Issue link: https://digital.copcomm.com/i/1225425
16 Working Nurse l WorkingNurse.com March 23–April 27, 2020 A DIFFERENT KIND OF FLU A t the turn of the last century, much like today, "the flu" was a seasonal annoyance that could be temporarily debilitating, but was seldom life-threatening except to the very young, the very old or people with compromised immune systems. The strain that caused the first wave of the pandemic in the spring of 1918 was much more dangerous. Transmitted through respiratory droplets, "Spanish Influenza" was not particu- larly virulent, at least in its milder initial form, but the crowded living conditions of the time nonetheless caused it to spread rapidly — par- ticularly in military camps, where the epidemic probably began. Onset was equally swift, often accompanied by massive secondary infections like pneumo- nia. An infected patient might be fine in the morning and dead by nightfall. Symptoms included not only the familiar fever, aches and congestion, but also pulmonary hemorrhaging, hallucinations, delirium, dyspnea and cyanosis. "The faces [of the sick] wear a bluish cast; a cough brings up the blood-stained sputum," wrote pathologist William Henry Welch, M.D., then president of the Maryland State Board of Health. "In the morning, the dead bodies are stacked about the morgue like cordwood." The virus hit the young and healthy surpris- ingly hard. Most fatalities were adults in their 20s and 30s. According to the National Archives and Records Administration, the pandemic reduced overall American life expectancy by about 12 years. No one was safe. Even Woodrow Wilson and Franklin Roosevelt succumbed, although both survived. The initial epidemic subsided for a time in mid-1918, but a second wave struck that fall, just as the Great War was winding down. By the time the third and final wave had run its course in the early summer of 1919, tens of millions were dead. The exact death toll is unknown, but it may have been as high as 50 million worldwide. ACUTE NURSING SHORTAGE P eriod records give us a glimpse of what caregivers could do to relieve suffering and stop the spread of the virus — in two words: not much. Even so, nursing care was crucially important, the clearest predictor of survival. By 1918, the U.S. had a sizable nursing workforce. Long before the outbreak, the Committee on Nursing of the Council of National Defense had established an infrastruc- ture of public health nurses, as had the Red Cross, with its Town and Country Nursing Service. The complex field of military nursing had not been neglected either. In the U.S., the Army had already established its own Nurse Corps, which got its own School of Nursing in May 1918. Unfortunately, the first wave of the pandemic struck as the U.S. was ramping up its involve- ment in World War I. Most skilled nurses were overseas with the American Expeditionary Forces — including as many as 80 percent of nurses from East Coast cities like Philadelphia. This resulted in widespread nursing shortages. One Philadelphia official declared, "If you would ask me the three things Philadelphia most needs to conquer the epidemic, I would tell you, 'Nurses, more nurses and yet more nurses.'" The end of the war in the fall of 1918 made the situation even worse. Returning troops car- ried with them a new and more virulent strain of the disease, which took a deadly toll on nurs- es as well as soldiers and sailors. Why It Became the "Spanish" Flu ✜ DURING THE FIRST World War, countries on both sides censored the press, allowing only positive news coverage. As a neutral party, Spain was the first country to publicly report on the outbreak, which was consequently dubbed "Spanish Influenza." Later research has suggested that the starting point of the epidemic was probably an American military base in Kansas! Nursing During the Spanish Influenza Pandemic of 1918