Covid-19, the 2019-20 coronavirus has a current mortality rate of 6.5% of reported cases. As of yesterday, 145,429 deaths of 2,180,617 infected. So how does this pandemic differ from the 1918 flu pandemic? And how is it eerily similar.
2020 Central Park Field Hospital 1918 Field Hospital
First, “Spanish flu” did not start in Spain. It earned its misnomer because Spain was neutral during World War I. Unlike its European neighbors, Spain didn’t impose wartime censorship on its press. Since Spanish journalists were some of the only ones reporting on the widespread flu outbreak in the spring of 1918, the pandemic became known as the “Spanish flu.” It is now known as H1N1, originating from an avian virus which jumped to humans.
The 1918 Spanish flu, with a mortality rate of 2.5%, was the most severe pandemic in recent history. The virus infected 500 million people worldwide and killed an estimated 20 – 50 million (about 675,000 in the United States) –more than all of the soldiers and civilians killed during World War I combined. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus. And unlike a normal seasonal flu, which mostly claims victims among the very young and very old, mortality was just as high in healthy people 20-40 years old.
Complicating matters in the U.S., World War I had left parts of America with a shortage of physicians and other health workers. And of the available medical personnel, many came down with the flu themselves.
Hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.
2020 Central Park Field Hospital 1918 Field Hospital
Influenza is caused by a virus that is transmitted from person to person through airborne respiratory secretions. An outbreak can occur if a new strain emerges against which the population has no immunity. The science of 1918 simply didn’t have the tools to develop a vaccine for the virus and there were no antibiotics to treat secondary bacterial infections. Microscopes couldn’t even see something as incredibly small as a virus until the 1930s.
Control efforts worldwide were limited to isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly. Public health departments distributed gauze masks to be worn in public. Cities were put on lock down; theaters, schools and churches closed. Stores could not hold sales, and 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 enforced by extra officers. Bodies piled up as the massive deaths of the epidemic ensued and there was a shortage of coffins, morticians and gravediggers.
The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages. And eerily similar to those in 2020.
A LITTLE EXTRA READING, OR A BRIEF HISTORY OF THE PANDEMIC:
When the Spanish flu first appeared in early March 1918, it had all the hallmarks of a seasonal flu, albeit a highly contagious and virulent strain. One of the first registered cases was Albert Gitchell, a U.S. Army cook at Camp Funston in Kansas. The virus spread through the Army installation, and by the end of the month, 1,100 troops had been hospitalized and 38 had died.
As U.S. troops deployed en masse for the war effort in Europe, they carried the Spanish flu with them. Throughout April and May of 1918, the virus spread like wildfire through England, France, Spain and Italy. Luckily, the first wave of the virus wasn’t particularly deadly, with symptoms like high fever and malaise usually lasting only three days, and mortality rates of about 0.1%, similar to seasonal flu.
Reported cases of Spanish flu dropped off over the summer of 1918, and there was hope at the beginning of August that the virus had run its course. In retrospect, it was only the calm before the storm. Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged that had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection.
In late August 1918, crowded military ships departed the English port city of Plymouth carrying troops unknowingly infected with this new, far deadlier strain of Spanish flu. As these ships arrived in cities like Brest in France, Boston in the United States and Freetown in West Africa, the second wave of the global pandemic began.
From September through November of 1918, the death rate from the Spanish flu skyrocketed. In the United States alone, 195,000 Americans died from the Spanish flu in just the month of October. Death statistics formed a W pattern with the very young, those 20-40, and over 65 dying in similar numbers.
Not only was it shocking that healthy young men and women were dying by the millions worldwide, but it was also how they were dying. Some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals known as “cytokine explosion.” In those cases, the body is overloaded with cytokines leading to severe inflammation and a buildup of fluid in the lungs which caused the victim to suffocate and die.
The rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime. In Britain, for example, government officials wouldn’t risk crippling the war effort by keeping munitions factory workers and other civilians home. Armistice Day celebrations of November 11 brought millions of people in even closer contact with one another
By December 1918, the deadly second wave of the Spanish flu had finally passed, but the pandemic was far from over. A third wave erupted in Australia in January 1919 and eventually worked its way back to Europe and the United States. It’s believed that President Woodrow Wilson contracted the Spanish flu during the World War I peace negotiations in Paris in April 1919.
The mortality rate of the third wave was just as high as the second wave, but the end of the war in November 1918 removed the conditions that allowed the disease to spread so far and so quickly. Global deaths from the third wave, while still in the millions, paled in comparison to the apocalyptic losses during the second wave.