Lessons learned from 1918 Flu Pandemic and COVID-19

“Those who don’t know history are doomed to repeat it,” attributed to Edmund Burke, is now transformed into “Those who don’t know history are doomed.”

Lessons for COVID-19 from the 1918 flu epidemic were:

1. Cities that enacted social distancing and cancelled large public gatherings did far better than cities that let nature take its course,

2. The 1918 Flu Pandemic, like COVID-19 was far more contagious and lethal than the typical flu, and

3. The name Spanish Flu was given to the whistleblower country, Spain, while other countries suppressed news of the virus presumably to avoid panic during WWI.

Cities that practiced social distancing and used masks in 1918, like St. Louis, had 1/8th the death rate of cities that did nothing, like Philadelphia. Urban infection rates were certainly higher than rural, but rural areas were not spared.

The same lesson is clear from the rest of the world’s response to COVID-19. Countries like the U.S. and Brazil, that are closer to letting nature take its course, are doing far worse than the rest of the world in containing the virus.

Like the 1918 Flu Pandemic, pregnant women and young younger people, especially young men, seemed to have almost as high a mortality rate as frail people. Ordinarily, young, healthy people should be hardier than frail people.

The public health term for unnecessary deaths is

“excess mortality.” We might have had a death toll under 20,000 and no economic shutdown if we started early in enforcing social distancing, using masks, and quarantining positive cases and contacts until they tested negative for the virus.

Our excess mortality is 180,000 and rising, and we have already been told the U.S. will not be shut down again no matter what, and will not enforce any mandatory social distancing measures or give specific guidelines. That is, the current administration has chosen to let nature take its course until we have a vaccine in 2021. How tragic.

Kenneth Sakauye, M.D., Memphis