Historian analyzes the death toll from the 1918 Spanish Flu outbreak

The measures currently being taken to contain the spread of Covid-19 is based on the fear that the virus could prove as deadly as the Spanish Influenza of 1918-19.

Some researchers believe the disease may have infected nearly one third of the world’s population and resulted in 50-100 million deaths worldwide. The U.S. death toll has been estimated at 675,000. But was it really that bad?

To me these numbers seem inflated. One hundred million deaths would be equivalent to the entire population of the United States in 1918.

Where are the mass graves? Assuming 500 bodies per grave, 100 million bodies would require 200,000 mass graves. The estimated U.S. death toll appears more reasonable but also seems a little high, in my opinion.

I decided to take a look at some figures on my own. Two main sources were used: the Mortality Statistics from the Annual Report of the Department of Commerce Bureau of the Census for the years 1916-1921 and the burial records from the “Find A Grave” website on the internet.

As Find A Grave appears to have recorded only marked graves, the true number of deaths seems to be understated. For example, the Census report shows 1,474,821 deaths in 1918 while Find A Grave lists 1,156,871 burials that year — roughly 78 percent of the census total.

The Spanish Flu pandemic took place primarily during the fall and winter months of 1918-19, with the highest number of deaths occurring in October and November. Another influenza wave struck in January 1919 and continued through March, but it was not as deadly.

According to the mortality statistics in the Census report, the number of deaths from all causes in the United States in 1918 was 1,474,821; the number in 1919 was 1,096,436.

I also looked at the number of deaths in 1916- 1917 — the two years preceding the Spanish Flu and also in 1920-1921 — the two years following the epidemic as recorded by Find A Grave. The number of burials during those four years averaged 1,061,355.

The total number of deaths in 1918 and 1919 appears to be 448,547 above average. Assuming that most of the excess deaths can be attributed to the Spanish Flu and not the World War, the total is about a quarter of a million less than the number cited in the first paragraph of this article. Of course 448,547 is still a substantial number.

One might expect the U.S. population to decrease as a result of the influenza pandemic. However, according to the Census report, the population of the U.S. increased from 103,564,694 in 1918 to 104,976,970 in 1919. Due to wartime restrictions only about 110,000 of the 1.4 million increase can be attributed to immigration.

Find A Grave lists 1,156,871 burials in the United States in 1918 and 833,484 in 1919. The annual number of burials in the two years preceding and the two years following the flu pandemic averaged 820,014. This is about 337,000 more than the average number of deaths during the four non-flu years. Dividing the number of excess deaths by the total deaths using the census figures yields a ratio of 0.30. Dividing excess deaths by total deaths using the Find A Grave figures yields a ratio of 0.29. This suggests the two sets of data are comparable.

Turning now to the State of Nebraska. The population of Nebraska was 1,266,000 in 1918 and 1,290,000 in 1919. Mortality statistics for Nebraska were not included in the census reports until 1920 but Find A Grave shows 15,870 burials in 1918 and 11,577 in 1919. The average number of burials in the two years preceding and the two years following the flu epidemic was 11,337. Thus the number of deaths was about 40 percent above average in 1918 but only 2.1 percent above average in 1919. The national rate was +41 percent and +1.6 percent respectively. These figures also seem comparable.

Dividing the number of burials by the total population of Nebraska yields a crude death rate of 12.5 deaths per 1000 people in 1918 and 8.9 deaths per 1000 in 1919. The average death rate during the four non-flu years was 8.8 per 1000. This suggests out of every 1000 Nebraska residents in 1918, less than four deaths out of every thousand was due to the flu and only one in 10,000 in 1919. Of course, the death rate was significantly higher for those who actually contracted the flu, but I found no figures on the number of people who contracted the flu but recovered.

The population of Cedar County was 16,225 in 1920. Figures for non-census years were not found but probably were not much different in 1918 and 1919. The total number of burials in the county was 166 in 1918 and 123 in 1919. The average number of deaths in the four non-flu years was 109. Thus, it seems reasonable to attribute 57 deaths to the flu in 1918 and 14 deaths to the flu in 1919. This would suggest an influenza death rate of 3.5 per 1000 in 1918 and less than one per 1000 in 1919. Incidentally, the Nebraska State Board of Health reported 60 deaths from the Spanish Flu and its complications in Cedar County in 1918. Thus, the mathematically derived prediction (57) seems comparable to the actual reported figure (60).

The Spanish Flu was bad but it wasn’t the Black Plague. Next week, I will wrap up this series by looking at the influenza death toll in Cedar County’s major towns. One town seems to have suffered more than the others.