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History of the Spanish Flu

One hundred years before there was COVID-19, another pandemic shook the world. The Spanish Flu pandemic spread across quickly, as people travelled more than ever after World War I.

Are you wondering why we are looking back at this pandemic? Well, during the spread of the Spanish flu, there was no known vaccine or even antibiotics* to treat the infections. So, to stop the spread of this deadly pandemic, effective methods were first implemented worldwide like isolation, quarantine, washing hands, use of disinfectants, and limitations of public gatherings.

Read on and see how much this historical event was similar to the current pandemic, and it will make you very glad about how far we’ve come in such a short time.

*Penicillin, the first true antibiotic, was discovered by Alexander Fleming in 1928 [1]

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What was the Spanish flu?

The Spanish flu pandemic, also known as the 1918 influenza pandemic, was one of the deadliest pandemics in history. It took place between 1918 and 1920 (just after the First World War) and infected around 500 million people around the world*—that was about one-third of the planet’s population at the time!

It was caused by an H1N1 virus, which leads to a form of influenza (or the flu) that attacks the respiratory system and is highly contagious. If H1N1 sounds familiar to you, that’s because it was also the virus that caused the 2009 swine flu pandemic.

*(as of April 2021, COVID-19 has infected over 140 million people worldwide, with about 3 million deaths)

What caused the Spanish flu?

While we know that the Spanish Flu was caused by an H1N1 virus that probably originated in birds (so basically, it was a type of bird flu), it’s still not known where it came from.

Where did the Spanish flu come from?

Despite the name “Spanish flu,” no one knows where it actually originated, and the first cases were seen in March 1918 in Kansas in the USA.
But it soon traveled with soldiers who had returned from Europe's battlefields, and around the same time, there were also cases reported in Brest, France, and around Europe.
Eventually, it spread across Europe, America, and areas of Asia before spreading to almost every inhabited part of the world.

Why was it called the “Spanish” flu?

While the 1918-1920 outbreak of influenza was commonly known as the “Spanish flu” in the United States and Europe, we have already seen that it did not originate in Spain. This name was actually due to a misunderstanding.

During World War I, Spain was a neutral country, so its media was not affected by any wartime censors, and they freely covered the outbreak.
It made headlines in May 1918 after the Spanish King Alfonso XIII was infected.
A lot of other countries who were still fighting the First World War could only read about the flu from Spanish news sources and they believed the pandemic originated there!
This was because Allied and Central countries often covered up news of the flu to keep morale high during the war
In fact, in Spain, they thought that the virus had come from France, so they actually called it the “French flu!” [2]

How did the Spanish flu spread?

Wherever the flu originated, it was soon seen all around the world. But how did it spread?

Infected soldiers spread the disease across military camps and then took it overseas when they went home after the war.

When people touch something with the virus on it (and then touching their mouth, eyes, or nose).

Any contact with respiratory droplets from infected patients, like when they cough or sneeze.

What was the history of the Spanish influenza pandemic?

When did the Spanish flu start?

The very first reported case of the Spanish Flu was in March 1918 in Kansas in the United States.
This led to the first wave of the 1918 pandemic in the spring and, though it was widespread, most cases were generally mild.

How long did the Spanish flu last?

There was a second, more highly contagious wave in late 1918, which led to almost 20 million deaths
In 1919 there was a third wave in the first half of the year and a smaller fourth wave in spring 1920

When did the Spanish flu end?

After the fourth wave in early 1920, the Spanish flu slowly died out
Despite the high mortality rates, it was almost forgotten until recent bird flu outbreaks in the 1990s and 2000s

(this was probably due to limited media coverage at the time!)

Who was most affected?

During the Spanish flu pandemic, it affected children younger than 5, and seniors over 65.
Unusually it was also deadly for healthy young people between 20-40 years old—a group normally resistant to this kind of flu!
This was likely because many became ill returning from the First World War in crowded ships and trains.

How many people were impacted by the Spanish flu?

In total, 500 million people (or one-third of the world's population) became infected with this virus. The Spanish Flu killed around 20 million to 50 million people (about 3% of the global population). This was more than the number of people who died in the First World War!*

These were the countries that were affected the worst [3]:

Country	Number of Deaths
India	12–17 million (about 5% of the population)
Russia	450,000–2.7 million**
Iran	902,000–2 million (8% to 22% of the total population)
Indonesia (then called the Dutch East Indies)	1.5 million
USA	500,000–850,000
France	400,000
Brazil	300,000
South Africa	300,000 (6% of the population)
Spain	260,000 (1% of the Spanish population)
Britain	250,000
Canada	50,000

*(the total number of military and civilian deaths in World War I was around 20 million deaths [4])

**Russia was in the middle of a revolution, so the number is not clearly known.

What were the symptoms of the Spanish flu?

Most mild cases of the Spanish flu would experience typical influenza symptoms like sore throat, headache, and fever.

But more serious cases would also experience nosebleeds and bleeding from the mouth or ears, hair fall, delirium, dizziness, loss of hearing or smell, and hands and feet turning blue.

Is there a treatment for the Spanish flu?

In 1918, unfortunately, doctors and scientists were unsure of what caused the outbreak and how to treat it. There were also no effective vaccines*, antivirals, or antibiotics to treat patients. [5]
Mostly, it was handled through non-pharmaceutical measures such as isolation, quarantine, wearing masks, and social distancing, though patients were also given things like aspirin to manage their symptoms.
Luckily today, we have both an H1N1 vaccine and numerous seasonal flu vaccines to prevent such outbreaks.
Nowadays, patients can also be treated with antivirals as soon as they experience flu symptoms, and we have strong antibiotics in case of any other complications.
Even in mild cases, we can manage symptoms with over-the-counter pain medications like paracetamol and ibuprofen, as well as lots of liquids and rest!

*The first fully licensed flu vaccines appeared in the 1940s.

How was the Spanish flu different from the Coronavirus outbreak?

Obviously, with the world again in the middle of a pandemic, it’s natural that we want to compare COVID-19 with the Spanish flu. But, there are several important ways they are different:

	Spanish Flu	COVID-19
They are not the same disease	The virus that caused the Spanish flu was an influenza virus (A/H1N1)	The virus that causes COVID-19 is a coronavirus (SARS-CoV-2)
The worst affected age groups are different	It affected children younger than 5, and seniors over 65, and was also deadly for healthy young people between 20-40 years old	While people of all ages can get infected, most of the serious cases have been in people above 65, or those with underlying medical conditions
Where it came from is not the same	No one knows where it originates, but the first cases were in Kansas, in the United States, in March 1918	Cases were first reported in Wuhan, the capital of China’s Hubei province, in Dec 2019
The origin of the viruses is different	It is an avian flu virus that likely came from birds	It is thought to have originated in animals, likely bats
The mortality rate is very different	The global death-to-case ratio was around 10% worldwide	The death-to-case ratio is 2.2% worldwide, based on Johns Hopkins University statistics (as of April 2021)
How they are treated is different	There were no effective vaccines, antivirals, or antibiotics, and it was mainly handled through measures like quarantine and social distancing	While there is no specific, effective treatment for COVID19, there are many ways to manage it apart from social distancing and quarantines, such as oxygen support, antivirals, plasma transfusions, and most importantly, vaccines.

Influenza is a highly contagious disease, and unfortunately, we still see outbreaks that range from small to full-blown pandemics every few years. But, the devastating Spanish flu epidemic has many things to teach us, from the importance of a quick initial response to the effectiveness of public health measures like social distancing and wearing masks.

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