Caring for Pandemic Orphans: The Spanish Flu Experience Free

Since the coronavirus disease 2019 (COVID-19) pandemic began, the COVID-19 Orphanhood Calculator estimates >200 000 US children have lost a parent to the infection.¹  However, COVID-19 is not the first pandemic to generate orphans on a massive scale. When the Spanish flu circulated the globe from 1918 to 1920, children lost 1 or both parents in unprecedented numbers. If we accept the common estimate that the flu killed at least 675 000 Americans,²  roughly half of whom were in the prime parenting years of 20 to 45,³  the number of children orphaned must have run in the hundreds of thousands. Some communities were hit particularly hard. During the 3 deadliest months of 1918, for example, New York City reported 21 000 new orphans²  and Pennsylvania reported 45 000.⁴  These children experienced the insidious and often overlooked impact of pandemics.

As COVID-19 has demonstrated, pandemics wreak disproportionate damage on vulnerable communities; influenza was no exception. Records were not kept regarding influenza’s impact on many racial and ethnic groups, with the notable exception of Indigenous communities. Subarctic Indigenous peoples, for example, were particularly susceptible to influenza’s ravages.⁵  Eyewitness accounts described Native Alaskan villages in which a large proportion of parents died, leaving children exposed to bitter winter conditions and food shortages.⁶  US Indian Service employees conveyed similar reports of influenza devastating Navajo settlements.⁷  Children from both groups were rounded up and shipped to boarding schools and orphanages, where their culture, language, and community were expunged.⁶  Poor access to nursing and medical care, limited food, distrust of governmental health workers, and systemic racism combined to exacerbate an already dire situation.

Just as influenza exploited the susceptibility of Indigenous lives, it also exposed the tenuous economic and social foundations of immigrant life. Disease ripped through crowded tenement communities with limited access to affordable health care. Many first- or second-generation immigrants lacked extended family to care for the sick.⁸  The scarcity of doctors and nurses, many of whom were serving in World War I,⁵  decreased health care access. Whether living in a congested tenement or on a subsistence farm, families had few charitable or government resources when disease threatened their economic survival. When a father died, the primary breadwinner disappeared. To avoid destitution, mothers were forced into low-paying jobs with meager resources for child care. On the other hand, strict gender roles left fathers unprepared to assume household and childrearing duties when mothers succumbed. In either scenario, newly widowed parents struggled to balance home and work demands and turned to family and friends for help. Reformers had opened day nurseries as low-cost child care opportunities for poor working parents, but widespread availability was lacking.⁹  Without kinship support, affordable child care, or other forms of relief, caregivers had few options other than placing their children in the grim halls of an orphanage.

The early 20th century orphanage was designed to be a temporary waystation, providing shelter, food, a rudimentary education, and if church-sponsored, religious instruction.¹⁰  Although some children resided there for years, most moved in and out, on the basis of their family’s financial vicissitudes. Astonishingly, about 90% of children in orphanages had 1 living parent.¹¹  Indeed, the term orphan implied a child whose family was unable to care for him/her because of death, disease, or destitution of 1 or both parents. These institutions prioritized timely adoption or “placing out,” often dividing siblings among various homes. Some children boarded “orphan trains” to be separated and adopted.¹²  Progressive reformers campaigned to close orphanages, worrying about the stultifying effects of “institutionalism” and preferring more homelike options.¹⁰  Progressive “child-saving” and “maternalist” agendas led to the rise of mothers’ pensions, a precursor of modern welfare that provided financial support to widowed women so they could afford to raise their children at home.¹⁰  Yet, although orphanages were on the wane, they experienced a temporary resurgence after the 1918 influenza. Pittsburgh’s Gusky Orphanage, for instance, experienced a 50% increase in the number of young inhabitants between 1917 and 1919.¹³ 

In addition to creating practical challenges of housing and feeding orphans, influenza precipitated a psychological crisis for bereaved children. Numerous accounts describe young survivors who grew up bearing the scars of parental loss. William Maxwell, a novelist and long-time editor at The New Yorker, looked back on his mother’s death when he was aged 10 years as a critical turning point. “My childhood came to an end at that moment,” he wrote. “The worst that could happen had happened, and the shine went out of everything.”¹⁴  Novelist and social critic Mary McCarthy described the psychological pain of realizing she and her siblings were now orphans. The McCarthy children were never told their parents had died; instead, relatives ignored their grief. “It was to everyone’s interest, decidedly, that we should forget the past, the quicker, the better…,” she wrote.¹⁵  Although many families scrambled to absorb orphaned children into their homes, keeping siblings together proved challenging. As a result, children’s bereavement was often compounded by separation from their siblings. Kinship care was preferable to institutionalization but did not insure a loving home. As the COVID-19 pandemic was unfolding, archeologist Sarah Parcak reflected on how epidemics influence children when she described the Spanish flu’s effect on her grandmother and great-aunt. At ages 1 and 4 years, they were sent to different relatives, “who all fought over the inheritance and sold the nice house and all the nice things inside. Ruth ended up in a decent home with her father’s family, whereas Helen was shunted from relative’s house to relative’s house, facing horrid abuse and mistreatment.”¹⁶  Experts at the time believed that focusing on grief was unhealthy for a child’s psychological well-being.¹⁷  Over the ensuing decades, fields such as child development and child psychology evolved to investigate childhood trauma, but in the epidemic’s aftermath, children were encouraged to push their grief aside.¹⁸ 

Historian Alfred Crosby called the 1918 epidemic the “Forgotten Pandemic” because it faded from our country’s collective memory, seemingly absorbed into the more compelling, victorious narrative of World War I.⁵  Children, though, became the forgotten survivors. Despite numerous scholarly analyses of the pandemic, its impact on children remains understudied and overlooked. Even in the midst of the Progressive Era’s fervent child-saving campaigns, these young epidemic victims were told to move on and forget. For those who found refuge in orphanages, their physical needs were met without explicitly addressing their psychological needs. Stories passed down in families suggest that many children found happy homes, but a disturbing number suffered deep psychological wounds.

As the number of children orphaned by COVID-19 continues to rise, society needs to recognize the insidious damage pandemics inflict on children. Surviving the epidemic does not imply thriving; pandemics leave indelible scars on children. Ignoring those scars, as was done all too often a century ago, fosters long-lasting pain. As historian David Jones warned, epidemics “reveal what really matters to a population and whom they truly value.”¹⁹  Investing in children’s mental health and putting in the hard work to treat their grief offers long-term benefits that far exceed the cost. COVID-19 will ease, just as influenza did a century ago, but children will continue to suffer unless we choose to attend to this “hidden pandemic.”²⁰ 

COVID-19

coronavirus disease 2019