Third year history student Tomás Pizarro-Escuti explores the lessons of The Spanish Flu through the lenses of applied history.
History, in its purest form, can be defined as the knowledge of humanity’s past based upon reliable sources. Nevertheless, the historian’s role in its reconstruction of the past should not only be inspired by knowledge for its own sake but rather to collect the lessons of the past, to understand the present and project us into the future. This, in my view, is history’s ultimate purpose and the guiding value that should be shared by those devoted to this discipline.
The pandemic that spread across the world in the first half of the twentieth century, known as the “Spanish flu” (1918-1920) left humanity with lessons that can be applied today to better confront the latest coronavirus epidemic which continues to expand throughout the planet. These lessons are as relevant to the social, political, and economic fields as they are to the medical sciences.
According to the limited statistics of the period, the Spanish flu infected approximately half a billion people and caused between 50 and 100 million deaths. This is almost six times more people than the 17 million soldiers and civilians who died in the First World War and equivalent to around three per cent of the world population at the time. The large number of victims was undoubtedly due to the fact that most countries lacked the necessary hospital infrastructure, enough medical professionals and the medicines needed to cope with the virus, whose contagiousness and deadly effects were higher than COVID-19. The sources of the period (mainly newspapers and journals that were consulted) show that in the face of the devastating effects of this pandemic, the different health services across the world used all the means at their disposal to mitigate it; from the old procedure of bleeding patients, to supplying oxygen to those in the most critical state, and the most common method of providing enormous quantities of aspirin to those infected.
As is the case today, there was an effort to develop new vaccines and serums, mainly against various types of pneumococcus and what medical science calls “haemophilus influenzae”. However, the truth is that only one therapeutic measure showed more effectiveness and success in the treatment of the ill: the transfusion of blood or blood plasma from patients already recovered from the flu to newly afflicted people. Currently known as “convalescent plasma therapy”, its main benefit is the export of antibodies from recovered patients which ultimately help to fight the infection. This procedure was not only successful in reducing mortality rates during the Spanish flu but was also beneficial during the Sars epidemic in 2002–2004 and the most recent Ebola virus outbreak in 2014-2016. Based on this evidence, and on the absence of a vaccine to prevent the coronavirus, states should encourage the use of this medical therapy to fight the current pandemic.
Another significant lesson from history that we should consider today concerns the misuse of drugs to treat patients. Dr Karen Starko, an infectious disease specialist, is one of the authors of a series of academic papers connecting the Spanish flu’s high death toll with the overdose of aspirin. In 1918, many well-established medical intuitions such as the Journal of the American Medical Association recommended the indiscriminate use of aspirin. Physicians without fully understanding the pharmacology of the drug- which at that time was relatively new- advised patients to intake up to 30 grams per day. Today, medical experts consider doses of aspirin above four grams to be dangerous and 30 grams to be simply toxic. Aspirin poisoning can generate fluid build-up in the lungs, hyperventilation and pulmonary endemas. This is currently believed to be a factor that exacerbated the number of deaths by either worsening the symptoms of the flu or by aspirin poisoning. In the fight against COVID-19, it is essential that before launching drugs to the wider public there must be strict scrutiny of the drugs’ side effects, being mindful of the importance of the doses prescribed to patients. Good communication and clear guidelines are key for keeping people safe, especially from self-medication. The WHO has been clear that there is currently no proof of any drug that can be used to treat coronavirus. Regrettably, several cases of people’s death have been recently reported around the world due to the misuse of drugs many times linked to self-medication.
The Spanish flu outbreak led to numerous scientific investigations that were completed after the twentieth century and that today constitute a good basis for research on COVID-19. For example, it was not until February 2001 that an article published in the scientific journal, PNAS, showed how a group of scientists reconstructed the 1918 influenza with the sequence of the NS segment of the virus and with the sequence of a mouse-adapted virus derived from a human influenza strain. The reconstruction of the Spanish flu shed new light on its virulence and contagiousness. The scientific contribution from this research was that the key to understanding the virulence potential of a strain of influenza virus involves studying its molecular pattern and the phenotypic characteristics associated with its genetic sequence.
Later, in February 2004, Science Magazine published an article written by two teams of researchers, the first led by Sir John Skehel, director of the National Institute for Medical Research in London, and the second by Professor Ian Wilson of the Scripps Research Institute in San Diego, California. The researchers by various means obtained the synthesis of the hemagglutinin protein, ultimately responsible for the pandemic that began in 1918. The synthesis was achieved by gathering DNA from the lungs of an Inuit woman found in the Alaskan tundra and from the preserved remains of American soldiers who fell on European soil. This research, and others that followed over time, constitute a valuable scientific legacy that will allow the scientists of this century to reveal at some point the characteristics that are still unknown of COVID-19.
Analysts Sergio Correia, Stephan Luck and Emil Verner have recently published an article in the SSRN journal about the economic consequences of pandemics based on the policies taken by the United States during the Spanish flu epidemic. The article argues that cities which implemented quarantine and social isolation measures earlier and enforced them effectively 100 years ago had far fewer deaths and recovered economically more rapidly once the pandemic was over. In fact, these cities grew even faster in the medium-term than those who apparently favoured the economy by having less restrictive measures put in place. In other words, the pandemic depressed the economy, but public health interventions did not. Non-pharmaceutical interventions not only saved lives; they also alleviated the negative economic costs of the pandemic. According to these experts, in cases where measures were taken at least ten days before the arrival of the flu, manufacturing employment increased by about 5% in the post-pandemic period, and where such distancing measures were extended for an additional 50 days, that rate increased by 6.5%. They also claim that the closure of schools, church, theatres, and the banning of public gatherings reduced mortality and helped the economy. These measures, although they undoubtedly lowered the economic activity in the initial phase of the pandemic, nonetheless, resolved the associated problems with fighting the transmission of the virus, thus, mitigating the economic disruption provoked by the increase of death and the lack of labour force which constituted the biggest shock to the economy. The Spanish flu pandemic, which affected the world between January 1918 and December 1920, caused an average 18% reduction in industrial production in the United States and led to business failures and poverty in thousands of households. In the most affected areas, the economic depression lasted until 1923. Something similar may happen with the current pandemic; the economic recovery is not likely to be fast and may take some years. However, if we are willing to take restrictive measures, if we are willing to make this great sacrifice with our civil liberties, we will not only save invaluable human lives, but we will also protect our economy in the medium and long term. Today we can begin to see the interconnection of these factors in countries such as South Korea, Taiwan, or Singapore, who took very restrictive measures at the beginning of the pandemic. These countries limited the transmission of the virus and these measures appeared to mitigate the economic consequences more than other states such as Italy or Spain, where they took longer to contain the virus.
It should be borne in mind that the 1918 pandemic took place in the context of the First World War, the first of the great international conflicts that not only tore apart European society but also the whole world. The virus killed thousands of soldiers from the various belligerent countries on the battlefields. In fact, more American soldiers died from the Spanish flu than died fighting battles. The war prevented a global coordination to face the health crisis. Nevertheless, solidarity initiatives, such as soup kitchens and homeless shelters to sustain the most vulnerable people, were created by civil society. Today we can rescue the spirit of these initiatives, especially in the poorest countries where the state has a less predominant role. The solidarity of local communities is very important in our defence against the virus, in addition to the role of institutions such as NGOs, charities and faith-based organisations who can help to alleviate the socio-economic consequences of the pandemic.
One of the positive consequences of both the First World War and to some extent, the Spanish flu itself was the need to restructure the world in terms of world peace and the security of nations. American President, Woodrow Wilson, leader of the country that would become the first world power after this conflict, was one of the architects of the initiative to propose a new world order. This initiative, summarised by Wilson in his famous “fourteen points” that guaranteed, among others, the freedom of the seas, the removal of trade barriers, and an international association to guarantee peace, which would become The League of Nations and subsequently The United Nations of today. Although the prime role of The League of Nations was to prevent wars- which as we know had little success- the prevention and monitoring of infectious diseases was also one of the core missions included in its founding treaty. With limited resources and having learned from the Spanish flu pandemic, the League established a system of global healthcare co-operation which later helped to defeat typhus in 1922 through the imposition of quarantines and mass examinations. The League of Nations also worked toward developing international investigation, functioning as a platform for the global sharing of medical knowledge that helped the fighting against infectious diseases in an unprecedented manner. Returning to the lessons of history, this core idea that health in a co-dependent world must also be safeguarded with international co-operation should be reinforced in times of coronavirus. Today, more than ever, it is necessary to revitalise and strengthen this international institutional framework derived from the twentieth century. The best proof of this is that, in the face of the challenge of the current pandemic, the world has been incapable of generating an effective global response, because institutions such as the United Nations and the World Health Organisation itself have not been able to coordinate a common strategy, much less a common plan of action. A plan of action whose first point should be the exchange of accurate information on the new virus and its impact on the population of each country. Because of this each country seems to have been left on its own, waging the fight against the virus with unequal means.
The need for coordination is reinforced by recognising that this new pandemic will bring not only a global health emergency but also a profound economic and social crisis that will generate unemployment, hunger, and misery to millions of people. It is clear today that no country is able to fight COVID-19 on its own and that greater international co-operation is urgently needed to successfully defeat the virus. It is therefore imperative that we also rescue the old value of solidarity, which, in the wake of this pandemic, should be the fundamental pillar of international relations.