essay on the spanish flu

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The Spanish Influenza Pandemic: a lesson from history 100 years after 1918

V gazzaniga, nl bragazzi.

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Mariano Martini, Department of Health Sciences (DISSAL), University of Genoa, largo R. Benzi, University of Genoa, Italy - Tel/Fax +39 010 35385.02 - E-mail: [email protected]

Received 2019 Jan 15; Accepted 2019 Feb 22; Collection date 2019 Mar.

This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) , which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to https://creativecommons.org/licenses/by-nc-nd/4.0/

In Europe in 1918, influenza spread through Spain, France, Great Britain and Italy, causing havoc with military operations during the First World War. The influenza pandemic of 1918 killed more than 50 million people worldwide. In addition, its socioeconomic consequences were huge.

“Spanish flu”, as the infection was dubbed, hit different age-groups, displaying a so-called “W-trend”, typically with two spikes in children and the elderly. However, healthy young adults were also affected.

In order to avoid alarming the public, several local health authorities refused to reveal the numbers of people affected and deaths. Consequently, it was very difficult to assess the impact of the disease at the time.

The first official preventive actions were implemented in August 1918; these included the obligatory notification of suspected cases and the surveillance of communities such as day-schools, boarding schools and barracks.

Identifying suspected cases through surveillance, and voluntary and/or mandatory quarantine or isolation, enabled the spread of Spanish flu to be curbed. At that time, these public health measures were the only effective weapons against the disease, as no vaccines or antivirals were available.

Virological and bacteriological analysis of preserved samples from infected soldiers and other young people who died during the pandemic period is a major step toward a better understanding of this pandemic and of how to prepare for future pandemics.

Key words: History of Pandemic, Flu, Public Health, Mortality rate

War and disease: the spread of the global influenza pandemic

On March 4, 1918, Albert Gitchel, a cook at Camp Fuston in Kansas, was afflicted by coughing, fever and headaches. His was one of the first established cases in the history of the so-called Spanish flu. Within three weeks, 1100 soldiers had been hospitalized, and thousands more were affected [ 1 ].

In Europe, the disease spread through France, Great Britain, Italy and Spain, causing havoc with First World War military operations. Three quarters of French troops and more than half of British troops fell ill in the spring of 1918. In May, the flu hit North Africa, and then Bombay in India; in June, the first cases were recorded in China, and in July in Australia.

This first wave is not universally regarded as influenza; the symptoms were similar to those of flu, but the illness was too mild and short-lasting, and mortality rates were similar to those seen in seasonal outbreaks of influenza [ 2 ].

In August, a deadly second wave of the Spanish pandemic ensued. This was probably caused by a mutated strain of the virus, which was carried from the port city of Plymouth in south-western England by ships bound for Freetown in Sierra Leone and Boston in the United States. From Boston and Freetown, and from Brest in France, it followed the movements of the armies.

This second wave lasted almost six weeks, spreading from North America to Central and South America, from Freetown to West Africa and South Africa in September, and reaching the Horn of Africa in November. By the end of September, the flu had spread to almost all Europe, including Poland and Russia. From Russia the epidemic spread throughout northern Asia, arrived in India in September, and in October it flared up again in China. In New York, the epidemic was declared to be over on 5th November, while in Europe it persisted, owing to the food and fuel shortages caused by the war. Most cases of illness and death due to the pandemic occurred during the second wave [ 3 ].

Deadly clusters of symptoms were recorded, including nasal hemorrhage, pneumonia, encephalitis, temperatures of up to 40°C, nephritis-like blood-streaked urine, and coma [ 4 ]. While the new virus struck military personnel, influencing war strategies, it did not spare those who lived in privileged conditions, one of the most famous cases being that of the King of Spain, Alfonso XIII, who was certainly not afflicted by the privations of the war.

By December 1918, much of the world was once again flu-free, and in early 1919 Australia lifted its quarantine measures. However, in the austral summer of 1918-1919, more than 12,000 Australians were hit by the third wave of the disease. In the last week of January 1919, the third wave reached New York, and Paris was hit during the post-war peace negotiations. Overall, fewer people were affected by the disease during the final influenza wave. Nevertheless, mortality rates are believed to have been just as high as during the second wave [ 5 ]. In May 1919, this third pandemic was declared finished in the northern hemisphere. In Japan, however, the third epidemic broke out at the end of 1919 and ended in 1920.

Looking for the Spanish flu bacillus

Although official communications issued by health authorities worldwide expressed certainty about the etiology of the infection, in laboratories it was not always possible to isolate the famous Pfeiffer’s bacillus, the Haemophilus influenzae bacterium first identified by the renowned German biologist in the nasal mucus of a patient in 1889, which, at the time, was considered to be the causal agent of influenza [ 6 ]. In October 1918, Nicolle and Lebailly, scientists at the Pasteur institute, first advanced the hypothesis that the pathogen responsible for the flu was an infectious agent of infinitesimal dimensions: a virus. Its immuno-pathological effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia and other co-infections, such as measles and malaria, or co-morbidities such as malnutrition or obesity [ 7 , 8 ].

The Spanish flu hit different age-groups, displaying a so-called “W-trend”, with infections typically peaking in children and the elderly, with an intermediate spike in healthy young adults. In these last cases, lack of pre-existing virus-specific and/or cross-reactive antibodies and cellular immunity probably contributed to the high attack rate and rapid spread of the 1918 H1N1 virus, and to that “cytokine storm” which ultimately destroyed the lungs.

Only in 1930 was the flu pandemic rightly attributed to a virus, and in 1933 the first human influenza virus was isolated [ 9 ].

Public health measures to control the disease

There was no cure for the disease; it could only be fought with symptomatic treatments and improvised remedies. Moreover, the return of soldiers from the war fronts, the migration of refugees and the mobility of women engaged in extra-domestic activities had favored the rapid spread of the virus since the onset of the first pandemic wave. Preventive public health measures were therefore essential, in order to try to stem the spread of the disease [ 10 ].

The first official preventive measures were implemented in August 1918; these included the obligatory notification of suspected cases, and the surveillance of communities such as day-schools, boarding schools and barracks. In October 1918, local authorities in several European countries strengthened these general provisions by adding further measures, for instance the closure of public meeting places, such as theaters, and the suspension of public meetings. In addition, long church sermons were prohibited and Sunday instruction was to last no more than five minutes.

Street cleaning and the disinfection of public spaces, such as churches, cinemas, theaters and workshops, were considered to be cornerstones in controlling the spread of Spanish flu, in addition to banning crowds outside shops and limiting the number of passengers on public transport. However, they did not prove very effective.

Among public health interventions, local health departments distributed free soap and provided clean water for the less wealthy; services for the removal of human waste, the regulation of toilets, and the inspection of milk and other food products were organized; spitting in the street was forbidden, which determined the spread of pocket spittoons, and announcements in newspapers and leaflets advertised the therapeutic virtues of water.

To simplify mortuary police services, many administrations in the worst affected centers in Italy set up collection points for corpses and abolished all the rituals that accompanied death.

In addition, identifying cases of illness through surveillance, and voluntary and/or mandatory quarantine or isolation, also helped to curb the spread of Spanish flu, in a period in which no effective vaccines or antivirals were available.

The silence of the press: the censored Spanish flu

As Spain was neutral in the First World War, newspapers there were free to report the devastating effects that the 1918 pandemic virus was having in that country. Thus, it was generally perceived that the pandemic had originated in Spain, and the infection was incorrectly dubbed “Spanish flu” [ 2 ]. During the fall of 1918, the front pages of Spanish newspapers were filled with the names of those who had died of the pandemic in the country [ 2 , 3 ].

In other European countries, however, the press refrained from reporting news of the spreading infection, in order to avoid alarming the general population, which was already suffering the privations caused by the First World War. On 22 nd August 1918, the Italian Interior Minister denied the alarming reports of the spread of the flu pandemic, and in the following months, both national and international newspapers followed suit. Nor was censorship restricted to news of the spread of the fearsome infection; it also extended to information and comments that contrasted with the official versions of the nature of the disease.

In order to avoid public alarm, several local hygiene authorities refused to reveal the numbers of people affected and deaths [ 11 ]. Moreover, it was announced that the average duration of the epidemic did not exceed two months. By the middle of October 1918, however, it had become impossible to verify this claim.

Some scientists believed that one of the causes of the epidemic was the poor quality of food, which was rationed at the time of the epidemic crisis. The extent to which the gravity of the pandemic was accentuated by malnutrition among war-tired populations is unclear. However, the fact that the disease, even in serious forms, spread through countries that were neutral or completely uninvolved in the war, such as Spain, seems to suggest that malnutrition was not a key factor.

Another thesis was that the disease had been triggered by a bacteriological war waged by the Austro-German enemy. On the one hand, newspapers were essential to publicizing emergency measures to contain the epidemic, such as closing cinemas and theaters or prohibiting other types of gathering, including funerals. On the other, any mention of the horror that was unfolding was to be avoided. Even sounding death bells was sometimes forbidden, to prevent their continual dismal tolling from revealing the extent of the tragedy that was to be hidden. The unseen enemy mainly attacked young people, causing major social upheaval; if Spanish flu did not take the lives of children, it made them orphans.

A tragic legacy: mortality worldwide

The influenza pandemic of 1918 killed more than 50 million people and caused more than 500 million infections worldwide. In the military camps and trenches during the First World War, the influenza pandemic struck millions of soldiers all over the world, causing the deaths of 100,000 troops. However, it is not clear whether it had an impact on the course of the war [ 12 ]. The highest morbidity rate was among the Americans in France, during the Meuse-Argonne offensive on the Western Front from September 15 to November 15, 1918, when over one million men of the US Army fell sick [ 12 ].

General understanding of the healthcare burden imposed by influenza infections was unclear. Several factors were suspected of increasing the risk of severe flu: length of service in the army, ethnicity, dirty dishes, flies, dust, overcrowding and the weather. In overcrowded camps, the risk of flu, and its principal complication, pneumonia, increased 10-fold [ 13 ]. Bacterial pneumonia secondary to influenza was the overwhelming cause of death, owing to increased susceptibility due to transient immuno-pathological effects and dysregulated, pathological cellular immune responses to infections [ 14 , 15 ].

It is difficult to ascertain the mortality rate of the pandemic, as data on deaths were transmitted in incomplete form to the Central Statistical Office. In Italy, the “Albo d’oro” collected documentation on the number and demographic characteristics of the soldiers who died during the conflict, which enabled more accurate data to be obtained on deaths due to influenza among military personnel [ 16 ].

Military nurses and medical ofﬁcers were intensively and repeatedly exposed to the inﬂuenza A (H1N1) pandemic strain in many areas. However, during the lethal second wave, nurses and medical ofﬁcers of the Australian Army, and other groups of healthcare workers, displayed inﬂuenza-related illness rates similar to those of other occupational groups, and mortality rates that were actually lower. These ﬁndings suggest that the occupational group most intensively exposed to the pandemic strain had relatively low inﬂuenza-related pneumonia mortality rates [ 17 , 18 ]. The dynamic relationship between the host and the influenza virus during infection, the unusual epidemiological features and the host-specific properties that contributed to the severity of the disease in the pandemic period still remain unknown [ 19 , 20 ].

Conclusions

The 1918 pandemic influenza was a global health catastrophe, determining one of the highest mortality rates due to an infectious disease in history.

Virological analysis of preserved samples from infected soldiers and others who died during the pandemic period is a major step toward a better understanding of this pandemic. Such knowledge may contribute to the discovery of new drugs and the development of preventive strategies, including insights into the appropriate timing of the administration of antivirals and/or antibiotics, thereby providing indications on how to prepare for future pandemics.

The 1918-1919 pandemic led to enormous improvements in public health. Indeed, several strategies, such as health education, isolation, sanitation and surveillance, improved our knowledge of the transmission of influenza, and are still implemented today to stem the spread of a disease that has a heavy burden.

Acknowledgments

Funding sources: this research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors.

Conflict of interest statement

None declared.

Authors’ contributions

MM and IB conceived the study, MM and IB drafted the manuscript, VG and NB revised the manuscript. IB, MM, VG and NB performed a search of the literature. All authors critically revised the manuscript. All authors have read and approved the latest version of the manuscript.

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The Flu Pandemic of 1918

Red Cross workers make anti-influenza masks for soldiers, Boston, Massachusetts. (National Archives Identifier 45499341 )

Before COVID-19, the most severe pandemic in recent history was the 1918 influenza virus, often called “the Spanish Flu.” The virus infected roughly 500 million people—one-third of the world’s population—and caused 50 million deaths worldwide (double the number of deaths in World War I). In the United States, a quarter of the population caught the virus, 675,000 died, and life expectancy dropped by 12 years. With no vaccine to protect against the virus, people were urged to isolate, quarantine, practice good personal hygiene, and limit social interaction. Until February 2020, the 1918 epidemic was largely overlooked in the teaching of American history, despite the ample documentation at the National Archives and elsewhere of the disease and its devastation. The 100-year-old pictures from 1918 that just months ago seemed quaint and dated now seem oddly prescient. We make these records more widely available in hopes that they contain lessons about what to expect over the coming months and ideas about ways to avoid a repeat and prepare for what may follow.

Online Exhibit

A selection of photographs and documents from the National Archives' nationwide holdings tell the story of the 1918 influenza pandemic.

Photographs

(Click image to view gallery)

Images from the 1918 Flu Pandemic

Female clerks in New York City wear masks at work. (National Archives Identifier 45499337 )

Department of the Navy: Precautions Against Influenza. (National Archives Identifier 6861947 )

Traffic "cop" in New York City wearing gauze mask. (National Archives Identifier 45499301 )

New York City "conductorettes" wearing masks. (National Archives Identifier 45499323 )

Letter carrier in New York City wearing mask. (National Archives Identifier 45499319 )

To prevent the spread of Spanish Influenza, Cincinnati barbers are wearing masks. (National Archives Identifier 45499317 )

Additional Photographs

Red Cross volunteer nurses in Eureka, CA
Red Cross Women’s Motor Corps aids injured patients
Red Cross workers in Seattle
Street cleaner in mask
Boston Red Cross workers making masks for soldiers
Female elevator operator in New York City
Eberts Field, Lonoke, AR: Convalescent influenza patients in hospital overflow space
Emergency hospital, Brookline, MA, to care for influenza cases
Fighting influenza in Seattle: Flu serum injection
A nurse wearing a mask fills water from a pitcher
Mother and daughter work on a quilt for soldiers
Red Cross Motor Corps on duty
San Francisco police court meets in open air for influenza prevention

Author Lecture

Dr. Jeremy Brown, Director of Emergency Care Research, National Institutes of Health, spoke about his book Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History, at the National Archives in Washington, DC, on March 5, 2019.

Archival Film

Nurses make bandages for flu epidemic (stock newsreel footage from CBS)

Blogs and Social Media Posts

Forward with Roosevelt: One of the Millions: FDR and the Flu Pandemic of 1918–1920

Text Message: The “Spanish Flu” Pandemic of 1918–1919: A Death in Philadelphia

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Pieces of History: Influenza Epidemic 1918—“Wear a mask and save your life”

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Unwritten Record: The 1918 Influenza Pandemic

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Tumblr: 1918 to COVID-19

Tumblr: Influenza Epidemic 1918—“Wear a mask and save your life”

For Educators

Influenza Directive from DC re: treatment and procedures , 9/26/1918

Influenza Prophylaxis Memo from Third Naval District Medical Officer

Documents Related to the Flu Pandemic of 1918

Memo Re: Sanitary Precautions, 9/12/1918

Additional primary sources and educational resources from DocsTeach

At the Presidential Libraries

Truman Library: Letter from Harry to Bess , referencing the influenza epidemic, and expressing relief that Bess has recovered from it.

Ford Library: Remarks Upon the Signing of National Swine Flu Immunization Program of 1976

Ford Library: President Asks Congress for $135 Million for Swine Flu Vaccine Ford Library: Fact Sheet on Swine Influenza Immunization Program

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The 1918 Flu Pandemic: Why It Matters 100 Years Later

Group photo of Red Cross nurses in Boston wearing personal protective equipment.

Here are 5 things you should know about the 1918 pandemic and why it matters 100 years later.

1. The 1918 Flu Virus Spread Quickly

In 1918, many people got very sick, very quickly. In March of that year, outbreaks of flu-like illness were first detected in the United States. More than 100 soldiers at Camp Funston in Fort Riley Kansas became ill with flu. Within a week, the number of flu cases quintupled. There were reports of some people dying within 24 hours or less. 1918 flu illness often progressed to organ failure and pneumonia, with pneumonia the cause of death for most of those who died. Young adults were hit hard. The average age of those who died during the pandemic was 28 years old.

2. No Prevention and No Treatment for the 1918 Pandemic Virus

Policemen patrol the streets in masks in Seattle to ensure public safety.

3. Illness Overburdened the Health Care System

A black-and-white advertisement for the Chicago School of Nursing.

As the numbers of sick rose, the Red Cross put out desperate calls for trained nurses as well as untrained volunteers to help at emergency centers. In October of 1918, Congress approved a $1 million budget for the U. S. Public Health Service to recruit 1,000 medical doctors and more than 700 registered nurses.

At one point in Chicago, physicians were reporting a staggering number of new cases, reaching as high as 1,200 people each day. This in turn intensified the shortage of doctors and nurses. Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

4. Major Advancements in Flu Prevention and Treatment since 1918

A man dress in personal protective equipment in a laboratory.

There is still much work to do to improve U.S. and global readiness for the next flu pandemic. More effective vaccines and antiviral drugs are needed in addition to better surveillance of influenza viruses in birds and pigs. CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.

5. Risk of a Flu Pandemic is Ever-Present, but CDC is on the Frontlines Preparing to Protect Americans

A crowd of people with the Washington Monument in the distance.

CDC works tirelessly to protect Americans and the global community from the threat of a future flu pandemic. CDC works with domestic and global public health and animal health partners to monitor human and animal influenza viruses. This helps CDC know what viruses are spreading, where they are spreading, and what kind of illnesses they are causing. CDC also develops and distributes tests and materials to support influenza testing at state, local, territorial, and international laboratories so they can detect and characterize influenza viruses. In addition, CDC assists global and domestic experts in selecting candidate viruses to include in each year’s seasonal flu vaccine and guides prioritization of pandemic vaccine development. CDC routinely develops vaccine viruses used by manufacturers to make flu vaccines. CDC also supports state and local governments in preparing for the next flu pandemic, including planning and leading pandemic exercises across all levels of government. An effective response will diminish the potential for a repeat of the widespread devastation of the 1918 pandemic.

Visit CDC’s 1918 commemoration website for more information on the 1918 pandemic and CDC’s pandemic flu preparedness work.

63 comments on “The 1918 Flu Pandemic: Why It Matters 100 Years Later”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy » .

Hi, Thank you for this article. Very informative. Maybe the people that do not understand and do not accept the vaccination campaign will change their minds.

Excellent historical perspective on the 1918 incident. We have come a long way in treatment protocols and diagnostic advancements with respect to infectious diseases. The major concern,at this time, is an unknown pathogen which will be quickly spread worldwide my international jet travel. A few sick people on an aircraft entering the US could easy spread the disease from one end of the Country to the other. Depending on the conditions’ incubation period many more people will be affected before public health officials begin to see a problem. I guess the only thing we can be sure of is something similar will occur again , it’s just a matter of the right conditions and time.

This is a wonderful article on the influenza virus. I have extensively read about the pandemic, and its devastating effect on people. I must admit that I am appalled at the refusal to use trained nurses because they were Black Americans. That nonsense was part of the failure to help people in need of care at this crucial time . I must say it was hateful and ignorant of White Americans. White Americans are not reminded enough that they are immigrants to America just like any other race that came to this country from another country. America does not belong to white people. I don’t believe sick people care who is attending to them when they are on the brink of death.

Well done article. However. You could include a list of historical accounts for Further reading materials.

The possibility of another potential outbreak of any kind is a very scary and real test of how very little know. We indeed have come along way but still have a distance to go. .. Thank you for sharing this fascinating story.

Two of my grandparents were killed in their 30s by this epidemic, leaving my 1 year-old mother, my aunt, and my uncle orphaned. This is important stuff; people need to take influenza seriously.

My grandfather was a doctor in the Spokane Wa area and died from the flu in July of 1918 at age 46 . He was from the St Louis Missouri area and had been in the Spokane area for several years but could have visited or was visited by people from the St Louis area which is close to Kansas City to have caught the flu . Spokane was very isolated . This article gives no answer but gives some background to how he caught the flu in the middle of nowhere at the beginning of this pandemic

Would the mortality rate be as bad as the flu pandemic in 1918 where 675,000 people were killed? How would our economy be affected? Any thoughts?

The book “The Great Influenza” by John M. Barry has many historical references on this topic.

Good summary of the 1918 flu pandemic. But the sentence “The average age of those who died during the pandemic was 28 years old” (end of the first section) is inaccurate. Twenty-eight was the age at which mortality peaked among young adults, who were the hardest hit, along the very young and the very old. As for the average, variations in infant or old adult mortality could easily tip the balance away from 28 years.

In researching flu a few years ago, I read that one reason this flu killed people of supposedly optimum age for strength and resistance (~28 years), was for exactly that reason – their immune systems responded so quickly – with fluid in the lungs – that they drowned. People who responded more slowly, with less fluid produced less quickly – were more likely to survive.

By the way, if this thing posts (my first post ever on this site), I’m getting this message:

You are posting comments too quickly. Slow down.

(Please check your software)

I would agree with Tonya and Robert, there is an ever-present threat of a variant flu virus reeking havoc as many go unprepared for each flu season by not vaccinating, but also with a new, unknown pathogen. With the climate changing and the glacier ice melting to new low levels, bacteria, viruses and parasites previously encased in ice soon may be exposed to air, water, and humans. I am thankful for the diligent surveillance that the CDC and the WHO provides.

Thank you for that summary. The pandemic took my grandmother in the Spring of 1919. My father and his two sisters were orphans then. Their father had died in France, November 1918. It is always so sad for me to read about this.

Any plan to slow or stop a pandemic would include quickly identifying those who are contagious and minimizing their contact with others. However we do not have in place policies that would encourage that behavior, particularly in the low income and immigrant populations, including people who: * cannot afford to take time off work without pay * would lose their jobs if they did not show up * have no health insurance and can’t afford medical care * are afraid to seek care because of immigration status (their own or family member’s) And anyone who was quarantined would want to know that their basic needs would be met if they complied. I believe these issues would be best addressed in advance to overcome resistance. Once a potential pandemic starts, it will be difficult to get the necessary public and private buy-in, resources and authority until it is too late.

It’s surprising that to see that the first three items listed would apply to any similar pandemic of unknown origin today. Today’s air travel would spread an illness at previously unheard of rates. Couple that with an unknown origin and our health care systems would be over run just as they were in 1918.

Thank you so much for this article. I appreciate the information included and I pray that it convinces people with reservations to keep their own and their families health in mind for everyone’s sake but especially their own.

My grandmother was 11 years old in 1918. The family was from Philadelphia. I remember her telling me that she had to help load dead bodies into wagons. They would yell in the neighborhoods, “throw out your dead!” She never got the flu, but it must have been horrible! That is why we were always told never to spit on the streets. It can carry diseases, etc. People—Don’t think this cannot happen again. We live in an age where we can prevent the worst from happening when it comes to flu and other diseases. Get your flu shots!

Very educative write-up. A big lesson for us in Africa. The surveillance of influenza viruses must be sustained especially at animal-human interface to monitor possible new mutations. Thank you.

My grandfather was 15 years old. His parents and his two siblings were very ill with the flu so he ran to get help. By the time he got back to the house they were all dead. I am lying in bed with the H1N1 right now. Probably the sickest I’ve ever been. I personally believe facemasks should be mandatory and all public transportation. What a tragedy all the way around.

Great information on the flu pandemic. Very educative and sad.

History has taught us much about various past outbreaks. It’s the future unknown pathogens manmade or natural we need to worry about.

Great article on the flu pandemic. I have done a lot of studying on the issue. John Barry has written many books about the pandemic I find it incredible and riveting to learn about how people would wake up in the morning feeling fine and be dead in the evening. I have spoken to many people who experienced the flu through their families. I have always wondered if this can never happen again. Let’s hope not.

Great informative article thanks I`ve just been watching THE LATEST NEWS ON THE 2020 CORONAVIRUS! making me wonder ?? I also remember COLLAPSING as I was walking down the street with HONG KONG FLU in 1956 Woke up in hospital…..TOOK MANY WEEKS TO RECOVER!!

while air travel will spread the virus faster today than before, the news of such virus is traveling even faster today, as can be seen in the current outbreak of 2019CoV. People around the world are in a state of panic as soon as it is reported. China did a total lock down pretty quickly. Nowadays, we get more information about the characteristics of the virus, like the temperature and humidity condition that is favorable/unfavorable to it, Scientists can produce a vaccine much sooner than before. So yes, we should be vigilant, but we do not need to be too scared to live our life normally.

Reading this in 2020, and it looks like the U.S. has not learned much.

those who do not know history are doomed to repeat it.

Actually, if you read how fast the flu spread, and how many died, some within 24 hours, we have come a long way! It took over 30 years to develop a flu vaccine, and within 3 months of coronavirus hitting, we have already started the clinical trials of a vaccine. Amazing!!

It’s like you saw into the future. The very not so distant future. Thanks for writing this as it reinforces the steps and procedures being followed today. If only they had been implemented sooner.

Here we go all over again

From this article I think WHO and CDC have not learned much to be in preparation. After 100 year another virus is here to take million lives away. Poor nation like Africa is in trouble. America should have known better to be prepare after 100years. God save us all

Apparently, there was no national plan then either. The lack of leadership by politicians on national and local levels is appalling and the realization that many top officials refuse to accept and follow recommendations of the CDC and other experts is terrifying. We are following exactly the same recommendations as were suggested in 1918, and there is inconsistent use of the precautions that we know help. Please support those who are taking the Coronavirus seriously and working to help us all. Bless the CDC and Drs and nurses on the front lines trying to save us all.

Great information

Watching the overrun hospitals, lack of supplies and reliance on local and state authorities because the federal government cannot or will not help. Schools are canceled. All groups more than 10 people. Social distancing rules are in place. The economy is crashing. No possible vaccine. History is repeating itself. I am literally hiding in my home with my family, knowing it’s the only way to avoid it.

Thank you for this article. It certainly puts the current COVID-19 pandemic in perspective, as well as reinforcing the need for social distancing! We are fortunate to live in a time when significant advances have been made in medicine and technology.

The CDC dropped the ball on this one, we need to shut down the country to prevent a worst case scenario. (writing this on 3/30/20) The economy will tank no matter what, but we can prevent millions of deaths yet.

My mother’s cousin was 21 when the 1918 influenza epidemic hit. He had cerebral palsy and was at risk for disease and he died. It’s hard though to comprehend how the influenza reached his tiny town outside of Abilene, Texas. There was very little medicine for colds or pneumonia for anyone in that time period.

100 years later viruses are still a problem.

The history repeats itself, we can see USA as the richest country, powerful country, is so unprepared! Doctors and nurses are lacking of protective gears, yet they have to work with the patients who are infected with the virus! The States have to bid against one another for ventilators etc. So many people are infected and die from this neglected, unguided way ! So sad!

Very informative information and thanks to all those people that put this information together. It seems to be working for this coronavirus we are currently experiencing. Keep up the good work and lets try to do our best to improve what we have learned from this virus and make it better next time around as we can see …. there will be a next time …. just currently unknown as to when.

Sydney Daniels Looking back at the comments in 2018 it is haunting. The accuracy of concerns and predictions! The rapid spread through international travel , the less privileged forced to continue working ,not only to perish but spread it. The fear of an unknown pathogen and it’s economic impact. The parallels of past and present are too hard to ignore. The Spanish flu acting very similar to Coronavirus. There are several stories in the news of patients over 100, who were alive during the 1918 flu, surviving coronavirus. Is it a stretch to think whatever immunity they acquired back in 1918 could have given them an edge or are they just tough as nails!? Is it immunologically impossible being a different virus and the years past? Just a thought? Unfortunately the reassurance, given in this article, that we have multiple guardrails in place to prevent such a huge spread again was wishful thinking. God bless everyone and stay safe.

My grandfather died from the Spanish flu and struck both my father and uncle as children. My father suffered cardiomyopathy and succumbed to it decades later. Financial struggles where perhaps worse since women had less legal rights and job opportunities that had any semblance of equal pay. My grandmother supported her family through a variety of seamstress jobs and cleaning for those that could afford that luxury. History is a good teacher if we can learn from it.

Watching the BOSSA. 45 min documentary on the spanish flu of 1918 so enlightening also. The symptoms of severe cases were bizarre and freakish, fatal in less than 24 hrs. A second wave (fall 2020) of covid must be minimized if world wants to prevent millions of deaths. Unfortunately, so many spoiled americans are selfish and very impatient willing to risk and sacrifice many others lives for a day at the beach or a new tattoo. If only they all could have done a 6 month sentence in county jail they would see that they could stomach months of quarantine in their own homes standing on their head, provided ample food and necessities are avialable.Too bad history will be repeated and this will be a disaster for so many more that shall lose their lives

here we go again!

102 years later and the struggles that our ancestors dealt with daily are being resurfaced again. As an RN working in the frontlines with the current flu pandemic, the level of stress that is experienced among health care workers is almost unbearable. Just as the 1918 flu was fast to spread with no prevention or treatment plan in place, this new outbreak is fast to spread and hard to treat and prevent. Taking a lesson from the 1918 pandemic, our facility took to making the staff and the patients wear mask for all interactions during their stay at our facility in an effort to reduce the risk of spreading patient to nurse or nurse to patient. The most unnerving concern to me personally is the fact that unlike the 1918 flu, an estimated 50% of individuals who have the COVID-19 virus have experienced zero symptoms. This makes the task of identifying the positive patients from simple screening procedures much more difficult due to lack of testing ability to confirm actual positive patients. For example, we had an elderly man in our facility for more than two weeks for an unrelated health care issue, screening upon admission declared he was a zero risk for COVID-19 and he never exhibited a single symptom during his admission, however upon discharge and transfer to a rehab facility, he had a COVID-19 positive test result. He continues to have ZERO symptoms but has exposed multiple health care workers and family members to COVID-19. The risk of infecting health care workers who are already spread thin only increases the workload demand on those still able to work.

We are currently short staffed at our facility with most nurses working four to six 12 hour shifts per week to keep the work demand in our facility at a manageable level. With the re-opening of our surgical units and other outpatient services, the “extra” support we were receiving from their health care staff has diminished but the increased workload demand on the inpatient staff is ever growing as the community continues to open up and social distancing is not adhered to. Our COVID-19 related ER visits more than doubled over one weekend when beaches alone opened up. As with the 1918 pandemic, the call for help in many areas had been made even to the point of allowing current nursing students to perform duties as an RN.

Because health care facilities across our nation are short staffed and limited on PPE, the task of identifying positive flu patients is important to isolate the continued spread of the virus but to also protect the health care workers and reduce the waste of precious PPE. Just as our health care workers in the past, social distancing, hand washing and face covers are the best methods that we have available to help slow the spread of this virus.

A hard lesson learned in the 1918 pandemic was that the early shut down of large social events and gatherings could help slow the spread and decrease the the burden on the local healthcare facilities. The CDCs plans of closing down schools, shopping centers, social gatherings of large numbers, and bars/clubs was the outcome of that hard learned lesson from 1918. Our community seems to have fared well with the early closing as we have not had many local citizens hospitalized with COVID-19, we do have a many COVID-19 patients in our facilities due to hospital transfers however due to our location being near two other States, one of which is a well known hot zone. We are all in this together and just like our 1918 health care teams, we too have answered the call to aid our neighboring States.

Opening up the public with care and caution is going to have to occur as many small business owners have already had to close their doors to our community permanently due to the length of time they went with no income. The economical impact this virus had already had on our community is evident and will only be truly seen in the future as things begin to return to our “New” normal.

COVID19 will also last for years as compared to Spanish flu and we should take the precautionary measures seriously

That was hard to read , here we are again in 2020.

im postin just to post kepp up the good work guys

It was so good but it was only 100 years and we have a sickness that is killing the people.

My father and his younger sister both had the flu in Glasgow in 1919. He survived, his sister died. He never had the flu again, and I have never had it…I’m 81 now. I’ve been told I am immune and have never had the flu shot. There is an area south of Glasgow/northern England that has been studied because there is are a number of people there who are also immune. J. Wilson Saville

To keep this thread (article) in check and updated I’d like to add that there was hope of a slow down. However, the desire for normalcy has in turn resulted in a resurgence of the virus. Hospitals are now getting brunt of the aged ill. Some retirement homes are nearly at 75% plus positive to the virus, whereas; the nurses are infected as well and even though now overtaken by the virus are capable of working. In my opinion, this will continue for another year. I hope the timeframe is less, but the end result will likely be another depression. Our country needs to prepare and seek aid from other countries to prepare for this. The USA are the worlds leading consumers and I dint believe the rest of the world could take a financial hit like a US collapse.

Well, vaccines are on the way. Half of America is still crazy. I guess you could say we started “rounding the corner” on Nov. 3rd. Hopefully things back to normal this time next year.

Very good and informative article. Thank you

The Spanish fly and the COVID -19 are are bit similar

When roll out to massive vaccinate happens worldwide we will heal. It reminds me of the World War 2 armament. Once we got the ball rolling we were successful.

I was always strong never in the hospital because of illness. October 2020 came , and despite all my efforts to avoid COVID-19 I landed in the local hospital, and spent the month of October in the covid unit. The infectious disease specialists went to work with what was available, and saved my life. I was on oxygen until March, or April, and I was doing rehab at home until I could walk again. Thank God my wife and I were able to get our COVID-19 shots. Please get yours, everyone!!!

History have already repeating it self In a bad way and we did not learn anything at all ! .

The covid -19 or coronavirus in 2020

Life expectancy dropped by 12 years during the Spanish flu. The virus continued until 1957. Some believe a lack of nutrition played a part in the mortality rate at the time Life expectancy for COVID 19 is the same as normal life expectancy (around 78). Like the Spanish flu our body should adapt to the coming variations. Like the Spanish flu it may last decades.

Why was there a 37 year absence of flu pandemic between 1920 & 1957; yet subsequent to 1957 they have appeared more frequently?

@Sumeyo, I think you mean “The Spanish Flu” 😉

people did not learn about the requirements for this😑. I mean really!

Good info and everything but could had added more info

The article was worded very well and fairly informative. And that leads me to bring up a part of the Article that most people tend to over look. The flu started in the military and spread rapidly. When i was six years old i had very similar symptoms of the Spanish flue and I compared the symptoms of covid 19 and what I had when it was six was actually worse. Im 55 yrs old now and I haven’t had a flu shot in 36 years now and I have no intentions of getting another one with all the Chemical war fair going on in the world.