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Separated by a century, 1918 flu and coronavirus pandemics share startling similarities

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Posted at 5:53 PM, Mar 11, 2021
and last updated 2021-03-11 19:34:57-05

CLEVELAND — When the novel coronavirus started to change our world one year ago, perhaps we should have looked back 101 years for an idea on what would happen next. In terms of policy, approach and public reception, the steps taken across the country to curb the coronavirus pandemic have largely been influenced by the lessons learned from the Influenza Pandemic in 1918.

In the waning months of World War I, a virulent strain of the flu virus began to spread across the globe, eerily following the paths of troop movements, especially those coming from the United States. Although the 1918 flu pandemic is commonly referred to as the Spanish Flu, the moniker is often a misnomer. Spain, which had remained neutral in the war, and newspapers there, were able to freely report on the burgeoning epidemic. Although the exact location of where the virus originated remains unknown, some of the earliest reports about the disease-centered on Camp Funston, Kansas, a US Army camp. More than 500 men were later sickened by the virus.

"Spain was the first nation to report on the epidemic and report freely on the epidemic so it seemed like the epidemic started there and was really bad there," said Dr. Amanda Mahoney, an expert in medical history and chief curator at the Dittrick Medical History Center at Case Western Reserve University. "Who you were, the individual circumstances of your life and where you live made your experience very different between communities and even between neighbors."

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Although the flu pandemic of 1918 didn't finally conclude until the spring of 1920, the public health measures taken back then -- and the lessons learned from those decisions -- are still relevant today.

"It's amazing to see the same measures that were applied during the 1918 time period and what we're faced with now," said Dr. Robert Salata, the physician-in-chief and chair of medicine at University Hospitals. "Yes, there are lessons to be learned from what happened before. We should apply them. We know those measures work. Secondly, we have to be better prepared for another pandemic in the future."

According to archives from the Cleveland Plain Dealer, On Sept. 22, 1918, Clevelanders and those living in Northeast Ohio received their first warning of what was to come. Cleveland's health commissioner, Dr. Harry Rockwood, had received notification from the US surgeon general, warning him of the potential spread of the flu virus. Eight days later, on Oct. 4, Dr. Rockwood began to come up with a citywide plan for what precautionary measures should be taken.

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By then, the virus had already encircled the city. Dr. Rockwood estimated there to be about 500 cases of influenza by Oct. 7. Cases and deaths began increasing, ultimately leading to Dr. Rockwood recommending that the city government ban all public gatherings and close businesses where the public typically gathered, including movie theatres and churches. The next day, Mayor Harry Davis followed those recommendations, issuing the public health orders, which would take effect about four days later, on Oct. 14. According to newspaper reports at the time, saloons were not required to close, which angered churchgoers and clergy members.

City officials also forbid people from spitting from public railcars and ordered that windows be opened. At the time, conventional thinking led many to believe that fresh, open air would help ward off the virus. Other businesses and manufacturing plants were either closed or operated with a smaller staff. People with symptoms were urged to stay home.

However, while the vast majority of large gatherings were forbidden at the time, Liberty Loan rallies outdoors were permitted to continue in order to help fund the war effort. Other essential businesses tasked with producing war supplies also operated at full capacity. The existential debate over what constituted an 'essential business' during the early days of the coronavirus pandemic was hardly a new phenomenon.

"The pandemics are very similar in that there was a disconnect between what public health officials knew what needed to be done, which was a full shutdown and quarantine, and what was possible both economically and culturally to do," Dr. Mahoney said. "In the US especially, we don't like to think our personal liberties are being impinged upon, right? If you don't do a good job of providing information, you're asking too much of people individually."

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Reporters at the Cleveland Plain Dealer chronicled the daily happenings on the virus front just as much as they did on the war in Europe, which finally ended in an armistice in November 1918. In the hundreds of articles written at the peak of the pandemic are the common threads seen during the coronavirus pandemic.

There were stories of public officials violating their own health orders; the legal challenges filed by churches and businesses; experts and doctors advocating for mask usage and a back-and-forth debate on whether kids should return to class.

From public health policy to public reception, history has, indeed, repeated itself over the past year.

"One of the great tragedies of the history of health is that we've done all this already. We've learned these lessons and people forgot about it," Dr. Mahoney said. "There was an 1889 and 1890 epidemic that killed a million people. We forgot about that. The polio epidemic, which tremendously shaped not just the American healthcare system but also American culture, has been widely forgotten about until the coronavirus made pandemics interesting again.

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"We historicize something and make something like a pandemic feel like it's something that happened in history and not something that happens now. We think, 'oh this can't happen to us. We are so technologically advanced where if a disease like this should pop up, science is going to immediately come up with a solution."

Dr. Salata said if the past is any indication, reducing restrictions and lifting mask mandates could lead to additional surges.

"These measures have been proven scientifically time and time again to make a difference," Dr. Salata said. "The decision recently by Texas and Mississippi to stop the mandate for masks, I think is a mistake."

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For Dr. Salata, fighting the coronavirus over the past year had made a couple of things clear, he said. Moving forward, he said more money is needed for building up and maintaining the infrastructure of public health. Once the pandemic is over, Dr. Salata said, additional study and research will be paramount.

"The past year has been unprecedented. But as I reflect upon this, the other term that comes to mind is resiliency," Dr. Salata said. "We have conducted over 180 different clinical trials [at UH] that have been linked to COVID. It's not only controlling issues from the infection control point of view but it's also the time to use this to our advantage to study and to discover."