How Are the Spanish Flu and COVID-19 Alike? Here’s What Doctors Say

Both caused global pandemics; here’s how they compare in terms of symptoms, treatment, and death toll.

Since the onset of the COVID-19 pandemic, numerous parallels have been drawn to historical pandemics, notably the H1N1 influenza outbreak in 1918, commonly referred to as the Spanish flu.

Similar to COVID-19, the 1918 influenza virus was characterized as “novel,” signifying its emergence as a previously unseen pathogen. Analogous to the present situation, immunity was absent among the population, and the virus exhibited a high degree of transmissibility, primarily through respiratory droplets. This discussion delves into the Spanish flu, offering a comparative analysis with COVID-19, exploring its eventual containment, and examining the duration during which individuals employed masks as a preventive measure.

Where did Spanish flu come from?

Contrary to its designation, the initial documented instances of Spanish flu manifested in the United States, France, Germany, and the United Kingdom. Many nations, already grappling with the aftermath of World War I, implemented press censorship measures. However, Spain, having maintained neutrality throughout the conflict, permitted unrestricted reporting by its national newspapers regarding the virus’s impact. Consequently, a distorted notion emerged, falsely attributing the virus’s origin to Spain.

The precise origin of the 1918 influenza pandemic remains a topic of extensive discourse. Epidemiologist Supriya Narasimhan, MD, who serves as the Division Chief of Infectious Diseases and Medical Director of Infection Prevention at Santa Clara Valley Medical Center in San Jose, California, emphasizes the complexity of pinpointing its source. She advocates against designating it as the “Spanish” flu, as such geographical associations could lead to unjust stigma, akin to the reasoning behind discontinuing the usage of terms like “Wuhan” virus for COVID-19.

How was Spanish flu transmitted?

The 1918 virus, classified as Influenza A Subtype H1N1, and the novel coronavirus, SARS-CoV-2, belong to distinct viral families, affirms Amesh A. Adalja, MD, a prominent infectious disease expert and senior scholar affiliated with the Johns Hopkins Center for Health Security in Maryland.

Nevertheless, their transmission mechanisms bear notable similarities. Both viruses are predominantly disseminated through respiratory droplets and aerosols – minute liquid droplets suspended in the air. Charles Bailey, MD, who holds the position of Medical Director for Infection Prevention at Mission Hospital and St. Joseph Hospital in Orange County, California, underscores this parallel mode of transmission. He emphasizes that this shared characteristic necessitates close interpersonal contact for effective propagation within a community.

How long did Spanish flu last?

The 1918 influenza pandemic extended over a span of two years, characterized by a sequence of three distinct waves as outlined by the Centers for Disease Control and Prevention (CDC). The initial wave commenced in March 1918, while the second, most impactful wave surged during the autumn period in the US. By December 1918, the devastating impact of this second wave had waned. However, the narrative did not conclude there. In January 1919, a third wave emerged in Australia, gradually making its way to both the US and Europe. As the summer of 1919 unfolded, this third wave gradually receded.

The trajectory of the Spanish flu prompts inquiry: what became of it? While the virus never entirely vanished, a collective immunity began to take root by the year 1920.

How long did people wear masks during Spanish flu?

During the year 1918, health authorities advocated for the utilization of masks as a preventive measure to mitigate the rapid dissemination of disease. At that time, these masks were fashioned from materials such as gauze and cheesecloth. Notably, individuals who declined to comply with these mandates in cities that enforced them risked penalties, including fines or even imprisonment, as reported by The New York Times. Remarkably, a parallel sentiment of resistance to mask-wearing is observed in the current COVID-19 pandemic, echoing the historical reluctance.

What were the symptoms of Spanish flu?

Both the Spanish flu and COVID-19 present as “influenza-like illnesses,” characterized by symptoms such as fever, muscle aches, headache, and respiratory distress, according to insights provided by Dr. Bailey. Notably, Dr. Bailey points out that a unique symptom associated with COVID-19, distinct from seasonal influenza or historical observations of the Spanish flu, is the loss of taste and/or smell.

The convergence of symptoms has spurred a proactive drive among medical professionals and researchers to advocate for widespread influenza vaccination. Dr. Bruce Polsky, the Chairman of Medicine at NYU Langone Hospital—Long Island, emphasizes that this emphasis on vaccination stems from the aim of reducing diagnostic ambiguity. In cases where symptoms are present, but a conclusive distinction between flu and other illnesses is challenging, vaccination contributes to reducing the likelihood of influenza, thus assisting in more precise diagnosis and medical decision-making.

Who was most affected by Spanish flu?

Elevated mortality rates were observed among individuals under the age of 5 and those aged 65 and above. However, an intriguing divergence emerged wherein young adults within the age bracket of 20 to 40 faced the highest susceptibility, as highlighted by Dr. Adalja.

Further complicating the scenario, Dr. Narasimhan underscores that the Spanish flu’s impact extended significantly to pregnant women, individuals in lower socioeconomic strata, and immigrant communities. This broad spectrum of demographic groups experiencing heightened mortality stands as a pivotal contrast between the Spanish flu and the ongoing COVID-19 pandemic.

What’s more deadly: COVID-19 or Spanish flu?

As of September 29, the global COVID-19 death toll surpassed 1 million individuals, and the count has risen to 1,332,470 fatalities as of November 17, based on data from the Johns Hopkins Coronavirus Resource Center.

In contrast, the precise death toll attributed to the Spanish flu remains elusive, with approximations spanning between 17 to 50 million individuals worldwide, and the actual number potentially exceeding even these estimates. The Centers for Disease Control and Prevention (CDC) indicates that around one-third of the global population was afflicted by the virus, ultimately leading to a minimum of 50 million fatalities.

Why did the Spanish flu kill so many people—didn’t treatment exist?

The substantial mortality resulting from the Spanish flu can be attributed to several key factors. Firstly, the medical care available during 1918-19 was rudimentary compared to contemporary standards. Dr. Polsky elucidates that many influenza-related deaths stemmed from secondary bacterial infections, which are now effectively treated with antibiotics—a resource entirely absent at that time. Moreover, modern critical care measures such as ICU facilities, advanced mechanical ventilation, and ECMO (extracorporeal membrane oxygenation) were far from being realized.

Dr. Narasimhan underscores the absence of vaccines and antiviral agents during that era. The dearth of scientific advancements for vaccine development hindered the ability to curtail transmission and mitigate disease severity and fatality.

The backdrop of World War I played a significant role in the virus’s spread. Military encampments, often characterized by close quarters and limited separation, facilitated transmission, especially in the colder months. Dr. Narasimhan emphasizes that troop movement during the war facilitated the dissemination of the virus to other susceptible populations. Economic conditions also fostered crowding, inadequate ventilation, and congregation, all of which exacerbated the rate of spread.

Furthermore, historical hygiene standards were less stringent a century ago. Intriguingly, the counsel dispensed during that period remarkably mirrors the recommendations for COVID-19: wearing masks, avoiding contact with sick individuals, and maintaining rigorous hand hygiene, as observed by Dr. Narasimhan.