Deadly 2nd wave of Spanish flu pandemic of 1918 may hold clues for reopening today

As governments ease up on COVID-19-related lockdowns, policy-makers should heed the lessons learned from the 1918 Spanish flu pandemic and the potential deadly consequences of removing physical distancing restrictions too quickly, experts say.

"This is one of those rare moments that historians can actually more or less agree that there are lessons you can learn that are fairly straightforward and could be applied in the present," said Christopher McKnight Nichols, an associate professor of history and director of the Center for the Humanities at Oregon State University.

More than 100 years ago, the Spanish flu was responsible for the deaths of at least 50 million people worldwide — 55,000 in Canada and 675,000 in the U.S., including many people between the ages of 20 and 40.

The virus also came in multiple waves, the second wave in the fall of 1918 considered the deadliest.

"And in that deadly wave there was ample time to have ramped up procedures and thought about public health policy, phased reopening and closings and all that sort of stuff," Nichols said.

'Learn those lessons'

"And it didn't happen. And that's partly why it's so deadly. And so I want us to learn those lessons today."

Back then, in Canada, the U.S. and around the world, a series of restrictions were imposed in an attempt to stave off the disease. Those measures included shutting down public gatherings, closing schools and theatres, and prohibiting religious services. In some communities, mask wearing became mandatory. 

John Barry, author of The Great Influenza: The Story of the Deadliest Pandemic in History, said many cities back then tried to reopen too soon.

"That was quite common," he said.

And he fears the policy-makers of today will repeat those same mistakes.

'We learn nothing from history'

"I quote [German philosopher Georg Wilhelm Friedrich] Hegel: What we learn from history is that we learn nothing from history."

Barry said he is particularly concerned that cities and states are reopening while cases in their jurisdictions continue to rise.

"That did not happen in a single [U.S.] city that I know of in 1918," he said. "They would wait until the curve dramatically turned down before they would take any action to reopen. So they were considerably more conservative."

Like today, there were people clamouring for the restrictions to be lifted so they could go back to life as normal, said Nancy Bristow, a history professor at the University of Puget Sound and author of American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic.

And some cities attempted to go slowly, staggering the openings of theatres, opening some churches one weekend, then public amusement areas the next, she said.

"But in a lot of places, people were so desperate that [officials] would just say, 'OK, we're done. Tomorrow you can go do  whatever you want.'"

But communities that imposed restrictions early, enforced them and removed them as late as possible — or re-imposed them as necessary — had lower mortality rates, she said.

"They couldn't know that in 1918 because they didn't have all the data. We've got their data, so we have the advantage," she said. 

"We can do this differently."

One city that did follow a good path was Seattle, which imposed increasingly strict restrictions and kept them in place for five weeks. Officials closed schools, prohibited church services, shortened work hours and mandated the wearing of masks in public, she recently wrote in an article for The Guardian.

When the second wave hit, the city immediately went to a quarantine system and didn't end up having to re-impose tough physical distancing measures. Instead, officials put infected individuals into quarantine with placards on their homes as a way to keep track of them.

"And the public in general was really compliant. And they did really well. They had half of the per-capita death rate than those of the hardest-hit cities," Bristow said. 

In Denver, as deaths were decreasing, officials began reopening the city, culminating in an Armistice Day parade on Nov. 11. That led to cases surging again, prompting stricter measures, including mandatory face masks.

Many public health commissioners and mayors during the fall of 1918 and spring of 1919 would ratchet measures up and down based on whether phased reopenings were leading to an increase in cases, Nichols said.

Decrease in commercial activity

Still, as cities reopened, many people remained anxious about getting sick and returning to work, he said. Some cities reported a 40 to 70 per cent decrease in all commercial activity across the board even after they reopened.

Canadians have expressed a similar sentiment in the current pandemic. Results from a weekly tracking poll conducted by Leger for the Association for Canadian Studies suggest that a majority of Canadians want to see significant signs of progress before governments lift restrictions and allow a return to work. The poll found 21 per cent of respondents don't want to see these measures relaxed until there is a COVID-19 vaccine. Another 29 per cent said they want to see at least two consecutive weeks with no new cases. 

"I think what one big lesson of that time is: Even if everything could come roaring back, even if you could flip the lights on to the whole economy, individuals are going to make choices related to their exposure, which differ significantly from the kind of ways in which this is talked about in political rhetoric."

Nichols said then, as now, there were a lot of suspicious treatments floating around. One 1918-era doctor recommended that people sniff a mix of boric acid and sodium bicarbonate (baking soda) powder to rinse out nasal passages.

Popular theories spread that warming your feet would prevent infection, or gobbling brown sugar, or getting an onion rub-down. As well, purported vaccines were rushed across the country when there were outbreaks, and none of them worked.

"So one other interesting lesson from that era is taking our time to get the vaccines right. Makes a lot more sense than rushing out … miracle cures that then will make people more fearful or give false hope."