Spanish Flu and Coronavirus

The Spanish Flu of 1918 offers some interesting lessons and parallels as the world of 2020 struggles to contain the Coronavirus.

“This is the greatest public health catastrophe in the US since the 1918 influenza, and the principal difference is that we knew enough to stop this from happening to this extent” – Barry Bloom, a professor of public health at Harvard University, on coronavirus.

I recently had the privilege of meeting Laura Spinney, a British science journalist, and reading her 2017 book “Pale Rider – The Spanish flu of 1918 and how it changed the world”.

My much-thumbed copy of “Pale Rider”

“Pale Rider” is an account of one of the 20th century’s greatest cataclysms – and one directly relevant to the coronavirus pandemic of 2020.  Spinney paints a big picture.  She says that the Spanish flu may have killed between 50 and 100 million people.  But she brings that incomprehensible figure to life with accounts both of how the pandemic devastated communities.  She tells stories from Rio de Jaineiro to Croatia, from Japan to Alaska, from the Transkei to Turkey.  She shows how the Spanish flu affected individuals and families.

Governments struggled in 1918, too

One of the key lessons to emerge from Pale Rider is how in 1918 governments struggled to make the right decisions in response to the pandemic. This has happened in 2020 with the coronavirus, too.  But there are big differences, too.  In 1918, the world was at the tail-end of a terrible war – in theory, making an effective response much harder than now.  Plus, in 2020, the world is far more globalised, with more rapid and frequent travel potentially spreading disease more quickly. But also – in theory – making possible better exchanges of information.

Quotes from “Pale Rider”

Many of the references to the events of 1918 could equally be written about 2020.  Here are a few quotes.  All refer to 1918 unless otherwise marked:

• parents were used to surviving at least some of their children.  People regarded death very differently.  It was a regular visitor.  They were less afraid.
• [In Rio de Janeiro, during a tour of the city] [he paused] in wonder at the sight of the Praça de Republic, the vast public space in the centre of the city, as empty as the moon.
• On 12 October [in Rio de Janeiro], the satirical magazine Careta (Grimace) expressed a fear that the authorities would exaggerate the danger posed by this mere “limpa-velhos” – killer of old people – to justify imposing a “scientific dictatorship” and violating people’s civil rights
• [Again in Rio] Footballers played to empty stadia.
• The world was at war in 1918, and many governments had an incentive (more incentive than usual, let’s say) to shift the blame for a devastating disease to other countries.
• An epidemic will run its course and vanish on its own, without intervention, but measures that reduce [the density of susceptible individuals] – collectively called ‘social distancing’ – can both bring it to an end sooner, and reduce the number of casualties.
• In some places… the wearing of a layered gauze mask over the mouth was recommended… but health officials disagreed as to whether masks actually reduced transmission
• Your best chance of survival was to be utterly selfish.  Assuming that you had a place you could call home, the optimal strategy was to stay there… not only would this improve your own chances of staying alive, but if everyone did it, the density of susceptible individuals would soon fall below the threshold required to sustain the epidemic, and it would extinguish itself.  In general, however, people did not do this.
• What the Spanish flu taught us, in essence, is that another flu pandemic is inevitable, but whether it kills 10 million or 100 million will be determined by the world into which it emerges.
• One 2007 study showed that public health measures such as banning mass gatherings and imposing the wearing of masks collectively cut the death toll in some American cities by up to 50 per cent…  The timing of the measures was critical, however.   They had to be introduced early, and kept in place until after the danger had passed.  If they were lifted too soon the virus was resented with a fresh supply of immunologically naive hosts and the city experienced a second peak of death.
• [After the flu] Some countries, at least, saw an economic rebound… In America, industrial output and business activity took a serious hit in 1918 (with the exception of businesses specialising in healthcare products) due to the flu, but when economists Elizabeth Brainerd and Mark Siegler looked at state-by-state flu mortality rates and compared them to estimates of personal income for the following decade, they found a striking correlation: the higher the death rate, the higher the growth in per capita income through the 1920s… [but] Not all communities recovered.
• On 28 October 1918, The Times of London muttered darkly about neglect and lack of foresight, and looked to make ‘somebody answerable for the nation’s health’.
• The hubris of the medical community was punished, at least in the industrialised world.  The [medical] irregulars had all claimed higher cure rates than the regulars, and their followings now grew.  Over the next two decades, as scientists argued over who had caused the Spanish flu, they flourished and acquired respectability – including the more respectable label, ‘alternative medicine’.
• A report published by the Commission on Creating a Global Health Risk Framework for the Future (GHRF) – an independent, international group of experts convened by the US National Academy of medicine – estimated there to be a 20 per cent chance of four or more pandemics occurring over the next hundred years, and a high probability that at least one of them will be flu.  Most experts consider it inevitable that there will be another flu pandemic.  The only questions are when, how big, and what can we do to prepare ourselves?  Lessons learned from the Spanish flu could help us to answer all three.
• If disease containment works best when people choose freely to comply, then people must be informed about the nature of the disease and the risk it poses… whatever the rights and wrongs of shock tactics, the media clearly have a critical role to play in any future pandemic, and 1918 taught us a valuable lesson in this too: censorship and playing down the danger doesn’t work; relaying accurate information in an objective and timely fashion does.

Fascinating stuff.  I commend “Pale Rider” wholeheartedly.

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