Coronavirus and the 1918 flu: University of Massachusetts Amherst professor says similarities between 2 outbreaks are many

1918 flu

An emergency hospital in Brookline, Massachusetts, where medical professionals care for influenza cases in 1918. (U.S. National Archives)

On Aug. 27, 1918, two sailors in Boston reported to the sickbay feeling ill. The men wound up being the first people in the United States diagnosed with the Spanish Influenza - an epidemic many consider to be misnamed, as it may have originated in the U.S.

The outbreak, which began in the wake of the horrors of World War I, would go on to infect 500 million people and kill at least 50 million. Some have called the disease’s impact on the world the “greatest medical holocaust in history.” According to the Centers for Disease Control and Prevention, it was the most severe pandemic in recent history.

Today, the world is facing the mounting threat of another public health crisis: the coronavirus. The outbreak that begin in Wuhan, China has spread to 179 countries within three months, according to Johns Hopkins University. So far, more than 800,000 COVID-19 cases and roughly 41,000 deaths due to the viral respiratory infection have been confirmed.

And the rate of people dying is exponentially increasing.

“The coronavirus may spread more rapidly than the 1918 flu. Most experts agree it will be on the same scale or worse," said Emily Hamilton, a history professor at the University of Massachusetts Amherst. "Hopefully, we’re all wrong about that.”

Dr. David Hooper, chief of the Massachusetts General Hospital’s infection control unit, said it is hard to tell so early on whether the coronavirus outbreak will reach the same severity as the crisis of the early 1900s. The nature of the two pandemics are certainly similar, though, he said.

“The scale will be, in my view, dependent on how rigorously we do social distancing in the community,” the doctor said.

Hooper and Hamilton noted that one difference between the diseases is that the 1918 flu severely affected young people. The number of fatalities was high among patients younger than five years old, individuals 20 to 40 years old and those 65 years and older, according to the CDC.

“The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic,” the agency said.

Whereas, with COVID-19, the virus is largely not impacting young adults and children. Patients above the age of 55 to 60 years old are most at risk of bad outcomes due to the disease, according to Hooper.

“This virus does not seem to be affecting young people at all," the doctor said. “A lot of the younger people seem to have very mild disease.”

But Hamilton, who has been seriously studying the early 1900s epidemic for the past decade, told MassLive that the similarities between the flu of 1918 and the coronavirus are many. First, officials need to look at the history of the earlier pandemic to understand the commonalities.

1918 flu

Boston Red Cross volunteers assemble gauze influenza masks for use at the hard-hit Camp Devens in Massachusetts in 1918. (Centers for Disease Control and Prevention)

The flu of 1918, its origins and how the coronavirus emerged

The 1918 influenza pandemic was caused by an H1N1 virus with possible origins from birds, according to the CDC. COVID-19, similarly, emerged from an “animal reservoir,” the agency’s website says. Other coronaviruses, like MERS and SARS, originated from bats.

Early patients with the coronavirus in the Hubei province of China had some link to a large seafood and live animal market. The CDC noted this fact suggests the infection initially spread from animals to people.

While the exact location of the beginning of the COVID-19 outbreak is identifiable, there is no widespread agreement about where the 1918 pandemic originated. However, in the United States, it was first reported among military personnel in the spring of 1918.

The earlier, less deadly version of the disease is theorized to have emerged in March 1918 at Camp Funston in Fort Riley, Kansas, according to the CDC. Eighteen severe cases and three deaths were reported in Haskell, Kansas by April.

Hamilton said the milder strain slowly dissipated and then came back with a vengeance in August 1918.

France, Sierra Leone and Massachusetts were hit by the outbreak at roughly same time. New England was particularly impacted by the flu.

After the two sailors in Boston were diagnosed with the virus, 100 new cases were reported among others on the pier by the end of the week, according to the city’s website. Camp Devens, a United States Army training camp located just outside of the city, was also impacted.

By September, the flu had reached the greater public, and by the end of 1918, more than 4,000 Bostonians has died from the flu. The New England Historical Society said Devens became a “hellhole of death,” with piles of dead bodies, overflowed beds and soldiers lined up outside hospitals.

“The most severe outbreak of influenza that has ever prevailed in Boston occurred during the last four months of 1918,” the city’s public health department wrote in the 1900s. “During September and October it constituted a veritable epidemic, causing sickness and suffering among a large part of the population of the city and bringing death and misery into thousands of homes.”

The disease spread quickly throughout the country. In the fall of 1918 and in the spring of 1919, more than 675,000 people in the United States died from the disease. About 28% of the country’s entire population was infected over the course of the pandemic, according to Hamilton.

While medical professionals and public officials are still waiting for more data about the coronavirus, COVID-19 has already had significant negative repercussions, including deaths, hospitalizations, a downturn in the global economy and business closures.

“It’s going to be bad. It kind of already is. Hopefully, people take this seriously," Hamilton said about the pandemic.

1918 flu

A Cincinnati Board of Health sign in 1918 attempts to educate residents on how to prevent influenza, pneumonia and tuberculosis. (Centers for Disease Control and Prevention)

Accessible travel and the rapid transmission of the two diseases

The UMass professor noted another similarity between the 2020 and 1918 pandemics: a rapid rate of transmission.

Between August and September 1918, more than 14,000 flu cases and 757 deaths were reported at Camp Devens in Boston. The number of coronavirus cases and COVID-19-related fatalities has not reached nearly that level in the city or the state, but positive diagnoses and deaths have been steadily increasing.

At the beginning of February, there was only one diagnosed case of the viral respiratory infection in Massachusetts. As of Monday, the state has reported 6,620 positive diagnoses of the disease and 89 people dead from the illness.

Globally, the World Health Organization identified 87,137 cases of the virus at the start of March. Johns Hopkins is now reporting nearly 10 times that number worldwide.

Hooper noted the disease seems to spread even more readily than the annual flu. The Mass. General doctor said that may be due to the fact that people have some degree of partial immunity to yearly influenza.

“We’re dealing with zero immunity to the coronavirus in the population," he said.

Easily accessible travel may have something to do with the quick spread of both viruses, according to Hamilton.

During the 1918 epidemic, countries were in the midst of World War I. The U.S. entered the global battle in April 1917, with 378,000 armed service members deployed throughout the world. By May 1918, hundreds of thousands of American soldiers were traveling across the Atlantic Ocean each month, according to the CDC.

New transportation options in the early 1900s, like electric streetcars, also paved the way for the spread of the flu in more densely packed communities, Hamilton said. Ships were quarantined as they docked in harbors, and crowded trains were seen as especially problematic.

On Sept. 11, 1918, the first case of the virus in Connecticut was reported, and within a week, it had spread across the state. In Hartford, four Yale University students got off a train to New Haven after feeling ill, and a day later, each student had died, according to the New England Historical Society.

“You see people moving around in mass a lot more," Hamilton said, adding that in military barracks, World War I fighters were in close quarters as well.

Today, the world is far more interconnected than it was in 1918. Transportation is far more accessible than it was in the early 1900s, Hooper noted.

“It ramped up a little more slowly than here," the doctor said of the 1918 flu, adding that once the coronavirus got out of China “it really exploded across the world.”

In the wake of the coronavirus outbreak in January, President Donald Trump issued travel restrictions for those coming into the United States from China. Since then, Trump has halted all non-essential traffic between the U.S.'s border to Canada, and on Saturday, the president said he is considering a two-week quarantine on parts of Connecticut, New Jersey and New York.

International air travel already allowed the virus to spread throughout the world, though, during the early stages of the outbreak. Currently, community transmission is a large issue.

“That’s why it’s so easy that this becomes a pandemic," Hamilton said.

1918 flu

An open-air police court in San Francisco, California during the 1918 flu epidemic. To prevent indoor crowding over the course of the pandemic, judges chose to hold court proceedings outside. (Centers for Disease Control and Prevention)

Politicians’ and the public’s response to the outbreaks

Massachusetts and other states in 1918 saw widespread school and business closures due to the virus. Stores across the country started implementing staggered hours to combat the spread of the flu as well, according to Hamilton.

Officials in Boston took the same steps at the local level, closing schools and limiting crowded gatherings to stave off transmission.

“Their efforts met with some success, but when World War I ended, crowds gathered to celebrate the armistice,” the city’s website says. “Boston’s Health Department reported that cases of flu increased immediately after the celebration of the armistice. A similar increase in flu cases and deaths occurred after Bostonians gathered to celebrate Christmas.”

Hamilton noted that the public is seeing virtually the same preventative measures being taken now to fight the coronavirus outbreak.

Gov. Charlie Baker, as well as other state leaders, canceled school programming and on-site restaurant service through May. He, like many other public officials, has also limited large gatherings of people.

A number of grocery stores, considered essential businesses during the public health crisis, have also changed their hours of operation to prevent transmission and protect populations most at risk of severe illness due to COVID-19, including older people and people with pre-existing medical conditions.

Face masks were also commonly used in the early 1900s, as they are now - though supplies are dwindling on store shelves. During the deadly influenza outbreak, many people wore the piece of personal protective equipment to stop themselves from touching their faces, according to Hamilton.

Americans even sang a song in the 1910s to remind themselves to wear masks, according to Hamilton. The song went, “Obey the laws, and wear the gauze. Protect your jaws from septic pause.”

Posters were also distributed across the country urging citizens to take flu prevention measures. Signs were put up on some cities’ street cars that aimed to educate the public about how to protect against influenza, pneumonia and tuberculosis.

Similar efforts to teach people about proper health precautions in the wake of the COVID-19 pandemic are being circulated on social media. Posts about recommended preventative measures are “exploding” on various forums like Facebook and Twitter, Hamilton said.

Like 2020, travel restrictions were also put into place in 1918, according to the UMass history professor.

“There were some cities that demanded a health certificate if you traveled into them,” Hamilton said. “Worldwide, you’re seeing lots of closed borders and requirements for testing if you enter a country today.”

Despite the extensive worldwide fight being mounted to combat the coronavirus, there are also flaws in officials’ responses, as there were in 1918, Hamilton said.

Then-President Woodrow Wilson spoke frequently during the time period to generate public support for World War I. However, he said next to nothing about the influenza epidemic, according to the UMass professor.

Hamilton added that today, top governmental executives are not addressing the coronavirus outbreak with concrete measures. She added that many officials, in both 2020 and 1918, tried to ignore the crises due to their impacts on business.

Texas Lieutenant Gov. Dan Patrick was criticized after appearing on Fox News last week and suggesting that many grandparents in the U.S. would be willing to risk their health in order to see a resurgence in the economy.

“In 1918 and now, you see state and local governments that really balk at the economic aspect of this," Hamilton said. “In 1918, some government leaders told people to ignore quarantines.”

The Trump administration said earlier this month it would work to relax social distancing guidelines amidst the public health crisis. It appears the president has since backtracked on the loosened restrictions, though, and on Sunday, he extended federal stay-at-home guidelines to the end of April.

“It seems to be clear there will be major economic effects of this and that it won’t go away by Easter," Hooper said. “That was laughable, sadly.”

1918 flu

An advertisement for the Chicago School of Nursing. Nurses were in short supply during the 1918 flu epidemic. (Centers for Disease Control and Prevention)

Overwhelmed hospitals

During the flu of 1918, nurses, doctors and other medical personnel were in short supply.

In New England, hospitals were overwhelmed with the number of patients. Makeshifts emergency triages were set up in Brookline, Lawrence and other locations in Massachusetts, where the effects of the pandemic were particularly harsh.

The outbreak led to a shortage of employees at Boston City Hospital, according to the city. Many doctors and nurses were already serving in Europe during the war, so workers were in short supply. Student nurses at the hospital’s training school were deployed to help in the midst of the crisis.

The hospital treated roughly 2,300 influenza patient, around 675 of whom eventually died from the virus, according to the city of Boston

In Connecticut, 325 deaths were reported in Hartford, 294 in Waterbury and 209 in New Haven - all recorded within five weeks. Doctors even turned the Hartford Golf Club into an emergency hospital. The commissioner of health in the state urged all medical professionals to resist requests for help from Massachusetts, according to the New England historical society.

“We saw lots of problems with health care infrastructure with the 1918 flu. That’s primarily because we didn’t have the robust health system that we do now worldwide," Hamilton said.

Still, in 2020, officials are seeing staffing shortages in the wake of the coronavirus pandemic. As the outbreak continues, some are also predicting a lack of intensive care unit space.

According to an analysis by Harvard University researchers, parts of the United States, including Massachusetts, may have far too few hospital beds for the potential influx of COVID-19 patients in the coming months.

Medical professionals have seen a shortage in personal protective equipment as well. The Massachusetts Nurses Association, the largest union in the state, urged the governor to help alleviate a deficit of face masks and stop all hospital closures.

“This isn’t the time we want to have closed hospitals," Hamilton said.

Officials in the state are taking action currently to increase the number of medical staffers.

As officials expect to see a surge in hospitalizations in April, volunteer medical professionals will be deployed to support hospitals who are reporting increased caseloads. Since last week, more than 1,800 volunteers have signed up. Baker said his administration is trying to expedite the on-boarding process for volunteers.

The Massachusetts governor also announced earlier this month he was collaborating with the U.S. Army Corps of Engineers to convert colleges, closed nursing homes and other spaces into extra medical treatment facilities.

Hamilton noted that the U.S. did not have as many hospitals in 1918 as it does now, especially due to the fact that World War I was happening at the same time as the influenza epidemic.

However, concerns remain today, particularly for states that did not pass medicaid reimbursement mandates, according to the UMass professor. Small community hospitals in rural areas have been forced to close, making it so residents in a large regions only have a single medical center to go to.

“If that closes, you don’t have an area hospital," Hamilton said. “That’s disturbing.”

1918 flu

During the 1918 flu epidemic, residents flocked to druggists to purchase a host of medications to treat the virus. Here, a pharmacist is pictured in Washington, D.C. (Centers for Disease Control and Prevention)

The hoaxes: ‘Selling snake oils to make a quick buck off of people’s fears’

As is happening today, individuals capitalized off the concerns of others during the 1918 pandemic.

Historians heard of people “selling snake oils to make a quick buck off of people’s fears,” said Hamilton. The professor added that various “hucksters” tried to peddle fads, attempting to trick individuals that a certain product would help protect them from the flu.

“You’re profiting off people’s panic,” she said.

Since the spread of the coronavirus, those seeking to take advantage of individuals’ fears have similarly tried to sell products they have claimed without evidence will help treat or prevent COVID-19.

Federal government agencies have issued warning letters to multiple sellers of misbranded and unapproved products, including essential oils and teas, that allege being able to protect people against the virus.

The companies peddling the items have no evidence to back up their claims, according to the Federal Trade Commission. The agency added that there are no approved vaccines, drugs or investigational products available to treat the disease

False information, like the idea that going into a sauna will kill the majority of a virus, has also been propagated.

“It’s just totally horrible that people would do this and take advantage of people in difficult times," Hooper said.

The Mass. General doctor added, “The advice would be to obviously seek advice from bonafide medical professionals.”

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