What Can We Learn From the 1918 Pandemic?

What Can We Learn From the 1918 Pandemic?

Spread Far and Fast

What can we learn from the 1918 pandemic?


The new disease, public officials said as people began to fall ill with unfamiliar symptoms, was “trifling” and “nothing to worry about provided ordinary precautions were taken.” It was just the flu. In Spain, one newspaper said all that people needed to overcome it was “three days’ bed rest and a medicine cabinet.” In the United States, as cases began to multiply, people were told that their government was working “to confine this disease to its present limits, and in this we are sure to be successful.” But that did not happen. Instead, it spread with astonishing rapidity from country to country, continent to continent. Medical

facilities were overwhelmed. At Bellevue Hospital in Manhattan, “people were dying in beds, on stretchers and in the corridors. In the pediatric wards, children were packed three to a bed.” Doctors and nurses were working virtually around the clock. “We didn’t have time to treat them,” said one. “We didn’t take temperatures; we didn’t even have time to take blood pressure.”

Governments, medical services, and ordinary citizens were unprepared. Famous people began to fall ill; the British prime minister was so badly affected that reports said it was “touch and go” whether he would live or die. Special hospitals were hurriedly constructed to deal with the extra burden of thousands upon thousands of sick and dying patients. In the morgues, bodies were stacked one on top of another, identified only by tags tied to their left feet. The families of victims resorted to stealing coffins, so great was the shortage caused by the massive rise in demand.

Medical opinion was uncertain in the face of the new disease. Only as it spread did a better understanding of it develop, and in the meantime, all sorts of dangerous home remedies were tried, from gargling with disinfectant solution to ingesting kerosene administered on a lump of sugar. A more agreeable way of disinfecting the digestive tract, recommended by some, was to down several straight whiskeys or tumblers of gin. One young man in North Carolina reported wearing a bag of asafetida around his neck. “People thought the smell would kill germs,” he wrote. “So we all wore a bag of asafetida and smelled like rotten flesh.”

In some cities, including New York, schools and theaters remained open, and officials continued to play down the seriousness of the situation. When medical authorities, concluding that the disease was spread by droplet infection through coughing and sneezing, recommended the wearing of face masks, residents of San Francisco were particularly resistant: One downtown attorney in the city described an official order to wear a mask as “absolutely unconstitutional.” The police did their best to enforce the regulation. On occasion, they could go too far. One public health officer, according to a local newspaper report, drew his gun when a man refused to comply; the man “closed in on him and in the succeeding affray was shot in the arm and the leg” before being taken to a hospital, where he was arrested, while being treated for his wounds, for refusing to obey the officer’s order.

Public health precautions worked, but they were applied only patchily. In Manchester, England, the city’s chief medical officer managed to get the schools closed and the sick placed in lockdown, which was said to have saved many lives. He had been through a similar epidemic more than a quarter-century earlier and knew what to do. In Washington, D.C., too, the schools, theaters, pool halls, and bars were closed, and the Red Cross issued face masks. Advertisements called on Washingtonians to “Obey the laws / And wear the gauze / Protect your jaws / From septic paws.” Wrote one young man, looking back on these events:

We were afraid to kiss each other, to eat with each other, to have contact of any kind. We had no family life, no school life, no church life, no community life. Fear tore people apart.

This story must seem a familiar one as we struggle to cope with the Covid-19 pandemic that started at the end of 2019. But these examples and quotations are taken not from contemporary news media but from Pandemic 1918: Eyewitness Accounts From the Greatest Medical Holocaust in Modern History, Catharine Arnold’s absorbing account of the so-called Spanish flu, which was first recorded in the American Midwest in March 1918. As the United States shipped hundreds of thousands of troops to Europe during World War I, the disease crossed the Atlantic, then went farther afield, reaching India in June. Its impact was relatively mild, not much greater than that of an ordinary flu, but in August 1918 a second wave rolled over the globe, deadlier by far than the first. It was followed by two more waves, somewhat less severe, before fading away in 1920. The second wave, in particular, generated symptoms that were horrifying even to seasoned medical workers. One doctor described the “bluish cast” of the victims’ faces as “a distressing cough brings up the blood-stained sputum”; sometimes the cough was so violent that the blood shot right across the ward. The victims died in agony as their lungs filled with blood, suffocating them.

The pandemic spread far and fast, not least because it was helped on its way, as so many pandemics over the centuries have been, by troop movements, which were taking place on a global scale as the war entered its final stage. Troops carried infections from the United States to Europe, from Europe to its colonies in Africa and Asia, and across Russia in the civil war raging in the aftermath of the 1917 revolution. World War I involved not just service members from Europe and America but also many thousands of Indian troops and Chinese laborers, Australians and New Zealanders, and African forces deployed by the British and French imperial powers against German colonies. However, whether the pandemic had a real effect on the outcome of the war has to be doubted: Things might have been different had it discriminated among the various combatant nations, but it took no sides and affected them all. And the German spring offensive of 1918 failed for different reasons—above all, because the Germans did not possess tanks, as the Allies did in their summer advance, and so were unable to overrun trenches, ward off machine-gun bullets, and reverse the advantage that defensive positions had held over attacking forces ever since the war began. The German generals sacrificed huge numbers of fighters in bloody frontal attacks, and the Allied economic blockade had severely damaged the German economy’s ability to replenish the army’s resources.

Given the inadequacies of statistics and of the registrations of deaths in many parts of the world at the time, it is not surprising that there is a good deal of uncertainty about how many people died. Arnold claims that global deaths totaled “upwards of 100 million.” However, other recent estimates put the figure more plausibly somewhere between 17 million and 20 million. This was still catastrophic, given that the world’s population at the time stood at around 1.8 billion.

The high death rate and the onset of unusually severe pulmonary symptoms were also a result of years of privation, poor nutrition, and stress caused by the war, which had a serious effect on food supplies. In Germany, for example, more than half a million people died of malnutrition and associated diseases as a consequence of nearly five years of the Allied blockade, and food supplies in other countries were interrupted by submarine warfare and the disruption of peacetime trade patterns.

The disease’s origin is thought, though not with any great certainty, to have been in a genetic mutation that took place in the influenza virus in 1915 in the United States, possibly in Kansas. But this was not recognized at the time. On the contrary, in another striking parallel to the present-day pandemic, conspiracy theorists in the United States began to claim that the disease had been deliberately manufactured by the Germans, who had taken it across the Atlantic by submarine and offloaded it on America’s East Coast. “Let the curse be called the German plague,” one said. Of course, the flu was rampaging across Germany as well.

One thing, however, is certain: The disease did not originate in Spain, nor was it particularly virulent there. It got its name because Spain, as a neutral country in World War I, did not suffer strong state censorship of the news media, as the combatant nations did. Journalists there could widely report on the early stages of the pandemic, while their colleagues in Britain, France, Italy, and the United States, on the one hand, and Germany and Austria-Hungary, on the other, were often hindered by restrictions imposed in order to prevent the enemy from getting the impression that the population was anything but flourishing.

Like the current pandemic, the Spanish flu hit populations unevenly. Although it is the elderly and the sick who are the worst hit today, in 1918 it seemed to be young, otherwise healthy adults. South African workers returning home from the gold mines of the Rand were crowded onto trains, where they began to die in huge numbers. One newspaper reported that their corpses lined the tracks, and one ticket collector refused to go into the carriages designated for Black riders “because there was so much illness there.” Everywhere the poor, living in cramped conditions, malnourished, and weakened by existing health problems, suffered the most. The disease stoked prejudice on all sides. White South Africans called it the “black man’s sickness”; Black South Africans called it the “white man’s sickness.”

On November 11, 1918, the vast crowds that thronged the squares of Europe’s and America’s great cities to celebrate the end of the war spread the virus more efficiently than almost anything else. Returning ships laden with troops did the rest. In Australia, after a long period during which quarantines were effective in warding off the importation of the disease, the pandemic arrived in January 1919, and precautionary measures, prepared over several months, were put into effect. Bars were closed, churches stopped holding services, and even public telephone booths were sealed off. The authorities issued proclamations telling people to wear masks. Despite all this, some 15,000 died on the sparsely populated continent, the situation worsened by growing differences among Australian states over how to deal with the problem.

One of the many virtues of Pandemic 1918 is that it ranges across the globe, so we get a useful picture of just how widespread the disease was. Arnold knows how to tell a good story and brings home the human dimension of the pandemic. But after a while, the stories all start to seem rather similar, and one begins to long for deeper analytical penetration. There’s no way of telling from this book, for example, which countries or cities combated the pandemic most effectively and why. This homogenizing approach makes it in some ways difficult to extrapolate lessons from 1918 for today. But lessons there surely are.

The first one is that governments need to be prepared for something like this. At the beginning of the 1890s, a pandemic dubbed the Russian flu killed an estimated quarter-million people in the United States and around 100,000 in the UK; perhaps a million died worldwide. Nearly three decades later, few seemed to remember it or show any concern about a recurrence. Those who did and managed to take effective action saved many lives. But action then, as now, was patchy. With an airborne infection like influenza, spread by people breathing on one another and by residues with the virus lingering on surfaces of many different kinds, a coordinated policy—imposing quarantines, closing places where people crowd together, and getting everyone to take hygienic precautions, notably frequent handwashing—is essential.

Arnold pours scorn on mask wearing as useless, and maybe the thin gauze masks people wore in 1918 didn’t offer a great deal of protection for the individual. But in the present pandemic, evidence has accumulated over the months to show beyond doubt that modern masks are highly effective in preventing the spread of the disease. Lockdown measures have been equally successful in limiting the impact of the coronavirus. South Korea, which had plans ready to deal with a new epidemic as a result of previous recent flu outbreaks, managed to roll out an effective testing program and then isolate carriers, including those without obvious symptoms. As a result, in a population of more than 50 million, there have been some 600 deaths from the disease at the time of writing, despite its return in late August.

South Korea’s relative success in controlling the virus has nothing to do with a supposedly more obedient population, one more willing to submit to government controls. In Greece, a country with just over 10 million inhabitants, the first wave of the virus was kept under control. The first case was confirmed on February 26. Within three weeks, schools, theaters, cafés, bars, and similar places were closed; within a month, all nonessential movement within the country was banned, the tourist trade suspended, and a package of financial support measures introduced. Greece’s moderate conservative government took advice from medical scientists on the country’s rapidly convened coronavirus task force and decided that saving lives should take precedence over continuing normal economic activity. It was only with the arrival of the second wave of the pandemic, which followed a period of relaxation of controls, that infections and deaths began to rise, with Greece reporting some 3,600 deaths from the pandemic by the middle of December.

Countries that have not followed medical advice or implemented a coherent national policy have fared less well. In particular, states led by populist politicians who are hostile to science, especially with regard to the climate crisis, have seen soaring numbers of deaths—more than 300,000 in the United States and over 180,000 in Brazil, both countries where the president openly dismissed the pandemic as trivial, scorned precautionary measures, and refused to take scientific advice. Health policy during the pandemic has become politicized, along the lines of the climate crisis, with catastrophic results.

Epidemics have always produced conflicts between saving lives, on the one hand, and sustaining the economy, on the other. Here, as in the climate crisis, too many politicians have seen only the negative, short-term impacts of preventive measures and decided to sacrifice human lives on the altar of profit. This conflict between economic interest and medical science isn’t an aspect of the Spanish flu that Arnold’s book has much to say about, though it’s clear that state authorities’ denial or trivialization of the pandemic in its early stages was governed above all by economic considerations.

Despite our tendency to look to the past for lessons and despite some obvious parallels, it’s important to recognize that today’s situation is very different from 1918’s. People then did not have to contend with populist politicians who refused to take action against a deadly disease. Science now is better equipped to deal with pandemics, though in some political circles skepticism about scientific advice has increased, and there is a far greater tendency to politicize the issues it raises. Above all, the 1918 pandemic happened in the final stages of a catastrophically destructive world war, which weakened people’s resistance to disease in myriad ways and paved the way for a second wave of the infection that turned out to be much more serious than the first. This is not the case with the present pandemic, and the second wave of infection that is underway in many countries is unlikely to prove as devastating as in 1918, not least because, so far, it seems to be mainly affecting younger people and so is relatively mild in its impact.

What is truly alarming, however, and without precedent in 1918 or any other year in the modern era, is the way that large numbers of people are denying the evidence presented by medical science and refusing to take medical advice that would help prevent the spread of the disease. There have been major demonstrations in a number of countries—including the United Kingdom, the United States, and Germany—that have linked the pandemic to wild and demonstrably false conspiracy theories like QAnon, with its undertones of anti-Semitism, its distrust of science, and its far-right ideology.

The degradation of political discourse such theories represent can only do harm to our democratic political order. In the early 1920s, after the Spanish flu, fascism and Nazism began to make waves, too, fueled by the unscrupulous falsehoods spread by propagandists like Joseph Goebbels. When the Nazis began to describe Jews as “parasites” and “viruses,” the language of medicine was being used as a tool of racial abuse that would end in mass murder. The political situation today may be different, but the threat to reasoned and evidence-based political discourse—and, through this, to the safety and security of all our lives—is no less severe.

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