From the Black Death to Spanish Flu, how past pandemics have, and haven’t, informed our response to coronavirus

Virus Outbreak Ohio
Posted at 4:14 PM, Nov 10, 2020
and last updated 2020-11-10 16:15:01-05

CLEVELAND — Cleveland, and the world, are more than eight months into the most virulent pandemic in more than 100 years, but how is COVID-19 different from the Spanish Influenza and other pandemics past?

The 1918 Spanish Influenza unfolded political, social, and psychological impacts on the City of Cleveland.

Baldwin Wallace professor Dr. Rachel Boaz has studied different pandemics from various centuries.

Previous pandemics have impacted history and the response to them has changed over the years.

The first major plague to happen in recorded history was the Bubonic Plague, or the Black Death, in the 1300s.

The onset of the Black Death coincided with what was, by that point, overcrowding—that, combined with squalid living conditions, fear of bathing, and a complete misunderstanding of disease transmission, spelled doom for tens of millions, Boaz said.

“Unfortunately, medical knowledge was resistant to change in Western Europe, and various theories and practices, concerning the respective origins and treatment of disease, prevented effective prevention and treatment for centuries,” Boaz said.

During the time of the bubonic plague, people across the world believed that they could get the disease from bathing.

“Offensive odors were recognized as a source of disease—this is why plague doctors wore beaks stuffed with strong herbs, and where “malaria” got its name (the damp night air made people sick). Other perceived causes of sickness were astrological disturbances, the wrath of God, hexes by 'witches' (or others in cahoots with the devil), and the poisoning of the water supply by the Jewish minority,” Boaz said.

Modern medicine wasn’t available during the Black Death, so people would treat it by attaching leeches to their bodies.

“This practice was commonplace for thousands of years—we have writings, bleeding vessels, and images as proof. Instead of improving a person’s condition, bleeding them instead often hastened their demise—our own George Washington serves as one such example,” Boaz said.

In the 1800s when people started immigrating to different countries, a cholera outbreak wreaked havoc in cities across the world.

Boaz said the outbreak was the result of people consuming their own waste.

Cities had a difficult time keeping waste away from where people were living.

“The waste couldn’t be removed quickly enough, however, and it often overfilled in cesspools underneath dwellings. From there, it leaked into the drinking water,” Boaz said.

Hundreds died in London from the outbreak and thousands died worldwide.

While the Spanish Influenza of 1918 is perhaps the most notorious influenza pandemic in modern history, it was not the only pandemic of the 20th Century, according to the CDC. Two other influenza outbreaks - the 1957 Asian Influenza (H2N2) and the 1968 Hong Kong Influenza (H3N2) both spread worldwide and were considered pandemics.

While the 1968 and 1957 pandemics wreaked havoc on the world and U.S. populations, each estimated by the CDC to have caused about 100,000 deaths in the United States, neither compares to the 1918 Pandemic, which caused at least 50 million deaths worldwide and about 675,000 in the U.S.

Like other cities around the country, Cleveland banned public gatherings such as religious worship, sporting events, funerals, and weddings during the 1918 Pandemic. However, officials did a bit too little too late according to Boaz.

“Cleveland’s deaths-per-capita were better than Philadelphia’s (often pointed to as an example of what can go wrong when one fails to act quickly enough in enforcing social distancing), but the city ranked last in this category statewide,” Boaz said. “This may have been because Cleveland officials dragged their feet a little. They were more hesitant to close restaurants and bars, with the reasoning that the numbers of patrons did not constitute ‘enough of a concern.’”

So what lessons have we learned from past pandemics?


The symptoms of Spanish Influenza had some similar symptoms of COVID-19.

Residents who were diagnosed with Spanish Influenza in 1918 had a lack of appetite, headache, pain behind the eyes, high temperature, aching bones and were lethargic.

Occasionally, some patient's skin would turn blue, which is a rare symptom some people that are diagnosed with COVID-19 have.


Doctors and nurses in 1918 died at large rates while treating patients for Spanish Influenza.

For instance, a 1918 camp hospital designed for approximately 1,200 was packed with 6,000 desperately ill men.

At Camp Grant, the death toll reached more than 500 on a single day.

There was also a shortage of doctors during the outbreak.

Fast-forward to 2020, Cleveland had to send nurses and doctors to New York City to assist in treating patients for the virus.

Cleveland opened off-site medical housing locations in case there was a surge in cases but those were never needed.

Gov. Mike DeWine has also signed numerous health orders advising Ohioans to stay six-feet apart in order to stop the spread of the virus.


In 1918, Cleveland conductors were tasked with helping police officers identify residents that would spit on other passengers in an attempt to spread the virus.

Cleveland’s RTA has had dozens of employees test positive for COVID-19 and it is unknown if any passengers got the virus riding the buses and rapid.


Unlike DeWine, Gov. James Cox did not shut down schools during the Spanish Influenza. Instead, he put it on the parents to keep their child home if they exhibited symptoms of the virus.


It may come as a surprise to many people but during the Spanish Influenza pandemic, lots of companies asked their employees to wear masks.

Ohio didn’t have an ordinance during the 1918 breakout, but similarly to now, some people refused to wear them because they said they “portrayed a sign of weakness.”


According to Boaz, overcrowding and filthy living spaces helped transmit other viruses such as the bubonic plague in the 1300s.

“All of the pandemics share an obvious pattern in that they have been dependent upon both increases in, and movement of, populations,” Boaz said.

COVID-19 also spread through movement, although it was mostly airborne, compared to cholera, which spread through the sewage.

The reason COVID-19 was able to spread worldwide is because of modern-day technology such as airplanes and cruises. Hundreds of years ago, diseases were usually transmitted inside a specific area and had a much more difficult time spreading worldwide.

During the Spanish Influenza pandemic in the 1900s, doctors and nurses were dying in large numbers with their patients.

In Cleveland, streetcar conductors had to assist police officers to enforce knowing spitting on the floor of the cars.


In Ohio, DeWine announced bans on social gatherings to attempt to help slow the spread of COVID-19.

This isn’t the first time gatherings have been banned to help stop the spread of a virus.

During the Spanish Influenza pandemic, cities decided to take charge and ban gatherings, rather than the state.

Cleveland banned gatherings such as religious worship, sporting events, funerals, weddings.


Sanitation hasn’t been a major issue with COVID-19, unlike previous pandemics.

Boaz said the cholera outbreak was so bad because people were consuming their own waste.

“History shows us that people have long known it’s best to keep a certain distance between where one eats and drinks, and where they have ‘used the toilet,'" Boaz said. "Among other indicators, rows of fossilized fly larvae show us that latrines had long been strategically placed far from living (and eating, and drinking) quarters."


After its first run-through, the plague would reappear throughout Europe every few hundred years and would demolish populations.

Pandemics have occurred multiple times during history. The trends show pandemics happen every 100 to 150 years.

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