Lessons From 1918

COVID-19 may be novel, but it is not unprecedented. This is hardly the first global pandemic, yet government leaders act as if we don’t already have a guide for surviving severe respiratory illnesses recorded in our history books. The 1918 Spanish influenza pandemic may have occurred over a century ago, but the lessons learned from it still apply to our current situation — if we choose to pay attention. However, the response to the COVID-19 pandemic so far appears to ignore past experiences completely. History is repeating itself with this novel pandemic, but we are still making the same mistakes in our response. 

The 1918 flu emerged as World War I was ending. It ravaged the global population in waves, beginning in the spring of 1918 as a typical flu with chills and fever but returning as a severe respiratory infection in the fall. This second wave of the flu was known to kill victims within 24 hours of first showing symptoms. An illness initially dismissed as a minor discomfort soon became a worldwide nightmare. Between 1918 and 1920, the Spanish flu spread around the globe, trailed by a death toll that amounted to at least 50 million people, the majority of whom were young and otherwise healthy, which exceeded the deaths due to World War I combat casualties. 

It is easy to draw parallels between the Spanish flu and COVID-19. Both are severe respiratory infections for which we have neither natural immunity nor a vaccine, and they both quickly became global pandemics. Even the favored preventative measures are the same for both viruses. Lacking vaccines, antiviral drugs, and many antibiotics, 1918 health officials instead prescribed “non-pharmaceutical interventions” to limit the spread of the virus. These interventions consisted of cancelling large public gatherings, encouraging proper hygiene, and limiting potential interactions between infected and susceptible populations. The non-pharmaceutical interventions of 1918 have become the ‘social distancing’ practices of 2020. 

Public health has come a long way since 1918. European nations, including Russia, France, and Germany, saw the devastation of the Spanish flu as a reason to significantly expand access to medicine, creating centralized public healthcare systems to serve all of their citizens. These efforts provided the basis for global healthcare policy for the rest of the 20th century. There was also an attempt to incorporate an international partnership solely dedicated to responding to global pandemics into the new League of Nations. While the League of Nations did not last, the branch devoted to global health served as a forerunner to the World Health Organization, which is still responding to public health threats over a century later. Medications have also improved dramatically since 1918, with the development of antiviral drugs, flu vaccines, and antibiotics to treat the secondary infections common in flu patients. The Spanish flu took medical professionals by surprise, but the impressive innovations of the following decades transformed global immunology and medicine. 

COVID-19 presents a significant challenge, but past improvements in public health and records from the Spanish Flu should provide some advantage in combating the novel virus. Medical officials today know that social distancing is effective in reducing viral transmission because data from 1918 shows a 50 percent reduction in mortality rates for cities that took social distancing seriously compared to those that didn’t. The Spanish flu also shows that in order to be effective, these social distancing measures must be instituted early and maintained throughout the duration of the pandemic. This lesson is particularly relevant considering Texas and other states have planned to reopen by the end of April even though medical professionals still fear a resurgence in cases. New York City is struggling to accommodate the influx of COVID-19 patients in need of hospitalization and medical attention, but 1918 data predicted that this would happen as well. Cities like Philadelphia allowed crowded public events to continue in 1918 and subsequently found their hospitals and medical staff overwhelmed by severely ill patients, a fate that awaits Florida as a consequence of keeping public beaches open even after COVID-19 cases surged in other states. 

The data is available. Local government leaders can easily look to the 1918 influenza for guidance in dealing with COVID-19, but many seem to ignore the lessons of past pandemics. Very few cities chose to implement strict lockdowns or social distancing guidelines early in the outbreak. Bars were still packed the weekend before St. Patrick’s day, even though several other nations were incapacitated by the virus at that point. In Florida, televised wrestling has been deemed an essential business, meaning certain sports and entertainment companies can continue operating without audiences even as small businesses shutter across the nation. These may seem like small, isolated events, but similar mistakes cost thousands of lives during the 1918 pandemic. 

Since the start of the pandemic, President Trump has claimed the mortality rate is far lower than the numbers calculated by health agencies, suggested relaxing social distancing policies far earlier than experts advise, and even made false statements about the resources available for testing and treatment. People look to government leaders in times of crisis and it can be extremely dangerous if these leaders are spreading false or misleading information. Trump assured the nation that anyone who wants a COVID-19 test can get one, but this is not true since testing is determined by state and often limited only to people who are already showing symptoms or belong to a high risk population. This is not the time to make false assurances and ignore scientific fact. 

During periods of crisis, the population needs transparency and accurate information from their leaders. During the Spanish flu pandemic, wartime censorship suppressed updates on the rising number of flu infections to maintain morale among soldiers and civilians. The Spanish flu was named as such because Spain was the first nation to report on the growing epidemic due to its neutral status during World War I, leading others to believe that the virus originated in Spain even though the first cases were actually found in Kansas. In the United States, newspapers could be accused of sedition for reporting on the virus. Rather than boosting morale, the media silence only created further panic and fostered a lack of trust in local officials. Communication and accuracy are necessary for slowing the spread of the virus. Until a vaccine can be developed, social distancing is the best option for preventing infection, but social distancing relies on large-scale public cooperation and trust in local and national authorities developed through honest communication, support of scientific data, and prioritizing the health of the community over the health of the economy. The government’s policy of wartime censorship during the Spanish flu only generated more uncertainty, and the Trump administration’s tendency to misinform during COVID-19 is following that same pattern. 

Some officials are eager to believe President Trump’s false information about reopening the nation early because social distancing measures have slowed the economy to a standstill, causing financial devastation that will likely last for years. Shutting down industries for extended periods of time is causing a recession that will significantly affect the most vulnerable members of the population the most. This occurred during the Spanish flu pandemic as well, but economic data from the years following show that strict social distancing policies actually resulted in an improved ability to economically recover from the pandemic. For example, the Spanish flu caused a decrease in manufacturing output in the United States, but cities that were able to lower their mortality rate through social distancing saw higher growth post-pandemic than cities that relaxed their policies too early. Ignoring past data and the warnings of medical professionals will only cause more economic anxiety in the long term. 

COVID-19 is a serious matter and should be treated as such, but we are not completely lost in how to confront it. The Spanish flu proves that we have survived a serious pandemic before and we will survive again, as long as we choose to learn from the past rather than ignore it. Though rare, there will be more pandemics in the future, and our actions now will determine our ability to deal with them appropriately. The world will recover from COVID-19, but we should use the lessons from past pandemics to guide our recovery, ensuring that we will be better prepared for the next crisis. The virus is dangerous, but ignoring history is even more so.



Categories: Domestic Affairs

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