A run on surgical masks. No viable vaccine. Opportunists. Uncertainty. Fatalism. Fear.
These were just a few of the elements converging at the uncontrolled intersection of medical science, politics and human nature — not this week, but a century ago, when the flu pandemic of 1918 crept into Colorado, gathered deadly momentum and claimed thousands of lives in a matter of months.
COVID-19 IN COLORADO
The latest from the coronavirus outbreak in Colorado:
- LIVE BLOG: The latest on closures, restrictions and other major updates.
- MAP: Cases and deaths in Colorado.
- TESTING: Here’s where to find a community testing site. The state is now encouraging anyone with symptoms to get tested.
- VACCINE HOTLINE: Get up-to-date information.
- STORY: Colorado changes vaccine plan again, moving down most essential workers to bump up older, sicker people
And while circumstances surrounding the new coronavirus threat, called COVID-19, and the century-old flu pandemic have some significant differences, Colorado’s response at that point in history, though less well-informed, provides a cautionary tale about the difficulty containing an airborne illness with no ready cure.
Influenza killed more than half a million people nationwide, tens of millions worldwide, though record-keeping in some states was spotty at best. With World War I nearing its end in Europe, frequent troop movements among training sites, and later the return stateside of thousands of soldiers, undoubtedly played a role in the rapid spread of the illness.
In Colorado, an estimated 7,500 “excess deaths,” or those beyond what a normal flu season might bring, occurred roughly from September of 1918 to January of 1919, though less virulent waves continued into the spring. Only 24 states reported their flu deaths, but among those, Colorado’s death rate ranked among the highest, behind only Maryland, Montana and Pennsylvania. Some speculate Colorado’s reputation as a healthful spot to recover from tuberculosis, as well as a prominent mining state, contributed to its high death rate.
Extrapolating for the state’s population growth, the estimated 7,500 flu-related deaths in 1918 would translate to 37,000 people dying here in the next four months, notes Stephen Leonard, a history professor at Metropolitan State University of Denver whose 1989 monograph on the pandemic presents a detailed account of the statewide response.
In Colorado, the flu struck in waves, fooling authorities into lifting health restrictions and then raging anew. It triggered a range of measures across the state, from quarantines to bans on public gatherings — including funerals for those victimized by the illness — to common sense policies like covering your cough in a crowded movie theater to less logical requests that were baffling in their inconsistency.
At various points, citizens were required to wear masks in theaters and shops, but not churches and hotels. Restaurant waiters had to wear them. Diners did not. Plus, enforcement proved difficult.
Katie Rudolph, an archivist at the Denver Public Library who has blogged on the flu pandemic, notes that the way local authorities often reversed course inspired neither public confidence nor cooperation.
“One thing I noticed is that they flip-flopped on policies and closures,” Rudolph says. “In the Denver health department, (director) William Sharpley kind of caved to business leaders’ pressure. Specifically, movie house proprietors and theater owners marched to the mayor’s office, wanting the new ban on indoor gatherings to be overturned because they lost money in the weeks prior.”
The public’s responses to the pandemic, and the restrictions civic leaders tried to place on their activity, held a mirror to citizens’ hopes and fears.
“It does show how human beings react to sudden threats — overwhelming threats,” Leonard says. “In part it’s a kind of panic, in part it’s a laugh-in-the-face-of-death approach. Some of the social leaders were having parties, as if they were making a statement that we’re immune to this, it won’t get us. People just don’t change their modes of behavior easily, even if it makes good sense to do so.”
One notable exception: the town of Gunnison. Authorities there almost entirely shut themselves off from the outside world, even though trains stopped there regularly. Not only did the town impose rules that helped it largely dodge the disease that ravaged other nearby rural areas, but it also became a case study for researchers at the University of Michigan under contract with the Department of Defense to examine how a few scattered communities managed to avoid the 1918 pandemic.
“They cut people off at the pass, literally,” Leonard says. “They allowed the trains to go through Gunnison, but nobody could get off. If you did get off, they put you in jail.”
Colorado’s well-founded fears about the spread of influenza emerged on Sept. 21, when the first Colorado cases appeared among a dozen military trainees who took ill at the University of Colorado in Boulder. Within four days, 75 students were quarantined in fraternity houses.
The first fatality in Denver was a University of Denver student named Blanche Kennedy, but Sharpley, the city’s manager of health, voiced confidence that it would not lead to others. Still, as a precaution, he ordered her house quarantined. Nevertheless, Blanche’s brother William, an assistant city attorney, soon afterward became one of 10 in Denver to succumb in a short period.
At the time, medical science’s understanding of the flu fell woefully short. Many doctors believed the illness to be bacterial, not viral, though they knew enough to realize that such an airborne disease could spread quickly, especially in crowded places. With no cure at hand, the emphasis fell on trying to contain it, which gave rise to many of the fundamental recommendations that remain in force today: washing hands frequently, covering coughs, avoiding crowded places.
In Colorado Springs, the commissioner of public health offered advice that still echoes as authorities try to get a handle on coronavirus. “There is no need to become panicky over the matter,” Perry Botts said in the wake of three flu deaths at Colorado College. “The thing to do is to keep cool and be careful.”
Sharpley, who earlier had done a turn as Denver’s mayor, and the city’s board of health soon ordered schools, churches, theaters and other entertainment venues closed, though shops, restaurants and similar businesses could remain open. Outdoor gatherings were OK, indoor meetings prohibited. Sharpley even asked residents to refrain from burning their leaves because the practice “often causes severe colds.”
A number of other measures went into effect, including a crackdown on sidewalk spitting while brothels and vagrants got a pass to avoid bringing the flu into jails. Civil liberties took a brief hit when lawyers were prevented from meeting with their incarcerated clients.
By the end of the first week of October, Gov. Julius C. Gunter pushed local governments to ban public gatherings as influenza marched through towns large and small — 37 had died in Denver, 11 in Colorado Springs while new cases sprung up from Fort Lupton to Durango. At the end of the month, as the state was completely in the grip of the pandemic, optimism still persisted whenever new preventative measures went into effect. Even Gunter fell ill.
(If the state declares an official public health emergency, Gov. Jared Polis also has the same broad authority to order quarantines and ban public gatherings, among other measures.)
The ban on gatherings went by the wayside on Nov. 11, 1918 — Armistice Day — as thousands took to the streets to celebrate the war’s end. And briefly, it seemed that perhaps the flu had abated. But it soon returned with a vengeance.
Colorado Springs began placing placards reading “Sickness” outside homes touched by the flu. Towns like Monument didn’t allow customers to enter stores — they could receive their orders at the door. When a passenger on a Durango-bound train died, his bedding was burned and the railcar fumigated.
The Southern Ute reservation in southwest Colorado counted 40 flu-related deaths, but those were regarded differently by white residents. The Durango Evening Herald blamed the victims, saying they “have paid the toll of negligence and disobedience to the advice of their superintendent and nurses and physicians.”
But finger-pointing also was aimed at immigrant communities. In Sterling, German-Russian residents, also known as Volga Germans, were considered for quarantine because “the people from this section are notoriously careless regarding health rules.” In Denver, the north side’s heavily Italian community was regarded warily for the way they tended to gather at the homes of sick relatives. Cops even broke up a funeral.
In the Rocky Mountain News, Sharpley attributed the difficulty of getting a handle on the pandemic to “the foreign settlements of the city.”
“They stumbled around terribly, which is probably what we’ll do with the coronavirus,” Leonard says of early global efforts to stem the pandemic. “I shouldn’t say ‘probably’ — we’re already doing it. They’re less culpable. We’ve got lessons from history.”
The pandemic rendered the state’s medical resources terribly inadequate, whether it was Denver’s 300 doctors serving a population of more than 240,000 or rural towns that often had no doctor at all. Teachers were pressed into service as nurses since schools were closed. In Salida, a local madam volunteered her ladies to serve in that capacity.
When the caregivers took ill, the situation quickly grew worse. Denver General Hospital created a separate ward for the 53 nurses that caught the bug. None died.
“There were no deaths among the health staff at Denver General because they were really careful,” Leonard says. “Maybe that’s the cautionary tale — be careful with health care staff. There has to be a fair amount of attention paid to keeping health workers healthy.”
Although efforts were made to concoct an effective vaccine, test results weren’t conclusive that the resulting formulas actually worked. Pueblo vaccinated its steel workers to no avail. Patients in Greeley and Montrose took shots of a vaccine developed at the Mayo Clinic, again with no success. Beyond vaccines, there loomed all manner of home remedies and cockamamie advice.
“The public health officials did recognize they didn’t have understanding of viruses, but hoped for a vaccine,” Leonard says. “That was only a small hope they had. But they had general ideas about hygiene, not coughing on other people, especially when you have a lot together in enclosed spaces.”
Commerce also found a niche amid the chaos.
While this week Amazon reports that profiteers have been popping up on the shopping site with inflated prices for items like surgical masks, businesses in 1918 seized opportunities to hawk anything from elixirs to onions to bicycles in the name of staving off the illness. Glenwood Springs offered its hot springs vapors as a curative.
Among all the efforts, only one place seemed to be getting it right.
While the initial waves of the pandemic filled newspaper columns across the state with one-line obituaries, when there was even enough room to print them all, Gunnison suffered two cases and a single fatality.
Around 2006, the University of Michigan’s Center for the History of Medicine in Ann Arbor was contacted by the U.S. Defense Threat Reduction Agency seeking help in identifying best practices to safeguard and protect American troops. In particular, they were interested in exploring methods used in the 1918 influenza pandemic.
Someone at DTRA had heard of a potential “escape community” called Yerba Buena Island, which is home to a naval base in San Francisco Bay and came through the pandemic unscathed, largely by virtue of its isolation and the fact it was under military control. DTRA then contracted with the university to examine other communities that essentially closed down and came close to escaping the 1918 influenza pandemic.
“In our research,” says Alex Navarro, the Center’s assistant director, “we discovered Gunnison, Colorado.”
Among civic communities, rather than institutions and military bases, Gunnison stood out for its unique and rapid attention to the crisis. It closed schools on Oct. 8, at the earliest statewide warning, and also made other congregating areas in the county off limits for at least four weeks.
The push had a staunch ally in the Gunnison News-Champion, the local weekly paper, which published a steady stream of articles chronicling the flu’s rapid spread to other nearby areas, including Sargents, where it speculated that the illness had infected nearly every resident. Salida, little more than an hour away by car, reportedly saw its already crippling 200 cases spike to 500, though the paper acknowledged that this was based on rumors passed along by rail workers.
In any event, the point was made. Dr. J. W. Rockefeller of Crested Butte was put in charge of the entire Gunnison County protective policy. Enforcement followed swiftly.
Although railroad travelers could visit Gunnison, they first had to be quarantined for two days. Barricades went up on primary roadways into the county warning vehicles to proceed through the county without stopping or face quarantine. Locals could leave freely, but with the understanding they’d be subject to quarantine upon return. Travel was restricted even within the county.
Gunnison didn’t realize that one other factor figured into their eventual success — luck.
“Although they did everything right from that point on, it was about four or five weeks after influenza had been circulating throughout the state,” Navarro explains about the fortuitous timing of their restrictions. “So they lucked out it didn’t hit their town before that, or it would have been useless.
“Other towns at the time were already being hit throughout the Rockies. We suspected the reason why they were so hard hit was because of underlying respiratory issues due to mining. Gunnison was spared somehow, through sheer luck.”
Luck aside, the county meant business. Two Nebraska travelers were jailed when they tried to skirt the barricade on their way to Delta. A man from Pitkin, within Gunnison County, was hit with a fine when he tried to avoid quarantine.
Contributing to the urgency was the fact that there were two known cases in the county already. A woman named Ellen Gavette met her sister at the Gunnison train station after she’d returned from a trip to Chicago. It turned out she brought the flu with her. On Nov. 4, a few days after they’d settled into their ranch, Ellen died.
That death inspired vigilance, and the measures remained in effect across Gunnison County until the first week of February 1919, ending four months of “protective sequestration,” and a remarkably clean record. But as had happened repeatedly in other locations, the celebration came too soon.
About a month after the prohibitions were lifted, a third wave of the pandemic did infect Gunnison County, triggering about 100 cases in the town of Gunnison and others throughout the area. At least five deaths from pneumonia were attributed to the outbreak.
Navarro says the question has been asked often since — most recently during the 2009 appearance of the swine flu — whether protective sequestration actually works. He pegs the answer at “a qualified maybe.”
“The devil’s in the details,” Navarro says. “You have to do it early or you have to get lucky. And no one wants to count on luck in a public health emergency. It has to be as strict as possible. It has to last long enough for community transmission in the outside world to end, which could be many, many months.”
Around the world and in Colorado, the horror eventually subsided. Life went on, perhaps, as Leonard wrote in his 1989 monograph, tinged with a dual sense of hope inspired by technological breakthroughs and fatalism.
“Americans like to think that they could defeat any enemy — Germans or germs,” he wrote then.
In the search for lessons learned, Rudolph, the Denver library archivist, says that while the lack of an effective vaccine ties together the 1918 pandemic and the current COVID-19 concern, one significant difference jumps out. One of the big challenges of 1918, she notes, was the lack of a centralized system, like the federal Centers for Disease Control and Prevention, so city and state authorities grasped at straws to deliver public health information and enforce order.
“I think they were overrun,” she says.
Leonard agrees, pointing out that the state board of health was so egregiously underfunded at the time that it had to commandeer an appropriation dedicated to controlling venereal disease to fill the gap. In 1918, the state spent more to control livestock disease than on the board.
In his view, it seems that Americans took threats of pandemic a little more seriously 30 or 40 years ago — he recalls the 1976 swine flu in particular — in part because the collective memory of 1918 was stronger than it is today. That said, some parallels to 1918 also stand out to him, and not in a comforting way.
“We stumbled around with it in 1918, and we’re stumbling around now,” he says. “There’s a natural tendency not to want to believe something horrible is about to hit you. It may be that this isn’t going to be horrible, but who knows?”
Navarro takes a different angle. He says institutions have used historical data and statistical modeling to determine that early, layered and sustained use of non-pharmaceutical intervention, another term for preventative measures like those that Gunnison took, was actually a good practice that had impact in 1918, before a vaccine, and became the basis for the CDC’s response policy.
“We’ve taken what happened in 1918 and used that historical data to create solid public health policy that’s in place and working,” he says. “It’s not perfect. It’s difficult to control highly contagious respiratory disease. But if both national and local public health authorities were not doing the things they’re doing now, this outbreak would be much, much worse.
“So we have learned from history, I think.”