What Can We Learn from the Spanish Flu Pandemic of 1918?

In my recent post, Pandemics in History, I, naturally, included the 1918 Flu Pandemic (also called the “Spanish Flu”) on the list. I want to expand on that part of our history for one very obvious reason; there are many parallels between the flu pandemic and the nightmare we have been living for the last 17 months.

First, allow me to be very clear; Covid-19 and the flu ARE NOT the same thing. Yes, I made sure to underline, italicize, bold, and color the “are not” because this is a crucial point. The “flu,” as we know it today, is hardly comparable to covid, but you’ll find that there are a not-so-shocking number of commonalities in government and public response.

Let’s dig a little deeper into the 1918 Flu Pandemic. How did it start and finish? What parallels can you pinpoint between this pandemic and ours? Maybe it can give us a little hope about the future…

a brief summary of the 1918 flu pandemic

Emergency hospital during influenza epidemic, Camp Funston, Kansas (1918). Original image from National Museum of Health and Medicine. Digitally enhanced by rawpixel.

As many as 50 million people died globally when influenza type A (subtype H1N1) hit western Europe in March 1918. It spread rapidly, and by August 1918, a second wave arrived. By then, it had mutated into a more contagious and deadly variant.

“For example, at Camp Devens, Massachusetts, U.S., six days after the first case of influenza was reported, there were 6,674 cases.”1

It reached every country in the world from the crowded train routes of Asia to the more secluded islands, like New Zealand and Samoa. India lost 12.5 million people in total; the United States lost 675,000. The majority of deaths occurred during the second and third waves of the pandemic, when the virus began to hit what was thought to be the most unlikely age groups the hardest.1

Healthy young adults were taken by the virus at unprecedented rates, and this was just one of many firsts in the flu pandemic. To date, historians and scientists continue to debate over the origins and consequences. As a result, there are many misconceptions and falsehoods surrounding the pandemic, including:

  • The flu originated in Spain. This is simply incorrect, and the name “Spanish flu” is largely misleading. The most likely explanation for this name is that it was a consequence of the First World War. The key countries involved in the conflict had every reason to downplay the effects of the pandemic in their countries. Spain, being neutral in the war, did not. As such, the pandemic appeared to be worse there; in reality, it was no worse than the majority of countries.
  • Treatments were just as lethal as the disease. Some argue that the death rate was exacerbated by the large doses of aspirin prescribed by doctors to treat the symptoms of the flu. It is certainly possible that aspirin poisoning was present (doctors were prescribing doses nearly eight times the safe daily amount); however, death rates in parts of the world without easy access to aspirin were just as high.
  • No one knows what made it so deadly. The virus was replicated in 2007 and studied in monkeys. They now know that the leading cause of death in healthy, young people was an overreaction of the immune system. They named it the “cytokine storm.”2

In all the precariousness, you may wonder how public officials handled this pandemic. Does it compare to how our leadership has handled covid?

Official response to the 1918 flu pandemic

“Public health officials, law enforcement officers and politicians had reasons to underplay the severity of the 1918 flu, which resulted in less coverage in the press.”2

The American Soldiers in Presence of Gas suring World War I (1918). Original image from National Museum of Health and Medicine. Digitally enhanced by rawpixel.

With the war in full swing, officials in the United States deemed it necessary to downplay the pandemic’s severity. They feared that acknowledging it globally would weaken their position in the war and embolden their enemies. They did, however, taken action.

Without proper treatment or vaccinations available, officials had to resort to preventative measures to stop the spread of the virus. Many of these will sound very familiar:

  • They pushed the use of disinfectants and regular sterilization.
  • Cities with larger outbreaks were placed under quarantine.
  • In some areas, public places were closed for extended periods of time.
  • They wrote legislation to stop the use of common cups and utensils in public places.
  • Masks were mandated nationally.
  • Schools shut down, but often opened too soon.
  • Committees were formed to canvas rural areas for unreported cases.
  • Health Departments released posters and imagery to educate the community on the importance of hand-washing and personal hygiene.

Hospitals also had to adjust their practices to accommodate the influx of patients and contain the spread within the facilities. In keeping with the preventative measures for any contagious, airborne disease, they tried to utilize well-ventilated spaces, like large rooms with high ceilings and even outdoor areas.

Of course, just as we are seeing right now with covid, they experienced massive overflow in hospitals. Historical photographs show nurses attending to patients in rows of beds inside gymnasiums and on balconies. They practiced continuous disinfection and sterilization and “utilized scientific ideas of germ theory to reduce transmission.”3

Walter Reed Hospital flu ward (ca. 1910–1920). Original from Library of Congress. Digitally enhanced by rawpixel.

how did it end?

In fact, there was no definitive end to the 1918 pandemic, which is a significant bummer. Given that I spent nearly all of 2020 pregnant and worried and now all of 2021 a new mother and worried, a part of me is holding out hope for some miraculous day when I will walk out of my house without an N-95 and a bottle of Purell and just feel safe. I won’t hold my breath.

In 1919, they thought the pandemic had ended. Cases dissipated in the summer season when people were spending more time outside, but they shot back up in the winter when everyone was indoors again. Once so much of the world population had been infected and so many lives had been lost, there simply weren’t enough susceptible people left to create another pandemic. Of course, that does not mean there weren’t epidemics.4

Today we have the vaccine, and we simply live with the flu. It is what it is. You go to the grocery store for a gallon of milk and stop by the pharmacy for a flu shot. Easy as pie. We have much bigger fish to fry these days.

what can we learn from the flu pandemic?

Women wearing surgical masks during the influenza epidemic, Brisbane (1919). Original image from State Library of Queensland. Digitally enhanced by rawpixel.

One key difference between the flu pandemic and the covid pandemic is the faith that the population had in science. In 1918, there was much more of it. When people were asked to put on masks, they did. When they were asked not to get too close to each other, they didn’t. When they were quarantined, they complied, and when kids didn’t go to school, parents understood.

The most important difference is the vaccine. It took several years to develop the flu vaccine, and even though we have it now, it did not play a role in the end of the pandemic. Now, more than 100 years later, medicine did what it always does; it improved. We can develop a vaccine more quickly because we have been developing vaccine technology for over a century. Vaccines eradicate infectious diseases. The proof is in our history.

Lastly, one key similarity is that people were shaken in the beginning and gradually started to break the rules. Without preventative measures and in the absence of a vaccine, of course the spread continued, and the flu came back in deadly waves because…surprise, surprise…”a pandemic isn’t over just because we’re over it.”

click below to read more from pandemic-reset.com…

Sources:

  1. Britannica. “Influenza pandemic of 1918-19.”
  2. Healthline. “1918 flu pandemic facts.”
  3. Stanford University. “The Public Health Response.”
  4. Time Magazine. “How Does a Pandemic End? Here’s What We Can Learn from the 1918 Flu.”

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