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Here's How COVID-19 Compares to the 1918 Flu in Miami

The novel coronavirus outbreak of 2020 is not the first time Miami was hit with a virus that shut down businesses, emptied schools, canceled meetings, and shuttered movie theaters.

In 1918, as World War I was ending, a raging influenza pandemic struck. Sometimes called the Spanish flu, the virus reached nearly every part of the globe. When it abated in 1919, more than 500,000 people were dead in the United States, and more than 50 million had perished worldwide.

Although the flu first appeared at an army camp in Kansas in March 1918, it wasn't until September that thousands worldwide began to die.

The 1918 virus was spread by particles in the air, and death came quickly. Often within 12 hours of showing the first symptoms of fever and coughing, a victim's lungs would fill with fluid, and the body often turned blue from the lack of oxygen. Those who did not die typically recovered within two weeks.

South Florida was not exempt. Dade, Broward, and Palm Beach counties — populated at the time by farmers, recent arrivals, winter residents, and tourists, along with communities of Seminole Indians — had a combined population of about 58,500 residents, nearly two-thirds of whom lived in Dade.

Locally, the first public mention of the epidemic was September 25, when the Miami News reported over 23,000 cases of the disease in U.S. Army camps, including 112 deaths. Two days later, the first local death from pneumonia, a 22-year-old woman, was reported but not yet identified as related to the looming viral outbreak.

By October 1, more than 50,000 cases had been reported nationwide, with 237 deaths. Two days later, a 28-year-old Miami man died. It was reported that he had a keen sense of humor and was "a leading and enthusiastic member" of his church's Bible class. The Miami Board of Health began to track cases.

Military camps, where many men lived in close quarters, became key places of viral spread. At the Dinner Key naval air station in Coconut Grove, sick Navy men began filling the camp's hospital, which quickly ran out of beds. The camp commandant began sending his men to Miami's sole city hospital.

At first, the Dade County Medical Society met and recommended that people keep a distance from others, not sneeze in each other's faces, stay away from crowds, and keep out of movie theaters. But the doctors did not believe the situation was alarming or that it was necessary to close schools. They sensed that the disease would wear itself out within ten days if people followed the recommended precautions.

Their optimistic outlook was soon upended. By October 4, 500 cases and three deaths were reported in Miami. The city hospital began to fill, and all local physicians were taking care of patients with the flu. Three days later, doctors recommended closing the schools, citing a number of teachers with the disease.

Soon, theaters were closed, meetings were canceled, and church choir practices were called off. On October 12, city health officials ordered the closing of all businesses except for grocery stores, which were allowed to remain open from 8 a.m. to 6 p.m. All public gatherings, including church services, were canceled. Congregating on street corners and sitting in parked cars was prohibited.

The sudden outbreak came during the dramatic closing weeks of World War I when news of Allied victories and the collapse of the German side dominated the front pages. In early October, the fourth Liberty Bond drive was nearing its end, and it appeared Miami had oversubscribed its quota of $1.5 million.

But the celebratory tone was marred by the publication of daily military casualty lists, which often contained the names of hundreds of young soldiers. And soon, the papers began to print the names of those who were sick or who had died from the flu.

Health officials updated their recommendations, advising people to eat wholesome foods and to keep their homes well ventilated. They did not consider quarantining those who were sick or infected; it was only after the epidemic was nearly over that the possibility was raised.

The number of sick Navy men sent to the city hospital quickly overwhelmed the nursing staff, some of whom were becoming sick themselves. In response to the Navy patients' complaints about the lack of care, the station commandant ordered a takeover of the hospital, saying the military could better run the operations. City officials strongly objected, as the number of local cases was quickly rising and the beds were needed. In the end, a deal was struck wherein the Navy could use the hospital but had to care for its own sick. The city opened an emergency hospital, which also began to fill with flu patients.

Racial segregation meant that black patients were not allowed in city hospitals and that white doctors and nurses were not expected to treat them. When one white resident offered up a house in a white neighborhood to be used as a black hospital, neighbors strongly objected. Finally, a large home was found in a black neighborhood to treat black patients. Health officials appointed a black doctor to oversee the care, but he soon fell ill and another had to be summoned.

Amid the crisis, numerous volunteers stepped forward. The local Red Cross chapter, which was very active in support activities during the war, offered aid. Some members volunteered as nurses to work in both the white and black hospitals and to visit the homes of the sick. Others organized a soup kitchen for those stricken by the disease. As with their hospital work, they did not discriminate by race when handing out meals. At the height of the epidemic, the kitchen provided food for 100 families, representing 500 patients sick at home.

The Red Cross also organized a daycare center to look after children whose parents were sick. Boy Scouts canvassed homes across the city in search of the sick and found many in distress. To encourage more volunteers to get involved, newspapers reported the names of those who helped.

The epidemic hit Broward and Palm Beach counties, but not as hard as in Dade. Palm Beach recorded only a handful of deaths. The local Red Cross chapters began to send volunteers and donations to Miami. As sparsely populated Broward County had minimal medical facilities at the time, the sick were either cared for at home or sent to hospitals in Miami.

From October 6 to October 16, city officials tallied 28 deaths in Dade. The county Medical Society reported that 25 percent of the population was affected. Yet there was good news: The naval air-station hospital was receiving fewer cases and beginning to discharge large numbers of men who were recovering. The number of new cases in the city was declining.

On October 21, stores and restaurants were allowed to open, albeit with limited hours. Closed schools in Palm Beach County reopened. On October 23, the Miami city council met and appropriated $10,000 to pay for the hospital's increased medical expenses. Grocery store and restaurant hours were expanded, and by October 28, business activity in downtown Miami looked normal. On November 1, theaters reopened and the soup kitchen closed. The following day, the Miami Board of Health declared that the epidemic — which had killed 1,216 Floridians in October alone — was over.

Within a week, no further mention of the epidemic appeared in the press. One exception: Looking forward to the upcoming winter season, the Board of Health proclaimed Miami was "the best place in the United States for influenza convalescents to recuperate."

Fred Fejes is a professor emeritus at Florida Atlantic University. He is working on a history of the LGBTQ community in Fort Lauderdale.

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