1918 Spanish Flu: Lessons From History
The 1918 Spanish Flu was a global pandemic that rapidly spread throughout the world in three distinct waves, claiming, at the upper estimates, 50 million lives. While medicine and preventative measures have advanced since then, lessons from the Spanish Flu can still be applied to the current fight against COVID-19.
The Spanish Flu’s origins are debatable. Some researchers link the virus to avians, others denote a similarity in structure to both swine and avian influenza. What is understood, is that the 1918 Spanish Flu originated from animals and was transmitted to humans. The influenza rapidly spread throughout European and American armies, likely due to the ongoing world war. Within a matter of weeks, 1100 soldiers had been hospitalized and thousands more affected.
Likewise, COVID-19 is linked to animals, specifically bats. Its spread was rapid amongst communities but one of the most novel characteristics is its ability to be completely asymptotic. This asymptomatic characteristic allows those infected to carry the virus and infect others without knowing so. In contrast, the 1918 Flu demonstrated typical flu like symptoms allowing preventive actions to be taken to combat the first wave of the virus.
Without vaccines or modern day testing, preventive measures were limited to surveillance, and quarantine. These measures proved effective in curtailing the virus, as cases died down and the world breathed a sigh of relief. This relief was short lived as a second mutated strain, carried from Plymouth in south-western England, was transmitted by ships to Sierra Leone and Boston. Again preventive measures were implemented, quarantine and surveillance, in addition to closing of public meetings, free soap and clean water, and inspection of food products. However, this second wave proved the most deadly as millions fell ill and died to this new mutated strain. After a six week second wave, the number of cases died down briefly before a final third wave, originating in Australia, spread throughout the world. This third wave’s effects were lesser, but the final death toll fell between 20 and 50 million.
One of the most important lessons gleaned from the 1918 Flu is the importance of accurate reporting. The 1918 Spanish Flu came in the midst of World War 1, an important fact in understanding why European countries refused to accurately report the number of cases. Spain was neutral during WW1, and thus, was able to freely and accurately report on their total cases, whereas Europe was actively warring and refused to report the influenza for both strategic and public concerns. This lack of information likely contributed to the original spread of the virus, as newspapers were essential for publicizing preventative measures. This is why it’s essential that states accurately and timely report the number of cases of COVID-19 as to not downplay the seriousness of the virus, or limit the scope of preventative measures.
The Spanish Flu exhibited a distinct W shaped mortality curve, i.e. the pandemic killed elderly, young, and healthy adults in semi-equal quantities. Many deadly diseases show a U-shaped mortality curve, with young and elderly most likely to be killed by the disease. In contrast, the Spanish Flu was far less selective. Analysis of the Report on WHO-China Joint Mission published on Feb. 28 by WHO, shows that the Coronavirus becomes increasingly fatal as age increases. A distinct failing of states reports on the virus is a lack of age, racial, or sex demographics. While the WHO report is dated, it does show how COVID-19 differs from the Spanish Flu.
Nonetheless, the deadliness of COVID-19 should not be blown off, as the asymptotic nature of the virus could allow individuals to transmit the virus to those more likely to see serious symptoms.
Ultimately, the Spanish Flu and COVID-19 share both similarities and differences that can glean important lessons for the future. Both likely originated from animals and demonstrated a rapid spread throughout communities. Likewise, inaccurate reporting and downplaying of the seriousness of the pandemics contributed to their spread and overall effects. Finally, while we are currently in the first wave of COVID-19, trends of the Spanish Flu show the risk of lessening restrictions too soon.