From Spanish Flu to COVID-19

If we put the masks-vs-no-masks and real-virus-vs-not debate aside, we can draw conclusions from the pandemic before us and the Spanish flu of 1918. Strangely, I was researching the Spanish flu in early March, when most people around me were telling me not to panic — that this might just be another flu. I wish I had been the one who was wrong!

The Spanish flu killed 50 million people worldwide, and 675,000 in the US alone. In its first four months it had killed 300,000 Americans. We have analogous numbers now with COVID-19: in four months we have over 125,000 dead in the US.

Mailman in 1918 — a mask was necessary

People were asked to wear masks, avoid crowds, and travel by train only if necessary. You'd think that 100 years later — with reusable rockets, Alexas, and smart homes waking us up, controlling the temperature, and managing the doors — things would be different. Sadly, no: the prognosis, diagnosis, and people's behavior are remarkably similar.

Police force, 1918

One reason behavior remains so similar may be that, despite killing so many, the Spanish flu was a footnote — mainly, I think, because the war was going on. Though the flu killed three times more people than the war, it was the war that looked deadly: war wounds were visible and gory. But some American communities escaped the flu with hardly any deaths. One such community lived on Yerba Buena Island.

Newspapers and correspondence during the Spanish Flu

Yerba Buena Island is a naval station near San Francisco. While the US had seen 675,000 flu deaths, Yerba Buena saw only two. Being an island, it was easy to sequester from the mainland: no one could enter or exit during the flu period. Of the 6,000 people living there, only a few could go to the mainland for essentials — and only under strict instructions. Those who went wore masks at all times; on return they quarantined for several days, gargled with an argyrol solution several times a day, had their nasopharynx sprayed, and maintained a distance of 20 feet from each other (note — not 6 feet, but 20).

Yerba Buena belonged to an elite group known as "influenza escape communities." Princeton was another: when cases rose in the borough of Princeton (population ~7,000), measures on the university campus were strict. Freshmen became incident officers, identifiable by a handkerchief around their wrist; they could stop students from loitering on Nassau Street. A strict vigil was enforced. Only one death was reported — a professor.

Of all the influenza escape communities (7–8 in total in the US), Bryn Mawr College tops the list. Its infection rate was 23% — right in line with national numbers — but its deaths were zero. Zero! Zero deaths was unheard of in any community. The credit rests with president Martha Carey Thomas (1894–1922), who was determined to make this all-women's college equal to any prestigious university. Her measures were simple: no visitors on campus, non-resident students asked to stay away, mothers allowed to visit a daughter only if she was ill, and Bryn Mawr women prohibited from taking public transportation or going to theaters.

The path to containing the virus is clear: distance, isolation, masks, no public gatherings — and, more importantly, recognizing COVID-19 as a public health issue. The question is whether we can behave responsibly.

Sources: U-M Center for the History of Medicine — escape communities, National Archives — influenza epidemic records. Originally published June 2020.