Lessons from the 1918 pandemic
Did we or could we have learned some lessons from America’s experience with the influenza pandemic of 1918? Of course, much has changed during the intervening century, but a few things are as valid today as they were back then.
The 1918 influenza pandemic spread in three waves, infecting one third of the world’s population and killing 50 million people. Younger adults were hit the hardest, and life expectancy in the United States that year plunged from 51 to 39 years. Only the Black Plague pandemic of 1350 was more deadly. By comparison, American life expectancy decreased during the beginning of COVID-19, 2019 to 2021, by two years.
The rest of the 1918 pandemic story is that it broke out in the midst of the American mobilization for a late and decisive entry into World War I. In less than one year, four million “dough boys” were drafted and trained, with half of them arriving in France over a period of just a few months. Major disease outbreaks were first documented in March 1918, as soldiers from farms and towns collected at Ft. Riley, Kansas. Severe illness traveled with the troops as they moved by rail to east coast cities where they crowded onto troop ships bound for France. By April 1918, as the disease spread through war weary Europe, news coverage about it was suppressed in order to maintain fighting morale. When the illness broke out in Spain, which remained neutral during World War I, foreign correspondents in Madrid freely reported it, and the 1918 pandemic unfairly came to be known as the “Spanish Flu.”
Doctors understood in 1918 that this flu was a highly contagious airborne respiratory infection. The germ theory of disease was already accepted, and bacteria could be identified using optical microscopes. But this flu was a virus, not bacterial, and back then there was no understanding of its molecular nature. Viral particles are far too small to be seen without using an electron microscope, a tool not developed until decades later. Since the viral nature of the 1918 influenza was not understood at that time, there was no way to devise a test or a vaccine.
Back in the United States, big waves of the 1918 flu devastated every east coast city, with Philadelphia being the hardest hit. A second wave of infection worked its way across the country reaching the west coast in October 1918.
A few cities, among them San Francisco, passed temporary public masking and social distancing ordinances that were enforced with fines and jail time for “slackers.” This significantly reduced this city’s death rate during the second wave, but the measures were very unpopular, and the ordinances were allowed to expire. When a third wave arrived in January 1919, San Francisco’s death rates spiked.
Subsequent waves were less severe. World War I was over, and the 1918 pandemic was soon forgotten. We learned little or nothing about it in school or from family stories handed down through the generations.
Getting back to the opening question, when COVID-19 arrived, there were no useful lessons in our collective memory about dealing with pandemics.
There are, however, two lessons that we could have learned. First, social distancing and masking in public do reduce infection and death rates. Especially in the absence of vaccines and reliable tests, these low-tech measures definitely save lives. The second big lesson is that most folks prefer to get back to “normal” behavior prematurely, even when science and technology give us excellent ways to stay safer. Just as in 1918, too many of us avoid wearing masks when necessary. We are fortunate now that effective COVID-19 vaccines are at hand. Still, too many of us fail to get them.
How can we best approach this COVID-19 conundrum? The Atlantic magazine’s Benjamin Mazer wrote that “COVID won’t end up like the flu. It will be like smoking.” In his words, choosing not to get vaccinated is a serious yet “modifiable health risk on a par with smoking, which kills more than 400,000 people each year.” Even with our excellent technology, COVID-19 ends up being a behavioral problem.
In addition to searching distant history for lessons, let’s also apply some more recent tobacco wars lessons to the vaccination wars. Nearly half of all American adults smoked cigarettes in the 1960’s. After 60 years of public health efforts, peer pressure has tilted from glamorizing smoking to making it unfashionable, and today the U.S. adult smoking rate is down to 12.5%.
The medical technology to control COVID-19 is here. Over the longer term, we need to create as much acceptance of COVID-19 vaccinations as already exists for the other routine shots we get for preventable diseases.
Ross Hemmendinger is a registered nurse and a former history teacher.