The Pandemics of 1918 and 2020: A Comparison
by Robert L. Harrison
An initial comparison of the Pandemic of 1918, popularly known as the Spanish Flu, with today’s COVID-19 Pandemic suggests the former was more lethal than today’s pandemic. The comparison is necessarily limited because the media coverage of the 1918 Pandemic was largely inaccurate and our experience with COVID-19 has been documented for just eight months in 2020, with its future course unknown.
One feature of the 1918 Spanish Flu is clear — it did not originate in Spain. While COVID-19 can be traced to the Wuhan area of China, the exact source of the Spanish Flu is unknown. The best research identifies animals or birds in the American Midwest as the source of the disease. Of particular interest is the report of Dr. Loring Miner, the lone physician in isolated, sparsely populated, Haskell County Kansas. In the April 1918 U. S. Public Health Service Public Health Report, Dr. Miner attributes the sudden deaths to a flu-like disease spreading across Haskell County in early 1918. Some of Dr. Miner’s patients, frequently strong young men and women, suddenly died after exhibiting typical influenza symptoms for just a few days.
To serve their country in World War I (WW I), patriotic young men from Haskell County joined the U.S. Army at Camp Funston, today’s Fort Riley, Kansas. On the morning of March 4, 1918 Army Private Albert Gitchell complained of a sore throat, fever and headache. Later that day over 100 soldiers at Camp Funston reported similar symptoms. These men were ultimately regarded as the first cases of the 1918 Pandemic later known as the Spanish Flu. Gitchell was the first confirmed victim of the Pandemic.
The Flu initially spread slowly but was widely dispersed to Army bases around the country and then to Europe. The first major European outbreak was in Spain. Because Spain was neutral in WW I their press was not subjected to censorship and able to report extensively about the disease including the infection of the Spanish king, Alfonso XIII. Most Spanish Flu fatalities were people between the ages of 15 and 40, the age of soldiers needed to fight the war. To maintain a high morale, WW I combatant nations did not fully report on the deadly plague. Because of Spain’s neutrality and ability to report thoroughly and accurately, the 1918 disease has been commonly referred to as the Spanish Flu.
The United States joined other nations in suppressing information on the Flu. The 1918 Sedition Act became law a little over a year after the nation entered the war. The act made it a crime to say anything perceived as harming the country or the war effort. This led to some newspapers downplaying the risk of the Flu and the extent of its spread. The impact of media censorship was described by John M. Barry in his book The Great Influenza:
“As terrifying as the disease was, the press made it more so. They terrified by making so little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read.”
By the end of 1918 the Pandemic had become highly lethal. Over 470,000 Americans died that year. In three years Spanish Flu killed nearly 850,000 nation-wide. . The single year toll of over 470,000 deaths in 1918 exceeds the fewer than 330,000 COVID 19 deaths projected for all of 2020. When the larger current population is taken into account, the 2020 national flu death rate per capita would be less than one-fourth that of 1918–0.10% versus 0.46%. Projections of 2020 annual COVID 19 deaths are from the Institute of Health Metrics and Evaluation (IHME), University of Washington, dated October 29, 2020.
The 1918 Pandemic struck hard at many of America’s largest cities. New York City, for example, suffered 33,000 deaths. The Flu was blamed on the Germans and on Bayer Aspirin which was said to contain poison. The New York Times wrote: “Let the curse be called the German plague. Let every child learn to associate what is accursed with the word German not in the spirit of hate but in the spirit of contempt born of the hateful truth which Germany has proved to be.”
Following Philadelphia’s September 28, 1918 Liberty Loan Parade, attended by 200,000 spectators, the city morgue was overloaded with hundreds of victims. In his book Barry recounted it this way:
“Within seventy-two hours after the parade, every single bed in the city’s thirty-one hospitals was filled. And people began dying. Hospitals began refusing to accept patients — with nurses turning down $100 bribes [$1,700 in 2020 dollars] — without a doctor’s or police order.”
In its first year the 1918 Flu in California appears to have been over ten times more deadly per capita than the rate projected for COVID 19 in its first year. The state’s 1918 flu death rate per capita was 0.67% compared to an estimated 0.06% death rate per capita in 2020. (16,800 deaths in a population of 2.5 million versus 23,450 deaths in the State total of 39.9 million).
In its first year, the 1918 Flu in California appears to have been over eight times more deadly per capita than the rate projected for COVID-19 in its first year. The state’s 1918 flu death rate per capita was 0.67% compared to an estimated 0.08% death rate per capita in 2020. (16,800 deaths in a population of 2.5 million versus 30,180 deaths in the State total of 39.9 million).
Comprehensive 1918 Flu morbidity data are not readily available for Marin County. The first Marin Spanish Flu death occurred on October 24, 1918. Spotty subsequent accounts of fatalities were reported from many areas of the county but complete information is not available. Assuming the 1918 California Spanish Flu death rate per capita (0.67%) as an approximation, Marin County, with a total 1918 population of 27,000, might have experienced 180 Pandemic Flu deaths that year. The absence of thorough reporting of such a high local mortality appears consistent with the national policy to limit bad news on the 1918 Pandemic.
Through September 2020, COVID-19 has claimed 91 lives in Marin County, excluding San Quentin State Prison. Assuming the County’s recent trends will continue, total Marin COVID 19 deaths for all of 2020 would reach 160. The 2020 Marin County COVID-19 death rate per capita would be 0.062%. (160 deaths in a non-prison population of 258,000).
Through October 2020 COVID 19 has claimed 99 lives in Marin County, excluding San Quentin State Prison. Assuming the County’s recent trends will continue, total Marin COVID 19 deaths for all of 2020 would reach 112. The 2020 Marin County COVID-19 death rate per capita would be 0.043%. (112 deaths in a non-prison population of 258,000).
In 2020, like in 1918, Public Health officials recommend measures such as wearing a mask; frequent hand-washing; and maintaining a safe social distance, to mitigate the spread of the virus.
Article updated November 5, 2020.
