An All-Too-Familiar Past: The Spanish Flu, 1918

At the height of American involvement in World War I in March 1918, soldiers stationed at Camp Funston in Fort Riley, Texas, began to report flu-like symptoms, including chills, high fevers and respiratory distress. Within the month, over 1100 soldiers had contracted the disease—46 had died. 

The start of this first wave of the Spanish Flu, or H1N1 influenza, pandemic was dwarfed by the second wave. By its conclusion, the flu had infected 500 million people, a third of the global population at the time, and killed, by conservative estimates, between 50 and 100 million of them.

While the current COVID-19 coronavirus does not appear to be as deadly as the Spanish Flu, there are some clear comparisons to be drawn between the effort to combat the 1918 pandemic and those which are ongoing today. 

Then, as is the case now, there was no drug to combat the disease, so “non-pharmaceutical interventions” occurred. In 1918, these interventions included precautions uncannily similar to today’s: social distancing, diligent hand-washing and attempts at quarantine. The hope was to significantly reduce the spread of the disease or “flatten the curve.” 

We need to understand what this phase of intervention, labelled “suppression,” can and cannot accomplish. We also need to understand what can help it succeed. Containment has failed: China has limited the virus far more than initially predicted, but its initial hesitance to act has allowed the virus to spread beyond its borders. As of now, it means that the disease is here to stay, re-infecting even those countries which had initially controlled its spread, such as Singapore, Taiwan and Hong Kong. 

Suppression has no chance of succeeding if cases are not identified. Right now, the United States has tested about 50,000 of its entire population and is struggling to catch up with a disease that is spreading rapidly with every grocery visit, pharmacy run and dog walk. This is not to undermine the importance of staying at home or cancelling school; attempts at suppression are an important factor in buying time to develop vaccines and drugs. However, it is unrealistic to rely on suppression to entirely eliminate viruses as infectious as COVID-19.

Another pitfall of suppression is conformity—or lack thereof. To prevent the influenza from infiltrating army camps, civilians were banned from the premises and whole units were to be quarantined on suspicion. However, only about 75% of the camps followed orders. A later Army study found that there was no difference in the mortality rates of the camps that did and did not comply with orders, because such a small number of camps actually imposed the orders strictly to begin with. This is reminiscent of the numerous Florida beaches currently strewn with spring-breakers despite the health risks they pose to themselves and others. 

For non-pharmaceutical interventions to be effective, conformity is a necessity. If Army camps in the height of wartime could not sustain compliance, it will be a difficult task to ask civilians to do the same during peacetime, regardless of whether the pandemic is a national emergency. When early interventions fail, and it is a matter of when, many cities and states will need to take radical and stringent action, which may include complete lockdown. 

Another resemblance, and maybe the most important factor to take into consideration here, is transparency from authorities. In 1918, to sustain wartime morale, neither regional nor national officials gave the public legitimate information. Trust in authority disintegrated, and much of the public did not follow advised precautionary measures. 

Today, the White House and reactionary media have complicated conformity by downplaying the gravity of the situation. For instance, the President stated on several occasions different versions of the same sentiment—the virus is nothing to worry about. “It’s very mild” and “I’m not concerned at all,” the President stated. Other members of the federal government further the spread of misinformation. As Fox News medical correspondent claimed, the “worst case scenario” that could result from the coronavirus would be symptoms of “the flu.”

Just like in 1918, the American healthcare system is tattered and fraught. Republican governors, who refused Medicare reimbursement, have burdened their communities with small-town hospital closures. The absence of universal health coverage in the United States will de-incentivize treatment at the very moment when citizens are at their most vulnerable.

There is a lot that we could have learned from 1918, and there is still more. Right now in America, a little history might just be what the doctor ordered.