The 1918 influenza pandemic killed an estimated 50 to 100 million persons worldwide, surging in 3 waves starting in the spring and summer of 1918. In the United States, 1 million deaths were recorded, and the case-fatality rate reached approximately 2.5%, compared with less than 0.1% in other influenza pandemics. These figures were likely significantly underestimated because of nonregistration, missing records, misdiagnosis, underreporting, and restriction of reporting to the major season (the fall and winter of 1918–1919) (28–30).
These limitations are especially apparent when assessing influenza's effect on black Americans, a “shockingly sparse” historical database (31). Before 1918, epidemic disease already exacted a disproportionate toll on black Americans, who, for example, accounted for an overwhelming number of the 50 000 deaths in the 1862–1867 smallpox epidemic (26). Contagion also augmented biologically deterministic beliefs, including that blacks were innately immune to certain diseases. During the 1792–1793 yellow fever epidemic in Philadelphia, white physicians, such as Benjamin Rush, asked black community leaders Absalom Jones and William Gray to “furnish nurses to attend the afflicted” because of the erroneous assumption that blacks could not contract the disease (32, 33).
However, in the context of these preceding epidemics, the 1918 influenza pandemic forms a unique case study. Although all-cause morbidity and mortality in the early 20th century was higher for black Americans than white Americans, the few studies examining racial differences in the 1918 pandemic found that the black population had lower influenza incidence and morbidity but higher case fatality (23, 34). Black physicians shared this view, as evidenced in the Journal of the National Medical Association and local newspaper articles (35, 36). Meanwhile, white public health figures, like Chicago Commissioner of Public Health John Dill Robertson, used these findings to justify biological determinism, concluding that “the colored race was more immune than the white to influenza” (37).
Rebuttals to these innate immunity theories circulated in the black print media. Respected and widely read periodicals, such as Baltimore's Afro-American, The Chicago Defender, and The Philadelphia Tribune, carefully documented influenza's effect, with personal columns, church registers, and town updates listing the many community members who had the “flu,” shaming those not taking it seriously, or mourning others, such as a promising young teacher and Morgan College graduate (38–42). Other articles warned black Americans to take adequate precautions and discounted theoretical immunity: “While the death rate from the epidemic of influenza is not as high as the white death rate, colored people are far from being immune of the disease” (43). In December 1918, African American columnist William Pickens debunked the claim of a white West Virginian who claimed the “influenza germ had shown that God was partial in favor of black people.” Pickens countered that for whites, “when Negroes die faster, it is often escribed [sic] to their inferiority,” but if spared, “well, that proves they are not human like the rest of us” (44). These critiques highlight differences between pandemic coverage and explanatory models in the “mainstream” versus black press—the latter was community-centered, focused on trusted sources and internal solutions, and skeptical about the veracity and benevolence of white responses.