she is survived by her 21-year-old son andrew who is studying to be a nurse like his mom. may they rest in peace and may their memories be a blessing. >> announcer: the following is a cnn special report. ♪ >> april 1917, the united states joins allies france, britain and russia in their battle against germany. they call it the great war. a war to end all wars. all over the united states, americans prepare to join the fight overseas.

but there was another fight about to take place right here on american soil. one that would eventually kill more people than the great war itself. it was the influenza pandemic of 1918. known back then as the spanish flu. you said you can't understand how america dealt with the influenza pandemic in 1918 without understanding world war i. >> because everything about the pandemic was related to the war. everything about the war at that time was related in a sense to the pandemic. >> historian kenneth davis says an early outbreak of flu was reported at a camp in kansas. young men arriving for training and deployment were suddenly becoming sick.

the outbreak was march of 1918. >> march 4, 1918. we know the date. doctors are starting to notice a strange influenza that doesn't look like anything else they have seen. >> what were the first symptoms that they started to see? >> very high fever. tremendous body aches, like back breaking b ining body breaks. as it progresses, healthy young men who had reported for duty were on their backs in tremendous pain. people would talk about it like being hit by bats. that's how bad it was. >> within weeks, more than 1,000 soldiers were in the hospital. at least 38 died. these were men who should have recovered if it was a normal flu. dr. fauci says that's when doctors began to realize, this was a new pathogen. it was young, healthy people who early on were getting it, was

that a sign that this was a new influenza? >> this was devastating even to young people. so quantitatively, who it affected, was really extraordinary and unprecedented. this was something very special. it occurred in a way that crept up on us. >> you called the 1918 pandemic the mother of all pandemics. >> global impact it had was unprecedented in recognizable history. it was a pandemic that gripped the planet. it was truly an enormously devastating pandemic. >> in 1918, the cdc didn't exist. there were no requirements for doctors to report flu outbreaks to any officials. by the end of march, the cases in kansas were so unusual, a local doctor decided to report what he called an influenza of severe type to the u.s. public health service. the virus quickly spread.

an historian says it was traced to other army camps where it flourished. it spread to ships heading to europe. >> raf thalf the military camps the spring did have significant outbreaks. according to a man who spend his life studying influenza, could you follow the disease with american troops crossing the ocean and arriving in france. >> ov"over there, " that's what everyone was singing. a million young men land in france. that's when the flu really exploded. >> looking back, historians can trace the spread of the flu to the movement of troops.

>> absolutely. the port in france where most of the american troops landed became like a ground zero for the spread of this. the speed with cl which it spre was breathtaking. it became a worldwide pandemic because the war was going on. millions of soldiers going from the united states to europe carrying infection. >> this would turn out to be just the first wave of the influenza. it would last through the beginning of the summer of 1918. where this outbreak originated is still unknown. it wasn't in spain. how it started is more clear. did it cross from animals to humans? do we know the origins? >> yeah. very extensive sequencing of of the genetic makeup of the virus indicate very, very clearly that it is of avian origin.

it's a bird-like flu, likely from a wild waterfowl. the sequences very clearly indicate that it was zoonotic and jumped species. >> all influenza viruss are bird flu. sometime prior to march of 1918, it might have been a few months, it may have been a couple of years, a virus jumped species from animals to humans. it spread very rapidly and created a pandemic. it certainly wasn't the first influenza pandemic in history. it's not going to be the last influenza pandemic. >> troops overseas were getting infected as well, on all sides of the couldnnflict. the death rate was low. most who got it recovered. >> it wasn't particularly lethal. people who did experience it as a general rule treated it with a

shrug. the army, even on the front lines in april, troops referred to it as three-day fever. they had a different attitude when the virus turned much more virulent a few months later. >> even though the infected were likely to survive, a huge number of sick soldiers began to impact the war. >> it did affect what was going on on the battlefield in germany and in france. there was a major german offensive that was supposed to take place in 1918. half a million german soldiers were sick with the flu. they couldn't do it. it didn't change the outcome of the war but it affected it. >> the german commander blamed the outbreak for the failure of the last german offensive, the last effort the germans thought that might win the war. >> the full impact of this first wave wouldn't be understood until much later. countries involved in the war

were sensoring news about the influenza. >> nobody was actually talking about it. the newspapers were talking about it. >> spain was neutral in the war and their newspapers were allowed to report on this fas-spreading virus. it infected their king. that is how the influenza became known as the spanish flu. >> the first report of an epidemic comes out of madrid. it's published, mysterious disease strikes spain. the king was sick. they shut down the transit system. that news report went to england and then from there on, that's about may of 1918, it becomes the spanish flu, at least in the english speaking world. >> historian doris kerns-goodwin says the president was concerned. >> it's extraordinary that when

you read about wilson's presidency, the way he handled the flu and even the flu itself is hardly mentioned. historians argue that he had two crises to face. the first was the flu and the second was the war. the war went first. anything about the flu and the soldiers getting it in great numbers in the barracks would hurt recruitment and the war effort. >> wilson wanted nothing to distract from the war effort or in any way hurt morale. therefore, national public health leaders said things like, this is ordinary influenza by another name or you have nothing to fear if proper precautions are taken. >> there was no motivation for the president back then to get america focused on fighting this flu? >> president wilson never mentioned the spanish flu.

>> never mentioned it ? >> never mentioned it during his presidency. the war was all that mattered. for most americans, the war was all that mattered. the war effort doesn't just mean sending troops over there. it means keeping factories going really around the clock, making uniforms, making tanks, making airplanes. >> raising money for the war. >> raising money. that's where this question of misplaced priorities is so important. there were misplaced priorities in 1918. the war was the priority. that took precedence over everything. >> the war and the influenza would later directly impact wilson personally. in a way that may have changed the course of history. with summer and warmer weather, the new influenza seemed to die down. a british medical journal declared the epidemic over in august of 1918. they were wrong. the death and misery had barely

begun. >> did people know there was going to be a second wave? >> they did not. the force with which it came just took everyone by surprise. it was just totally devastating. the vcapability of the virus to cause devastating disease was really unprecedented. >> in september, an article in "the american medical association" warned of a rapidly spreading epidemic of influenza. it said it was the spanish influenza but warned saying it's more severe and complications are more frequent and serious and it shows an extraordinary degree of contagiousness. they concluded, we have every indication that this outbreak will soon spread all over the united states. the second wave had arrived. last night's sleep, interrupted by pain?

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and headache may occur. tell your doctor about your medicines and if you're pregnant or planning to be. otezla. show more of you. my gums are irritated. otezla. i don't have to worry about that, do i? harmful bacteria lurk just below the gum line. crest gum detoxify works below the gum line to neutralize harmful plaque bacteria and help reverse early gum damage. crest. september 1918, the great war is in its final months. the second wave of the influenza is just beginning. now it is spreading faster and it is far more deadly. a historian says it may have mutated into a new strain. >> the 1918 virus combined to cells in the upper respiratory tract that made it easily

transmissible. it could also bind to cells deep in the lung. many reports of people dying 24 hours after the first symptoms appeared. some of the symptoms could be very unusual and very frightening. >> whether it was a new strain or a new virus all together, the effects were terrifying. >> the second wave was so deadly, it's interesting, we talk about the first and second wave, we were presuming that the virus that hit us in the spring of 1918 was essentially the same virus that accounted for the so-called second wave. we knew there was disease in the spring of 1918. we knew there was a lull in the summer. then we got hit very, very badly in october and november of 1918. call it a second wave or what, it was a devastating wave of

infection. >> in early september, an outbreak outside of boston is reported. young, healthy soldiers were getting infected and dying fast. scientists went to investigate. >> that's where four doctors, probably the best virologists, epidemiologists at the time, go up and they are seeing these men being brought in by the dozens and then by the hundreds. that's when one of the doctors says, i think this might be a new plague. >> by the end of september, more than 14,000 flu cases were reported. 757 people had died. the deaths were gruesome. victims turned purple and black from a lack of oxygen. >> to give you a sense of what it was actually like, i would like to read a letter that a physician wrote to a colleague. these men start with what looks like an ordinary attack of the grip or influenza.

when brought to the hospital, they very rapidly develop the most vicious type of pneumonia that has ever been seen. it's a matter of hours until death. it's horrible. it takes special trains to carry away the dead. for several days, there were no coffins and the bodies piled up. it beats any sight they had in france after a battle. good-bye, old pal. god be with you until we meet again. >> despite the alarming number of cases, servicemen from the boston naval yard continued to deploy around the country. >> those same ships from boston also went to new orleans, chicago. they went out to the west coast. every one of these port cities where boats from boston docked, the flu exploded very quickly. it was extremely, extremely virulent. the infection rate was very high. the mortality rate was very high. >> on september 7, 1918, a navy

ship from boston arrived in philly. public health officials had downplayed the seriousness. the city would soon pay the price for that. >> philippoussis wfill philly wt hit. that was related to the political and public health leadership. >> philly leaders organize ee e parade to raise money for the war effort by encouraging americans to buy war bonds. parades were drawing large crowds throughout the war. americans were eager to show their patriotism. >> the medical community was concerned. urged the public health director to call it off. >> he allowed it to go on? >> that's correct. he had been told in a meeting two days before by other doctors not to allow it to go on. he was a mrpolitical appointee.

philly had a rather corrupt government. he was not willing to go up against the bosses. he went ahead with this. >> there were hundreds of thousands of people in the street, packed close together, shouting and singing songs. like clockwork, 48, 72 hours later, the disease exploded in philly. >> 200,000 people are in the streets. two days later, every hospital bed was filled. philly had a lot of hospital beds. >> it became a superspreader event? >> the mother of all in 1918. philly was probably the hardest hit. they knew it was coming. they should have seen it coming. they shouldn't have allowed this parade. they did because priorities. what were the priorities? the war effort and selling the war bonds.

>> when i was reading about the parade in philly, this huge liberty loan parade that was in 1918, i was thinking to myself, don't do the parade, don't do the parade. then the week later, i think it's thousands of people die, perhaps 14,000 people. then you go to st. louis, another city, also had prepared a parade. they listened to medical authorities. only 700 people died. when you read this as an historian and you know the end of the story, you want to say, stop, do the right thing. >> the day after the parade, the philly enquirer printed this picture, the caption, fighting men of navy thrill vast crowds as they march along broad street. no mention of the influenza. less than a week later, the board of health finally begins shutting down the city. >> in the streets of philly, people were actually dropping dead in the street.

>> there were stories, rather well documented stories, anderson, of people who would wake up in the morning, feeling maybe a little bit under the weather. get up and go to work. starting to feel really very, very sick. by the time the end of the day came, they were dying in bed and would die literally within a 24-hour period. >> it was that fast ? >> absolutely. >> the situation was so dire, it couldn't be ignored any longer. this issue dated october 15, 1918, reports entire families dying from the flu. it reads, husbands and wives, mothers and children, brothers and sisters have died within a few hours of one another. >> they were using steam shovels to dig. sometimes it would be a couple of days before a body could be

disposed of. you had to live with the body in your home. the fear really emptied the streets. >> there were empty streets in cities across the country, all were experiencing the same fear and panic as philly. in the month of october, more than 195,000 americans died. many of them in excruciating pain. >> it was a terrible way to die. you can picture young men and eventually young women and nurses, family members, literally choking to death on their own body fluids, turning blue and dying. one of the doctors in one of the hospitals in new york said, they coming in by the hupdndreds, th are turning blue and dying. i see them twice. once when they check in and once when i sign their death certificates. >> this is rare foot anl age of patient being brought in for treatment. there was little doctors could

do. there was no way to treat the influenza. doctors and nurses just had to watch their patients die. this letter was written by a volunteer nurse in washington, d.c. when i was in the officers' barracks, four of the officers whom i had charge died. two of them were married and called for their wife nearly all the time. it was pitiful to see them die. i had to go the nurses' quarters and cry it out. they couldn't treat the dying in 1918 because they didn't know what they were fighting. they didn't know what an influenza virus was. >> the doctors at the time, scientists did not know what the pathogen was because the virus itself, influenza, was not discovered until more than a decade and a half, two later in the 1830s. what was likely going on -- we didn't recognize it because we did not have antibiotics -- is that it was not only the primary

virus itself unrecognized at the time, which turned out to be influenza a, that it was causing devastating viral pneumonia, but superimposed, when you went back and did autopsy examinations retrospectively, you found that very many of the people died from secondary bacterial infections. in other words, they had a primary viral pneumonia and superimposed upon that was a bacteria pneumonia that could have been treated with common antibiotics. >> how do you treat a virus you don't understand? easy to wear with soothing vicks vapors for her,

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this fox movie newsreel shows each other approaching each other with a salute. it was an effort to educate the public on safe behavior during an outbreak. these recommended measures

couldn't stop the spread because not everyone would listen. >> the virus was spread clearly by the respiratory route. just even ru-- people were crowd together indoors or sometimes even outdoors. it was very clear that this was person-to-person spread. >> pretty much everything was tried, even to the extent that one report of a doctor who injected hydrogen peroxide intravenously thinking the oxygen would help the patient. roughly half of his patients died. he claimed that was successful. people were desperate in trying absolutely everything. >> there was no federal plan.

no real strong federal public health service in the u.s. at the time. local states and cities took it upon themselves to fight a pandemic they didn't really understand. new york made it a misdemeanor to cough or sneeze without covering your mouth or nose. in philly, spitters were fined $2.30 for jeopardizing health. open-air courts in san francisco dealt with people who didn't wear masks in public. they were fined and in some cases thrown in jail. back then, masks were not as controversial as they are now. they may not have been as effective. these nurses were making masks out of gauze which they fold over four times. but it's porous and didn't protect people from getting the virus. "the journal of the american medical association" in september of 1918 said the virus was infecting doctors and nurses in hospitals in spite of the use

of gauze masks and other precautions by all those in contact with the patients. watch this one group of nurses as they demonstrate how to wear the masks. first, they wrap them around their mouths but then fold them down to expose their noses. the virus can infect through the nasal cavity. still, a properly worn mask back then was better than no mask at all. >> we know now that masks are effective. they are not 100% effective. they likely are more effective in preventing a person infected from transmitting it versus someone protecting themselves from getting infected, even though recent data indicate that there is some degree of protection both ways. the fact that back then individuals who were wearing masks and even now with covid-19, some people who wear masks can get infected. that doesn't mean that masks are not helpful.

>> despite these attempts at public health and safety, people kept dying. cities around the country who were hit later with the virus were learning the lessons of boston and philly. when you look at president wilson, there was a war going on. so there want a lot of talk by wilson about the pandemic. >> no, there was not. that was the point. it was left up in many respects to the individual states, cities and locations. there wasn't that uniform type of coordination and communication about what worked or did not work in one city versus the other. they essentially were left on their own to do what it was they wanted to do. there was some stark failures. there were some notable successes. >> there were other cities which didn't even print the names of the dead. they were trying to pretend this thing wasn't happening. that wasn't reassuring people.

they knew it was happening. it increased the level of fear, increased alienation. there were very few places where they did tell the truth. one was san francisco. san francisco, the mayor, the public health leaders, leaders of the business community, leaders of trade unions, all jointly signed a statement. this was printed in huge type in the newspaper. it said, wear a mask and save your life. that was a very, very different message than, this is ordinary influenza by other name. >> san francisco shut the city down. they banned mass gatherings, closed schools and movie theaters. it worked. at least in the beginning. >> they have great success initially in the fall of 1918. they relaxed too soon. >> in november, they got rid of the mask mandate and reopened

businesses. >> san francisco went like this down and then up. then when it started to go up, they tried to put the mask law back into affect. the people weren't having it the second time around. the same arguments we are hearing today about wearing masks. infringement on freedom, liberty. all of the arguments we heard about non-mask wearing, they argued in san francisco. it was bad. >> go back 102 years to what happened in san francisco to try and reopen maybe a bit too early or not without the kind of constraints that should essentially guide you as you try and reopen. yet again, another example of lessons that could have been translated across more than a century. >> the war is over. >> on november 11th, the war came to an end. all over the country, americans

were celebrating, hoping for a new era of peace. they were also hopeful that the second wave was coming to an end. like the first wave, it seemed to have burned quickly through the population, only to die down as winter approached. >> one of the key questions is what happened to the virus. i think two things ended the pandemic really. number one, people's immune systems became used to the virus. they were better able to deal with it than they were -- remember, this caused the pandemic because it was a new virus that people had never experienced before. once the immune system was able to recognize it, it was better able to fight it. in addition, i think the virus itself probably continued its mutation and mutated in a direction of mildness. >> the virus wasn't completely gone. a third wave would soon emerge. while it wasn't as deadly as it

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march 1919, the mood in paris is joyful. world leaders, including president wilson, are meeting in france to negotiate a peace treaty. the war is finally over. the pandemic is not. it is now in its third wave and spreading in france. there's a warning printed. the epidemic of influenza has broken out anew in a most disquieting mann ining manner. this was overshadowed. they were trying to negotiate how to settle peace terms with germany. when the war ended and peace talks were approaching, what was wilson's stance on the germans going into the talks? he talked about peace without victory. >> woodrow wilson talked continually about peace without victory.

he wanted no real retribution against germany, no humiliation against germany. he thought that would set off a century of war. he went into the peace talks hoping he could persuade the european nations of moving in that direction. it would have been a hard job. the war had been fought on european soil. millions of europeans had been hurt by it. that desire for exacting retribution was there. he was coming up against a difficulty when he came there. he was hoping he would get it through. >> on april 3rd, as the peak talks continued, president wilson collapsed. he was so severely ill, so suddenly, that his doctors suspected i may have been poisoned. it turns out it was likely the influenza. it may have affected him mentally and physically. this is a private letter from wilson's doctor in paris dated april 14, 1919. he wrote, the president was suddenly taken violently sick

with the influenza at a time when the whole of civilization seemed to be in the balance. >> a temperature of 103, violent coughing, standard symptoms of influenza. as he started to recover, everybody around him from hoover, who was the white house usher, to the later president herbert hoover stated his mind didn't work. he don't remember things that had happened a few hours earlier. he got pai paranoid. thought there were french spies behind the furniture. strange things. he insisted on returning to the negotiations. physically weakened. while his mind was still not working. >> doctors and historians believe the influenza may have had a profound affect on patients' brains. >> just like covid-19, the 1918 virus had very significant

neurological manifestations. >> certainly, there were neurological sequelae could have been due to the flu. not completely proven but suggestive. >> after wilson recovered from the worst of his illness, he went back to the talks. but observers said he was changed. he caved in on what he was fighting for before he had been infected. >> the result was a peace treaty that violated the principles he said the u.s. had gone to war over. it was a long way from a peace without victory. germany was blamed for the war, reparations were demanded. there were deals made between countries trading territories. all these things that wilson had stood up against, he just caved in. he himself told someone that if he was a german, he wasn't sure

he would sign the treaty. essentially, every historian of the 20th century believes and is said the peace treaty agreed to in versailles in 1919 was a significant contributor to the rise of the nazis, because it gave the germans good reason to feel that they had been taken advantage of unfairly. >> it is a fascinating idea that whether something like the flu changed the course of history in terms of the rise of naziism. if germany hadn't been punished so punitively, would there have been such dissatisfaction and anger in germany? >> history is something that is a cycle of events. the fact that the treaty of versailles had such draconian provisions, it demanded so many economic sanctions and humiliation for germany, they

argue, historians, that it contributed to the rise of nationalism and the rise of hitler. if you go back and you unroll that and you make some new arguments about whether the flu and its impact on wilson affected the treaty of versailles, if you go back and look at wilson and argue maybe his having the flu affected his behavior in the negotiations of the treaty, then it unrolls more. again, i think that's something that historians will be studying for many decades to come. >> some say wilson may have experienced a different strain of flu, not the strain that caused the pandemic back then. there's no dispute that president wilson's behavior changed after his illness. >> people who knew wilson then and had been with him for a long time said he was never the same after that flu. there is a suggestion by quite a few historians that the flu might have affected wilson's judgment, his reasoning, his will power.

>> we will never know for sure what was going on inside president wilson's mind. historian john barry puts it this way. >> i'm not a real believer in alternative histories. you could argue that wilson would have given in on all these things even if he had stayed healthy. you can't be certain. all you can be certain of is that he did have influenza. his mind and spirit were seriously impacted by the disease. he did cave in. the nazis did rise.

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8

before finally going away. by the end, an estimated 1/3 of the world's population had been infected by the virus and the death toll in america and across the globe was stunning. >> 675,000 americans in the space of a year, that's more than all of the men who have died in world war i, world war

ii, korea, and vietnam put together. the numbers around the world are even more in astonishing. >> within the realm of recorded histo history, there were anywhere from 50 to 100 million people died and in a population of the world that was at that time, in 1918 about 1/3 of what the population of the world is today. you could just imagine and do the math of in today's time what that would have meant. that would have meant anywhere from 150 to 300 million people dying from this. >> so, even the worst, worst case projections for covid-19 are absolutely nothing like what occurred in 1918. fortunately. >> the death toll in this current pandemic may never reach the levels of the influenza of 1918, partly because in this

outbreak, there's promise of a vaccine. >> that's going to be the game changer. and that's going to be the difference that separates us from the 1918 ultimate impact. to the ultimate impact of what we are seeing now. as bad as it is right now, we have within our power the capabilitity to turn it around, that does not lessen the fact that we are going through an extraordinary challenge with this outbreak. the thing that i believe, anderson, is going to prevent us from creeping up on the numbers of 1918, with correction for population numbers, is the vaccine that we now have that our counterparts in 1918 did not have. >> it's been 10 on2 years sincee

pandemic started and more than a century later, there's still similarities again -- between then and now, many of the same mistakes were repeated. in 1918, and in 2020, we saw crowds gather when they shouldn't. only to lead to more infections and deaths. in 1918, and in 2020, we saw cities shut down early only to reopen too soon. in 1918, and in 2020, we saw people refusing to wear masks even though it would protect others. in 1918, and 2020, we saw leaders ignoring the science is, down playing the severity of the virus because they wanted the public's attention focused elsewhere. >> were the lessons of the 1918 pandemic, were they forgotten? >> in some respects, they were.

again, when historians write about this, and juxtapose 2020 with 1918, they are going to see that there were things that should have been learned in 1918 that 102 years later somehow corporate memory got lost and things were not used in the sense of a storing of knowledge from back then that could have been applied today. >> i think the chief lessons from 1918 are clear. the first is to tell the truth. >> if cn you don't tell people truth, you will cost lives, it happened in 1918 and i believe it happened again in this pandemic. >> leadership is central in a crisis. there's a saying from robert sherwood who worked for fdr, most of the time you can keep the president in a little portrait on your desk and you don't have to worry about what he is doing. but in a time of crisis, when

people need somebody in leadership other than themselves and they need to ban together. that is when leadership was essential. the war was a crisis, the flu was a crisis, we are having a crisis right now and leadership is essential. >> these are the lessons that can and should be remembered from the two global pandemics. lessons that be can be applied to help the next pandemic. >> without a doubt, the future will hold pandemics, exactly what it will be or when it will occur is without a doubt unclear right now. but it will occur.

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