By 1918, H1N1 influenza A, more commonly known as the Spanish flu, had claimed the lives of between 20 to 50 million people globally, many of them between the ages of 20 and 40 years old. Ceylon was no exception. The virus entered the island through two of the busiest ports handling high volumes of international passenger traffic – Colombo in the southwest and Talaimannar in the northwest. Colombo linked Ceylon to ports around the world, and Talaimannar was a hub for maritime traffic from southern India.
Disease control (or the lack of it) during the 1918–1919 pandemic in Ceylon was similar to global patterns epidemiologically, in that the disease spread in distinct waves. In Ceylon, cases surged in the latter half of 1918. The Registrar-General for Ceylon recorded that the Spanish flu claimed 41,916 lives from 1918-1919 – the highest ever number of deaths recorded in the island in a single year. Approximately 6.7 percent of Ceylon's population was lost.