By Hettie V. Williams
Diseases have a history. Everything has a history. There are some historical parallels between the Spanish Flu of 1918 and the 2020 coronavirus (COVID-19). Though a word of caution is necessary here: these two pandemics are not the same thing; and, the public should be mindful of this fact. That said, my interest here is in illustrating the importance of history as a tool for understanding society, culture, and the politics of disaster. History might be used to inform the present if we consider the comparative story of the Spanish Flu of 1918 and COVID-19. This does not mean that one event is an exact repeat of the other; but, rather that, history is the best mechanism we have for understanding human actions and it is also a proficient guide for shaping public policy. There are several points of connection between the event of the Spanish Flu of 1918 and COVID-19 in terms of origins, fear of contagion as expressed through a prism of ethnic bias, and the political, social, and cultural dimensions of each event.
These two diseases are both viruses with origins in specific regions of the world understood to be illnesses commonly associated with influenza like illnesses. Both have been classified as pandemics. The flu is considered to be a highly contagious respiratory illness that affects the lungs, throat, and nose in, at times, debilitating ways sometimes leading to death. This illness kills an estimated 290,000 to 650,000 people per year around the world as indicated by the World Health Organization. According to the Center for Disease Control (CDC), some 9 to 45 million people contract the flu in a given year in world societies. National Safety Council statistics indicate that influenza is the eighth leading cause of death in the United States (U.S.). The flu is a serious illness and a major killer of humans. COVID-19 is a flu-like respiratory illness that is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 or SARS-CoV2) and is “genetically related” to the virus that caused SARS in 2003. It is a lethal respiratory disease.
There are some noticeable similarities and points of contrast between the Spanish Flu and COVID-19. The 1918 flu has come to be understood as a variant of an earlier H1N1 (swine flu) virus that was circulating among humans in 1900. This flu conjoined with genetic material from a bird flu that was first transferred to pigs then to humans before 1918. Thus, older members of society may have already built up some measure of resistance to an earlier form of the virus. Epidemiologists and historians of disease have theorized that the influenza of 1918 existed in migratory birds who left their droppings in the food supply of pigs (swine). The great influenza of 1918 was first reported in the Midwest region of the U.S. in the state of Kansas on a military base where the condition was initially identified. American soldiers from the Midwest deployed to support the Allied war effort, in World War I (WW I), spread the disease to Europe. The phrase “Spanish Flu” is a misnomer in that Spain, as a neutral party during WWI, was one of the only European nation-states publicizing the illness at the time. Spain was not the place of origin of this disease.
COVID-19 also originated as a type of bird-flu like illness that emerged in the Wuhan wet markets, in China, among bats and it is defined as a novel virus or severe acute respiratory syndrome (SARS) caused by coronavirus (any group of RNA viruses or cluster of viruses that cause diseases in animals and humans transmitted between animals and humans). This is significant because, unlike the 1918 influenza, COVID-19 is a disease caused by a novel or new coronavirus that appeared in 2019 and it is difficult to predict ultimately how the virus may behave or evolve at the present. More than 250,000 cases of COVID-19 have been confirmed worldwide and 11,310 deaths from the disease have occurred as of March 20, 2020.
There is currently no vaccine for COVID-19. It is pertinent to note here that the great flu of 1918 killed an estimated 40–50 million people worldwide and scientists, at the moment, do not predict such numbers with COVID-19. The great pandemic of 1918 was the most-deadly pandemic in twentieth century world history infecting 500 million people worldwide. These two diseases are similar yet characteristically different, in key ways, but a comparative analysis here helps us make sense of the past to inform our present social, political, and cultural conditions.
Ethnic Bias and Disease
Historically, disease outbreaks and the idea of contagion have been associated with marginalized groups including people of Jewish descent, Asians, African Americans, and members of the gay community. This has happened with conditions such as tuberculosis that was once associated with blackness in the Jim Crow South down to the present with illnesses such as SARS; and now COVID-19. Jews were persecuted and massacred during the height of the Black Death (1347–1351), likely the first major pandemic in world history, African Americans with tuberculosis were stigmatized in the Jim Crow South, and AIDS was initially referred to as the gay plague.
The Spanish Flu was brought to Europe by American soldiers in 1918. This does not mean that we should call the disease the American Flu. It is no more accurate to label COVID-19 the “Chinese Flu” than it would be to call the Spanish Flu the American Flu. Furthermore, because American identity is most frequently associated with whiteness, we continue to use either Spanish Flu or a more neutral term such as “great influenza,” or 1918 flu, to refer to the 1918 influenza. There are a set of biological and environmental factors as to why and how diseases develop over time. Germs and viruses are present everywhere on the planet. Race does not cause disease. Ethnicity does not cause disease. These are manufactured social constructions that have been used to justify oppression and sometimes slaughter.
Asian Americans are being marked as forever foreign, dirty, or diseased with the language currently being used by the Trump administration to describe COVID-19. This is racism. In 2009, an H1N1 virus, a novel A influenza, was first detected in the United States and eventually spread around the world killing an estimated 151,700 to 574,400 people. No one has ever suggested calling this virus the American Flu.
Race and ethnicity continue to shape ideas about cleanliness, contagion, and disease. President Donald J. Trump has repeatedly referred to COVID-19 as the “Chinese Flu.” This is a reflection of his lackluster leadership and ethnic bias that has been documented by countless observers. There have been more deaths due to COVID-19 in western nations such as Italy as compared to countries in Asia such as China or South Korea. COVID-19 could have occurred anywhere. It is idiotic to apply an ethnic or racial label to a disease that is killing countless people of various ethnic identities across the globe. Trump has used racialized fear-mongering to bolster his stature in a nation that has a long history of bias against marginalized groups and this is a dangerous distraction as thousands of Americans are fighting for their lives.
The Politics of Disease and the Culture of Hysteria
The politics of disease past and present reveal a great deal about the human response to disaster and political leadership in times of crisis. Racialized notions of the other become inculcated into politics in times of disaster. Given that WWI was a total war, that involved humans far removed from the battlefield, including the use of lethal technology such as poison gas, unrestricted submarine warfare, and the machine gun, the Allies came to believe that the Germans had unleashed a new biological weapon to destroy their war effort. War propaganda used by both sides only fueled the hysteria that surrounded the event of the Spanish Flu. There are already conspiracy theories currently circulating about COVID-19 and the Chinese government. Some people have come to believe that COVID-19 is a disease engineered in a Chinese lab to harm their political adversaries. These theories are fictions and a reflection of a culture of hysteria shaped by racialized fears of the other.
American presidents are not immune to disease. Woodrow Wilson fell ill of the flu while he was in Europe negotiating the Treaty of Versailles in 1918. He subsequently suffered a stroke thereafter and was never able to convince the public that the treaty to end WWI should be approved by the U.S. Congress. Maintaining public confidence is key to any disaster response. The Trump administration, in many respects, lost public confidence well before COVID-19 came to impact the U.S. The Washington Post has reported that Trump has made 16,241 “false or misleading claims in his first three years” as president. A lack of trust fuels panic. His biggest lie about the coronavirus was to call the disease a Democratic party “hoax.” Trump was recently tested for COVID-19, having come into contact with a Brazilian man at Mar-a-Lago who later tested positive for the disease, but many in the public took to social media declaring that they do not believe the White House press release that he tested negative for the disease. Trump also initially stated that the disease was under control and there would not be “many cases” while he maintained that a “miracle” would happen to stop the illness.
Social and Economic Impact of Disease
Social and economic disruption are common effects of natural disasters. Pandemics have a widespread impact on the social organization of nations including in the areas of healthcare services, education, leisure activities, food service, and in the workplace more generally. History also indicates to us that the overwhelming of healthcare systems, economic recession, and escalating death rates are routinely major points of impact in pandemics. This has been evident throughout time in that global outbreaks of disease have led to social unrest, economic decline, and high mortality rates. There are some notable examples in the case of the Black Death (1347–1351) that led to a mass loss of life, riots, and ethnic pogroms, the 1918 flu, the 1957 pandemic, that killed 1.1 million people worldwide, and now COVID-19.
There were a specific set of historical conditions that led to the astronomical deaths in the case of the great flu of 1918. These include the event of the global war, and the spread of the disease that came with rapid troop movements, and that a mutated more virulent version of the disease emerged following the initial outbreak. This mutated version of the disease made the very young fall deathly ill and it killed some within 24 hours. Soldiers became more prone to the disease due to poor nutrition coupled with the conditions in the trenches that were full of filth and rodents. It was a disease that spared no one in that the young, middle aged, and old were all highly susceptible to the illness. There were more than 500,000 deaths in the U.S. alone. This disease also placed a social strain on society as some communities ran out of caskets to bury their dead and overwhelmed hospitals attempted to organize quarantine zones while cities such as St. Louis forbid large gatherings. There was also a tide of strikes by workers and anti-colonial protests around the globe as people made the state, and in some cases the military, the focus of their anger over economic conditions that were exacerbated by the pandemic.
Economic consequences came with the great flu of 1918 including a loss of wages, decline in business revenue, and increased rates of unemployment. Men between the ages of 20 and 39 made up a disproportionate number of those who died of the flu. This reflects the larger social and economic impact of the great flu in that these men were the major breadwinners of the family at the time. In Little Rock, Arkansas, merchants claimed that their business declined between 40 and 70 percent and in Tennessee there was a 50 percent decrease in coal production. While most businesses endured double digit losses in revenue, Little Rock experienced a loss at the rate of $10,000 per day. Some cities such as St. Louis closed schools and entertainment venues and other cities such as San Francisco required people to wear masks in public. Family structure was different at the time so the closing of schools may have not had as great an economic affect on the family as COVID-19 may have, at the present, given that most homes now rely on two incomes.
The main issue with COVID-19 has more to do with the potential social and economic strain that it may place on society as opposed to a concern about exponentially high mortality rates. COVID-19 is not the great flu that was the pandemic of 1918 in terms of loss of life. This disease, unlike the Spanish Flu, does not seem to attack the young and middle age with the same lethal impact it has on the older members of society though cases in Italy, and now the U.S., raise some concerns about the nature of the disease on various age groups. Governor Andrew Cuomo recently stated that he only has 3,000 intensive care beds available in the state of New York and that “80 percent of them are already full” on a recent episode of “Morning Joe.” Italy has been enduring a national lockdown with reports of hundreds of coronavirus deaths while doctors and nurses there continue to fall ill of the disease as they are forced to triage patients in hospital hallways. These two instances suggest the potential for breakdown of healthcare systems. In one eyewitness account shared with me from Bergama, Italy a resident there has stated, “Italy is collapsing.”
There have been some clear economic repercussions as a result of COVID-19. Some economists predict that unemployment may rise into high double digits as hundreds of thousands of service workers in bars, restaurants, hotels, and in the travel and leisure industry more generally, are laid off or forced to shelter in place at home without pay. According to the U.S. Labor Department, there were 281,000 claims for unemployment the week of March 14. Goldman Sachs predicts that the unemployment claims will rise to more than 2 million for the week of March 15. Many hourly service workers do not have health insurance and the cost of a test for COVID-19 is thousands of dollars while hospitalization for the illness is an estimated $34,927.43. The longest winning streak in history on the U.S. stock market has ended with the spread of COVID-19 amid global economic panic. This is reflected in the 3,000-point drop on March 16, the largest in history, and a loss of all the gains acquired during the Trump presidency.
History is perhaps the best guide to help us prevent or ameliorate the social and political impact of pandemics. This is particularly true for highly contagious diseases that spread efficiently such as COVID-19. Governor of California Gavin Newsom has recently stated he anticipates that 56 of Californians may likely fall ill of COVID-19. COVID-19 is a serious disease. This is a new coronavirus that is unpredictable but lessons from the past should be our point of reference when combating this scourge. The past tells us something about who we have been and where we are going.