The US Is Repeating Its Spanish Flu Mistakes

Camp Funston, at Fort Riley, Kansas, during the 1918 Spanish flu pandemic (Uncredited photographer for St. Louis Post Dispatch/Public domain)

In 1918, a newspaper assured its readers not to worry about the flu that seemed to be facing the nation. After all, influenza posed no danger. Flu was as old as history.

Two years later, after two years of a worldwide flu pandemic, there were approximately 50,000,000 deaths worldwide and 675,000 in the United States. It turned out to be the most lethal pandemic in known history.

But it was “only the flu.” No need to worry.

One hundred and two years later, a new virus called SARS-CoV-2 (or as the disease is called, COVID-19) swept across the world. It’s basically a respiratory virus. According to President Trump, it’s a lot like the flu. Don’t worry.

So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!

— Donald J. Trump (@realDonaldTrump) March 9, 2020

Trump has since contradicted his previous assertion, now claiming it is not just like the flu.

As of this writing, nearly seven weeks later, global deaths are over 200,000 and rising. In the United States alone, more than 50,000 have died and there have been over 1 million cases of COVID-19. Currently, the United States leads the world in both numbers of cases and deaths. There are lessons we can glean from the US response to the 1918 Flu so that we can avoid making this even worse.

The 1918 “Spanish Flu”

The United States entered World War I in 1917. President Woodrow Wilson reluctantly entered the war, but when he did, the entire national machinery became part of the war effort. Above all, they had to maintain morale. And that meant no bad news.

No one knows for sure the origin of this flu. The general consensus has been that began with a soldier stationed in Kansas and spread as troops were moved. However, it was relatively mild compared to the vicious form it would take within months. More later about how it erroneously became known as the Spanish flu.

Meanwhile, as the flu spread, scientists tried to raise the alarm. However, new sedition laws and press censorship had come into being. Morale was all-important. We were at war.

The flu began in the military in overcrowded, dank transports. It disabled military on both sides. And it did not take long for it to wreak havoc on the civilian population.

The war effort did need the mobilization of the entire fabric of America. Doctors and nurses served. Men from all walks of life were drafted. Goods were rationed. People voluntarily made sacrifices. It was an all-out war.

And “The preservation of morale itself became an aim. For if morale faltered, all else might as well. So free speech trembled,” as John Barry said in his masterful book, The Great Influenza: the Story of the Deadliest Pandemic in History. It was only the flu. Humanity had dealt with the flu throughout history.

The influenza epidemics we are most familiar with are hardest on the very young and the very old. This was different. Its main targets were between twenty and forty years old. Perhaps older people had some immunity from an earlier, milder version.

Further, despite the need to “maintain morale,” this flu could not be hidden. As it grew in lethality, it struck quickly and viciously. It often killed young healthy people within hours, sometimes even faster. The signs were unmistakable. Mahogany spots appeared on the cheeks, followed by the person turning cyanotic – blue – because a rapid onset pneumonia blocked the flow of oxygen. A sudden nosebleed could signal death within hours. Or minutes.

While mayors and governors begged for help from the federal government, President Woodrow Wilson remained silent. No one in the federal government issued statements. Media downplayed it, even though people could see and experience its brutality. The world only heard about this disease from Spanish sources, as Spain remained neutral during the Great War and did not censor its news. Hence it became known as the Spanish flu even though it had long been in existence.

Because of the lack of real news and efforts to downplay the obvious, people lost trust in institutions and each other.

And there was a second wave, even worse. Some people ”helped their friends and neighbors, but others stayed away out of fear. The more fear grew, the more people were told that fear actually caused the disease. After all, it was only the flu.

In Philadelphia, a massive parade to support the war effort was planned for September 1918. Some did warn that holding such a parade courted disaster. But the war effort and morale mattered. This would be the largest parade in Philadelphia’s storied history. The parade went on as scheduled. It’s aftermath left Philadelphia ravaged by illness.

On the other hand, we had a good example with how St. Louis, Missouri, handled the epidemic better than most. They immediately instituted quarantines, social distancing, masks, and the respiratory hygiene measures we use today.

Influenza epidemic in United States. St. Louis, Missouri, Red Cross Motor Corps on duty, October 1918. (National Archives)

That surprised me. Several years ago, I visited a cemetery in St. Louis in search of my ancestors. I was dumbfounded by two things: a huge number of people died in their thirties and forties, and most of those deaths were in 1918.

However, I did learn why despite their precautions, so many died. St. Louis relaxed their vigil too early. It came back with a vengeance. Their cemeteries contain a startling number of people who died in 1918.

They reopened too soon.

In 1918, scientists didn’t know:

• That a virus caused influenza as opposed to a bacterium.
• Even though they knew vaccines existed, they couldn’t make an effective one.
• That antibiotics even existed, but if they had, they’d still be useless against any virus. Antibiotics only work against germs.
• And they had no idea how to treat it. That led to a plethora of quack, dangerous “cures.”

Aspirin had recently been invented by a company called Bayer in Germany. That was touted as a miracle cure. The medical establishment knew little of proper dosing or side effects. Therefore, aspirin was administered in potentially lethal doses. Ipecac, which causes vomiting, was thought to be helpful. Opium relieved pain Strychnine was used. Doctors were desperate. People were desperate.

Scientists and nonscientists raced to create a vaccine. Many were marketed; none worked. In fact, the first flu vaccine did not appear until the 1930s.

And real information was scarce. After all, the Great War necessitated good morale, and governments heavily censored information.

COVID-19 Origins

At first, we thought we knew the origin of the current pandemic, COVID-19. In December 2019, this virus was reported spreading through Wuhan, China. A later report shows that a 55-year-old man in Hubei province in China had the disease in mid-November 2019. But just as the origin of the 1918 flu is shrouded in mystery and a source of conjecture, the less certain we become of the origin of COVID 19.

If anything, this has given birth to a panoply of conspiracy theories:

• It originated in a Chinese lab and intentionally spread as a bioweapon.
• 5g technology caused it.
• The United States created and spread it.
• The Jews did it (a reliable source of blame for millennia).

The bottom line: we don’t really know for sure. The consensus theory: it originated from a bat. While various groups are trying to spread the blame for dubious geopolitical advantage, only one important fact emerges. The virus is here. And the only important question becomes: what do we do about it?

The present Coronavirus outbreak was first reported in Wuhan, China, in December, 1999. The first death there was announced a month later. Also in January, China studied and released the genome, and the World Health Organization (WHO) reported that human to human transmission was possible.

And in January, the first Coronavirus death was reported in the United States, in the state of Washington. The patient had just returned from a trip to Wuhan. We took some measure of comfort in the assumption that transmission was directly from people who’d traveled abroad.

The public remained unaware of the warnings circulated – and ignored by the government. However, American intelligence sources warned in November 2019, of a potential “cataclysmic event” originating in China in the spreading disease.

By January, White House advisor Peter Navarro was circulating a memo that warned of a coming pandemic and massive deaths. HHS Secretary Alex Azar also warned President Trump in January, as did intelligence officials in his presidential daily briefings. President Trump was unruffled on and January 30, announced: “It’s going to have a very good ending for us.”

The administration has had a difficult time coming to terms with this pandemic. They played it down and didn’t get adequate testing running, even as the stock market plunged and new cases surged in February and early March. So why did Trump assure is we weren’t heading into a pandemic not seen for over a century?

“I’m a cheerleader for the country,” he said in March. Truth became as knotty an issue as in 1918.

Early on, President Trump assured Americans a vaccine would be quickly developed and made available. He ignored his scientists’ warning that if developed, a vaccine would not be available for 12-18 months.

Vaccines do have to be thoroughly tested before release lest they turn out to be ineffective or even dangerous. No vaccine was ever created for the 1918 flu, nor is there one for a modern pandemic, AIDS.

In 1918, mayors and governors begged for help from the federal government. They got almost nothing. Today, medical personnel lack PPE – personal protective equipment – and are getting sick and dying at alarming rates. And as before, governors and mayors are practically begging the federal government for help. Other than hospital beds and ventilators, which the Trump Administration was slow to deliver, they’ve still yet to receive all they’ve asked for.

Testing today is way below par. PPE is in short supply to protect even health care workers, who are getting sick and dying at alarming rates. Contact tracing is almost nonexistent. Despite this, the Trump administration is pushing the country to reopen. In 1918, the second wave was far deadlier than the first. And while it’s true that this pandemic is crushing the economy, it will be even worse if we end protective measures prematurely and leave ourselves open to another wave. A second wave could be deadlier.

When the flu pandemic swept the world, science was less developed. It existed, but not with the incredible precision, rigor, and advances we know today. With our well-developed hindsight, we can understand the inadequacy of the scientific community to cope.

Today, we have much higher expectations. Science should be able to fix everything- now. But science doesn’t work that way. It’s still a difficult process of creativity, rigor, and endless patience.

We’ve seen the issues that worsened the 1918 pandemic and turned it into a killing machine. Today, we do know more about the science and the measures that will help. We must learn from 1918, not repeat the same mistakes.

Even if we do everything just right, this will be a long, hard process.

If we ignore science, we could make this as bad or worse than the 1918 influenza.

Our choice. And that of the rest of the country.