One hundred years ago, the world suffered a serious pandemic called the Spanish Flu. It came about near the end of World War I – 1918. For around two years (February 1918 to April 1920) it was deadly, and around 75 million people died after being infected. The pandemic went away by itself – it mutated into something benign. The COVID-19 pandemic does not appear as deadly as the Spanish Flu, but COVID-19 has killed 1,000,000 people between January 2020 and September 2020 (nine months).

  1. In about 1,000 words, I will discuss the Spanish Flu and compare it to COVID-19.
  2. The Spanish flu was a deadly pandemic caused by a virus (H1N1 influenza A).
  3. It lasted from February 1918 to April 1920 (two years and two months).
  4. It infected 500 million people – about a third of the world’s population at the time – in four successive waves.
  5. About 75 million people are thought to have died, representing about 5% of the world’s population.
  6. The first observations of illness and mortality were documented in the United States, France, Germany and the United Kingdom.
  7. To maintain morale, World War I correspondents or censors minimized early reports of the pandemic.
  8. In neutral Spain, newspapers were free to report the pandemic’s effects, such as the grave illness of their king, and these stories created a false impression of Spain as especially hard hit. This gave rise to the name “Spanish” flu.
  9. The first wave of the flu occurred in the beginning few months of 1918 and was relatively mild. The Spanish flu resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily.
  10. The second wave occurred between August 1918 and December 1918, and it was much more deadly than the first.
  11. During the second wave, the disease was often complicated by bacterial pneumonia, which was often the cause of death. This more serious type would cause the skin to first develop two mahogany spots over the cheekbones which would then over a few hours spread to colour the entire face blue, followed by black colouration first in the extremities and then further spreading to the limbs and the torso.
  12. After this, death would follow within hours or days due to the lungs being filled with fluids. Other signs and symptoms reported included spontaneous mouth and nosebleeds, miscarriages for pregnant women, a peculiar smell, teeth and hair falling, delirium, dizziness, insomnia, loss of hearing or smell, blurred vision, and impaired colour vision.
  13. One observer wrote, “One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and hemorrhages in the skin also occurred”.
  14. The majority of deaths were from bacterial pneumonia, a common secondary infection associated with influenza.
  15. The strong immune reactions of young adults were postulated to have ravaged the body, whereas the weaker immune reactions of children and middle-aged adults resulted in fewer deaths among those groups.
  16. The devastating second wave of the Spanish Flu hit American shores in the summer of 1918, as returning soldiers infected with the disease spread it to the general population – especially in densely-crowded cities. Without a vaccine or approved treatment plan, it fell to local mayors and health officials to improvise plans to safeguard the safety of their citizens.
  17. On 28 September 1918, the city went ahead with a parade for the returning soldiers attended by tens of thousands of Philadelphians, spreading the disease like wildfire. In just 10 days, over 1,000 Philadelphians were dead, with another 200,000 sick.
  18. In January 1919, a third wave of the Spanish Flu hit. The third wave was more lethal than the first but less so than the second.
  19. In spring 1920, a fourth wave occurred.
  20. The Spanish flu pandemic resulted in a higher than expected mortality rate for young adults. COVID-19 attacks the elderly people (above 70) more than the young.
  21. At that time, there were no antiviral drugs to treat the virus, and no antibiotics to treat the secondary bacterial infections. The first licensed flu vaccine appeared in the US in the 1940s. 
  22. Maritime quarantines were declared on islands such as Iceland and Australia, saving many lives.
  23. At the height of the pandemic, quarantines were instituted in many cities. Some were forced to restrict essential services, including police and fire.
  24. Social distancing measures were introduced, for example closing schools, theatres, and places of worship, limiting public transportation, and banning mass gatherings.
  25. Wearing face masks became common in some places, such as Japan, though there were debates over their efficacy.
  26. Citizens in San Francisco were fined $5 – a significant sum at the time – if they were caught in public without masks and charged with disturbing the peace.
  27. People were advised to avoid shaking hands and to stay indoors, libraries put a halt on lending books and regulations were passed banning spitting.
  28. Even in areas where mortality was low, so many adults were incapacitated that much of everyday life was hampered. Some communities closed all stores or required customers to leave orders outside.
  29. There were reports that healthcare workers could not tend the sick nor the gravediggers bury the dead because they too were ill. Bodies were buried without coffins in many places.
  30. Funeral parlours were overwhelmed and bodies piled up. Many people had to dig graves for their own family members.
  31. The flu took a heavy human toll, wiping out entire families and leaving countless widows and orphans in its wake.
  32. More men than women were killed by the flu, as they were more likely to go out and be exposed, while women would tend to stay at home.
  33. Many businesses in the entertainment and service industries suffered losses in revenue, while the healthcare industry reported profit gains.
  34. The Spanish flu was detrimental to the economy. In the United States, businesses were forced to shut down because so many employees were sick. Basic services such as mail delivery and garbage collection were hindered due to flu-stricken workers.
  35. In some places there were not enough farm workers to harvest crops.
  36. Even state and local health departments closed for business, hampering efforts to chronicle the spread of the Spanish flu and provide the public with answers about it.
  37. The majority of the people who contracted the 1918 flu survived. National death rates among the infected generally did not exceed 20%. For COVID-19, it is around 1%.
  38. Of course, even a 20% death rate vastly exceeds a typical flu, which kills less than 0.1% of those infected.
  39. The rapidly mutating virus likely evolved over time into less lethal strains. This is predicted by models of natural selection. Because highly lethal strains kill their host rapidly, they cannot spread as easily as less lethal strains.
  40. Today, scientists know more about how to isolate and handle large numbers of ill and dying patients, and physicians can prescribe antibiotics, not available in 1918, to combat secondary bacterial infections.

© Comasters October 2020.

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