"Encyclopedia Dubuque is the online authority for all things Dubuque, written by the people who know the city best.”
Marshall Cohen—researcher and producer, CNN
Affiliated with the Local History Network of the State Historical Society of Iowa.
Generally, influenza is transmitted through the air by coughs or sneezes. Influenza can also be transmitted by direct contact with bird droppings or nasal secretions, or through contact with contaminated surfaces. Influenza viruses can be inactivated by sunlight, disinfectants and detergents. As the virus can be inactivated by soap, frequent hand washing reduces the risk of infection.
The first recorded epidemic of influenza in what became the United States occurred in 1647. It appeared many times including a particularly strong epidemic in 1890. (1) The worldwide influenza epidemic of 1918 killed an estimated 50 million people---more than the estimated 16 million killed in WORLD WAR I---more people than any other illness in recorded history. (2)
Archbishop James J. KEANE instructed priests to consider offering a low Mass for Christmas with a very brief sermon. All churches were to ensure adequate ventilation. The concern lasted a long time with Lenten Regulations in 1920 repeating concerns about flu and holding services. (4)
It is considered likely that the pandemic was called "Spanish flu" as a result of WORLD WAR I. Countries actively involved in the war did nothing to encourage their enemies. Illness and death reports from Germany, Austria, France, England, and the United States were suppressed. Spain, with no need to hide its information, made full reports and was therefore unfairly considered the source of the illness. Theories as to where the disease originated have blamed East Asia, Europe and even Kansas which had gained a national reputation for its campaign against TUBERCULOSIS. (5)
Beginning in 2016 Professor Kristin Anderson-Bricker, professor of LORAS COLLEGE, and her students undertook a lengthy study of the 1918 flu epidemic. Her conclusion was that the disease was carried to Europe in the respiratory system of American soldiers. Finding conditions there ideal with the crowded conditions, it mutated into a killer. This was returned to the United States with returning soldiers. Attacking the lower portion of the lung, the disease was attacked so powerfully by the immune system the tissue of the lung was destroyed. (6)
One week prior to the epidemic of flu beginning in Iowa, the National Swine Show and Exposition opened in Cedar Rapids on September 30, 1918. Within days some of the swine were showing symptoms of an illness being carried to other pigs. The show was quickly closed. J. S Koen, a livestock inspector in the U. S. Bureau of Animal Industry from Fort Dodge, noticed that the illness seemed similar to human influenza. He coined the term "swine flu." Hog producers were outraged, but Koen stuck to his term noting the similarity with human flu and the coincidence between the human flu and the one occurring in hogs. (7)
In Dubuque the influenza epidemic of 1918 ranks as one of the city's worse health events. The population had already witnessed 611 deaths from the disease in 1917. Anderson-Bricker's research found in October, 1918 more than 1,500 reported cases and 37 confirmed deaths. (8) City officials declared the city closed. (9) State health officials ordered all theaters, schools, churches, movies, and lodge rooms across the state closed. The Iowa State Board of Health in its final report indicated that influenza claimed 6,116 lives with another 3,085 dying of pneumonia, a disease that frequently followed flu. (10) In Dubuque, 823 people died. Among the agencies taking an active role in caring for the ill was the DUBUQUE VISITING NURSE ASSOCIATION which maintained a twenty-four hour answering service at its office in the BANK AND INSURANCE BUILDING and operated a "motor service" through the efforts of W. H. Gunn. (11)
Newspapers of the time were filled with advertisement for products which claimed to prevent an individual from catching the flu. Will's Cascara Bromide Quinine should be taken "at the first sign of a cold." "Anointing" the nose "to protect delicate membranes" was a frequently suggested course of action. Nature's Remedy, a laxative, promised that keeping the organs of digestion and elimination active would protect a person from the illness. De Vilbiss Atomizers promised that "Spanish influenza is preventable" while Munyon's Inhaler was said to "cure" influenza and all diseases of the throat and lungs.
In 1919 more than 614 Dubuque residents died of influenza/pneumonia. On October 1st, Spanish influenza became a quarantinable disease as required by state health regulations. The rules specified that the quarantine would be maintained until the infected people had a complete recovery certified to in writing by the attending physician or three days had passed after the temperature returned to normal. Upon recovery, the patient was to have a complete change of clothing with the items worn during illness aired in the sun for at least eight hours. The house was to be aired for the same amount of time. (12)
In February, 1920 the United States Surgeon General telegraphed each state health commissioner with three directives. First, the United States Board of Health and the State Board of Health ordered that all new cases of influenza and pneumonia must be promptly reported to the local board of health and victims quarantined. This information was to be promptly reported by telegram to the State Board of Health. Deaths were to be reported in the same manner. The State Board of Health reported this information daily to the United States Board of Health. Secondly, people were to avoid crowds and breathing into the faces of others. Third, undertakers were forbidden to hold public funerals for those who had died of influenza or pneumonia nor would the bodies of such people be exposed to the public in any way. The Iowa state health officer also wrote to the city council asking that physicians correctly identify Spanish influenza by that name and no other. Posters were available with the symptoms of the illness. (13)
At a special meeting of the city council on February 3, 1920 it was suggested that all newspapers be asked to inform the public that all churches, theaters and places of gathering should be well ventilated. Keeping schools open was considered important because they could maintain a better record of all communicable disease. The City Sanitary Officer offered a resolution to be presented to the State Housing Commissioners--(14)
Be it resolved: by state housing commissioners that we recommend to the next Iowa legislature that they pass appropriate legislation giving the local board of health the power to compel water companies to put in water mains and furnish city water to such portions of cities as to the local board of health shall deem for the best interest of the people living in such communities.
It was moved and carried that the clerk would have notices printed covering instructions related to holding public funerals of anyone who had died of influenza or pneumonia and that a copy would be sent to every doctor, undertaker and pastor in the city. It was also moved and carried that anyone having a vault cleaned be instructed not to pay the bill until the vault had been measured by the sanitary officer. It was also moved and carried to continue the same restrictions that had been used in 1919. Large stores were to be closed in the evening. Church services were limited to 45 minutes. Elevators were limited to 6 passengers; street cars could only carry their seating capacity. All moving theaters, dance halls (public and private), and skating rinks were closed. (15)
The swift response of civic leaders paid dividends. The quarantine placed in effect on February 5th was lifted on February 14 with the exception that dance halls which were not permitted to be open until February 16th. No deaths had been reported for two days, there had been no new reported cases, and thirty-two people had been released from quarantine. Since influenza and pneumonia had become epidemic in Dubuque around January 28 there had been 450 cases of influenza reported, 30 cases of pneumonia, 21 deaths from pneumonia and 3 deaths from influenza. City leaders received letters of congratulations on their results. Dubuque was the only city in Iowa that recognized the advisability of a quarantine and enforced one immediately. In one week, the total number of cases for one day was lowered from 50 to less than 10. In nine days, the epidemic was generally controlled. Other cities continued to report to the state board from 50-150 cases each day with no decrease expected. Special praise was given to the Visiting Nurses for their care of patients not admitted to hospitals or able to hire private nurses. (16)
Following 1920, known strains of influenza reappeared in the late fall and early winter but never reached epidemic proportions. This ended in the spring of 1957 when Walter Reed Army Institute identified flu viruses from Hong Kong that were new. Cases appeared on both the East and West coasts of the United States and the race began to develop a vaccine prior to the flu season. (17) Hong Kong influenza caused a pandemic in 1968 and like Spanish flu in 1918 entered swine. It was discovered there in 1998 in North Carolina feeder pigs brought to Iowa. The Centers for Disease Control continue to monitor swine farm workers, their families, and their hogs for evidence of hybrids of human, swine and avian strains. (18)
In January, 1976 the first known victim of swine-flu, an army recruit at Ft. Dix, New Jersey, died. In August, 1976 the producers of the vaccine refused to release it unless the government assumed liability for any side effects. (19) A massive $135-million national swine flu immunization program was begun in October, 1976 but stopped at the end of December. Only 41 million out of 220 million Americans had received the vaccine. The program was halted based upon "significant evidence" to link the vaccine with Guillain-Barre syndrome, a rare form of paralysis. Of the 41 million vaccinated, there were 160 deaths, 1,600 cases of non-fatal reaction, and at least 496 cases of Guillain-Barre. Private physicians were allowed to continue vaccinating patients if they received an informed consent paper from the patient. (20)
An estimated 85 million doses of swine-flu vaccine was stored under refrigeration. In 1977 the $43-million hoard was considered the nation's last resort against Russian influenza known as A-USSR. The vaccine, however, was "age-specific" meaning that it might give protection to some age groups and not others. In December, 1977 there had been no reports of A-USSR in the United States, but there had been widespread outbreaks of A-Texas influenza which was similar to the A-Victoria strain found in Pennsylvania and New Jersey. (21)
Health officials employed by the DUBUQUE COMMUNITY SCHOOL DISTRICT in 1978 estimated in January that 30% of the cases of illness reported to the schools was flu. The state was not usually informed of suspected-influenza outbreaks because the reporting was not considered helpful prevention. The required tests took so long the patient was usually over the illness before the results were received. (22)
In 2009 Dubuque residents braced for the possibility of another flu epidemic. Swine-flu, better known as H1N1, threatened to close schools across the nation. By early 2010 several Iowans had died of the disease, but the initial threat of the disease seemed unfounded. One theory suggested that older Americans may have had some defense to the disease from their earlier bouts with Asian flu in the 1950s. Vaccines which were scarce in September 2009 were so widely available by February 2010 that those wishing for the "shot" could receive it at many pharmacies.
A host of options awaited those receiving flu vaccinations in 2011. The patch with microneedles that penetrate the skins and then dissolve releasing their vaccine were still being developed. (23) The traditional "shot" required a needle an inch or more long because the vaccine was was injected deep into muscle. A new type of needle, used only on adults, was called the Sanofi Pasteur's Fluzone Intradermal. It was one tenth of an inch long. Patients could also receive the traditional vaccination, a special high-dose for seniors, and a squirt of vaccine into the nose. While knowledge of how a person's immune systems weakens over time remained unclear, physicians urged everyone to receive an annual vaccination to provide protection. (24)
The traditional vaccine used for thirty years provided protection against two common Type A strains called H1N1 and H3N2 and one strain of Type B. Flu strains continually change forcing medical personnel to try to anticipate the needs for a coming year and include those subtypes of strains considered most likely. Type A flu causes more serious disease and deaths--especially the H3N2. Type B, a milder form, sickens people and can kill. Two forms of Type B circulate around the world making it difficult to know which to include. A model developed by the Centers for Disease Control estimated it could prevent up to 484 deaths annually depending upon how much Type B flu was spreading. Adding both kinds of Type B eliminated the guessing.
The new quadrivalent vaccine was first available in 2013. Present in all nasal versions sold in the United States, it was capable of guarding against four strains of flu rather than the traditional three. The nasal spray, however, was only for healthy people between the ages of 2-49 who were not pregnant. Younger children, older adults, pregnant women and people with chronic health conditions could receive the new vaccine as a shot. These were sold under the names Fluzone Quadrivalent, Fluarix Quadrivalent, and FluLaval Quadrivalent. Obtaining the new vaccine was difficult. Of the estimated 135-139 million doses of flu vaccine produced in 2013 only about 30 million would be the new version. (25)
Outbreaks of high path avian influenza in commercial turkey flocks Minnesota, Missouri, and Arkansas and a backyard chicken and duck flock in Kansas were reported in March, 2015. Iowa Department of Natural Resources with United States Department of Agriculture Wildlife Services officials tested 150 snow geese for the presence of the disease. The Centers for Disease Control considered the risk to people from high path infections in wild birds or backyard flocks to be low. (26)
In 2018 the continued problem of designing the flu vaccine was again proven. In February preliminary figures suggested the vaccine was only 36% effective in preventing flu illness severe enough to send a patient to the doctor's office. The vaccine was only 25% effective against Type A H3N2. Despite the poor showing of the vaccine, physicians stressed that it could still lessen the severity of the illness. (27)
The flu season generally runs from December through March. Because it takes several weeks for immunity to build up, the best time to receive a flu vaccination is between October through mid-November. Because a person might already be carrying the flu virus, the possibility exists that he/she could receive a vaccination and still develop flu. The illness, however, was not the result of the shot. Flu vaccine is created using dead virus unable to spread the illness. Physicians have urged patients to receive a pneumococcal vaccine at the same time to prevent pneumonia, bronchitis, middle ear infections and sinusitis that often follows a case of the flu. The vaccine available since 1977 was only needed once in a lifetime. (28)
The flu epidemic of 1918 remains a source of study. The idea that the epidemic was the result of a "super-virus" has been studied. The conclusion is now that high death rates were due to crowding as well as poor nutrition and sanitation. It is also believed many deaths resulted from bacterial pneumonia in lungs weakened by influenza. The belief that the first wave of deaths was the greatest as been proven incorrect. The second wave from October to December, 1918 was the most lethal. A third wave in the spring of 1919 was more lethal than the first, but less than the second wave. The virus did not kill most people who were infected. Although it proved especially deadly to Native Americans, the death rate among others generally did no exceed 20%. This, however, is far higher than the typical flu which kills 1%. There were no anti-viral therapies available during the 1918 flu epidemic. Some researchers believe some deaths may have been due to over use of aspirin. Physicians at the time were recommending up to 30 grams daily. In modern times, 4 grams is considered a maximum dosage. The epidemic did not dominate the daily news. Law enforcement officials and politicians had reasons to under-report the event. The genetic sequence of the 1918 influenza virus was determined in 2005. The virus was recovered from the body of a flu victim buried in permafrost in Alaska and samples of American soldiers who became ill at the time. (29)
1. "Questions and Answers," Dubuque Telegraph-Herald, October 1, 1919, p. 6
2. "The Deadly Virus," National Archives and Records Administration, Online: https://www.archives.gov/exhibits/influenza-epidemic/
4. Gallagher, Mary Kevin. Seed/Harvest: A History of the Archdiocese of Dubuque. Dubuque: Archdiocese of Dubuque Press, 1987, p. 76
5. Gunderman, Richard. "What We Can Learn 100 Years Later from the 1918 Flu Pandemic," The Conversation. Online: https://www.cnn.com/2018/01/29/health/1918-flu-history-partner/index.html
6. Jacobson, Ben. "100 Years Later, Loras Class Digs into Deadly 1918 Flu Outbreak," Telegraph Herald, February 4, 2018, Online: http://www.telegraphherald.com/news/tri-state/article_f40c3a99-82b1-5fcc-8687-194e7203a3f9.html?sp-tk=F4DAAABA26218FBE5FC14F02EECF27E22D98C28FD11B71FE46FE6641CDAB159BA554009F74E2A8264C0C0E8EF0E8C911CE8C04AF255EA31EC3ADAA01A4F9AFCC8401B9BDF609EF25B2AB9276422269CB84E2BBF6F0C3728599776D90D9F5C333E22ED3333E171EA2955EED122CB6059A5A37ABEDC62170C334F49BF17663A80FB8B591E1C1F0D71AB54C44609F1387A188589E8F
7. Currier, Russell W. "People and Pigs: Iowa's Role in 20th-Century Influenza History," Online: https://www.iowapha.org/Resources/Documents/People%20and%20Bigs%20Iowas%20Role%20in%2020th%20Century%20Influenza%20Hx%20-%20IHI%20Summer%202005.pdf
9. "Flu Killed More Than 6,000 Iowans in 1918," Time Machine, Cedar Rapids Gazette, Online: http://www.thegazette.com/subject/news/archive/time-machine/time-machine-flu-killed-more-than-6000-iowans-in-1918-20180218
11. "VNA Helps with Influenza Cases," Dubuque Telegraph-Herald, October 20, 1918, p. 17
12. "Influenza May be Quarantined Now," Dubuque Telegraph-Herald, October 1, 1919, p. 8
13. "City Council Proceedings," Dubuque Telegraph-Herald, February 7, 1920, p. 3
16. "Flu Epidemic in Dubuque Finally is Stamped Out, Telegraph-Herald, February 14, 1920, p. 1
20. "Resumption of Swine Flu Shots Very Unlikely," Telegraph Herald, December 30, 1976, p. 2
21. "Swine Flu Vaccine Stockpile May be Used Against Russ Flu," Telegraph Herald, December 22, 1977, p. 9
22. Schwar, Kathy. "Flu, Other Ills Sock it to Dubuque," Telegraph Herald, January 13, 1978, p. 8
23. Schmid, Randolph E. "Microneedles Could Make Shots Easier," Telegraph Herald, July 19, 2010, p. 6
24. Neergaard, Lauran. "Flu Shot Time, Some Could Get Tiny Needle," Telegraph Herald, September 6, 2011, p. 17
25. Neergaard, Lauran. "Flu Vaccines Now Offer More Protection," Telegraph Herald, September 3, 2013, p. 11
26. "Avian Influenza Testing Planned," Telegraph Herald, March 22, 2015, p. 39
27. Stobbe, Mike. "Weak Flu Shots Worsen Bad Year," Telegraph Herald, February 16, 2018, p. 21
28. "Experts Fear Few Get Flu Shot," Telegraph Herald, October 14, 1998, p. 16