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Kentucky prohibited public funerals and churches and schools closed during the 1918 flu. In one month alone, it caused more than 5,000 deaths in the state. “Nothing else—no infection, no war, no famine—has ever killed so many in so short a period,” wrote medical historian Alfred W. Crosby.

Worldwide, the flu attacked more than a billion people during the 1918 pandemic. (A pandemic is an epidemic that involves all people, is severe, and is pervasive for only one or two years.) Between 20 and 40 million died. In the U.S., 25 million cases were reported. More than 500,000 died—more than were killed in all U.S. wars of the 20th century.

This pandemic struck America in three waves, from March 1918 to March 1919. The flu’s first assault struck in March 1918. In Kentucky, deaths due to influenza and its often-attendant pneumonia ran at 500-600 a month from January through April, then dropped. In the tumult of World War I, this first wave was hardly noticed.

Flu was not unusual. But this flu mutated into a monster.

Flu viruses are now known to be very unstable. Some change on their own. Others engage in “reassortment,” where two viruses trade genes. And when human flu viruses enter animals, they often undergo a transformation. Usually this creates only minor differences. Sometimes, however, a monster virus is created. The 1918 flu was such a Frankenstein.

In the first three-quarters of 1918, more than 1.5 million U.S. soldiers went overseas, crowded together on ships and in barracks and trenches. Some came from Ft. Riley, Kansas, where the mutated virus is believed to have first appeared.

Soldiers sickened and died. The revamped virus came back to America with returning soldiers.

This flu first reappeared at Camp Devens, Massachusetts. According to a State Board of Health statement, this second-wave flu’s first appearance in Kentucky came in Bowling Green on September 22, 1918, when a group of soldiers was feted there.

Physicians soon noticed a frightening fact: while flu usually strikes the weak, very young, and very old, the 1918 flu searched out the young, strong, and vigorous. Those between 20 and 40 were the hardest hit.

Doctors were at a loss. Bacteria were known, but viruses would not be observed for several years. So, since viruses cause influenza, researchers trying to isolate a flu germ were chasing a phantom. More than once they believed they found the right bacteria. Serum was created. Each failed.

Six days after the celebration for the soldiers in Bowling Green, on September 30, 1918, the Kentucky State Board of Health issued its first flu proclamation. It urged “all patriotic people” who showed symptoms of the flu to “isolate themselves.”

On October 4, U.S. Surgeon General Rupert Blue advised communities to close all churches, schools, theaters, and public institutions where the flu had struck.

On October 6, the Kentucky state board issued a proclamation closing “all places of amusement, schools, churches and other places of assembly.”

October was the deadliest month in the nation’s history. In Kentucky, a reported 5,201 deaths were attributed to influenza and its resulting pneumonia.

According to the official breakdown, the second, and worst, wave of the 1918 flu ended in December. This is the wave that gave the virus its notorious reputation.

But the disease was not through.

Officially, the third wave lasted from February through March 1919. In Kentucky, there was no break between waves—in January 1919, influenza and pneumonia took 2,143 lives. By April, the flu began fading in Kentucky, with 509 related deaths that month.

Behind it the flu left devastation, disruption, and heartache, affecting almost every aspect of American life.

On October 19, 1918, every saloon, soft drink stand, and drug store soda fountain in Kentucky was ordered closed at 6:30 each night until 6:30 the next morning.

The state health board had closed all local schools. But when allowed to reopen in late 1918, some stayed closed or closed again due to the illness of teachers.

Kentucky’s young men enthusiastically went off to war only to die in training camps and behind the lines. They went overseas only to receive word their wives or children had died.

When the pandemic finally faded, did the virus really die out? Most researchers fear not. And how did such a monster come about? Only recently have investigators started to solve that riddle.

In March 1997, molecular pathologist Dr. Jeffery Taubenberger and colleague Ann Reid got the first direct look at the 1918 virus.

A 21-year-old Army private died from the flu in 1918. His lung tissue was preserved in paraffin and stored at the Armed Forces Institute of Pathology. Doctor Taubenberger managed to extract flu virus RNA from the preserved lung.

One theory had held that the virus infected humans from birds. Dr. Taubenberger’s analysis showed that the 1918 flu strain was also closely related to a pig virus. Many farmers in early 1918 had complained about their pigs being very sick. No such pig virus had been reported before 1918.

But the 1918 flu strain had a touch of both swine and bird viruses. The avian virus suggested that perhaps a bird flu infected the pigs, combining with regular swine flu and perhaps a human virus. This led investigators to suspect that pigs could be “dangerous ‘mixing vessels’ that give rise to new strains lethal to humans.”

But even with all this research, no one is yet sure why the 1918 pandemic was so lethal. Nor, more importantly, how to prevent its return.

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