Just over 100 years ago, the world experienced one of the worst disease outbreaks in recorded history. The 1918 outbreak of the H1N1 virus — often called the Spanish flu, not because it originated in Spain but because Spain was the first to report it — infected about 500 million people worldwide, about a third of the world’s population at the time. Of those infected, some 50 million died.
Occuring at the same time as WWI, one of the most violent wars in human history, the most devastating killer of the era was the silent one: the 50 million who died from the 1918 flu dwarfed the total lost in the war, an estimated 17 million worldwide.
Now, we’re facing the most severe pandemic since the 1918 flu. As COVID-19 continues to alter life as we know it, only a handful of centenarians have seen anything like the national quarantine we are currently experiencing, and nobody really knows what to expect this time around.
It is impossible to predict the future, but as the saying goes: “History doesn’t repeat itself, but it often rhymes.”
With that in mind, let’s take a look back at how the 1918 pandemic played out and how it altered health care, the economy and American culture.
Health care
The 1918 pandemic was the most devastating in modern history. At this juncture, it is unclear if the COVID-19 pandemic will have the same kind of human toll as the 1918 influenza pandemic did.
However, we can glean some important lessons from how our ancestors handled the 1918 pandemic and the way the influenza behaved.
Social distancing works
The 1918 pandemic was the last time that social distancing measures were implemented on a wide scale in the United States. Like today, different cities and states applied social distancing measures to varying degrees. By and large, the cities that put in place stronger social distancing measures had less severe outbreaks.
Philadelphia, a city that was slow to enforce social distancing, saw a sharp spike in the rate of infection early on, and experienced a high death rate of 748 per 100,000 over 24 weeks. Other cities that waited to order social distancing, such as Pittsburgh, New Orleans, Boston and San Francisco, tended to see similarly high death rates.
In comparison, cities that ordered social distancing earlier and for longer periods, such as St. Louis, Columbus and Seattle, generally experienced lower death rates. New York had a quick and extended response to the influenza and saw the lowest death rate on the Eastern seaboard at 452 deaths per 100,000. Minneapolis had the lowest fatality rates with 267 deaths per 100,000.
While cities had varying results controlling the virus with social distancing measures, in general, earlier and longer applications of social distancing helped to control the rate of infection and slow the rate of death.
Interestingly, as explained below, there is also some evidence that cities that imposed social distancing also had stronger rebounds economically.
We need to prepare for a second outbreak
The Spanish flu occurred in three waves in the spring, fall and winter of 1918, respectively. The first outbreak was minor in comparison with what was to come and resembled a typical flu. Infected people typically recovered within several days and the death count was relatively low.
The second outbreak occurred in the fall of 1918 and was far more severe. A mutated version of the same flu was more contagious, and the infected tended to become severely sick within hours or days of developing symptoms. Regions that had less exposure during the first wave were hit severely during this second wave, and most of the deaths in the United States occurred during this period.
The third wave of the illness occurred during the winter of 1918 and continued into the spring of 1919 before ultimately subsiding in the summer of 1919. While this wave continued to add to the death toll, it was not as severe as the second wave.
As of now, although it is not clear whether we can expect a more aggressive second wave of COVID-19 during the fall, there are some positive signs.
Coronaviruses are less likely to mutate rapidly than influenza viruses, a sign that bodes well for the development of vaccines and treatments.
We also may be better prepared if and when a second wave does come, though a resurgence would also pose problems of its own. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), has said that he is anticipating a second wave of the virus in the fall and winter, but he expects the United States to be better equipped to handle it due to the ability to test and contact trace.
However, in an interview with the Washington Post, CDC Director Robert Redfield warned that a second wave in the fall would coincide with flu season, which could further overwhelm health care systems.
“There’s a possibility that the assault of the virus on our nation next winter will be even more difficult than the one we just went through,” Redfield said. “We’re going to have the flu epidemic and the coronavirus epidemic at the same time.”
The economy
As the global economy remains largely closed, many people are understandably anxious about the long-term economic consequences of an extended shutdown. In the United States, the unemployment rate is expected to reach a record high of 25 percent as millions of workers are laid off due to the shutdown. In the past month, 22 million workers have filed for unemployment and the unemployment rate is expected to rise to around 15 percent in April, an unprecedentedly rapid rise from a low of 3.5 percent unemployment in February.
Are we headed into a new recession, or even a depression? At this juncture, when so much remains uncertain about the trajectory of the virus, it is difficult to predict exactly what long-term economic consequences of the shutdown will be.
Looking back on 1918 can give us some insight into what we can expect as this pandemic continues to unfold, but the comparison is by no means perfect. The differences in the economies of the early 20th and the early 21st centuries are significant. The Spanish flu also occurred during WWI, which had profound economic consequences of its own, so it is difficult to gauge the economic effects of the 1918 influenza as an isolated event.
There was a downturn in 1918 and an up-and-down recovery
In 1918, the influenza pandemic had mixed effects on the American economy. Some industries were hit severely in the short term due to quarantines around the country. As is the case today, the service and entertainment industries were hit particularly hard and suffered double digit losses in revenue.
Other industries, however, saw less significant downturns. Interestingly, the 1918 pandemic did not cause a stock market crash like the one that occurred in March 2020. In fact, the effects of the pandemic barely registered in the markets in comparison.
On the whole, there was an economic decline, reducing manufacturing output by an estimated 18 percent overall during the pandemic. After the pandemic subsided, there was a modest recovery at the end of 1919, followed by a global recession — sometimes even referred to as a depression — in 1920-21.
Fortunately, the downturn of the early ‘20s was short-lived, and in the long-term, the economy rebounded well, giving way to one of the fastest growing economies in American history during the 1920s.
Will we see a similar upswing after COVID-19 subsides? It’s hard to say.
The boom of the 1920s was largely influenced by myriad other factors, including the expansion of American industry during WWI, an influx of capital from war loans granted to the UK and the widespread availability of cheap credit. It’s worth noting that the so-called “Roaring ‘20s” were also buoyed by a stock market bubble that would pop in 1929, inducing the Great Depression.
Estimates about how extended and deep the current downturn will be vary wildly and are largely dependent on the health care response. Economists are largely expecting a U-shaped recovery, in which we see an extended downturn and a slow rebound. In large part, the trajectory of the recession depends on the trajectory of the pandemic — an aggressive resurgence in the fall could deepen the economic damage.
“Our central expectation is for a rebound in the second half of the year; however, that is riddled with uncertainty and downside risks,” Kevin Loane, senior economist at London’s Fathom Consulting, told Reuters.
“We see the risks are that: lockdowns are extended longer than envisaged, there is a second wave of COVID-19 cases, temporary job losses are made permanent resulting in labor market friction, businesses fail resulting in wasted capital, or businesses and households remain fearful even without lockdown and opt not to spend or hire.”
Jesse Rothstein, director of UC Berkeley’s Institute for Research on Labor and Employment (IRLE), is anticipating a recession of a depth not seen since the Great Depression.
“We’re definitely headed to something much deeper than the Great Recession, and comparable to [the] Great Depression in depth,” he said during an online forum as part of the Berkeley Conversations: COVID-19 series. “What we don’t know yet is whether we’ll be able to bounce back quickly or whether it will linger on for a decade or more. … The greater extent that we can keep workers attached to their firms and keep their firms afloat, the more likely it is it will bounce back quickly.”
Social distancing is better for the economy in the long run
As the U.S. economy has ground to a halt in an effort to slow the spread of COVID-19, some have questioned whether the public health benefits of social distancing are worth the costs for the economy. Governors in some states, including Georgia, Texas and Florida, are already working on plans to reopen in short order, even as case counts continue to rise across the country.
However, while social distancing may hurt now, it may actually lead to a stronger recovery in the long run.
A recent paper by two federal reserve economists and a professor at MIT analyzes the effects of the 1918 pandemic on the economy in various American cities. The paper, entitled “Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 flu,” finds that cities that imposed non-pharmaceutical public health interventions, such as social distancing, earlier and more aggressively do not perform worse economically, and tended to grow faster after the pandemic ended.
The authors found that in general, cities experienced similar economic downturns regardless of how aggressive their social distancing policies were. For example, a city like Philadelphia, which had a lax social distancing policy, saw similar economic declines to a city like Cleveland, which had a stricter and longer-lasting social distancing policy. The public health effects, however, were dramatically different: Philadelphia suffered a mortality rate that was approximately 40 percent higher than that in Cleveland.
In an interview with NPR, Emil Verner, an assistant professor of finance at the MIT Sloan School of Management and co-author of the paper, explained why leaving the economy open doesn’t actually improve economic outcomes.
“Generally, what happens is if you try to take the strategy of keeping calm and carrying on, people can’t keep calm. It’s naturally human to be worried about your health and the health of your loved ones during an outbreak like this. And so that’s why that strategy doesn’t work.”
The more effective policy, he said, is to focus on keeping people healthy.
“And so in a pandemic, the pandemic itself has such a severe negative consequence on the economy that any policy that you can use that actually mitigates the severity of the pandemic and reduces the risk of contracting the virus and reduces the ultimate mortality is actually going to allow the economy to come out stronger on the other side.”
So while it’s tempting to reopen the economy as quickly as possible, mitigating the spread of COVID-19 will help the economy down the line, even if it means waiting longer to reopen.
Culture
What kinds of long-lasting effects will the COVID-19 pandemic have on American culture? Will people be more hesitant to gather in crowded areas? Will virtual meeting rooms in Google Hangouts, Skype and Zoom become our new gathering spaces? How will we remember the coronavirus?
It is difficult to predict what cultural effects of the coronavirus pandemic will have, and in this case, looking back to 1918 doesn’t really tell us much.
The forgotten pandemic
The 1918 pandemic is sometimes called the “forgotten pandemic,” in large part because the influenza was overshadowed by WWI. More Americans died from the Spanish flu than in combat during the entire 20th century, yet while tales of triumph in battle are etched into our collective memories, few can tell you about what life was like for Americans in quarantine in 1918.
In large part, it seems, Americans wanted to put the pandemic behind them. Life during the 1918 pandemic was quiet and lonely. As many are doing today, Americans by and large sheltered in place. Sporting events were cancelled, schools sent students packing, and movie theaters, restaurants and retail stores closed their doors. But while today’s quarantiners can have virtual drinks together over video chat, those of the past were left to contend with the fear and uncertainty of a vastly more devastating pandemic in isolation.
After the 1918 flu subsided, Americans turned their attention elsewhere and an eerie silence seemed to surround the topic of the pandemic. The war became the focus of most news coverage. Writers from the era largely ignored the pandemic in their books. Even John Dos Passos, who himself had caught the flu on a troop ship, never wrote with any depth about it.
In many ways, it seemed a silent melancholy overtook American society.
Survivors remember a feeling of isolation and suspicion — one that lasted even after the disease had gone away. Eventually, life went back to normal. People went back to hosting parties, attending football games and going to music clubs. But for many survivors, life was never the same. In the 1997 PBS documentary “Influenza 18,” then 85-year-old John Delano remembered life after the flu as a child:
“After the flu, I was a pretty lonely kid. All my friends had died. These were the friends I had played with for years, gone to school with. When I lost them, my whole world changed. People didn’t seem as friendly as before, they didn’t visit each other, bring food over, have parties all the time. The neighborhood changed. People changed. Everything changed.”
The pandemic helped advance women’s rights
One interesting side effect of the 1918 flu was it created opportunities for women to enter the workforce as they never had before.
The flu and WWI had a devastating effect on the population of young men in America. While the American losses in the war were modest compared to those of European countries, over 53,000 soldiers died in combat and another 63,000 died due to disease. Back home, the disease killed more men than women as well. On the whole, 175,000 more men died than women during 1918.
As a result of WWI and the pandemic, there was a significant labor shortage in many areas of the United States, and women moved in to fill that gap. Women were not only entering the workforce in never-before-seen numbers, but they were entering male-dominated fields like manufacturing. By 1920, a fifth of the American workforce was composed of women.
Furthermore, as women entered the workforce in greater numbers, laws were passed to ensure their rights as workers. Furthermore, the role of women in society continued to grow more important from a political perspective, ultimately leading to the passage of the 19th Amendment in 1920, granting women the right to vote.
Lessons from history
The 1918 pandemic was one of the great pandemics in human history. As of the date this article is being written, the COVID-19 pandemic has yet to make an impact even close to that of the 1918 flu pandemic. However, the health crisis that we face today is unprecedented in its own right and will likely create a host of unforeseen issues and effects.
There is no crystal ball that will tell us how we will emerge from this pandemic, so the only place to look is toward the past. As we navigate this period of uncertainty, reminding ourselves how previous generations dealt with their own crises can help us understand how to prepare and, to some extent, what to expect.
