Since the current pandemic of COVID-19 began, the gaze has turned to the serious health crisis of 1918-1919 caused by the flu, trying to find similarities between both episodes that help to better understand what is happening and illuminate its future evolution.
Similarities between the 1918 flu and COVID-19
The emergence of the 1918-1919 influenza pandemic has been linked to the current complex historical situation. That combined the development of the First World War and its impact with the great economic and social crisis registered, from which neither the countries that took part in the contest nor those that did not, as was the case in Spain, escaped.
Linked to the war, there was a great displacement of the military population, but also of the civilian population, who were exposed to overcrowding, lack of hygiene and poor food, as a consequence of their scarcity and famine. These elements contributed to the spread of influenza and its increased severity. The conditions in the trenches and the soldiers’ exposure to toxic substances, such as mustard gas, were also aggravating.
In fact, the greater virulence of the autumn 1918 outbreak compared to that of spring has been attributed by some scientists to the mutagenic action of this gas on the virus, although for others it would be in connection with the presence of crowded bird farms in the vicinity of military camps near the English Channel. Both proposals refer to the important role of environmental transformations in health crises and the second to that of animals in the development of viral diseases, factors that have also been invoked as triggers for the current pandemic.
Although our current context is different from that of the 1918-1919 biennium, we also share other elements discussed, such as the great mobility of the world population for work, leisure or looking for better living conditions than in the country of origin.
Furthermore, overcrowding is a very present condition. Not only does it occur among vulnerable people, with few resources and difficulty in accessing a house with the minimum hygienic conditions, but it is also the result of our current society, which has privileged the development of huge cities, which requires large daily trips from the city. citizenship in an insufficient and saturated public transport, which facilitates the proliferation of respiratory transmission diseases, such as the flu or COVID-19.
There are still more similarities derived from the effects of globalization, the generalization of neoliberalism, uncontrolled capitalism and the negative impact of the severe economic crisis of 2008, which have accentuated socioeconomic inequalities, worsened working conditions and the vulnerability of citizens, have facilitated an increase in environmental pollution and actions on the most aggressive environment, which facilitates human closeness to animals that act as reservoirs and / or transmitters of viruses pathogenic for humans.
In parallel and linked to the above, the public sector has continued to become thinner worldwide, with a strong negative impact in the field of health and social protection, which has acquired and is highly relevant to face the current pandemic.
So, as in 1918-1919, health resources – personnel, infrastructures and equipment – have been lacking in the existing health systems, not only due to the increase in demand, but also due to its continued scarcity over time, which prevents good attention on a daily basis, without there being a crisis situation.
And the differences
Along with these similarities, differences are identified regarding the reasons that may explain these health deficiencies. In 1918, in the countries participating in the world war, they were related to the need to move and allocate part of the health resources to face the pathologies and accidents of the armed conflict, and, in Spain, which did not participate, was due to existing health delay and economic hardship.
However, more than a hundred years later, the current insufficiencies are not explainable in the same way, but a consequence of the lack of investment in public health (infrastructure, equipment and, above all, personnel) maintained. This situation is especially serious when today we know how important it is to have well-equipped primary care or the relevant role of epidemiologists, and we continue to neglect it after the teaching that the 2009-2010 influenza pandemic gave us.
Instead of reinforcing our public health systems or considering acting to reduce socio-economic inequalities and improve living and working conditions, prioritizing therapeutic and prophylactic resources is to have, respectively, a specific antiviral and vaccine against coronavirus, as It tried to do during the 1918-1919 pandemic without proven success, despite the various initiatives developed, but it was not possible to determine the aetiological agent of influenza by the laboratory, nor to reach a consensus among scientists. It wasn’t until 1933 that the first flu virus was isolated and the first vaccines were not available until the following decade, although without the possibility of providing total and lifelong immunity, due to the constant changes that take place in the virus.
Undoubtedly, as in 1918, today it is also necessary to improve our knowledge about coronavirus and COVID-19 and to have an effective vaccine to prevent it, but that is not enough, as some Spanish doctors saw during that pandemic, who considered that To avoid a new situation as serious as the one they were experiencing, it was necessary to introduce improvements in the quality and availability of housing, facilitate access to basic food in good condition, improve working conditions, carry out sanitary reforms, raise the scientific level of our country, introducing social insurance or, at least, compulsory health insurance.
Responses given during the 1918-1919 Flu and Covid-19
The similarities in the clinical picture of both viral diseases and the pandemic preparedness plans developed by the different countries after the avian influenza of the late twentieth century have led to the use of the influenza response model for COVID-19 . Let’s see to what extent the measures proposed more than 100 years ago coincide or move away.
If in 1918 military censorship hid the presence of influenza among the soldiers of the contending sides during the spring outbreak, and its existence was only admitted when Spain reported on the epidemic that began in Madrid in May, the appearance of COVID- 19 in China, it was also initially silenced and tensions were registered between the authorities of Beijing and Wuhan over the recognition of the health crisis and the measures to be adopted. Difficulties in admitting the arrival of COVID-19 to other countries have been common.
As in 1918, limited scientific knowledge of coronavirus and its effects is available, nor is there a specific vaccine or antiviral. However, it does have structured health systems and a greater number of personal and material resources, although the distribution and access are uneven.
However, the main prophylactic measures used are basically the same as in 1918 and since the times of Plague, which include: the isolation of sick people and their contacts, quarantine, confinement, interruption of collective activities (closure of schools, theaters, cinemas, soccer games and other sports activities, and any massive event), hand washing, disinfection and the use of masks.
And at a therapeutic level, the control of symptoms, together with support measures, is being vital, although old and new remedies have been experimented, as in 1918. With the difference that developed countries currently have more infrastructure, personnel specialized health and pharmacological resources, which are still limited for those poorer countries.
As a little over a hundred years ago, it has been necessary to build or enable new healthcare spaces, mobilize personnel and equipment between countries or internally, to care for a large number of sick people in a short period of time. It has also been common the impossibility of meeting all needs or being able to bury at the speed of death.
Differences are noted with respect to the most affected age group. If in 1918 the young adult population was the most affected, now the role has been reached by the elderly and those with previous pathologies.
Then and now, shortages and shortages for the population of fresh food and the most demanded resources (most used medicines, masks or disinfecting gels) have been common. Now, in addition, the relocation of European production and the conversion of China into the world factory have caused the lack of personal protective equipment (PPE) or mechanical respirators and a sharp rise in their price at the peak of the pandemic.
At the same time, a similar society response has been maintained, first marked by disbelief to gradually give way to fear and panic behavior that was accompanied by the hoarding of food and other basic resources, the search for the scapegoat. Thus, initially the Chinese population and its businesses were stigmatized, followed later by the rejection of populations from other countries, such as the veto recently imposed by Great Britain on people arriving from Spain.
The similarities noted in the triggers and the responses of both pandemics should encourage us to work to correct socio-economic inequalities, reflect on the changes to be made to achieve the sustainability of our society and a way of life that prevents new episodes like COVID-19, rather than encrypting the solution just to have a specific vaccine or antiviral. Of course, scientific-medical and technological development is necessary, but not sufficient to avoid catastrophes such as the current health crisis.
Maria Isabel Porras Gallo She is Professor of History of Science at the University of Castilla- La Mancha.