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Spanish Flu of 1918 vs. COVID-19

Kenneth Durbin

Youngstown State University

NURS 4844: Community Health Nursing

Wendy Thomas

September 27, 2021

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Spanish Flu of 1918 vs. COVID-19

Throughout the course of history there have been many events that have had worldwide

impact on massive numbers of people. Perhaps nothing from the course of human history

(besides that black death that plagued the middle-ages) has had as much impact on the world as

the Spanish flu pandemic of 1918 and the COVID-19 pandemic that is ongoing today. Each

disease brought along new challenges the world had never seen before, along with advancements

in medicine and even in the practice of community nursing. Between the two viruses there are

many similarities, many differences, interventions that helped, and mistakes that were made.

The Spanish flu was decimating in the 20th century. It is estimated that 500 million people

were infected with the flu (one third of the world’s population at the time). From these 500

million cases, around 50 million deaths are attributed to the virus (Docs, 2020). Of particular

importance with this strain of H1N1 was that the mortality rate in 20–40-year-old age group was

outrageously high. As many as half of the global deaths from the Spanish flu were in this

younger population (Robinson, 2020).

The COVID-19 pandemic that started in early 2020 completely changed the way of life

for many people. Between quarantines and many public gatherings being postponed until further

notice, a great number of people spent more time indoors than normal. Also, mask mandates

brought a long a whole slew of political opposition and divided many people. False news has

been more rampant than ever before especially on social media platforms. As of September 24,

2021, there have been over 230,000,000 cases of COVID-19 and over 4,700,000 deaths because

of COVID-19 (Worldometer, n.d).

In comparing the COVID-19 pandemic to the Spanish flu pandemic of 1918 there are

obvious similarities but also some differences. The first similarity is a nationwide shortage of
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nurses. The Spanish flu was during World War 1 so as many as 25% of the nurses in the United

States were supporting armed forces abroad. A second similarity is the short supply of personal

protective equipment (PPE). During the Spanish flu pandemic there were no such things as N95

respirators. Many nurses during this time wore makeshift masks made of gauze.

During the COVID-19 pandemic N95 masks were in very short supply. New rules on the

reuse of them became commonplace in hospitals. The shortage of respirators brought many

concerns for the nurses working during this current pandemic.

In fact, the ANA released findings from a nationwide survey of more than 32,000 nurses

which revealed PPE access was a top concern of approximately 9 out of 10 nurses. These

nurses feared going to work for lack of protection and about 25% reported having to

create their own surgical masks. (Robinson, 2020)

A third similarity between the virus outbreaks was the lack of a vaccine during the beginning of

the two pandemics. The only method of control the outbreak of both viruses were

nonpharmacological. Some methods for both included: mandatory quarantine, handwashing, face

mask wearing, and school closures. Even though there are many similarities between the

COVID-19 and Spanish flu pandemic of 1918 there are still many differences.

The first difference is that during the early 1900s there was very little understanding of

viruses. It was originally thought that the Spanish flu was caused by a bacterium and a vaccine

was made for a bacterium even though it was caused by a virus. In contrast researchers know

from the beginning that COVID-19 was caused by a virus, and they were able to study it in

depth. The second difference is how modern hospitals operate. During the 1918 pandemic

patients were put into huge wards literally lying next to each other and only separated from

others by thin cotton sheets. Today, especially with COVID-19, modes of transmission are
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understood along with the importance of infection control and isolating patients to prevent cross-

contamination (Brown 2020). The third and most important difference is the profound impact

social media has had on the response to the COVID-19 pandemic. Many people have been

divided based on responses put in place by medical professionals and are very open about it on

social platforms. During the Spanish flu, the main source of information was either from

newspapers or directly from medical professionals. Also in comparison between the two

pandemics were the interventions put in place by government officials to protect the public.

For the Spanish flu there were some interventions put in place by people that might have

been ahead of their time. San Francisco was a prime example of how to prevent a deadly virus

from taking over. The public was mandated to wear masks in public, social distancing measures

were enforced, and mandatory quarantines were put into place. Interventions that were not as

effective was limiting the spread of false news stories (such as aspirin causing the Spanish flu),

the first vaccine was ineffective, and those that were infected with the virus were not kept

isolated from others.

The COVID-19 pandemic had history to help with interventions. Health professionals

and researchers knew that social distancing works and recommended it at once. Massive hand-

washing campaigns were started to inform the public about preventing the spread of the virus.

And lastly, new effective treatments such as Remdesivir and the use of mechanical ventilation

have been very effective interventions for the COVID-19 pandemic. Many mistakes were also

made in response to the COVID-19 pandemic. One mistake that was made was waiting too long

to mandate mask wearing. Another mistake that was made was not being prepared for a

pandemic as big as COVID-19. And finally, the last mistake that was made was not doing the

proper research on drugs such as hydroxychloroquine to see if they would be effective or not.
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In the comparison between COVID-19 and the Spanish flu of 1918 there are many

similarities but also many differences. The two pandemics have had profound impacts on the

world. Between the many infections and deaths, along with the rapid advancements in medicine,

events such as these become very important moments in history. As time goes on many more

pandemics may cause many infections and deaths, but hopeful history provides a manual on how

governments should act to protect the public.

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References

Brown, J. (2020, March 6). The coronavirus is no 1918 pandemic. The Atlantic.

https://www.theatlantic.com/ideas/archive/2020/03/were-not-facing-second-spanish-flu/

607354/

Coronavirus Cases (n.d.). Worldometer. Retrieved September 24, 2021, from

https://www.worldometers.info/coronavirus/

Docs, M. (2020, April 19). Spanish flu 1918: the forgotten pandemic. YouTube.

https://www.youtube.com/watch?v=Zvt0ldtJFIM

Markel, H. (2021, August 19). History won't help us now. The Atlantic.

https://www.theatlantic.com/ideas/archive/2021/08/1918-influenza-pandemic-history-

coronavirus/619801/

Robinson, K. R. (2020, July 20). Comparing the Spanish flu and COVID‐19 pandemics: Lessons

to carry forward. Wiley. https://onlinelibrary.wiley.com/doi/epdf/10.1111/nuf.12534