Spanish Flu and Covid-19: How Valid are Comparisons? | Sam Hall

Each historical event must be examined and situated in context. There are certain commonalities and immediate differences. Like Covid-19, the influenza pandemic of 1918-20 (Spanish flu) caused closure of popular public spaces, like bars and churches and, like Covid-19, the way it was managed was disjointed; national quarantines were rarely imposed with localised quarantine varying from closing the settlement to all incoming traffic to curtailing certain activities. This pandemic is contextually very different however: the death rate from Covid-19 is many times lower than that of Spanish flu, in which 50 to 100 million are thought to have died; and older people, who were less susceptible to the Spanish Flu, are much more acceptable to Covid-19. One of the strongest comparisons is how economically damaging both pandemics are. We don’t know the full extent of the damage Covid-19 will do to the economy as it is still ongoing, but it would seem that pandemics are universally expensive. The timing of each pandemic, each roughly one hundred years apart, is a valid comparison as is the disruption it caused – but that is where the comparisons start to become more fragile. There are comparisons to be drawn but the effects are not the same.

The wearing of masks appears a valid comparison. During the Spanish flu, masks were similarly a major source of contention; however, they were only made compulsory in some areas with varying degrees of enforcement. Initially there was similar contention with Covid-19; in May 2020, it was reported that more than only 50 countries had made masks compulsory. Some also argued that masks might spread the virus due to contamination or through creating a false sense of security, and to add to the confusion, the World Health Organisation recommended that healthy people did not need to wear a mask. Nonetheless, what is different from the 1918-20 influenza pandemic is that masks became the norm across the world in response to Covid-19, with more than 120 countries mandating masks in public spaces by July 2020. Therefore, the initial lack of consensus surrounding masks is an example of where initial comparisons can be made but as time has progressed, management of the pandemics have diverged.

On the other hand, confusing application of the rules often characterises Covid-19 as it did Spanish flu. Just as today, there were multiple restrictions on social activities to stop the spread of influenza and yet people still used crowded public transport to get to work through the influenza pandemic. Social restrictions have also proved contentious with Covid-19. In September 2020, the government specifically ruled that grouse shooting was exempt from the ‘rule of six’ neglecting groups like choirs who were left guessing. A significant comparison is that today modern technology means working from home is much more feasible than it was 100 years ago. Efforts to stop the spread of Covid-19 by restricting social activities are not compromised by packing public transport. This emphasises again that context is key.

Nonetheless, in both cases the closure of schools (in Britain at least) went on for as long as three weeks to combat Spanish flu. To deal with Covid-19, the government shut schools across the UK for the first time in March 2020. Yet again, despite this obvious similarity, we see that comparison is not straightforward. Just as many can currently work from home, children can today learn from home in a way that was not possible in the early twentieth century. There will be some children who struggle to do so, like their twentieth century counterparts (due to lack of internet access, computer, quiet space etc.) but accessing the curriculum is feasible today for most and hence the educational impacts of Covid-19 will not be as sharp compared to Spanish flu; we have the technological capabilities to teach children remotely. Shutting schools is a tactic used in both cases to contain the spread of the disease, today’s children will probably come out of this pandemic better than their twentieth peers.

In the early 21st century we are, by now, very familiar with the concept of national lockdowns, whether across Wales, England, or the whole of the United Kingdom. Yet for those who lived through Spanish flu in Britain at least, the response was far more localised. The similarity here is that there was still an element of dis-jointed and localised management; for examples in Wales health is a devolved matter so measures differ depending on which side of the Bristol Channel you live.

There are further stark differences between Spanish flu and Covid-19. Medical science is clear about how Covid-19 is spread whereas in the early twentieth century such consensus was absent. Doctors in the early twentieth century had been taught by a previous generation that embraced the theory that disease was spread in the atmosphere by decaying filth (miasma) rather than by person-to-person contact; consequently, there was not a consensus about modern theories of contagion. The response to Spanish flu was consequently un-orthodox by the standards of Covid-19; by December 1918 the Ministry of Food regarded the shortage of spirits in some districts as a health problem. It offered to supply extra quantities of alcohol on request from Medical Officers of Health. Problem in Britain’s (and the wider world’s) response can be attributed to the four years of war. Many doctors and nurses were still overseas and hospitals were dominated by military fulfilment. This additional burden that we do not suffer with contemporarily, partially explains why it took until 1933 to the identify the virus. As a highly contagious air-borne infection with a short incubation period, neither was influenza vulnerable to traditional methods of disinfection, notification and isolation. As a consequence, Spanish flu had a much higher death toll than Covid-19 is currently experiencing. Some estimates place global mortality at 21 million, for Spanish flu, but recent scholarship suggests that the death toll in India alone exceeded this figure. Other estimates place deaths between 50 to 100 million. Furthermore the demographic of those most susceptible to two the disease is different. Older people were not as susceptible to the Spanish Flu, perhaps because they had survived a very similar strain of flu which had started to spread through human populations in the 1830s. By contrast, it is older people over 70 who are more likely to become seriously unwell with Covid-19 according to Age UK and in the USA it will have killed 405,000 to 438,000 people by 30th January 2021; with the Pfizer/BioNTech and Oxford/AstraZeneca vaccine available in countries like the UK, it seems unlikely that Covid-19 will kill as many people as the Spanish flu or in the same demographic as we have a vaccine far sooner with fewer deaths that are predominantly biased towards older people. The scale of COVID-19 deaths and the demographics who get seriously unwell cannot be compared to those of Spanish flu approximately a century ago. The mortality rates for the 1918-20 influenza pandemic remain far higher than current rates for Covid-19.

Comparisons can be made also in terms of economics. Both pandemics have been economically costly; Spanish flu cost Britain alone £120,000,000 and whilst we don’t know exactly how much Covid-19 will cost Britain or the world, due to the ongoing nature of the situation, The Guardian gives an indication; accumulated borrowing for the first five months of the fiscal year reached £174bn (more than that of an entire year at the peak of the financial crisis) and puts government debt at more than two trillion pounds. The financial situation is still developing but clearly pandemics do substantial economic damage- whether society is combatting influenza in the early twentieth, or Covid-19 in the early 21st. This can be attributed to lost productivity due to illness as well trading restrictions and the large amount of money the government has borrowed to support people’s wages in our time. In as much as the economic damage is significant in both cases, arguably it is worse today, even if the death toll is not. This can be partially explained by the current stronger social contract between government and its people today which was only in its infancy 100 years ago when hallmarks of our current daily life were still decades away- free secondary education to all pupils the 1944 Education Act and the NHS in 1948. Therefore, similar schemes to those that we have experienced during Covid-19 like furlough, in which the government pays 80% of a worker’s wages when they are placed on leave, were inconceivable. Though both pandemics have a high economic cost. Covid-19 comes in an era where we have a greater precedent and expectation that the state will support us, and therefore the economic cost exceeds the mortality rate- The opposite can be said for Spanish flu.

The management of mortality might be a final comparison. The Spanish flu mortality rates exceeded current Covid-19 predictions and therefore effective disposal of the body is soon For this reason, deaths and what to do with the bodies became a pressing issue in a way it has not in our time. Emergency burial services were called upon to deal with the backlog of corpses. With local variations, this was adopted in America with remarkable uniformity, especially considering the de-centralised nature of planning. In Britain deaths often went undealt with in some areas like Bethnal Green where dead bodies would remain, potentially spreading infection in private, crowded residences for two weeks. As mentioned earlier, some of the lower estimates for total influenza death figures are twenty-one million people, which explains the chaotic treatment of bodies; people were dying faster than existing infrastructure can deal with them. Although the scale is different now, the ad-hoc nature of dealing with bodies remains to a degree. New York City, for example, was so overwhelmed at certain points that bodies were sent to mass graves on Hart Island before a cause of death was determined or next of kin had been identified. Although, deaths are unlikely during this Covid-19 pandemic to reach the levels seen during Spanish flu yet despite this, there is evidence that the ‘process’ of managing the dead has been similarly disrupted in places, especially in densely populated areas like New York. The established system of giving the right body to the right family in a dignified and hazardless way has not adapted in the 100 or so years since the influenza pandemic in the early twentieth century to deal with higher-than-average deaths- in New York at least.

Future historians may well notice the coincidence though these pandemic’s occur a century apart and then look for further synchronicities. Yet by digging deeper we can see that although valid comparisons can be made, the effects experienced during Covid-19 often seem less severe. We have also been able to mitigate some of the impacts in a way that our forbearers could not; working from home with a laptop and internet connection instead of packing on to crowded public transport every working day. Partially as a result, total deaths from Covid-19 stand to be much lower than a century ago. Nonetheless what we save in people we lose in other areas. Notably, owing to the more interdependent nature of the people and government today, the economic cost will probably be far greater. We expect the government to be more involved in the welfare of its people than a hundred years ago, meaning compared to the 1918-20 pandemic, we will likely be building back from a lower level of fiscal health.

Overall, a comparison between the influenza pandemic of 1918-20 and Covid-19 is at its most valuable in terms of timing, occurring approximately a century after another disruptive pandemic and high economic cost. Thereon, the comparisons become less strong. We are not at the tail end of a war and we must situate each significant piece of history within the context it is found. It is tempting in a period of rampant instability such as the one in which we find ourselves to look for ‘anchors’ in the past for comfort, and in theory to avoid repeating past mistakes. Some limited valid comparisons can be made but our ability to mitigate the worst impacts with science, technology, and a better understanding of how pandemics spread distinguishes Covid-19 from the influenza pandemic of 1918-20.

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