Lessons from the Spanish Flu

By Amy Heydlauff

In 1918 the entire world suffered a pandemic now referred to as the Spanish Flu. Over the last few weeks news outlets frequently compare COVID-19 (Coronavirus) to the Spanish Flu. So, I decided to do a bit of research.

The Spanish Flu occurred during World War I. It is believed 5 percent of the world’s population succumbed (approximately 50 million). It must have been a frightening time. Researchers don’t believe it originated in Spain. There is good evidence it originated in Asia and spread across the globe when workers were rounded up and shipped to Canada by way of the U.K.

Other theories point to the filthy, damp and foreboding trenches soldiers dug and inhabited in France or perhaps even an army barracks in Kansas. Regardless, high-density communal living was at the heart.

How did Spain get stuck with the flu moniker? They just happened to be the country willing to talk about the impact of this virulent strain of influenza on their population. Other countries were engaged in the world war and didn’t want their enemy to know they were weakened from fighting disease on the home front. Politics and spin aren’t new.

The Spanish Flu spread rapidly in 1918. It came in three waves with the second wave being the deadliest, probably because the virus was mutating along the way. There was a third wave that was less deadly than the second.

Researchers believe the virus reversed the virulence of its mutations. Viruses can do that if they become too deadly. They don’t want to kill their hosts too quickly because they need the host to survive.

Spanish Flu spread quickly through military encampments, displacement camps and the over-crowded tenements in major cities across the globe. In the U.S. many of those tenements were packed with the destitute (think Gangs of New York).

Many deaths are believed to have been secondary pneumonia – both viral and secondary bacterial pneumonia. It is interesting to note, the Spanish Flu was an H1N1 virus, as are many modern-day influenzas.

While there are epidemiologic similarities between the 1918 pandemic and Covid-19 (a very basic definition of epidemiology is the study of frequency and spread of disease) there is no reason to assume the outcome will rival the Spanish Flu in spite of sensationalizing media.

Two major things contribute to our likely ability to prevail over COVID-19. Health and wealth.

Population health is much improved. Utilities like running water and sewage treatment (including proper disposal of sewage) were spotty or even non-existent in 1918. Militaries across the globe billeted in camps and barracks we would consider squalid, today. Interventions to prevent the spread of bacteria and viruses were not widely understood.

Many people went days without washing, even their hands. And there was no way to spread the word to keep your distance.

In 1918, most of the world’s people were poor. Just since 1990 the global, extreme poverty rate has been reduced from 36 percent of the population to less than 10 percent. That means we have significantly more clean hospitals, superior medical equipment (albeit slow in coming), antibiotics for secondary bacterial infections, extraordinary communication channels, and well-educated medical staff.

In the U.S. we have world-renown, highly educated experts – some we are getting to know like Doctors Fauci and Birx – but thousands of others work behind the scenes. All these facilities, medicines, communications and educated people exist because poverty is no longer prevalent.  

We can’t put our heads in the sand. This is serious and there will be illness and death. Especially in high-density communities.

Health care systems in many places will be strained. But we are well-equipped to curtail COVID-19 in ways they couldn’t in 1918.

I find this heartening.

In 1918, we learned a lot about how pandemics work. Those lessons will save millions of lives this time around.

We will learn a lot from the COVID-19 pandemic, too. And because of strides in health and wealth, we are learning quickly, on the fly.

Every day the upside information increases and informs next steps.

I’m glad I’m alive for this century’s pandemic, and not the last.