Why Was It Called the 'Spanish Flu?'

Why Was It Called the 'Spanish Flu?'


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In the spring of 1918, just as the man-made horrors of World War I were finally starting to wind down, Mother Nature unleashed the deadliest strain of influenza in modern history. The virus infected as much as 40 percent of the global population over the next 18 months. Of these, an estimated 20 to 50 million perished—more than the roughly 17 million people killed during the First World War. The pandemic’s grasp stretched from the United States and Europe to the remote reaches of Greenland and the Pacific islands. Its victims included the likes of President Woodrow Wilson, who contracted it while negotiating the Treaty of Versailles in early 1919.

As the pandemic reached epic proportions in the fall of 1918, it became commonly known as the “Spanish Flu” or the “Spanish Lady” in the United States and Europe. Many assumed this was because the sickness had originated on the Iberian Peninsula, but the nickname was actually the result of a widespread misunderstanding.

READ MORE: See all pandemic coverage here.

Spain was one of only a few major European countries to remain neutral during World War I. Unlike in the Allied and Central Powers nations, where wartime censors suppressed news of the flu to avoid affecting morale, the Spanish media was free to report on it in gory detail. News of the sickness first made headlines in Madrid in late-May 1918, and coverage only increased after the Spanish King Alfonso XIII came down with a nasty case a week later. Since nations undergoing a media blackout could only read in depth accounts from Spanish news sources, they naturally assumed that the country was the pandemic’s ground zero. The Spanish, meanwhile, believed the virus had spread to them from France, so they took to calling it the “French Flu.”

While it’s unlikely that the “Spanish Flu” originated in Spain, scientists are still unsure of its source. France, China and Britain have all been suggested as the potential birthplace of the virus, as has the United States, where the first known case was reported at a military base in Kansas on March 11, 1918. Researchers have also conducted extensive studies on the remains of victims of the pandemic, but they have yet to discover why the strain that ravaged the world in 1918 was so lethal.

READ MORE:

As the 1918 Flu Emerged, Cover-Up and Denial Helped It Spread

Why the Second Wave of the 1918 Spanish Flu Was So Deadly

Amid 1918 Flu Pandemic, America Struggled to Bury the Dead











Pandemics that Changed History


Spanish flu pandemic: Why is it called Spanish flu? How deadly was the pandemic of 1918?

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Spanish flu: Doctor warns deadly disease could make a return

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The great pandemic of 1918 was the deadliest disease in recent history, as of millions of people died from the deadly Spanish Flu.

Flu season in the UK generally lasts during the Winter-Spring months of a year and is marked by thousands of cases of traditional influenza infections.

Generally, the symptoms can knock people off their feet, confining them to their beds for up to a week, but fatalities are generally restricted to those with compromised immune systems.

The Spanish Flu however was an entirely new phenomenon, as the disease materialised seemingly out of nowhere and killed those in their prime.

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Spanish Flu was a strain of seasonal influenza which formed as an airborne virus with huge potential to spread around the world.

Diseases which become &lsquoairborne&rsquo are those which can spread via droplets which are sneezed or coughed up by people and thrown into the air.

People who breathe these droplets in then contract the disease and become sick.

Most of the time, airborne diseases aren&rsquot particularly deadly, as in order to become airborne diseases often have to trade off deadliness for enhanced transmission.

Spanish Flu was a different case, however, as it remained extremely deadly while also retaining the spread rate of seasonal flu.

Spanish Flu outbreak 1918- What was the Spanish Flu? (Image: GETTY)

Why was it called Spanish flu?

The disease was named Spanish Flu because of where cases first began to develop.

Exactly where the disease originated is unknown, but the first cases were discovered in Spain, where one of the early victims was King Alfonso XIII.

This resulted in quick worldwide press coverage, but many countries - including the UK - administered media blackouts to prevent morale being affected during World War One.

Spain was seemingly one of the only places with the flu, as no media coverage reported it in other countries, so it became known as &lsquoSpanish Flu&rsquo.

The origination of the disease is thought to be from the trenches of the First World War, when soldiers returned to civilisation.

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Spanish Flu outbreak 1918- Nurses care for scores of victims (Image: GETTY)

How deadly was the great pandemic of 1918?

The pandemic in 1918 saw 500 million people infected as the flu swept the planet, a whole third of the world&rsquos population.

Spanish Flu struck in waves between 1917 and 1918 period, with milder infections at first before two other waves which were much more deadly.

In the UK, the disease is thought to have been caused from returning troops travelling home via train, allowing the disease to spread into major cities and travel hubs.

At least 50 million people were killed worldwide in the pandemic, and a quarter of the British population was infected, with 228,000 dead.

Spanish Flu outbreak 1918- Masked nurse treats patients in Washington (Image: GETTY)

The disease infected a completely different segment of the population to seasonal flu, being most prevalent in healthy people aged 20 to 30 years old.

This is unusual for the flu, which commonly strikes those youngest or oldest with weaker immune systems.

With these being primary infected populations, life expectancy in the USA massively declined.

Life expectancy fell by more than a decade in the one year the disease gripped the USA, by 12 years, to 36.6 years for men and 42.2 for women.

Scientists later confirmed the Spanish Flu was caused by a H1N1 virus (swine flu) and was prominent in the world for another 38 years.


What caused the Spanish flu?

The outbreak began in 1918, during the final months of World War I, and historians now believe that the conflict may have been partly responsible for spreading the virus. On the Western Front, soldiers living in cramped, dirty and damp conditions became ill. This was a direct result of weakened immune systems from malnourishment. Their illnesses, which were known as "la grippe," were infectious, and spread among the ranks. Within around three days of becoming ill, many soldiers would start to feel better, but not all would make it.

During the summer of 1918, as troops began to return home on leave, they brought with them the undetected virus that had made them ill. The virus spread across cities, towns and villages in the soldiers' home countries. Many of those infected, both soldiers and civilians, did not recover rapidly. The virus was hardest on young adults between the ages of 20 and 30 who had previously been healthy.

In 2014, a new theory about the origins of the virus suggested that it first emerged in China, National Geographic reported. Previously undiscovered records linked the flu to the transportation of Chinese laborers, the Chinese Labour Corps, across Canada in 1917 and 1918. The laborers were mostly farm workers from remote parts of rural China, according to Mark Humphries' book "The Last Plague" (University of Toronto Press, 2013). They spent six days in sealed train containers as they were transported across the country before continuing to France. There, they were required to dig trenches, unload trains, lay tracks, build roads and repair damaged tanks. In all, over 90,000 workers were mobilized to the Western Front.

Humphries explains that in one count of 25,000 Chinese laborers in 1918, some 3,000 ended their Canadian journey in medical quarantine. At the time, because of racial stereotypes, their illness was blamed on "Chinese laziness" and Canadian doctors did not take the workers' symptoms seriously. By the time the laborers arrived in northern France in early 1918, many were sick, and hundreds were soon dying.


Why Was the Spanish Flu Called the "Spanish Flu"?

Seeing we're unfortunately in the middle of a pandemic, I figured now would be a good time to learn a little about the last pandemic that rocked the United States (and the world), the Spanish flu. We can sit and debate whether Trump should be calling the current coronavirus "the Chinese virus" all day long, but technically, he's not wrong, it came from China. However, the Spanish Flu, which killed 17 million to 50 million, and possibly as high as 100 million, did not start in Spain, so whats the deal?

Well when the 1918 Flu pandemic first kicked off, World War 1 was in full swing and troops on both sides of the conflict started dropping like flies. Not wanting to demoralize their military and civilians back home, the governments of USA, UK, France, and Germany all made the media censor reports of how bad the pandemic was in their respective countries. Spain, however, was neutral in WW1 so their media freely publicized the havoc that the flu was wreaking making it seem like the disease was much worse there and leading everyone to start calling it "The Spanish Flu".

To this day experts still aren't sure where it originated with a military camp in Kansas, the UK, and China all being possible contenders, but they do know it didn't start in Spain.

Some other "fucked facts" about the Spanish Flu:

1. It killed more people than all WW1 battles combined.

2. The 1st Wave of the pandemic was fairly mild, mainly only affecting people who were already sick and the elderly. The 2nd wave in the autumn of 1918, however, killed mostly people between the ages of 20-40 who had been completely healthy beforehand. In fact, people below the age of 65 accounted for 99% of all flu fatalities. Some experts think this was caused by the immune systems of healthy young individuals over reacting to the virus.

3. The flu came to an abrupt end.

(Wikipedia) In Philadelphia, for example, 4,597 people died in the week ending 16 October, but by 11 November, influenza had almost disappeared from the city.

One explanation for this is that the virus mutated extremely rapidly to a less lethal strain. This happens a lot with viruses because the hosts of the most deadly strains die out before they even have a chance to spread it. Don't count on this happening with Covid19 tho as it appears a bunch of people don't even show symptoms when they get it, making it particularly hard to contain.

4. The Spanish flu lead to the 1919 Stanley Cup between the Seattle Metropolitans and the Montreal Canadiens being called off after Canadiens defenseman Joe Hall collapsed on the ice in game 5 and later died from the Flu. No team would win the Stanley cup that year.

Ok this is getting depressing so I'm gonna stop. In brighter news, next week or the week after I'm going to be launching an animated "Donnie Does History" series. Each episode will be a 4 minute cartoon of me explaining some of the wildest stories from history I've come across. I originally made a pilot for the series a year ago with an animator friend of mine.

Barstool wanted me to use in-house animators tho so now Milmore and Katherine Mooney are helping me bring the series to life! First episode will be on the history Magic Mushrooms. Stay tuned.


What were the symptoms of the Spanish flu?

Most of the people that caught the Spanish flu had mild symptoms or no symptoms at all. But a percentage became seriously ill.

In the beginning, the epidemic startled doctors since the sick were reporting so many symptoms.

Some patients had chills, fever, sore throat, difficulty breathing, cough, and headache. So their illness was recognized as a type of flu.

But other patients with the same disease would bleed through the nose, ears, and even eyes. A German researcher wrote that “hemorrhages occurring in different parts of the interior of the eye” were frequent.

The hardest-hit victims coughed blood and other secretions from the lungs.

Many patients turned blue due to the lack of air within hours of the onset of the symptoms. That turning blue is called cyanosis. And then they would abruptly die of either bacterial or viral pneumonia (pneumonia is lung inflammation).

Others yet presented paralysis, and even emotional-mental symptoms like depression or suicidal tendencies.

Hemorrhages, coughing blood, cyanosis, paralysis, mental issues were not usual symptoms of the flu. Plus, most of the victims were young men. And young men do not tend to die from the flu.

So what was this? And why did some patients only have flu-like symptoms while others developed other conditions?

A doctor of Camp Devens, a military camp near Boston which was hit by the pandemic during the Fall of 1918, wrote on September 29:

“These men start with what appears to be an ordinary attack of… influenza, and when brought to the hospital ,they very rapidly develop the most vicious type of pneumonia that has ever been seen… and a few hours later, you can begin to see the cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes… It is horrible… We have been averaging about 100 deaths per day… Pneumonia means in about all cases death…

Meanwhile, the chief pathologist of New York City’s Health Department said: “Cases with intense pain look and act like cases of dengue… hemorrhage from nose or bronchi… paresis or paralysis of either cerebral or spinal origin… impairment of motion may be severe or mild, permanent or temporary… physical and mental depression… led to hysteria, melancholia, and insanity with suicidal intent.”


The so-called "Spanish" flu

Did a cook from a US military training base cause the great flu pandemic of 1918?

'Tis the season for pandemic paranoia. Just when you thought you'd forgotten what SARS stands for, dire warnings of an avian-generated flu outbreak are spreading faster than the disease itself. If the epidemiologists in question are correct, the planet may soon be ravaged by a devastating plague.

The flu strain in question, the innocuous-sounding H5N1, has already killed some 65 people in Asia, to say nothing of the millions of chicken, geese and ducks who've met their makers as a result. To make matters worse, dead birds have started popping up in Europe as well. Some World Health Organization estimates put the potential number of deaths from anywhere between two to seven million, should a pandemic occur, with the possibility of a virulent outbreak leading to more than 100 million deaths. Of course, fearsome media coverage of worst-case scenarios and predictions of vaccine shortages are helping to fuel concerns. But perhaps we can take some comfort in the fact that, whatever transpires this flu season, we've come a long way since the mother of all flu years: 1918.

When the so-called Spanish flu hit in the spring of that year, things were already looking a little suspicious. Normally, the flu season lasts from October to March and those who succumb to it are predominantly young children, the weak and the elderly. This flu, however, reared its ugly head months later than usual and proved to be most lethal to otherwise healthy adults, aged 20 to 40. Within 18 months, the killer virus vanished almost as suddenly as it had appeared. But before it ran its course, more than 50,000 Canadians and 675,000 Americans had succumbed to it. More dramatic still, it quickly circled the globe in multiple deadly waves, killing between 40 and 50 million people, perhaps more.

But where did it begin and how? The most common name for the killer virus, the Spanish flu, implied, of course, that it originated in Spain. Perhaps this was because there were serious outbreaks in both Madrid and Seville that infected eight million people in May of 1918 alone, even almost taking out the king himself, Alfonso XIII. But, more likely, Spain had this fatal flu named in its honour because of the freedom enjoyed by the Spanish press at the time. Because of its neutral position in World War I, Spain was not subject to wartime censorship, which in turn meant that the press could freely and passionately report on the extent of local outbreaks. This widespread coverage mistakenly gave the world the impression that the flu was more prevalent there than anywhere else.

The real geographical culprit, however, was not Spain, where the virus in question was actually most often referred to as the "French Flu." And, unlike the other serious but less deadly influenza pandemics that followed -- the Asian flu of 1957 and the Hong Kong flu of 1968 -- the site of the very first confirmed outbreak was not China, but the good old U. S. of A. The first known victim was an American soldier who also happened to be responsible for food preparation at his army training camp and may have unintentionally spread the sickness Typhoid-Mary style.

PATIENT ZERO
Camp Funston was situated within Fort Riley, Kansas, a military training facility housing 26,000 or so doughboys-to-be, the young men packed into barracks on 8100 cold and remote hectares. Soldiers dreaded the frigid winters and the gruelling hot summers as much as the severe dust storms in between. Still, their ultimate destination was far less pleasant the Great War had been waging in the muddy trenches and foxholes of Europe for four long years. Right before spring, however, hell hit a little closer to home.

On Monday, March 11, 1918, mess cook Private Albert Gitchell awoke feeling achy and hot, his throat burning terribly. It would prove to be more than just your average case of the Mondays. Gitchell suited up and dragged himself down to the infirmary where the medic on duty realized this was no ploy to get out of serving up hard bread and bad coffee. With a fever over 103°F, Gitchell had chills as well as aches and pains just about everywhere.

As a precaution, Gitchell was ordered to the tent reserved for soldiers with potentially contagious conditions. But nothing could change the fact that Gitchell had been serving up meals to soldiers until the previous evening. A few hours after the cook was admitted, Corporal Lee Drake came in with almost identical symptoms. Then, Sergeant Adolph Hurby showed up. He too had frighteningly similar complaints. One by one, men with fevers of 104°F, blue faces and horrendous coughs made their way to the infirmary. By midday, Camp Funston had 107 cases of the flu, a total of 522 reported within the first week alone, and a staggering 1127 by the time April rolled around. In the end, 46 of those afflicted at Fort Riley died.

Though the situation was unusual, both the government and the military were distracted by the war effort. Officials called it a pneumonia outbreak and chalked it up to the strange combination of conditions in Fort Riley that week. Not only had the camp been shrouded in a vicious prairie dust storm, soldiers had been breathing in something even more noxious: putrid black ash created by tons of burning manure courtesy of the camp's thousands of horses and mules. In retrospect, the fact that countless swine and poultry were also living in close proximity to the soldiers may be a more likely place to lay blame since pigs can be susceptible to avian influenza viruses -- those strains responsible for most serious forms of flu -- which can then mutate and be transmitted to humans.

CATCH THE WAVE
As Camp Funston neared recovery from the outbreak, crowds of coughing American soldiers, many barely over this mysterious flu, were shipped off to Europe to live in even more cramped quarters. And, unfortunately, they brought the Spanish flu with them, spreading it first to France, England, Germany and then Spain. It followed not only the movements of the troops, but also travelled rapidly along shipping and trade routes throughout the world. By the end of the pandemic, only one major region on the entire planet had not reported an outbreak: an isolated island called Marajo, located in Brazil's Amazon River delta.

In September 1918, a second wave of the epidemic hit North America and this time it could not be ignored. It had mutated since its Fort Riley appearance and was now deadlier than ever. First, soldiers began dying at military bases around Boston, whose bustling port was working hard to manage all the much-needed war shipments. New shipments of soldiers brought the mutated form of the virus back to Europe, where more soldiers on both sides were felled by the flu than by enemy fire. It's no wonder. Crowded and unsanitary living conditions, damp trenches, and weakened immune systems proved the perfect breeding ground for the killer flu. At home, things were just as bad for civilians. By October, the domestic death toll reached staggering heights: some 200,000 Americans died in that month alone, with millions more infected. With the end of the war in November came a third wave of disease for the US and Canada as victory parades and massive parties spread yet another round of the fearsome flu.

CONSPIRACY THEORIES
Unfortunately, not much was known or understood at the time about the nature or spread of the epidemic. Governments imposed curfews, suggested masks be worn and banned public gatherings, but all bets were off when it came to celebrating V-Day. Allied countries suggested that the Germans and their new biological weapons -- namely, mustard gas -- were to blame, or perhaps it was just the damp winter weather of Europe. At one point, members of the American government even suggested that the popular new "wonder-drug," Aspirin, and its German drug-company manufacturer, Bayer, were to blame in some sort of smallpox-infected-blanket-type scheme. Of course they were way off, since Aspirin was one of the things that actually helped flu sufferers find relief!

In his own way, Albert Gitchell and others like him contributed to the war effort, though to which side is debatable. The flu he had was so devastating that few would disagree it was a significant factor contributing to the end of World War I. Weary governments and troop shortages on both sides made it pretty hard to fight the good fight.

To be fair to poor Albert Gitchell, there is another current school of thought, which actually links the 1918 Spanish flu to an earlier outbreak that winter in the Canton Province of China, one which possibly remained unknown and unreported because of its remote location and inadequate record keeping. The theory suggests that Chinese workers then brought the virus to France, where they were digging trenches for the French Army. Whatever its cause or origins, the frightening flu of 1918 was a bird of a different feather. So this fall, as you try to curb your patients' panic and we all take the wait-and-see approach with regards to avian flu H5N1, it couldn't hurt to have a back-up plan.

Anyone got tickets to Marajo?

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The 1918 "Spanish flu" in Spain

The 1918-1919 influenza pandemic was the most devastating epidemic in modern history. Here, we review epidemiological and historical data about the 1918-1919 influenza epidemic in Spain. On 22 May 1918, the epidemic was a headline in Madrid's ABC newspaper. The infectious disease most likely reached Spain from France, perhaps as the result of the heavy railroad traffic of Spanish and Portuguese migrant workers to and from France. The total numbers of persons who died of influenza in Spain were officially estimated to be 147,114 in 1918, 21,235 in 1919, and 17,825 in 1920. However, it is likely that >260,000 Spaniards died of influenza 75% of these persons died during the second period of the epidemic, and 45% died during October 1918 alone. The Spanish population growth index was negative for 1918 (net loss, 83,121 persons). Although a great deal of evidence indicates that the 1918 A(H1N1) influenza virus unlikely originated in and spread from Spain, the 1918-1919 influenza pandemic will always be known as the Spanish flu.


Spanish flu: the virus that changed the world

In spring 1918 a disease began to sweep around the planet – a lethal virus that infected a third of the world's population and left upwards of 50 million dead. Laura Spinney explores the devastating impact of the Spanish flu pandemic and how it compares to the Coronavirus crisis

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Published: March 2, 2021 at 1:00 pm

The Spanish flu pandemic of 1918–20 infected a third of the global population and left at least 50 million people dead – a greater number, possibly, than the Second World War. Explore the dramatic effects of the outbreak here, including the ways in which the world struggled to come to terms with the disease – medically, socially and politically…

  • How many people died from Spanish Flu?
  • Why was it called ‘Spanish Flu’?
  • How did Spanish Flu spread? And who did it affect?
  • Political aftermaths of Spanish Flu
  • How does Spanish Flu compare to Coronavirus?

Where did Spanish flu originate?

One of the few certainties we have about the Spanish Flu Pandemic is that it didn’t start in Spain. We actually don’t know where it did start – but we know it didn’t start in Spain. The Spanish felt, and to a very great degree were, stigmatised by this.

There is also no way of being certain where Spanish Flu originated, although the trenches of the First World War, where poor sanitation and disease was rife, are an often-cited contender. The filthy, rat-infested conditions undoubtedly affected the soldiers’ immune systems, making them more vulnerable to illness.

It is thought the first cases were in military forts in the United States before spreading at an alarming rate to Europe. But yet the pandemic was called ‘Spanish Flu’ – again, a result of the war.

Wartime censorship exaggerated the affects of the virus in Spain. While Britain, France, Germany and the United States censored and restricted early reports, papers in Spain – as a neutral country – were free to convey all the horrid details of the pandemic.

This made it look much worse there, so the unfortunate name spread with the disease around the world.

Monday 4 March 1918: the day Spanish Flu strikes the world

Written by Dominic Sandbrook

When Private Albert Gitchell awoke on Monday 4 March 1918, he felt awful. A company cook at Fort Riley, Kansas, Gitchell was supposed to be serving breakfast to hundreds of young American recruits, who were waiting to be shipped off to the battlefields of France. But when the doctors had a look at him, they realised that, with a temperature of more than 103, Gitchell was in no state to work in the mess.

A few hours later, another man, Corporal Lee Drake, appeared at the infirmary with similar symptoms. Then another, Sergeant Adolph Hurby. Still the men kept coming: there were 107 by lunchtime and more than 500 by the end of the week. By the end of the month, no fewer than 1,127 men at Fort Riley had come down with flu – and 46 of them had died.

In the next few months, as American soldiers flooded into Europe, they brought the deadly influenza with them. With vast armies surging across an exhausted continent, the conditions were perfect for a pandemic. This was one of history’s deadliest disasters. Across the world, some 500 million people had been struck down by flu by the end of 1920, perhaps 100 million of them fatally.

Many governments banned public gatherings or buried the victims in mass graves. Reporting restrictions in the combatant nations meant that the disease’s progress in neutral Spain drew disproportionate attention: hence its nickname, Spanish flu. Only one populated part of the world reported no cases at all: the island of Marajo, at the mouth of the Amazon.

How many people died from Spanish flu?

The Spanish flu was one of the deadliest disasters in history. It lasted for two years – between the first recorded case in March 1918 and the last in March 1920, an estimated 50 million people died, though some experts suggest that the total might actually have been twice that number.

The ‘Spanish flu’ killed more than the First World War, possibly more even than the Second World War – indeed, perhaps more than both put together.

The pandemic struck at a critical juncture in the evolution of understanding of infectious disease. Well into the 19th century, epidemics were considered acts of god – a notion that dated back to the Middle Ages. Bacteria were first observed in the 17th century, but initially weren’t connected with human illnesses. In the late 1850s the French biologist Louis Pasteur made the connection between micro-organisms and disease, and from a couple of decades later German microbiologist Robert Koch furthered modern concepts of infectious disease. ‘Germ theory’ was disseminated far and wide, slowly replacing more fatalistic ideas.

By the 20th century the application of germ theory, combined with improvements in hygiene and sanitation, had made significant inroads against the so-called ‘crowd’ diseases that afflicted human communities, especially those inhabiting the great cities that had mushroomed in the wake of the industrial revolution. Throughout the 19th century, so many urbanites had been lost to such diseases – cholera, typhus and tuberculosis, to name but three – that cities needed a steady influx of healthy peasants from the countryside to keep up their numbers. Now, at last, they had become self-sustaining.

By 1918, then, faith in science was high, and some scientists had even adopted a certain swagger. Twelve years earlier, this had prompted the Irish playwright George Bernard Shaw to write The Doctor’s Dilemma, in which an eminent doctor, Sir Colenso Ridgeon – a character based on Sir Almroth Wright, who developed the typhoid vaccine – plays god with his patients’ destinies. Shaw was warning doctors against hubris, but it took an outbreak of another ‘crowd’ disease – influenza – to bring home to them just how little they knew.

When scientists thought about ‘germs’ in the early 20th century, they generally thought about bacteria. The virus was a novel concept the first virus, discovered in 1892, infected tobacco plants and had been detected indirectly by its ability to transmit disease. Unlike many bacteria, it was too small to be seen through an optical microscope. Without having actually seen viruses, scientists debated their nature: were they organism or toxin, liquid or particle, dead or alive? They were veiled in mystery, and nobody suspected that they could be the cause of flu.

During the previous flu pandemic – the so-called ‘Russian’ flu, which began in 1889 – a student of Koch’s named Richard Pfeiffer claimed to have identified the bacterium that caused the flu. Pfeiffer’s bacillus, as it became known, does exist and does cause disease – but it does not cause flu. During the 1918 pandemic, pathologists who cultivated bacterial colonies from the lung tissue of flu victims found Pfeiffer’s bacillus in some, but not all, of their cultures, and this puzzled them. To add to doctors’ puzzlement, vaccines created against Pfeiffer’s bacillus seemed to benefit some patients. In fact, these vaccines were effective against secondary bacterial infections that caused pneumonia – the ultimate cause of death in many cases – but scientists didn’t know that at the time. They would realise their mistake too late.

Why was it called ‘Spanish flu’?

The Russian flu had acquired its name because it was thought to have originated in Bukhara in Uzbekistan (at that time, part of the Russian empire). The pandemic that broke out nearly 30 years later will always be known as the ‘Spanish flu’, though it didn’t start in Spain.

It washed over the world in three waves which, in the northern hemisphere, corresponded to a mild wave in the spring of 1918, a lethal wave the following autumn, and a reprisal in the early months of 1919 that was intermediate in virulence between the other two. The first cases were officially recorded in March 1918 at Camp Funston, a military base in Kansas. Within six weeks the disease had reached the trenches of the western front in France, but it wasn’t until May that the flu broke out in Spain.

Unlike the United States and France, Spain was neutral in the war, so it didn’t censor its press. The first Spanish cases were therefore reported in the newspapers, and because King Alfonso XIII, the prime minister and several members of the cabinet were among those early cases, the country’s plight was highly visible. People all over the world believed that the disease had rippled out from Madrid – a misconception encouraged by propagandists in those belligerent nations that knew they’d contracted it before Spain. In the interests of keeping morale high in their own populations, they were happy to shift the blame. The name stuck.

Understandably, Spaniards smarted at this calumny: they knew they were not responsible, and strongly suspected the French of having sent the flu across the border, but they couldn’t be sure. They cast around for a different label, and found inspiration in an operetta performed at the capital’s Zarzuela Theatre – a hugely popular reworking of the myth of Don Juan, featuring a catchy tune called ‘The Soldier of Naples’. The catchy disease became known in Spain as the ‘Naples Soldier’.

But though the Spanish flu didn’t start in Spain, that country did suffer quite badly with it. In the early 20th century, flu was viewed as a democratic disease – nobody was immune from it – but, even in the thick of the pandemic, it was noted that the disease struck unevenly. It ‘preferred’ certain age groups: the very young and the elderly, but also a middle cohort aged 20 to 40. It preferred men to women, with the exception of pregnant women, who were at particularly high risk.

These age and gender-related patterns were repeated all over the world, but the virulence with which the flu struck also varied from place to place. Inhabitants of certain parts of Asia were a staggering 30 times more likely to die from the flu than those in parts of Europe. In general, Asia and Africa suffered the highest death rates, with the lowest seen in Europe, North America and Australia. But there was great variation within continents, too. African countries south of the Sahara experienced death rates two or even three times higher than those north of the desert, while Spain recorded one of the highest death rates in Europe – twice that in Britain, three times that in Denmark.

The unevenness didn’t stop there. In general, cities suffered worse than rural areas, but some cities suffered worse than others, and there was also variation within cities. Newly arrived immigrants tended to die more frequently than older, better-established groups, for example. In the countryside, meanwhile, one village might be decimated while another, apparently similar in every way, got away with a light dose.

Why Spanish flu isn’t a ‘flu’ at all…

On 28 September 1918, a Spanish newspaper gave its readers a short lesson on influenza. “The agent responsible for this infection,” it explained, “is the Pfeiffer’s bacillus, which is extremely tiny and visible only by means of a microscope.”

The explanation was timely, because the world was in the grip of the most vicious flu pandemic on record – but it was also wrong: flu is caused by a virus. Unfortunately, it wasn’t just one Spanish newspaper that had misidentified the causative agent of the disease. The idea that flu was caused by a bacillus, or bacterium, was accepted by the most eminent scientists of the day, who would find themselves almost entirely helpless in the face of the scourge.

How did Spanish flu spread? And who did it affect?

The flu seemed to strike with an element of randomness, and cruelly so. Because adults in the prime of life died in droves, unlucky communities imploded. Children were orphaned, elderly parents left to fend for themselves. People were at a loss to explain this apparent lottery, and it left them deeply disturbed. Attempting to describe the feeling it inspired in him, a French doctor in the city of Lyons wrote that it was quite unlike the “gut pangs” he had experienced while serving at the front. This was “a more diffuse anxiety, the sensation of some indefinable horror which had taken hold of the inhabitants of that town”.

It was only later, when epidemiologists zeroed in on the numbers, that patterns began to emerge, and the first elements of an explanation were put forward. Some of the variability could be explained by inequalities of wealth and caste – and, to the extent that it reflected these factors, skin colour. Bad diet, crowded living conditions and limited access to healthcare weakened the constitution, rendering the poor, immigrants and ethnic minorities more susceptible to infection. As French historian Patrick Zylberman put it: “The virus might well have behaved ‘democratically’, but the society it attacked was hardly egalitarian.”

Any other underlying disease made a person more susceptible to the Spanish flu, whereas prior exposure to the flu itself modulated the severity of a case. Remote communities without much historical experience of the disease suffered badly, as did cities that were bypassed by the first wave of the pandemic, because they were not immunologically ‘primed’ to the second. For example, Rio de Janeiro – capital of Brazil at the time – received only one wave of flu, in October 1918, and experienced a death rate two or three times higher than that recorded in American cities to the north that had received both the spring and autumn waves. And Bristol Bay in Alaska was spared until early 1919, but when the virus finally gained a foothold it reduced the bay’s Eskimo population by 40%.

Public health campaigns made a difference, despite the fact that medics did not understand the cause of the disease. Since time immemorial, whenever contagion is a threat humans have practised ‘social distancing’ – understanding instinctively that steering clear of infected individuals increases the chance of staying healthy. In 1918, social distancing took the form of quarantine zones, isolation wards and prohibitions on mass gatherings where they were properly enforced, these measures slowed the spread. Australia kept out the autumn wave entirely by implementing an effective quarantine at its ports.

Exceptions proved the rule. In 1918 Persia was a failed state after years of being used as a pawn in the ‘Great Game’ – the struggle between the British and the Russians for control of the vast area between the Arabian and Caspian Seas. Its government was weak and nearly bankrupt, and it lacked a coherent sanitary infrastructure, so when the flu erupted in the north-eastern holy city of Mashhad in August 1918, no social distancing measures were imposed.

Within a fortnight every home and place of business in Mashhad was infected, and two-thirds of the city’s population fell sick that autumn. With no restrictions on movement, the flu spread outwards with pilgrims, soldiers and merchants to the four corners of the country. By the time Persia was again free of flu, it had lost between 8% and 22% of its population (that uncertainty reflecting the fact that, in a country in crisis, gathering statistics was hardly a priority). By way of comparison, even 8% equates to 20 times the flu-related mortality rate in Ireland.

Where disparities in rates of illness and death were perceived, people’s explanations reflected contemporary understanding – or, rather, misunderstanding – of infectious disease. When Charles Darwin laid out his theory of evolution by natural selection in On the Origin of Species (1859), he had not intended his ideas to be applied to human societies, but others of his time did just that, creating the ‘science’ of eugenics. Eugenicists believed that humanity comprised different ‘races’ that competed for survival, and by 1918 their thinking was mainstream in industrialised societies. Some eugenicists noted that poorer sectors of society were suffering disproportionately from the flu, which they attributed to a constitutional inferiority. They had also incorporated germ theory into their world view: if the poor and the working classes were more prone to infection, reasoned the eugenicists, they only had themselves to blame, because Pasteur had taught that infection was preventable.

The terrible consequences of this line of thinking are illustrated nowhere better than in India. That land’s British colonisers had long taken the view that India was inherently unhygienic, and so had invested little in indigenous healthcare. As many as 18 million Indians died in the pandemic – the greatest loss in absolute numbers of any country in the world. But there would be a backlash. The underpowered British response to the spread of flu fuelled resentment within the independence movement. Tensions came to a head with the passing into law in early 1919 of the Rowlatt Act, which extended martial law in the country. This triggered peaceful protests, and on 13 April British troops fired into an unarmed crowd in Amritsar, killing hundreds of Indian people – a massacre that galvanised the independence movement.

The political aftermath of Spanish Flu

The Spanish flu prompted uprisings elsewhere. The autumn of 1918 saw a wave of workers’ strikes and anti-imperialist protests across the world. Disgruntlement had been smouldering since before the Russian revolutions of 1917, but the flu fanned the flames by exacerbating what was already a dire supply situation, and by highlighting inequality. Even well-ordered Switzerland narrowly avoided a civil war in November 1918 after leftwing groups blamed the high number of flu deaths in the army on the government and military command.

There were still parts of the world where people had never heard of either Darwin or germ theory, and where the population turned to more tried-and-tested explanations. In the rural interior of China, for example, many people still believed that illness was sent by demons and dragons they paraded figures of dragon kings through the streets in the hope of appeasing the irate spirits. A missionary doctor described going from house to house in Shanxi province in early 1919, and finding scissors placed in doorways – apparently to ward off demons “or perchance to cut them in two”.

Even in the modernised west, people vacillated. Death often seemed to strike without rhyme or reason. Many still remembered a more mystical, pre-Darwinian era, and four years of war had worn down psychological defences. Seeing how ill-equipped their men of science were to help them, many people came to believe that the pandemic was an act of god – divine retribution for their sins. In Zamora – the same Spanish city whose newspaper stated with such confidence that the agent of disease was Pfeiffer’s bacillus – the bishop defied the health authorities’ ban on mass gatherings and ordered people into the churches to placate “God’s legitimate anger”. This city subsequently recorded one of the highest death tolls from flu in Spain – a fact of which its inhabitants were aware, though they don’t seem to have held it against their bishop. Instead they awarded him a medal in recognition of his heroic efforts to end their suffering.

This exemplifies how responses to the flu reflected gulfs in understanding. The 1918 pandemic struck a world that was entirely unprepared for it, dealing a body blow to scientific hubris, and destabilising social and political orders for decades to come.

Laura Spinney is a journalist and the author of Pale Rider: The Spanish Flu of 1918 and How it Changed the World, (Jonathan Cape, June 2017).

How does Spanish flu compare to Coronavirus?

In an episode of the HistoryExtra podcast recorded in spring 2020, Laura Spinney expanded on how the Spanish Flu pandemic statistics stack up against the early data recorded about Covid-19.

“You might have seen a figure floating around of a case fatality rate of 3.4 per cent, which refers to the proportion of people who catch the Covid-19 infection who go on to die of it,” she explained. “The number that’s often quoted for the Spanish Flu fatality rate is 2.5 per cent – but it’s a very controversial figure because the numbers are so vague.

“We think that (probably) 50 million people died of Spanish Flu, but there was no form of reliable test at the time, so we can’t be sure about that and that just throws all the numbers out.

“So it’s really difficult to make the historical comparisons, even if you have accurate data now. On both sides of the equation, if you like, it’s a moving target.”


Did the 1918 Influenza Outbreak Really Begin in Spain?

Followed by outbreaks of the “Asian flu” in 1957 and the “Hong Kong flu” in 1968, the 1918 pandemic spurred decades-long disagreements among scientists over how the novel influenza virus formed. For years, some believed the genes of the H1N1 virus morphed from an already-circulating human virus, while others argued that the disease grew from some sort of bird flu. Citing studies that involved excavating and analyzing body tissue from the pandemic’s victims, the Centers for Disease Control and Prevention (CDC) has affirmed the latter research.

While the genetics of the virus are largely undisputed, the exact location where it began infecting humans is not. The U.S. recorded its first patients in the spring of 1918, all of whom were military men fighting in WWI. Almost simultaneously, in March and April, health officials in other parts of North America and across Europe and Asia reported cases, too, according to virologists.

But newspapers recorded the outbreak differently — and wartime censorship was to blame. In an attempt to keep spirits high among Allied and Central Powers countries, newspapers in those countries did not fairly report on the outbreak’s toll. Meanwhile, in Spain, one of only a few European countries to remain neutral in the war, officials talked more openly about how patients were dying from the novel virus.

“ [Spain] could report on the severity of the pandemic, but countries fighting the war were suppressing reports on how the disease affected their populations,” according to BioSpace , a news site for scientific advancements.

The resulting nickname, “Spanish flu,” did not go over well in Spain. Medical professionals and officials protested that its people were being inappropriately stigmatized. In an Oct. 1, 1919, “Letter from Madrid” published in the Bulletin of the American Medical Association, an official said the outbreak in Spain was brief and subsided with little impact, according to a 2020 story by The Washington Post . Spaniards at the time called the infectious disease “The Soldier of Naples,” after a popular song at the time, or referred to it as the “French flu”, asserting French tourists brought the illness to Madrid.

But the news media and popular culture drowned out the complaints from Spain. “The disease also became known as ‘The Spanish Lady,'” the Post story reported. “A popular poster showed a skeleton-like woman, clad in a veil and a long, dark dress, holding a handkerchief and a Flamenco fan. One implication was that she was a prostitute, spreading her infection worldwide.”

The Associated Press, too, has called the common name for the 1918 pandemic unfair. “‘Spanish’ flu is a misnomer, and the strain is theorized to have actually developed in Kansas,” a 2018 Associated Press story read . “America’s troop mobilization in World War I spread the disease across the country and eventually into Europe once deployed. Stateside military encampments, with their crowded and often unsanitary quarters, became hotbeds of disease.”

Other research has tied the origin of the global outbreak to the East Coast — New York, specifically. But scientists overall remain indecisive. “ The origin of this pandemic has always been disputed and may never be resolved,” Dr. Edwin D. Kilbourne, a flu vaccine expert, said in a 2006 study .

By the end of 1920, the virus had spread across the globe, even infecting people on remote islands of the Pacific Ocean and rural Alaska. And, still, a century later, scientists not only question the outbreak’s origin but also what properties of the influenza strain made it so deadly.


INTRODUCTION

The Spanish Influenza pandemic is one of the most lethal pandemics of the Modern Age. The number of deaths which it produced throughout the world has been estimated at 21.5 million (Jordan, 1927) and 39.3 million (Patterson and Pyle, 1991). Other researchers have proposed even higher figures, which seem to be somewhat excessive. Nevertheless, the appearance and development of the Spanish Influenza continue to present a number of unanswered questions (Phillips and Killingray, 2003 Gualde, 2006), which should be addressed in the light of the new influenza pandemics which have appeared at the beginning of the present XXI century, including the avian influenza and the swine influenza [A/swine (H1N1)], which are considered by some, such as Taubenberger et al (2005, 2006) or Smith et al (2009), to be directly related to the Spanish Influenza.

The first pandemic wave, which was benign and caused few deaths, took place in the spring of 1918. After a period of calm at the beginning of the summer of 1918, the virus mutated, becoming extremely virulent, and simultaneously caused millions of deaths throughout the world during the following months of October and November. A milder third wave occurred during the initial months of 1919, while the fourth and final wave spread during the first months of 1920. The majority of those who died were young, healthy adults between the ages of 15 and 44. Mortality rates varied between countries and continents, but mortality in Europe has been estimated to be 1.1% (Ansart et al, 2009) and 1.2% (Erkoreka, 2006).

Our principal concern here is to establish where, when and under what circumstances the pandemic began. Did it really begin in the Spring-Summer of 1918 or were there previous episodes related to the great pandemic, which constitute its prehistory?


Episode 124: The “Spanish” Influenza of 1918-1920

In the age of coronavirus and COVID-19, comparisons are being made to an unusually long-lived and virulent epidemic of influenza that occurred a century ago. The so-called “Spanish” flu went around the world in three waves, claiming more than fifty million lives–more than perished in the just-ended First World War. What was the Spanish flu? Why was it called that? And can we learn anything about what’s in store during the coronavirus pandemic of 2019-20 by casting our eyes back a century?

Guests

  • />Christopher Rose Postdoctoral Fellow, Institute for Historical Studies, The University of Texas at Austin

Hosts

  • />Augusta Dell’Omo Doctoral Candidate, Department of History, The University of Texas at Austin

Hi, everyone. Welcome to 15 Minute History. I am here with my good friend, Dr. Christopher Rose, who is here to talk to us about the 1918 Spanish flu.

First off, I hope everybody everyone is keeping safe and social distancing and staying at home. And we’re so glad that you’ve tuned in to our podcast to learn a little bit more about the Spanish flu, which is making its rounds on social media and in the news as a comparison point for the current COVID-19 outbreak. But there’s a lot of misinformation and so we thought it would be a good idea to bring on one of our former co hosts to give us a little bit of information about the Spanish flu. Chris, thanks for being here.

Just to inform our listeners if they aren’t familiar with your bio, our newly minted Dr. Christopher rose is a historian of the modern Middle East, specifically focusing on Egypt. He got his PhD in 2018 from the University of Texas at Austin in History, I was there at the defense, it was very exciting. He has authored an article titled “Implications of the Spanish Influenza Pandemic (1918- 1920) for the History of Early 20th century Egypt“, which is forthcoming in the Journal of World History.

So let’s start off with just as a baseline, what was the Spanish flu?

The so called Spanish flu pandemic was a epidemic event that took place between 1918 and 1920. It went around the world in three waves, it was eventually identified as a mutated strain of the H1N1 virus. This is the same one that caused the the so called swine flu pandemic about 10 years ago in 2009. And it was usually virulent and had a very high mortality rate. A mortality rate means the number of cases that ended in fatality. And it also had an unusual morbidity curve is what they call it, which is where, in addition to the usual suspects who are at the highest risk from from death from influenza, which is the very young and the very old people with very strong immune systems, those between the ages of 15 and 25, globally, were also at very high risk of dying from the pandemic because it triggered the body into and an over response, so the immune system would cause the the lungs to fill with fluid in an attempt to kill the virus. And ultimately what would happen is that victims would drown basically from an overstimulated immune system. And the pandemic came right at the end of World War One, as the the treaties were being signed, and troops were on their way home. And so this is believed to have contributed to the spread of the pandemic globally.

One of the questions that I’ve definitely seen on social media is what we should call the virus, because we’ve seen a lot of comparisons between should we be calling COVID-19, the Chinese coronavirus or the should we use the technical term, but I’ve also seen comparisons with the Spanish Flu saying that that was a xenophobic term similar to using Chinese flu now. So why was it called the Spanish flu? And could you talk a little bit about the origins of that term?

So the irony here is that the the name Spanish flu is actually a false analogy with the idea of referring to the corona virus as Chinese because we know for a fact that the the pandemic didn’t originate in Spain. There are three theories as to where the virus actually originated. One is that it originated in France at a British military base. One is that it was imported from China, with Chinese laborers who are being deployed to the Western Front to assist with the French war effort. And one is that it originated in Kansas, and it was actually first detected at a US army base in Kansas that’s now Fort Riley. Apparently, this is well known in that local community. But it was the it was the army medics on the base who first were the first chronologically as far as we can tell with the records that we have to realize that this was an unusually virulent strain of the flu.

But the term Spanish Flu came about because Spain was a neutral country during World War One. And as such, its press was not subjected to military censorship. And so it was the first to sort of freely report on the unusual nature of the outbreak, and when other nations picked it up and their presses were under military censorship, they would sort of refer to the quote unquote virus as seen in Spain as a way of talking about the disease in code. So that people who were reading articles would were supposed to be able to read between the lines and understood that what was being described in Spain was, was actually happening in their own countries, and was what they were seeing in person. And so eventually, the the disease became known as the Spanish flu.

Another term that that was thrown about, interestingly was it was also called the Spanish lady. I guess that made sense in the early part of the 20th century. It seems a bit odd to me now. But in fact, over time, the reason that that was the name has sort of been lost, and people frequently now assumed that that was called Spanish flu because it came from Spain. In fact, I was having a conversation on Twitter last week. And it turns out that a number of people who are Spanish have, at some point been told, you know, your country killed 50 million people in the 1910s. So that memory is still very, very strong. And the idea that that the name was was unfairly given to the Spanish is still very present.

I was actually going to ask, bringing up the historical memory of the Spanish flu and that Spanish being blamed for this. We’re seeing a lot of instances with COVID-19 of racism against Asians. Were there similar racist actions and restrictions against the Spanish during this time where there were travel or people were putting quarantine Was that something that took place during the Spanish flu?

Only to an extent. I think one of the things we have to remember is that one of the reasons that the Spanish stayed out of the war was that they had fought a war with the United States a little over a decade earlier, and lost a number of their global possessions. You know, Puerto Rico, Cuba, the Philippines, Guam, so the Spanish were already kind of our Boogeyman here in the West. So, you know, I think there are probably parallels to be to be made.

One of the things that also came out of the Twitter conversation was people were pointing out that we’re more concerned with with clearing Spain because it’s white, whereas diseases like Zika, or Ebola, which are named for places in Africa don’t get the same treatment.

I think there is a question about the degree to which the Spaniards were considered “white” in the early 20th century, quite frankly, this is the era when, after all, the US was restricting immigration from Southern Europe, because they were too different, that they didn’t want Spanish and Portuguese and Italians and Greeks migrating to the country. So they might not necessarily have been considered of color, but they weren’t considered equals to, you know, Britons and French and Germans and, and, and Scandinavians and the like. So there’s definitely a racial component behind all of this.

You know, viruses have neither ethnicity nor passport nor belief. So viruses aren’t having no nationality. We can talk about whether governments were able to effectively control them, but we have not seen a lot of effective control of viruses pretty much at any point in history.

Yeah, and I want to come back to that point in a second. But first, can you talk a little bit more about what context the Spanish Flu took place in considering the First World War? And you know, you already mentioned Spain being neutral and the important role that that played, but what else is important to know about the role that played in the pandemic.

So there’s a demographer of the war named Jay Winter, who is very adamant that the war didn’t play any role at all in the pandemic. And I would agree with that only insofar as I don’t think World War One caused the Spanish influenza pandemic. Viruses come as they will. And this is probably just a seasonal flu that you know, mutated somewhere, somehow. And there have been conspiracy theories that it was some sort of bio experiment gone bad. But you know, I, again, we’ve seen this virus emerge at other points. But one of the things that it did come into was a world where medical resources were already strained to their maximum, where food resources had been stretched beyond what they could reasonably carry. And so basically, it came into a world where people were already immunocompromised.

Because of the draw down from the war, there was a lot of movement troop bases like the one in Kansas where the virus was first detected. Those guys came from all over the country, they were being stationed there waiting deployment orders. And so, you know, you just had a bunch of people in close quarters, who were a terrific pool of victims who were susceptible to the virus who might otherwise have been exposed. Right now, we’re all about social distancing, right, you know, everyone has to stay at home. And that wasn’t possible because it was wartime.

So, so that played a huge role. One of the things that that I have argued, and I’m picking up on on work done by other people, is that the food requisitions particularly in colonial settings, I looked at Egypt and I would argue that this is also the case in India as well, where food was being taken by the British colonial government, the French colonial government or what have you, for military purposes, left the local populations malnourished and put them at higher risk for for the disease.

And we see this reflected–because I don’t think I’ve actually mentioned it in this in this episode so far–in the global death toll, which is believed to have been in excess of 50 million, that’s five zero million people. 675,000 in the United States, that is 6.5% mortality. So basically, of the people who caught the disease that’s 6.5 per thousand, you know, that’s extremely high for for a disease like this. And so the war is looming in the background, and and it was definitely a contributing factor. There are large parts of the world that we don’t even have that much data for.

For a long time, it was stated that it’s possible that the virus came from China because there doesn’t appear to have been a very high incidence rate in China. And the fact is we just don’t actually have data for China. So we’re not sure that there wasn’t high incidence, or if we just don’t know, war time destroyed records, records aren’t being kept properly. And this is one of the reasons why the numbers have been in flux, about the death toll and and the infection rates, right.

So in the context of, we have sort of more limited or fluid data about the mortality rate and strategies that different nations were using, what steps were countries taking to try and curb this pandemic? How prepared were they? What happened once it hit? You know, we’re hearing about lots of different approaches now used by different countries. Some are seeing social distancing. Some are, you know, in Italy, there’s full lockdown. So what were some of the strategies that were used were countries prepared when this happened, and then once it did hit, what was it looking like for everyday people dealing with the pandemic?

It’s really interesting from a historical perspective how how little has actually changed in terms of our ability to deal with such a thing. As I mentioned, the the pandemic spread in three waves. The first one was not terribly lethal, it was virulent, by which I mean people got it and one of the reasons why it caught the attention of the medics was that it presented in March. And usually that’s toward the end of the annual flu season. And not only was it in March, but a lot of people seem to be getting it. The really lethal wave was the second wave which popped up toward the end of summer, August, September, that timeframe. Most areas appear to have been hit very hard start between the October and December timeframe. So for example, in Egypt, which is the case study I’ve been looking at, the estimate is that 140,000 Egyptians died in the last eight weeks of 1918, which at the time was over 1% of the population.

The medical infrastructure was overwhelmed. And one of the reasons for that, well, there are a couple of reasons, one of which is that in countries that were at war, a lot of medical professionals had been pressed into into military service. So they weren’t available to serve the civilian population. So those people were just sort of left to carry on as on their own.

The other thing is that this is a time when hospitals were places you went if you had sustained injury and needed constant treatment, but most people were treated at home, the doctors made house calls, right? The idea of when you became sick enough because “it’s just the flu,” to call a doctor and to seek medical treatments. You know, what was also something that played in here. In a number of places there were actually cultural aversions to going to hospitals because, you could recover best at home in the care of your own family.

And this is before we even get into to issues of things like racial dynamics, you know. So for example, in the United States, a lot of white doctors would not treat patients of color and that sort of thing. So what you really had in 1918 as we see today was the medical infrastructure just being completely overwhelmed you know, that we’ve I think we’ve all seen now photos and social media of you know, the the sort of field hospitals set up in gymnasiums and, and other structures to treat victims of the influenza, just like we have with Corona virus, but the other, you know, simple factors that this is prior to the age of antibiotics, you know, there really was no effective treatment for influence at the time. So you just kind of had to rideit out and hope that the the disease would eventually wear down on its own.

But in terms of government response, shutdowns, yeah, schools started to shut down factories were shut down, and sometimes it wasn’t even done necessarily, by government order. People just didn’t show up to work because too many people were sick, there were places where agricultural production ceased. And so, you know, it’s almost harder to tell whether or not you know, people died of the the influenza per se or whether it was coupled with malnutrition because, again, food delivery and supply was shut off. And really there’s a reason why people still remember this as a time of massive suffering, because, you know, the the response was, was was inadequate on on a global level.

And what were the economic impacts of the pandemic?

So it this is an interesting question. And honestly, there haven’t been a lot of global studies about the economic impact. So there was a study that came out in 2003 by Elizabeth Brainard and Mark Siegler, looking at the impact in the United States. And basically, their argument was, again, this will ring familiar to a lot of our listeners–that the the sort of global shock of the epidemic had its biggest impact on small businesses, which were the most likely to fail. And that a lot of this sort of economic growth that we saw in the 1920s was really returned to normality, especially in the early part of the decade. They don’t go as far as drawing a connection between the economic shock from the influenza and the Great Depression, because their argument was that we had exceeded you know, we’d return to normality and then exceeded it by then. But that there was a bit of a slump in and economic production. So that’s one of those areas that we’re just starting to look at much of the new scholarship on the pandemic and it’s both both its medical and social, and economic effect is real. I had a list in front of me and most of the articles have been written since the year 2000. So, you know, this is all all pretty new scholarship.

But that’s fascinating and to end I wanted to ask you, even though you’re a doctor, you’re not the doctor that actively is saving people right now, but I wanted to ask you what lessons you think we can draw from the Spanish influenza to the current pandemic.

I think there’s a number of lessons that we can draw, one of which is that especially in the last few days, you know, we’ve had these these debates about whether or not we’re doing more harm than good by by ordering people to go home is that the Spanish influenza pandemic really was a period when we saw what happened when the medical infrastructure gets overwhelmed and that the rationale for what we’re currently calling social distancing isn’t just about making sure that people don’t get sick, but it’s also about making sure that the hospitals are able to treat patients who need treatments.

So, for example, you and I are in Austin, Texas, where we have just under 100 confirmed cases of COVID-19. And the statistics that were released on Tuesday, that Tuesday, March 24, said that of those half of those cases in people under 40 years of age. Number one, this this sort of belies the the prevailing narrative that this is a disease that only affects the elderly. And it may be true that the elderly are more at risk of dying. But again, for every one of those 40 people who may need a medical boost in order to get through their case, you know, that could also be a hospital bed that would be denied somebody who is at much higher risk of dying. And you you, we don’t want to have obviously make judgment calls about who shouldn’t shouldn’t be treated, or at least that’s what we’re trying to avoid here.

Again, if we look back in history, we’ve seen that this has happened before. And I think this is one of the things that we’re trying to avoid encouraging people to stay home and encouraging people to just try to be healthy and practice good hygiene. And I won’t lie. I have wondered what people were doing before the the current crisis since we apparently nobody knew how to wash their hands

I was thinking about how many people have suddenly started washing their hands?

Right? What were you doing beforehand? (laughs) But, but you know, part of it is this, this is where it comes from is, you know, we’ve been through this before. We are now as as they were in 19 1918, quarantines were relatively useless because once the virus is in a place and started to spread, you can’t do much about it. What you can do is try to slow it down to spread internally in order to give the infrastructure a chance to work in order to give the government chance to put a response into place. And that’s what we’re doing now. And I think it’s important that we not lose sight of, of that being the ultimate goal, which is this is about making sure that more people don’t get sick and that we can slow it down. It’s not necessarily about, you know, trying to stop the epidemic altogether, although this is certainly one of the ways that it can be done.