Story at a glance

  • The 1918 influenza pandemic killed an estimated 50 million people.
  • Many of the same public health measures were put in place like closing schools and banning large gatherings.
  • Some records show that people were reluctant to follow face mask orders.

The 1918 influenza pandemic, also known as the Spanish flu, swept through the world in three devastating waves from spring of 1918 through spring of 1919. As many as 500 million people were infected and the flu killed an estimated minimum of about 50 million people, according to the Centers for Disease Control and Prevention. In the U.S., about 675,000 people died from the disease. There are many similarities with the current COVID-19 pandemic, including how people have responded to the public health measures put in place.

Spanish flu is a bit of a misnomer. The 1918 influenza virus did not originate in Spain, according to accounts, and the first known case was reported in Kansas. Newspapers in Spain reported more openly about influenza cases while countries involved in World War I did not, giving the impression that the situation was worse in Spain.

The influenza virus itself is quite different from SARS-CoV-2, the coronavirus responsible for COVID-19. Influenza viruses are a different family of viruses that are commonly found in animals like birds and pigs. There are several subunits that make up the influenza virus, and the combinations of the types of subunits can mutate and combine with other influenza viruses. The 1918 virus is likely to have originated from an avian strain that jumped into and mutated to spread easily among humans.


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The public health measures that were put in place during the 1918 pandemic are similar to the ones for COVID-19: closing of schools, banning mass gatherings, mask-wearing, quarantine and disinfection of public areas. There were studies published back then about face masks for individuals coming into contact with people with a respiratory illness. Newspaper articles at the time reported that face masks were recommended in public and in large crowds.

That said, resistance to public health recommendations is not new to the current COVID-19 pandemic. Although face coverings and masks were widely used during the 1918 pandemic, not everyone was happy to comply.

A medical historian points out that people refused to wear masks during the 1918 flu pandemic, according to CNBC. “One woman, a downtown attorney, argued to Mayor Rolph that the mask ordinance was ‘absolutely unconstitutional’ because it was not legally enacted, and that as a result, every police officer who had arrested a mask scofflaw was personally liable,” according to the Influenza Archive. This newspaper article published in the Rocky Mountain News has the headline “Masks Not Popular; Many People Ignore Health Board Rules.”


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In the response to the current COVID-19 pandemic, it is important to take all the precautions and prevention measures that we can to keep the coronavirus from spreading and killing even more people. As of this writing, the number of deaths worldwide from the novel coronavirus has surpassed 1 million. This is not on par with the deaths during the 1918 influenza pandemic, thankfully due in part to the coronavirus being less deadly and to quicker communication and dissemination of information.

That does not mean we’ve done our best in dealing with the pandemic. In the U.S., the public has gone through confusing waves of information and changes in policy related to the coronavirus response. This may not only result in lower trust in science and experts but lower willingness to take the coronavirus risks seriously. Marginalized communities, such as Black communities and other communities of color, who have been abused or mistreated by the medical community, will have an even harder time trusting the guidance of health experts.

One of the biggest challenges that lies before us even if a coronavirus vaccine becomes available is rebuilding that trust in medicine and science, as well as trust in the most basic protective measures like wearing a face mask.

For up-to-date information about COVID-19, check the websites of the Centers for Disease Control and Prevention and the World Health Organization. For updated global case counts, check this page maintained by Johns Hopkins University.

You can follow Chia-Yi Hou on Twitter.


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Published on Oct 01, 2020