Understanding the 1918 Spanish Flu outbreak could help us deal with COVID-19

By March 24, 2020 No Comments
Spanish Flu

1918 Spanish Flu outbreak headlines

By Tom Lisi
Pittsburgh Current Contributing Writer

Twenty-two-year-old Elvira Vinc saw the devastation of the pandemic around her in Monessen and decided to act. She volunteered for the Red Cross, despite having no training, and cared for the sick before she caught the deadly virus herself. When she died, mourners draped her casket with the American flag, and a local newspaper called her as heroic as anyone who took up arms to defend the nation.

Vinc’s story is just one from the fall of 1918, when the improperly named “Spanish Flu” (the flu did not originate from Spain)  decimated Pittsburgh and Western Pennsylvania shortly after it had devastated Philadelphia and the eastern seaboard.

There’s a lot more discussion of that misnamed virus now as people and nations across the world grapple with the spread of the coronavirus.

The Spanish Flu, or “Spanish Lady,” caused mass closures and shutdowns in the U.S., part of a rapidly improvised and unprecedented public health response. Its symptoms even mirrored today’s COVID-19 virus. Most cases were mild, but the unlucky few suffered terrible respiratory complications, whereby the virus’ attack on the lungs caused them to fill with fluid, essentially leaving the body to drown itself.

“It is eerily similar,” said Thomas Soltis, assistant professor of sociology at Westmoreland County Community College. Soltis has studied and written about the response to the Spanish Flu in Western Pennsylvania for years.

Before and since the pandemic’s anniversary in 2018, Soltis has given a presentation on how it struck Pittsburgh and the surrounding region. “The question I always got was, ‘Could it happen again?’ My answer was always, ‘It’s not a matter of if, but a matter of when.’”

He won’t get that question anymore.

Pittsburgh was among the hardest hit of all American cities in 1918. In a city of about 580,000 people (well over today’s 300,000), the daily death counts hovered near 100 for a nightmarish three-week period in the fall of 1918.

Surrounding coal-mining towns suffered even more, since medical treatment and other resources were hard to come by.

As quick as the virus arrived in Pittsburgh, it vanished. By November, cases declined exponentially. In Pittsburgh, the Spanish Flu left in its wake some 4,500 dead out 22,000 reported cases. That’s a mortality rate of more than 20 percent

Before the current outbreak, the historical highlights for many might have been the sheer number of fatal cases — how more American troops died in World War I of the flu than in combat — and how little this tragedy entered popular culture in the decades since. 

“I think the pain was just so deep that everyone experienced it,” Soltis said. “And then you had the war ending, it was almost just like, ‘Let’s just close the door and move on.’”

But now it’s tantalizing to dwell on the similarities between the 1918 experience and today’s pandemic. Accounts of the public response from contemporary newspapers are uncannily similar.

Some business leaders and skeptics accused government officials of overreacting by closing down movie theaters, dance halls and saloons.

Part of a fascinating summary of the local 1918 response from a 1985 article in the Western Pennsylvania Historical Magazine, a front-page editorial in the Pittsburgh Leader castigated the state health commissioner for closing public gatherings in Pennsylvania. 

“Probably the only thing that will result from it will be that many people will be deprived of what are their rights under ordinary circumstances and no great good will be accomplished,” the editorial read.

It’s not all gloom and doom — there are also hopeful parallels as well. In the fall of 1918, church congregants, social club members, religious orders and mutual aid societies sprung into action with volunteers to tend to the sick. Lay members of Sacred Heart parish in Point Breeze surveyed the sick in nearby homes and delivered food and other supplies.

Dozens of nonprofits and volunteer initiatives all over the region are now mobilizing to help vulnerable families with food and medical access in response to the coronavirus.

Back in 1918 and 1919, the regular people who stepped up to care for the sick were venerated, Soltis said. The professor pointed to Vinc’s story as an example.

“The newspapers called her as much as a hero as someone who picked up a gun and went to fight in World War I,” Soltis said. Vinc is buried in Grandview Cemetery in Monessen, he said.

By the end of the pandemic, Pittsburgh saw horrors that hopefully won’t befall the city again 102 years later. As in other cities, the death toll grew so quickly, bodies accumulated at cemeteries. A shortage of grave diggers meant that some grieving family members had to bury their loved ones themselves.

The events of the 1918 pandemic surely have some similarities that would’ve been difficult to relate to even weeks ago. But Mari Webel, a history professor at the University of Pittsburgh, warns that there are important differences that should not be lost in the frenzy to make sense of contemporary events.

One is that the U.S. was occupied with the events of World War I at the time. Many doctors and nurses in the country had been mobilized to serve in the war effort and were not available back home.

The Spanish Flu is also famous for its “W-shaped” mortality curve. Unlike most influenza strains, the 1918 flu showed higher incidents of serious cases among younger adults. Early data and anecdotal evidence suggests few children are seeing severe COVID-19 symptoms. 

The W-shaped curve doesn’t so far seem to be the case for coronavirus either, but more data analysis is needed. Back in 1918, those in the prime of their lives were among the hardest hit.

Of all the major contrasts between 1918 and 2020, one that might be oddly overlooked is how medical advancements have come a long way in 100 years, even though there are not yet any antiviral treatments or vaccines for COVID-19.

Medical and epidemiological researchers are working around the clock to better understand the coronavirus and develop not only strategies for containment, but also potential treatments or vaccines, Webel pointed out. In 1918, the medical community had almost no understanding of what caused the Spanish Flu and where it came from.

Webel also emphasized that in 1918 and 1919 there were no ventilators, the most important life-saving method to treat patients with severe fluid build-up in their lungs.

First-person accounts from 1918 detail the horror of watching pneumonia-stricken patients gasp for air as their symptoms worsened. 

If anything, it’s a harsh warning of what could befall medical systems if there are more severe cases than there are ventilators, Webel said. It’s a reality that American medical professionals are already issuing dire warnings about if people do not stay home to slow the virus’ spread.

“If we do see [intensive-care units] overwhelmed, that’s one histrical comparison that is devastating to look at but is one that we should probably be thinking about,” Webel said “And one we should be trying to learn from and help  inform us to sort of stay away from one another and give those health care providers the slack that they need.”

The jury is still out on important details regarding today’s epidemic, Webel said, and there are important lessons to be learned from other public health crises, including H1N1 “swine flu” in 2009 and the HIV/AIDS crisis in the 1980s.

But the overlap between the event 102 years ago and now are undeniable, and both Webel and Soltis said the Spanish Flu provides one more important lesson: the coronavirus will eventually disappear and leave many, many survivors to describe what happened.

“There will be mistakes made, changes that come about, but we will navigate through it,” Soltis said. “I think that’s what 1918 can show us.”

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