Lessons we can learn from the Spanish Flu outbreak of 1918

Often overlooked today in favor of World War II, the first World War was a global conflict the scale of which had never been seen at the time. Millions of French, German, British, and Russian soldiers passed away during the fighting, as well as over 100,000 Americans. 

Foolishly, when the war first started in the summer of 1914 most of the nations involved promised their citizens that it would be a quick and decisive contest, and predicted victory parades by Christmas. In reality, the vast majority of Europe was in store for four years of bloody and brutal warfare. By the time the Great War finally ended in 1918 all of the nations involved were ready for peace and a return to normalcy. Unfortunately, nature had other ideas. 

Just as the carnage finally came to an end, the most lethal modern strain of influenza reared its viral head. The Spanish flu’s origins are still debated to this day. Ironically, however, it’s universally agreed upon that it certainly didn’t come from Spain. The Spanish flu received its name simply because neutral Spain was the only country willing to openly report on the new deadly disease at the time. 

Wherever it came from, the Spanish flu wreaked havoc on an even larger scale than the war had, infecting an estimated one-fifth to one-third of the planet’s population and killing as many as 50 million people. World War I killed 17 million for comparison’s sake. 

All of this just goes to show that while the current COVID-19 pandemic is definitely a new challenge for today’s generation, it isn’t all that unique within the context of human history. From the black death in the middle ages to the cholera pandemic exactly 200 years ago, mankind has periodically been faced with such challenges. 

Fast forward to now, and we’ve all begun to self-isolate and hunker down in our homes for the foreseeable future. These social-distancing measures aren’t fun, there’s no getting around that, but a new analysis of Spanish flu mortality rates and statistics conducted by the Loyola University Health System has some reassuring news. These policies worked 100 years ago during the Spanish flu outbreak in the United States, and there’s no reason why they shouldn’t work again this time around.

Dr. Stefan E. Pambuccian, a Loyola Medicine cytologist, surgical pathologist, and professor & vice-chair of the Department of Pathology and Laboratory Medicine at Loyola University Chicago Stritch School of Medicine, analyzed three research projects from over 100 years ago that focused on the spread of the Spanish flu in the US.

According to his analysis, cities that quickly responded to the Spanish flu and enacted sweeping isolation and prevention measures saw much lower disease and mortality rates. Preventative strategies like school and church closures, mandatory mask-wearing in public, a ban on all mass gatherings and events, and strict hygiene practices were incredibly effective then, providing all the more reason to have faith we’re taking the right approach today. Cities that acted quickly, such as Kansas City, St. Louis, San Francisco, and Milwaukee, had 30-50% lower infection and mortality rates than other US cities that didn’t act in a timely manner.

Conversely, the city of Philadelphia failed to take swift action at the time and ended up suffering the highest death rate of any US city. Just 10 days after Philadelphia recorded its first case of Spanish flu, the city held a World War I victory parade that saw 200,000 residents gathered in close quarters on the street. In retrospect, that decision cost thousands of lives.

There’s a great deal of talk these days about “flattening the curve,” or the idea that social distancing isn’t going to completely stop COVID-19 but it will slow its spread enough for hospitals not to be overrun with new patients. Legitimizing this idea, Dr. Pambuccian’s work found that proactive cities during the Spanish flu pandemic saw a much greater delay before hitting “peak mortality.” These delays ultimately helped lower the overall mortality numbers in said cities.

“The stricter the isolation policies, the lower the mortality rate,” Dr. Pambuccian comments.

It’s estimated that 675,000 Americans died due to the Spanish flu, and just like today, there were a number of citizens at the time who were skeptical about the effectiveness of social distancing measures.

“There was skepticism that these policies were actually working,” Dr. Pambuccian adds. “But they obviously did make a difference.”

The US, and the rest of the world for that matter, are in a much better position today than we were 100 years ago to deal with a pandemic. Thanks to modern technology, an advanced understanding of viral diseases, and higher overall living quality, there are reasons to be optimistic. Nonetheless, however, social distancing is going to be key to beating this virus.

“Although the world is a much different place than it was 100 years ago, the efficacy of the measures instituted during the 1918-19 pandemic gives us hope that the current measures will also limit the impact of the COVID-19 pandemic,” Dr. Pambuccian concludes.

You probably heard it countless times from your history teachers growing up: “those who do not learn history are doomed to repeat it.” Well, history is telling all of us to stay home for the next few weeks, and it’s in all of our interests to heed its warning.

The full study can be found here, published in the Journal of the American Society of Cytopathology.