The Spanish Flu and COVID-19

Jessica Crish

Youngstown State University

NURS 4844

Dr. Ballone

Introduction
 In 1918, it was recorded that 675,000 deaths occurred in the United States due to the

Spanish flu, which was .64% of the population. In 2020, 500,000 COVID-19 deaths, or .15% of

the population, were reported. Although these death rates are difficult to measure and do not in-

clude other pre-existing illnesses, the 1918 pandemic was worse than COVID-19. (Ewing, 2021).

Even though these pandemics took place over 100 years apart, they exhibit extraordinary similar-

ities as well as some differences.

Origins

Although both pandemics had similar outcomes, the origin and spread of each disease

was quite different. There are several different theories regarding how the Spanish flu was able

to spread so easily. It is agreed upon that a small town in Kansas was responsible for the out-

break. The flu traveled through military bases and was soon spread globally by way of World

War I. Once a mass group of soldiers began experiencing symptoms of the flu, it was only a brief

time before everyone they encountered was also sick. During this time there was no isolation or

quarantine of sick patients. The lack of precautions helped to further mutate and spread this

virus. The origin of the coronavirus is unknown, though several theories consider it may have

come from bats, wet markets, or was manufactured in a lab. It is agreed, however, that COVID-

19 was spread by international travel. Since the first reported case in December 2019, it has

spread rapidly and mutated into different variants of the virus.

Similarities

Many of the strategies used for the Spanish flu were repeated for the COVID-19 pan-

demic. During each pandemic peak, some local and state governments issued mandates which

closed schools, restaurants, movie theaters, and churches to lessen the spread of the virus. People

were told to stay home, wash their hands, and wear masks to cover their nose and mouth. Public
gatherings were also banned. At the onset of the Spanish flu, San Francisco had a relatively low

infection rate due to early efforts to close schools and places of public amusement. Similarly, in

March of 2020, California’s Bay Area was ordered to shelter in place in response to rising

COVID-19 cases. The stay-at-home order and closure of all non-essential businesses was one of

the first and most aggressive measures taken in the United States. Also in both cases, many state

and local authorities downplayed the severity of the virus, kept businesses open, and urged peo-

ple to go about their daily lives. In 1918, a large parade in Philadelphia drew a crowd of 200,000

people which contributed to the widespread outbreak of the Spanish flu in the city. Against the

suggestion by local physicians to cancel the parade, Philadelphia’s public health director insisted

the parade go on and as a result, more than 2,500 people were dead by the end of that week

(Barry, 2019). Comparably, in the spring of 2020 & 2021 when other sections of the country

were urging citizens not to travel, states like Florida and Texas were proclaiming it “business as

usual” for millions of high school and college students on spring break. In both years, COVID-

19 numbers surged in those hot spots. Areas that took outbreaks more seriously had to deal with

the economic ramifications of the closures. Small businesses were hit hard by the mandates to

close while more established businesses were able to survive. Diseases that are not always fatal

eventually become more dangerous. The Spanish flu and COVID-19 do not always cause death;

however, this allows the virus to become stronger and mutate often more than once. The strong-

est portion of the virus survives to become a more virulent strain. This is demonstrated by the

resurgence of the Spanish flu in 1919 and the delta variant of the COVID –19 virus.

Differences

To combat these more virulent strains, a vaccine was developed against the Spanish flu.

Nevertheless, it was determined that this vaccine was ineffective and offered no protection
against the virus. In 2020, three different Covid-19 vaccines received emergency FDA approval

in the United States. According to the Centers for Disease Control and Prevention, (2021) “All

COVID-19 vaccines currently available in the United States are effectively preventing COVID-

19 as seen in clinical trial settings.” Viral pathologists estimate that by 1920 the Spanish flu was

less pernicious and almost indistinguishable from the regular flu. By this time people had also

developed natural immunity. Therefore, most deadly strains existed from 1918 to early 1920

(Roos, 2020). Conversely, COVID-19 has been flourishing for nearly two years. Although vac-

cines are proving to be effective in fighting off COVID-19, epidemiologists are unsure of when

the pandemic will end. Another difference between the Spanish flu and COVID-19 is access to

information in the 21st century as opposed to the early 1900s. Now, information can be obtained

via the internet at any time. People can look up symptoms, treatments, and statistics online with-

out leaving their homes. It is also possible to speak with doctors over the phone or virtually. To-

day more than 50 major news networks are on the air. The ability to acquire information,

whether right or wrong, is at most people’s fingertips. By contrast, in the 1900s, people had very

few avenues to get information and medical advice. A handful of newspapers and magazines

were in existence and limited to local and regional news. When people got sick they tried to treat

the illness at home instead of going to the hospital. Lower socioeconomic status usually meant

even less access to healthcare.

Global Effects

Globally, both pandemics have had adverse effects on health and the economy. Long-

term health complications have been observed from both viruses. The Spanish flu was known to

cause an increased risk for cardiac-related illnesses. Although the survival rate for COVID-19 is
around 98%, there are many long-term health complications that have been known to follow the

infection. Shortness of breath, chest pain, neurological disorders, joint and muscle pain, and loss

of taste and smell are just a few of the complications “long haulers” experience. The world lead-

ers’ solution to both pandemics was a global shutdown of businesses. This slowed the spread of

both diseases, but it also decreased the profits for many companies, especially those that are pri-

vately-owned with fewer employees. Healthcare workers around the world are overwhelmed

anytime there is an outbreak of disease. Worldwide shortages of healthcare workers not only af-

fect patients suffering from the virus, but also patients who have other medical issues. Many doc-

tors and nurses contracted the Spanish flu and died leaving less workers to care for an increasing

number of patients. Similarly, nurses in the 21st century face unsafe staffing ratios. This problem

was occurring long before COVID-19, but the pandemic exacerbated the issue. Many nurses and

doctors became ill because of COVID-19, while some resigned due to safety concerns. Others

died after being infected by the virus. As hospitals fill up with COVID-19 patients there are

fewer beds for non-covid patients. This leaves people unable to get the medical care they need,

which can result in patients becoming more ill or dying.

Interventions

The Spanish flu and COVID-19 interventions were remarkably similar. Both pandemics

encouraged mask wearing to stop the spread of the virus. Doctors believe masks are highly effec-

tive at filtering airborne viruses. In 1918, there were monetary fines and jail time for not obeying

the mask laws. These laws were enforced by police and business owners, however most citizens

obeyed these mandates with little or no resistance. In contrast, mask wearing and mask mandates

have turned into controversial topics in 2020-21, mostly due to political differences among U.S.

residents. Throughout the COVID-19 pandemic, people have refused to wear masks while in-
doors and have eschewed advice to limit close contract with others. Frequent hand washing was

also encouraged for both pandemics. Hand hygiene was a new topic in 1918 as doctors did not

have the knowledge of viruses that we have today. Schools, churches, stores, and large gather-

ings were restricted and closed. The rationale for closing public places was to control the number

of people exposed to viruses. People from both pandemics fought the shutdown of businesses

and churches. Isolation and quarantine also have proved to slow the spread of airborne illnesses.

Keeping infected patients in isolation worked very well during the COVID-19 pandemic. Isola-

tion was a foreign idea to doctors in 1918 and they did not practice it. Contact tracing has been

used to determine who has been exposed to COVID-19. With access to the internet and phones,

finding out who has been exposed to the virus has been made easy. The people exposed to the

Spanish flu had know way of knowing unless they were told by the infected person or relatives.

Since medicine has advanced, we now can test for certain viruses and be more accurate in diag-

nosis. Accurate diagnosing is a key factor in controlling the spread of disease.

Conclusion

Overall, both the Spanish Flu of 1918 and the COVID- 19 pandemic have had lasting effects on

the world. The Spanish Flu ended, but did not ever disappear. The inventions and precautions put

in place helped to slow the spread of each virus. However, it has proven that even 100 years

apart, people will always protest government mandates whether that be no mass gatherings or

just wearing a mask into the grocery store. Public health officials should be using the mistakes

made in the past to help prevent other pandemics and epidemics. We need to focus on prepara-

tion for future global outbreaks to ensure our healthcare systems are ready for the challenges

they will surely face.