What We Haven’t Learned from The 1918 Pandemic

Since the onset of COVID-19, the world has turned to lessons from historical experience with the Spanish flu pandemic of 1918. Interventions today like physical distancing and closures of public spaces are guided by similar efforts to stop the spread of the flu in 1918-19. Instead of learning lessons from the world’s greatest pandemic over a hundred years ago, history seems to be repeating itself in several other ways.

Like the 1918 virus, COVID-19 is ‘novel’ in that it is a highly infectious virus previously unseen. The 1918 virus (Influenza A Subtype H1N1) and the new coronavirus (SARS-CoV-2) come from different viral families. What they have in common are transmission methods. These are primarily through respiratory droplets and surfaces they land on. Additionally, respiratory failures reported from COVID-19 patients are haunting echoes of H1N1 patients during the Spanish flu.

An Interconnected World

The origins of the deadly strain of the H1N1 virus remain a matter of debate, but evidence indicates that troop mobilization during World War 1 drove virus transmission. Soldiers left their homes in small towns or cities and traveled the world, passing through several ports, transit hubs, and came in contact with civilians. The first wave of the Spanish flu took place in the early summer of 1918 coinciding with these movements. Both viruses are undoubtedly products of their time – both driven by an increasingly connected world.

Phases of the Virus

According to the Center for Disease Control and Prevention (CDC), the 1918 pandemic lasted for two years: the first wave in March 1918 and the second wave – marking the most devastating phase – occurred in the fall of the same year. In January 1919, a third wave started in Australia, working its way to Europe and the US, finally subsiding in the summer.

The virus never disappeared entirely, but by 1920, it appeared people had developed herd immunity. The ebb and flow of the 1918 virus share commonalities with what the world is experiencing today.

Social Distancing and Mask Wearing

Much like today, resistance to mask-wearing and social distancing was prevalent in 1918. Health regulations mandated the wearing of masks to slow the spread of disease. Many people resisted, citing restrictions to their personal and civil liberties. Back then, people wore masks made of gauze and cheesecloth. Those who refused to wear masks faced fines or even imprisonment in cities that mandated them.

Social Mitigation Efforts

Even during the 1918 pandemic, it was clear that social mitigation efforts could drastically slow down the virus – the flu vaccines made an appearance only in the 1940s. Until then, health officials emphasized the need for mask-wearing, frequent hand-washing, and social distancing to curb the spread. Places that implemented these guidelines – along with closures of public businesses, schools, and public spaces – saw fewer deaths, similar to what is happening today.

Reporting and Misinformation

Since the early days, conspiracy theories on the origins and spread of COVID-19 have been rife. The 1918 pandemic had its version of sensational reporting or fake news. From blaming German U-boats and jazz music to targeting immigrants and Jews – trends that are disturbingly similar to what is happening today. A century apart and two pandemics later, not much has changed. The spread of misinformation and resistance to health guidelines remain. Amid a global health crisis, rationality takes a back seat as extreme behavior and theories prevail.

Medicine and science have made remarkable strides since 1918, but the world is yet to learn other lessons. Numerous lives were lost, and economies decimated before countries took the threat of the virus seriously. Most places now have vaccines for COVID-19 yet also face new virus variants, potentially more infectious.

Complacency in the wake of vaccines only adds to a crisis we do not have full knowledge of yet. The fundamental differences in the COVID-19 strain do not offer predictability or exact parallels to the influenza waves of 1918-19. Until then, the world needs to rely on social mitigation measures to contain the virus spread.