The 1918-1920 Spanish Flu Pandemic: Lessons Learned and Lessons Forgotten

History does not repeat itself, but it often rhymes. – Mark Twain

From the Saint Louis Dispatch, 1918

The ongoing COVID-19 pandemic, while caused by a novel pathogen, is by no means a novel occurrence. Pandemics have walked hand in hand with human history. Accounts of influenza pandemics were recorded in Sanskrit in ancient Babylonia, the bubonic plague ravaged the world throughout the Middle Ages, most notably in Europe during the Black Death, and as recently as 2009, the world fought off the swine flu. COVID-19, along with its effects on human health and society, most closely resembles the pandemic of 1918-1920: The Spanish Flu. That pandemic was caused by the H1N1 influenza virus, which was also the cause of the 2009 swine flu. It infected roughly one third of the world’s population and led to the death of at least 50 million people worldwide (the equivalent of about 220 million today when adjusted for population growth), including 675,000 Americans (about 2 million today), making it one of the deadliest pandemics in human history, according to Dr. Alfred Crosby, author of America’s Forgotten Pandemic.

While World War I (1914-1918) was not the direct cause of the Spanish Flu, according to Crosby. The first cases were reported on U.S. military bases in Kansas and North Carolina in early March 1918. Modern transportation systems made possible the mass movement and close quartering of troops, which accelerated its worldwide spread. Notably, Crosby describes how the common name for the pandemic derived from Spain having stayed neutral during the war and not imposing wartime censorship, which was common at the time for unfavorable news as a pretext for keeping morale high during war. As such, its newspapers freely reported on the disease’s spread and impact across the globe, including the infection of its own King Alfonso XIII. This coverage gave the false impression of Spain being the epicenter of the pandemic.

It is likely that the Spanish Flu first reached the Wenatchee Valley in the fall of 1918 with returning troops from Europe, according to local historian Chris Rader of the Wenatchee Valley Museum and Cultural Center. The Leavenworth Echo reported the town’s first Spanish Flu death in early October 1918. Shortly after, on October 9th, as reported in the October 11, 1918, edition of the Echo, an order was issued by Chelan County health official Dr. Frank Culp, in coordination with political and business figures, including Leavenworth’s Mayor Ross Irwin, to close “all public places where people assemble”, including schools and churches. In addition, local officials ordered the wearing of “gauze masks that cover both the mouth and nose until all danger of the epidemic had passed.”

Much like the spikes and waves of COVID-19 infections and deaths, the Spanish Flu surged, receded, and surged again over the many months of the pandemic. After the initial restrictions were eased in the Wenatchee Valley in late 1918 as infection rates dropped, Rader recounts that the disease soon roared back with vengeance. The Leavenworth Echo and other valley newspaper accounts detail at least two dozen more dead, and many times that sick, from the virus by early 1919. Along with the previous orders, strict new mandates were emplaced, including mandatory quarantining of anyone displaying symptoms, along with the members of their household. Schools in Leavenworth and the rest of the Valley opened and closed throughout 1919. An emergency hospital was built in Wenatchee and proved to be particularly instrumental and effective in keeping infected and sick people out of, and away from, the general population. Finally, with a significant ebb in disease in early 1920, schools reopened for good on February 16th of that year and, not long after, the pandemic was declared over locally by Dr. Culp, and worldwide soon after.

Despite the marked similarities of the 1918 and 2020 pandemics - from the method of airborne droplet transmission of a deadly respiratory virus, which also affects almost every organ in the body, to similar mandates, orders and recommendations made by local officials to combat its spread - the history and significance of Spanish Flu pandemic is not well known. CHS Senior, Rory Swoboda said that she “thinks [she] heard of the Spanish Flu but didn’t know that it also was a pandemic.” Derek Richardson, a junior, had much the same recollection: “I definitely know of it, and know that it was a deadly respiratory illness, but as to how widespread it was or how it was combatted, I had no idea.” Freshman Kestrel Foley said that she did not recall learning “much about it in history,” but thought she knew that it was “quite a bit more deadly than COVID-19, so far, and that many younger people died.”

“I’ve never been able to come up with a good explanation as to why there’s so little written about the 1918 pandemic” says John Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History. “Yet so much can be learned from it to inform our response today,” continued Barry. “It is true that there are differences between the two pandemics, chief among them being that there is a different target demographic.” Between 1918 and 1920, according to Barry, “roughly 95 percent of the excess mortality was people under 65, [which is,] of course, the opposite with COVID.” In addition, “the duration of this virus, which moves much more slowly than influenza, whether it’s the incubation period, how long you shed virus, or how long you’re sick, has put vastly more stress on the economy due to that duration,” stated Barry.

Laura Spinney, the author of Pale Rider: The Spanish Flu of 1918 and How It Changed the World, said that “there was a lot more reason to be afraid in 1918. People saw death all around them - and in many cases, horrible deaths. There is fear out here now, but it’s not, in most cases, the same intensity. So, in terms of getting people to comply with the [public health] advice, I think if people are deeply concerned that they themselves are vulnerable and could be killed, that’s much more powerful than worrying, well, you know, maybe this person I’m having a drink with might go home and infect their grandmother - maybe.”

Nonetheless, it is the opinion of both Barry and Spinney that many countries did learn from history and did do the right things to combat COVID-19. “Those countries, such as New Zealand and Canada, were extremely transparent. In early meetings among officials, their message was to always tell the truth.” According to John Barry, the United States was once on the right track “after the George W. Bush administration, determined to learn the lessons of 1918, and led by an assistant secretary of Health and Human Services named Stewart Simonson, and backed up by the President himself, created an infrastructure to prepare for a pandemic. President Barack Obama continued it and did in fact respond well both to H1N1 [the 2009 swine flu pandemic] and [the 2013-2016] Ebola outbreak.” The response in 2020 to COVID-19, however, has not followed the same path. Unfortunately, as is delineated on the World Health Organization’s “Coronavirus Disease (COVID-19) Dashboard, the U.S. has been just about last in the world in containing this virus and preventing deaths from it. As a headline from the New York Times stated on December 16th, “[t]he U.S. again stands virtually alone in the severity of its outbreak.”

It is both a blessing and a curse though, as Spinney points out, that with today’s advanced epidemiology, antiviral medication, and rapid vaccine development, defeating a pandemic is less a fight against a disease as it is a fight against ignorance and for personal responsibility. Barry has stressed in his writings and in many recent interviews that “those in [medical and political] authority must retain the public’s trust.”

The great lessons of the Spanish Flu can still be applied to the COVID-19 pandemic, and the pandemics to come, according to Barry. In other words, as Chris Rader stressed, those who understand history and learn its lessons are not doomed to repeat it.

Dr. Frank Culp, courtesy of the Wenatchee Valley Museum and Cultural Center.

Meet Incoming Staffer Isabel Menna