Frightening Lessons from the 1918 Pandemic and Why History May Repeat
COVID-19 has the advantages of simple math, human overconfidence and Mother Nature’s lack of empathy
On Aug. 27, 1918, two sailors at a pier in Boston came down with Spanish Flu. They were the first people in the United States to be stricken by the virus. Within a week, 100 sailors at the pier were falling victim each day. By September, one person was dying every 9 minutes in Boston. The flu spread across the country and by spring of 1919 had killed 675,000 Americans in a pandemic that left more than 50 million people dead around the world.
“In Boston, officials closed schools and tried to limit crowded gatherings to combat the spread of the disease,” according to the city’s historical archives. “Their efforts met with some success, but when World War I ended [on Nov. 11, 1918], crowds gathered to celebrate the armistice. Boston’s Health Department reported that cases of flu increased immediately after the celebration of the armistice.”
A century later, armed with far more scientific knowledge and ample time to plan, governments and health officials face a virulent disease that history may well liken to the Spanish Flu.
It’s all about the math, overconfidence, political dawdling and Mother Nature’s lack of empathy, says Skip Desjardin, author of “September 1918: War, Plague, and The World Series.”
“The biggest challenge of any pandemic is math, more than science,” says Desjardin tell me. “The exponential nature in which a virus spreads makes it very difficult to contain. Every infected person potentially spreads it to each person with whom they come in contact, and those people each spread it to even more.”
Knowns & unknowns
The 1918–19 influenza virus killed 2% of the people it infected, far more than the 0.1% rate for typical seasonal flu. The COVID-19 death rate remains to be determined, but appears to be at least 10 times that of the seasonal flu, says today’s top infectious disease health official, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. While most young people seem to escape the worst effects, older people and those with pre-existing health conditions are particularly vulnerable.
A new report in the Journal of the American Medical Association, published March 17, finds a 7.2% death rate among all 22,512 known COVID-19 cases in Italy, with a rate of 19.7% and higher for people over age 70. These figures should be viewed with caution, since not all cases are diagnosed or reported, but in the early days of this pandemic, the numbers are sobering.
And there’s no question the coronavirus that causes COVID-19 spreads easily between humans. A new study March 16 in the journal Science finds that people who don’t know they have the disease, and even those who have no symptoms, are spreading it. Such “super spreaders,” as they’re sometimes called, have infected dozens of people in a single hospital visit or other event in past viral outbreaks.
And the virus lasts out there. Research published March 17 in the New England Journal of Medicine finds coronavirus remains detectable in airborne droplets up to 3 hours, on cardboard up to 24 hours, and for up to 3 days on plastic and stainless steel.
By some analyses, COVID-19 cases may double every six days, which could lead to 1 million cases in the United States by the end of April and 2 million by the end of May.
Reflecting on past pandemic scares, from anthrax to swine flu to ebola, Fauci said he’s seen “nothing of the magnitude” of COVID-19. “Many of them evolved slowly” or never materialized as a serious threat in the United States, he said in an interview Feb. 18. With the current outbreak, “clearly we know what it can do” based on what’s happened in China, Italy and elsewhere, he said, adding: “This is totally unique.”
“It shouldn’t panic us or frighten us,” Fauci said, But we need to address this “very serious problem: in “in a very bold way.”
Science isn’t enough
Meanwhile, raw science is not going to save us: Just as in 1918, there is no vaccine. While the first trials for a COVID-19 vaccine began this week in Washington State, a working vaccine available to the masses is at least a year away, officials say. That leaves us with personal measures (wash your hands this way), the healthcare system and decisions by businesses, civic leaders and politicians.
Antiviral drugs that may prove effective against COVID-19 have so far not been found to be so by any research, Fauci said. Only anecdotes abound.
Amid all the knowns and unknowns of the COVID-19 pandemic, anyone who wonders why borders and businesses are being closed, events canceled, and social distancing is the new normal, need only look at the lessons from 1918.
I reached out to Desjardin for some perspective on two simple questions. The following interview has been lightly edited.
Robert Roy Britt: How does this outbreak compare to 1918, specifically in terms of the speed of spread and challenges faced by healthcare professionals?
SKIP DESJARDIN: “In 1918, the country’s foremost expert in infectious disease, Dr. Milton Rosenau, treated the very first Spanish Flu victim at a Boston Naval Hospital. He did everything right, but the math got way from him. The virus had spread before he could contain it.
“The second biggest challenge — then as now — is the limitation on our medical infrastructure. By the third week of the pandemic in 1918, virtually every hospital in Massachusetts closed its doors to patients. The beds were full, the hallways were full, the waiting rooms were full. Doctors, already in limited supply because America was in the midst of World War I, were dying. So were nurses. There was no one to drive the ambulances.
“It’s this kind of spike in cases we’re working to flatten with the steps we’re taking in America today. But we could still be overwhelmed quite quickly. With less than 100,000 available intensive care units nationwide in 2020, it wouldn’t take much to see hospitals turning away sick patients or rationing care.”
RRB: Given the historical perspective, what should have been done (or should be done now) in the United States to reduce the spread of COVID-19?
SD: “The Spanish Flu lesson that has not been applied effectively with COVID-19 is the essential need for government officials to tell the full truth, backed by medical facts, regardless of the political fallout.
“In 1918, the political pressure came from a desire to keep factories busy turning out ships and guns and boots for the war effort. So the government made dangerous statements about how the weather would stop the virus, or how a sure-fire way to stay healthy was to ‘avoid tight shoes.’ This year, time was wasted trying to downplay the threat by promising to distribute tests or underplaying the number of confirmed cases, again with an eye toward politics rather than public health.”
The microscopic coronavirus enters through the eyes, nose and mouth, infecting human cells and hijacking them to reproduce itself. That’s how a virus, which is not technically a living thing, survives.
The coronavirus hops between humans when someone coughs, sneezes or just breathes, according to the U.S. Centers for Disease Control and Prevention, which therefore advises people to avoid large gatherings and to stay 6 feet apart whenever possible to help curb the spread.
Only in retrospect will we know exactly how exactly easily this germ spreads compared to others in history, and exactly how deadly it will be. It’s those unknowns, along with the knowns, that Skip Desjardin fears.
“A century after the Spanish Flu pandemic killed over 50 million people worldwide, our scientific advances have been amazing,” he says. “But Mother Nature doesn’t care. Tiny microbes can still be more powerful than we are, and it is imperative that we recognize that, or our overconfidence will get people killed.”