung just before she died. Her brother Kenneth had been vaccinated at the same time, but he was okay.

Not only did some people injected with the tainted vaccine get sick, but some who got the vaccine went on to infect family members and neighbors.

The government ordered the Cutter vaccine withdrawn on April 27. But damage had been done.
“By April 30, within forty-eight hours of the recall,” Offit wrote. “Cutter’s vaccine had paralyzed or killed twenty-five children: fourteen in California, seven in Idaho, two in Washington, one in Illinois, and one in Colorado.”

On May 6, all polio vaccinations were postponed. They were resumed on May 15 after the government had rechecked the vaccines for safety. But people were still frightened.

Years later, in a suit brought against Cutter, the firm was found not negligent in making its vaccine because it had done its best making a new drug that was complicated to produce.

But it was found financially liable for the calamity it had caused during that spring of 1955.

The jury foreman said: “Cutter Laboratories [brought] to market a … vaccine which when given to plaintiffs caused them to come down with polio.”