X Close

Why this could be worse than the Spanish flu We may have far better medicine than 100 years ago, but we're not as well prepared for the aftershocks of an epidemic

Red Cross volunteers fighting against the spanish flu epidemy in United States in 1918. Photo: Apic/Getty Images

Red Cross volunteers fighting against the spanish flu epidemy in United States in 1918. Photo: Apic/Getty Images

March 25, 2020   5 mins

While viruses continually evolve, the human response to them remains a constant. Though we’d like to think that we’re more level-headed than our forebears one hundred years ago, our reaction to the relentless advance of Covid-19 bears striking resemblance to the hysteria surrounding the 1918 Spanish flu pandemic. Have we learned anything from past experience? Nope.

The epidemic of 1918 first appeared in the spring and seemed mild; most people quickly recovered. But then a second, more deadly, wave arrived in the autumn. Some died within hours of contracting the disease, suffocating as their lungs filled with fluid. A third phase in the spring of 1919 was less deadly, but still lethal. We’re now in phase one of Covid-19. Will there be subsequent, more deadly, phases? No one knows for sure.

Some 500 million people contracted the Spanish flu, roughly one-third of the world’s population. By the time the epidemic ran its course, 50 million were dead, maybe twice that number. Doctors and hospitals were overwhelmed, as were mortuaries. Some families were forced to bury their own dead. In the United States, where perhaps 750,000 people died, the disease lowered the average life expectancy by 12 years.

There was, though, nothing particularly Spanish about the Spanish flu. The epidemic came to be identified with Spain because of censorship during the Great War, when governments in belligerent countries, fearing mass panic, suppressed news reports. Since Spain was neutral, no controls existed, and so the first reports came from Spain. Then, as now, governments seized the opportunity to blame the pandemic on a foreign power; Americans, struck by the perplexing peculiarity of this strain, were inclined to blame those mysterious Chinese.

In fact, this flu probably originated at Camp Funston in Kansas where an army cook named Albert Gritchell fell ill on 4 March 1918. Within hours, the infirmary was packed with over one hundred similarly afflicted soldiers. In truth, however, it hardly matters where the disease began, since its distinguishing feature was ubiquity, not specificity. As we’ve seen recently, however, blaming others is an effective way of distracting attention from government incompetence.

Politicians respond to epidemics in a similar manner to the classic five stages of grief, starting with denial and eventually moving to acceptance. Donald Trump at first insisted that the virus would mysteriously disappear when the weather warmed; Boris Johnson boasted about shaking hands with sufferers.

A century ago, President Wilson, keen to avoid an economic slump, urged factory workers to keep working even if they felt ill. Some died on the assembly line, but not before spreading the virus to their workmates. The second wave of the disease coincided with victory celebrations, which officials everywhere were reluctant to cancel (where they did, as in St Louis, the effects were dramatic). Politicians gave blithe assurances based on nothing but reckless hunches; for instance, a Boston health commissioner claimed that brief exposure to the sun would kill the disease (which sounds familiar), but even the United States Surgeon General said to avoid tight shoes.

But are we that much smarter now? Over the last few weeks, I’ve come across a plethora of wacky cures and avoidance strategies. These include drinking water every 15 minutes, swabbing the nostrils with saline, bathing with chlorine, using a hairdryer all over the body and — this from an Iranian cleric — rubbing the anus with violet leaf oil. Quack remedies are blooming quicker than the daffodils in my garden, so much so that health authorities have set up websites to refute the myths.

On YouTube, a young Ghanaian evangelist named Addai argues, on the basis of “extensive research”, that frequent sex helps prevent the coronavirus. He’s thinking not just every day, but for hours every day. He cites a report on CNN that sex strengthens the body’s immune system, but I couldn’t find that report. Of course there might be some logic to Addai’s advice, since staying in bed constantly copulating will reduce exposure to the public.

On that sex issue, behaviour has perhaps changed over the last century. In 1918, Spanish priests in Zamora told their flocks that the flu was God’s punishment for licentiousness. Parishioners were told to seek redemption by lining up to kiss the relics of Rocco, the patron saint of pestilence. (I probably don’t need to finish this story.)

In the early 1900s, people everywhere were in thrall to science, which presaged a brave new world. Einstein and Darwin had offered brilliant solutions to perplexing mysteries. H. G. Wells converted complex scientific discovery into entertaining plot lines. Religion was in decline. But, then came the epidemic, and because established medicine was helpless to cure victims or limit the spread, the reputation of science suffered. That partially explains the popularity of quack cures, such as quinine, arsenic, camphor, digitalis, strychnine and castor oil.

That sudden suspicion of science inspired a minor religious revival. Churches became packed, with inevitable consequences for contagion. Nowadays, the situation is significantly different, because a virulent wave of scepticism toward science preceded the coronavirus.

In the present climate, it will be interesting to see how societies react. Will the virus inspire renewed respect for science, or the opposite? How, for instance, will the powerful anti-vax movement react to an eventual Covid-19 vaccination? My guess is that we’re in for even greater scepticism toward science and maybe a new religious revival.

The thing about viruses is that they don’t lend support to scientific thinking. Yes, 2% might die, but 98% will not. Survivors will seize upon easy explanations for their good fortune – that saline up the nose, that oil up the butt.

In recent weeks, experts have tried to reassure us that “coronavirus is not the Spanish flu”. That’s true, but also dangerously misleading. The 1918 flu was much more lethal than Covid-19 appears to be, but that’s partially because the 1918 population, recently ravaged by war, was much less healthy than we are today, and did not have access to the quality healthcare most of us enjoy.

It bears stressing that we’re a more mobile population today, which is why the current epidemic is spreading much more quickly than in 1918. Back then, women were less susceptible than men because they were more home-bound. In any case, a virus today does not need to be as lethal to be nearly as destructive as in 1918. If today’s virus has a fatality rate of just 1%, but affects the same percentage of the population as in 1918, it will kill around 27 million people.

That would still make it less of a disaster than a century ago, but one thing is certain: the economic effect of this virus will be catastrophic compared to 1918. The Spanish flu occurred at the end of the Great War when austerity was already the norm. Economies everywhere were geared toward high government intervention and low personal consumption.

The opposite is the case today. We’re doubly cursed in that we’re accustomed to lavish consumption and the infrastructure for massive government intervention does not exist. At the moment, world leaders are frightened by the plummeting stock market, but very shortly mass unemployment will take centre-stage. We’re soon going to find that, like loo paper, the lifestyle we’ve come to expect is out of stock. Fasten your seatbelts, this could be a rougher ride than 1918.

Gerard DeGroot recently retired from the School of History at St Andrews. He has written books on various aspects of twentieth century history, including moon landings and the nuclear bomb.

Join the discussion

Join like minded readers that support our journalism by becoming a paid subscriber

To join the discussion in the comments, become a paid subscriber.

Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.

Notify of

Most Voted
Newest Oldest
Inline Feedbacks
View all comments
Anna Lloyd
Anna Lloyd
4 years ago

Just a comment on the Boston health official recommending the sun and the author of the essay lumping this in with the other quackery: exposure to the sun creates Vit D in the body, the only other way you acquire it is through supplements. Vit D has a powerful effect on the immune system, deficiency in the winter months is linked to many diseases. There are lots of studies on this. So I think getting out in the sun as much as possible is an excellent idea during this pandemic. At a good distance from others, of course!

4 years ago

Disagree with the author … get out into the sun and fresh air. Not only do you need the sun for your body to synthesize Vitamin D but daily exercise is vitally import for a healthy body, mind and soul.

J Cor
J Cor
4 years ago

“Back then, women were less susceptible than men because they were more home-bound.” Same thing now even though women are highly non-homebound, it appears — men do not practice as good hygiene and are more likely to smoke and drink, which is causing them to die in far greater numbers. People have tried to come up with a dozen other more convoluted explanations that are not down to behavior, but that’s basically it.

And women have never been less susceptible because they were homebound. They have always taken care of children by the dozens and old people, and nursing homes and schools have always been germ factories. I think your presumption doesn’t hold water.

4 years ago

The delay in imposing the lockdown in the UK will have far-reaching consequences. A large number of unnecessary deaths will be the inevitable result of this government’s bungling, murderous handling of the crisis.

Here is a worked-out example for arithmetically-challenged ministers:

An early guess was that the size of a pool of Covid-19 infected people doubles in size every 4-5 days. Many people now suggest this was wildly optimistic and in a well-populated country without any containment measures, the pool may actually double every 3 days. (A German university estimates it’s only 2 days for the USA).

So starting with just 100 people, within 21 days, the size of the infected pool may grow to 12,800 of which at least 1.84% (236 people) may die. It seems simple: Deaths = (100 x 2 x 2 x 2 x 2 x 2 x 2 x2) x 1.84% (Case Fatality Rate of detected infected people in South Korea).

But that is an incorrect calculation.

The real equation looks at the availability of intensive care units (ICU) and hospital beds. We know from China that the percentage of infected people requiring hospital treatment is 13.8% and an additional 4.7% require intensive care. We can safely say that sick people who do not get intensive care will die due to the nature of Covid-19, so let us focus on this first.

The survival rate of 1.84% for the 12,800 infected people was derived from South Korea which had enough medical resources for all degrees of illness. But if the number of ICUs for our example pool of infected people is limited to, say, 50 ICU beds (because they are normally rare in hospitals), then the equation changes dramatically, thus:

12,800 x 4.7% = 602 people requiring ICU

602 ““ 50 ICUs = 552 people therefore do not get ICU treatment

But that is not all. Let us limit the hospital beds as well, not just the ICU beds, and assume only 500 beds are available. Then the equation is also expanded as follows:

12,800 x 13.8% = 1,766 people requiring hospital beds

1,766 ““ 500 beds = 1,266 people without hospital beds

Assuming 50% of such patients can survive without hospital beds, we may get 633 new deaths.

So finally we can get to the real equation, which expresses the true death rate once medical resources finally run out. In the above example, it is:

(552 without ICU + 633 without hospital bed) / 12,800 + 1.84% = 11.1% death rate

And the above is exactly what is happening in Italy right now, because they have run out of medical resources. Also note the example over-estimates the numbers of beds and ICUs available in most countries ““ Italy actually has 3.2 combined hospital beds and ICUs per 1,000 of population, which is considerably more than the UK (2.54) and USA (2.77). Thanks for cutting funding to the NHS, folks.

Therefore, just 100 infected people who did not self-confine may be responsible for over a thousand avoidable deaths. And of course, we probably have hundreds of thousands of people who are unknowingly spreading this disease.

Perhaps this gives you an idea about how important self-confinement is, and why it is a necessity. The horror of a collapsed medical system in a pandemic is beyond words.