Volume 6        Number 268     

Think the coronavirus is bad?  It was just over one hundred years ago that the “Spanish Influenza,” the deadliest in history, tore through the world and infected one-third of the world’s population. Before it abated, there were an estimated 50 million deaths worldwide, including 675,000 of ours. Those American deaths are bound to be six times the level of 2020, occurring among a populace that was one-third of what we have now.

                       ambulance Spanish flu

The misnomer “Spanish flu” came about because the Spanish press had the only coverage of the spread of the virus, creating an incorrect assumption that the epidemic originated in Spain. This was untrue and was because the rest of the nations at war had extreme censorship on reporting about the disease, whereas Spain did not. So the rest of the world thought the problem had originated in Spain because that is where the news came from. Scientists are still unsure of its source. France, China and Britain have all been suggested as the potential birthplace of the virus, as has the United States, where the first known case was reported at a military base in Kansas on March 11, 1918.

This illness is of particular interest at this time because of the similarities with our current coronavirus pandemic. Besides outright curiosity, monitoring the sequence of the influenza virus of 1918 may help us to predict the risks that we face with our new pandemic.

The 1918 influenza wasn’t a stand-alone. We have seen other influenza pandemics since then: the 1957 Asian flu, the 1968 Hong Kong flu, and the 2009 swine flu. Although these were milder than the 1918 flu, they were a constant reminder of the danger that flu viruses pose to society, and of the likelihood of other new viruses, as we have seen in the 2020 Covid-19 pandemic. Back in 1918, biologists had been successful in discovering microorganisms responsible for other diseases like tuberculosis and cholera, but the Spanish flu was a mystery. The difficulty was accentuated because the scientists had studied these other diseases for many years; the Spanish flu came all at once and violently.

It was found that the best measure that helped was quarantine, but that was, and is, a difficult measure to enact on a widespread basis. Because of ignorance, popular culture sought to understand the disease in creative ways. Conspiracy theories were there in abundance, blaming it on the war and the enemy, or foreigners, Jewish people, dancing, jazz music and just about anything else anyone can think of. Governments and public health authorities were described as useless and slow, bumbling officials who puffed themselves up without providing any real support or assistance. Even today, false rumors of rising death tolls have been linked to “disinformation” spread on social media. The rumors and myths surrounding the Spanish Flu may seem silly and absurd to us now, but they serve as a warning. We must be cautious about what we see or hear, and what we believe, on social media and radio talk shows.

There is no doubt that war censorship and propaganda had negative effects on efforts to quell the 1918 pandemic. The censoring of information on the seriousness of the situation by belligerent countries hampered public health officials’ ability to derail the pandemic. Back then, after years of war propaganda, the populace didn’t believe the government or its information.

The current situation sounds eerily like what happened in 1918. Now, early in its development, president Trump was downplaying the impending seriousness of the situation and public health officials were giving conflicting accounts. The president’s unreasonable optimism continued, as to the precautions people should be taking and the likelihood of potential cures and abatement of the disease.

While World War I didn’t create the pandemic, it played an important role in the disease’s propagation. The mixing of men, the circulation of troops, the mobilization and de-mobilization, with hundreds of thousands shipped from Europe back to the states, had a profound effect on the level of contagion here in the states. This is comparable to the 2020 back-and-forth that has been commonplace today, where millions were traveling incessantly, for business and pleasure, before the current outbreak. In 1918, troop movements and living in close quarters were an equivalent factor.

In addition to troops spreading the disease, there was also a higher incidence among the civilian lower class, just the way we see it now. This was especially true of the people suffering from the effects of war: the starving, ill, malnourished, with poor sanitation and accompanying diseases, e.g., typhus and tuberculosis.

On top of this, bad military decisions were made, continuing troop engagement and deployment instead of having quarantine. The war also hindered getting medical aid to the flu sufferers, because doctors and nurses had to give priority to soldiers wounded in battle. It was said there was a domino effect, whereby the deadly impact of the flu among young men contributed to food shortages in rural areas because of an absence of workers in the fields.

One explanation for the severity of the outbreak was the nature of the viral strain itself. It turns out that the virus could spread to other tissues besides the respiratory tract, which made it more virulent. Also, the virus had mutations which made it more easily transmitted between humans. Just like today, basic methods to reduce transmission helped reduce the likelihood of contagion, if followed early and regularly. This included staying away from public gatherings, hand washing and wearing masks.

Initially. some cities staggered work times and store hours to prevent crowding. This was followed by the closure of all but the most essential businesses. Better ventilation was called for on streetcars, meaning more distancing. There were bans on public gatherings, even prohibitions on weddings and funerals. Some cities tried requiring the wearing of masks. Others turned to quarantining the sick.

A comparison was done on cities in 1918-19 that adopted quarantining and social isolation policies earlier, compared to those that adopted them later. Their conclusion? “We find that cities that intervened earlier and more aggressively… ,if anything, grow faster after the pandemic is over.” This means that their economies rebounded faster.

Distancing was recognized as the primary deterrent to the Spanish flu, but there was instance after instance where premature failure to adhere to this edict resulted in a bounce-back of the second wave. In San Francisco, where the case load was down to zero, there was a big, crowded parade to celebrate. Two months later the deadly disease was back, even worse than before. Even though 600 sailors in the Philadelphia Navy Yard had the flu, that city also didn’t cancel a scheduled parade. Quickly there were hundreds of new cases in Philadelphia.

These kinds of cases showed that different places will reach different peaks at different times. But just because a place has moved past a peak doesn’t mean that the disease can’t rise again. The anxiety in 2020 of the American leadership to quickly return to close-to-normal activity doesn’t bode well for the speedy cessation of the coronavirus.

World War I worsened the reach of the Spanish flu and its effects. There were three successive waves: in the spring of 1918, the second and most lethal, responsible for 90 percent of the deaths, in the autumn of 1918, and the final upsurge in the following winter and spring.

The 1918 catastrophe led to improvements in public health. We became more aware of the need for health education, isolation of the ill, sanitation, surveillance, and gained a better understanding of how the flu virus is transmitted. Ministries of health were created in a number of developed countries.

In the intervening years, medical advances have been extraordinary. Now thousands of sophisticated researchers around the world are working frantically to come up with a vaccine to prevent Covid-19 and with better treatments for the patients who have contracted the disease. But the medical community failed to have backlogs of needed equipment on hand and enough trained personnel as precautionary measures. This lack of preparedness must not be allowed to happen again. We also must be aware of the likelihood of a bounce-back, like in the Spanish flu where the second wave was even more deadly than the first.

Surprisingly, the 1918 pandemic had less economic fallout than the current sickness is having. In fact, despite 675,000 deaths the flu left little or no mark on the U.S, economy. There were several reasons for this.

 According to some estimates real gross national product actually grew in 1919 by a small margin of one percent. The main reason for this economic activity was World War I. Businesses were under pressure by the government to produce goods and commodities to aid the war effort. There was a ceaseless demand for coal, steel, machinery, textiles and other products needed for the war effort, and that offset the shortfalls in other areas of the economy.

The 1918 flu occurred right after a downturn in the market just before the event, so it had already bottomed out.

Another important reason why it is worse now is that currently a good deal of the workforce has either been furloughed or Is working at home. The stringent social isolation in 2020 also contributes to less business. These constrict buying power. One hundred years ago most continued to work, albeit on a somewhat curtailed basis, during the 1918 pandemic and few worked from home.

 Bear in mind, society paid a price for this work ethic. Remember, almost 700,000 died from the flu at that time. Fortunately, it is doubtful that we will be anywhere near that level this time. At this time, a large expansion in government spending can help soften the economic impact of the crisis that is tearing at consumption and private investment.

The government officials, at least in the United States, have made many of the same types of errors as their 1918 counterparts. And we are paying for it with the preventable deaths of many thousands and with the worst economic distress since the Great Depression. It is probably too late to correct the erroneous public policies. All we can do is hold on and pray for a miracle vaccine. Hopefully, the next round of leaders will be better at preparing us to combat the next pandemics, which seem to be coming with increasing frequency.

“Like the 1918 pandemic, the severity of any future outbreak will result from a complex interplay between viral, host and societal factors. Understanding these factors is vital for pandemic preparedness.”

       –Dr. Carlien van de Sandt, Australian, Research Fellow,Microbiology And Immunology.

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