How Did They Flatten the Curve in the 1918 Spanish Flu Pandemic?

Many parts of the world are now approaching their third month in lockdown and it’s safe to say that we’re all feeling it. Since the beginning of the COVID-19 pandemic, experts around the globe have told us that social distancing is the key to reducing cases and getting us back to normal as quickly as possible.

Although this coronavirus outbreak is unique in many ways, historical events have given experts a good idea of how best to flatten the curve. Perhaps the 1918 Spanish flu, the most famous example of past pandemics, is a great example of how social distancing worked to eradicate the virus. Let’s look at how health experts used social distancing to help the world regain normality.

What was the 1918 Flu?

The 1918 flu is also known as the Spanish flu and over the course of two years, it wreaked havoc on the entire planet. 

Although the virus is known as Spanish flu, the first reports of illness and death were actually in the US as well as France, Germany, and the United Kingdom. However, due to World War I, reports were minimized in those countries to maintain moral. Spain was neutral during the war so their press was free to report on the virus, which gave the impression that the country was badly hit. Hence, the rise of the name Spanish flu.

The 1918 flu is widely considered one of the most deadly pandemics in history and there were an estimated 500 million cases, which was around a third of the world’s population at the time. Of those, between 17 and 50 million people died, and some estimates put that number much higher at 100 million.

The First Cases in America - How Different Cities Reacted

The first known case of the 1918 flu was on a military base in Kansas. From there, the flu spread across the entire country, eventually killing 500,000 Americans. However, the death rates varied hugely from city to city, and it’s likely that this was due to how local officials reacted to the deadly virus.

It was September 1918 when Philadelphia detected its first case of the deadly flu that would go on to sweep the entire globe. At first, the government acted quickly, and within 24 hours it had launched an official campaign to stop citizens from coughing, sneezing, and spitting in public. But then, social distancing measures slipped and a parade of 200,000 people was allowed to go ahead just ten days after the discovery of the initial case. 

Philadelphia went on to suffer one of the highest peak death rates in the US, and just two weeks after the first case was reported, another 20,000 had been identified. This was likely partly due to the fact that city officials waited eight days to ban gatherings and close schools, churches, and theaters. 

San Francisco became another cautionary tale of the need for social distancing. Shortly after the city relaxed its measures, a second wave of deaths swept through the area and data shows that 673 people per 100,000 died from the deadly flu virus. In contrast, New York City put quarantine measures in place early and made it mandatory to stagger business hours, and the city reported the lowest death rate on the Eastern Starboard: just 452 deaths per 100,000 people. 

What do These Numbers Tell Us?

From these numbers, it appears to be clear that social distancing was working in the cities that adapted the measures early. St. Louis, Milwaukee, and Kansas City responded quickly and effectively, and those interventions were credited with slashing transmission rates.

This analysis is supported by a 2007 study in the Journal of the American Medical Association. The study compared fatality rates, timing, and public health interventions across 43 US cities and found that death rates were up to 50% lower in cities that acted quickly. This data seems to support the theory that early quarantining and social distancing measures are key to flattening the curve and reducing fatalities.

Another important note to be taken from the way that the curve was flattened during the 1918 flu is that relaxing these measures too soon can cause a second wave and higher death rates.

How Can We Apply These Lessons to COVID-19?

In the 100 years since the Spanish flu ravaged Earth, a lot has changed. Travel is more widespread, cities are more densely populated, and these factors have proven to facilitate the spread of COVID-19 across cities and countries in a matter of hours. And if anything, this makes social distancing measures even more of a necessity.

Although many states are ending lockdown, the battle against coronavirus is far from over and we must remain vigilant. By continuing to keep these important lessons in mind, we may be able to save thousands of lives. 

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