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The disease was influenza: in October 1918, the second and deadliest U.S. wave of the 1918 influenza pandemic killed an estimated 195,000 Americans, according to the CDC and the U.S. Census Bureau. The figure is an estimate for one month, not the total number of Americans who died during the pandemic.
What disease killed an estimated 195,000 Americans in October 1918?
It was the 1918 influenza pandemic, often later called the Spanish flu. The CDC’s historical timeline says the virus killed an estimated 195,000 Americans during October alone; the Census Bureau independently identifies October 1918 as the deadliest month of the pandemic in the United States.
October fell within the pandemic’s highly fatal second wave. The CDC says that wave peaked in the United States in fall 1918 and caused most U.S. deaths attributed to the pandemic. Its broader timeline describes an initial wave in spring 1918, the severe wave from September through November, and a third wave in winter and spring 1919.
How should the October figure be compared with other death totals?
These numbers describe different periods and categories, so they are not interchangeable.
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| Figure | What it measures | Source |
|---|---|---|
| Estimated 195,000 deaths | Americans who died in October 1918 during the pandemic | CDC timeline, reviewed 2018; also reported by the Census Bureau, 2023 |
| 477,467 deaths; 583.2 per 100,000 | U.S. deaths from the combined category of influenza and pneumonia during calendar year 1918—not an October-only pandemic count | Census Bureau, 2023 |
| About 675,000 deaths | Estimated U.S. toll across the pandemic | CDC overview, reviewed 2019 |
| At least 50 million deaths | CDC’s estimate of the worldwide pandemic toll | CDC overview, reviewed 2019 |
| 20–100 million deaths | A separate published estimate range for worldwide deaths | Emerging Infectious Diseases, October 2018 |
The Census Bureau also reports nearly 300,000 American influenza deaths from September through December 1918, compared with about 26,000 in those same months in 1915. That comparison uses a four-month period and should not be confused with either the October estimate or the annual influenza-and-pneumonia total.
Why was the second wave so deadly?
The fall wave spread amid World War I troop movements and crowded military settings. The CDC timeline describes a severe outbreak at Camp Devens: by the end of September 1918, more than 14,000 soldiers had been sick and 757 had died. A shortage of professional nurses further strained care as the wave intensified.
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Influenza also killed in an unusual age pattern. The CDC notes elevated mortality among children younger than five, adults aged 20–40, and adults 65 and older. The high death rate among otherwise healthy young adults stood out from the usual pattern of seasonal influenza.
What could people do to limit the spread?
There was no influenza vaccine available at the time, and antibiotics could not treat secondary bacterial infections associated with influenza. Public-health measures included isolation, quarantine, hygiene, disinfectants, and limits on gatherings. Some cities closed schools or other public venues, but responses differed by place; there was no single uniform national restriction.
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Did the 1918 flu originate in Spain?
No definitive origin has been established. The CDC says there is no universal consensus about where the virus originated. “Spanish flu” became a familiar name in part because wartime censorship limited reporting in combatant countries, while neutral Spain’s press reported cases. The label is not evidence that the virus began in Spain.
The CDC describes the pandemic virus as an H1N1 influenza virus with genes of avian origin. It spread worldwide during 1918–1919. Accounts of the pandemic’s waves and end dates vary: the CDC summarizes three principal waves, while the Census Bureau’s broader chronology describes a fourth deadly wave in early 1920.
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