'Throughline': The 1918 Flu Pandemic Differs From Coronavirus Crisis

The coronavirus is often compared to one of the most severe outbreaks of the 20th century: the 1918 flu pandemic. NPR's History Podcast Throughline investigates how that pandemic differs from today.

STEVE INSKEEP, HOST:

What can history teach us about our national emergency? We've never faced a crisis exactly like this, but the world has seen many pandemics, including the 1918 flu, which infected roughly one-third of the population of the world. It became known as the Spanish flu. NPR history podcast Throughline compared then to now. Rund Abdelfatah and Ramtin Arablouei have the story.

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JEREMY BROWN: So the first reports that we have in the U.S. actually originate in Haskell County, southwest rural Kansas. A physician by the name of Loring Miner. He noted that on one day, 18 people in his community had come down with influenza and that three of those had died.

RUND ABDELFATAH: Wow.

BROWN: This was a remarkable event, remarkable enough to prompt Dr. Miner to write a report to health officials. And that is the first recorded instance of a physician warning about the outbreak of influenza.

RAMTIN ARABLOUEI: This is Jeremy Brown, a physician and author of the book "Influenza: The Hundred Year Hunt to Cure the Deadliest Disease in History." Jeremy's also the director of the Office of Emergency Care Research at the National Institute of Health. But he talked to us as a private citizen, not as a representative of the NIH or the federal government.

ABDELFATAH: The virus in 1918 came to be called the Spanish flu, even though it did not originate in Spain.

BROWN: No. So why was it called the Spanish flu? And the answer is this. There was a tacit agreement between the governments of the Western powers and the newspaper editors not to report bad news.

ARABLOUEI: Wow.

BROWN: Spain was a neutral country in World War I. It did not have therefore this tacit agreement between its newspaper editors and its government not to report influenza. And so the first reports of influenza being widespread came out of Spain.

ABDELFATAH: Yeah.

BROWN: But this does not mean that the disease came from Spain. It certainly did not.

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ABDELFATAH: What would it have felt like to witness its spread?

BROWN: Well, it must have been truly terrifying. There was no understanding of viruses as we know them today. So as this disease was sweeping through the community, people were becoming sick. And you really had no idea what the causes were.

ABDELFATAH: And it turns out all these social distancing measures we're now taking to stay safe are not new.

BROWN: That's right. Back in 1918, people understood that there was something about interpersonal contact that made it more likely to catch the disease. And so churches were not meeting. Department stores were going to only have staggered opening times. Dance halls closed down. Funerals were banned. And so very quickly this disease really changed the shape of society.

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BROWN: There's a very dramatic eyewitness account that we have of the carnage that influenza caused by a very prominent position at the time called Victor Vaughan. He wrote that the deadly influenza demonstrated the inferiority of human interventions in the destruction of human life. It's a very frightening description and one that really brings us all to a very different place, a place that is very far from where we are today.

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ARABLOUEI: It's really important to understand how the coronavirus is and is not like the 1918 flu. First, the similarities - both are novel viruses, novel meaning never before seen in humans.

BROWN: The second similarity is that both are winter viruses and are likely to disappear as we get the warmer weather in the spring. That's why the 1918 influenza virus disappeared. But what happened then was it returned in the fall of 1918. The question is, what will happen to coronavirus? Will this then come back in the fall of this year or not? And the third similarity between influenza of 1918 and the coronavirus is that it too has rapidly become a world-wide problem.

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BROWN: But let's pause for a moment and think about the differences between them because I think the differences are in many ways more important than the similarities and also provide us with reassurance. First of all, in our understanding of the virus, within about two weeks of the very first cases of coronavirus, a Chinese team had published the full genome of COVID-19 in a major U.S. medical journal in English.

And this goes to show just how quickly we got to it and also how - well, there is this international sharing of data. The second big, big difference is in our treatments. In 1918, you were likely to get a whiskey, an enema and perhaps some bloodletting from your doctor for your influenza. Today, we have hospitals and intensive care units. We have specially trained emergency medicine physicians. We have intensive care physicians. All this was, of course, unheard of even 50 years ago, let alone a hundred years ago.

And the final difference is the reporting. In 1918, there was this tacit agreement to keep the news of influenza epidemic off of the front page. Compare that with today, where we have heard nothing other than coronavirus on the front pages of our newspapers, on the top of our screens and on our feeds. So our reporting of the illness is very, very different today.

ARABLOUEI: So are there any examples of resilience that we could draw from the 1918 pandemic, you know, as humanity is dealing with the coronavirus today?

BROWN: Sadly, most of these recollections are of how hard it was. It was a very, very difficult time, and we mustn't forget that. But one story that I like to recall is a picture of a group of Red Cross nurses. And they're putting together cloth masks. And in the background, there is a sign, and it says, if I fail, he dies.

And it's a reminder to these nurses that, just putting together these masks, you're taking part in a lifesaving chain that can make a difference to people. It's a reminder of how we can take even the small things - washing our hands - and really magnify that and say, OK, in a microcosm, this seems like a relatively insignificant activity to do. But, of course, we know that, multiplied across the U.S., these things are of great importance. And who knows? Perhaps it too will result in some improvements in the way that we take care of not only the most vulnerable people in our society, but of each other as well.

INSKEEP: Dr. Jeremy Brown speaking with Throughline hosts Rund Abdelfatah and Ramtin Arablouei. You can hear the whole episode by finding the amazing Throughline podcast wherever you get your podcasts.

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