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The places that escaped the Spanish flu

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Spanish flu: 100 years on

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Disease

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In places like Alaska, the Spanish flu exacted a terrible toll. But while
some communities suffered many deaths, others nearby escaped the carnage.
How?

Author image

By Richard Gray

24th October 2018

[29][p06p0lvp.jpg]

Filthy and frightened, the three young children staggered up the beach.
Their tiny frames were feverish and behind them, on board the small
sailboat they had drifted ashore upon, lay the bodies of two dead men.

The group had been attempting to flee an outbreak of disease that had
devastated their small, isolated village further upstream from the spot
where they run aground on the Naknek River in Bristol Bay, Alaska. The
three young survivors were quickly taken to a hospital run by a salmon
canning company.

Their unexpected arrival at the Alaska Packer Association’s “Diamond O”
cannery on the Naknek announced that “Spanish flu” had taken hold in
this remote, largely ice-bound part of the world. The inhospitable
winter weather conditions had prevented travel to the area between the
months of September and May, meaning it had escaped the waves of
influenza that swept the world during 1918.

By the time the pandemic had run its course, it claimed somewhere
between 50 and 100 million lives – more than the total number of deaths
from the terrors of World War One.

The arrival of the boat at the cannery on 4 June 1919 indicated the
disease had finally found its way to the remote native Inuit
communities that dotted the Alaskan coastline. The next day, the
superintendent of the cannery dispatched a team to the children’s
village to see if they could help.

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What they discovered was horrifying.

Reports from the men on the expedition described the village of
Savonoski as being in a “deplorable state” and “[33]wretched”. Nearly
all of the adult population in the small cluster of around 10 houses
were dead. Those still alive were gravely ill and told how their
relatives had [34]dropped even as they walked around. The team from the
cannery buried the dead in a mass grave and brought those still alive
back to the hospital in Naknek.

It was a picture that was repeated in villages all across Alaska. In
just a few days nearly 200 people would die from the disease in the
Bristol Bay area, leaving dozens of children orphaned. From some
places, stories emerged of packs of [35]stray dogs feasting on the
bodies of the dead. In some communities, up to 90% of the population
died and the mortality rates were some of the highest in the world.
[p06pkqtn.jpg]

Many of Alaska's settlements were remote and difficult to reach - but
the flu still found them (Credit: Getty Images)

Yet, just a few miles from some of the worst hit areas of Bristol Bay,
one community in a tiny settlement called Egegak escaped the disease
entirely.

“It is strange to relate that Egegak was the only village on Bristol
Bay that was not troubled with the malady,” the Alaska Packing
Association’s superintendent at Naknek station, JF Heinbockel was to
say in his [36]official report of the epidemic. “The natives there were
apparently just as healthy when we left as they ever were.”

Other medical reports stated that some villagers at Egegak showed only
mild symptoms of the disease. It appears they were lucky.

“More people per capita died from influenza in Alaska than almost
anywhere else in the world,” says Katherine Ringsmuth, a historian who
has been piecing together the story of the [37]canneries in Bristol
Bay. “Some places like Egegak escaped it and no one really knows why.”

The survival of these so-called ;escape communities’ could prove valuable
today as public health officials look fearfully towards the next influenza
pandemic

As the world tried to pick up the pieces in the aftermath of the global
pandemic, stories began to emerge of similar places that had escaped
the virus. There were not many – a handful of remote islands, rural
towns, walled asylums and schools were left unaffected.

But the survival of these so-called “escape communities” could prove
valuable today as public health officials look fearfully towards the
next influenza pandemic.

The lessons they contain are considered so important that the US
Department of Defense’s Threat Reduction Agency [38]investigated the
handful of the places across the United States that were untouched by
Spanish flu in the hope of gleaning some clues about how to keep
military personnel safe in the future.

In all, the authors of the report focused on seven communities that
they found had escaped the virus, although they say there may have been
others they did not identify. Among them were the rural farming village
of Fletcher, in northern Vermont, and Gunnison, Colorado, a remote town
in the Rocky Mountains. Princeton University in New Jersey, Bryn Mawr
College in Pennsylvania, the Western Pennsylvania Institution for the
Blind in Pittsburgh and the Trudeau Tuberculosis Sanatorium in Saranac
Lake, New York.
[p06pks49.jpg]

In some communities, many adults died and orphaned children had to fend
for themselves (Credit: Getty Images)

“These communities basically shut themselves down,” explains Howard
Markel, an epidemiological historian at the University of Michigan who
was one of the authors of the study. “No one came in and no one came
out. Schools were closed and there were no public gatherings. We came
up with the term ‘protective sequestration’, where a defined and
healthy group of people are shielded from the risk of infection from
outsiders.”

The people of Gunnison managed this by erecting guarded barricades on
the main highways in and out of the surrounding county. Railway
passengers were forced to submit to two days of quarantine upon
arrival.

The sanatorium and school for the blind benefited from being relatively
closed communities already, with walls to confine those who lived there
also helping to protect those inside from the disease running rampant
through the communities on the outside.

Being hard to reach also helped to protect other communities in 1918.
The US naval base on the island of Yerba Buena, in San Francisco Bay,
was only accessibly by boat. The base’s 6,000 residents were confined
to the island and no visitors were allowed ashore. The few arrivals
allowed on the island were confined to quarantine, were given three
times daily throat sprays, and had to maintain a distance of 20 feet
from one another.

For severe pandemics it might be cost beneficial for some islands to close
their borders

When these measures were lifted in November 1918, as reports of cases
in San Francisco were on the decline, the base experienced only mild
cases, but at least three people did die.

“The moment you open up the gates, the virus enters in the bodies of
people who come in,” says Markel. “Protective sequestration is only as
good as long as you are doing it.

“The notion that you can shut down a modern city or even a university
today is not very likely though. It is extremely expensive and
disruptive.”

But there may be some benefit to keeping the virus out for as long as
is possible. American Samoa implemented a five-day quarantine for all
boats that kept influenza from its shores until 1920. When it finally
did arrive, the virus appears to have lost much of its sting and there
were [39]no deaths attributed to influenza in a population of more than
8,000. The main island of Samoa to the northwest, however, lost around
a fifth of its population to the pandemic.
[p06pkrht.jpg]

The villages on the Naknek River of Alaska were hard hit by the sudden
arrival of the flu (Credit: Getty Images)

A similar story unfolded on the on the Australian island of Tasmania,
which implemented strict quarantine measures for boats arriving on its
shores that required all passengers and crew to be isolated for seven
days. When the infection penetrated the island in August 1919, medical
officers reported that it was a milder infection than that on the
mainland. The death rate on Tasmania was one of the lowest recorded
worldwide.

“For some islands, it might have been a mix of chance, remoteness and
small numbers of travellers,” says Nick Wilson, a professor of public
health at the University of Otago in Wellington, New Zealand. “This
experience has some modern relevance – for severe pandemics it might be
cost beneficial for some islands to close their borders.”

Other islands had similar success at keeping the pandemic at bay. The
French territory of New Caledonia in the South Pacific did not
experience an [40]outbreak until July 1921, again escaping with just a
mild form of the disease.

In some areas, the older populations particularly were not as affected as
much because they had some protection – Gerardo Chowell

It’s not clear why those attempts to delay the arrival of the disease
reduced the mortality rates in these places. But research has suggested
that over time, as the virus burned its way through populations, it
accumulated mutations that naturally reduced its capacity to cause
disease.

Another possibility could be that some populations [41]may have
acquired a degree of immunity against the pandemic strain from
comparatively harmless seasonal flu strains that were circulating in
the years running up to 1918.

In Denmark, for example, the pandemic claimed just [42]0.2% of the
population while in [43]Australia just 0.3% died. China also escaped
lightly, with [44]relatively few deaths – again something that has been
attributed to some existing immunity within the population. Some large
cities also reported lower mortality rates than might be expected in
places where the risk of passing the virus from person to person is
high, perhaps also due to [45]immunity obtained in earlier less deadly
outbreaks.
[p06pmlts.jpg]

Even some of the most isolated Alaskan settlements were infected, often
by trappers or mail teams (Credit: Alamy)

“This is known as the ‘antigen recycling hypothesis’,” says Professor
Gerardo Chowell, an epidemiologist at Georgia State University who has
been attempting to piece together the [46]events that led to the 1918
pandemic. “In some areas, the older populations particularly were not
as affected as much because they had some protection that they probably
acquired when they were children.”

While the idea is still debated, it has provided some clues that could
help health officials in the fight against future pandemics. Today some
countries offer annual vaccinations against seasonal flu strains that
can help their populations build up temporary immunity. According to
[47]research by Jodie McVernon, an immunologist at the University of
Melbourne, this could “provide important protection in the early stages
of a new pandemic”.

“The more times you get vaccinated, the more you are exposed to
different versions of the flu virus,” adds Markel.

Transportation was much scarcer than nowadays and the population of Brazil
was much smaller, so it is easy to see that Marajo might have got lucky

But locations even with this potential immunity still saw people fall
ill and some deaths. Just two small chains of remote volcanic islands
in Fiji, in the South Pacific – the [48]Lau and Yasawa islands – along
with Marajo island on Brazil’s Amazon delta, and a handful of tiny
communities in Alaska and the Bering Strait could claim to have been
left entirely untouched by the pandemic.

Their isolated locations and lack of outside visitors meant these
island communities were never exposed to the virus.

“Transportation was much scarcer than nowadays and the population of
Brazil was much smaller, so it is easy to see that Marajo might have
got lucky,” says Wladimir Alonso, a technical officer at the World
Health Organization who has studied the patterns of the 1918 pandemic
in Brazil. “But you would expect the population to remain
immunologically susceptible to the pandemic virus.”
[p06pmpw9.jpg]

The Danish capital Copenhagen was one of the cities that escaped the
worst effects of the flu in 1918 (Credit: Getty Images)

This could mean that these remote locations were hit by the virus at a
later date, but the very isolation that protected them from the waves
of flu hitting other parts of the world meant these cases went
unreported.

Blood tests conducted in Alaska, however, have confirmed that some
remote populations were never exposed. People in the Yupik settlements
of Gambell and Savoonga on St Lawrence Island in the Bering Strait and
the even more remote Saint Paul Island further to the south, [49]showed
no trace of antibodies to the 1918 virus when they were tested in the
1950s.

While it appears these places were largely protected by their geography
alone, other communities took matters into their own hands. Villagers
in Barrow and Wainwright in north Alaska posted armed guards around
their villages and travel between settlements was prohibited. When
scientists tested people living in a number of [50]remote settlements
in north Alaska, they found they too were free of antibodies,
suggesting they had never been exposed.

It appears that many of these villages were given advanced warning of
the oncoming virus as it spread across Alaska by dog sled teams that
raced ahead of the infection to alert villages. It was an incredible
gamble – mail delivery teams and seal hunters moving through the region
were already spreading the virus from settlement to settlement – but
one that paid off.

One native Inupiaq community placed armed guards eight miles south of the
town. It was among those villages to evade the flu completely

One native Inupiaq community called Shishmaref, situated on a barrier
reef island to the north of the Bering Strait, received news in this
way and were able to place armed guards eight miles south of the town
with [51]orders not to let anyone pass. It was among those villages to
evade the flu completely.

“A few places had warning,” says Nicole Braem, a cultural
anthropologist with the Bering Land Bridge National Preserve, which is
part of the US National Park Service. “Numerous settlements in Alaska
were unaffected, largely because of quarantines established along
travel routes or their remoteness. Communities at the time were very
self-sufficient for food and clothing. They were not as dependent on
food and goods imported from elsewhere in the United States [compared
to today].”

In the modern world, shutting down settlements like this would be far
harder. Few places are now not dependent on goods brought in from
around the world. Global travel networks and supply chains could also
mean few places would be remote enough to escape a modern pandemic.
[p06pms5v.jpg]

The Australian state of Hobart instituted strict quarantine - and
suffered very few deaths (Credit: Getty Images)

“In 1918 they had very little idea about viruses or what caused the
pandemic,” says Howard Markel. “Today we would have a better shot at
coping with it – we have antivirals, hospitals with intensive care
units, respirators and much better surveillance. But we travel further
and faster than we ever have before, so the spread could be much faster
than we could cope with.”

Some communities in 1918 also appear to have escaped the virus against
all logic. The 737 people living in the town of Fletcher, Vermont,
defied advice to avoid contact with the outside world, holding a dance
and attending a county fair in a neighbouring town. The town even
[52]hosted a wedding for a soldier from a military camp in
Massachusetts that saw 28% of its population hit by influenza and
suffered 757 deaths in the same month as the wedding. Despite 120
guests attending the wedding, the residents of Fletcher appeared to
have dodged a bullet.

And this good fortune is perhaps the greatest lesson that the escape
communities of 1918 have to offer modern health officials. Many
communities that implemented rigid protection and quarantine measures
were still hit by the pandemic.

The disease struck so quickly, most people didn’t have a chance to respond

It was a lesson that the communities of Bristol Bay in Alaska learned
the hard way.

“Although they knew about the flu and did what they could to prevent it
from coming, it arrived anyway,” says Katherine Ringsmuth. “The disease
struck so quickly, most people didn’t have a chance to respond.” A fall
in salmon stocks may have ultimately helped the Egegak village. “It was
a terrible year for salmon as they had been producing so much canned
salmon for the war effort in Europe, it caused the fish numbers to
decline.

“It might have meant no one had any reason to visit the area. It was
just chance.”

Survival, it seems, can sometimes come down to blind luck.

--

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