We at Pretty Light Science don’t just drink coffee and talk about the future. We are also interested in the past because history is a bottomless source of knowledge - which we believe is key to success. In today’s post we are going to go back about a hundred years to have a look at the events that may help us understand our current situation with the coronavirus. More specifically, we are going to talk about the 1918 flu pandemic (the Spanish flu), a brutal influenza pandemic caused by the H1N1 influenza A virus. As severe and deadly as SARS-CoV-2 is, it’s nowhere near as dangerous as the virus that caused the Spanish flu. The Spanish flu killed extremely quickly, in huge numbers, and all over the world. It is believed that the Spanish flu was responsible for between 50-100 million deaths. Meaning that it eliminated around 5% of the world’s population with a powerful, ruthless sweep.
Why did the Spanish flu take so many lives that to this day, some doctors call it the “greatest medical holocaust in history”? Three factors that made the Spanish flu extremely deadly.
1. Wide spread
People rarely traveled long distances in 1918 - making it difficult for infectious diseases to spread between countries and even within a country. Despite this, the Spanish flu found its way to most corners of the world. This virus simply used those methods of transportation that were available at the time. No flights? Not a problem. Instead the virus “took” a train or “boarded” a ship or even “walked”, with soldiers going to and returning from the war.
This brings us to the first major reason why the Spanish flu was so deadly - because it coincided with World War I. The realities of war required people to travel far and in very tough and unsanitary conditions, in close proximity to each other. So even though globalization hadn’t reached the same level as today, people were moving around a lot for that time in history. This means that the Spanish flu virus was moving a lot too.
Volunteer nurses from The American red cross during flu epidemic (1918). Original image from Oakland Public Library. Digitally enhanced by rawpixel.
2. Know your enemy
The current situation with the novel coronavirus is undeniably serious and alarming. However, we have a number of massive advantages compared to those who had to fight the Spanish flu. One of them - and we can’t emphasize the importance of it enough - is that we know exactly what we are dealing with. We know the origin and the nature of the new SARS-CoV-2 virus, and it is much easier to fight an enemy when you know what it is.
As severe and deadly as SARS-CoV-2 is, it’s nowhere near as dangerous as the virus that caused the Spanish flu.
Scientists in 1918 did not have this advantage simply because science was not quite there yet. Powerful enough microscopes did not exist, scientists did not have access to sequencing tools or any computational power to analyze the data. This resulted in the fact that doctors didn’t know that the infection was in fact caused by a virus. They mistakenly assumed that they were dealing with a bacterial infection. And since bacterial vaccines activate the immune system to prevent bacterial infections, all their attempts to vaccinate the population against the virus failed. Knowing who your enemy is is a vital condition to be able to defeat it. And we do have this luxury in 2020.
3. Hygiene
Compounding the previously discussed problems, the majority of medical and other public resources were dedicated to combat the consequences of the war. In addition, the very idea of public health care was not as well developed as it is today. Few could afford to go to a doctor - this privilege was left to the rich or famous. The less fortunate part of the population often lived in conditions that did not have sufficient hygiene standards, and their nutrition was also sub par - resulting in perfect conditions for the virus. In general, viruses tend to target those whose defense mechanisms aren’t at their best, whether it’s because of malnutrition, a weak immune system, or the lack of proper sanitation.
Walter Reed Hospital flu ward (ca. 1910–1920). Original from Library of Congress. Digitally enhanced by rawpixel.
Secondary infections
In general, the immune system weakens while fighting a virus and becomes more susceptible to bacterial infections. This is why older people and those with compromised immune systems are common targets of any virus. But it is not always the case. The Spanish flu killed not only older people with weak immune systems but also young and healthy people, with strong and active immune systems, perhaps, too much so. Under normal circumstances, a healthy immune system should be able to neutralize a flu virus, but the Spanish variety attacked so ferociously, with such an intensity, that it overwhelmed the immune system, and made it produce way more “fighting agents” than needed. As we discussed in one of our previous posts, sometimes the immune system may be a bit too enthusiastic about fighting an infection and it may produce too many antibodies which in fact weakens the immune system. In the case of the Spanish flu, this created perfect conditions for secondary infections which were the main cause of death in many cases. In fact, many victims of the Spanish flu pandemic died not from the virus itself but from pneumonia.
Consequences - Public Health Sector
The Spanish flu caused horrific damage all around the world, around 500 million people (⅓ of the world’s population at the time) were infected by the virus over the course of the pandemic. The end of the 1918 pandemic only occurred when the virus infected so many people that it couldn’t find any more susceptible hosts. When enough people get infected by a virus and develop immunity, the infection will gradually die out because it will have nowhere else to go - a so-called “herd immunity” that is being discussed today in relation to COVID-19.
The Spanish flu spurred the development of public health systems across the developed world, as scientists and governments realized pandemics would spread more quickly than they had in the past. It became obvious that treating people one-by-one like during a normal flu season wasn’t an option during a pandemic.
The end of the 1918 pandemic only occurred when the virus infected so many people that it couldn’t find any more susceptible hosts.
Fighting against a powerful virus requires a similar approach to what we do during a war. All the possible resources should be mobilized, instructions from the governments should be clear, and public efforts must be cohesive. The measures that are implemented today are a direct result of our experience dealing with the Spanish flu and other similar pandemics that have taken place in the past.
We can do better
People aren’t perfect creatures and sometimes we don’t learn from our past experiences. At least, not fast enough. Otherwise, during the COVID-19 pandemic, the government instructions would have been clearer and the public response more disciplined. Instead, responses have been slow and unclear instructions have resulted in poorly followed health measures. However, the longer the pandemic continues, it appears that in most of the places things are turning around, the seriousness of the situation has been understood and people have realized the importance of following the health guidelines. We managed to beat the Spanish flu in 1918, although that victory came at a high cost. So we can certainly beat the COVID-19 virus a hundred years later, when we have at our disposal all the knowledge provided by modern science.
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