Lessons For COVID-19 From 1918

Apr 15, 2020

The COVID-19 crisis has been compared to the 1918 pandemic commonly known as the Spanish Flu. A Stony Brook University history professor knows very well how that pandemic played out—and how it compares to today.

Nancy Tomes gave a lecture to her Stony Brook class on March 10. The topic—the 1918 Influenza Pandemic and Public Policy. It later aired on C-SPAN. What she told the students at one point to make a comparison sounded kind of crazy.

“Let’s say they come to you tomorrow and say we have to shut down Stony Brook,” she said. “How are people gonna respond? Businesses don’t want to close. Workers don’t want to stay home. Why? Because they don’t get paid.”

The day after her lecture, the university cancelled classes.

“In many ways, I know what I’m going to read in the paper when I get up in the morning because it is so eerily reminiscent of 1918, 1919,” Tomes says.

A nurse wears a cloth mask while treating a patient at Walter Reed Hospital in Washington, D.C. Patients were set up in rows of beds in an open gallery, separated by hung sheets.
Credit Harris & Ewing via Library of Congress / Wikimedia Commons

Tomes says she’s seen a lot of the same successes—and mistakes—in the weeks since that lecture. She said it’s not a historian’s job to be a fortune teller…

“And yet, there are basic outcomes that we can predict if we’ve studied something like a pandemic,” she says. “For example, the most vulnerable people in that society will suffer the most. I can’t name a pandemic going back as long as we have a historical record where that is not the case. And I wake up in the morning with a heavy heart seeing that that is playing out—the headline in The New York Times today that even though many areas are not keeping track of statistics by race, that in big cities, black Americans are being hit harder by this virus.”

The so-called Spanish Flu killed tens of millions of people—more than World War I, which took place at about the same time. Tomes says the term “Spanish Flu” is an unfortunate misnomer.

“The irony has everything to do with journalism,” she says. “It was the fact that Spanish newspapers reported about it earlier because Spain was not a combatant in World War I. The countries that were fighting World War I, first the war news was dominating the papers, but also they were more reluctant to say we have this terrible influenza outbreak among our troops. Spain was the first person to kind of stick their hand up and say, nope, something’s going on here and then they end up getting the flu named after them.”

Here in the U.S., the government’s recommendations were reported in the newspapers: wash your hands, stay at home, practice what we now call social distancing. But one major difference back then—the press and public health officials presented a unified version of the truth.

“They argued back during the World War I pandemic, but they did it in private,” she says, “They were not arguing on the front page of The New York Times.”

And unlike today, there were no other ways of getting information.

“I mean, if I want to go on a Twitter feed and say this virus was concocted by the governor of New York for his own political gain and we should all start calling it the Cuomo virus, who could stop me?”

Tomes says the 1918 flu was the first attempt at nationwide public health education.

An early public health message at the Naval Aircraft Factory in Philadelphia in October 1918.
Credit U.S. Naval History and Heritage Command via AP

“So using posters, placards. Public health departments were just starting to borrow techniques from product advertising to produce non-profit messages. Instead of selling Listerine, they were selling the principle that if you coughed or sneeze, you needed to cover your mouth or your nose. Use a handkerchief.”

Tomes says it worked as well as it could have under the circumstances.

“What we’re doing today, the so-called flattening the curve—that approach to managing a pandemic that moves fast, kills a lot of people—that idea of flattening the curve to buy time is straight out of World War I. Flattening the curve worked in the World War I pandemic. Cities that were further away had time to make decisions—okay, we’re gonna close the schools, we’re gonna close businesses, we’re gonna discourage people from leaving the house.”

And Tomes says the cities that adopted social distancing had fewer deaths.