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We Heard the Bells: Introduction

We Heard the Bells: The Influenza of 1918

Throughout history, influenza viruses have mutated and caused pandemics or global epidemics.  In 1918 and 1919, the worst influenza in recorded history killed an estimated 50 million people around the world.  In the United States, the death toll reached 675,000 – five times the number of U.S. soldiers killed in World War I.  The disease seemed to target young adults and pregnant women, leaving many young children without mothers or fathers.  Where did the 1918 influenza come from? And why was it so lethal? What can be learned from those who survived the 1918 pandemic? 

We Heard the Bells, narrated by award-winning actress S. Epatha Merkerson (Law & Order), explores the personal and family experiences of a diverse group of Americans during the influenza pandemic of 1918.  History unfolds as survivors of the pandemic tell their stories.  Their memories frame the key questions that still drive the search for answers to help us weather the current H1N1 pandemic and future flu pandemics. 

“The survivors of the pandemic whom we met came from very different circumstances culturally and geographically.  They spoke about their experiences with different accents, but their memories had so many common threads,” says Lisa Laden, We Heard the Bells producer. “I was particularly struck by how often survivors remembered the pandemic in terms of its sounds:  bells, hammers, shovels, the voices of men coming in tired after attending to the victims.  I was also impressed by the resiliency of the survivors. Their personal strength and endurance reminds us that our country was strong enough to endure the flu pandemic of 1918-1919 and recover, too.” 

The pandemic of 1918-1919 occurred in three waves. The first wave occurred when mild influenza erupted in the late spring and summer of 1918.  The second wave occurred with an outbreak of severe influenza in the fall of 1918, and the final wave occurred in the spring of 1919. 

“My mother and father and my two sisters all had the flu.  It was a very sad period, there was like a sadness over the city.  When you looked out, you saw hardly anybody walking around. People stayed in their houses because they were afraid,” recalls Reba Haimovitz who was a child living in Philadelphia at the time. 

In the last 100 years, new influenza viruses have caused four pandemics:  in 1918, 1957, 1968, and 2009.  An influenza pandemic is different from the more predictable seasonal influenza.  An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population.  The virus causes serious illness and spreads easily from person-to-person worldwide.  

Among the survivors who share their stories in We Heard the Bells are:

  • Maria Prats Gomez, whose family moved to El Paso to escape the turmoil of the Mexican Revolution.  Ninety years later she still remembers the fever dreams she had when she was ill with the flu, and how the flu pandemic changed the city.
  • Annah Elnora Thurber, who survived the influenza in January 1919 in a farmhouse with no running water in Sequoyah County, Oklahoma.  Annah’s mother, pregnant with her fourth child, cared for eight very sick family members. 
  • Florence Parks, who became ill with the flu while living in housing for Bethlehem Steel’s African-American workers.  Florence praises the brave woman in her community who took it upon herself to care for her sick neighbors, and somehow managed to avoid coming down with the flu herself.

 “There was a shortage of doctors and nurses during the 1918 influenza pandemic because so many of the physicians and nurses were serving in the war (World War I) effort.  So you had a mixture of both trained medical personnel and those with some training, and those who basically were very civically minded individuals, who wanted to participate in the tending to the ill,” said Dr. Alexandra Minna Stern, Associate Director, Center for the History of Medicine, University of Michigan.  “These brave individuals were putting their lives on the line in order to help others recover from the flu.”

An estimated 500 million people, one third of the world's population (approximately 1.6 billion at the time), became infected.  There were few communities that were sheltered from the waves of deadly disease that swept around the world.  The pandemic spread to the Arctic, and to remote Pacific islands.

We Heard the Bells chronicles Dr. Johan Hultin’s expedition as a graduate student to a remote Alaskan village that was nearly wiped out by the pandemic.  His 1951 attempt to find live virus from the 1918 pandemic fails, but his return to the site 46 years later is crucial in helping molecular pathologist Dr. Jeffery Taubenberger to sequence the genome of the 1918 flu virus, the culmination of a ten year effort.

Prior to Dr. Hultin’s retrieval of Alaskan native tissue, scientists only had a thumbnail of tissue to try to sequence the 1918 virus.  Dr. Hultin’s expedition provided large sections of tissue, so that scientists were able to sequence the genes of the virus.  “We have seen an explosion in information about influenza in the last 10 years or so, because…of sequencing of the 1918 virus…” says Dr. David Morens, Senior Scientific Advisor, National Institute of Allergy and Infectious Diseases.

In 1918, as now, most people did not think of influenza as a disease that could lead to death.  In fact, complications from seasonal flu typically cause an average of more than 200,000 hospitalizations every year in the U.S., and an average of 36,000 people die from those complications. 

In 1918, people did not know what they were dealing with.  Antibiotics had not yet been discovered that could treat secondary infections from the flu.  Today, we have biomedical and healthcare technical advances to help us weather both seasonal and pandemic flu.  We have vaccines as our first line of defense.  Antiviral drugs are now available to help treat flu.  Respirators and good intensive care units are also available today.  Further, we have the benefit of global surveillance of influenza, which can help us track diseases and to prepare.  Our parents and grandparents living in 1918 had little warning or chance to prepare. 

“There is a lot to be learned from continuing to study the 1918 flu,” says Dr. Anthony S. Fauci, Director, National Institute of Allergy and Infectious Diseases.  “The important lesson is that pandemics can be very serious.  But also, pandemics can be widespread but not that serious…So you always must prepare for the worst-case scenario.  The one thing you can predict about influenza is that it’s unpredictable.”