Column: What the deadly 1918 flu epidemic can teach us about our coronavirus reaction
It’s hard to believe we’ve devoted so little of our memory to something that killed 50 million people. Once in a while, the 1918 flu epidemic pops up — like a plot point in the period TV drama “Downton Abbey.” But in an age before instant communications, and in the midst of that vast man-made meat grinder of death called World War I, our exhausted species buried the epidemic along with its dead. Yet with the coronavirus now on the move around the world, it’s worth resurrecting the 1918 pandemic to study ourselves then, know how we reacted to it, how we learned and didn’t learn from it.
Laura Spinney is a science journalist whose book “Pale Rider: The Spanish Flu of 1918 and How It Changed the World,” gives us what we have forgotten or never knew about this illness that killed almost three times the 18 million victims of World War I. Many millions caught the Spanish flu but survived: the king of Spain, paradoxically; Mohandas K. Gandhi; Franklin Delano Roosevelt; and Walt Disney. When you think of our alternative history had they not survived, you get a sense of how life-altering this death tsunami was for the world.
Are we seeing deja vu all over again for what was called the Spanish flu?
The Spanish flu is one of the worst, if not the worst, pandemics that humanity has ever known. And I think we should hope that this one is not that bad. We’ve had many other pandemics, both of flu and of other diseases, that were not nearly as bad as the Spanish flu of 100 years ago.
So, yes, there are parallels, but I think we need to keep it within perspective.
The 1918 flu was one the worst pandemics in history, infecting one-third of the world’s population. How cities responded to the crisis in 1918 provides lessons on handling COVID-19 today.
What are some characteristics that we see in every one of these, about human behavior, human psychology, the disruptions to society and to economies?
An epidemic of infectious disease is something that brings us right down to earth. It kind of makes a mockery of all the ways that human beings like to divide themselves up, by class, by wealth, by color, by religion, because everybody is vulnerable.
For example, borders — borders don’t coincide with geographical frontiers, with oceans or mountains. They’re lines on a map. They’re ideas that some politician had. And viruses have no idea what that means, and they just walk across them.
What about our individual psychology?
There’s a lot of fear and some of that is reasonable. This is a disease that we don’t yet understand. It looks to be more lethal than seasonal flu, and perhaps more contagious.
But I think that a big important issue here is information. And people will act sensibly and appropriately and proportionately if they’re properly informed. And we don’t seem to be able to manage that information dimension of pandemic very well.
In 1918, for example, there was a big problem of wartime censorship, which blocked information getting out there.
And today we have a very different problem, which sort of comes to the same thing in the end, which is fake news. I think it’s a big problem in trying to inform people about this current outbreak and how best to manage it and behave in it.
As a lot of young people have pointed out to me, information tends to be locked behind paywalls these days, whereas fake news is free. And this is the attitude of people who’ve grown up with the internet: They don’t expect to pay for their information. And so they get deluged with a lot of bad information. And I think that a lot of the kind of disproportionate behavior stems from that fact.
Information, we’ve learned, is absolutely crucial to managing an epidemic. You want people to comply with your public health measures voluntarily, because we know that mandatory health measures tend to be counterproductive. They’re only going to do that if, A, they trust you, and B, you give them correct information. We have a massive problem of fake news, and that is going to be a major obstacle this time around.
Does people’s behavior alter, or are we at heart the same scared, selfish creatures we’ve been for thousands of years?
I think we’re the same inconsistent creatures we’ve been for thousands of years. In Europe, 40,000 people will probably die from seasonal flu this winter. Nobody is panicking about that. And in a sense, that’s understandable, because we know a lot more about the flu. There’s a flu season every year. We sort of know what to expect.
Whereas we don’t know what to expect from this coronavirus.
But in another way, it suggests that we’ve got things out of perspective. And I think that in some ways we’re very irrational and we react to the news cycle. If we could just draw back a little bit and see that HIV has been killing legions of people for decades. TB is on the rise because there’s anti-microbial resistance, which means that the drugs aren’t working that well anymore. Childhood diseases are coming back largely because of vaccine hesitancy.
I mean, this could go very big, this coronavirus. But at the same time, it’s not the only problem, and we mustn’t lose sight of the others.
What would it have been like to be alive and in your 20s in 1918 or 1919, when you were doing your daily business, whether it was going to the market or maybe going to the movies or taking a train to see a relative? How different did the world look with the flu afoot?
One thing that we can’t overlook is that the world was at war. And so people in their 20s — say, people between 20 to 40 — were of conscriptable age and in many countries were active in the military.
The age group of 20 to 40 unfortunately was also very vulnerable to the Spanish flu for reasons that we only partly understand today. Daily life was rather traumatic at that time. Pregnant women were particularly vulnerable and had miscarriages in large numbers, and also died more commonly than people who weren’t pregnant and people in other age groups.
Everything I say has to come with the caveat that it depends where you were in the world, because this is a global phenomenon. But say we’re talking about the industrialized parts of the world: Those were the parts that were beginning to be used to the concept of public health campaigns, to the idea that governments could intervene in your private lives and tell you how to behave for the collective good of society. Wear a mask. Don’t cough. Use a handkerchief.
Also it was a very much more obedient society in some ways. Doctors were far more paternalistic, and people were far more willing to do what the doctor told them without questioning it than they are today.
That was enhanced also by time of war. It was almost a patriotic duty to put your mask on and not shake hands and use a handkerchief and so on.
People were more likely to respond with mystical explanations in religion in 1918, to find religious explanations for what was happening to them. Psychologically, I think it was much easier even for people in supposedly advanced countries to try and find mystical explanations for this maybe divine punishment for this dreadful war.
You’re going to go to the church or the mosque, go to the synagogue and pray, which is probably not wise if it means that you’re going into a crowd of other people. And indeed, you see that as we’re seeing in South Korea today, that gatherings in religious sects and so on in places of worship are accelerating the spread of the disease. And they did so in 1918 as well.
During the war, of course people would have had to sacrifice and pull together. Did that in any way prepare them to deal with this pandemic of flu? Because in your book, you write that your best chance of survival was to be selfish and guard your food and water and ignore all pleas for help, which seemed to work against the “let’s all pull together” war effort of the previous four years.
What I was trying to say in the book was that logically, rationally, the best way to bring a pandemic or epidemic to an end quickly with the minimum number of casualties is that everybody isolate themselves because then the virus can’t spread and it dies out.
But actually, and in some ways heartwarmingly though not very rationally, our instinct is to help each other. You see that very often people went to each other’s aid — and not just family and friends, but also strangers.
Psychologists talk about something called collective resilience. They talk about the idea that when there’s an external threat — a disease of this kind, for example — people start redefining themselves. The self is no longer the individual self. It’s the collective self, because it’s everyone who’s threatened by this external thing, and so people pull together as a collective self and they consider themselves all in the same boat.
And of course, it is antithetical to the idea of stopping the infection from spreading. But it’s a basic human instinct, for better or worse.
Over centuries, when diseases have appeared, blame has been assigned. Sometimes the Jews were blamed. Syphilis was called the French pox, if you weren’t French. In this case, the Spanish flu was not Spanish. This is an uglier aspect of disease and human nature.
It is the eternal human dilemma. Who is us and who is not us? Who is other and where is this threat coming from? And so the other side of human behavior that we tend to see in epidemics is this pointing of blame.
And we’re seeing it today with the coronavirus. There have been massive reports, spiking reports, of xenophobia directed at people of East Asian descent. During the plague outbreaks of the Middle Ages, Jews were very often blamed for poisoning the water in the wells, and expelled, and all sorts of other awful things happened to them.
This is a perennial and ugly side of human nature.
After the flu epidemic there were world-shaking political consequences.
When 50 million people die, or 2.5% of the human population, which is what we’re talking about, that is not negligible. That is going to have an impact.
If you take the example of South Africa, there were already the stirrings of what would become apartheid. There had been talk of segregating towns along color lines, but nothing had been translated into law. And you see that translation into law happening from the 1920s.
One of the arguments I made in my book, for which I think there’s pretty good evidence, is that the epidemic gave a big spur to that legislation because white people blamed very explicitly black people for bringing in the disease without any evidence whatsoever. In fact the black population suffered much worse than the white population in terms of percentages in South Africa.
In India, when the pandemic struck, it became absolutely blatantly clear to everyone how dismally the British colonial authorities had provided for the healthcare of the indigenous population. People were dying in droves and in the absence of any British doctors — the British doctors there were, were very often at the front as well — the hole was even more glaring.
The people who stepped into that [medical] breach tended to be the militants, the grassroots militant activists for independence who had already worked out how to cross caste barriers and work together for a different goal, i.e. independence.
Once the pandemic passed, emotion against the British was even higher than it had been before. And secondly, those people were far more united than they had been. And now they came together behind Gandhi. He found that suddenly, he had the grassroots support that he had been lacking until then.
What about social changes within the family or a society?
Huge demographic changes. Often it was the pillars of the community, the breadwinners, who were being taken out. The few studies there are suggest that old people went in droves into workhouses because they no longer had any way of supporting themselves.
There were also millions of orphans created. Even in the most advanced countries of that time, there was no real social welfare net, no organized system of adoption. And so these people kind of just vanish.
Another interesting observation is that we’re talking about a time when the biggest killer of human beings was infectious disease. What it did as a result was to leave behind a smaller but in many ways healthier population, which now began to reproduce at a higher rate. So what you see in the 1920s is a baby boom.
If you look at humanity at the population level, it’s recovering from this huge disaster very, very quickly in a way.
When it comes to medicine and its ability to cope and its advances, we’d had four years of very heroic battlefield medicine, but those techniques were exactly the opposite or inadequate when it would come to dealing with a pandemic. What came out of this in terms of medicine and public health?
Virus was a relatively new concept when the Spanish flu exploded, and once it had receded, I think doctors took a long, hard look at what they knew or more importantly, what they didn’t know.
You see from the 1920s, the field of virology takes off, also the field of epidemiology, and epidemiology is the cornerstone of good public health.
You see the discussion around socialized healthcare, the idea of a universal healthcare system that’s free at the point of delivery, start. They’d already been ongoing for a couple of decades, but now they really start coming together.
And then the other really important thing is, is a global health agency. The League of Nations had a health branch — essentially the forerunner of the World Health Organization, which was created in 1946.
Of course, it’s the World Health Organization that is managing the global response to this current outbreak. But what I think is interesting is that these days, the World Health Organization has less sway than it had in the past. It’s chronically underfunded by its member nations. And many of them have ignored its recommendations during this outbreak.
We’ve forgotten a lot of the lessons that we learned after the Spanish flu and other pandemics, and we may be about to learn them again.
When you watch the news, read the news, follow this, what are you watching for?
One of the things that’s become clear about managing any epidemic is that they tend to grow very fast in the first weeks or months. You can think of it like a forest fire that initially, when it sparks is surrounded by dry wood and so it just takes off, and then it gradually burns up its fuel and it runs out of fuel and it slows down and gradually it burns itself out.
An epidemic is a little bit the same, in the sense that it’s initially surrounded by everybody susceptible. As it burns through those hosts, either kills them or leaves them to some extent immune, it runs out of hosts and so gradually burns out.
If you can slow down that initial pattern of growth, that initial period of growth, you can make a massive difference in terms of how many people will eventually suffer from this pandemic overall.
How are we doing?
In retrospect, I think the Chinese did an amazing job. We see now that the rate of new cases in China is slowed down dramatically. We shouldn’t be complacent, but that is encouraging. That means that, OK, it took a certain authoritarian regime to enact it.
Did you have any episodes of this flu in your family history in 1918-19?
The grandfather of my stepdaughter. When he died, they renovated his farmhouse in the north of Sweden. They found a pack of love letters bricked up inside the wall. And it turned out they were love letters that he’d written to his first wife, his beloved first wife, who died a few weeks after their marriage, in the summer of 1918, of the Spanish flu, and he ended up marrying her best friend, who was the grandmother of that whole branch of the family that survived.
It illustrates how to us, looking back, everything seems to have happened as it should have been. But there was a huge game of musical chairs that set in after the Spanish flu, and people’s families were rearranged. You didn’t necessarily feel that you were married to the person you wanted to be or you were supposed to be. Life suddenly took a very different path and people had to adapt.
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