Health & Healthcare

Spanish Influenza: The Last Big Pandemic

Spanish influenza epidemic poster from 1918
Alberta Board of Health/Public Domain

It was 102 years ago that the last major global pandemic happened, known as Spanish influenza, and in many ways, COVID-19 pales in comparison.

The Spanish influenza pandemic that began in 1918 didn’t actually originate in Spain; that’s just where it was first publicly reported.  Its origins are unclear, although there is some suggestion that it began in China.  It was an H1N1 virus, which describes particular surface proteins on the viral capsule.  Like the novel coronavirus the world is dealing with now, it was a novel influenza virus.

So what exactly is a novel virus?  It means there’s been a significant enough “genetic shift” in the virus DNA (as opposed to the smaller-scale “genetic drift” that normally occurs) that no one in 1918 had any immunity from previous influenza they’d been exposed to, just like exposure to previous kinds of coronaviruses doesn’t appear to confer protection against COVID-19.  There was no herd immunity to slow the movement of the virus through the population.

The 1918 influenza season began with a mild wave in the spring.  The mutated influenza virus hit hard in the fall of 1918.  It spread like wildfire, which was facilitated at least in part by soldiers returning home at the end of World War I in November.  It infected an estimated 500 million people, around 1/3 of the world’s population at the time.  An estimated 50 million or more people died from it.  In the U.S., the average life expectancy actually dropped by 12 years, and more U.S. soldiers were killed by the pandemic than by WWI.

Unlike COVID-19, where the population that’s at high risk to get really ill from being exposed to the virus is relatively narrow, with the Spanish flu there were multiple high-risk age groups, including children under 5 and healthy people between 20 and 40.  People would develop pneumonia and their lungs would fill up with fluid, leaving them unable to breathe.

Some areas ordered people to wear masks in public, and schools, churches, and other gathering areas were closed or, in some cases, converted to makeshift hospitals to deal with the overflow.  Businesses and public services had difficulty operating because so many workers got sick.  There were also huge shortages of health care workers.

By summer 1919, the pandemic had mostly worn itself out, as those who got it and survived had built up immunity.  The final wave was in spring 1920.  Vaccines and antivirals weren’t developed until years later.

COVID-19 is serious, without question, but imagine what it would have been like back in 1918.  There was basically sweet bugger all in terms of treatment options.  No one was working on a vaccine because they didn’t exist.  Information-sharing would have been spotty, and most likely the average person had very little understanding of what was actually happening.  We can shelter in place and have groceries delivered, but there wouldn’t have been much in terms of options back then.  Imagine being quarantined at home with no internet.  Not a pleasant prospect.

I wonder what the folks of 1918 would have thought of the present-day crop of anti-vaxxers and vaccine-hesitant people.  I’ve got a post coming next week about how vaccines work and what that means for COVID-19.

We’ve come a long way, anti-vaxxers aside.  Pandemic life now is far more bearable than it would have been back in the day, and even if there’s not a treatment or vaccine yet, we know that it will come.  In the meantime, we have medical care, particularly critical care in ICUs, that represents a whole different world compared to what was available in 1918.

The world made it through then, so we will most certainly make it through now.

For more on public health, you can visit The Science Corner.

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41 thoughts on “Spanish Influenza: The Last Big Pandemic”

  1. Very interesting!

    My dad has told me about the Spanish flu. His mother was born in 1918. His father was a little boy or young teen in that year. (Can’t remember.) He told my dad that people were dropping dead in the streets, pretty much. In fact, this particular grandfather of mine (I have, like, four or five grandpas) got sick with the Spanish flu himself. At the hospital, they opened up his lungs and removed the fluids. It saved his life. They only did it to him because they felt he was young enough to recover from the surgery (and they were right).

    “Imagine being quarantined at home with no internet. Not a pleasant prospect,” you wrote. Oh mylanta!! Don’t make me picture that! πŸ˜€ Yikes!! Times are so much better now!!

  2. Yes we will. Things are opening up here in Colorado, we went to put a few items into a storage unit and were surprised to see how many people were out and about. I feel like there’s going to be another surge of the virus.
    Great post and insights, thank you

        1. I’m more afraid of running out of Ben’s juice than I am of the virus.😱
          Our lives are a roll of the dice every day. πŸ€·πŸΌβ€β™€οΈ
          I can imagine how awful it would be without the internet. The 3 months I spent bedridden were without internet or TV. Holding a book was difficult. I learned a lot about myself during those 3 months, so something good came out of it.

          Thank you for a counter to the fearmongering “media”πŸ€—πŸŒ»

  3. Great summary and comparison here. I’m not too worried about Covid, honestly, I suspect I already had it. I do worry about older people in nursing homes and things like that though.

  4. Hah, you bring up a good point about it being much easier to shelter-in-place with the conveniences of technology and modern life! And I like your optimistic outlook – it’s a refreshing break from the fear-mongering I see all over social media!

  5. Interesting perspective of comparing the Spanish Influenza to Covid-19 and the times in which all of it has or is taking place.
    No, I can’t imagine not having the internet, but I could certainly not watch the news like I have in recent months 24/7. That nearly put me over the edge.
    Excellent post as always, Ashley!

  6. I really enjoyed this post. Thankfully it’s 2020. Even lockdown in 2004 would have presented different communication challenges. Dial up internet anyone?

  7. An excellent point and draw from history – if we made it through that nightmare, we will make it through this one too, although I can sure understand the struggle in the meantime. Ironically, a few years back (well before any of this started) I wrote a historical-fiction novel that had a few chapters revolving around the 1918 Pandemic. Although it is completed and fairly polished, I probably won’t query it for awhile given everything going on. Good thing I have other works to focus on!

  8. I can’t imagine seeing so many people dying (lungs full of fluid) and not in the possibility to understand what the hell is going on. Terrible. Makes me think of the Black Plague even a longer time ago. People just tried to stay healthy and kept on going I guess. No work, no food it must have been.

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