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Nonetheless, the government and newspapers continued to reassure. Although physicians fully understood the explosive nature of the pandemic, they routinely misled people, covered up the truth and lied. In Philadelphia, for example, public-health director Wilmer Krusen promised — before a single civilian had died — to "confine this disease to its present limits. In this we are sure to be successful." As the death toll grew, he repeatedly reassured the public that "the disease has about reached its crest. The situation is well in hand." When the number of daily deaths broke 200, he again promised: "The peak of the epidemic has been reached." When 300 died in a day, he said: "These deaths mark the high-water mark." Ultimately, daily deaths reached 759. The press never questioned him.
Same old fever?
Unfortunately, Philadelphia's communication strategy was the rule, not the exception. Local officials and newspapers across the country were either deceptive or said nothing. Many papers did not print lists of the dead. Even as 8,000 soldiers were hospitalized in Camp Pike, Arkansas, over four days, the Arkansas Gazette in Little Rock, just a few miles away, maintained, "Spanish influenza is plain la grippe — same old fever and chills." This communication strategy of either reassurance or silence had its effect. Its effect was terror.
Lies and silence cost authority figures credibility and trust. With no public official to believe in, people believed rumours and their most horrific imaginings. A man living in Washington described the result: "People were afraid to kiss one another, people were afraid to eat with one another ... It destroyed those contacts and destroyed the intimacy that existed amongst people ... there was an aura of a constant fear that you lived through from getting up in the morning to going to bed at night."
Under that pressure, society first drifted, then threatened to fall apart. The health-care system, already drained of physicians and nurses by the military, collapsed first. Elsewhere, fear, not illness, kept people at home. Absenteeism reached extraordinary levels. Shipyard workers were told that their duties were as important as a soldier's; they were paid only if they worked; and, unlike elsewhere, physicians were available to them on site. Yet absentee rates in the shipyards — one of the few industries for which there are good data — still ranged from 45% to 58% (ref. 3). Absenteeism crippled the railroad system, which transported nearly all freight, bringing it to the point of collapse. It shut down telephone exchanges, closing off communication, and further isolating and alienating people. Grocers refused to open. Coal sellers closed. In cities and rural communities, the Red Cross reported that people "were starving to death not for lack of food but because the well were too panic stricken to bring food to the sick".
Victor Vaughan, a sober, serious scientist, for years dean of the medical school at the University of Michigan in Ann Arbor, worried that if this trend accelerated "for a few more weeks ... civilization could easily disappear from the face of the Earth".
Better communication led to better results. In San Francisco, for example, despite a slow reaction to the initial onslaught of flu, in October 1918 the mayor, health officials and business and union leaders all signed a full-page newspaper advert in huge type reading: "Wear A Mask and Save Your Life!" It was a rare, bold statement. In this city, society, although reeling, functioned. Food was delivered, and the sick were cared for. Where people had accurate information and knew what they faced, they often performed heroically. Red Cross professionals, physicians and nurses routinely risked their lives. When Philadelphia's city police — who knew the facts even if the papers weren't printing them — were asked to supply four volunteers to "remove bodies from beds ... and load them in vehicles", 118 officers responded4.