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Investigating the Pandemic of 1918 and its Relationship to Today’s Coronavirus: A History of the Health Sciences Guide : Introduction to Pandemic Research

Background

For the last year and ½, Ebling’s Historical Reading Room has been home to  my exhibition, Staggering Losses: WW1 and the Influenza Epidemic of 1918. Hundreds of campus and community members have visited this “memorial” to the soldiers, nurses, doctors, ambulance drivers and animals that gave their lives, or cared for others with innovative techniques and treatments, during that unprecedented time in history. Currently, I’m being asked by the media, students and others, to talk about the differences and similarities between the two Pandemics.


The short answer is that our world is very different than it was 102 years ago, in terms of the ease of worldwide travel, the global supply chain, and in terms of economic supply and demand. Medical treatment is more sophisticated, both established isolation protocols, the availability of antibiotics and antivirals, and the existence of specialists in respiratory care and infectious diseases. Record keeping in terms of disease transmission and mortality and morbidity is more standardized and shareable… the list goes on. But similarly, in terms of the approach to the spread of the virus (in 1918, an H1N1, in 2020, the coronavirus), the dynamic remains the same, trying to control the spread of a virus, its attendant morbidity and mortality and limiting the impact on the healthcare system.


It wasn’t called “flattening the curve,” or social or physical “distancing,” but the intent was the same-  those cities that enforced quarantines, restricted public gatherings, and banned spitting, fared better than those that did not. No one presumes that COVID-19 will come near the postulated number that died in 1918, somewhere between 50 and 100 million, worldwide, in what was often, erroneously called “The Spanish Flu.” Still, no one wants to test that presumption. Stay home, wash hands, resist public spitting, don’t gather in groups. Basic, good advice then; still good, albeit inconvenient advice, now. 
 

As we head into autumn, additional concerns of schooling, how the Pandemic is affecting the economy and travel, and the upcoming Presidential election; whether there will be a resurgence in the number of cases, complicated by a “normal” flu season, the role of the media and social media in informing the populace about the Pandemic, which states mandate the wearing of masks, whether there has been mismanagement of the Pandemic by public health officials, etc. all give additional food for thought. In a nutshell, nearly everything we are currently concerned about, even the disparity of care or mortality and morbidity in marginalized communities, were concerns in 1918. We may have enhanced technology and the ability to do research on smartphones and computers, but the humanistic concerns remain poignantly the same, the wish to stay healthy, see friends and family, and be unrestricted in one's day to day life remains universally significant.
 

Articles about Pandemics

A Pandemic Double-Take, Forbes, May 1st, 2020 (Photographs)

What we can learn from 1918 Influenza Diaries, Smithsonian Magazine, April 13, 2020

The Influenza Encyclopedia from the University of Michigan

Pandemics in History: A Short Bibliography by Columbia’s Stephen Novak, March 25, 2020

Keep it Clean, the Surprising 130 History of Handwashing by writer, Amy Fleming and historian, Nancy Tomes, The Guardian, March 18, 2020

Reconstruction of the 1918 Influenza Pandemic Virus from CDC, December 17, 2019

The 1918 influenza pandemic: 100 years of questions answered and unanswered by Jeffery K. Taubenberger et al., sciencemag.org (AAAS), July 24, 2019

Race and 1918 Influenza Pandemic in the United States: A Review of the Literature by Helene Økland & Svenn-Erik Mamelund, International Journal of Environmental Research and Public Health, July 12, 2019

The Eighteen of 1918-1919: Black Nurses and the Great Flu Pandemic in the United States by Marian Moser Jones & Matilda Saines, American Journal of Public Health, June 2019

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918 by M. Martini et al., JMPH, April 2, 2019

A Year of Terror and a Century of Reflection: Perspectives on the Great Influenza Pandemic of 1918-1919 by Michaela E. Nikol & Jason Kindrachuk, BMC Infectious Diseases, February 6, 2019

Historical and clinical aspects of the 1918 H1N1 pandemic in the United States by Barbara Jester et al., Virology, January. 15, 2019

The 1918 Influenza Pandemic: Looking Back, Looking Forward by Cécile Viboud & Justin Lessler, American Journal of Epidemiology, December, 2018

Unanswered questions about the 1918 influenza pandemic: origin, pathology, and the virus itself by John S. Oxford & Douglas Gill, The Lancelet Infectious Diseases, November, 2018

Back to the Future: Lessons Learned from the 1918 Influenza Pandemic by Kirsty R. Short, et al. Frontiers in Cellular and Infection Microbiology, October 8, 2018.

What Happens if parades aren’t canceled during pandemics? Philadelphia found out in 1918, with disastrous results by Meagan Flynn, Washington Post, September 21, 2018

Photos of the 1918 Pandemic, The Atlantic, April 20, 2018

1918 Influenza: the Mother of All Pandemics by Jeffery K. Taubenberger and David M. Morens, in Emerging Infectious Diseases • Vol. 12, No. 1, January 2006

Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus by Terrance M. Tumpey, PhD, et al., from sciencemag.org, (AAAS), October 7, 2005

 

1918 Pandemic (H1N1 virus), Centers for Disease Control. March 20, 2019

Opinion: The 1918 pandemic tells us that we can’t celebrate the end of covid yet, by John M. Barry, May 2021, The Washington Post 

COVID-19: a comparison of the 1918 influenza and how we can defeat it, Liang, Shu Ting et al., May 2021, Postgraduate medical Journal

Measuring Mortality in the Pandemics of 1918-19 and 2020-21, E. Thomas Ewing, April 2021, Health Affairs Blog

Down memory lane: Unprecedented strong public and scientific interest in the “Spanish flu” 1918/1919 during the COVID‐19 pandemic, by Kaspar Staub & Joël Floris, March 2021, Influenza Other Respir Viruses

Fighting the War Against COVID-19 via Cell-Based Regenerative Medicine: Lessons Learned from 1918 Spanish Flu and Other Previous Pandemics, by You Jeong Park et al., February 2021, Stem Cell Rev Rep.

History repeated: Applying lessons from the 1918 flu pandemic: More than a century later, the flu pandemic still offers key lessons on steps to counter COVID-19, but heeding them will require a sharp course correction in the United States, by Bryn Nelson & David B Kaminsky, Feb. 2021, Cancer Cytopathology, https://pubmed.ncbi.nlm.nih.gov/33528906/ doi: 10.1002/cncy.22408.

Comparing the COVID-19 Death Toll to the 1918 Flu, H1N1 and More, 9News, Allison Sylte, February 15, 2021

Politics, Pushback, and Pandemics: Challenges to Public Health Orders in the 1918 Influenza Pandemic, By Alexander J. Navarro & Howard Markel, Jan. 2021, American Journal of Public Health, https://pubmed.ncbi.nlm.nih.gov/33476227/ doi: 10.2105/AJPH.2020.305958

The 1918 Influenza Pandemic Has Lessons for COVID-19: An Anthropology Student Perspective, by Taylor P van Doren, January 2021, American Journal of Public Health, https://pubmed.ncbi.nlm.nih.gov/33326261/ doi: 10.2105/AJPH.2020.306021

May the analysis of 1918 influenza pandemic give hints to imagine the possible magnitude of Corona Virus Disease-2019 (COVID-19)?, By Raffaele Scarpa et. al., December 2020, Journal of Translational Medicine, https://pubmed.ncbi.nlm.nih.gov/33353549/ doi: 10.1186/s12967-020-02673-6

A tale of two pandemics, by John Gordon Harold, MD, MACC, December 16 2020, American College of Cardiology, https://www.acc.org/latest-in-cardiology/articles/2020/12/01/01/42/editors-corner-a-tale-of-two-pandemics

How the COVID Pandemic May End: Lessons From the 1918 Flu, by John Whyte, MD, MPH & Howard Markel, MD, PhD, Nov. 2020, Medscape, http://www.medscape.com/viewarticle/940788

Lessons From the 1918 Flu Pandemic: A Novel Etiologic Subtype of ADHD?, by James M Swanson & Nora D Volkow, Nov. 2020, Journal of the American Academy of Child and Adolescent Psychiatry, https://pubmed.ncbi.nlm.nih.gov/33186710/ doi: 10.1016/j.jaac.2020.09.024

Spanish Flu vs. COVID-19: Here's How They Compare, by Claire Gillespie, Nov. 2020, Health.com, https://www.health.com/condition/infectious-diseases/how-are-spanish-flu-and-covid-19-alike#main-content

What to learn from 1918's deadly second wave, Kristen Rogers, October 29 2020, CNN, https://www.cnn.com/2020/10/29/health/1918-pandemic-vs-2020-pandemic-fall-wave-wellness/index.html

Historian John Berry compares COVID-19 to the 1918 flu pandemic, by Kathleen McGarvey, Oct. 6 2020, University of Rochester, https://www.rochester.edu/newscenter/historian-john-barry-compares-covid-19-to-1918-flu-pandemic-454732/

What the 1918 flu pandemic can teach us about Coronavirus by Kristen Rogers, for CNN Health, September 25, 2020

Comparing mortalities of the first wave of coronavirus disease 2019 (COVID-19) and of the 1918-19 winter pandemic influenza wave in the USA, by David J Muscatello & Peter B McIntyre, Sept. 2020, International Journal of Epidemiology, https://academic.oup.com/ije/article/49/6/2089/5905673.

Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward by Lakshmi Krishnan et al., American College of Physicians, September 15, 2020

Pandemics and methodological developments in epidemiology history by Alfredo Morabia, Journal of Clinical Epidemiology, September, 2020

Comparing COVID-19 and the 1918–19 influenza pandemics in the United Kingdom by Daihai He et al., International Journal of Infectious Diseases, September, 2020

History Professor Sees Similarities Between 2020 and 1918 Pandemics by Brenda Tremblay, from WXXI News, August 31, 2020

Fact Check—COVID-19 is deadlier than the 1918 Spanish Flu and seasonal Influenza, USA Today, August, 20, 2020

Scientists say the Coronavirus is at least as deadly as the 1918 flu pandemic by Berkeley Lovelace Jr., for CNBC, August 13, 2020

MU Researchers Compare 1918 Flu to COVID-19, Missouri Medicine, June 29, 2020

Compare the flu pandemic of 1918 and COVID-19 with caution- the past is not a prediction by Mari Webel and Megan Culler Freeman. June 4, 2020

The lesson is to never forget, Harvard Gazette, May 19, 2020

Virus-afflicted 2020 looks like 1918 despite science’s march, Associated Press’s Calvin Woodward: May 5, 2020

Enforced Isolation in Spanish Flu Outbreak from msn.com, March 27, 2020

Ten Myths About the 1918 Flu Pandemic from Smithsonian Magazine, updated March 17, 2020

Don’t let COVID-19 Unleash Bias by UW-Madison’s Judith Levitt, Phd and Louis Leavitt, M.D., March 16, 2020

Why we should be careful comparing the COVID-19 coronavirus outbreak to the 1918 Spanish flu by Dylan Matthews in VOX, March 9, 2020

The Coronavirus is no 1918 Pandemic by Jeremy Brown, M.D. in the Atlantic, March 3, 2020

What the 1918 flu pandemic can teach us about Coronavirus by Kristen Rogers, for CNN Health, September 25, 2020

Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward by Lakshmi Krishnan et al., American College of Physicians, September 15, 2020

Pandemics and methodological developments in epidemiology history by Alfredo Morabia, Journal of Clinical Epidemiology, September, 2020

Comparing COVID-19 and the 1918–19 influenza pandemics in the United Kingdom by Daihai He et al., International Journal of Infectious Diseases, September, 2020

History Professor Sees Similarities Between 2020 and 1918 Pandemics by Brenda Tremblay, from WXXI News, August 31, 2020

Fact Check—COVID-19 is deadlier than the 1918 Spanish Flu and seasonal Influenza, USA Today, August, 20, 2020

Scientists say the Coronavirus is at least as deadly as the 1918 flu pandemic by Berkeley Lovelace Jr., for CNBC, August 13, 2020

MU Researchers Compare 1918 Flu to COVID-19, Missouri Medicine, June 29, 2020

Compare the flu pandemic of 1918 and COVID-19 with caution- the past is not a prediction by Mari Webel and Megan Culler Freeman. June 4, 2020

The lesson is to never forget, Harvard Gazette, May 19, 2020

Virus-afflicted 2020 looks like 1918 despite science’s march, Associated Press’s Calvin Woodward: May 5, 2020

Enforced Isolation in Spanish Flu Outbreak from msn.com, March 27, 2020You have pending changes that have not yet been saved.

Ten Myths About the 1918 Flu Pandemic from Smithsonian Magazine, updated March 17, 2020

Don’t let COVID-19 Unleash Bias by UW-Madison’s Judith Levitt, Phd and Louis Leavitt, M.D., March 16, 2020

Why we should be careful comparing the COVID-19 coronavirus outbreak to the 1918 Spanish flu by Dylan Matthews in VOX, March 9, 2020

The Coronavirus is no 1918 Pandemic by Jeremy Brown, M.D. in the Atlantic, March 3, 2020

Differences and Similarities

  1. A different viral culprit: 1918 was an H1N1, today’s is the coronavirus.
  2. A different demographic in terms of mortality, in 1918 the population most affected was young people between the ages of 18 and 32, now it is mainly older or elderly citizens, many with pre-existing conditions. There are exceptions in both eras.
  3. The complicating factor in 1918 was a bacterial pneumonia that opportunistically complicated the viral influenza. This not as relevant to 2020, but the availability of ventilators (a point of debate) and the variant debilitating effects of the coronavirus, are informing treatment, patient morbidity and mortality and public health policies.
  4. The world was at war during 1918. Thousands of soldiers were transported back and forth on crowded troop ships, and they lived and fought in close quartered trenches, where diseases were easily transmitted. Losing loved ones to war, and countless childhood and other communicable diseases that did not yet have the treatment or vaccines was a somewhat routine occurrence. In other words, people were used to having their daily lives disrupted in ways that 100 years later we, depending on our age, are not familiar with.
  5. The medical, therapeutic and nursing care has progressed in 2020, though, like in 1918 there is, as of autumn, 2020, no conclusive treatment or vaccine for COVID-19.
  1. A tendency to blame other countries for the virus's origin, or mismanagement of public health policies regarding the virus. A prime example, the descriptor, Spanish Flu. “Spanish Flu” was a result of press embargoes in Europe designed to limit the public’s knowledge of an influenza epidemic while the war was going on. Spain was the only country that did not have a press embargo, so were reporting on the number of cases they were seeing of the flu. European correspondents started reporting it as the Spanish Flu, a designation that far outlived the pandemic itself.
  2. A tendency to withhold or paradoxically overshare information regarding the virus and its impact on the public, the health care system, etc. Social media, the traditional media, and cable stations all contribute to a daily barrage of news items we must quickly process. Still, at the turn of the last century there were hundreds of newspaper publications, telegrams and letters, chronicling the spread of influenza.
  3. The trajectory of the virus itself, beginning in the spring, ebb and flow in the summer, then, the highest mortality in 1918 was in the autumn and early winter. We wonder if that will repeat itself in 2020. 
  4. The question of whether the virus will mutate and affect other populations, exist in concert with the “regular” flu season for increased morbidity and mortality, and whether a vaccine can be developed and affect the strain likely existent in 2020.

How many people died from the 1918 Pandemic worldwide?

30 million: 2 votes (18.18%)
50 million: 7 votes (63.64%)
15 million: 2 votes (18.18%)
Total Votes: 11

 

 

One-third of the world's population contracted the virus, nearly 500 million people! Of those infected, it is estimated that 50 million people died due the 1918 pandemic.