Déjà Flu: What Covid Has in Common with the 1918 Pandemic
Clerks in New York work with masks on during the 1918 pandemic. Photo: National Archives
BY EMILY LAW, RACHEL DONG, and ALIKA AWAN
Take a moment and paint this picture in your head. An outbreak. A virus. But it’s overseas. It can’t affect you at all, right? Wrong. In a matter of days, it has taken over the wheels of your life, slamming them to a halt. Your usual daily activities are now off-limits. In fact, you can barely leave the house. That may sound very familiar to all of us who experienced 2020, but I’m actually talking about the Spanish Flu of 1918.
In the midst of the spread of the Covid-19 Omicron variant, it seems like a good time to take a look back on previous pandemics and examine the measures that were used, in order to try to learn from the past. So let’s start by jumping back in time 100 years, during World War I.
The Spanish Influenza, a somewhat forgotten pandemic, killed 50-100 million people worldwide, about 1 in 30, over a year and a half during 1918-1919. It was far more deadly than the war itself. By comparison, Covid has killed roughly 6 million people worldwide, which is less than 1 in 1,000.
The Spanish Flu was downplayed at the time by the federal government to “protect morale” and hide weakness during the war. Spain, on the other hand, remained neutral during WWI and freely reported on the outbreak, thus making it the supposed “epicenter” and giving the flu its name.
The Spanish Flu was very unusual compared to previous viruses and Covid-19 in that it targeted a younger age group: healthy 20-40-year-olds. In victims, it could progress from cough and fever to organ failure and pneumonia (the most common secondary infection).
Hundreds of patients during the Spanish Flu were packed in crowded hospitals under unsanitary conditions. Photo: National Museum of Health
Life during the 1918 pandemic was similar to ours in many ways. Schools across the country were closed for up to four months, and in some places, remote classes operated on telephones. Restaurants, businesses, theaters, and churches were also ordered closed by local governments and public gatherings were banned, with the exception of grocery stores and drugstores. Like now, people were ordered to quarantine.
There were a few conspiracy theories about the flu back then, just as we have now. Some people believed that the virus was thriving because the planets were misaligned, some said it was because Russian oats were tainted, and some blamed too many volcanoes erupting.
There were also mask mandates, though the only masks available at the time were made of gauze and cheesecloth. While many people complied, others complained that masks were uncomfortable and ineffective. One Denver salesperson claimed her “nose went to sleep.” Others snipped holes in their masks to smoke cigars. Penalties for going without a mask could be $5 to $10 fines (about a day’s wage back then) or ten days imprisonment.
Red Cross PSAs shamed non-maskers, saying, “The man or woman or child who will not wear a mask now is a dangerous slacker.” Philadelphia street signs warned, “Spit Spreads Death,” with some no-spitting ordinances, and advised people to cough or sneeze into a handkerchief.
There were also some unique quirks back then with how some dealt with germs. Many people did not leave their houses without an “atomizer,” a water vapor spray believed to prevent disease by keeping nasal and throat passages clear. Many restaurants were required to scald their dishes in hot water to sterilize them.
The less-developed medical science at the time understood the existence of viruses but didn’t have the technology to see the virus nor find any effective methods to treat it. Scientists didn’t figure out the genetic makeup of the virus until nearly 20 years later. (With Covid, scientists had access to the virus’s genetic code within weeks.) They also didn’t even have any vaccines against the Spanish Flu. Instead, nurses’ care – hydrating patients, lowering their temperature, and easing coughs – was the only effective response.
Doctors back then suggested drinking champagne and consuming phenolphthalein as medicine, which was later found to cause cancer. The process of bloodletting was also recommended because many experts believed that bleeding out a patient would remove impurities. In retrospect, we now know that these “treatments” only made things worse, and that the only help for patients came through nurses’ alleviation of symptoms and through the body’s natural immune response.
In all, human efforts were largely ineffective trial-and-error attempts, and in 1920 the Spanish Flu died down naturally, as those who caught it and survived developed immunity. The rapidly changing virus eventually mutated into less lethal strains, leaving behind increased herd immunity. This is very similar to Covid’s current path to the less deadly Omicron variant.
The infection waves (the patterns between the surges of cases), show that for both pandemics, reported cases first hit a high peak in America during the late winter, slowed down during the summer months, then mutated into a more contagious variant, reaching a second high peak during the colder months. The Spanish Flu then had a third and final, less deadly wave.
Immunologists explain that this is because a virus naturally wants to spread to other hosts, so it works to become more contagious and less lethal, so current hosts aren’t killed before the virus can spread to others. In fact, people can still get infected today by the same Spanish Flu variant that infected millions in 1918, but our immunity has evolved to combat it.
Could Covid be following the same pattern to less serious infection? That is what experts hope will happen. As shown with Omicron's last-ditch efforts to become more contagious, Covid might mutate itself out of existence, and like the Spanish Flu, children and adults over 100 years from now might not ever know about the worldwide catastrophe that terrified so many over the course of the last two years.