According to the Centers for Disease Control and Prevention, prior to Covid-19, the largest pandemic in the United States was the 1918 influenza epidemic. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918.
It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States. Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.
While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
In at least one prison, Eastern State Penitentiary in Pennsylvania, various measures were taken. According to Eastern State Penitentiary Historic Site, on the day the first case of the flu virus appeared at Eastern State—September 30, 1918—Warden Robert McKenty closed the penitentiary to outsiders. He wrote: “On account of the epidemic of influenza, I stopped all visits both to prisoners and for purpose of visiting the institution.”
The prison continued functioning as a correctional institution. It received and discharged people throughout the pandemic, but officials barred all assemblies and meetings.
Church services were halted. Warden McKenty encouraged prisoners to get “plenty of sleep, plenty of fresh air, [and] plenty of exercise,” according to The Umpire, Eastern State’s prisoner-produced newsletter.
All told, 63 incarcerated individuals contracted the virus that fall. All cases were isolated in the prison hospital. Prison officials scrubbed the cells that sick patients vacated with formaldehyde. Staff fell sick as well. Forty-two officers called out sick in October—most for a few days, but at least two for the entire month. Christopher Hines, a 33-year-old guard, died of influenza-induced pneumonia on October 11.
Eastern State saw its first flu-related prisoner casualty the next day. Joseph Deal, a 23-year-old painter from Luzerne County, died on October 12. A week later, a second prisoner, 22-year-old Stewart Clugston, died of the flu.
A week after that, a third prisoner succumbed to the virus: Andrew Conway, a 38-year-old originally from Maryland. Deal, Clugston, and Conway were the only three people—out of a total incarcerated population of around 1,350—who died of the flu that fall at Eastern State.
After a “thorough house-cleaning, disinfecting, etc. had been effected,” according to The Umpire, the warden lifted the quarantine on Sunday, November 10, 1918, following a 43-day lockdown.
Catholic mass was said in the prison chapel. A group gathered for a service of songs in the prison’s center surveillance hub. Eastern State’s incarcerated population praised the administration and even conferred an honorary status of Surgeon General to the prison’s resident physician, Dr. H. W. Hassell.