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  • Writer's pictureAlan Frischer, MD, MPH

1918 Pandemic

We are in the midst of a worldwide pandemic, and it has changed our world. Predictions about the near future are difficult to make. Still, let’s remember that this isn’t the first time! What can we learn from the Spanish Flu pandemic of 102 years ago?

The 1918 flu was caused by an H1N1 virus that probably originated in birds. In this country, it was first seen in members of the military. Thought to have begun in Spain (it most likely did not), the name Spanish Flu stuck. Over nearly three years, this virus infected an estimated 500 million people. That came to roughly one out of every three people on the planet! It killed some 675,000 people in the United States alone, with a much higher mortality rate than we are seeing today with COVID-19.

Much like COVID-19, it was transmitted through respiratory droplets, and older adults were most at risk of developing severe symptoms. However, in stark contrast to today’s pandemic, the Spanish Flu more seriously impacted children under the age of five, and adults aged 20–40.

Today’s world is far more densely populated than the world of 1918 – the population has grown from less than 2 billion then, to 7.5 billion today. We are far more mobile today, making the spread much faster. People in 1918 tended to live in closer quarters, did not fully understand the value of hygiene, and did not have access to the medical care that we have today. As today, in 1918 there was no vaccine to prevent the disease, but today we do have the benefit of antibiotics, steroids, and antiviral agents to lessen the severity. The world of 1918 was at war, with large numbers of troops traveling to distant locations, and this aided the spread. Malnutrition was a factor for both soldiers and for civilians, and this made victims more susceptible to disease.

Back in 1918, officials downplayed the significance of the first cases. Mass gatherings continued and schools remained open. After the first cases appeared, Philadelphia waited some two weeks to implement physical distancing and other measures. In contrast, St. Louis moved to implement physical distancing measures within two days of its first reported cases. Philadelphia ended up facing a considerably larger epidemic than that of St. Louis.

Let’s look at how two countries have handled our current pandemic: the United States and South Korea. Coincidentally, the first confirmed case of COVID-19 was found in both countries on the same day, January 20. The government of South Korea immediately banned mass gatherings and implemented extensive testing, contact tracing, isolation, and quarantine. South Korea contained the spread of the virus, and has had, very roughly, 14,000 cases and 300 deaths. The United States is, of course, far larger, but we currently have experienced nearly four million cases and close to 150,000 deaths.

Governments have a responsibility to prepare for a pandemic. They have an obligation to invest in public-health systems that will protect us from the likelihood of the next pandemic. Our government reacted neither quickly nor adequately back in January, and early action is critical because a contagion spreads exponentially. Every day counts. Our government officials have a responsibility to create a consistent message in order to help prevent the spread of disease and to keep us as safe as possible.

Deaths from the 1918 pandemic came in three major waves. The second wave proved to be the deadliest. Today’s health experts nervously study that pattern. Just like then, we have all grown tired of physical distancing, masks, and other safety mechanisms, and want to return to our pre-pandemic lives. Will history repeat itself with a much larger second wave?

Keep in mind that the major treatment for the Spanish Flu was aspirin. After three years of misery, the virus disappeared. This was likely due to the eventual herd immunity as enough people got infected and either recovered…or died. Pandemics do eventually end. While human nature and behavior have not changed in 102 years, medical science certainly has. Despite a complex geopolitical situation, we are not in the midst of a raging world war. We have unprecedented global communication and the ability to share information. Drug and vaccine trials are being conducted worldwide. I am praying, like all of you, that this modern pandemic ends soon, so that we can learn from it and resume the life we choose. Let’s all work together on this mission.

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