Influenza Encyclopedia

As of yet there were only 25 diagnosed cases in Omaha, although Health Commissioner Manning could not be certain of this number as influenza was not a reportable disease. For the time being, he had to rely on informal reports of area physicians. The outbreak at Fort Omaha and the cases in the city were enough, however, to prompt Manning to act. He hoped the closure order would limit the ability for the public to intermingle and spread the disease. He also urged the public to self-isolate if they felt the symptoms of influenza begin to develop, and to refrain from using common drinking cups or kissing.2

Manning believed the epidemic, and thus the closure order, would be short-lived. After only a day in effect, he told residents that the city’s efforts had already brought the epidemic under control. Given incubation period of influenza, Manning told the public, the effect of the closure order on the spread of the disease could be better estimated in a few days. It would then be possible to determine how much longer the closure order would be necessary. In the meantime, streetcars were ordered to maintain good ventilation and people were reminded once again to remain vigilant.3 Manning was hopeful.

The short notice for the closure order and the belief that Omaha’s influenza situation was not severe enough to warrant such drastic measures left theater owners and managers angry. Most had sold tickets for upcoming shows, and several had sold advertising as well. The Brandeis Theater was expected to lose at least $4,500 on its upcoming performance of “Marry in Haste” alone. Its next production, “Hearts of the World,” would also incur heavy losses unless the order was removed soon. The situation was similar for the rest of Omaha’s theaters. As the manager of the Orpheum explained, even if the closure order were lifted quickly the losses likely would continue for some time, as theaters would have to build up patronage once again.4

Within less than a week, however, it became clear that Omaha’s epidemic would not be over any time soon. There were an estimated four hundred cases in the city, prompting health officials to request that physicians with light workloads pitch in to help those in need. Health Commissioner Manning instructed hospitals to refuse all cases that could be cared for at home to alleviate some of the pressure on staff and health care resources. He also notified the public that the closure order would not be removed any time soon. In fact, he tightened it by banning outdoor gatherings as well, including parades, open-air church services, public funerals, and patriotic meetings.5

Manning may have been quick to respond to Omaha’s epidemic, but he was not very strict in enforcing his orders. After learning of the ban on outdoor gatherings, the athletic director of Creighton University announced that the upcoming football game against Lincoln’s Cotner College would still be played. Manning responded that he would not call the police to halt the event, but instead would ask fans “to stand back of me in this attempt to stop the influenza epidemic,” essentially leaving the matter to public opinion.6 It was not until October 22, when the Nebraska Board of Health issued a statewide closure order and a gathering ban on all groups of twelve or more people, that residents of Omaha were denied their football games.7

Meanwhile, Omaha’s epidemic was growing worse. Hospital space for influenza victims was at a premium as hundreds of cases filled the beds. Nurses were in short supply and high demand. The local chapter of the Visiting Nurses Association struggled to fill shortages, but many area residents were unwilling to expose themselves to influenza by caring for the ill. One city physician, who remained anonymous, reported two nurses for refusing to treat influenza patients.8 Ambulance drivers were also desperately needed, but, as the city soon found, over a third of the applicants contracted influenza before they could be hired.9 Some Omaha residents did volunteer, however, and did their best to help their city through the crisis. More than one hundred area medical students volunteered to be on-call with the Omaha Visiting Nurses’ Association for the duration of the epidemic.10 Many city teachers took nursing courses, volunteered as ambulance drivers, or made flu masks.11

The Nebraska Board of Health lifted the closure order and gathering ban for the state effective on November 1. In Omaha, Health Commissioner Manning announced that the City’s bans would be lifted at the same time, as they were no longer needed.12 Residents were thrilled. Theater owners fumigated their venues, and a few even redecorated, in anticipation of the reopening. The Gayety Theater held a special performance at one minute after midnight on the morning of the reopening. Movie houses opened for special matinees. Department stores held the special sales they had been holding back at the request of health authorities. Restaurants and cafes overflowed with patrons. Downtown bustled with activity. Schools reopened on Monday, November 3.13

Almost immediately, however, Omaha began experiencing new influenza cases and deaths. Manning had not expected the sudden spike, and was surprised at the news. He attributed the cases to tonsillitis or bad colds–although this did not explain the rise in the death toll–but warned the public that social distancing measures might once again be implemented. In the meantime, he told residents of the South Side and Florence neighborhoods, where the spike was most noticeable, to voluntarily quarantine themselves.14 At Creighton University, 420 members of the Student Army Training Corps were quarantined after several of them developed influenza symptoms.15

Manning was reluctant to resort to another closure order, despite the fifty to seventy new influenza cases being reported each day. The problem with a second closure order for Omaha, he argued, was that it would be ineffective unless surrounding communities took the same measures. Otherwise, residents could simply go outside the city for entertainment and public gatherings, contract influenza, and bring it back to Omaha with them. As Thanksgiving approached, however, it became clear that something needed to be done to stem the rising tide of new influenza cases. The Nebraska Board of Health issued a warning against group celebrations and events, and Manning asked that Omaha residents comply by not attending public gatherings.16

As November rolled into December, new cases continued to crop up across the city. Manning responded by launching a public education campaign, believing that it would be much more effective than a second closure order. The health department used newspaper cartoons, posters, lantern slides in movie theaters, and leaflets, all with the phrase ‘Cover up each cough and sneeze; If you don’t you’ll spread disease,’ hoping that it would prove more catching than influenza. Manning also called for the isolation and quarantine of individuals with influenza symptoms and directing physicians to placard homes of influenza patients to prevent visitors from entering the premises.17 Personal responsibility, not group action, Manning believed, would bring the epidemic to an end.

That did not preclude more active measures, however. Anti-pneumonia vaccine doses were made available to physicians for free. Unfortunately, Manning soon discovered that some doctors were charging as much as $10 to administer the injection.18 To prevent crowding in downtown stores, he also suggested that retailers open earlier in the day, giving customers more flexibility in when they shopped.19 To prevent crowding on public transportation, Manning prohibited streetcars from carrying more passengers than could be seated and ruled that at least one window in each car must be kept open at all times.20 Public dances were ordered closed. Poolroom owners were strong-armed into agreeing to a voluntary anti-crowding measure: two players and two spectators per table.21 Theaters were ordered to use alternate-row seating to reduce capacity. Most theaters did this by roping off half of their rows, only to find patrons casually stepping over the ropes to sit wherever they pleased.22

On Christmas Eve, with the epidemic across Nebraska still raging, the state Board of Health made influenza a mandatory quarantine disease, with fines ranging from $15 to $100 for violations. Approximately 1,000 homes in Omaha were placarded, with their occupants unable to leave for at least four days after the last fever had subsided. Manning disagreed with the state quarantine order–despite his general stance that personal responsibility was the best way to bring the epidemic to an end–but announced that he did not intend to formally protest the state Board’s decision.23

Omaha’s business interests were growing increasingly upset by what they considered to be half-baked health orders coming from both the Nebraska Board of Health as well as Manning. The Chamber of Commerce protested the quarantine order. Theater and movie house owners protested the alternate-row seating they were being forced to use. Patrons were ignoring the order, and there was little they could do to enforce it. They argued for a full citywide closure order that would bring the epidemic to a quick end, or to remove the alternate-row order altogether. Manning removed the seating order effective Monday, December 30. He also removed the public gathering ban, such as it was. Dancing, however, was not permitted until 6:00 pm on New Year’s Day.24

By the first days of 1919, Omaha’s influenza situation had improved dramatically. Small numbers of new cases and a few deaths were reported throughout January and February, and several dozen homes were placed under quarantine as late as February 14, but the main threat had passed. By this time, nearly 1,200 people in Omaha died as a result of the epidemic.25 The result was a total excess death rate of 554 per 100,000 people, making Omaha’s epidemic one of the more severe in the nation.