What Can We Learn from the Deadly 1918 Spanish Flu Pandemic?

Jaime Breitnauer

Twentieth Century
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Covid-19 might be filling the column inches right now, but we’ve been here before. Jai Breitnauer looks to history for a solution.

Whether you’ve been stock piling toilet roll or had to cancel your holiday, Covid-19 will be on your radar. With a mortality rate of 3.4% and its rapid spread through business communities and among holiday makers, this novel Coronavirus certainly seems quite scary.

But we’ve been here before, pandemics aren’t new, and if we look at the deadly Spanish flu outbreak of 1918 – 1920, we can find both useful info and comfort in how far we’ve come in a century.

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Spanish flu is a much more ‘catchy’ name than Covid-19

In fact, the scientific name for Spanish flu is H1N1, and is related to the Swine flu outbreak of 2009. The reason we call it Spanish flu is because at the time of the outbreak in Europe, most countries were knee-deep in the trenches of World War One.

They were practising media suppression of anything that might make the enemy think they were weak; massive killer flu outbreaks included.

Spain was not involved in the Great War, so when people started coming down with a mystery bug, including King Alfonso XIII, the national media had a field day.

In other countries, this outbreak in Spain was reported in the news with no mention of what was happening locally, which made it seem unique to that country, and the name Spanish flu was born.

As you can imagine, the Spanish aren’t too happy about this. In Spain, it was referred to as Soldado de Napoles or ‘Soldier of Naples,’ after a song in a popular opera playing in Madrid.

The flu was said to be ‘as catchy’ as that tune by one reporter. But in reality the deadly H1N1 virus that swept the world had nothing to do with Spain, and could well have come from China like Covid-19, although there is also evidence it may have started in America, or even in the trenches in France.

1918 flu outbreak
Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C (Credit: Library of Congress).

I think we can all agree that sticking to the scientific name is best, as it avoids accidental racism, the blame-game and fear mongering that can come with these more casual monikers.

Something else we should all agree on is that information is a good thing. While many believe some media outlets are scaremongering, in 1918 many people caught and died of flu before their friends and family even knew what was happening.

At least none of us can say we are ignorant when it comes to Covid-19, and being well prepared is essential.

Like Covid-19, Spanish flu came from animals

In 1918, we didn’t even know what virus’ were. It wasn’t until the electron microscope was invented in the 1930s that we were able to see them for the first time.

Many medical types had hypothesized that there was something smaller than bacteria out there, with Russian botanist Dmitry Ivanovsky and Dutch microbiologist Martinus Beijerinck successfully demonstrating the existence of a such a pathogen with an experiment using tobacco plants in the late 1800s.

However, it was still unclear what a ‘virus’ actually was, and there was no way to identify it or treat it.

When people began falling foul of Spanish flu, all eyes turned to German bacteriologist Richard Pfeiffer, who had theorised that human flu was the result of a bacteria he modestly named Pfeiffer’s bacillus.

He undertook some research on samples, and hastily developed a vaccine. It is likely that the bacteria, present in lots – but not all – of the throats of flu victims sampled was a secondary infection.

Richard Pfeiffer
Richard Pfeiffer.

Confusingly then, the vaccine actually had mixed results with the positive responses fuelling support for its use. Now, 100 years later, we know the best way to treat a virus is with rest and fluids, and virologists have managed to map how the flu virus originated from birds.

In his memoir Flu Hunter, virologist Robert Webster remembers seeing birds, animals and humans in close quarters in Hong Kong back in the 1970s.

He had already identified flu virus’ in Mutton Birds off the coast of Australia, and had noted how although the birds remained largely unaffected by flu, they could easily spread it to animals who in turn could spread it to humans in a much more deadly form.

This is because virus’ adapt to survive, and over time make small changes to allow them to live in a new host, or avoid detection from the host’s immune system.

When Webster saw the bird and animal markets in China, he realised that this could be a place where virus’ could incubate, change and spread. In fact, his advice changed the way animals and birds were kept and sold in many markets across China and the rest of the world.

But we are a society that relies on farming, which means birds, animal and humans will always live in close quarters which increases the risk of novel virus’ developing.

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Social distancing reduced cases

During the Spanish flu pandemic, there was no global unified approach to fighting the spread. In fact, most countries had no public health system at all, and information was scarce and often misleading with a focus on continuing the war effort.

The way Spanish flu spread through the trenches on both sides is a key indicator of how crowded locations suffered more severe outbreaks.

On 12 October, a week after New York authorities had accepted they were in the midst of a mass outbreak of flu, President Woodrow Wilson was allowed to lead a procession of 25,000 people through the city to raise money for the war effort; 2000 people died from flu in New York city that same week.

Spanish flu
Emergency hospital during the Spanish flu in Kansas (Credit: Otis Historical Archives, National Museum of Health and Medicine)

Over in Western Samoa, a ship was allowed to dock with sick people on board, and 22% of the island population subsequently died.

Meanwhile, Japan notably had a much lower death toll than many other countries. This has been put down to the use of herbs to reduce fever and pain, a focus on fluids, and the cultural preference for people to rest when sick rather than the European notion you should ‘push through’.

Most Japanese self-isolated when symptoms came on, reducing the spread.

If Spanish flu has taught us anything, it is to look out for others. In 1918 we saw desperation, confusion and grief at the hands of Spanish flu, but we also saw communities pulling together and a move, politically, toward social care.

We saw how disease cuts through barriers of class, language and culture, leaving just our innate humanity behind.

We may have been raised on a Hollywood diet of movies and books that show society crumbling at the hands of a virus, but in reality all we have is each other.

We’ve achieved so much, together, in the last 100 years. Our ability to help and support our communities is what will see us through the next century.

Jaime Breitnauer is a British born writer and editor who divides her time between the UK and New Zealand. A graduate in History and Sociology, she has contributed to a wide variety of newspapers, magazines and journals. This is her first book. The Spanish Flu Epidemic and its Influence on History, £19.99, published by Pen and Sword.

Jaime Breitnauer