The 1918 influenza pandemic and how the ordeal played out in Wisconsin illuminates the scale at which the experience of and response to public health emergencies impact both human lives and the economy.
Also known as the “Spanish Flu,” due to early news coverage of the disease in Spain, the 1918 pandemic hit Wisconsin in the fall of that year, just before the end of World War I. Nearly 103,000 Wisconsinites fell ill with the H1N1 influenza and related pneumonia, with over 8,000 losing their lives — a total greater than the number of people from the state who were lost in World War I, the Korean War and Vietnam War combined. Globally, the 1918 flu claimed 20-100 million lives, depending on the estimate.
Wisconsin was the only state in the nation to respond to the pandemic with measures that were both particularly aggressive and well-followed by the public. The state laid the foundation for this comprehensive approach decades earlier. Wisconsin was an early adopter of several public health practices, including implementing a State Board of Health in 1876, the precursor to the Department of Health Services. It was only the tenth state to do so.
During public health emergencies, the board was granted power to implement quarantines and issue rules and regulations for the state in the interest of public health. Not long after establishing the board, the state also required that all localities (cities, villages and townships) create a local board of health and appoint a public health officer. At the time of the 1918 flu, nearly 1,700 local boards of health existed to bridge individual communities to the State Board of Health and enforce local regulations.
Impacts in Mortality and Health
Much like the COVID-19 pandemic, the 1918 flu interrupted routine life in Wisconsin. Large gatherings posed a risk of spreading infection, and the public was directed to avoid crowded venues. Eventually, the State Health Officer, a member of the State Board of Health, ordered all public institutions in the state to close. Further, at the direction of that official, local governments were ordered to close all movie theaters, schools, churches and public gathering spaces indefinitely. Nearly all localities cooperated within a day.
Wisconsin was the only state to issue such comprehensive statewide measures.
This state-level approach and public compliance, combined with low population density and the relatively late arrival of the flu, is credited with the relatively low death rates for Wisconsin in 1918. Indeed, flu mortality rates had little relationship to states’ economic conditions, climate and geography, perhaps further suggesting Wisconsin’s government intervention played at least some role.
The death rate in Wisconsin was 2.91 per thousand compared to 4.39 per thousand in the rest of the United States. Alternatively, one study found a death rate of 3.3 per thousand for the state — the third lowest among 25 reporting states — compared to 4.8 per thousand nationally for just the four months between September and December 1918. Yet another analysis ranked Wisconsin as having the lowest mortality rate of states reporting in the U.S. that year.
The excess mortality rate — which refers to deaths beyond what would be expected during a typical flu season — was one of the lowest in the nation at 360 per 100,000. Milwaukee had one of the lowest death rates of all cities of its size.
In addition to these relatively low mortality rates partly attributable to the intervention strategy in Wisconsin, a 2020 study suggests there may be economic benefits. The economies of cities that intervened sooner and more aggressively performed at least as good if not better once the pandemic was over.
The Consequences in 1918
Despite the uniquely coordinated efforts at the state and local level, hospitals throughout Wisconsin faced a shortage of beds and healthcare workers. Communities augmented their capacity with temporary emergency facilities and a network of volunteers. Locally, many places participated in anti-influenza education encouraging people to stay home when sick and cover their cough.
Wisconsin’s rural and urban areas faced, to some extent, different challenges in dealing with the 1918 flu pandemic. In more urban places, the number of patients overwhelmed healthcare systems and limited access to quality care. In rural areas, scattered populations and limited resources to channel toward education and public initiatives left some people dangerously uninformed. Rural areas across the nation, though, did fare better as indicated by lower rural mortality rates across several states and compared to state averages. In Wisconsin, the ratio of the mortality rate for cities compared to the state average was 1.17; that is, the urban mortality rate was 17% higher, indicating that rural areas likely had fewer flu-related deaths.
The 1918 pandemic ultimately proved most severe for prime age adults — peaking from ages 15 to 35 with higher mortality rates for males. For many households, the loss of a breadwinner, even for only the two weeks necessary to recover, was crippling. Many families suddenly found themselves in dire need of assistance.
Civic life changed as well, as the outbreak hindered public campaigning events, causing political parties to largely switch to mail outreach. Businesses suffered too. Movie theaters, restaurants, bars and saloons missed months of revenue. Unsurprisingly, healthcare-adjacent businesses, such as equipment manufacturers and other suppliers, experienced growth. Beyond those businesses forced to close, many faced worker shortages when broad swaths of the labor force fell ill. Additionally, sick farmers meant unharvested fields and untended animals, piling on the losses.
Though little economic data exists for states and localities for this time period, the economic losses surely echoed throughout the U.S. and around the globe.
One 2020 study found that nations typically experienced a flu-related decline in GDP near 6% from 1918-1920. There is some evidence that wages increased in the U.S. as a result of the pandemic, as the illnesses and deaths reduced the labor supply for manufacturers across the country.
With fewer employees working with existing equipment to maintain or even increase production, economic theory would suggest that productivity per worker would increase and drive income growth. Indeed, research has found that the 1918 pandemic was linked to subsequent state-level income growth. Importantly, even though there is some evidence of gains, these gains must be placed in context of the large overall loss of economic activity, not to mention the overwhelming personal losses during the pandemic.
While there were economic consequences of the 1918 pandemic, most were found to be short-lived. One study found, however, that some negative effects were long lasting, as people who were born in the wake of the pandemic went on to achieve poorer education and economic outcomes in their lives.