In this 1918 photograph, influenza victims crowd into an emergency hospital at Camp Funston, a subdivision of Fort Riley in Kansas. The flu, which is believed to have originated in Kansas, killed at least 50 million people worldwide.

Ninety-one years ago, the mother of all influenza pandemics struck the world, killing an estimated 50 million people.

According to the U.S. Department of Health and Human Services, more Americans died of the virus than in World War I, with estimates at 675,000.

In Kansas, it reportedly infected 222,000 people, claimed 5,500 lives and cost $102 million in economic losses.

According to a newspaper article in 1919, the outbreak caused an estimated 12,000 teachers to be idle for an eight-week period, and more than 10,000 businesses were hit by closing orders and flu bans.

“The average Kansan can scarce comprehend the meaning of the enormous loss to the state as a result of the influenza epidemic,” Dr. J.J. Sippy, the state epidemiologist, said at the time.

There are different theories on where the 1918 Spanish flu pandemic originated.

According to “The Other War,” by Dr. David Gray and other articles, the virus was first reported on March 11, 1918, at Fort Riley’s Camp Funston when a cook came down with a bad cough, fever, severe sore throat, headache and muscle pains. By noon that day, 107 soldiers were sick with the same symptoms, and by the end of the week, 522 were hospitalized. Within five weeks, 46 soldiers died.

While the disease abated somewhat in the United States during the summer, it was only getting its second wind.

“Initially in the spring months, the disease was not very serious although widespread in some places. But when it came back the following autumn, it was a much more fierce enemy,” said Dr. Jason Eberhart-Phillips, today’s Kansas health officer.

Comparing the two

Recollections of the pandemic have resurfaced in light of the current flu pandemic — H1N1, more commonly known as swine flu.

According to the World Health Organization, it has killed 3,500 people. The Centers for Disease Control and Prevention estimates at least 600 people have died in the United States and about 10,000 have been hospitalized. There have been two deaths reported in Kansas.

The Spanish flu and swine flu started in the springtime and targeted young, healthy adults. Both also are an influenza A virus strain of subtype H1N1.

“It is similar in that it has the same potential for worldwide spread and easy transmissibility between humans — none of us have a natural immunity against this virus and we are susceptible to it as a species,” Eberhart-Phillips said.

Fortunately, that seems to be where the similarities end.

Dr. Chien Liu, professor emeritus of medicine who served as director of infectious diseases at KU Med Center from 1963 to 1991, described the two viruses as distant relatives.

“They still belong to this large group called H1N1, but they are distant cousins. They are so distant that they are totally not related.”

Liu said the Spanish flu was much deadlier because there were no antibiotics, antivirals or vaccines to treat or prevent infections and associated complications. He said many people died from secondary problems like pneumonia.

New record

Medicine has come a long way since then.

In fact, the current H1N1 virus may go into the history books as well — not for its mortality rate, but for saving lives with a vaccine that is being produced at an unprecedented level.

“This could be the first pandemic in history that we can really stop dead in its tracks, and that’s a monumental achievement,” Eberhart-Phillips said. “It was inconceivable even a few years ago to make a vaccine this rapidly for an entirely new infectious agent in just a matter of months to protect an entire population.”

But, he said, it’s going to take a lot of work, and it’s going to take a lot of understanding on the part of the public. That means people, especially those who are at high risk of getting the virus, need to get the vaccination when it becomes available.

“It’s been produced using the same methodology that is used every year for the seasonal flu vaccines. Technically, it’s called a strain change,” he said. “So everything about the vaccine is the same except for the little part that has to do with the antigen — the protein that’s on the virus that’s going to stimulate an immune response in people that’s specific to this particular strain.”

Eberhart-Phillips said health professionals will monitor reactions to the vaccine “very closely,” but they don’t expect serious adverse reactions.

Same safety precautions

Meanwhile, he reminds people that one thing hasn’t changed in the last nine decades, and that’s how people protect themselves from getting sick and help prevent the spread of disease. Such measures include: good hand hygiene, covering coughs and sneezes, staying away from people who are sick and staying out of circulation when ill.

“We still are kind of depending on many of the same community mitigation measures that sanitarians in those early days of public health would have been promoting back then,” he said.

Extreme precautions were taken in Lawrence on Oct. 8, 1918, when Kansas University was closed and the mayor ordered closure of theaters and forbade public gatherings of more than 20 people.

“It’s not like we have some magic pills that people can take,” Eberhart-Phillips said. “There are antiviral medications, but they are not curative in the sense of a lot of the drugs that we take these days. They just have the potential to lessen the severity and the risk of complications.

“It’s still going to come down to prevention — more than treatment. Fortunately, we have a tool that they didn’t have in the new vaccine.”