The Other Great War
SMHS faculty discuss the 100th anniversary of the influenza epidemic of 1918-19, which took the lives of 27 UND students—including one medical student.
“Months of boredom punctuated by moments of terror.”
This is how one young British officer described his experience of the First World War to the Times of London in 1914.
Little did this officer know then that the war would drag on for another four years, killing a minimum of 15 million soldiers and civilians.
And little could he have known that such figures actually pale in comparison to the carnage of 1918-19, during which an outbreak of influenza (also known pejoratively as “Spanish flu”) that began just as the war was winding down killed some 50 million people worldwide, including thousands of North Dakotans.
Like the Great War, the great influenza outbreak—which was its own sort of terror—marks its 100th anniversary this academic year.
“The reported number of deaths from the Influenza epidemic in North Dakota was 1,378,” wrote Stephen L. McDonough, MD, in his 1989 history of public health in North Dakota The Golden Ounce, describing how 100 cases of flu were reported in New Rockford and 125 in Fargo only days after a likely ill soldier on leave visited family in the state. But, he adds, “This figure probably significantly underestimates the true mortality.”
Whatever the flu’s actual impact on North Dakota, of those several thousand deaths were 27 UND student-soldier members of the Student Army Training Corps (SATC), who succumbed to the pandemic on the UND campus as they trained for the fight in Europe only months before the Armistice ending World War I was signed.
Many months before a relative peace was official, UND had become a military training camp for 470 young men in 1918. Davis and Budge Halls (now both demolished) became barracks, and students were housed in close quarters.
When the campus was hit hard by infection, Gustafson Hall (then the Phi Delta Theta fraternity house) became a makeshift hospital. According to Louis Geiger, who wrote University of the Northern Plains, a history of UND, 320 of the 470 trainees became ill, with six dying in a single day.
Medical student Walter Pennington Belyea, a native of Lakota, N.D., was among the 27 students who died from influenza that year.
A student in the two-year Bachelor of Science in Medicine program at what was then known as the UND School of Medicine, Belyea died at the age of 23 at UND on Oct. 26, 1918, unable it seems to escape his fate even as the war was winding down.
“Probably the death of no student in the history of the University has caused more universal sorrow than that of Walter Belyea,” noted UND’s Quarterly Journal that year (vol. 10, 1 Oct. 1919), explaining how although disqualified for military service by “a serious lameness,” the medical student volunteered as a nurse to care for the members of his company who were ill, whereupon he caught the bug. “His sterling character, superior ability, and unfailing kindliness and courtesy won him friends among all who knew him.”
Ideal case study
But Belyea, about whom little is known, actually died from pneumonia, triggered by a case of the flu, reported the Quarterly Journal. Even so, the epidemic, which McDonough says likely sickened more than 200,000 North Dakotans, accelerated efforts by governments and health providers not only to improve their clinic and hospital protocols and public health regimes, but their search for vaccines for multiple illnesses.
“The real advances [in prevention] didn’t occur until we learned the actual cause of influenza in 1931,” explained Paul Carson, MD, who noted that the U.S. military developed the first approved vaccine for influenza after the Great War. “Later, in 1966 came the drug amantadine, and in the 1990s, came point-of-care diagnostic tests. All of these things helped foster better surveillance systems to track the disease, and more aggressive vaccine campaigns.”
A Clinical Professor with UND’s School of Medicine & Health Sciences and Professor in the Department of Public Health at NDSU, Carson calls 1918-19 a “game-changer.”
“Influenza is a huge focus for state and national public health systems,” he continued, explaining how medical schools still use the epidemic as a case study in the classroom. “We teach 1918 as a model for pandemic diseases with the full realization that influenza, or other viruses like Ebola, have the potential to cause worldwide pandemics with high lethality. Scientists have been so interested in this that they unearthed corpses of persons who died of the 1918 flu and were buried in the permafrost in the Arctic to try and retrieve remnants of the virus for genetic sequencing. They used this information to reconstruct the virus in a high level biosafety lab to study it further in hopes of gaining information about how to prevent a future pandemic.”
UND too is contributing to such research.
As home to a host-pathogen research “core” dedicated to exploring how disease-causing microbes or viruses sustain themselves within host organisms on a molecular and population level, the School has made infectious disease one of its research emphases.
“Since bacterial infection following influenza is the cause of significant global mortality, we’re investigating the role of pandemic influenza virus on the development of secondary bacterial diseases such as bacterial pneumonia and sepsis,” said M. Nadeem Khan, PhD, assistant professor in UND’s Department of Biomedical Sciences. “Specifically, our lab focuses on better understanding influenza-mediated inflammation in airway tissue damage, and its relationship with increased susceptibility of bacterial infections. A better understanding of the host and influenza interactions will eventually lead to the development of therapeutics to counter influenza and influenza-associated bacterial diseases.”
Convincing folks to vax
Carson added that the anniversary of the epidemic brings into stark relief the value of vaccines today in the face of a growing movement by some Americans to limit—or eliminate—vaccinations.
“Vaccines have been one of the most important and effective public health interventions we have ever seen, preventing millions of unnecessary cases of disease and death,” said Carson, who also serves as director of the NDSU Center for Immunization Research and Education. “Vaccines have become victims of their own success. Thanks to vaccines, most people have never seen diseases today like polio or measles, so they have come to fear the alleged harms of the vaccines themselves rather than the diseases they prevent. Most people don’t realize these diseases still circulate the globe and are only a plane ride away.”
According to Carson, although influenza still kills thousands of people in the United States annually, and hospitalizes over 200,000, immunization rates remain poor one-hundred years after the most devastating epidemic on record—even among populations especially prone to worse outcomes.
“Only about 65 percent of people over the age of 65 are immunized, only 39 percent of adults with high risk medical conditions are immunized, and only 50 percent of pregnant women are immunized during flu season,” he said. “This is of great concern to me as these are all individuals at high risk for bad outcomes should they contract the flu.”
This development should be of great concern for us all: influenza pandemics in the future are very likely, said Carson, and the risk of a new highly lethal strain continues to loom as a concern to those working in public health.
Should such an event unfold, the world might just find itself reversing the British soldier’s assessment: “Months of terror punctuated only by mere moments of boredom.”