Many comparisons have been made between the current Covid-19 pandemic and the Spanish Flu pandemic in 1918-1919. The ongoing pandemic has been called the most severe to have occurred since then. That may be true, but the comparisons stop there. Making too many comparisons between two things that are in no way comparable to one another makes the lesser seem far worse than it is. Thus, comparing Covid to the Spanish Flu greatly exaggerates its severity. It is just one of many ways the fearmongering over this pandemic has gone completely over the top.
The Spanish Flu drew many comparisons to the Black Plague and was the world’s deadliest pandemic since the Plague outbreak in the 1300s that had wiped out a quarter to half the population of Europe. The Spanish Flu killed an estimated 10-50 million people worldwide, and possibly as many as 100 million, including 500-850,000 in the U.S, with 675,000 being the number most commonly cited. That would be 2 million or more with today’s population. By comparing Covid to the Spanish Flu, it is effectively being likened to the Plague.
Covid is thought to have a mortality rate of about 1-2 percent, though some estimates place it as low as .25 percent. The Spanish Flu’s mortality rate was harder to calculate since record keeping was not as good, but estimates range from 2 percent to 20 percent, with most placing it around 10 percent. But it is always difficult to calculate the mortality rate for an illness when it is unclear how many people have had it, which makes it difficult to calculate for either one. Mortality rates also vary widely depending on the demographic it infects, and the characteristics of the people who die can say more about the severity of the illness than calculating an average death rate. The overwhelming majority of deaths involving Covid have been people with pre-existing health problems, most over the age of 65, and a plurality of those over the age of 80. The Spanish Flu, on the other hand, killed people of all ages, regardless of their health, and most deaths were reported in healthy young people.
Another indication of the severity of an illness is its symptoms. Some strange symptoms have been reported in severe cases of Covid, including blood clots and kidney failure. Much media coverage has sensationalized this as something strange or unusual that makes Covid unique from other flu-like illnesses, despite the fact that similar strange symptoms have been reported in severe cases of other coronaviruses and flu strains. But a record of the symptoms recorded during the Spanish Flu are far stranger and far more graphic. In fact, people initially did not believe it was a flu or pneumonia because the symptoms were so strange and severe. When it first arrived on the battlefields of Europe, it was mistaken for the Plague and people believed the Black Death had returned.
It was bad enough that it killed so many healthy young people, but the way they died was even worse (trigger warning). Many people died drowning in their own mucus, which would fill their lungs and drip out of their mouths. People at the time remarked that it looked just like soldiers dying on the battlefield after inhaling chemical gas. Other symptoms included hemorrhages, bleeding out of the eyes, coughing up blood from the lungs, and severely high fevers causing hallucinations. Ex-ray scans and autopsies revealed lungs torn up by the disease. Patients’ skin would turn blue before dying, which was thought to be the result of severe oxygen deprivation, and the Spanish Flu was nicknamed “the blue death.”
Many of the symptoms it caused are now thought to be the result of a cytokine storm, when the disease attacks the immune system and the immune system responds by attacking the body. But even this doesn’t seem like a full explanation, given that Covid, along with other flu strains, have been known to trigger cytokine storms as well, sometimes resulting in deaths, including rare isolated incidents involving healthier young people dying, but without causing such severe symptoms or killing people in such horrific ways. It is still a mystery as to why exactly the Spanish Flu was so severe.
If the comparisons between the two pandemics is deeply misleading, so too are the historical comparisons in how people and governments responded. The history of the Spanish Flu outbreak has been grossly misrepresented and has been effectively cherry picked and twisted to fit a narrative to try and justify the measures that have been implemented during this pandemic and make an excuse for keeping them in place.
The worst example of this is the misrepresentation of the responses of St. Louis and Philadelphia. Many have tried to use St. Louis as an example to justify the current shutdown and argue it will not have any adverse social or economic effects. They have tried to draw parallels between the current response to Covid and how St. Louis responded to the Spanish Flu, highlighting St. Louis as a model for how to respond to an outbreak while contrasting it to Philadelphia is an example of how not to respond to an outbreak. The contrast between St. Louis and Philadelphia is certainly true, but the comparisons between St. Louis during the Spanish Flu and the current response to the Covid pandemic is certainly not.
St. Louis did implement restrictions that were considered quite extreme at that time, but they were nowhere near as extreme as the shutdowns implemented now. Schools, theaters, churches and entertainment venues were closed and most forms of public gatherings were banned, but everything else remained open. School sporting events continued, but spectators were barred from attending. Nonetheless, there was widespread backlash to the closures, particularly from churches and business owners affected by them. Some refused to comply while others went into underground bootlegging.
The closest St. Louis came to implementing measures comparable to today was in November, when the outbreak was nearing its end, when all non-essential businesses and factories were ordered to close for a period of four days before reopening. The city’s health commissioner, Max Starkloff, argued that since the shutdown coincided with a national holiday to mark the end of the war, the economic impact would be minimal. The city did not issue any stay-at-home orders and still allowed for gatherings to celebrate the armistice. Despite the short-term closure, business owners were still outraged and the federal government intervened to keep factories involved in war-time production open.
Starkloff’s handling of the situation was certainly exemplary and St. Louis faired much better than many other cities. But nonetheless, its death rate was not much different from other cities in the Midwest, regardless of what restrictions they implemented. The death rate in St. Louis was not much lower than Chicago, where restrictions were much looser (shortly after the outbreak ended, the two cities got into an argument, stemming from their health commissioners, over which city was healthier and which handled the outbreak better). Nor was it significantly lower than New York, where restrictions were also quite loose.
If anything, the most extensive, prolonged shutdown occurred in Philadelphia, which has been highlighted as an example for how not to respond to an outbreak, and for good reason. Philadelphia’s initial response was to ignore it. Even as it started spreading in the city, officials downplayed the seriousness of the flu and held a war bonds parade that drew 200,000 people. Shortly after that, the outbreak spiraled out of control. The government panicked and instituted widespread closures of schools, theaters, bars, churches, entertainment venues and was one of the few cities to close cafes. City services stopped running and even government buildings closed. The city was shut down, in part on government orders, but in part out of fear and paralysis as the outbreak ravaged the city. But nonetheless, many still objected to government ordered closures, and the Philadelphia Inquirer was one of the most vocal critics.
There seems to be a widespread delusion that America has learned from the past and is doing a better job at responding to Covid than it did to the Spanish Flu. America’s response is nothing like that of St. Louis, which took advance preparations, and is far more like Philadelphia. Just like Philadelphia during the Spanish Flu, American officials at all levels of government initially ignored and sought to downplay Covid-19 for weeks while it was spreading and allowed major events that drew large crowds, then made an abrupt U-turn, panicked and shut everything down while the outbreak has spiraled out of control. Once again, society has effectively collapsed and ground to a halt, in many ways even more so than Philadelphia in 1918, all for a virus that is far less severe, and all the while ignoring the successful containment strategies other countries have used, particularly in Asia.
If the economy in cities like St. Louis recovered well, perhaps that is because they were never shut down. Philadelphia’s economy took the biggest hit, both because of the virus and because of the way it shut down. That does not bode well for countries that have shut down even more than Philadelphia, and for a much longer period of time. Some have tried to argue that leaving the economy open while workers get sick will have a worse social and economic effect than shutting everything down, but the Spanish Flu outbreak shows that is not the case. Despite the severity of the outbreak and disruptions to the economy from workers falling ill, the U.S. economy recovered quickly, and the places that suffered the most, like Philadelphia, were the ones with the most extensive prolonged shutdowns.
When Wuhan was locked down in January, people were alarmed and skeptical and said such a thing had never been done before. It was the first time in human history such measures had been tried. But when Western countries started doing it, suddenly media outlets and health experts backtracked and tried to say such measures had been tried in the past and were proven effective with no harmful side effects. They were right the first time. Never in human history have countries tried to institute a prolonged shutdown like this, and it should be pretty obvious that not only is this failing to contain the outbreak but that the economic and social consequences will be disastrous.
The other historical comparison that has been used to justify keeping the current measures in place, that cities that lifted their restrictions too early during the Spanish Flu suffered a second wave, is also misleading. Fundamentally this is true, many cities were under a lot of pressure to lift their restrictions and experienced a second wave, though not all of them. New York lifted its restrictions early and was largely spared. San Francisco suffered the most, as it was largely spared the fall 1918 wave but got hit hard in the winter after lifting its restrictions, and it is thought it could have saved many lives if it had kept them in place. But the comparison is misleading because the restrictions that were in place and were lifted early were nowhere near as extreme and crippling as the current ones. They were basic, common sense restrictions, unlike today.
The comparison is also misleading because in most cities the second wave was far less severe than the first, and many of the restrictions that were in place the first time were not reinstated because officials did not believe the situation was bad enough to warrant it. After getting hit with a second wave, Atlanta’s health commissioner, Dr. J.P. Kennedy, stated that “The influenza situation in Atlanta is up to the people themselves,” and that instituting new restrictions and closures would be “useless.” The decision to rely more on voluntary compliance rather than intrusive restrictions is a lesson people would do well to take heart of today.
As much as people like to think they have responded to the Covid pandemic better than the Spanish Flu pandemic, I believe the opposite is true. Many mistakes were made during the Spanish Flu, particularly the decision to censor news of the outbreak as it was unfolding in Europe. But even this decision, wrong though it may be, is partially understandable, given that leaders in the midst of a major war were afraid of emboldening the other side and putting soldiers in greater danger and depressing their morale by acknowledging the devastating impact the flu was having amidst their ranks. It is also little better than today’s response to simply ignore the outbreak as it was approaching. Also, during the Spanish Flu, many cities did a better job at making advance preparations and implementing reasonable restrictions that balanced between the need to protect public health and the need to keep society running and protect people’s livelihoods.
Unlike today, people then understood the importance of economic considerations and taking into account the impact of closures on people’s lives and livelihoods. When people complained about closures hurting them financially, they were not dismissed and ridiculed like today, they were understood, and city leaders and health officials empathized with them. St. Louis health commissioner Starkloff agreed to lift restrictions on business operating hours shortly after implementing them, saying he understood they were causing hardship for small businesses. This change had little effect on the course of the outbreak and other measures remained in effect for several more weeks.
It is hard not to be amazed at the foolhardy way so many objected to even the most basic and sensible restrictions at that time given the severity of the outbreak. There seemed to be less fear and panic then there is now, and government officials and media outlets at that time focused on trying to keep people calm rather than fueling fear. It is clear that even amongst reasonable people who favored some closures and restrictions, few would support the extreme measures that have been taken today, not even for something as serious as the Spanish Flu. Some have felt the reason people were not as afraid and did not favor tighter restrictions was because they did not understand it could be transmitted asymptomatically. Others have suggested it was because people didn’t have the means to work at home. These things may have contributed, but I do not think this is the primary reason. Ignorance may have played a role in the more foolhardy people of the time, but people knew it was not always possible to tell who was sick. I just think people were more used to hardship and tragedy and less prone to fear and hysteria than they are today. I think the stereotypical grandpa who always rants about how society has become weak and people were much tougher in his day was right.
I cannot imagine the fear and panic a pandemic like the Spanish Flu would cause if it were to occur today. Conversely, if a pandemic like Covid were to have occurred instead of the Spanish Flu, I do not think people would have thought very much of it or reacted very much. People at that time were used to deadly outbreaks of flu and pneumonia and many other illnesses such as cholera, tuberculosis, typhoid, measles and smallpox. In fact, the first wave of the Spanish Flu in the Spring of 1918 was largely ignored because it was not too severe and people were distracted by other illnesses. The army at that time was struggling with a deadly measles outbreak. To them, Covid-19 would have been just another bout of pneumonia. It is also true that there are many more older people and people with chronic health problems today then there were back then, so perhaps the death toll from this type of illness may not have been as high.
In fact, that may be one of the reasons Covid stands out so much, as it does not appear to be the first pandemic of its kind to have occurred since the Spanish Flu. It looks a lot like the Asian Flu pandemic in 1957 and the Hong Kong Flu pandemic of 1968. Both illnesses behaved a lot like Covid, and the symptoms described sound very similar. Their estimated mortality rates of .2 to 1 percent may not be that different from it. The Asian Flu of 1957 is thought to have killed an estimated 1-4 million people worldwide, the equivalent of 3-12 million today. The CDC estimates it killed 116,000 in the U.S. in two waves, one in the summer and one in the winter. That’s the equivalent of 230,000 today. The Hong Kong Flu in 1968 is also thought to have killed 1-4 million people worldwide and the CDC estimates it killed 100,000 in the U.S., though some estimates are lower. Most fatalities involved people who were older or with pre-existing health problems, again just like Covid.
Both outbreaks caused anxiety, but no shutdowns or closures were implemented and both were largely ignored despite their impact. Schools and businesses reported widespread absences and hospitals were overwhelmed. Morgues and funeral homes were also sometimes overwhelmed, particularly in Germany during the Hong Kong Flu, where 60,000 are thought to have died. The Hong Kong Flu is also thought to have killed 30,000 in France. Despite widespread disruptions caused by workers falling ill and being absent, sometimes as many as 50 percent at one time, there were no long term social and economic effects. Both pandemics could have been far worse were it not for the early development of a vaccine.
When comparing the current pandemic to those of the past, it is more accurate to compare it to the Asian Flu and Hong Kong Flu pandemics, rather than the Spanish Flu. It has far more in common with the former two. In fact, I think there is a lot we can learn about Covid from taking a look at the Asian Flu and Hong Kong Flu and how differently people responded to them. It may not be advisable to be as casual about it as people were in 1957 and 1968, particularly since there are now far more people with pre-existing health problems or over the age of 65 than there were then, but it shows there is no reason for this level of panic or for shutdowns that have done more harm than good.