Spanish Influenza: The Last Big Pandemic

Maybe COVID-19 isn’t quite so bad after all

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It was 102 years ago that the last major global pandemic happened, known as Spanish influenza, and in many ways, COVID-19 pales in comparison.

The Spanish influenza pandemic that began in 1918 didn’t actually originate in Spain; that’s just where it was first publicly reported. Its origins are unclear, although there is some suggestion that it began in China. It was an H1N1 virus, which describes particular surface proteins on the viral capsule. Like the novel coronavirus the world is dealing with now, it was a novel influenza virus.

So what exactly is a novel virus? It means there’s been a significant enough “genetic shift” in the virus DNA (as opposed to the smaller-scale “genetic drift” that normally occurs) that no one in 1918 had any immunity from previous influenza they’d been exposed to, just like exposure to previous kinds of coronaviruses doesn’t appear to confer protection against COVID-19. There was no herd immunity to slow the movement of the virus through the population.

The 1918 influenza season began with a mild wave in the spring. The mutated influenza virus hit hard in the fall of 1918. It spread like wildfire, which was facilitated at least in part by soldiers returning home at the end of World War I in November. It infected an estimated 500 million people, around 1/3 of the world’s population at the time. An estimated 50 million or more people died from it. In the U.S., the average life expectancy actually dropped by 12 years, and more U.S. soldiers were killed by the pandemic than by WWI.

Unlike COVID-19, where the population that’s at high risk to get really ill from being exposed to the virus is relatively narrow, with the Spanish flu there were multiple high-risk age groups, including children under 5 and healthy people between 20 and 40. People would develop pneumonia and their lungs would fill up with fluid, leaving them unable to breathe.

Some areas ordered people to wear masks in public, and schools, churches, and other gathering areas were closed or, in some cases, converted to makeshift hospitals to deal with the overflow. Businesses and public services had difficulty operating because so many workers got sick. There were also huge shortages of health care workers.

By summer 1919, the pandemic had mostly worn itself out, as those who got it and survived had built up immunity. The final wave was in spring 1920. Vaccines and antivirals weren’t developed until years later.

COVID-19 is serious, without question, but imagine what it would have been like back in 1918. There was basically sweet bugger all in terms of treatment options. No one was working on a vaccine because they didn’t exist. Information-sharing would have been spotty, and most likely the average person had very little understanding of what was actually happening. We can shelter in place and have groceries delivered, but there wouldn’t have been much in terms of options back then. Imagine being quarantined at home with no internet. Not a pleasant prospect.

I wonder what the folks of 1918 would have thought of the present-day crop of anti-vaxxers and vaccine-hesitant people. I’ve got a post coming next week about how vaccines work and what that means for COVID-19.

We’ve come a long way, anti-vaxxers aside. Pandemic life now is far more bearable than it would have been back in the day, and even if there’s not a treatment or vaccine yet, we know that it will come. In the meantime, we have medical care, and in particular critical care in ICUs, that represents a whole different world compared to what was available in 1918.

The world made it through then, so we will most certainly make it through now.


Originally published at on May 4, 2020.

Mental health blogger | Former MH nurse | Living with depression | Author of 3 books, latest is Managing the Depression Puzzle |

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