Why We Can’t Compare the “Spanish Flu” Waves to This Pandemic

The 3 Waves of the “Spanish Flu”
Most people had no idea that the first wave was happening, thus a faulty comparison to now.
Centers for Disease Control and Prevention / Public domain

We’ve heard the predictions of multiple COVID-19 waves for months. Our current stage is being disputed, with some people calling this the 2nd wave, while others argue that we’ve haven’t left the first. Regardless, the comparison between this pandemic and the “Spanish Flu” has been ongoing throughout this crisis. This focus on the waves of the 1918-19 influenza pandemic has particularly been used as a PSA of what not to do now. However, as I wrote in my post “Your Wise Friend Was Wrong” about a “Spanish Flu” meme that was circulating, this ahistorical comparison assumes too many similarities between then and now. Yes, we can and should learn from historical outbreaks, but we have to first understand what was known about disease at the time and what was communicated to the public.

Influenza (also called “la grippe”) was a familiar disease in 1918, predictably seasonal and usually mild. Doctors were not required to report deaths from influenza to the U.S. Public Health Service, even though it became epidemic in several years, including 1915-16. Influenza was not usually fatal, at least not for those outside of vulnerable populations.

The First Wave (from a contemporary understanding)

The H1N1 virus that attacked in 1918-19 was unique in its frequent complication of a deadly pneumonia and its high mortality among young adults. Outbreaks of this influenza/pneumonia likely first occurred in Kansas, at Camp Funston and the nearby Haskell Institute. Throughout the next two months, other military camps experienced high numbers of cases. These clusters of disease and death received almost no media coverage, other than a few stories that presented the outbreaks as isolated incidents, downplaying the severity of this new threat.

This article appeared at the bottom of page 2 of the Topeka State Journal on April 4, 1918. Coverage of (what we now identify as) the first wave was limited.

By the end of May, the outbreaks dwindled in the U.S.

Looking back, we now recognize these Spring outbreaks as the “first wave” of the influenza pandemic. However, in the moment, the lack of media coverage meant that most Americans had no knowledge of the rising cases. Most attention was directed to supporting the soldiers in World War I.

For the people of 1918, the influenza pandemic appeared to begin in June. Stories in The New York Times, Washington Post, and other U.S. papers reported on June outbreaks in China, Madrid, Morocco, India and Berlin and then throughout Europe in July. While cases appeared back in the U.S. at the end of the month, American media outlets only covered the epidemics elsewhere.

The Second Wave (but it seemed like the first)

It wasn’t until an eruption of U.S. cases in mid-September that the government and press publicly acknowledged that the epidemic had arrived. From September through November, the “Spanish Flu” raged throughout the United States. Quarantine was imposed at various degrees, as stores, public venues, and schools closed for 1-2 months. The people felt and lived this wave, as it affected the everyday lives of even the healthy.

The Third Wave

A third wave followed in the Spring, much of which was attributed to the mass transport of troops following the end of the war. Life didn’t shut down for this reemergence, however, at least not on a mass scale.

Why we can’t compare the pandemics

Outside of their available newspapers and magazines, the people of 1918 had very little media access. Information beyond what was in print simply wasn’t conveyed to the public, including the prevalence of influenza in Spring of 1918. To them, as presented in media, the first wave didn’t exist, the “Spanish Flu” began overseas, and even at the height of the epidemic, the war dominated all news.

With our abundant media outlets and individual-created content, we are in a different world than 102 years ago. We have known about COVID-19 since 2019, tracking its spread and watching its devastation. In other words, we cannot compare the notion of waves in 1918 as applying to this pandemic, at least not in the response of the public back then to now. What we can take away, however, is that the “Spanish Flu” eventually did subside, as will COVID-19.

Why the masks look the same in “Spanish Flu” pics: The rise of mask-wearing during the 1918 “Spanish Flu” pandemic

Vintage photos of masked individuals and crowds during the 1918 influenza pandemic have been circulating in news stories and on social media. What I find particularly interesting is that they all seem to wearing very similar masks, consisting of a white, rectangle and two ties, like this one worn by barbers:

Open air barber shop during influenza epidemic. National Archives and Records Administration / Public domain

Or this mask, covering the face of an elevator operator:

 Elevator operator in New York City, N.Y., wearing mask.
National Archives and Records Administration / Public domain

Why are they all so alike, especially considering the diversity of homemade and store-bought masks in our current reality?

Two factors explained the uniformity in masks then (and lack thereof now). First, many of the masks were created and distributed by Red Cross volunteers. And when people had to make their own masks, they could follow the straightforward, Red Cross-issued instructions that encouraged the use of white gauze and ties. Sample masks to be used as demos were sent to local chapters. Before masks were required, people were encouraged to use handkerchiefs, but this doesn’t appear to be as common as the gauze coverings.

“New mask design” from the Red Cross.
Published in The Washington Times on September 27, 1918

The Red Cross was heavily involved in directly and indirectly caring for influenza patients. Newspapers encouraged people to do their part to help the sick, especially ill enlisted men. And they did. Volunteers donated chicken, rags, pajamas, canned jellies and fruits, and other items.

And when did wearing masks become required during the Spanish Flu? Not as quickly as some “Spanish Flu as a Lesson”-type stories may lead you to believe (messages that have been using as cautionary tales for the current pandemic. I debunk one here). In 1918, many folks were still getting used to the concept of sanitary practices in the hospital. This April 1918 gem explains why nurses sometimes wear face masks to care for contagious patients.

Printed in the Rock Island Argus on April 10, 1918.

It wasn’t common practice for the general public to wear masks then (or now, at non-pandemic times). Doctors and nurses masked up during the spring outbreaks in the military camps (downplayed and ignored by media). No evidence suggests that regular people wore masks during this time.

In the summer of 1918, news media reported on the deadly disease as it spread through Asia and then Europe. However, nothing suggests that the U.S. prepped for influenza to come home. Articles focused on a different type of protection — the gas mask — needed to protect soldiers from poison gas attacks in the trenches.

Warnings of the impending influenza appeared in July. At the end of the month, 5 cases were documented at Camp Eberts in Arkansas, but incidence remained low for the next month. August newspapers documented illness and deaths aboard ships headed for the U.S.

As ships were being quarantined at New York and other ports, September 13th, Public Health Reports published the Navy’s preparation plan for handling the epidemic, including “Methods for the control of the disease.” Quarantine and isolation, at least for the Navy, were deemed “impracticable” due to the prevalence of healthy carriers. The final section advised mask-wearing for patient attendants and discouraged gatherings:

Published in Public Health Reports, September 13, 1918.

Excerpts of this report were published in newspapers across the country, paired with stories of rising cases, for the next few months.

By mid-September, influenza had become epidemic in some of the army camps and continued to spread across the country. On September 18, the Richmond Times-Dispatch reported that the local Red Cross chapter had requested 4,000 face masks for caregivers the previous day. The next day, a Connecticut paper recommended masks made from gauze for those near influenza patients.

Over the next two weeks, reports of Red Cross volunteers producing masks for nurses and other influenza attendants in military camps increased, as did cases of influenza. Still, there was no indication that regular people had started wearing face masks, nor had quarantine (outside of ports) been implemented.

Approximately 23,000 cases had erupted at military camps before soldiers were advised to wear masks while training. Female volunteers made them for the Red Cross, producing an average of 1 every 5 minutes. Cases of influenza reached epidemic levels in 26 states before it became common for even enlisted men to wear masks.

Like we’ve experienced in the last three months, society shut down before masks became required. Similar to now, restrictions varied by city and state. Flu mask ordinances were implemented primarily in November and December, as barber shops, theaters, and other crowded places began to open. In some places, everyone was required to wear masks. More often, though, care attendants, those in recovery, barbers, and elevator operators were required to don masks, while others were simply encouraged, especially those riding on street cars.

Contrary to numerous social media posts and contemporary articles on “Spanish Flu,” mask-wearing did not occur immediately, nor was it universally required and accepted. That said, the wide distribution of masks by the Red Cross made them much more accessible, especially for those enlisted and/or caring for patients.

Note: In researching for this blog post, I examined newspaper coverage using the search terms “masks” and “influenza” from March through December 1918 (and beyond). I weeded through numerous articles about gas masks. Even at the height of the pandemic, war news dominated media outlets.

Published in several news outlets, including the Fulton County News,
September 26, 1918

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Your wise friend was wrong. Analyzing the viral post about influenza and Armistice celebrations.

This message has gone viral, warning people about the potential impact of easing up on social distancing restrictions too early:

Nicollet Mall in Minneapolis, MN, from the Minnesota Historical Society

The post appeared without naming the location. Yet, I have yet to identify where this information would have been true. The timeline does not make sense. Summer was not the deadliest time for the “Spanish Flu.” Fall was, peaking in October in both Europe and the U.S. The 3rd wave returned the following Spring, not immediately after armistice celebrations.

Furthermore, many countries did not implement “social distancing” measures because of turmoil due to the war. No one called it that either. Selective quarantine did occur in some places, but it was reactive, not proactive. In other words, even cities and states praised for the best responses didn’t shut down until cases had already emerged. Plans for reopening were already in place when the war ended.

As far as the deaths from war versus disease, it actually depends on the country. More Americans died from disease than combat. However, in England, approximately 700,000 people died from war, whereas 228,000 from influenza/pneumonia.

Besides the misinformation conveyed here, we need to take any comparisons between past epidemics and our current crisis with a grain of salt. This is not 1918 (or 1957-58, 1968, or 2009). We can certainly learn from the past from credible sources, but our technology, resources, and world are not the same.

Thank you to the folks who helped me track down the photo and original post. Iric Nathanson’s article contextualizes this photo.