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Stories on COVID-19 occasionally refer to the Spanish Flu, a devastating worldwide outbreak that came in three waves in 1918-1919 and took more lives than the notorious Bubonic Plague of 1347-1351. In an attempt to better understand the 2020 pandemic and reduce its impact, medical historians have been revisiting the events of what is known as the worst pandemic in world history.
The Spanish Flu (so-called owing to a mistaken belief that it originated in Spain) appeared just as World War I was winding down. Ironically, the age group that suffered most in the war, people between the ages of 20-40, were particularly vulnerable to the virus as well. When the flu struck, it hit hard, often progressing from an apparent bout of common influenza to a suffocating pneumonia in as little as 24 hours. In the end the cost in American lives was 10 times that of the war, with over 500,000 dying of the virus. The estimated worldwide death toll was a staggering 50 million.
Nations that were still absorbing the unprecedented death toll of the Great War scarcely noticed the arrival of the Spanish Flu. Spreading across the globe via trade routes and armed forces transport ships, in spring 1918 the virus reached the US. After first appearing at Fort Riley, Kansas, it proceeded to move through military installations and prisons. The country was preoccupied with ending the War, and as fatalities were low in the initial outbreak, few expressed alarm at this stage. As summer ended, though, the flu was on the move, latching onto troops as they moved through US towns and cities. Social distancing recommendations were still being neglected in November, when large-scale gatherings and close human contacts at Armistice Day celebrations acted as superspreader vehicles. As winter arrived, the nation was in the grip of a full-blown pandemic. A fierce third wave hit in 1919. Over 28% of the American population was infected and social systems were in crisis. Communities in hot spots wrestled with shortages of health care workers, medical supplies, coffins, funeral homes, and gravediggers.
How did the country respond to the pandemic? When the flu began raging through civilian populations, various localities made attempts to “flatten the curve,” as we now call it. The measures they took will seem familiar, as recounted by Molly Billings of Stanford University: “Public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines.”
Knowing the history of the Spanish Flu pandemic can have a profound impact on what happens today. Enacting social distancing rules—and adhering to them—saved lives in 1918-19. A recent National Geographic article cited the findings of two 2007 studies of the flu pandemic: “Death rates were around 50 percent lower in cities that implemented preventative measures early on, versus those that did so late or not at all. The most effective efforts had simultaneously closed schools, churches, and theaters, and banned public gatherings.” The studies also offer a warning against prematurely lifting social distancing rules: “St. Louis, for example, was so emboldened by its low death rate that the city lifted restrictions on public gatherings less than two months after the outbreak began. A rash of new cases soon followed. Of the cities that kept interventions in place, none experienced a second wave of high death rates.”
With these lessons in mind, historians as well as nurses are encouraging people to heed the advice of public health specialists. In the meantime, we can only hope that future studies of 2020 won’t have a compelling reason to quote philosopher George Santayana’s truism “Those who cannot remember the past are condemned to repeat it.”
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