Desfile da Filadélfia piora surto de gripe espanhola

Desfile da Filadélfia piora surto de gripe espanhola


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Em 28 de setembro de 1918, um desfile do Liberty Loan na Filadélfia provocou um grande surto de gripe espanhola na cidade. No momento em que a pandemia terminou, cerca de 20 milhões a 50 milhões de pessoas estavam mortas em todo o mundo.

A gripe é um vírus altamente contagioso que ataca o sistema respiratório e pode sofrer mutações muito rapidamente para evitar ser morto pelo sistema imunológico humano. Geralmente, apenas os muito velhos e muito jovens são suscetíveis à morte por gripe. Embora uma pandemia do vírus em 1889 tenha matado milhares em todo o mundo, foi somente em 1918 que o mundo descobriu o quão mortal a gripe pode ser.

A origem mais provável da pandemia de gripe de 1918 foi um pássaro ou animal de fazenda no meio-oeste americano. O vírus pode ter viajado entre pássaros, porcos, ovelhas, alces, bisões e alces, eventualmente se transformando em uma versão que se espalhou pela população humana. A melhor evidência sugere que a gripe se espalhou lentamente pelos Estados Unidos na primeira metade do ano, depois se espalhou pela Europa por meio de alguns dos 200.000 soldados americanos que viajaram para lá para lutar na Primeira Guerra Mundial. Em junho, a gripe parecia ter a maioria desapareceu da América do Norte, após cobrar um preço considerável.

LEIA MAIS: Como as cidades dos EUA tentaram impedir a propagação da gripe espanhola de 1918

Durante o verão de 1918, a gripe se espalhou rapidamente por toda a Europa. Uma de suas primeiras paradas foi na Espanha, onde acabou se tornando conhecida no mundo todo como a gripe espanhola. A gripe espanhola era altamente incomum porque parecia afetar pessoas fortes no início de suas vidas, em vez de bebês e idosos. No final do verão, cerca de 10.000 pessoas estavam mortas. Na maioria dos casos, hemorragias no nariz e nos pulmões mataram as vítimas em três dias.

Quando o outono começou, a epidemia de gripe saiu de controle. Portos em todo o mundo - geralmente os primeiros locais em um país a serem infectados - relataram problemas sérios. Em Serra Leoa, 500 dos 600 estivadores estavam doentes demais para trabalhar. África, Índia e Extremo Oriente relataram epidemias. A disseminação do vírus entre tantas pessoas também parece tê-lo tornado ainda mais mortal e contagioso, pois sofreu mutação. Quando a segunda onda de gripe atingiu Londres e Boston em setembro, os resultados foram muito piores do que os da cepa de gripe anterior.

LEIA MAIS: Em meio à pandemia de gripe de 1918, a América lutou para enterrar os mortos

Doze mil soldados em Massachusetts contraíram gripe em meados de setembro. Cada divisão das forças armadas relatava centenas de mortes por semana devido à gripe. Filadélfia foi a cidade mais atingida nos Estados Unidos. Após o desfile do Liberty Loan (celebrações para promover títulos do governo que ajudaram a pagar pela causa aliada na Europa) em 28 de setembro, milhares de pessoas foram infectadas. O necrotério da cidade, construído para acomodar 36 corpos, agora enfrentava a chegada de centenas em poucos dias. A cidade inteira foi colocada em quarentena e quase 12.000 residentes morreram. No geral, nos Estados Unidos, cinco em cada mil pessoas foram vítimas da gripe.

No resto do mundo, o número de mortos foi muito pior. Na América Latina, morreram 10 em cada mil pessoas. Na África, era de 15 por mil e na Ásia chegava a 35 por mil. Estima-se que cerca de 20 milhões de pessoas morreram somente na Índia. Dez por cento de toda a população do Taiti morreu em três semanas. Na Samoa Ocidental, 20% da população morreu. Mais pessoas morreram de gripe do que em todas as batalhas da Primeira Guerra Mundial combinadas.

Veja toda a nossa cobertura de pandemia aqui











Como duas cidades dos EUA responderam à pandemia de gripe de 1918 de maneira muito diferente - e o que podemos aprender com esses erros

Em 28 de setembro, a cidade de Filadélfia sediou o desfile "Liberty Loan" em meio ao surto de gripe de 1918-19 - às vezes conhecido como gripe espanhola. Pouco tempo depois, os hospitais estavam lotados e 2.600 pessoas morreram.

Na mesma época, a cidade de St. Louis estava fechando escolas, bibliotecas, tribunais, igrejas, playgrounds, bem como limitando o número de pessoas nos bondes e escalonando os turnos de trabalho para minimizar o contato.

Eventualmente, a Filadélfia seguiu o exemplo. Mas de acordo com um estudo publicado no Proceedings of the National Academy of Sciences, faltaram apenas dois dias - de 5 a 7 de outubro - entre o momento em que os primeiros casos apareceram em St. Louis e os encerramentos sendo decretados. Na Filadélfia, durou mais de duas semanas.

Essas ações muito diferentes contra a pandemia de gripe em 1918-19 levaram a resultados muito diferentes para as duas cidades. No seu auge, a taxa de mortalidade em St. Louis era um oitavo do que na Filadélfia. Na verdade, de setembro a fevereiro daquele inverno, a taxa de mortalidade por gripe foi de aproximadamente 358 por 100.000 pessoas em St. Louis e 748 por 100.000 na Filadélfia, de acordo com um estudo no JAMA.

Embora vivamos em uma época diferente em comparação com 1918, há lições que podemos aprender com essa história para aconselhar como lidamos com a atual pandemia de coronavírus.

"Fechar escolas, teatros e outros locais onde muitas pessoas se reúnem é essencial, pois os vírus respiratórios, incluindo a pandemia de gripe de 1918 e a SARS-CoV-2, são facilmente disseminados quando as pessoas estão próximas umas das outras e quando toque nas mesmas superfícies, mesmo com horas de intervalo ", disse Jennifer Toller Erausquin, epidemiologista social e professora assistente no departamento de educação em saúde da UNC Greensboro.

"O objetivo do distanciamento social e do isolamento é reduzir o pico da taxa de mortalidade. Um objetivo secundário é reduzir o excesso de mortalidade cumulativa. Tomados em conjunto, é isso que os epidemiologistas querem dizer quando falamos em 'achatar a curva'." fazer as duas coisas, disse ela.


A parada de 1918 que espalhou a morte na Filadélfia

A pandemia de gripe de 1918-19 matou entre 50 e 100 milhões de pessoas em todo o mundo, mais do que morreram nas batalhas da Primeira Guerra Mundial. Nos Estados Unidos, a cidade mais atingida foi a Filadélfia, onde a disseminação da doença foi estimulada pelo que pretendia ser um evento alegre: um desfile.

Escrevendo em Pensilvânia História: A Journal of Mid-Atlantic Studies, o historiador Thomas Wirth explica o que aconteceu: & # 8220Em 28 de setembro, apesar do aumento da infiltração da doença entre a população civil, uma manifestação pela Quarta Liberdade de Empréstimos prosseguiu com um debate mínimo sobre as repercussões para a saúde pública. & # 8221 chefe do Hospital Naval da Filadélfia e # 8217s disse ao Livro razão público nos dias antes do desfile: & # 8220Não há motivo para mais alarme. Acreditamos que temos tudo sob controle. & # 8221 Então, o desfile seguiu em frente. & # 8220 Nas ruas do centro de Filadélfia, 200.000 pessoas se reuniram para comemorar uma vitória aliada iminente na Primeira Guerra Mundial. Em uma semana do comício, cerca de 45.000 habitantes de Filadélfia foram afetados pela gripe. & # 8221

Embora frequentemente chamada de gripe espanhola, a doença não se originou na Espanha. Em vez disso, a neutralidade do país em tempos de guerra contribuiu para relatos mais elevados de sua escalada em seus jornais. Exatamente onde e quando começou em 1918 ainda está sob especulação. Mas, no outono daquele ano, ele havia chegado à Filadélfia.

& # 8220A princípio, a epidemia da Filadélfia & # 8217s não diferia daquela em outras grandes cidades americanas & # 8221 o historiador James Higgins escreve em Legados da Pensilvânia. & # 8220No entanto, na primeira semana de outubro, quase cinco semanas após o início do surto, a taxa de mortalidade da Filadélfia acelerou em uma escalada inigualável por qualquer cidade do país, talvez por qualquer grande cidade do mundo. & # 8221 E esse pico é atribuído ao evento patriótico, um dos vários comícios do Liberty Loan organizados na Filadélfia para arrecadar dinheiro para a guerra. Desta vez, um convidado pernicioso se juntou a ele: & # 8220O vírus, uma presença invisível no desfile, teve uma oportunidade sem precedentes de se espalhar pela cidade e nos dias seguintes anunciou sua presença em uma onda disparada de doença e morte. & # 8221

Logo os hospitais estavam lotados, assim como os necrotérios e cemitérios. Em um estudo publicado em 2009 no Anais da Academia Nacional de Ciências sobre as curvas de incidência da epidemia de 1918 na Filadélfia, os pesquisadores observam que, 72 horas após o desfile, todos os leitos da cidade & # 8217s 31 hospitais estavam lotados e & # 8220 na noite de 3 de outubro, o fechamento de escolas, igrejas, e os locais de diversão pública foram adotados pelo conselho municipal da Filadélfia. & # 8221

Em seis semanas, 12.000 morreram. O cheiro de corpos deixados para apodrecer nas casas enquanto esperavam para serem removidos impregnou as ruas. A disseminação do vírus foi exacerbada pelas condições existentes na cidade: uma população em expansão atraída pelas indústrias do tempo de guerra, uma densidade de moradias e falta de serviços de saneamento e água potável nesses bairros de classe trabalhadora.

O desfile dos Liberty Bonds na Filadélfia em 1918 via Wikimedia Commons

Somando-se à crise estava a falta de equipe médica, já que muitos estavam no exterior no esforço de guerra. À medida que mais e mais pessoas adoeciam, a operação da cidade foi interrompida. ” Relatórios de Saúde Pública. & # 8220Nos distritos de cortiços já superlotados, as condições simplesmente pioraram. Quando as enfermeiras também adoeceram, a situação tornou-se crítica. & # 8221

O diretor de saúde pública da cidade, Wilmer Krusen, declarou: & # 8220Se você me perguntasse as três coisas que a Filadélfia mais precisa para vencer a epidemia, eu diria a você & # 8216 Enfermeiras, mais enfermeiras e ainda mais enfermeiras. '& # 8221 Com nesta escassez de enfermeiras, freiras da arquidiocese católica romana intervieram para oferecer cuidados. É importante ressaltar que eles não apenas visitavam hospitais, eles iam para bairros há muito marginalizados pela cidade onde muitos dos doentes - especialmente aqueles que não podiam pagar por serviços médicos ou afro-americanos que não eram permitidos nos hospitais segregados - estavam morrendo.

& # 8220A importância do trabalho das Irmãs & # 8217 nas comunidades afro-americanas não pode ser exagerada durante esta época de forte segregação racial, & # 8221 a historiadora Christina M. Stetler escreve em História da Pensilvânia. "

Os alunos dos seminários católicos ajudaram a enterrar os mortos que montavam. Em junho de 1919, o Rev. Thomas C. Brennan relembrou a situação no cemitério de Santa Cruz, conforme registrado no Registros da American Catholic Historical Society of Philadelphia:

Quem pode descrever as cenas que viram durante esses dias angustiantes? Animus meminisse horret luctuque refugit. Devemos nos contentar com pequenas sugestões. Em todos os lugares, em todas as direções, sepulturas frescas varreram do olhar do observador, fazendo com que o cemitério bem cuidado se parecesse com um campo de batalha dilacerado por bombas. Uma procissão constante de carros funerários pressionava os portões - carros funerários e substitutos para carros funerários: vagões de jornais, caminhões, carros de carvão, carros de freixo.

Muitos dos que foram enterrados foram enterrados sem lápides em longas trincheiras. As mortes devem ter parecido que nunca acabariam. Mas, em novembro, a virulência da doença diminuiu. Embora houvesse casos em 1919, a frequência de infecção diminuiu. A grama cresceu sobre as sepulturas cavadas às pressas em Santa Cruz. E à medida que as pessoas melhoravam e o país era tomado pela euforia do fim da Primeira Guerra Mundial e do final da década de 8217, a breve turbulência da epidemia começou a desaparecer da memória coletiva.

Mesmo em março de 1919, poucos meses após o surto, o Rev. Francis E. Tourscher se sentiu compelido a começar uma compilação de histórias orais das freiras católicas da Filadélfia, com um reconhecimento da amnésia das epidemias:

Fatos não registrados são rapidamente perdidos no novo interesse da mudança do tempo. [& # 8230] Pouco nos resta agora, além de meras estatísticas materiais e impressões vagas tiradas de & # 8220 relatos de jornais & # 8221 sobre a epidemia de cólera que visitou a Filadélfia em 1832. Provavelmente sabemos o mesmo sobre a & # 8220Morte negra & # 8221 de 1348 na Europa ou da & # 8220Sweating Sickness & # 8221 de 1529 na Inglaterra, assim como fazemos da & # 8220Yellow Fever & # 8221 que assolou nossas cidades do Sul e ameaçou o Norte em 1849 e novamente em 1854.

As histórias dessas testemunhas são agora inestimáveis ​​para oferecer uma visão do nível do solo da epidemia da Filadélfia. Eles relatam como as freiras trabalharam em todas as classes e linhas raciais. Há cenas de famílias inteiras morrendo uma por uma. As freiras descreveram como limpar casas, visitar hospitais, levar água potável para os fracos e ficar com os moribundos em seus momentos finais. O relato de Tourscher, concluído na edição de setembro de 1919 da Registros da American Catholic Historical Society of Philadelphia, inclui irmãs de St. Anne & # 8217s que encontram & # 8220 uma mãe e dois filhos [que] estiveram deitados inteiramente vestidos por quatro dias sem ninguém para chegar perto deles. & # 8221 Em outro & # 8220 & # 8216bem-para- do family & # 8217 as Irmãs [de St. Columba & # 8217s] encontraram cinco crianças, todas doentes, em diferentes partes da casa, e a mãe na cama absolutamente inconsciente. & # 8221 As irmãs fizeram o que puderam - trocando a roupa de cama , trazendo comida e, às vezes, mandando chamar um médico e um padre.

Boletim Semanal

Nenhum memorial ou monumento público na Filadélfia comemora as ações daqueles que cuidaram dos doentes ou dos que morreram. Em 28 de setembro de 2019 - exatamente 101 anos desde o desfile mortal de 1918 - o grupo de artistas Blast Theory, em colaboração com o Museu Mütter do College of Physicians of Philadelphia, liderou uma procissão para homenagear os mortos e homenagear aqueles que cuidaram deles. Os participantes carregavam o nome de uma vítima enquanto a ladainha dos mortos era cantada.

Um filme desse desfile contemporâneo faz parte da nova Cuspir espalha a morte: a pandemia de gripe de 1918-19 na Filadélfia exposição no Museu Mütter. Por meio de artefatos, histórias pessoais, atestados de óbito e pesquisas recentes, ele lembra essa era da história muitas vezes esquecida. Também analisa como as lições do passado podem preparar o futuro, perguntando: estamos mais preparados para uma epidemia hoje e quem estará lá para cuidar?


Desfile da Filadélfia agrava surto de gripe espanhola - HISTÓRIA

O desenho animado no front esportivo The Inquirer em 6 de outubro de 1918 retratou o que estava acontecendo na Filadélfia durante as duras garras da gripe espanhola naquele outono e inverno.

Um fã desgrenhado, mascando charuto, foi fotografado sentado no topo de um mundo esportivo que havia sido "fechado por motivo de doença".

"Puxa", disse o fã insatisfeito, "isso vai se tornar um lixão solitário."

Em 2020, enquanto as autoridades esportivas aqui e em outros lugares lutam para lidar com o surto mundial de coronavírus, a epidemia de gripe de um século atrás pode oferecer algumas pistas.

Durante aquele outono e inverno, a gripe matou cerca de 50 milhões em todo o mundo, 675.000 nos Estados Unidos. Aqui na Filadélfia, onde a certa altura os funcionários da cidade foram de bloco em bloco coletando corpos, 12.191 residentes morreram em um período de quatro semanas. Mais de 700 sucumbiram somente no dia 16 de outubro.

Por toda a cidade, meninas cantavam uma rima macabra enquanto pulavam corda:

As autoridades responderam proibindo a maioria das reuniões públicas. Os eventos esportivos impactados incluíram jogos de futebol americano e universitário, partidas de futebol amador e uma luta entre Jack Dempsey e Battling Levinsky.

O surto também atingiu algumas figuras proeminentes dos esportes da Filadélfia.

Um ex-astro do futebol americano da Penn, o atacante William Robinson, morreu doente durante o treinamento para ser um piloto do Exército. Chandler Richter, filho do fundador e editor do Sporting Life, um influente semanário da Filadélfia, foi outra vítima. E o irmão do empresário de A, Connie Mack, Tom, morreu de gripe em sua casa em Massachusetts com seu famoso irmão ao seu lado.

“Meu pai estava delirando”, disse Helen, filha de Tom, aos repórteres. “Mas quando o tio Connie apareceu, ele se endireitou e eles conversaram sobre família, negócios e beisebol. Eles passaram as últimas horas juntos antes de meu pai morrer. Tio Connie ficou muito abalado. ”

Em Penn, onde os Quakers estavam saindo de uma aparição no Rose Bowl em 1917, a gripe atingiu fortemente o futebol. O técnico Bob Folwell teve que ser hospitalizado e, em um ponto em meados de outubro, apenas 22 de seus jogadores estavam saudáveis ​​o suficiente para praticar.

O jogo de Penn contra a Georgia Tech foi cancelado. Os Quakers adiaram uma competição com os fuzileiros navais da Navy Yard’s, e quando ela aconteceu em 26 de outubro, foi jogada em um Franklin Field vazio.

Um comício no campus para um jogo muito aguardado contra o eventual campeão nacional Pitt foi cancelado, assim como uma arrecadação de fundos para títulos de guerra com a estrela de cinema William S. Hart.

Penn não estava sozinho. A maioria dos times de futebol americano universitário, incluindo um time invicto de Michigan, teve que encurtar suas agendas por causa da epidemia.

Enquanto Pittsburgh permitia que ocorressem em estádios vazios, a Filadélfia proibiu todos os jogos de futebol americano do ensino médio. Quando Minneapolis fez o mesmo, algumas escolas ignoraram a restrição e a polícia teve que interromper as disputas ilícitas.

A Major League Baseball teve sorte. Por causa da Primeira Guerra Mundial, sua temporada terminou um mês antes, em 2 de setembro, antes do pior da eclosão. Ainda assim, em todo o beisebol organizado, pelo menos sete jogadores, incluindo o astro da Negro League Ted Kimbro, morreram de gripe.

Na Filadélfia, a conclusão antecipada da temporada poupou o sexto lugar Phillies e o oitavo lugar do Atletismo de qualquer efeito real. Mas quando Red Sox e Cubs se encontraram na única World Series disputada inteiramente em setembro, a gripe estava ganhando força.

Essa série foi contestada apesar dos apelos de alguns médicos de Boston, que advertiram que as grandes multidões no Fenway Park poderiam ser incubadoras de doenças. Babe Ruth do Boston, então um robusto de 23 anos de idade, foi atingido duas vezes, mas lutou o suficiente para lançar e ganhar um par de jogos para o Red Sox vitorioso.

O beisebol proibiria temporariamente a cuspideira como precaução de saúde e, em pelo menos um jogo da liga secundária, os jogadores usavam máscaras, estimulados por uma pequena cantiga que os instava a “obedecer às leis e usar gaze. Proteja suas mandíbulas de patas sépticas. ”

A luta sem título entre Dempsey e Levinsky, um meio-pesado da Filadélfia, foi adiada no final de setembro. Quando finalmente aconteceu em novembro no Olympia Club, Dempsey marcou um nocaute no terceiro assalto.

Filadélfia não teria um time da NHL por mais 49 anos, mas o impacto da gripe na liga de hóquei pode ser detectado em seu artefato mais famoso, a Copa Stanley.

Em meio à lista de campeões gravada na Copa está esta entrada:

Os Canadiens tinham ido para a prorrogação para vencer o jogo 5 em Seattle em 30 de março. Depois, vários jogadores de Montreal desmaiaram com febres que chegavam a 105. Alguns tiveram que ser hospitalizados. Outros foram ajudados a voltar para seus hotéis.

Com a série empatada em 2-2-1, o jogo decisivo foi definido para 1º de abril. Menos de seis horas antes do início programado, o gerente geral do Montreal, George Kennedy, ele próprio doente, disse que sua equipe sem gripe foi incapaz de Prosseguir. Quando a NHL rejeitou seu pedido de usar jogadores de outro time, Kennedy anunciou que a Copa teria que ser perdida para Seattle.

Os metropolitas esportivos não aceitaram sua generosidade, alegando que a doença não era culpa dos Canadiens e que eles não deveriam sofrer por causa dela.

Quatro dias depois, um dos canadiens aflitos, o defensor Joe Hall, morreu. Kennedy nunca se recuperou totalmente e sucumbiu alguns anos depois.


Desfile da Filadélfia agrava surto de gripe espanhola - HISTÓRIA

Penetrou na cidade como um ladrão sombrio no final do verão de 1918 e, quando saiu, em março de 1919, deixou uma trilha de cadáveres de 20.000 homens.

A grande pandemia de gripe matou 50 milhões a 100 milhões em todo o mundo e cerca de 700.000 nos Estados Unidos em 1918 e 1919. Filadélfia recebeu um golpe devastador. A certa altura, durante um período de seis semanas no outono de 1918, uma pessoa da Filadélfia morria de gripe a cada cinco minutos.

Em 12 de outubro de 1918, a doença insidiosa matou 800 pessoas na cidade, o maior número de vítimas em um dia.

Bem no meio do surto, a cidade postou avisos nas ruas: “Spit Spreads Death.”

E isso representou praticamente todo o reconhecimento do governo de que as coisas não estavam indo bem. Não houve um reconhecimento público real da magnitude do desastre. Simplesmente desapareceu.

Agora, o Museu Mütter do College of Physicians of Philadelphia - quem mais? - está preparando sua exposição mais ambiciosa de todos os tempos para trazer o surto mortal das sombras e contar a história da doença, ofuscação do governo, heroísmo público e o legado da morte.

A exposição, intitulada apropriadamente, "Cuspir espalha a morte: a pandemia de influenza na Filadélfia", abre em 17 de outubro para uma série de vários anos. Um desfile comemorando os caídos e reconhecendo o heroísmo dos profissionais de saúde pública e os muitos voluntários acontecerá em 28 de setembro. Ele está sendo produzido pelo coletivo de artistas Blast Theory, do Reino Unido.

“Não há monumentos para a gripe”, disse Robert Hicks, diretor do museu e da vasta biblioteca histórica da faculdade. “A guerra termina. A guerra é o que tudo ofusca e o governo teve muito a ver com o fato de a gripe não ser reconhecida. O presidente Wilson nunca fez uma declaração pública sobre a gripe porque não queria desviar a atenção do público da Primeira Guerra Mundial e do último grande esforço para vencer a guerra ”.

Na opinião de Wilson, nada era mais importante do que travar e vencer a guerra, exceto, talvez, pagar por ela. Foi assim que em 28 de setembro de 1918, depois que a cidade já estava sob a peste, o quarto desfile do Liberty Loan começou na Broad Street com o objetivo de arrecadar fundos para títulos de guerra.

Mais de 200.000 pessoas alinharam-se na Broad Street naquele dia para torcer pelo esforço de guerra e, involuntariamente, para espalhar doenças.

Não é que ninguém conhecesse os perigos de grandes reuniões públicas convocadas em meio ao contágio. Os médicos sabiam. Mas a cidade se recusou a falar publicamente sobre esses perigos, talvez porque o governo federal não desejasse que nada atrapalhasse os esforços de financiamento.

Um grupo de médicos frenéticos foi à imprensa. Certamente o público seria alertado pelos jornais.

“Houve médicos que avisaram a cidade que o desfile era uma má ideia e disseram: 'Vamos fazer o desfile'", disse Hicks. "Então os médicos disseram:" Vamos colocar editais nos jornais alertando as pessoas. ' Nenhum jornal os publicaria. Isso tudo fazia parte do patriotismo hiper-carregado da Primeira Guerra Mundial. Nunca vimos censura neste país como na Primeira Guerra Mundial, exercida do presidente para baixo. Não tivemos nenhuma agência federal intervindo para fazer uma grande coisa ou fazer o grande anúncio. ”

O desfile continuou conforme o planejado e pessoas morreram, talvez por falta de aviso. Nancy Hill, gerente de projeto do Mütter, disse que houve um “pico dramático” nas mortes relacionadas à gripe após o desfile, embora seja difícil dizer que o desfile por si só foi a causa.

“O desfile foi um momento crucial quando a consciência mudou”, disse ela. Depois que o frenesi patriótico voltado para o dinheiro para os títulos de guerra acabou, ela disse, as pessoas olharam em volta e perceberam que haviam caído em uma “situação de morte”.

O Mütter pretende comemorar os caídos em 28 de setembro, o 101º aniversário do desfile mal concebido do Liberty Loan, com uma marcha de seis quilômetros do Navy Yard à City Hall, produzida pela Blast Theory.

O desfile contará com carros alegóricos grandes e iluminados e uma trilha sonora criada pelo compositor vencedor do Prêmio Pulitzer David Lang (que teve parentes acometidos de gripe) e The Crossing, o grupo coral vencedor do Grammy. A música, entrelaçada com os nomes dos que morreram no dia mais fatal, 12 de outubro, será transmitida pelos celulares aos participantes do desfile.

Com o brilho iluminado das telas de celulares e paredes de plataformas móveis luminosas, o desfile deve criar uma eflorescência sombria ao anoitecer - pelo menos essa é a esperança.

(O público está convidado a se inscrever para participar do desfile em www.spitspreadsdeath.com.)

A Blast Theory também está fazendo um filme do evento, que estará em exibição na exposição do museu, juntamente com inúmeras exposições digitais interativas que permitem a exploração e classificação (por bairro ou quarteirão, por exemplo) de 20.000 artefatos de certidões de óbito mais de 200 fotografias documenta histórias orais e informações de saúde pública.

“Cada atestado de óbito abre uma janela para a vida de uma pessoa que, de outra forma, é desconhecida”, disse Hicks. “Por exemplo, aprendemos sobre Eliza Boney, uma mulher afro-americana que nasceu na Carolina do Norte e que‘ cuidava da casa do marido ’no norte da Filadélfia. Ela estava nos primeiros estágios da gravidez quando morreu pouco antes de completar 20 anos. Eliza é uma de muitas que não estão nos livros de história, mas esta exposição vai homenagear sua memória. ”

“A Blast Theory trabalhou muito para garantir que não fosse uma marcha funerária”, disse Hill, o gerente do projeto. “Queremos homenagear aqueles que morreram em 1918, que muitas vezes não conseguiam os enterros, os funerais, qualquer coisa que desejassem. Também queremos homenagear os modernos trabalhadores da saúde pública. Queremos ter certeza de traçar um paralelo entre essa mulher fora e no chão e usando um botão do Liberty Loan em 1918 e as enfermeiras em nossos pronto-socorros hoje, que serão as primeiras a saber quando isso acontecerá novamente. Eles estão se colocando em risco de outro novo vírus como este. ”

Na mesma linha, o Mütter sediará uma feira de saúde no parque Mifflin Square, no sul da Filadélfia, no dia 7 de setembro. Vacinas contra gripe gratuitas serão oferecidas lá, no desfile e em outros momentos durante a exposição.

A única marca que sobrou da gripe na cidade, Hicks observou, está nos cemitérios, onde lápide após lápide traz a data da morte de um dia sombrio no outono de 1918.

Os mortos falam eloqüentemente em seu silêncio, mas aqui eles falam sozinhos. Nenhuma política de gestão de saúde pública foi alterada em decorrência do desastre. Os protocolos do hospital permaneceram os mesmos. Afinal, a epidemia acabou em março de 1919, por que planejar para o passado?

Apenas pesquisadores médicos, que se empenharam em uma busca incessante pelas origens e pelo tratamento da gripe, se mantiveram firmes. Eles determinaram que era um vírus na década de 1930 e desenvolveram uma vacina na década de 1940. Ao longo do caminho, eles fizeram algumas outras descobertas em busca de pesquisas sobre o vírus da gripe - devemos a eles penicilina.

“O efeito duradouro mais visível são apenas as lápides”, disse Hicks. “Uma das coisas que as pessoas devem perguntar é: 'Existe um plano de cidade, um plano de resposta a emergências?' Eles devem perguntar o que isso significa.”


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Cólera vs. gripe: sucessos e fracassos históricos da epidemia da Filadélfia

Até agora, a maioria dos americanos já ouviu o conto de advertência da decisão da Filadélfia de realizar um enorme desfile patriótico com quase 100.000 espectadores no outono de 1918, um evento super-propagador culpado pelo surto de gripe na cidade nos dias seguintes. 72 horas após o desfile, todos os leitos hospitalares da cidade estavam ocupados. Em seis semanas, mais de 12.000 pessoas morreram, totalizando uma morte a cada cinco minutos.

Durante a atual pandemia, a resposta da Filadélfia em 1918 se tornou o exemplo de como não lidar com um surto. Mas a “gripe espanhola” certamente não foi a primeira doença infecciosa que a cidade enfrentou, e o historiador Timothy Kent Holliday afirma que a Filadélfia estava bem equipada para surtos décadas e até séculos antes.

Holliday obteve seu doutorado nesta primavera com sua dissertação intitulada "Sensações mórbidas: intimidade, coerção e doença epidêmica na Filadélfia, 1793-1854". Sua pesquisa analisa epidemias na Filadélfia e o papel do que ele chama de cuidado íntimo no gerenciamento dessas doenças em instituições, hospitais, prisões e estações de quarentena como o Lazaretto.

Penn Hoje conversou com Holliday sobre por que ele acha que a Filadélfia estava mais bem preparada para o cólera em 1832 do que quase um século depois, quando a gripe atingiu o Navy Yard, e que lições os cidadãos e governos podem tirar da comparação dos dois surtos.

Por que a epidemia de gripe de 1918 é tão referenciada durante o surto atual de COVID-19?

O melhor paralelo para o que está acontecendo agora sempre será a pandemia de 1918, apenas porque é um tipo de coisa centenária, é viral e está no ar.

But the 1832 cholera outbreak is also something that you can draw parallels with to COVID because it’s a disease wending its way across the world and people are really frightened by it. The world is tracing its movement, and it is interpreted as a new disease, as was cholera in the mid-1800s.

The place where the cholera outbreak becomes a good foil for the 1918 pandemic is that Philadelphia was really well prepared for cholera. They had hospital care in place to address the excess mortality and excess illness that cholera would bring. There wasn’t the same kind of strain on public health as there was in 1918.

Why was Philadelphia more prepared for cholera than the flu?

For one, cholera spread over the course of years, so cities could brace themselves a little further in advance.

Secondly, and this is kind of a happy accident, Philadelphia had a really good municipal water supply. And they didn’t know it at the time, but cholera was transmitted through water.

What did the city do to gear up for a possible cholera outbreak?

As cholera was spreading throughout Europe, the city government and the board of health established a number of cholera hospitals, sort of temporary locations where cholera of patients could be treated. These are like schoolhouses, carpenter shops, not newly erected buildings. They were places chosen for their airiness that were easily ventilated. Basically, they were whatever buildings fit that criteria they could get their hands on because a lot of places didn’t want to volunteer to house cholera patients out of fear. People didn’t want to be living next to places that were going to be designated as cholera hospitals.

They established about 20 of these temporary hospitals. A lot of them housed just a few patients over the course of the epidemic. Some of them stayed empty the whole time.

So, Philadelphia was really well prepared in terms of having an infrastructure in place to house cholera patients and to take care of them. They also appointed cholera physicians who would be tasked with managing the hospitals and the Sisters of Charity were really important as care providers during this time, too. So, you had religious nurses, you had lay nurses, you had attending physicians, and you had the presiding physicians in these hospitals. They were really very well staffed.

They could be chaotic places, some of the more crowded ones. But I think the point of all this is that Philadelphia prepared itself for the arrival of cholera well in advance.

To compare, in the early 20th century, and maybe the late 19th century, the onus was often placed on individuals to combat disease. There’s a big moral component and an individual component to what’s called ‘the new public health model’ in the era of the 1918 pandemic. As a result of that, at a governmental level, the underlying sort of systemic factors that contributed to the spread of infectious disease were ignored in favor of putting the onus on individual action.

Why was this idea of individual action popular at the time?

I think that it’s connected really strongly to germ theory because one of the side effects of germ theory is that the seat of disease becomes the individual. Disease is transferred from person to person.

So, the focus is on educating the individual, modifying the individual’s habits, and as a result, a lot of public health officials and physicians ignored or just didn’t pay attention to underlying systemic factors that would influence behavior or a range of behaviors available to people. Like we see today, not everybody is in a position where social distancing is an option. It was the same in 1918. You have people who are living in crowded tenement houses and are not able to avoid congregating. You have people whose livelihoods depend on close intimate contact with others. And there’s the focus on, ‘Oh, you need to do this and that and the other as an individual, as a person to make yourself a better person.’ Rather than saying, ‘Here’s what we as a community need to do to fix what is wrong or what needs to be addressed on a systemic level.’

How did the idea of individual action affect the response?

Philadelphia in 1918 is a really good example of an object lesson of how not to do public health.

The city’s public health director, Wilmer Krusen, gets a lot of blame from historians and amateur historians for letting the parade that we’ve all heard about go on in 1918 that led to the spike in cases in Philadelphia. Some historians have started to push back against that and say that it wasn’t necessarily within Krusen’s power to cancel it. Especially because the mayor at the time, Thomas Smith, was such a ‘boss mayor,’ very typical of what you might associate with that era.

Krusen toed a middle line between putting the ball in the court of individuals versus the government. So, when the state government ordered the closure of cinemas, theaters, ice cream parlors, and other places of social gathering, Krusen also added to that the closure of schools and places of worship. So, he recognized in a way that a lot of historians have ignored that there was a role for umbrella government initiatives to enforce what we would call social distancing.

There were things done wrong, and a lot had to do with corrupt politicians. If you look at the mortality rate of the 1918 flu pandemic, the top three cities are Pittsburgh, Scranton, and Philadelphia. Not only are they all in Pennsylvania, which had a lot of government corruption at the time, but they’re all cities with big boss mayors or boss governments.

The most obvious thing that's associated with ‘boss politics’ is corruption, corruption, corruption. Like a mayor who makes nails and sells them to the city and has the city buy them at exorbitant prices. It’s basically just running the government like a machine, like a business. Appointing people to positions based on personal financial interests and operating in ways that might seem pretty familiar on the federal level today.

So, what kind of lessons can citizens and governments take from the cholera epidemic?

Public health organizations, and the government more broadly, need to be invested in preparation for an infectious disease outbreak, even when there is no clear and present danger for such an outbreak.

Philadelphia in 1831 was preparing itself for cholera, but it was also already kind of prepared in the sense that there was already a strong history of public health, stretching back to the 1790s with yellow fever. Public health initiatives in Philadelphia really strengthened in response to that. The really clean municipal water supply is just one example of that.

For today, the big lesson from the cholera response is to be prepared, even in times when there isn’t an imminent risk for an outbreak.


1918 Spanish Influenza Outbreak: The Enemy Within

Horse-drawn carts plied the streets with a call to bring out the dead in the city where bodies lay unburied for days. The afflicted died by the thousands, and survivors lived in fear. But this wasn’t medieval Europe being stalked by the Black Death. This was Philadelphia, October 1918, and the city was under siege from a new variant of one of mankind’s oldest specters: influenza.

The flu lurking in the midst of this patriotic fervor, however, would prove far more lethal than trench warfare and poison gas. Most alarming was the fact that the disease ravaged previously healthy young adults in their 20s and 30s: the men and women who worked the factories, cleaned the streets, tended the sick — and fought the wars.

Many assumed, wrongly, that the flu had originated in Spain, where 8 million fell ill during a wave of relatively mild flu that had swept the globe in the spring of 1918. Because Spain was neutral and its press uncensored during the war, it was one of the few places in Europe where news about the epidemic was being reported. Whatever its origins, the flu was taking a toll on frontline troops. Commander Erich von Ludendorff blamed the disease for the failure of Germany’s major spring offensive.It was a grievous business, he said, having to listen every morning to the chiefs of staff’s recital of the number of influenza cases, and their complaints about the weakness of their troops.

Influenza wasn’t Ludendorff’s only obstacle. General JohnBlack Jack Pershing, commander in chief of the American Expeditionary Forces in Europe, pushed relentlessly to build up troop strength. The U.S. Army had fewer than 100,000 soldiers when it entered the war — the general’s plans called for approximately 4 million. The Americans would not simply plug holes in the British and French lines. The AEF would stand alone, and march to victory under the American flag. To do that, Pershing needed more men, more materiel. Always, endlessly, more.

Back home, the ramp-up hit a snag. On March 4, 1918, the Army installation at Camp Funston, Kan., reported a single case of flu. Before the end of the month, 1,100 men had been hospitalized, and 20 percent of those men developed pneumonia. Flu spread rapidly among Army camps as troops were rushed through on their way to the front. But the outbreak had subsided by summer, and it looked like the worst was over.

Only a Matter of Hours
Camp Devens, 35 miles northwest of Boston, was seriously overcrowded. Built to house 36,000 troops, it contained more than 45,000 in early September 1918. The flu struck there with a suddenness and virulence that had never been seen before.These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen, wrote Roy Grist, a doctor at the Camp Devens hospital.Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured man from the white….It is only a matter of hours then until death comes….We have been averaging about 100 deaths per day….We have lost an outrageous number of Nurses and Drs.

Flu victims were wracked by fevers often spiking higher than 104 degrees and body aches so severe that the slightest touch was torture. Cyanosis was perhaps the most terrifying hallmark of the pneumonia that often accompanied this flu. A lack of oxygen in the blood turned one’s skin a bluish-black — leading to speculation that the Black Death had again come calling.

While Devens tried unsuccessfully to contain the outbreak, a similar situation was developing at Commonwealth Pier, a naval facility in Boston. Flu was reported there in late August, but the war would not wait. Sailors were shipped out to New Orleans, Puget Sound and the Great Lakes Naval Training Station near Chicago. Josie Mabel Brown was a young Navy nurse living in St. Louis, Mo., when she was called to duty at Great Lakes.There was a man lying on the bed dying and one was lying on the floor, she said of her first visit to a sick ward.Another man was on a stretcher waiting for the fellow on the bed to die….We wrapped him in a winding sheet and left nothing but the big toe on the left foot out with a shipping tag on it to tell the man’s rank, his nearest of kin, and hometown….Our Navy bought the whole city of Chicago out of sheets. There wasn’t a sheet left in Chicago. All a boy got when he died was a winding sheet and a wooden box we just couldn’t get enough caskets.

Three hundred sailors from Boston landed at the Philadelphia Navy Yard on September 7 on the 19th the Philadelphia Inquirer reported that 600 sailors and marines had been hospitalized with the flu. It should have been apparent to city officials that a potential crisis loomed. In Massachusetts the flu had spread rapidly from military encampments to the public at large. Medical practitioners in Philadelphia called for a quarantine, but Wilmer Krusen, director of the city’s Department of Public Health and Charities, declined. There was recent precedent for such action: Quarantines were regularly enacted during a terrifying polio epidemic in 1916. But that was in peacetime. No civilian deaths from flu had been reported locally, and a Liberty Loan parade — perhaps the largest parade Philadelphia had ever seen — was scheduled for the end of the month. A quarantine would only cause panic, and the city would most certainly not meet its quota of war-bond sales.

Every American seemingly had a personal stake in winning the war. Even children were eager to do their bit. Anna Milani, who was a child in Philadelphia during the epidemic, remembered the rhyme she and her friends would sing in the street:

Tramp, tramp, tramp the boys are marching
I spied Kaiser at the door
We’ll get a lemon pie
And we’ll squash it in his eye
And there won’t be any Kaiser anymore

The parade stepped off as planned on September 28 with marching bands, military units, women’s auxiliaries and Boy Scout troops. Some 200,000 spectators thronged the two-mile-long parade route in a show of civic pride. Three days later, 635 new civilian cases of flu, and 117 civilian deaths from the disease and its complications, were reported in Philadelphia.

Worry is Useless
October 1918 was brutal in the City of Brotherly Love. Schools, churches, theaters and saloons were closed. So many Bell Telephone operators were home sick that the company placed notices in city newspapers pleading with the public tocut out every call that is not absolutely necessary that the essential needs of the government, doctors and nurses may be met. Krusen authorized Bell to discontinue service to those making unnecessary calls, and 1,000 customers were eventually cut off.

Even if emergency calls did get through, there weren’t enough people to answer them. A quarter of Philadelphia’s doctors and nurses were away serving in the military. Volunteers were called, but many were too sick themselves — or too frightened of contracting the disease — to be of much help. Entire families were stricken, and the prognosis was often grim.My mother called the doctor because the whole family was sick with this flu, said Harriet Hasty Ferrell.And I, being an infant baby, was very sick, to the point that the doctor thought that I would not make it. He told my mother it wasn’t necessary to feed me anymore.

Still, there were those who tried to quell panic. An October 6 editorial in the Inquirer advised:Live a clean life. Do not even discuss influenza….Worry is useless. Talk of cheerful things instead of the disease.

No amount of happy talk could make the nightmare go away. Between October 12 and October 19, 4,597 Philadelphians died of the flu and related respiratory diseases, and survivors struggled to carry out familiar mourning rituals.We couldn’t go inside the church, one city native remembered.The priest would say Mass on the step, and we would all be congregated outside….They figured maybe outside you wouldn’t catch the germ. Another recalled that her 13-year-old cousin, who was sick with the flu, had to be carried to the cemetery wrapped in a blanket in order to say the traditional Jewish prayers at his mother’s funeral service. Hundreds of unburied corpses posed another serious health risk. Caskets were in such short supply that the J.G. Brill Co., which manufactured trolley cars, donated packing crates to fill the need. The Bureau of Highways used a steam shovel to dig mass graves in a potter’s field. By the end of the month, the Spanish flu had claimed 11,000 victims in Philadelphia and 195,000 nationwide.

The tragedy played out with varying degrees of severity across the country. The city of San Francisco, where the flu hit hardest in late October, mandated that gauze masks be worn in public at all times. The mandate was widely followed, though in reality, masks did little to prevent the spread of flu. They were also uncomfortable and inconvenient, and the public would not tolerate them for long. Even officials showed a less than vigilant attitude when the mayor, a city supervisor, a Superior Court judge, a congressman and a rear admiral were photographed at a prizefight sans their protective masks. And there were those who claimed the act was an unconstitutional attack on personal freedom: If the Board of Health can force people to wear masks, said the San Francisco Chronicle, then it can force them to submit to inoculations, or any experiment or indignity.

Doctors searched desperately for a cure, or at least a stop-gap measure. But they were on the wrong track. Conventional wisdom held that the flu was caused by bacteria vaccines to fight bacterial infections, however, had no effect on the disease. (Flu was not identified as a virus until 1933.) The epidemic was a crushing blow to medical science, which had only recently come to be seen as a professional discipline.

Government agencies fared no better. Surgeon General Rupert Blue, head of the U.S. Public Health Service, was aware that an outbreak of flu was possible. But in July 1918, he denied a request for $10,000 to be dedicated to pneumonia research, and he made no other preparations. Blue’s first public warning came in mid-September and included such tips as avoid tight clothes, tight shoes, tight gloves — seek to make nature your ally not your prisoner and help by choosing and chewing your food well. Congress appropriated $1 million in emergency funding for USPHS Blue eventually returned $115,000 to the government.

Worse still, the government contributed to the national paranoia surrounding all things German. The USPHS officer for northeastern Mississippi planted stories in the local papers that the Hun resorts to unwanted murder of innocent noncombatants….He has [at]tempted to spread sickness and death thru germs, and has done so in authenticated cases. Lieutenant Colonel Philip Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation, which oversaw U.S. shipyards, theorized that U-boats had delivered German spies to America to turn loose Spanish influenza germs in a theatre or some other place where large numbers of persons are assembled. So persistent was the belief that Germany had somehow launched a biological attack that USPHS laboratories devoted precious time to investigating claims that Bayer aspirin, which was manufactured in the States under a German-held patent, had been laced with deadly flu germs.

“Let the curse be called the German plague, declared O jornal New York Times in October.Let every child learn to associate what is accursed with the word German not in the spirit of hate but in the spirit of contempt born of the hateful truth which Germany has proved herself to be.

Over There
The death toll mounted at home through September and October even as President Woodrow Wilson was faced with General Pershing’s demands for more soldiers. Through the summer, Americans were being sent to Europe at the rate of 250,000 a month. But flu was running rampant on troopships, and those who survived the interminable voyage simply spread the disease to frontline staging areas. Wilson was urged by several advisers not to dispatch additional troops until the epidemic had been contained. The president consulted with his chief of staff General Peyton March, who conceded that conditions on the overseas transports were hardly ideal. He would not, however, concede anything that might stand in the way of winning the war.Every such soldier who has died [on a troopship], said March, just as surely played his part as his comrade who died in France. Wilson relented. The transports continued.

Wilson had won a second term in 1916 because he had kept the United States out of the war. Once war was declared in 1917, however, he could not afford to waver in his commitment to seeing the conflict through to Allied victory. To shore up public support, Wilson created the Committee on Public Information a week after declaring war on Germany. (One of its lasting contributions was the Uncle Sam “I Want You” recruiting poster.) The CPI’s news division issued thousands of press releases and syndicated features about the war that made their way, often unedited, into newspapers across the country. The CPI also had a pictorial publicity division, an advertising division and a film division. In short, it used every possible media source to influence public opinion.

Wilson’s zeal for advancing democratic ideals abroad was secured by his willingness to suppress them at home. Dissent was not tolerated. Under the 1917 Espionage Act, roundly criticized as being unconstitutional, Socialist leaders Eugene Debs and Victor Berger were sentenced to a combined 30 years in prison for their antiwar protests. The act also gave the postmaster general the right to determine what constituted unpatriotic or subversive reading material and ban it from the U.S. mail. The Justice Department authorized the 200,000 members of a volunteer group called the American Protective League to report on suspected spies, slackers who didn’t buy war bonds and anyone who voiced opposition to the government.

In this hyper-patriotic atmosphere, fighting the flu came second to winning the war. Public officials, and the public itself, downplayed the seriousness of the silent enemy within and focused on the more tangible enemies of a nation at war. The Germans could be defeated on the battlefield overseas and by surveillance at home. Nothing could stop a disease that immobilized great cities for weeks and carried off hundreds of thousands in the prime of life.

And then, it was over. By the end of 1918, deaths from flu and pneumonia nationwide had subsided greatly, and a third wave in the spring of 1919 left far fewer casualties in its wake.In light of our knowledge of influenza and the way it works, explained Dr. Shirley Fannin, an epidemiologist and current director of disease control for Los Angeles County, Calif.,we do understand that it probably ran out of fuel. It ran out of people who were susceptible.

Those who survived their exposure to the flu developed immunity to the disease, but not to its lasting consequences. William Maxwell, writer and longtime editor at O Nova-iorquino, was a 10-year-old in Lincoln, Ill., when the flu struck his family, killing his mother.I realized for the first time, and forever, that we were not safe. We were not beyond harm, he remembered eight decades later.From that time on there was a sadness, which had not existed before, a deep down sadness that never quite went away….Terrible things could happen — to anybody.

For all the advances in medical science, it is still not clear where the 1918 virus originated, or why it took such a toll on healthy young adults. Flu viruses are extremely adaptable. According to the National Institutes of Health, one new strain of flu appeared in humans between the Hong Kong flu outbreak in 1969 (the last flu pandemic) and 1977. Between 1997 and 2004, five new strains appeared.

Modern researchers agree that it is probably impossible to prevent an outbreak of flu, but it is possible to prepare for one — if the public, health officials and government agencies can agree on a plan of action. Today, as in 1918, a global conflict demands an ever-increasing amount of resources. The government has enacted extraordinary measures in the name of national security. And a public health crisis of the magnitude of the 1918 epidemic is almost incomprehensible. After all, it’s only the flu.

This article was written by Christine M. Kreiser and originally published in the December 2006 issue of American History Revista. Para mais artigos excelentes, inscreva-se em American History revista hoje!


Not a typical Philly jawn

The parade is a precursor to a Mütter Museum exhibition all about the flu outbreak opening mid-October.

“It’s not like your regular parade, it’s no marching bands, no puppets,” Adams said. “It’s not really for spectators. It’s for participants.”

Participants can go online and pick a person who died of the flu to honor. The list comes from Oct. 12, 1918, the deadliest day of the pandemic when some 750 people died in the city.

The Crossing, Philly’s local Grammy-winning choir, will be heard solemnly singing the names of the victims through parade-goers’ smartphones — Anna Golden (28), Thelma Schumann (1), Marion Bernice Barth Lingle (22), and hundreds of more names.

The piece, written by Pulitzer Prize and Grammy-winning composer David Lang, also offers some practical advice.

“Beware of those who are coughing and sneezing… avoid crowded streetcars… walk to the office if possible…avoid crowds,” sings the choir in slow, spread out sections of music.

Four white 20-foot wide sculptures will also act as speakers. The panels will be illuminated by white light and pushed forward by teams of people.

The event will end with a health fair that celebrates advances made in modern medicine, including the discovery of an effective flu vaccine, which people can get at the fair. It also celebrates the unglamorous profession of public health workers.

“There aren’t many Hollywood films about people working in public health and yet those people save millions of lives year in and year out,” Adams said. “We want to take a moment to publicly honor them.”

“Spit Spreads Death” takes its name from a public health poster that was discouraged spitting at the time of the pandemic.

The exhibit will bring visitors to 1918-1919 Philly, recreating the look and feel of the city at the time while sharing the stories of those who fell ill.

But it’s also meant to get people thinking about how diseases can strike at any moment despite medical advancements. The conversation aims to start conversations about the government and the public’s role in fostering public health.

“We expect anyone coming through this exhibition in its lifetime will have somewhere cooking in their mind some news article they’ve heard of about a disease outbreak,” Hicks said. “It could be Ebola, it could be measles since that’s making a resurgence in places where people have not gotten vaccinated, or it could be the flu.”


Death on parade: How the 1918-20 influenza pandemic ravaged Philadelphia and terrorized the Lehigh Valley

By this time 100 years ago, the pandemic influenza that infected a third of the planet — from teeming cities to tiny towns to paradisaical islands in the remotest stretches of ocean — had done its worst.

In recorded history, no greater mortality from disease had ever occurred in so short a time. The bubonic plague pandemic of the 14th century, the Black Death, may have killed more, but that was over a period of years. The flu, in about a year, reaped a far greater toll than the four years of World War I, in which 16 million died.

In the United States, more than 25 million fell ill and more than 600,000 died. The American city hardest hit by the pandemic was Philadelphia. On Oct. 17, the city’s Mutter Museum is opening an exhibit called “Spit Spreads Death,” recounting a public health calamity in which 20,000 Philadelphians perished — more than 12,000 in just six weeks.

The flu exploded like dynamite there. What lit the fuse was the city’s decision to proceed with the Liberty Loan Parade, a patriotic event to promote the purchase of war bonds, despite the fact that the epidemic was well under way. On Sept. 28, some 200,000 people lined Broad Street, the virus raced among them and, within a day or two, more than 600 fell sick.

Within a week, 2,600 were dead.

Philadelphia would emerge with the highest death rate of any American city. The Lehigh Valley’s municipalities didn’t suffer on that scale, but the flu rampaged here, too, to the extent that one newspaper account called it “the dreaded plague.”

Among the events leading up to the Mutter exhibit is a “parade of light” through city streets on Sept. 28 to commemorate that disastrous decision — a somber musical procession of glowing lights along Broad Street from Marconi Plaza in South Philadelphia to City Hall.

The public is welcome to march in the parade. Participants can march in memory of a particular victim. The website has a searchable database of names for people who may have lost ancestors it can also assign one at random.

From a century’s distance, scientists and infectious disease specialists look back on the pandemic with distinct unease.

“The general consensus is that it isn’t a question of whether we’re going to have another pandemic, it’s a question of when,” said Dr. Jeffrey Jahre, an infectious disease specialist and senior vice president of Medical and Academic Affairs with St. Luke’s University Health Network.

“That doesn’t necessarily mean it will have the same kind of effect, because we do have a number of things we’ve learned since then,” Jahre said. “But that doesn’t mean it wouldn’t be serious.”

Whether it would have comparable impact in an age of antibiotics, antivirals, vaccines and other medical advances is impossible to say.

But, Jahre said, if a pandemic today killed as much of the world’s population as the 1918 flu — 3 to 6 percent — the death toll would range from 200 million to 450 million.

A World Health Organization report released last week said the world isn’t ready for a similar pandemic.

“If it is true to say ‘what’s past is prologue,’ then there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 (million) to 80 million people and wiping out nearly 5% of the world’s economy," the report said. “A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared.”

Growing fear

The first flu cases were reported in January 1918 among soldiers at Midwestern military posts. Some experts believe those cases may have been the worldwide point of origin for the illness, with soldiers carrying the infection to European battlefields.

Even so, it became known as the Spanish flu. Spain had remained neutral during the war, so stories about the illness weren’t subjected to the censorship imposed on news in other countries. And the Spanish king, Alfonso XVIII — he survived — was among the early victims.

The January illnesses flared into a springtime wave not markedly different from a typical flu outbreak. Victims who sickened and recovered were lucky. They developed immunity that protected them when the flu returned in August — an unusually early start to flu season, which typically arrives in the fall.

It would soon become clear that nature had unleashed something terrible.

The virus attacked with brute force and speed. Some victims rose healthy in the morning and were dead by dinnertime. Others went to bed feeling peaked and were found dead in the morning, blue-skinned from oxygen deprivation. Some, ravaged by the bacterial pneumonia that was the virus’ chief complication, almost literally coughed their lungs out.

Flu is normally most dangerous to the young and old, whose immune systems are immature or compromised. Those age groups certainly fell victim, but this flu also attacked people in their prime at an extraordinary rate. About half the victims in the U.S. were between 20 and 40.

One theory holds that healthy people fell victim to their own immune systems, which overreacted to the virus and caused a deadly inflammatory condition known as cytokine release syndrome.

Other research suggests that a common flu treatment — high doses of aspirin — contributed to deaths. The evidence is that some victims bled from their noses, ears and other orifices aspirin has blood-thinning properties science wasn’t aware of at the time. Jahre, for one, is skeptical of that theory, because the same symptoms occurred in places where aspirin wasn’t prescribed.

Jahre said most people, in that age before antibiotics, were especially vulnerable to pneumonia and other “supra-infections.”

“It’s an infection on top of an infection,” he said. “That happened then and it happens now.”

The federal government, worried that fear of a pandemic would affect wartime morale, minimized the threat. That’s one reason Philadelphia went ahead with its parade.

A lengthy article by the U.S. Public Health Service, “Uncle Sam’s Advice on Flu,” opened and and closed with catchy slogans that seemed designed to normalize a clearly abnormal illness: “Coughs and Sneezes Spread Diseases” and “Cover up each cough and sneeze, if you don’t you’ll spread disease.”

It advised typical precautions and noted that the “proportion” of deaths overall was not excessive, though the number of deaths in some parts of the country was extraordinary.

That piece ran in The Morning Call on Oct. 9 — the same day Allentown, criticized for foot-dragging, finally heeded the advice of the city health inspector and closed schools.

Three days later, Oct. 12, another story advised that the ailment was just one in a long history of outbreaks of what used to be called “the grippe."

No reason for panic, it said. “Go to bed and stay quiet. Take a laxative. Eat plenty of nourishing food. Keep up your strength. Nature is the only cure.”

The papers were full of advertisements for flu remedies. One advised sufferers to “Rub in and inhale Dr. Jones’ liniment, generally known as beaver oil, and get relief.” Another recommended “Hill’s Cascara Quinine Bromide” be taken “at the first sign of a sneeze or shiver.”

Still another promoted “Smok-O” tobacco-less cigarettes. The “medicated smoke” ostensibly disinfected the air passages (“Influenza Germs Smoked Out”) and eliminated the risk of stomach upset from oral drugs.

Readers must have found all of this less than reassuring. The paper had just reported 654 flu cases and 15 deaths in Allentown since the start of the outbreak. Easton and Phillipsburg reported 17 deaths Oct. 7-8. Statewide, deaths between Oct. 2-8 totaled 1,482.

The day the grippe story appeared, 751 Philadelphians succumbed, the city’s worst single-day toll.

“The dreaded plague”

In its Oct. 16 edition, the Allentown Democrat reported eight flu deaths in the previous five days. Two victims, Carl Frey and Roscoe Hargis, were Army privates stationed at Camp Crane, the military post at the Allentown Fairgrounds where soldiers were ordered to wear masks in a vain attempt to halt the flu’s spread.

Mary Brunetaki of Allentown caught the illness from her infant, who died. Brunetaki was too sick to go to the funeral and succumbed even as the child was buried.

Daniel Malone of Bethlehem went to Shenandoah to attend the funeral of his brother, an epidemic victim. Malone fell ill during the service and died within a day.

A Quakertown man, Clinton Schelly, died in a Hamburg sanatorium. An Allentown butcher, Norman Rauch, died at the hospital. Richard A. Parks, president of an Allentown wallpaper company, died at home.

The papers carried dozens of notices of flu-related public event cancellations. The Allentown Democrat ran an editorial demanding that authorities build a “contagious hospital” to quarantine and treat victims of epidemics.

Allentown, the Valley’s largest city, had started strong in the pandemic battle. It was the first Pennsylvania municipality to enact quarantines requiring isolation of patients. That was in September.

But when federal authorities recommended that municipalities consider closing schools and cancelling public gatherings, Allentown Mayor Alfred Reichenbach thought it would be a step too far. His city, unlike Bethlehem, had relatively few cases.

“Bethlehem,” Reichenbach told The Morning Call, "is filthy and dirty. A wagonload of refuse could be secured from three blocks of the highways, the streets are covered with thick layers of dust, the worst breeder of disease.”

Reichenbach would go on to serve as a pallbearer at the end of October for a notable victim, Lehigh County District Attorney Warren K. Miller.

The Chronicle newspaper editorialized that Allentown councilmen “obstinately persist in regarding the epidemic which is sweeping the country, and exacting an enormous death toll, as general cases of common colds.” Council even adopted a resolution saying the “colds” could be blamed on houses that were excessively damp because residents were trying to conserve coal.

“If people would take the opposite step — heat their houses where colds existed and promptly consult a doctor, more serious trouble would be avoided,” the resolution said. “We call upon people to heat their homes properly and call upon doctors promptly at the first sign of any unusual cold.”

The city came around, closing schools and cancelling public gatherings. In the city and across the Valley, churches were asked to suspend Sunday services.

A dozen deaths were reported in the area on Oct. 28 and the next day’s Morning Call headlines were dire.

“INFLUENZA TAKES TOLL OF FIVE IN HOKENDAUQUA: Mother and daughter, a man and two children victims of the dreaded plague.”

“DEATH’S HAND LAID ON YOUNG AND OLD: Dozens of well known in Allentown and Lehigh County pass away.”

Allentown had passed the 3,000 mark in the number of cases, the paper noted, with just shy of 400 cases reported the previous Sunday alone. In October 1917, the city had recorded 81 deaths from all causes. Now, in the same month a year later, more than 200 had been recorded, the vast majority from the flu.

The end

The flu began to abate through November. The Valley toll was grim. According to U.S. Bureau of Census’s Mortality Statistics for 1918, Allentown, a city of 73,500, lost more than 500 people. Easton, with a population of 33,813, lost 382.

Bethlehem’s figures show out of a population of 50,538, a total of 105 died, but historians believe that number is markedly low because the city had spotty record-keeping.

The global effect of the flu could hardly be reckoned. In India, some 5 percent of the population — 17 million — may have died. In Iran, the death toll may have reached 2 million, more than 20 percent of the population.

By the fall and winter of 1919-20, the virus had burned through its available hosts — they had either died or acquired immunity — and it may have mutated into a less lethal strain. So that season’s outbreak was far weaker and not nearly as widespread.

Pandemics have happened since 1918, but none approaching nearly the same scale. The worst, in 1957, killed about 2 million people worldwide. An outbreak a decade later killed about a million.

The most recent, the 2009-10 flu, may have killed 203,000 people, according to a 2013 analysis by an international group of researchers. That outbreak, of so-called swine flu, raised alarms because it was only the second caused by the H1N1 virus. The first was the 1918 pandemic.

Medical care is far more advanced today, of course, and flu vaccines are available each season. But the nature of flu is that it mutates, so it can breach the body’s defenses. And vaccines don’t always protect against all the strains that circulate in a season. The virus also adapts to thwart antiviral treatments such as Tamiflu, which can reduce the severity and duration of the illness.

Jahre is also worried by the effect of the anti-vaccination movement. One way vaccines prevent epidemics is by creating “herd immunity,” meaning the virus can’t find enough hosts to get a foothold in an area. The fewer vaccinations, the more vulnerable the herd. The anti-vaccination trend has already given rise to outbreaks of measles, a disease once thought to have been eliminated.

Jahre said the worldwide medical community maintains a virus surveillance program that flags worrisome outbreaks early on. The World Health Organization issues advisories when new threats emerge or when pandemics are thought to be imminent. These prompt countries to institute precautionary measures.

Even so, he has concerns about how widely and effectively health care could be administered in the event of a fast-moving, devastating pandemic. For example, only a few companies produce flu vaccines, and production disruptions have led to shortages even in ordinary seasons.

And federal government response to other disasters — Hurricane Katrina, for example — has been less than reassuring, he said, with troublesome failures in communication and widespread confusion about who, ultimately, is in charge.

John Kalynych, director of Lehigh County Emergency Management, said local authorities won’t be caught flatfooted in the event of a pandemic. The agency and its counterparts across the state would coordinate the response of hospitals and municipal health departments.


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