Explained: How coronavirus differs from the Spanish flu of 1918

As the coronavirus spreads around the world and public anxieties spike, comparisons between today’s situation and the Spanish flu pandemic of 1918 are proliferating in journalistic outlets and on social media.

While the fearful atmosphere — surgical masks, stockpiling of food and avoidance of public gatherings — and potential economic ramifications are like those of 1918, the medical reality is quite different.

“Nurses often walked into scenes resembling those of the plague years of the fourteenth century,” wrote historian Alfred W. Crosby in America’s Forgotten Pandemic. “One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty-four hours since the death and the births, and the wife had had no food but an apple which happened to lie within reach.”

In 1918, the world was a very different place, even without the disruptive influence of World War I. Doctors knew viruses existed but had never seen one — there were no electron microscopes, and the genetic material of viruses had not yet been discovered. Today, however, researchers not only know how to isolate a virus but can find its genetic sequence, test antiviral drugs and develop a vaccine.

Read | Here is how scientists are finding a cure for coronavirus

In 1918, it was impossible to test people with mild symptoms so they could self-quarantine. And it was nearly impossible to do contact tracing because the flu seemed to infect — and panic — entire cities and communities all at once. Moreover, there was little protective equipment for health care workers, and the supportive care with respirators that can be provided to people very ill with coronavirus did not exist.

The Oakland Municipal Auditorium in use as a temporary hospital during the Spanish Flu, 1918 (Photo by Harris & Ewing via Wikimedia Commons)

With a case fatality rate of at least 2.5%, the 1918 flu was far more deadly than ordinary flu, and it was so infectious that it spread widely, which meant the number of deaths soared.

Researchers believe the 1918 flu spared older people because they had some immunity to it. They theorize that decades earlier there had been a version of that virus, one that was not as lethal and spread like an ordinary flu. The older people living in 1918 would have been exposed to that less lethal flu and developed antibodies. As for children, most viral illnesses — measles, chickenpox — are more deadly in young adults, which may explain why the youngest were spared in the 1918 epidemic.

Regardless of the reason, it was a disaster for life expectancy, which plummeted. In 1917, life expectancy in the United States was 51 years. It was the same in 1919. But in 1918, it was just 39 years.

The new coronavirus tends to kill older people and those with underlying medical conditions, and it does not seem to kill children. All of which means it will have far less effect, if any, on life expectancy.

As for the coronavirus case fatality rate, it is not yet known, but the latest data from South Korea, with 7,478 confirmed infections, shows one in line with that of seasonal flu. After testing 100,000 people for the virus, the country appears to have a case fatality rate of 0.65%.

What the current situation does have in common with 1918, though, is the tenor of public concern.

Members of the Red Cross Motor Corps on duty at St. Louis, Missouri, United States, in October 1918. (Source: Wikimedia Commons)

Among the first places the 1918 flu arrived in the United States was Fort Devens, near Boston. So many young soldiers were sick, and so many were dying, that the surgeon general sent four of the nation’s leading doctors to investigate.

One of them, Dr. William Vaughan, later recalled: “Hundreds of stalwart young men in the uniform of their country, coming into the wards of the hospital in groups of 10 or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

Accounts like these scared Americans deeply.

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On Oct. 3, 1918, Philadelphia closed all schools, churches, theaters, pool halls and other gathering places. Undertakers were overwhelmed — some funeral homes increased their prices sixfold and some even made the bereaved bury their own dead.

In Tucson, Arizona, the board of health forbade people to venture out in public without a mask. In Albuquerque, New Mexico, where schools and theaters were closed, a local newspaper wrote, “the ghost of fear walked everywhere.”

At Walter Reed Hospital, Washington, D.C., during the great Influenza pandemic of 1918. (Source: Wikimedia Commons)

Similar actions are being taken today. Seattle has closed some public schools. The South by Southwest festival in Austin, Texas, has been canceled. Apple asked employees to work from home. More than 2,700 people are under some sort of quarantine in New York City. And some Costco stores are having trouble keeping bottled water in stock.

But so far this year, the annual epidemic of seasonal flu is proving much more devastating than the coronavirus in the United States.

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The Centers for Disease Control and Prevention reports that there have been at least 34 million infected with flu this season, 350,000 hospitalizations and 20,000 deaths. Those deaths include 136 children, nearly 10 times as many adult deaths from the coronavirus.