In 1918, more than 900 people died in Guam, approximately 70 percent of them due to influenza. The 1918 Influenza Pandemic was a significant historical event that impacted much of the world. Influenza killed between 50 and 100 million people as it moved across the globe. In total, influenza caused more deaths than an entire century of the Black Death, or the Plague, in Europe.

In 1918, Guam’s population was estimated at 13,000, and influenza killed more than five percent of the population – more than 90 percent of whom were native CHamorus. The actual death count varies, with estimates ranging from 673 to 858.

All the influenza deaths in Guam happened over a period of only eight weeks, from 3 November to 28 December 1918. The single worst day was 19 November when 63 people died. In this short eight-week period, the total number of deaths was 300 percent higher than the average yearly deaths that took place in 1916 and 1917.

In just one week, from November 17th to the 23rd, the number of people who died from the flu was almost equal to the total death rate for each of the previous two years. By any measure, this was a Guam catastrophe.

Guam’s Influenza Deaths, 1918

Week ofDeaths
November 3 – 927
November 10 – 16215
November 17 – 23238
November 24 – 3078
December 1 – 764
December 8 – 1430
December 15 – 2116
December 22 – 284
December 29 – 311
TOTAL673

Guam’s Annual Deaths, 1916-1919

1916243
1917243
1918944
1919175
1920216

Global Influenza

Scientists believe that, since 1590, the world has witnessed 10 probable and three possible influenza pandemics. Because of its constant reappearance, influenza has been one of the most studied viruses and a large body of research speaks to the concerns of biomedical scholars, physicians, and the pharmaceutical industry.

Unlike the typical seasonal flu, the 1918 pandemic influenza virus caused a severe form of pneumonia. This flu caused, in some people, extensive hemorrhaging and swelling in the lungs. Within an hour or two, a patient could quickly change from healthy to bed-ridden. The influenza virus caused high fevers, accompanied by severe muscle aches that could affect the joints, back, and head. In just a few days, the virus could cause the death of a previously healthy person.

The influenza pandemic struck in three waves, beginning in March 1918. The first wave was not particularly aggressive. At first, affected victims came down with shivers and a fever for three or four days. But the disease spread around the world in the next four months, and its symptoms became more severe. The spread around the world led to its classification change from epidemic (affecting a specific location) to pandemic (affecting the entire world).

The second wave, in the autumn of 1918, was responsible for most of the deaths, due to unusually severe pneumonia. In the same week of August 1918, three port cities located thousands of miles apart experienced intense epidemics as the virus spread and many people became ill. These occurred in Freetown, Sierra Leone; in Brest, France; and in Boston, USA. At this stage, the pandemic was considered a naval affair because it was spreading from port to port on Navy ships. These trafficking patterns would bring the virus to the Pacific Islands aboard various ships of the region’s colonizers.

Influenza and Guam

Within the US context, American historian Alfred Crosby writes that the military was commonly viewed as responsible for spreading the disease. The military responded with a bulletin issued on 9 August 1918. This bulletin came from the US Navy Bureau of Medicine and Surgery in Washington, DC. It warned that influenza was prevalent in Europe, Hawai’i, and elsewhere. This announcement described its symptoms, incubation period, and recommended treatment.

One week later, on 16 August, the Surgeon General of the United States Public Health Service ordered medical officers in charge of quarantine stations to hold ships with flu patients on board until the local health authorities were notified.

Despite these warnings, no particular care seems to have been taken when the US Army Transport ship named Logan landed in Guam at 6 am on 26 October 1918. The Logan was carrying troops from Manila and offloaded six bags of mail, two passengers, and one patient suffering from influenza. Guam’s Senior Medical Officer EL Jones reported that Mrs. Frederic Warren, wife of an American servicemen stationed in Guam, was already sick with influenza at the time of disembarking from the ship.

Dr. Jones stated that the mother and her accompanying child were isolated in strict quarantine. He ordered that anyone with a cough or fever should be sent to the hospital. The island’s governor came to recognize its infectious nature. Five days later, on 31 October, Governor Roy Smith issued an executive order mandating that schools be closed. He also ruled that public gatherings be prohibited and encouraged CHamorus to move to their ranches.

A follow-up bulletin issued on 4 November 1918 entitled “Epidemic of Influenza,” downplayed the disease’s dangers. This announcement stated that, “While the disease is not severe it is very widespread.” But the governor still repeated his concern that large gatherings be stopped, except in the open air. Gov. Smith also urged that all people should stop from visiting house to house.

The Governor also ordered that all cases of cold or fever be reported at once to the hospital. He ruled that any house in which a case of influenza occurs must put out a yellow flag and await orders from the Health Officer. CHamorus were again encouraged to move to their ranches, since they were in isolated rural areas where infections would be less likely to spread.

But Guam was not prepared for this virus, even though there were laws and history to prepare them. The government already had quarantine regulations, and the island had experienced two major epidemics in the five years before 1918. But the island’s quarantine regulations did not include influenza on the list of dangerous diseases. Quarantine regulations included scarlet fever, diphtheria, cholera, plague, yellow fever, smallpox, typhus fever, and measles. As in the rest of the world, influenza was not considered a quarantine-worthy disease.

Yet after the pandemic, reports by Navy officers claimed that they had placed a quarantine on the Logan when it arrived on 26 October. The Navy reported that it prevented visitors from coming ashore – even though they had allowed influenza-afflicted Mrs. Warren and her daughter to leave the ship. At the same time, they also allowed CHamoru stevedores to unload and load incoming and outgoing mail.

Also, as was customary upon the arrival of military vessels, a band of CHamoru musicians assembled at the dock to greet the passengers. By the end of that week, the deaths would start accumulating. Catholic Church historian Julius Sullivan reports that those band members who had gone to the dock to play were the first to fall sick. From them the disease spread rapidly among their relatives.

The Navy’s health officer reported that workmen who unloaded the ship’s cargo also came down with the disease. From them, it also then spread very rapidly, starting in the villages closest to Apra Harbor.

Sumai, home to Apra Harbor, was the first village to be hit with the flu. Soon, the neighboring village of Piti and the capital of Hagåtña followed. In just the first week, from 7 November to 13 November, 144 people in those three villages died.

Following that, the pandemic spread to villages next to Hagåtña and Piti: Anigua, Assan, and Sinahånña. Through the end of November, no deaths had been reported in the villages south of the harbor. Yet no system of on-island quarantine had been put in place to protect them. Subsequently, in December, 56 people from the southern villages of Hågat, Malesso’, and Inalåhan would die.

Island-wide, navy reports state that most of Guam’s residents caught the virus. But the majority of them suffered from only fever, pain, headaches, and weakness. Deaths occurred due to complications such as toxemia, bronchitis, congestion of the lungs, and pneumonia. Navy records describe their frantic efforts to accommodate the large numbers needing medical attention. The most afflicted were in the capital, where half the island’s population lived. There in Hagåtña, patients were taken care of in hospital wards, in tents erected on the hospital grounds, in the schoolhouse, and in patients’ homes.

In Piti, the schoolhouse was transformed into a clinic, and in Sumai, a camp was erected with the dental surgeon placed on supervisory duty. Navy reports praised the Red Cross for lending valuable assistance by providing milk to the needy.

Church historians Julius Sullivan and Pale’ Eric Forbes depict the tireless efforts of Catholic priest Pale’ Román de Vera. Pale’ Román walked through the streets of Hagåtña, Hågat, Sumai, and Piti in search of the ill. He rang a little bell to announce his presence, and then villagers would call him into their homes to administer to the dying. Day and night, Pale’ Román rose to the challenge of ensuring that every Catholic struck with the flu received the sacraments. Even more challenging was burying the dead, sometimes dozens in a single day. The main cemetery in Hagåtña, Pigo Cemetery, proved to be inadequate. So, an annex was opened in a lot on the seaside of the Agana-Piti Road which became the temporary resting place of many of the epidemic’s victims. Their bodies were later interred in the cemetery proper. For his heroic efforts, US President Woodrow Wilson awarded Pale’ Román a special commendation.

Just two months after it started, the flu was gone. It had all happened so quickly, and it left no physical scars. For these reasons and more, US historian Crosby has called it the “Forgotten Pandemic.” Even in Guam, the 1918 Influenza pandemic receives little attention in any of our history books, despite that fact that it took 5 percent of our population in such a quick period.

For further reading

Crosby, Alfred. America’s Forgotten Pandemic: The Influenza of 1918, 2nd ed. Cambridge: Cambridge University Press, 2003.

Forbes, Pale’ Eric, OFM Cap. Pale’ Roman. Hagåtña, GU: Capuchin Friars, 2009.

Guam News Letter. “Deaths.” Hagåtña, GU: US Naval Government of Guam (1918): 29-31.

–––. “Epidemic of Influenza.” Hagåtña, GU: US Naval Government of Guam (1918): 4.

–––. “Executive General Order No. 297, November 5, 1918.” Hagåtña, GU: US Naval Government of Guam (1918): 8.

–––. “Order, October 31, 1918.” Hagåtña, GU: US Naval Government of Guam (1918): 4.

Haddock, Robert L, ed. A History of Health on Guam. Hagåtña, GU: Crushers Football Club, 2010.

Hattori, Perez Anne. Colonial Dis-ease: US Navy Health Policies and the Chamorros of Guam, 1898–1941. Honolulu, HI: University of Hawai‘i Press, 2024, 2004.

Hattori, Perez Anne. “Making Local Sense of a Global Disease: The 1918 Influenza Pandemic in Guam,” The Journal of Pacific History, DOI: 10.1080/00223344.2024.2328019, 2024.

Sullivan, Julius, OFM Cap. The Phoenix Rises: A Mission History of Guam. New York: Seraphic Mass Association, 1957.

Underwood, Jane H. “Effects of the 1918 Influenza Pandemic Mortality Experience on Subsequent Fertility of the Native Population of Guam.” Micronesica Journal of the University of Guam: Devoted to the Natural Sciences of Micronesia and Related Areas 19, no. 1/2, 1983.

Underwood, Jane. “Population History of Guam: Context of Microevolution.” Micronesica 9, no. 1, 1973.