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The history of flu pandemics: Learning from past crises

Since 1918, there have been four flu pandemics, each one with different characteristics.
by Jaclyn Cosgrove Published: January 7, 2013

It wasn't easy to tell a 78-year-old man with a double bypass he couldn't have a flu shot.

Normally, he'd be the ideal candidate.

But this was different. This was 2009, and there was a shortage of vaccines for H1N1.

“We were doing big clinics at the local high schools and other places where we were doing thousands of people,” said David Legg, a public health nurse at the Oklahoma City-County Health Department. “It was just one flu shot after another.”

The swine flu outbreak in 2009 is the most recent example of a flu pandemic, a situation where an epidemic is affecting much of the world and crossing international boundaries.

This year's season hasn't reached such proportions, but the nation is experiencing its earliest regular flu season in about a decade, since the 2003-04 flu season.


There have been four flu pandemics since 1918, each with their own characteristics, according to the U.S. Department of Health & Human Services.

In 1918, many Americans lived their entire lives without visiting a doctor, according to the U.S. Department of Health and Human Services. Attitudes toward health care were beginning to change, though, and many doctors would make house calls, according to HHS.

State officials reported the presence of the flu in Tulsa and Clinton in September. Although the number of real cases is probably much higher, there were 2,456 cases of flu reported.

For example, the Red Cross opened an emergency hospital in Tulsa and admitted 200 residents; at least 20 people died. An estimated 50 million people died worldwide, including 675,000 in the U.S. The current-day population of Oklahoma City is about 592,000.

And after about 94 years, scientists and researchers still aren't sure what made that particular flu strain worse than the rest of them, said Gillian Air, a professor of biochemistry and molecular biology at the University of Oklahoma College of Medicine.

Scientists at the Centers for Disease Control and Prevention have been able to recreate the virus, but it's still not clear what features it had that made it so deadly, she said.

Air, who has studied the flu for the past 35 years, said part of the problem in 1918 was there were no antibiotics, and there were problems with secondary bacteria in hospitals.

“The history says that people were dead within hours of showing symptoms,” she said.


One of the worst nights of Dr. Boyd Shook's medical career was in February in the late 1960s.

It was the night he lost five patients to the flu. That February, he made an average of 10 house calls a night.

“The treatment was aspirin and ice water, and you try to keep their temperature down,” Shook said. “That's basically all we could do. Some of them we gave penicillin to, but unless they had clear cut pneumonia, there was no reason to give them penicillin.”

About 10 years before, a pandemic in 1957 and 1958 killed about 70,000 people in the U.S. Shook graduated medical school in 1957. His class was one of the first medical student groups to get the flu shot.

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by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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