Lessons from the 1918 Influenza Pandemic
Tue, April 20, 2021

Lessons from the 1918 Influenza Pandemic


Restaurants, office establishments, and schools are shutting down. / Photo by Franck Boston via Shutterstock


In the last few weeks and months, people in most parts of the world have been asked to stay at home. Restaurants, office establishments, and schools are shutting down. Gatherings and public events are canceled, if not prohibited. All of these have caused huge disruptions to normal life. Yet, this is not the first time that the world has done this.

In October 1918, the influenza pandemic or the Spanish Flu also struck the world viciously and fast. It was at the time when World War I was already starting to wind down. Scientists are still unsure of its source. What is known is that the pandemic got its nickname not because it originated in Spain but because of a widespread understanding. During World War I, Spain was one of the few major European nations that remained neutral and it did not censor their news. News of the sickness made headlines in Madrid. Thus, the country was associated with influenza viruses. Many researchers also believe that the conditions of the war aided the spread of the virus.

Social distancing works

The Spanish flu killed about 675,000 people in the US and tens of millions worldwide. Cities and states in the US also told people to do what we now refer to as social distancing. Businesses, restaurants, and schools were also closed. People were told to quarantine and there were some places where the isolation lasted for months. Things did not go well, though, as people did not always obey the officials telling them. But lessons from the 1918 pandemic shows that social distancing works to slow the spread of the flue and it reduced the overall mortality rate as well.

Premature pullbacks of restrictions saw a spike of cases

The key lesson here is not to give up on social distancing too early. During the 1918 flu pandemic, cities that gave on such measures caused deaths and flu cases to rise again. Things were also different before today as more people can now develop and deploy vaccines faster. University of Michigan Center for History of Medicine’s director Howard Markel said via American news site Vox that “we'll get through it” based on the lesson of the 1918 influenza.

The best interventions were layered

In Markel’s 2007 study that appeared in the Journal of the American Medical Association, it also showed that the best interventions were layered. It involved not just telling people to stay at home because they may still feel the need to go to work or school or they may ignore rules to still go to church, bars, events, and other large gatherings. The approach should be layered, which means prohibiting or advising against the aspect of public life from restaurants to schools and entertainment venues except for drugstores and grocery stores. Markel likened it to a “slice of Swiss cheese.” The actions should be layered so that the holes get smaller.


Lessons from the 1918 pandemic show that social distancing works to slow the spread of the flue and it reduced the overall mortality rate as well. / Photo by eamesBot via Shutterstock


Experts warn comparing Spanish flu and Covid-19

As much as there were lessons that we can get from the past pandemic, many experts warn against comparing Spanish flu and Covid-19 pandemic. Flu expert Jeremy Brown, for instance, said that there’s a difference in the distance that medicine traveled in the intervening nations before.

Some experts further note that there was no World Health Organization before and efforts to track the spread of the disease before were rudimentary or limited only to basic principles. Most countries in Europe in 1918, when the flu pandemic hit, were still under war censorship regime. They are keeping their military intelligence confidential from the enemy to counter-espionage but they were also holding back information from their citizens. This limited the spread of lifesaving and accurate information about the pandemic outbreak.

Our World in Data, a scientific online publication that focuses on large global problems, also emphasized that the Spanish flu differs from the coronavirus outbreak in 2020.  The virus causing the diseases are different. The virus that caused the Spanish flu and other influenza pandemics is the influenza virus while the virus that causes the Covid-19 is a coronavirus. The age-specific mortality likewise appears “very different.” The 1918 pandemic was especially dangerous to younger people and infants while the new coronavirus appears to be most lethal to the elderly, according to early evidence in China.



The decline of life expectancy in 1918

Life expectancy is a measure of the population’s health in a year and captures the mortality along the entire life course. Our World in Data shows an abrupt decline of life expectancy in 1918 caused by the unusually deadly influenza pandemic. The life expectancy was 50.3 years in Norway, 49.8 in Sweden, 47.2 years in the US, 46.3 years in Switzerland, 32.8 years in Finland, and 30.3 years in Spain.

China’s data shows that the fatality rate of the Covid-19 case increases with age. The estimated case fatality risk by age group are 0-9 years old (<.01%), 10-19 (.02%), 20-29 (0.9%), 30-39 (.18%), 40-49 (.40%), 50-59 (1.3%), 60-69 (4.6%), 70-79 (9.8%), 80+ (18%). However, the data also revealed that younger people with underlying health problems are more at risk so age doesn’t tell the whole story. It only shows that the immune system declines with age. The number of white blood cells that help eliminate and find infections declines so older adults are less adept in recognizing new pathogens to fight. As of writing, six European countries and two Asian countries are among the ten most affected countries with Covid-19. The list includes the USA, China, Italy, Spain, Germany, France, Iran, United Kingdom, Switzerland, and South Korea. Confirmed cases also increased significantly as testing was made more rapid.

Infectious disease hasn’t vanished but the good news is that we are in a better era. The world today is better connected. Planes carry people to different countries in a short time. We also have different health systems and infrastructure today than in the past. The US, for instance, started human testing of a drug to help treat the novel coronavirus. Hand-washing, masks, quarantine, isolation, and social distancing measures are age-old practices but are still useful to implement now to keep people healthy and help scientists buy more time to find the solution.