2020 and 1918: similar, but different

This blog was originally posted in March, 2020-very early in the pandemic. I feel moved to update it now (July, 2021) since we are still in this pandemic. Medical researchers know a lot about covid-19 now and they have developed a number of vaccines that provide protection against Covid. About half of the adult population in the US has has been vaccinated. However, some people are suspect of the vaccine and others think they won’t get very sick if they do get covid. The virus, the vaccine, and the question of whether or not to wear a mask has all become politicized. After a few months when numbers decreased, we are now at the beginning of a new surge in locations where vaccination rates are lowest. A new, more highly transmissable variant of covid-19, the Delta variant, is responsible for this surge and it is now spreading throughout much of the South and Midwest. Most of the rest of the world is waiting for their opportunity to get the vaccine.

Updates, corrections and comments are provided below in red.

Reflections on 1918 and the Spanish Flu in the days of Covid-19

As research for my next book, I have recently read a number of books about the Spanish Flu epidemic of 1918. The timing of this research has been interesting, to say the least. To watch Covid-19 take hold in China, followed by the rest of the planet, has caused me to reflect on the numerous ways in which the Spanish Flu is, and is not, like Covid-19. What follows are some of my reflections on the similarities and differences between these two pandemics.

The Spanish Flu and Covid-19 produce similar symptoms, (fever, body ache and acute respiratory illness), but are caused by different disease agents. The Spanish Flu was a particularly lethal form of influenza that scientists believe originally came from a bird. Covid-19 is caused by a virus that is also thought to have jumped to humans from another species, perhaps a bat.

While presenting symptoms for these illnesses are similar, covid also affects the circulatory system and can cause heart attacks, strokes and blood vessel inflammation. The Spanish Flu sometimes resulted in Ebola-like symptoms that included a lot of blood loss.

The Spanish Flu of 1918 was the single most devastating pandemic in the history of humanity. Millions of people died in every corner of the planet over the course of two years. Covid-19 has already travelled around the world with cases in more than 180 countries, however it does not appear to be as deadly as the Spanish Flu. Most people (98%) who become sick with Covid-19 recover.

We will never know how many people died from the Spanish Flu. Estimates from around the world are rough, at best. Entire villages disappeared in Alaska and the Peruvian Amazon. Global estimates range from a low of 20 million up to a high estimate of 500 million people lost. The number of US citizens who died from the Spanish Flu (675,000) is nearly the same as the number who have already died from covid (628,000), however the population of the US is much larger now than it was in 1918. This correlates to 6 people out of a thousand who died from the Spanish Flu and 1.5 people in a thousand who have died from covid.

No vaccine and little basic scientific information. In 1918, scientists were unable to study viruses directly. The Spanish Flu was caused by what they called “filterable agents”, something so small it can pass through a filter. It was only after more than a decade of scientific investigation that scientists were able to confirm the cause of the Spanish Flu. Because the Covid-19 virus has arisen so quickly, it was initially difficult for public health officials to determine accurate incubation periods, death rates, and transmission agents. However, with the speed of communication and modern technology, genetic sequencing of the virus was completed rapidly and analysis of public health data is taking place in real time. There was no vaccine for the Spanish Flu in 1918 and we will be very lucky if a vaccine for Covid-19 is produced within 18 months.

We’ve been lucky! Scientists have worked hard and shared information all around the globe! Now there are several vaccines that are effective at preventing death and hospitalization from covid.

In both epidemics inaccurate and misleading rumors have circulated about the origin of the disease. In 1918, the US was at war with Germany (World War I) and rumors circulated that the German government had released the Spanish Flu as a weapon of war. Anti-German sentiment was running high at the time with attacks on German-Americans in the streets and closure of German language newspapers by the US government. In 2020, a Senator from Arkansas and a reporter from the New York Post speculated that a Chinese biomedical lab released Covid-19–either purposefully or accidentally. These statements have been repeated multiple times in numerous news outlets. However, there is no scientific evidence to support either of these theories. The most recent research on the Spanish Flu indicates that it originated in the US, not Germany. Scientists who have studied the genetic sequencing of Covid-19 have found clear evidence that the virus originated in nature and that it lacks the “fingerprint” that would be expected if it had been genetically modified.

The role of confined spaces (boats, camps and trains). While the flu is generally not lethal to young people, the Spanish Flu was particularly deadly to people in their 20’s with the result that there was an extremely high death rate among enlisted men. Crowded training camps, trains and transit ships were responsible for efficiently spreading the Spanish Flu among enlisted men. In 2020, cruise ships and airline travel have played a role in quickly spreading Covid-19 around the planet. Several cruise ships have had outbreaks among their passengers and crew. These ships often carry an older crowd of passengers and covid-19 is particularly dangerous for people over the age of 60.

Cruise ships were shut down for many months but are beginning to sail again. Schools were closed for much of the year and large gatherings were discouraged. Now that the more virulent Delta variant is circulating around the US, the need for caution is even greater. Someone who became infected with the covid virus in Wuhan, China probably infected 2 or 3 other people. A person infected with the Delta variant is estimated to infect as many as 6.

Even with the new variant, many people have decided that the pandemic is over. They are attending large gatherings like the Sturgis motorcycle rally that annually draws 500,000 participants. This could result in more infections and will, undoubtedly, cause more sickness and death.

Social distancing is being encouraged globally in 2020 to slow the rate of infection so health systems can serve those who are ill. Some forms of social distancing were also encouraged in 1918 with the closing of schools, theaters and places of worship. The opposite of social distancing is documented in the propaganda photos of Mole and Thomas. These patriotic images were created by lining up many thousands of soldiers who stood less than a foot apart for hours. It isn’t known for certain whether these gatherings accelerated the spread of the flu, but in the training camp where the image of President Wilson’s head was created (by 22,000 men), there were 7600 cases of pneumonia over the course of three weeks in late September and early October-824 of those soldiers died.

The real “front line” are hospital workers, physicians, and nurses. While many soldiers died in WWI, more people died from the Spanish Flu than from the war. In addition, nurses and doctors often fell ill from the disease and sometimes also died. Covid-2019 is no different. Currently, there have been nearly 3400 health care workers in China who have fallen ill from the virus. To date, 13 have died.

I hate to have to update these numbers because health care workers have suffered horribly from covid. As of April, 2021, more than 3,600 health care workers have died from covid.

Despite these similarities, 2020 is not 1918.

While 2020-2021 is not the same as 1918-1919 and covid deaths are not (yet) as high as the Spanish flu, we are nowhere near the end of this pandemic. If the past teaches us anything, it’s that Nature is full of surprises and that humans fare best when they unite for our common good.

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