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Some historians believe that the epidemic originated in the United States. Historian Alfred W. Crosby has concluded that the flu originated in Kansas, and there are reports of a particularly serious outbreak in Haskell County, Kansas in 1918. But other studies have concluded that the cases from Kansas were milder and had fewer deaths compared to the situation in New York City in the same time period. The consensus however is that the virus likely had a North American origin.
The massive troop movements that took place during World War I both increased transmission of the virus and and augmented its mutation. The war is also suspected to have increased the lethality of the virus. Soldiers' immune systems were likely weakened from malnourishment, as well as the stresses of combat and chemical attacks. Transportation systems at the time made it easier for soldiers, sailors, and civilian travelers to spread the disease. The problem was made worse because of the unwise decision on the part of government to censor news of the pandemic, leaving the population unaware and ill prepared to handle the outbreaks.
In the United States, the disease was first observed in Haskell County, Kansas, in January 1918. Local doctor Loring Miner to warn the US Public Health Service's academic journal. On March 4, 1918, company cook Albert Gitchell, from Haskell County, reported symptoms while at Fort Riley, a US military facility that at the time was training American troops during World War I. Gitchell was the first recorded victim of the flu. Within days, 522 men at the camp had reported sick. By March 11, 1918, reports of the virus came out of Queens, New York.
In August 1918, a more virulent strain appeared simultaneously in Brest, France; in Freetown, Sierra Leone, and in September, an outbreak was reported at the Boston Navy Yard and Camp Devens (later renamed Fort Devens), about 30 miles west of Boston. Other U.S. military sites were soon afflicted, and the virus had spread among troops being transported to Europe. The Allies of World War I came to call it the Spanish flu, because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was one of the countries that had not imposed wartime censorship so news of its prevalence there was better known that most other places.
In April 1919, President Woodrow Wilson traveled to the Paris Peace Conference for negotiations for a treaty ending the war. Soon after arriving, Wilson become ill with a fever and was reported to have violent fits of coughing that left him nearly unable to breathe. Wilson's condition deteriorated so quickly that his personal doctor, Cary T. Grayson, suspected that Wilson had been poisoned. But he soon revised his diagnosis to a case of influenza. Wilson was so ill that the talks were nearly cancelled. Wilson could not even sit up in bed. In a letter to Colonel Edward House, Wilson’s chief of staff, Grayson described that the night Wilson became ill as "one of the worst through which I have ever passed. I was able to control the spasms of coughing but his condition looked very serious.”
Wilson's administration kept Wilson's diagnosis a secret. Grayson told reporters that Wilson had a cold and just needed some rest. He blamed Wilson's illness on the rainy weather in Paris. Wilson’s condition worsened, and he began acting strangely. According to Wilson's biographer Scott Berg, “Generally predictable in his actions, Wilson began blurting unexpected orders. Twice he created a scene over pieces of furniture that had suddenly disappeared,” even though the furniture had not moved. Wilson also claimed that he was surrounded by spies. Needless to say, Wilson's behavior greatly concerned the American delegation.
Colonel Starling of the Secret Service noticed that Wilson “lacked his old quickness of grasp, and tired easily.” Starling reported that Wilson was obsessed with such details as who was using the official automobiles. Journalist Ray Stannard Baker was allowed to see Wilson and later remarked how shocked he was by Wilson’s sunken eyes, his weariness, and his pale and haggard look. The talks went on, with Wilson relying on his aides until his health allowed him to return to face-to-face talks. His poor health was said to have caused him to capitulate on some French demands that he had previously said were non-negotiable.
Rather than report flue symptoms, the prevailing mindset of the time was one of censorship, both about Wilson's illness and about the widespread effects of the flu. They claimed that they were doing this "to maintain morale". Censors minimized early reports of illness and mortality in Germany, the United Kingdom, France, and at home in the United States. Newspapers were free to report the epidemic's effects in neutral Spain, including the grave illness of King Alfonso XIII. The stories created the false impression that the flue was unique to Spain, giving rise to the pandemic's nickname, "Spanish flu".
Most influenza outbreaks disproportionately kill the very young and the very old, with a higher survival rate for those in between, but the Spanish flu pandemic resulted in a higher than expected mortality rate among young adults. As news of the flu seeped out, public dance halls and even churches were closed. The flu reached the White House. Margaret Wilson, the President's eldest daughter, got it. Secret Service members did, too. Even the White House sheep were reported to have the flu.
One of the lessons subsequently learned from this pandemic was that keeping silent and trying to hide the seriousness of the problem was the wrong strategy. It appears that this was a strategy that emanated from the highest levels, including the office of the President.