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Coronavirus: How They Tried To Curb Spanish Flu Pandemic In 1918

A woman wears a flu mask during the Spanish flu epidemic

It is dangerous to draw too many parallels between coronavirus and the 1918 Spanish flu pandemic, that killed at least 50 million people around the world.

Covid-19 is an entirely new disease, which disproportionately affects older people. The deadly strain of influenza that swept the globe in 1918 tended to strike those aged between 20 and 30, with strong immune systems.

But the actions taken by governments and individuals to prevent the spread of infection have a familiar ring to them.

Public Health England studied the Spanish flu outbreak to draw up its initial contingency plan for coronavirus, the key lesson being that the second wave of the disease, in the autumn of 1918, proved to be far more deadly than the first.

Women from the Department of War take 15-minute walks to breathe in fresh air every morning and night to ward off the influenza virus during World War I, c. 1918. (Photo by Hulton Archive/Getty Images)

Britain was still at war when the virus claimed its first recorded victim, in May 1918. The government, like many others, was caught on the hop. It appears to have decided that the war effort took precedence over preventing flu deaths.

The disease spread like wildfire in crowded troop transports and munitions factories, and on buses and trains, according to a 1919 report by Sir Arthur Newsholme for the Royal Society of Medicine.

But a "memorandum for public use" he had written in July 1918, that advised people to stay at home if they were sick and to avoid large gatherings, was buried by the government.

Sir Arthur argued that many lives could have been saved if these rules had been followed, but he added: "There are national circumstances in which the major duty is to 'carry on', even when risk to health and life is involved."

The flu did not originate in Spain, but Spain was the first country to report deaths from it, leading to the assumption that it must have started there. Spain's newspapers were not subject to wartime censorship, because it was a neutral country. News of the epidemic was initially suppressed in other countries to avoid damaging morale.

Women wear cloth surgical-style masks to protect against influenza

In 1918, there were no treatments for influenza and no antibiotics to treat complications such as pneumonia. Hospitals were quickly overwhelmed.

There was no centrally imposed lockdown to curb the spread of infection, although many theatres, dance halls, cinemas and churches were closed, in some cases for months.

Pubs, which were already subject to wartime restrictions on opening hours, mostly stayed open. The Football League and the FA Cup had been cancelled for the war, but there was no effort to cancel other matches or limit crowds, with men's teams playing in regional competitions, and women's football, which attracted large crowds, continuing throughout the pandemic.

Streets in some towns and cities were sprayed with disinfectant and some people wore anti-germ masks, as they went about their daily lives.

A telephone operator with protective gauze

Public health messages were confused - and, just like today, fake news and conspiracy theories abounded, although the general level of ignorance about healthy lifestyles did not help.

In some factories, no-smoking rules were relaxed, in the belief that cigarettes would help prevent infection.

During a Commons debate on the pandemic, Conservative MP Claude Lowther asked: "Is it a fact that a sure preventative against influenza is cocoa taken three times a day?"

Publicity campaigns and leaflets warned against spreading disease through coughs and sneezes.

In November 1918, the News of the World advised its readers to: "wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply. Do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge."

A Daily Mirror cartoonist captures the confusion over public health messages

No country was untouched by the 1918 pandemic, although the scale of its impact, and of government efforts to protect their populations, varied widely.

In the United States, some states imposed quarantines on their citizens, with mixed results, while others tried to make the wearing of face masks compulsory. Cinemas, theatres and other places of entertainment were closed across the country.

Hairdressers took precautions to curb infection

New York was better prepared than most US cities, having already been through a 20-year campaign against tuberculosis, and as a result suffered a lower death rate.

Nevertheless, the city's health commissioner came under pressure from businesses to keep premises open, particularly movie theatres and other places of entertainment.

A New York city street sweeper wears a mask to help check the spread of the influenza epidemic, October 1918. In the view of one official of the New York Health Board, it is 'Better be ridiculous, than dead'. (Photo by PhotoQuest/Getty Images)

Then, as now, fresh air was seen as a potential bulwark against the spread of infection, leading to some ingenious solutions to keep society going.

Court is held outdoors in a park due to the epidemic, San Francisco, 1918. (Photo by Hulton Archive/Getty Images)

But it proved impossible to prevent mass gatherings in many US cities, particularly at places of worship.

The congregation praying on the steps of the Cathedral of Saint Mary of the Assumption, where they gathered to hear Mass and pray during the influenza epidemic, San Francisco, California.

By the end of the pandemic, the death toll in Britain was 228,000, and a quarter of the population are thought to have been infected.

Efforts to kill the virus continued for some time, and the population were more aware than ever of the potentially deadly nature of seasonal influenza.

A man sprays a bus of the London General Omnibus Co, with anti-flu preparation in March 1920. (Photo by H. F. Davis/Topical Press Agency/Hulton Archive/Getty Images)

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Spanish Flu: How Belfast Newspapers Reported 1918 Pandemic

By Eimear FlanaganBBC News NI

The Spanish flu pandemic of 1918 is believed to have infected about a third of the world's population

Just over a century ago, a highly-infectious disease swept around the world causing major public health problems in many countries, including Ireland.

Spanish flu was a pandemic that peaked in 1918, heaping more death and misery on populations already devastated by World War One.

It is believed to have infected about a third of the global population and caused about 50 million deaths worldwide.

That final death toll is disputed and very difficult to verify, but in Ireland alone Spanish flu is estimated to have caused or contributed to 23,000 deaths.

Despite its name, Spanish flu did not originate in Spain. The label stuck because Spanish newspapers were the first to report the outbreak.

Spain was a neutral nation during World War One, so its journalists did not face the same censorship as those working in countries involved in the conflict.

The deadly flu hit pre-partition Ireland in three waves, according to historian and author Ida Milne who has spent years researching the impact of Spanish flu across the island.

Belfast was hardest hit in the first wave in May 1918, she explained, whereas the flu peaked in many southern areas in the autumn.

So how did Belfast newspapers report what turned out to be the worst pandemic of the 20th Century?

Belfast City Hall in 1917 - a year before Spanish flu almost brought the city's tram system to a halt

With the benefit of 20/20 hindsight, given what we now know about the devastating impact of Spanish flu, it received relatively sparse coverage in Belfast's dailies in 1918.

It should be pointed out that in the dying days of World War One, editors were rarely, if ever, stuck for dramatic headlines.

As the Allies advanced to victory, Belfast's newspapers were filled day after day with incredibly detailed reports from battlefields in France, Germany, Italy, Palestine and further afield.

The first substantial mention of a problem developing on their own doorstep was on 11 June 1918.

The Belfast Evening Telegraph and the News Letter each devote just a few column inches to an "influenza epidemic" in Belfast.

The News Letter reported that about a dozen schools were closed and several businesses were affected due to the number of workers who had fallen ill.

But editors were clearly concerned about being accused of scaremongering.

"There is no reason for the general public to become unduly alarmed, and the rumours currently in the city may be accepted with the proverbial grain of salt," the Telegraph advised.

Keen to keep things in perspective, the paper stated the general view from the medical profession was "against the outbreak being any serious disease".

Ms Milne, who lectures on European history at Carlow College, is not surprised that the specific threat was not immediately obvious in 1918.

Death from a range of infectious diseases like tuberculosis, bronchitis, measles or scarlet fever were a common occurrence at the time, she explained.

"TB was a massive killer... And at those stages they had no antibiotics to counter bacterial pneumonia, so there were thousands of deaths on the island from that," she said.

"The background level of disease was so high that I think in some ways Spanish flu wasn't recognised within communities for what it was - with the same lens that we look back today and see that it was a big disease event - because they were so used to death within families."

Inside a week however, the Telegraph declared that "Berlin has Belfast's epidemic" and stated the disease has become known as "Spanish influenza".

Spanish flu affected up to 40% of the US Army and Navy, many of whom were sent to Ireland during WW1 (Colorado hospital)

By late June, the Irish News reported that thousands of Belfast's workers are laid up with flu, affecting the operation of the city's shipyards and trams.

The paper said chemist shops were being "literally besieged" and called on the public health authorities to issue instructions on how to deal with the illness.

Notably, the Irish News kept a close track on the monthly mortality rate from all causes across major Irish cities, and is clearly surprised when deaths are higher in Belfast than Dublin.

"It is a most remarkable fact that no less than 40 deaths from pneumonia occurred in Belfast. From the same cause in Dublin there were only six," the paper observed.

When the second wave of Spanish flu hit in autumn 1918, editors arguably had a better idea of what they were dealing with.

The Telegraph reported epidemics in Capetown, London and Dublin, describing the London death rate as "alarming" and warning that Dublin's hospitals were so congested there was no space for accident victims.

There were 50 burials in Dublin's Glasnevin Cemetery on 8 November alone, described as a "record" number in one day.

Spanish flu struck Dublin while the city was still trying rebuild after the 1916 Easter Rising

Spanish flu was particularly unusual because it claimed the lives of so many young adults who are not normally in categories considered vulnerable to flu.

A few examples of such cases appear intermittently in Belfast's papers - the deaths of a trainee nurse at the city's Union Workhouse and a new mother from Larne who "dropped dead" three weeks after giving birth.

The "sudden demise" of a Carrickfergus bank official is also reported - the Telegraph noted he was at his desk on Tuesday but had succumbed to flu by the following Saturday.

By early November, all schools in Belfast were closed and public entertainment was cancelled in a bid to stop the flu spreading.

These emergency measures were announced not in a headline, but via newspaper notices from the Public Heath Office.

To be fair, though, the measures were introduced days before the Armistice on 11 November, when the only story in town was the end of World War One.

Armistice celebrations were held in many towns and cities, including this one in England in November 1918

But then large public gatherings to celebrate victory exacerbated the flu outbreak.

"About a week to a fortnight later, there is a spike in flu and pneumonia deaths because of this movement of people," said Ms Milne.

Given its relative lack of prominence in Belfast news reports, the impact of Spanish flu on everyday life was often more obvious from adverts and public notices.

Bizarre and sometimes comical claims about flu prevention and so-called cures are regularly featured.

Belfast's Alhambra Theatre paid for an ad to reassure patrons it had been sprayed and disinfected. It clamed the theatre was now "influenza-proof".

The Picture House on Royal Avenue declared itself the "healthiest place in town" after spending thousands of pounds on a new ventilation system.

Veno's Lightning Cough Cure boasted it was not only a remedy for Spanish flu but also for those suffering from gas - not digestive gas but the chemical weapon used by the German army.

In the current coronavirus pandemic, stocks of hand sanitiser and face masks were the first to run low, but a century ago the must-have health protection item was beef tea.

Bovril was in such short supply in 1918 that the firm took out large adverts to apologise, explaining bottles could not be manufactured fast enough to meet demand.

The deadliest flu pandemic in modern history undoubtedly left its mark on the citizens of Belfast.

But, overshadowed by the drama and suffering of Great War, it rarely made headline news.

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The Spanish Influenza Pandemic Of 1918–1919

The Spanish Influenza Pandemic of 1918-1919 sheds new light on what the World Health Organization described as "the single most devastating infectious disease outbreak ever recorded" by situating the Iberian Peninsula as the key point of connection, both epidemiologically and discursively, between Europe and the Americas. The essays in this volume elucidate specific aspects of the pandemic that have received minimal attention until now, including social control, gender, class, religion, national identity, and military medicine's reactions to the pandemic and its relationship with civilian medicine, all in the context of World War I. As the authors point out, however, the experiences of 1918-19 remain persistently relevant to contemporary life, particularly in view of events such as the 2009 H1N1 swine flu pandemic. Contributors: Mercedes Pascual Artiaga, Catherine Belling, Josep Bernabeu-Mestre, Ryan A, Davis, Esteban Domingo, Magda Fahrni, Hernán Feldman, Pilar León-Sanz, Maria Luísa Lima, Maria deFátima Nunes, María-Isabel Porras-Gallo, Anny Jackeline Torres Silveira, José Manuel Sobral, Paulo Silveira e Sousa, Christiane Maria Cruz de Souza. María-Isabel Porras-Gallo is Professor of History of Science in the Medical Faculty of Ciudad Real at the University of Castile-La Mancha (Spain). She is the author of Un reto para la sociedad madrileña: la epidemia de gripe de 1918-1919 and co-editor of El drama de la polio. Un problema social y familiar en la España franquista. Ryan A. Davis is Assistant Professor in the Department of Languages, Literatures, and Cultures at Illinois State University. He is the author of The Spanish Flu: Narrative and Cultural Identity in Spain, 1918.

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