Most of us have heard of the Spanish flu pandemic of 1918-20 – when ten times the number died of the virus than had been killed in the four years of the First World War. However, I confess I was a bit hazy on the details. So, with time on my hands during the lockdown, I thought I’d find out a bit more. I was quite surprised at some of the facts – but also at how many similarities there are between the earlier pandemic and the one we are currently living through.
First of all, some facts about that pandemic
How long did the Spanish flu pandemic last? Just over two years – February 1918 to April 1920.
How many got sick/died? This one is difficult as reliable figures are hard to come by, but it is thought that worldwide there were 500 million cases, with somewhere between 50 and 100 million deaths, in four waves.
There are some similarities with the current pandemic
Both viruses seem to be zoonoses, i.e. can pass from animals to humans. In 1918 the first known case, a farm worker in Kansas, is thought to have caught it from birds on his farm. He was called up, went to training camp on the east coast, on to Europe and well, you can see how it spread from there. In the army camps in France we think the virus jumped to the men from the poultry and pigs used to feed the troops.
Our present pandemic is thought to have originated in a Chinese seafood market, possibly passing from bats.
In both pandemics cases tend to be year-round rather than just in winter (which is more usual for flu). Urban areas are more affected than rural areas, poorer people more than the better off, men more than women.
Travel seems to help the virus spread, in 1918 by troops and medical staff returning home from the war, today by our fondness for foreign travel and for importing goods from around the world.
In 1918 they had PPE but it was in short supply, as was the case here last year. As now, wearing masks was encouraged although many people didn’t like it (in San Francisco there was an Anti-Mask League).
In both pandemics, social distancing and staying at home were encouraged, public events and mass gatherings cancelled, and theatres, cinemas and churches closed.
There were not enough farm workers to harvest the crops, then as now.
Some overseas islands imposed quarantine laws (for example, by doing this in 1918 Australia reduced its numbers of sick and deaths considerably).
But there were also some big differences
In the Spanish flu pandemic, young adults, particularly if strong, seemed to be more susceptible than older people.
In 1918 the public and clinical health response was delayed, partly because flu wasn’t usually included in their alert system of infectious diseases. But also because it was felt that the need to keep providing for the war (munitions, etc.) meant that some public health precautions (e.g. closing factories) were not taken.
In 1918 some schools were closed, though not all. Pubs stayed open and football matches with crowds continued.
Some businesses closed down because of lack of employees. Undertakers were overwhelmed; sometimes bodies piled up or family members had to dig their loved ones’ graves.
Mail delivery and rubbish collection were not done properly.
Scientific knowledge and equipment is far more advanced and sophisticated now. For example, in 1918 the flu virus was too small to be seen under the microscopes of the time.
And, of course, in 1918 there was no NHS. Before the NHS was created in 1948, patients were generally required to pay for their health care, although free treatment was sometimes available from charitable voluntary hospitals. In 1918 many patients would have been nursed at home.
There were no vaccines against the virus then, or for many years – until the 1940s. Vaccines were developed, however, to fight the 1918 flu’s bacterial secondary infections.
In 1918 there were no antiviral drugs to treat the virus or antibiotics to treat the secondary infections. Patients were treated with aspirin, quinine, arsenic, digitalis, strychnine, Epsom salts, castor oil, iodine, and also traditional treatments such as bloodletting, ayurveda and kampo.
Lastly … Why was the 1918 pandemic called Spanish Flu?
I feel quite sorry that Spain got blamed for this as the virus didn’t originate there. It was first seen in Kansas, USA, but because of wartime restrictions, it wasn’t widely reported. But Spain was neutral in World War l, with no reporting restrictions, so when King Alfonso XIII became ill, it was reported and after that it was thought that Spain was most affected.
A fascinating comparison – there are so many similarities but also stark differences, not only in the disease but in our responses to it. We still lockdown too late and too softly, even now we did not have PPE available. We knew what was needed but we did not do it or were not prepared.
Currently, world fatalities are around 2.2 million. Fewer than with Spanish flu but we are not finished yet.
Joy of joys, we have 5 different but effective vaccines and I guess many of us have had one or other of them.