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Social Distancing, the Sequel

How the COVID-19 Outbreak Echoes—and Diverges From—the 1918 Flu Pandemic

By Sala Levin ’10

St. Louis Red Cross Motor Corps on duty Oct. 1918 Influenza epidemic

Photo courtesy of Library of Congress

The St. Louis Red Cross Motor Corps stands on duty during the 1918 Influenza pandemic. St. Louis, then the nation’s fourth-largest city, is considered a model of the social distancing effort.

Saloons stayed open, but had to cut back some of their booze-slinging; parades were canceled and movie theaters stopped projecting silent pictures; places of worship stood empty.

Sound sort of familiar? Those examples are from 1918–19, when the influenza pandemic—also known as the Spanish flu—was changing life across the world. Today, while many city and state responses to COVID-19 mirror those taken during the flu pandemic, the passage of more than 100 years has resulted in some notable differences, according to Marian Moser Jones, an associate professor of family science at the University of Maryland who studies the history of public health. 

Read on to learn more about how the flu pandemic of 1918–19 compares to the coronavirus one we’re facing today.

How They Started and Who’s Affected

  • The first wave of the 1918 flu arrived in the spring. World War I proved to be a fertile breeding opportunity for the virus, with a steady supply of young soldiers and nurses living in cramped, cold, dirty conditions, sleeping little and often lacking access to nutritious foods.
  • The virus preyed on young people, often striking down those between ages 20 and 40, as well as infants. Though there have been more reports of late about the novel coronavirus affecting younger people, mortality rates are higher among the elderly. By contrast, the Spanish flu generally spared older people, perhaps because of immunity they had developed in a bad flu season in the late 19th century. 
  • Doctors and scientists at the time at first mistakenly believed the disease to be bacteriological rather than viral, leading them to create a useless vaccine. “This time scientists have sequenced the virus; vaccines are now being developed that promise to target the disease agent effectively,” said Jones. 

How Government and People Responded

  • Social distancing—the buzzword of today’s outbreak—was put into effect to quell the Spanish flu, too, with the severity of the order ranging from place to place.
  • St. Louis, then the nation’s fourth-largest city, is considered a model of the effort. “They shut down pretty much every public gathering for 36 days straight, then they lifted (the restrictions) slightly and shut them down again when flu started going up,” said Jones. The city’s efforts resulted in the fewest excess deaths (meaning higher than the average rate per capita of deaths from flu and pneumonia) in any large city in the country, proof that social distancing is effective.
  • Politics were just as barbed in 1918. Saloons were allowed to continue operating in many cities, sometimes with limited hours or walk-up windows. “They felt like the barroom was essential, I guess like the grocery store,” said Jones. Those who wanted to outlaw alcohol used this to fan outrage—churches and synagogues were closed, but not barrooms? Jones points to abortion services as an equally hot-button issue that’s in the spotlight because of COVID-19. Texas, Ohio and Mississippi have all declared abortions non-essential procedures that must be delayed during the outbreak. 

A Century’s Change

  • One major difference today: the verifiability of number of cases and deaths. In 1918, influenza wasn’t a reportable disease in most places, meaning one that requires notification of a public health department. Estimates for total number of people killed worldwide by the Spanish flu vary from 50 million to 100 million—an enormous range. Today, record-keeping and information-sharing is more formalized and sophisticated in much of the world, although Jones says many places may have more cases than are being reported.
  • The biggest difference between today’s world and the world of the flu pandemic is the advent of digital life, making social and physical distancing a touch more bearable; people can stay connected and entertained through FaceTime, texts or their preferred streaming platform. “When people were isolated due to the flu, they were really isolated, and that was a struggle for a lot of people,” said Jones. 
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School of Public Health

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