COVID-19 vs. Spanish Flu: A comparison

30th September 2020

The 2019 coronavirus pandemic and the 1918 flu pandemic are important pieces of history that had/will have an echoing impact on society and the world of medicine.

The purpose of this piece is to compare and contrast the two outbreaks and uncover the similarities and differences between them.

What are they?

The Spanish flu was an influenza pandemic caused by the H1N1 influenza A virus. In virology, this means that it is a subtype of the Influenza A virus, which is commonly found in birds.

The coronavirus or SARS-CoV-2 is a variation of the severe acute respiratory syndrome coronavirus which is thought to have originated in animals as well, specifically bats.

Where do their names come from?

The Spanish flu was called such due to the war. At the time, newspapers were being heavily censored by countries involved in the war but, due to Spain's neutrality, wartime censorship did not prevent Spanish newspapers from reporting on the pandemic.

As a result, the widely-spread stories created the false impression that Spain was hit especially hard by the pandemic.

Several alternative names were used during the time of the pandemic, such as the Brazillian flu in Senegal, the German flu in Brazil, and the Bolshevik disease in Poland.

COVID-19 is a shortened version of Coronavirus disease 2019, referring to the type of virus that causes the disease and which year it was initially detected.

SARS-CoV-2 stands for severe acute respiratory syndrome coronavirus 2, referring to the fact that it is the second instance of this virus causing an outbreak.

Where did they originate, and how many people were affected?

The first outbreak of the Spanish flu is heavily debated, although the first observations of illness and mortality as a result of the virus were documented in the United States, France, Germany, and the United Kingdom in 1918. 500 million people were infected worldwide between 1918 and 1920 with a death toll estimated between 17 million and 50 million.

These figures have classified it as one of the deadliest pandemics in human history.

The exact origins of the coronavirus are also widely disputed but, the first instance of illness was recorded in December 2019 in Wuhan, Hubei, China. The virus quickly spread all over the world and infected 33 884 087 at the time of this article's writing, although health experts suspect that millions more could have been infected due to discrepancies in testing.

The death toll for COVID-19 is currently 1 013 457, which is nearly 50 times less than the Spanish flu, but, the 1918 pandemic was tracked over two years while COVID-19 has only been tracked for less than a year.

How do/did they spread?

The Spanish flu outbreak took place during World War 1, spreading through soldiers who had compromised immune systems from malnourishment and other stresses related to combat.

Travel also heavily contributed to the spread of the disease and denial by governments who did not place any travel restrictions for citizens left populations unprepared for outbreaks.

The pandemic also took place in several waves, mutating each time.

The second wave was propelled by soldiers carrying a deadly strain of the virus, who were sent home on crowded trains or sent to crowded field hospitals.

This was the reverse of what usually happens in a pandemic whereby people who are severely ill tend to stay home, while those who are mildly ill will travel to work and such, spreading a milder version of the disease.

By the third wave, however, the lethality of the virus had dropped significantly, as doctors became more effective at treating symptoms and preventing unintentional spreading in hospitals.

As for how exactly the Spanish flu spread, the clue is in the name itself.

According to the CDC, as a variation of the influenza virus, it spreads mainly by droplets made when people with flu cough, sneeze, or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

COVID-19 spreads from individual to individual in the same way, but unlike the 1918 pandemic, COVID-19 was initially spread by unaware travelers who might have dismissed symptoms as the common flu.

What are the signs and symptoms?

The first wave of the 1918 pandemic showed typical flu symptoms in the majority of infected people, such as headaches, fever, and sore throat.

During the more deadly second wave, bacterial pneumonia was the most common cause of death amongst those who caught the virus and, in some instances, heliotrope cyanosis would develop in people.

Due to the infection, the skin would first develop two mahogany spots over the cheekbones, which would then, over a few hours, spread to color the entire face blue, followed by black coloration first in the extremities and then further spreading to the limbs and the torso.

Some uncommon symptoms included spontaneous mouth and nosebleeds, miscarriages for pregnant women, a peculiar smell, teeth and hair falling out, delirium, dizziness, insomnia, loss of hearing or smell, blurred vision, and impaired color vision.

Respiratory failure and death through the resulting cytokine storms from fighting infections was the common cause of death during the pandemic.

Viral infections are difficult to accurately diagnose based on specific symptoms, especially in members of the flu virus family like the Spanish Flu and COVID-19, but, advanced medical resources have helped distinguish minor differences between symptoms from the common cold and other viral infections from the same family.

The most common COVVID-19 symptoms include fever, dry cough, and tiredness although, patients have also recorded aches and pains, sore throat, diarrhea, conjunctivitis, headaches, a loss of taste or smell, and rashes.

Some of the symptoms observed in critical infections include difficulty breathing or shortness of breath, chest pain or pressure, and loss of speech or movement.

On average, symptoms of a COVID-19 infection take 5-6 days to manifest.

How did authorities handle outbreaks?

According to Laura Spinney's book, Pale Rider: The Spanish Flu of 1918 and How It Changed the World, there is not much difference in the actions that authorities implemented during the outbreak in 1918 that authorities in 2019 and 2020 used.

Contrary to expectations, systems for alerting public health authorities of infectious spread did exist in 1918, but their general exclusion of influenza resulted in a delayed response.

Quarantines were implemented on islands such as Iceland, Australia, and American Samoa.

World War 1 caused many countries to engage in wartime censorship and suppressed reporting by the media, but social distancing measures were introduced, public gatherings were avoided, schools, theatres, and places of worship were closed and public transportation was also limited.

Wearing face masks was even common practice in some places like Japan, and much like the COVID-19 pandemic, organizations against the usage of face masks like the Anti-Mask League of San Francisco existed in 1918.

Vaccines were also developed but, they were designed to combat the secondary bacterial infections that would often accompany infections of the H1N1 virus.

Unlike the modern pandemic, doctors had to rely on administering a random assortment of medicines with varying degrees of effectiveness to treat infections.

Aspirin, quinine, arsenic, Epsom salts, castor oils, and iodine are some of the treatments that doctors used during the 1918 pandemic.

Other variations of medical treatment were also used, such as bloodletting, traditional Chinese, and Indian medicine.

What did we learn from the previous pandemics?

The Spanish Flu pandemic of 1918 was comparatively worse than the COVID-19 pandemic currently is due to a variety of factors such as war and its associated hardships, medical practices that were not as advanced as the current decade, and a lack of global coordination on sharing medical knowledge.

Mankind could not be prepared for the current pandemic but, advances in medicine and technology have ensured that outbreaks of new diseases would not eradicate the human race in a short space of time.

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