While I did all of the initial research for my Beneath the Alders series and for the first book in the series, The Innocent, I was greatly assisted in completing The Beleaguered and The Mending by the research skills of my good friend Colleen Mahoney, a pre-maturely retired librarian. In this article, Colleen answered specific questions I recently posed about the Spanish Flu and about how it ended.

Lynne: What was the Spanish Flu?

Colleen: The “Spanish Flu” is a misnomer…as this devastating new flu virus did not in fact originate in Spain. Spanish newspapers happened to be among the first to widely report on a new flu circulating and thus the name was coined. Modern academic literature refers to it as the “1918 Influenza”. But for our purposes, we will continue to use the term the Spanish Flu for ease of reference.

The Spanish Flu pandemic was caused by the H1N1 influenza A strain. The pandemic lasted from approximately February, 1918 to April, 1920. The onset was marked by sore throat, headache and fever. As it progressed, it often moved into the lungs, causing a bacterial pneumonia which was so severe that it could kill in a matter of days and in many cases, only a few hours. The majority of the deaths were caused by the secondary bacterial pneumonia.

Lynne: Where did the Spanish Flu actually originate?

Colleen: There is no clear answer to this question despite sustained academic and scientific research over many decades.  Theories include a military camp in Kansas, as well as locations in France, England and Asia.  Because there was a near simultaneous appearance of it in all these disparate locations, it has been impossible to definitively determine its origin. 

Lynne: How was the Spanish Flu brought to Canada?

Colleen: Again, opinions on this question differ. Until recently, the predominant theory was that soldiers returning from Europe brought it with them and it spread across the country as they returned to their home towns. This was certainly true to an extent. But more recently, it is thought that it was actually soldiers who were deploying to Europe from the United States with stopovers in Canada that initially brought it to Canada.

American troop ships often stopped in the Maritimes before crossing the Atlantic to France. In the fall of 1918, an American transport, the USS Nestor, sailed from New Jersey to Sydney, Nova Scotia. While there were no symptomatic personnel on board when it left its home port, when it arrived in Sydney there were 150 very ill men exhibiting signs of a virulent influenza. A couple of days later that number had increased to about 500. Men were put ashore and medical personnel and equipment had to be brought up from Halifax. An outbreak in the general population quickly followed. Outbreaks at two other camps, one in Quebec and one in Ontario, followed an influx of American soldiers who were to be deployed to France.

An additional unfortunate path of infection was caused by the recruitment and deployment of the Siberian Expeditionary Force. The Force was formed to support the “White Russians” (those loyal to the Tsar following the Russian revolution) in the hope that an eastern front could be established against Germany to prevent Russian arms and supplies from falling into German hands. Canada was asked to provide 2700 men for the Force. Men across Canada were recruited and assigned to the Force. A train left New Brunswick early in the fall of 1918. It was to pick up the recruits as it made its way to Vancouver where a ship would leave for Russian via Japan. The first cases of flu emerged even before the train arrived in Montreal. Two sick men were removed and healthy ones embarked. As the train moved west, more men would become ill and were offloaded in towns and cities along the way while healthy ones were picked up. This train is generally accepted to be an early “superspreader” of the Spanish Flu right across Canada.

One other unexpected delivery system was that of American attendees at a Eucharistic Congress in Victoriaville, Quebec. Within days of the completion of the Congress, Victoriaville and nearby towns that took part in the Congress, were in the midst of outbreaks.

Of course, once the Spanish Flu was raging in Europe, and vast numbers of soldiers were infected, it was inevitable that returning troop ships would further spread the virus.

Lynne: How did the Spanish Flu End?

Colleen: Apparently, it has never ended. What it has done is fade into the background, while its genetic traces continue to circulate in every Influenza A strain since 1918. So why has it not continued to kill on the scale and with the scope seen in the early 20th Century? Scientists explain that once most of the world had become exposed to the Spanish Flu in the years between 1918 -19 and a general immunity had been developed, the virus began a process called “antigenic drift”. Antigenic drift is part of a virus’s natural coping mechanisms to survive. It is in a virus’s best interests to spread before it kills its host - a very lethal virus will die out before it can spread, but if it mutates to a milder strain that allows it to pass from host to host, it will survive. Antigenic drift produced slightly altered versions of the Spanish Flu that were far less virulent and hardly distinguishable from the seasonal flu. Occasionally though, it combines with a bird flu or a swine flu and can still produce a potent new strain. The pandemics of 1957, 1968 and 2009 were lethal for millions of people. These flus were a direct descendent of the Spanish Flu and as a result it has become known as the “Mother of all Pandemics”.

Lynne: Why was the Spanish Flu so deadly for adults aged 20-40?

Colleen: Evolutionary biologist Michael Worobey explains that this has to do with which flu strains people had been exposed to as children. Dominant flu strains change over time, and anyone born after 1889 had not encountered an Influenza A strain before. Further, he says that the first flu strain that a child is exposed to will imprint on his/her immune system and will give him/her protection for exposure to later somewhat related strains.

Lynne: Why was the Spanish Flu so much more deadly for men than women? 

Colleen: Statistics tell us that the Spanish Flu caused significantly greater deaths in men than in women. For every 1000 males who contracted the flu, 672 died, while for every 1000 females only 498 perished. It is largely believed that the discrepancy in mortality rates was due to environmental factors rather than biological ones. As we know, the First World War was still raging in Europe during the spring, summer and fall of 1918. The United States entered the war in April of 1918, adding more than 4 million troops to the millions already in camps, trenches, ships, etc. Conditions in those camps, trenches and ships were often cramped and unsanitary, while the men were often in poor health because of inadequate nutrition, exhaustion and medical conditions common to war operations such as dysentery, tuberculosis, typhoid and trench fever. Effective medical treatment was limited in part because of logistics but also because medicines like vaccines and penicillin to treat secondary bacterial infections, had not yet been discovered and put to use. Control efforts were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene and use of disinfectants. These types of intervention were quite difficult to implement in a military theatre.

Once the Spanish Flu took hold among troops, it spread like wild fire. Those who were on the front lines and became very ill were transported to hospitals by trains, wagons and trucks, infecting others with the virus as they were moved. 45,000 American soldiers alone died of the Spanish Flu. Military camps on the home front did not fare much better. Crowded conditions contributed to the rapid spread and high mortality rate among men.

The higher mortality rates held true for civilian male populations as well. While non-pharmaceutical interventions were more easily put in place, it is thought that because men were more likely to work outside the home, they were at greater risk from infectious respiratory diseases such as tuberculosis. Co-morbidities, particularly if they were of a respiratory nature, led to higher mortality rates.

Lynne: How many Canadians died of the Spanish Flu?

Colleen: The generally accepted figure is about 50,000, however that number is very hard to confirm precisely. As mentioned previously, the Spanish Flu often led to a deadly secondary bacterial pneumonia. So, while some doctors would officially record the cause of death as Spanish Flu, others would record it as pneumonia or even tuberculosis. The number of Canadian fatalities could well be higher than 50,000 for this reason.



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