Coronavirus: What can we learn from the 1918 Spanish Flu?
The last major pandemic was the Spanish Flu of 1918-20 - what does that tell us about fighting Covid-19 today?
It is often said that while history doesn’t repeat itself, it does often rhyme.
And while the last major pandemic before today’s coronavirus crisis was in many ways very different to Covid-19, its story also sounds oddly familiar.
The Spanish Flu of 1918 to 1920 took place in an entirely different world, where the medical advances and technology of today – and therefore the ways in which we could respond – were pure fantasy.
The political backdrop was also wildly different, with Britain fighting the First World War – where a public health emergency on top all-out conflict, on which the nation’s survival depended, really was the very last thing the country needed.
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Yet while the differences with coronavirus are stark, the Spanish Flu remains a telling lesson in history.
So, can we learn anything from the crisis of a century ago which will help us save lives today?
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How did it spread?
One might assume that today’s globalised world makes the spread of diseases much easier – in 1918 few people owned cars, while the idea of getting on a plane abroad was a dream.
Yet both coronavirus and the Spanish Flu came almost as a bolt from the blue, showing how easily viruses can spread from nothing at all to infecting millions of people with breath-taking speed.
In both cases, it is hard to pinpoint exactly how and where the viruses started.
Covid-19 is widely thought to have started from a handful of cases in Wuhan, China, spreading as people travelled on flights around the globe.
University of Essex researcher Louise Rodwell said the Spanish Flu’s name is a “misnomer”, with Spain’s lack of wartime censorship and greater openness about the pandemic leading people to mistakenly believe it was the flu’s country of origin.
Many think it started in a US army camp in Kansas, before spreading through the trenches once those soldiers reached the frontline in Europe.
Celebrations at the end of the war are also widely blamed for a second wave of Spanish Flu, as so many people were close together during parades that it could spread more easily.
While global travel therefore might not have been the same in 1918, Ms Rodwell says: “When the First World War came to an end, it was an ideal breeding ground for the virus to spread.”
It is one of the reasons so many are worried football matches, concerts and other similar mass gatherings today.
Who was affected?
While Ms Rodwell said the “destructive” nature of the Spanish Flu meant the “scale of deaths was huge”, it is simply too early to tell the full impact of Covid-19.
Upper estimates put the Spanish Flu’s death toll at around 100million over two years, with a third of the world’s population believed to have been infected at some point.
Currently, about 270,000 people with coronavirus have died across the world. However, experts have warned the pandemic could still have months or even years to run - especially if the example of the Spanish Flu is anything to go by.
While doctors stress anyone in any age group can be affected by coronavirus, many of those who have lost their lives have tended to be older and have underlying health conditions.
But Ms Rodwell said: “Spanish Flu didn’t target people who would typically get flu.
“It seemed to target people in the 25 to 35 age communities.
“What was scary for people at the time was that this strain of flu was so virulent.
“There does seem to be a real worry that it was hitting the younger generation.”
How was it treated?
“Because of the time we live in now, we’re so much better equipped to deal with this,” Ms Rodwell said.
The treatments for Spanish Flu and coronavirus – getting plenty of bed rest and keeping oxygen in the lungs - sound remarkably similar, especially given they are 100 years apart.
However, compared to 1918, medical equipment in hospitals is vastly superior. In fact, back then nurses could do little but makes patients as comfortable as possible.
“They didn’t have any viral medicine,” Ms Rodwell said.
Letters from one nurse in the village of Birch, near Colchester, describe the “helpless” feeling medical professionals had when trying to treat the illness, often in vain.
Ms Rodwell said many hospitals tried to treat the Spanish Flu with aspirin, which at the time was a little understood, new drug and often only worsened the symptoms.
Part of the problem was that doctors didn’t even really understand the virus and how it worked – there was none of the modelling and research that we have into coronavirus today.
That extra knowledge has already proved extremely valuable and, despite a high coronavirus death rate, could have saved thousands of people who might otherwise have died.
A coronavirus vaccine – the only thing certain to beat the illness once and for all – still eludes medical professionals, with suggestions it could be some way before scientists can create one.
Yet at least there is a possibility it will happen at some point, hope that never existed during the Spanish Flu.
What was the government’s response?
The response to coronavirus has been characterised by lockdowns across the world to restrict people’s movements and therefore the spread of the illness.
The nation’s political leaders have been forced with difficult choices of balancing the economic impact of shutting down businesses, with all the hardship that entails, alongside saving lives.
However, Ms Rodwell said: “By the time the Spanish Flu took hold, it was almost too late at that stage.
“What can you do when you’ve got millions of men mobilised in places where bombs are falling? It must’ve been a nightmare.”
The technology of today means it is much easier for people to work and stay in touch remotely, and therefore enforce a lockdown in ways unthinkable 100 years ago.
“In 1918, people couldn’t work remotely,” Ms Rodwell said.
“All they could do was try to practise social distancing.
“There are lots of pictures of people wearing masks and shops trying to stagger opening times, but we’re so much better equipped today.
“Today, there are ways to effectively implement the lockdown which have contained the spread more than in 1918.
“Society was so different back then. Today, we have an environment where people are still connected and you can get things delivered.”
The Great War was a major factor in the response to the Spanish Flu.
“Countries were so aware that people were going to be disheartened,” said Ms Rodwell.
Shutting down factories, as we have done today, could equally have hampered the war effort and meant the difference between winning and losing.
Many governments therefore took what is now viewed as a highly controversial decision to suppress news of the Spanish Flu as part of their wartime propaganda.
Ms Rodwell said: “Whether or not you agree, you can see the reason behind them trying to suppress it.
“At the time, to deal with the with the reality of this scale of wartime death, people had to convince themselves that British soldiers were fighting for a noble cause.
“But that only works if they died fighting. It doesn’t work if they died from flu.”
How did the public react?
One of the more heartening aspects of the coronavirus pandemic is how people have rallied round to help each other in a time of need.
Claps for carers and deliveries of food packages have characterised the ways people have tried to support their neighbours during the crisis.
The war effort and inability to enforce a lockdown meant the public reacted differently to the Spanish Flu. Indeed, the suppression of news as part of wartime propaganda meant many were simply unaware of its true scale.
However, Ms Rodwell said there was strong evidence of “social enforcement”, with people confronting each other to say: “You’re making this worse.”
She added: “You can see similarities today – you only have to look at the papers today to see that people breaking lockdown are not well thought of.
“People are trying to regulate each other’s movements to ensure people are kept safe.”
What about a second wave?
As prime minister Boris Johnson claims the UK is “past the peak” of coronavirus, there are fears that easing the current lockdown could cause a rise in infections.
Here, the Spanish Flu provides a sobering lesson.
The pandemic first broke out in around March 1918, with many thinking it had passed its peak in the summer of that year.
But an even worse strain of the virus returned in the autumn of that year, with Ms Rodwell saying: “The most deadly wave was the second wave.”
The first wave was therefore “relatively mild compared to what we know it became from the autumn, when it really, really smashed through the armed forces and started to spread”.
She added: “It was really that wave which was the most catastrophic to communities going into the winter.”
Fast forward to 2020 and, while society may be much better at containing illnesses, history shows the risks of a second wave cannot be ignored.
Free weekly history talks are being provided by University of Essex researchers to help people learn more about the past during lockdown.
History Indoors has already seen around 100 people a time logging in to talks via Zoom on subjects such as the Civil War and smuggling in America.
“Our aim is to bring history to people’s homes during the lockdown,” said history PhD student Steven Bishop.
“The talks are general overviews of parts of history and thus are designed to be accessible to everyone, from secondary school pupils to the elderly, the novice to the expert.
“Though our talks feature broad topics in history, we try our best to offer an East Anglian twist.”
For more details, or to register for events, click here.