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The 1918 flu versus the coronavirus: pandemic lessons learned and ignored

This pandemic, however, is actually not unprecedented: the last time we faced such a mysterious, pristine and far-reaching pandemic was in 1918, when the flu devastated populations around the world.
The 1918 flu killed 50 to 100 million people until 1919. There are disturbing parallels between the 1918 flu and the 2020 coronavirus pandemic – a disease with a surprising range of symptoms for which there is little treatment, human behavior as a barrier to public health and cluster outbreaks that have spread, to name a few.

For 102 years, flu scholars and infectious disease experts have attempted to educate the masses in hopes of preventing future pandemics. Yet, here we are.

To be clear, the coronavirus responsible for the current pandemic is not a flu virus. Yet the pandemics of 1

918 and 2020 share similarities in basic terms about a new, formidable virus that has taken the world and every aspect of society by storm. To learn the lessons of the 1918 flu, the missteps we’ve taken since, and our post-pandemic future, CNN spoke to three experts on the subject.

The 1918 flu caused the cancellation of Halloween in the United States. It could happen again

These conversations have been edited and condensed for clarity.

CNN: What are the lessons of the 1918 pandemic?

John M. Barry: Number one, tell the truth. Number two, non-pharmaceutical interventions work. Asian countries, New Zealand, Germany and Senegal have done an incredibly good job thanks to transparency. But we have shown that you can actually control the epidemic if you do the non-pharmaceutical interventions (social distancing and masks). We didn’t do them in the United States. We didn’t respect them; we played with them.
Dr. Jeremy Brown: There was a backlash against wearing masks in San Francisco in late 1918 and early 1919. People were essentially fed up. There was a group of libertarians who suggested it was a violation of their rights and freedoms to be forced to wear masks, and they actually ended up preventing the health council from renewing the mandate to wear masks.
Young adults were more likely to die during the 1918 flu pandemic, in contrast to the current Covid-19 pandemic, in which the elderly face a greater risk of serious illness and death.

What happened was another spike in San Francisco in early 1919 flu cases, and they returned to wearing masks. The message is, perhaps, that things are not as new as they might seem and that human behavior in response to pandemics of this magnitude is actually quite predictable.

Gina Kolata: Even though we know exactly what the 1918 virus looks like, we still don’t know why it was so deadly.

And here we have the coronavirus, and we know a lot more, and we still don’t really know why it’s so deadly or what it’s doing. I think it’s a very powerful lesson that you can think: “I know molecular biology, I know viruses, I know how they replicate”, and yet there may be these diseases that you don’t understand.

CNN: 1918 and infectious disease experts stressed to pay attention to history to prevent future pandemics. Where do you think we have gone wrong since the 1918 flu?

Brown: We have to be very careful to say, “Well, it was obvious, do this, do it.” But I think it was pretty clear that the next pandemic threat would be a virus and not a bacterium, fungus, or parasite. Most people thought it was going to be a flu pandemic, and I was one of them.

What I think we needed to spend more time on was actually considering that it could be the flu and other things. It doesn’t matter, because if we put enough advance planning into how we would handle a flu pandemic, we would also have a game plan in place on how to handle a pandemic from another virus.

Unfortunately, we know that funding for these things comes in waves. The loan money is essentially awarded based on what is happening today. Very little attention is paid to what might happen along the way, and we have become complacent in our belief that we have the ability to control everything. We are all subject to the great extremes of time but also to nature.

The women wore cloth surgical masks to protect themselves from the flu.

If we had kept pandemic planning at the center and center, I think we would have been in a much, much better place. But every year you fund pandemic planning, you are saying no to funding something else. When there is no pandemic on the horizon, it is very easy to say, “Why don’t we take these many millions of dollars and invest it in the treatment of Alzheimer’s?”

CNN: How did the 1918 pandemic end and how do you think the current pandemic will subside?

Brown: The 1918 flu died out in early 1919. Today, circulating flu viruses include a descendant of that early 1918 H1N1 virus. So we are effectively exposed to a descendant of that initial pandemic.

In general, infectious disease ends when people run away from it until it disappears and when all people who are exposed to it have died from it, so there is no one else. And when other people who are exposed survive and gain immunity, it gives you some protection.

We saw these three effects throughout history in 1918 and today we will see some variations. There is no doubt that we will see the end of Covid-19. The big question is, what will the cost be and when will it be?

CNN: Given what you know about the 1918 flu, what are you particularly concerned about right now?

Barry: The most disturbing thing is that we know that the virus damages the heart and lungs, even if people don’t have any symptoms. It likely damages other organs even in people who have no symptoms. So, we don’t know the long-term effects, whether that damage will heal and haunt them and affect their lives in 10 or 25 years.
A man gets a shave from a barber with a flu mask during the ongoing pandemic in Chicago in 1918.
Brown: I am very concerned about people’s selfishness and this thought that, “If I’m okay, that’s all that matters.” I think the message we have seen is that people are selfish to a great extent which I don’t think we have seen before. The selfishness of people and their inability to empathize with others who are not like them is one of the very, very worrying aspects that the disease has highlighted. I think this is a deeply rooted part of American society.
Kolata: I’m worried about society, work, people who have lost everything and people who don’t have enough to eat. I’m worried about the kids in school because remote learning doesn’t work. And college kids who have to go to remote college. People who have just graduated cannot find work. They are kind of a lost generation when they should start their careers. I care about people carrying long distances, they just never recover. I care for people who lose family members.

CNN: Is there anything in the current pandemic that gives you hope?

Barry: Trump is right about one thing: this virus will not go away; will be here forever. But I think eventually, people’s immune systems will adjust to it with or without a vaccine. It probably won’t be as dangerous in the future as it is now. At least there is a good chance it is.

Brown: First of all, people seem to return to normal very quickly. Now I think it’s because infectious diseases were such a common occurrence at the turn of the century: we didn’t have vaccines against diphtheria, measles, hepatitis or meningitis, so waves of these diseases were very common in Europe and the United States. . People have been dealing with infectious diseases in their lives for centuries. In 1918 they recovered relatively quickly.

With Covid-19, I think it remains an open question whether there will be an economic rebound and, more importantly, an emotional rebound – where we are reminded in ways we have never been reminded of before that we are subject to the vagaries of nature when it comes to illnesses.

Kolata: Societies have somehow survived, recovered and survived some horrific pandemics in the past that were far worse than what we are going through now. Now, at least, we have a chance to get a vaccine that could actually stop this virus before it passes through the entire population and affects everyone who might be affected. So, I have some hope.

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