The Spanish Flu at KGH: A Frequent and Quick Killer

The following blog post was contributed by Andrew Belyea, who is the Museum of Health Care’s 2017 Margaret Angus Research Fellow. Andrew has a degree in Life Science from Queen’s University and will start at the Queen’s School of Medicine in the fall.  This is Andrew’s seventh blog post in a series he will be writing throughout the summer. Special thanks to Trustees of the Estate of Larry Gibson, Graeme Fraser & Jay Rayner, for their generous support of this fellowship.

The following data were obtained from the Admissions and Death Registers at Kingston General Hospital (KGH) for investigation during the research project. Within the Registers, cases of influenza were often associated with other diseases, most frequently pneumonia. If reference to ‘influenza’ was made in the patient’s Reason for Admittance, that individual was included in the cohort being studied. With such a high incidence of pneumonia developing from influenza during the Spanish flu, those with ‘pneumonia’ were also included in the cohort. However, because pneumonia may also develop from a myriad of conditions unrelated to the flu, diagnoses of ‘pneumonia and other non-influenzal disease’ were not included (e.g., anemia and pneumonia).

The Admissions Register was surveyed between the dates of October 2, 1918 and February 29, 1920. During this time period, there were a total of 902 admissions to KGH, comprised of 404 men and 498 women. Of these, 55.7% of male cases (225/404) and 62.7% of female cases (312/498) received diagnoses of influenza. By expanding the diagnoses to include influenza and pneumonia, the proportions increase to 61.9% of male cases (250/404) and 68.5% of female cases (341/498). Figure 1 highlights the admissions at KGH by date, displaying trends that agree with the more typical international Spanish flu experience: the highest number of cases occurred in October/November 1918, while January/February 1919 also had high numbers.

Figure 1. Number of admissions to Kingston General Hospital between October 4, 1918 and February 4, 1920 for influenza and/or pneumonia. The high density of admissions in October 1918 is a reflection of the Spanish flu.

As has been widely reported, the Spanish flu was notorious for affecting healthy adults in their twenties and thirties. This characteristic was a change from the typical pattern of influenza which affected young, elderly, and immunocompromised individuals. The Admissions Register at KGH provides support for the Spanish influenza affecting young adults, as the average age for influenza and/or pneumonia cases at the hospital was 22.3 years of age.

Figure 2. The number of cases admitted to KGH between October 2, 1918 and February 29, 1920 for influenza and/or pneumonia. The trendline was created by averaging four consecutive points and plotting that value.

The average length of stay for those ill with the flu and/or pneumonia was 12.1 days, as compared to 16.2 days for those in hospital for other reasons during the same period. The average stay of non-influenza/pneumonia cases (16.2 days) is inflated because of soldiers in the hospital with venereal disease (VD). At the time, venereal disease was a topic that was socially disregarded because it was deemed highly un-Victorian and improper. Nevertheless, venereal disease was forcibly brought to people’s attention following World War I as thousands of VD cases arrived home with soldiers. At KGH, 25 men were brought in with VD between October and November 1918, 20 of whom arrived on October 3, 1918. Of the VD cases at KGH, five men were in hospital for 61 days, four for 50 days, and two for 88 days. Due to their extended stays, the average length of stay for non-influenza/pneumonia cases is misleadingly elevated relative to what a normal stay would be. By removing the cases of VD from the sample, the average length of stay for non-influenza/pneumonia cases drops to 14.3 days.

So, those with the flu/pneumonia were in hospital for, on average, 12.1 days, while non-flu/pneumonia patients were in hospital for 14.3 days on average (VD not included). It is clear that those ill with the flu/pneumonia had shorter stays in hospital as compared to other cases, but why is this? Did they simply recover more quickly? Or, more gravely, did they die faster upon arrival at the hospital relative to their counterparts?

When looking at the numbers, the answer to both questions appears to be ‘yes’. For non-flu/pneumonia cases that survived their stay at hospital, they were admitted for an average of 14.5 days (excluding VD cases). On the other hand, flu/pneumonia cases that survived were admitted for 12.6 days. So, in general those with the flu recovered more quickly. Furthermore, it appears that flu/pneumonia deaths also impacted the length of stay: of the 44 deaths that occurred at KGH in October and November 1918 (the peak dates of the epidemic), 33 deaths (75%) are due to influenza and/or pneumonia. What’s additionally meaningful is that these deaths occurred following shorter hospital stays. For those 33 individuals who passed away, the average stay in hospital was only 4.03 days (SD: 3.04, mode: 4, median: 4) prior to death.

So what does this information tell us? It yields insight into the speed at which the Spanish influenza killed those it affected. The maximum length of time someone was in hospital with the flu/pneumonia before death was 11 days compared to 21 days for other diseases during the same period. This information does not tell the entire story of how the flu impacted Kingston, but it provides pieces of information that demonstrate the power of this horrible epidemic. These data yield insight into the frequent and quick killer we call the Spanish flu.

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