World war factors into pandemic comparisons

By JIM HARRIS | Special to The Washington Post | Published: May 11, 2020

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Scientists and scholars have spent the last few months scouring the past for precedents to offer suggestions for how to safely and successfully respond to the COVID-19 crisis. The result has been almost daily references to the global influenza pandemic of 1918-1919, with its massive ramifications across the globe, including in the United States. While we can draw many useful lessons from the 1918-1919 experience in terms of how to minimize cases, we must be cautious about an imperfect analogy.

During the 1918-1919 pandemic, upward of 500 million people were infected (about 30% of the global population), and conservative estimates count 50 million deaths. While our data on the number of cases and deaths from COVID-19 are very likely too low because of continued limited testing, it is still unlikely that we will reach such catastrophic levels of loss today.

Why? Because unlike the influenza pandemic a century ago, the world is not at war.

The first cases of the 1918 flu pandemic most probably occurred in early March 1918 at Camp Funston in Kansas, where 54,000 U.S. soldiers were gathered for basic training before their deployment to Europe. Within the month, 1,100 of these soldiers were admitted to the hospital with influenza. The pandemic then followed the movement of these and many other soldiers around the globe as the Allies rushed to deploy American troops to Europe to stop the last German offensive in the spring of 1918. While the number of soldiers who contracted an “offseason” summer flu was considerable, most patients recovered quickly, leading doctors to describe this as nothing more than a “three-day fever” worthy of little cause for concern amid the ongoing war.

In late August, however, the flu came back, beginning its far more deadly second wave almost simultaneously in Brest, France (Aug. 22); Freetown, Sierra Leone (Aug. 24); and Boston (Aug. 27) — all major military port cities. The Great War kept soldiers in close, infectious quarters and constant movement around the globe, carrying the pandemic with them.

Hospitals were overwhelmed and operating with very limited medical personnel thanks to the many deployed in the military medical services. The remaining civilian doctors and nurses could not keep pace with the volume of influenza patients. Permelia Murnan Doty, the executive secretary of the New York Nurses Emergency Council, described in late 1919 how nurses had been responsible for at least double their usual number of patients, many of whom were fighting off the flu.

Pulmonary complications appeared more frequently, contributing to a mortality rate 25 times as high as during a normal influenza outbreak. Influenza fatalities peaked in November 1918 just as the war was coming to its end — and this timing had major ramifications for the outbreak.

The war shaped public health responses, which varied nationally or even regionally. Sir Arthur Newsholme, the foremost public health expert in Britain, told Britons to simply “carry on.” A quarantine, the only tried and true method to contain past flu pandemics, would have been too detrimental to the war economy. The war necessitated tremendous domestic efforts to keep factories and supply lines operational, supplying those soldiers on the front lines. “Social distancing” was impossible to properly enact while fighting a world war, and postwar celebrations of peace further exacerbated these problems.

In Britain, therefore, large public gatherings were not banned until late November, as the pandemic was already peaking. The United States, an ocean away from the immediate threats of the war, was more proactive in enacting some social distancing measures, beginning in September, but these varied by region.

Cities that were proactive in introducing social distancing measures, such as New York City, where quarantine measures were implemented before “the surge” in influenza deaths, kept their death rates (452 per 100,000) low. Here, too, however, the war played a role in what happened. A two-mile parade on Sept. 28 to boost morale and funds for the war attended by 200,000 citizens in Philadelphia left the city with the unenviable record of one of the highest death tolls among U.S. cities (748 per 100,000).

Like influenza in 1918, COVID-19 has spread across the globe, with disastrous consequences. As of May 10, more than 4.07 million people worldwide have been infected and 281,287 have died.

However, in 2020, we are luckily not emerging from a world war. Freedom from war has better positioned our medical system to fight the pandemic, allowing it to fully direct resources and manpower toward fighting COVID-19 instead of returning wounded or diseased soldiers to the battlefield. This has enabled governments to be swift and aggressive in their public health response. Their prompt action has spawned a commitment to social distancing and mask-wearing.

Using the 1918 flu pandemic to inform our response to COVID-19 is only wise. It provides a template — overwhelming medical resources and aggressive actions — for what works to combat a dangerous and highly contagious virus like the coronavirus plaguing us now. But for the analogy to be effective, we must account for the war that made the 1918 flu so deadly. Only by doing so can we properly calibrate our response today.

Jim Harris is a historian of modern Britain and the history of science, medicine and the environment, with a focus on the history of public health and infectious disease. He is currently a lecturer in the department of history at Ohio State University.

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