When History Repeats: Covid-19 and the Flu of 1918

Just over a century ago, a pandemic struck the U.S.

What is known as the Spanish Flu (also known as the “1918 Flu” or “Spanish Influenza”) killed over 600,000 Americans and tens of millions worldwide.

More soldiers died of the Flu of 1918 than in WWI combat.

On this fifth day of the Illinois lockdown, I went in search of parallels between Covid-19 and the 1918 Flu. I looked for lessons we could learn from the response to our country’s last pandemic.

Similar Symptoms

The 1918 Flu and Covid-19 have similar symptoms. The deadliest symptoms of both are respiratory. Lungs fill with fluid causing victims to suffocate.

In both diseases, the lethal effect is caused by our immune systems going haywire. Called the “cytokine storm”. Lungs become inflamed and fluid builds up. This causes difficulty breathing and leads to Pneumonia.

What is different is that the 1918 Flu seemed to target younger people. Though young people contract Covid-19, they seem to be able to recover. It is the older population with pre-existing health issues that succumb to Covid-19.

Advice to the public has similarities across the century, but there are differences based on increased medical knowledge. Compare these two notices. One from 1918 and the other from 2020.

Health notice advising public on how to stay safe during the 1918 Flu. https://www.whitehousehistory.org/spanish-influenza-in-the-presidents-neighborhood
Health notice advising public on how to stay safe during Covid-19.
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx

Apparently Boy Scouts in 1918 handed out notices to people spitting on the street saying: “You are violating the Sanitary Code.”

Presidential Attitudes

Yesterday (March 24, 2020), President Trump announced that he wanted the U.S. open for business by Easter, April 12th despite repeated warnings by health advisors that this was unlikely.

“Easter is a very special day for me … Easter Sunday, and you’ll have packed churches all over our country.”

Trump is in favor of loosening self-isolation. He wants the pandemic, which has yet to peak in the U.S., to be over. The economy is suffering. We all need to get back to work.

In contrast to Trump’s nightly 90-minute press conferences, President Woodrow Wilson took a very different approach in 1918.

He said nothing.

Previously, Wilson had banned all pessimistic speech surrounding WWI and this extended to the 1918 influenza outbreak.

Ignoring the danger, Wilson traveled to Paris to negotiate the Treaty of Versailles. Wilson and his staff became infected.

Both Presidents downplay the seriousness of the outbreak, just in different ways.

With lack of Presidential leadership, the state and local leadership took control.

Local Governments Step In

The initial cases of both Covid-19 and the 1918 flu in the U.S. caused concern in the medical community but were not seen as dangerous by all.

The reaction of officials in Philadelphia and St. Louis during the 1918 Flu are often contrasted. The actions of one saved life, the actions of the other cost lives.

The famous example is the patriotic Liberty Loan parade in Philadelphia to honor returning WWI soldiers. Philadelphia’s public health director ignored warnings and said this was simply a seasonal flu. There would be no danger to the public if the parade went ahead.

He was wrong.

200,000 people attended the parade. Within two weeks 4,500 people in Philadelphia had died.

One decision by Philadelphia caused thousands to lose their lives.

Liberty Bonds Parade. Philadelphia 1918. Source: The Historical Medical Library of the College of Physicians of Philadelphia.

Other local governments, like St. Louis, took control and closed schools and banned public gatherings. They relied on health experts and instituted quarantines. The death toll in St. Louis was cut in 1/2 compared to cities like Philadelphia where health advice was ignored.

St. Louis flattened the curve. Philadelphia did not.

Graph published in study “Public health interventions and epidemic intensity during the 1918 influenza pandemic” by Richard Hatchett showing the difference in mortality rate between Philadelphia and St. Louis, September 8–December 28, 1918. https://www.pnas.org/content/104/18/7582

Notice how similar the historic chart above looks to predictions of the Covid-19 spread with and without self-isolation interventions.

Predictions of Covid-19 spread with and without preventative measures.

In a comprehensive study of the 1918 flu, researchers found U.S. cities that closed schools and banned public gatherings for around a month delayed the peak of the outbreak and had lower death rates. The longer the city self-isolated, the lower the death rates.

There is a major cautionary tale found in the study. Cities that eased self-isolation early often saw a spike in deaths as the virus returned.

When Will it End?

The first cases of the 1918 flu were reported in the U.S. in March of 1918. It wasn’t until summer of 1919 that the disease was finally under control.

Over a year.

The question is whether modern medicine can speed the wave of the outbreak. Can modern medicine find a vaccine faster?

But it’s not just up to the medical field. Community actions have widespread effects on how the outbreak takes control of a society.

Can we learn lessons from other countries who had dealt with outbreaks of MERS and SARS and lessons from our country a century ago? Or will we repeat history? Make the same decisions and mistakes our ancestors did.

Can we learn from the past and make decisions that reduce the death toll and shorten the outbreak?

For those of us who are in self-isolation and starting to get bored and wondering how long it will be before our lives get back to normal, we may need to adjust to this new normal.

If you’re interested in reading more about the 1918 Flu, I found these sources very helpful.

How U.S. Cities Tried to Halt the Spread of the 1918 Spanish Flu” History Channel

Philadelphia Threw a WWI Parade That Gave Thousands of Onlookers the Flu” Smithsonian Magazine

“What We Can Learn From the 20th Century’s Deadliest Pandemic” Wall Street Journal

“Spanish Flu” History Channel

“Pandemic Economics: The 1918 Influenza and Its Modern-Day Implications”

“This chart of the 1918 Spanish flu shows why social distancing works”

Markel, H. et al. (2007). Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic. JAMA 298(19), 2264.

Cover Image in Public Domain

Covid-19, Coronavirus, America, Politics, Virus, Lockdown, Stay at Home, Quarantine, Self Isolation,

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