During the 1918 flu epidemic, Wisconsin limited deaths with statewide stay-at-home measures, though some cities reopened early — with deadly results. Will history repeat with COVID-19?

Roy Cummings, a movie house owner in Oshkosh, knew he would lose big bucks — some $400 to $500 a week — if the northeast Wisconsin city shut down his business and other public gathering places. But he believed it was a wise call.

C.G. Baumann, another Oshkosh movie house owner, appeared less eager to shutter his business, “but stated he would be glad to do so if it was the opinion of the physicians and city officials that such a course was necessary,” Oshkosh’s Daily Northwestern newspaper reported.

The date on that dispatch: Oct. 9, 1918. Nearing the end of the epic war in Europe, later dubbed World War I, Americans faced an even deadlier battle on the homefront. The misnamed “Spanish flu” had swept into Wisconsin and other states, and public health experts urged dramatic actions to slow its spread. That included shutting down much of society to keep people away from each other. 

“It seems to me the financial loss that might be sustained is of little consequence in comparison to the saving of lives,” Dr. D.H. Bath told the Daily Northwestern.

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The headline of the Oct. 11, 1918 Wisconsin State Journal states that all schools, colleges, churches, theaters and other public meeting places may be ordered to close.

Oshkosh had already closed its schools when Cummings and Baumann offered their thoughts. And on Oct. 10, the city banned all public gatherings, shuttering “moving picture houses,” theaters, churches, rummage sales and more. State Health Officer Dr. Cornelius A. Harper that same day would issue a nearly identical order, pausing public life across the state.

But just a few weeks later, Oshkosh was among cities that opened up to celebrate the end of the World War, with joyous mass gatherings that later turned into deadly breeding grounds for the virus. Spanish flu ultimately killed an estimated 50 million people worldwide and 675,000 across the United States, including 8,459 people in Wisconsin.

History is resonating more than a century later as Wisconsin fights a new viral villain that has upended life across the world. Wisconsin is among 45 states and the District of Columbia that have had shelter-in-place orders intended to slow the spread of the coronavirus, which was detected in at least 6,081 Wisconsin residents, killing 281 as of Monday. But governors in several states — including Georgia, Tennessee and South Carolina — have since scaled back restrictions.

Gov. Tony Evers, a Democrat, issued Wisconsin’s Safer at Home order in late March and has since extended it through May 26 while easing minor restrictions related to golf courses and curbside services. Evers last week announced a program to reopen the economy in phases if certain testing, contact tracing and case reduction criteria are met.

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Two children in Lincoln County are bedridden during the global influenza pandemic that struck Wisconsin in 1918.

Evers announced an additional order Monday that he said “turns the dial a notch” on restarting the economy. It allows “nonessential” businesses such as pet groomers and small engine repair shops to offer curbside drop offs of goods and animals. The order also allows rental of outdoor recreational vehicles.  And on Tuesday, Evers announced plans to reopen 34 state parks and forests.

But the  prolonged shutdown is drawing the ire of GOP leaders who, citing widespread unemployment and other economic pain, argue for a quicker return to normalcy.

The Republican-controlled Legislature last week asked the state Supreme Court to block the order. And an estimated 1,500 protesters, most of them not wearing face masks, rallied at the Wisconsin State Capitol on Friday demanding an end to the shutdown, following similar protests in other states. 

Wisconsin ‘did better than most’

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This is a World War I-era chart of influenza deaths in U.S. cities, showing weekly accumulation of deaths from all causes above the norm for Philadelphia, Pittsburgh, Lowell, Chicago, New York, Denver and Milwaukee. Historians say Milwaukee was among the nation’s top cities in minimizing damage from the flu.

As the political fight unfolds, public health experts and historians say residents could learn from the state’s past, when Wisconsin — which had an advanced public health system for 1918 — was the only state to confront the flu pandemic with uniform, statewide shutdown measures. Save for a few hiccups, residents complied.

Influenza and related pneumonia blew through Europe in spring 1918, and Americans started getting news of a mysterious ailment in Army camps during the summer. It popped up on Wisconsin’s radar in late September after two sailors from the Great Lakes Naval Training Station near Chicago got sick in Milwaukee. The virus ravaged the state through the rest of 1918.

Aside from killing thousands of the state’s 2.6 million residents, it sickened 103,000. But Wisconsin’s death rate in the pandemic hovered far below the U.S. average and that of most states.

And historians say Milwaukee was among the nation’s top cities in minimizing the damage — even as Milwaukee County still recorded 1,292 deaths.

“The people of Wisconsin took bold measures in 1918, and despite widespread suffering, the state did better than most when the pandemic receded,” said Steven Burg, a professor of history at Shippensburg University in Pennsylvania, who authored a definitive history of Wisconsin’s response to the 1918 pandemic in his former job as researcher at the Wisconsin Historical Society. “Wisconsin in 1918 provided a clear lesson about what unity and collective sacrifice could achieve for the common good.”

Early measures worked

A 2007 study in the Proceedings of the National Academy of Sciences of the United States of America, said Milwaukee, San Francisco, St. Louis and Kansas City launched the most effective interventions against the 1918 flu, curbing transmission rates by 30% to 50% compared to cities that saw far more deaths.

“The timing of public health interventions had a profound influence on the pattern of the autumn wave of the 1918 pandemic in different cities,” the authors concluded.

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Anti-Tuberculosis Association staff members and students in the association's public health class make their rounds in Milwaukee in October 1918, demonstrating how to make flu-prevention masks. This photo ran in the Milwaukee Journal on Oct. 17, 1918.

Cities that introduced measures early on achieved “moderate but significant reductions” in deaths. Larger reductions came from cities that extended their interventions the longest, the study said.

The 1918 pandemic struck at a time when Wisconsinites held widespread faith in government, and patriotism meant following the directives of public officials, said Richard Pifer, a retired director of reference and public services at the Wisconsin Historical Society, where he specialized in life in Wisconsin during both World Wars.

“Wisconsin controlled the epidemic reasonably well because people did what they were asked to do,” he said.

That’s not to say no Wisconsinites questioned harsh restrictions on public life.

On Oct. 14, 1918, staffers at the Appleton Evening Crescent lamented the pushback they received for publishing warnings about the flu, including stories from Philadelphia, where the city sought gravediggers “to bury a thousand bodies waiting for burial.”

“It has ben (sic) said here that ‘Much of what the press says about Spanish Influenza is nonsense’ and that it was to be regretted that so many cases had been reported by the papers,” the newspaper said.

And on Christmas Day 1918, The Gazette of Stevens Point shared an opinion that, “The closing proposition to appease ‘public conscience’ is all right as long as they can pass the hardship on some poor fellow who can ill afford to bear the burden.”

Virus hit in pockets and waves

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A sign displayed at an Industrial Harvester Company plant during the 1918-19 Spanish flu pandemic directs workers on how to avoid influenza infection.

Pockets of 1918 Wisconsin offer real life examples of a warning that public health experts are issuing today: That a virus with no vaccine or cure might hit in waves, meaning that reopening too quickly can generate new hotspots in communities that thought they were safe.

Consider small communities in Dodge County, which recorded 111 flu deaths in the pandemic. Fox Lake, a village of roughly 1,000 at the time, lifted its ban on gatherings after the state allowed local governments the power to decide when to reopen. The flu swiftly returned, triggering another weeks-long local shutdown of churches and public meetings.

“After congratulating ourselves upon our lucky escape from the influenza epidemic, and opening up all public places, after they had been closed for several weeks, thinking that the danger had passed, this village suddenly developed a number of cases of the ‘flu’ and last week the lid was again clamped down,” the Fox Lake Representative reported on Nov. 21, 1918.

In the nearby village of Randolph, “they are having quite a time, many cases being reported and several deaths resulting,” the Representative added.

Flu swirled through the region for the rest of 1918. On Dec. 2, the Representative reported that the city of Waupun, 10 miles northeast, reinstated its shutdown following reports of 50 new cases and two deaths. On Dec. 26, the newspaper printed a bulletin from the Waupun Leader, reporting that the Central State Hospital for the Insane was “undergoing a siege” of the virus. Twenty-seven cases had sprouted, some serious.

Then there was Oshkosh, which reopened schools and other shuttered institutions on Nov. 4, 1918, although the newspaper reported that Mayor Arthur C. McHenry was warning that “all danger has not yet passed and the people should be warned to exercise every reasonable precaution in safeguarding their health during the next few months.”

McHenry and his constituents quickly forgot the message.

Celebrations — then a surge

On Nov. 11, news spread that the Allies and Germany had signed an armistice in France — halting fighting in the Great War that killed more than 116,000 Americans (more than half from disease). The news spurred a series of noisy parades and other wild celebrations in streets that were empty days before.

“There were hundreds of marchers and nearly 250 automobiles in line,” the Daily Northwestern reported, featuring floats and a cacophony of sounds: fifes, drums, honks, buzzers, bells, gunshots, pounding on pans. Folks on one truck took turns striking an anvil with sledgehammers.

Oshkosh quickly saw a surge of flu cases — 38 in different homes on one day, the Daily Northwestern reported on Nov. 14 — double the previous day. The flu shutdown was reinstated, not lifting until Nov. 29, according to archival research by University of Wisconsin-Oshkosh.

 Oshkosh would not reopen schools until Dec. 3, though officials barred sniffling students from attending. A plan to reopen schools earlier faltered after some health-conscious parents refused to allow their children to return.

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This map shows 1918 influenza deaths in Wisconsin by county. Oshkosh and Neenah in Winnebago County saw a surge of cases after public celebrations of the end of World War I. Data are from the State Board of Health’s annual report.

By Dec. 11, the city would report a total of 2,083 cases during the pandemic, according to UW-Oshkosh research.

Along Lake Winnebago, Neenah residents followed a similar path, filling the streets on Nov. 11 to celebrate peace. “A monster parade with state guards and bands leading the way was the feature of the day,” the Neenah Daily Times reported.

A month later, the Daily Northwestern reported that “fully half the population” of Neenah was touched by the flu, with more “falling victim to the dread malady every day.” The town had tallied more than 3,000 cases since pandemic began— a conservative estimate, according to “medical men” cited by the newspaper.

“You’ve certainly seen in places that stopped isolation measures too early — what the flu pandemic did in those places,” said James Conway, an infectious disease expert at the University of Wisconsin-Madison School of Medicine and Public Health and a self-described history buff.

Echoes of the 1918 pandemic

Infectious disease experts bristle at comparisons between COVID-19 and modern day flu for many reasons, including that scientists have long since developed antiviral drugs and vaccines to fight the flu, and much of the population is now resistant to it. But today’s coronavirus crisis has uncanny parallels with the 1918 flu epidemic, Conway told Wisconsin Watch.

“The 1918 (pandemic) does actually have a lot of similarities because there were no vaccines, and your only hope really was one of two things. It was social distancing, and the development of some herd immunity as people contracted the disease and then recovered,” he said.

Malia Jones, an expert in epidemiology who works at the UW-Madison Applied Population Laboratory, agreed.

“I think that's a really fair comparison,” she said. “Social distancing was the only tool we had during the Spanish flu pandemic.”

Republicans: Stop Safer at Home

In fighting today’s coronavirus, Evers and state health officials say Wisconsin’s strategy is working. Evers’ plan for reopening the economy includes expanded testing, the ability to quickly trace the contacts of people who test positive and a downward trajectory in disease lasting at least 14 days. He noted that Wisconsin has not yet met the federal guidelines that President Donald Trump’s administration unveiled on April 16.

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Influenza patients fill beds in an emergency hospital located at Camp Funston, a U.S. Army training camp in Kansas, during the 1918-19 influenza pandemic.

But Republicans have attacked Evers’  extended Safer at Home order as “unprecedented administrative overreach.” Assembly Speaker Robin Vos and Senate Majority Leader Scott Fitzgerald have sued Evers to reopen the state, questioning why Wisconsinites remain stuck at home as the state “is clearly seeing a decline in COVID infections.” (PolitiFact Wisconsin has since labeled that claim mostly false.)

“There’s immense frustration regarding the extension, as it goes beyond the executive branch’s statutory powers. Wisconsinites are forced to sit by with no voice in the process,” Vos and Fitzgerald said in a joint statement last week.

Models based on data compiled by the Wisconsin Department of Health Services from March 3-15 predicted the virus would have grown exponentially if Wisconsin failed to intervene. Statewide cases were projected to double every 3.4 days, and Wisconsin would see up to 22,000 cases of COVID-19 by April 8, with between 440 and 1,500 deaths.

The rate at which coronavirus cases are doubling in Wisconsin has since significantly slowed, though one key metric — the percentage of people tested for COVID-19 who test positive — continues to trend upward, according to the DHS. And trends run unevenly across the state. New cases are skyrocketing in the Green Bay area, for instance.

“What we’re seeing in Brown County and others in our state underscores the importance of taking a statewide approach to Safer at Home right now,” Evers said Monday.

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The headline of the Oct. 11, 1918 Wisconsin State Journal states that all schools, colleges, churches, theaters and other public meeting places may be ordered to close.

Speaking last week to reporters, DHS Secretary-designee Andrea Palm said the slowing rate of statewide cases proves “we reacted exactly right.”

But without the continued restrictions, the agency warns, the risk of future outbreaks persists. Public health experts agree, particularly if residents grow complacent.

“We've actually been far more successful in leveraging social distancing than we ever anticipated from a public health standpoint,” Conway said. “As we do start to take our foot off the brake a little bit, and let the car at least get back into gear….We may need people to reenact some social distancing. And I'm really worried that they're gonna basically say, ‘You cried wolf, why should we comply on the next go around?’ ”

Worst is yet to come?

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Women took over traditional male roles during the 1918 Spanish flu epidemic. In this photo published in the Milwaukee Journal on Oct. 22, 1918, “girl” crew member Edith Courteen of Milwaukee stands beside a city ambulance along with an unidentified state National Guardsman, all wearing mandatory gauze masks.

Robert Redfield, director of the federal Centers for Disease Control and Prevention, told The Washington Post last week that protests against stay at home orders are “not helpful,” and he warned of  “a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through” — as COVID-19 cases persist along with seasonal flu.

During a media briefing last week, Wisconsin’s deputy health secretary, Julie Willems Van Dijk, echoed Redfield’s warning — harkening back to the 1918 pandemic.

“One of the things we know about pandemics is that they generally don’t come with one peak, they come with multiple peaks,” Van Dijk said. “In fact, if you look back at the data about the Spanish influenza pandemic, it wasn't the first peak that killed the most people, it was the second peak of resurgence in the fall.”

Future historians will study how the country — and Wisconsin — responds in the coming months.

Despite political and legal fights over shutdowns Wisconsin and elsewhere, many Americans back the restrictions. An Associated Press-NORC Center for Public Affairs Research survey estimated that 61% of Americans considered government steps to prevent the spread of COVID-19 “about right,” 26% felt they don’t go far enough, while just 12% of respondents said they went “too far.” 

The survey of 1,057 U.S. adults was conducted April 16-20 and carried a margin of error of plus or minus 4 points.

Speaking to Wisconsin Watch last month, Pifer, the retired Wisconsin Historical Society researcher, said he hoped state leaders would heed lessons from the state’s pandemic past.

“The past does not repeat itself. Human beings and human society are too complex for that,” he said. “However, it provides a window into how human society behaves. And we can better understand the future if we understand the past — because it’s that window into the American soul.”

The nonprofit Wisconsin Watch (wisconsinwatch.org) collaborates with Wisconsin Public Radio, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates

                                                   

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