In 1918–19, countries around the world experienced an influenza pandemic that killed an estimated 50 million people, including about 675,000 in the United States. No vaccine was formulated, and responses to the disease, as is the case so far with today’s COVID-19 pandemic, were limited to non-pharmaceutical steps, including hygiene, quarantine and limits on public gatherings. We spoke about the current spread of the coronavirus and the 1918–19 epidemic with Carla Bittel, associate professor of history in the LMU Bellarmine College of Liberal Arts. Bittel is a historian of 19thcentury America who specializes in the history of medicine, science and technology. She was interviewed through email by Elizabeth Bromley ’20, a journalism major in BCLA and an editorial intern with LMU Magazine.
Did the medical community during the 1918 flu, known as the Spanish flu, understand the virus process — its origin, how it spreads, treatment — accurately by today’s standards?
As a historian, I think it’s important to examine medical knowledge situated in context. By the start of World War I, there was optimism that the laboratory and bacteriology could explain and resolve the threat of infectious diseases. While the source of the so-called Spanish flu was not bacterial, it was treated as such. This flu seemed very familiar until it didn’t, when young people started to fall ill and die quickly, and when symptoms varied dramatically, from fever and cough to blueness in the face and delirium. There was a lot of uncertainty about how this particular flu operated. This compares to the epidemiological uncertainties and the wide range of symptoms patients are experiencing with COVID-19. And, like today, the most important treatment in 1918 was supportive care to alleviate symptoms.
Was social distancing, still crucial today, the best and maybe even only tool they had then?
Quarantine was a very significant tool to stop transmission. Public health officials also turned to closures — including schools, theatres, amusement parks — and limited large gatherings. Also, they directed citizens to carry out personal acts of prevention, such as hand washing, coughing and sneezing into handkerchiefs, disinfecting clothes, getting fresh air, and wearing gauze masks.
Did that experience change the practice of medicine in ways that still benefit us today?
The pandemic had an enormous global impact on human life. And yet, there was a great deal of forgetting once the pandemic was over. Many people focused on the losses and outcomes of World War I rather than deaths from influenza. Historians describe a national amnesia of sorts as people tried to quickly move on. The reach of public health did expand in the United States, but the focus largely turned to other diseases. The 1918–19 flu did launch numerous laboratory investigations into the nature of the disease agent, which was determined to be a virus in 1933.
What are the ways in which the 1918 flu changed the way we treat pandemics socially?
In many ways, the social solutions for slowing epidemics did not originate in 1918. Quarantine originates as a term from the era of the medieval plague. We also see quarantine at work, for example, in the cholera outbreaks of the 19th century and many other epidemics. Public health officials and reformers had been determined to change social habits and spread hygienic practices before 1918, and that became amplified during the pandemic.
Are pandemics in any way predictable? Do they typically follow certain patterns?
Historians have traced the history of epidemics over time and described patterns in their emergence, development and resolution. They point to reoccurring themes, including uncertainty, denial and blame, and acceptance, as well as the “othering” of outsiders and victims. Many of these we have seen with COVID-19. But each context is different, and while we certainly see many connections across time and space, we should also recognize reactions to epidemics are often dependent upon specific social conditions and practices. With global pandemics, the lens widens as we look comparatively at national and international efforts to manage health crises.
Is a prepared government fundamental when it comes to pandemics and containing viruses?
In the current pandemic, we have seen incredible tension around the role of government in the management of disease, particularly in the United States. And clearly, preparation is critical, but what does it mean to be prepared? These are complex calculations — economic, political, social — that can shift with leadership and financial conditions. And it requires long-term investments in research into potentialities, in other words, what kind of diseases couldbe coming. Alarm bells have been going off for decades about the threat of novel viruses, and yet, many people were taken by surprise when this one arrived with such intensity.
In what ways is the general public’s response to COVID-19 similar to the response to the 1918 flu?
It’s difficult to generalize, since, as we can see today, reactions and experiences vary widely. But in both contexts, there was and is a great deal of both fear and isolation. In letters and diaries from 1918–19, people wrote about their experiences in quarantine and regularly reported on the health of family, friends and neighbors. They had no social media per se but did have pen and paper for sharing news and knowledge. While the collective memory of the flu faded quickly, surviving materials demonstrate how intimately it impacted many lives.
Based on recent trends, when do you predict the pandemic will end?
It’s very hard to say, and you will find varying predictions based on several factors. What ends a pandemic? Is it an effective treatment, a safe and effective vaccine, a deeper understanding of how the virus operates and how it might mutate? The growth of natural immunity or the dwindling of new vulnerable hosts? All of the above can have impact.
In 1918 the world population was 1.8 billion. Do pandemics spread differently with higher population density?
Pandemics spread based on multiple factors, both local and global. Public health researchers, for example, are trying to determine why COVID-19 has hit certain populations harder than others. Infectious disease can intensify in densely populated areas due to close proximities, but it can also be impacted by multiple social conditions.
Do you have any advice or words of wisdom for the general public?
History matters and is incredibly valuable for our current crisis. Making comparisons to 1918 seems particularly useful at the moment because it serves our need for some type of reassurance, that we have been here before. But there is a long history of health and disease from which we can draw. For us the real question will be: How do things look on the other side? Hopefully, we will not so quickly forget this crisis as many did after the 1918–19 pandemic.