Saturday, April 18, 2020

The Plague, the Spanish Flu, and the Coronavirus: Equivalence and Progress in Infectious Diseases

History forgotten is history to be repeated, for evolution occurs over such vast oceans of time that for our purposes, human biological nature is fixed. Yet history kept fresh can permit progress such that the species is better equipped to combat problems such as pandemics. At the time of the coronavirus pandemic of 2020, serious comparisons to the Spanish Flu of 1918 and the Black Death of the fourteenth century were lacking in the American media, including by public health officials and government officials even as claims of vague equivalence were made. Such claims, I submit, were erroneous. In fact, they did more harm than good by instilling excessive fear in the population.

Hearing the coronavirus being referred to as a plague on National Public Radio in the United States, I instinctively bristled at the assumed equivalence. A plague is a contagious bacterial disease with a high mortality rate. Coronavirus is a virus rather than a bacterium. The Black Death was a plague pandemic that “devastated Europe from 1347 to 1352 CE, killing an estimated 25-30 million people.”[1]  Paris buried 800 dead each day of the peak, or apex, there. “On average 30% of the population of affected areas [in Europe] was killed, although some historians prefer a figure closer to 50%, and this was probably the case in the worst affected cities.”[2] In 2020, two months after the first recorded death from the coronavirus in Europe, 97,000 people there were dead. The global mortality rate of coronavirus as of March 3, 2020, according to the World Health Organization (WHO), was just 3.4%, which is much closer to the 1% from seasonable flu.[3] Therefore, the coronavirus pandemic was not a plague.

The coronavirus pandemic was also publically likened to the Spanish Flu, which hit the U.S. in 1918. At least both were viruses, unlike the Plague. “The Spanish flu of 1918 lasted only a few months but took an estimated 50 million to 100 million lives around the globe, including 675,000 in the U.S.”[4] Ten days short of two months since the first death from the coronavirus in the U.S., 38,917 people were dead from the disease and less than 5% of the population had been infected. Worldwide, at least 158,000 people had died.[5] Clearly, the two pandemics were not equivalent. The assumed equivalence in the comparisons in 2020 demonstrates not only ignorance, but also a lack of interest in acquiring even a bit of historical knowledge so as to make tolerable comparisons.

In spite of historical knowledge being available and there being advances in knowledge, weaknesses of our species exerts a countervailing wind on the road of progress. The Spanish flu itself may not have been more virulent, however, because medical and public-health knowledge was so significantly less in 1918 than a century later. To put the two eras in perspective, model-T cars were on the road in 1918, whereas electric (and hybrid) cars were being driven and self-driving cars were being tested by 2020.

Parades and “other large public gatherings were common, contributing to the spread” of the Spanish Flu.[6] American governments facing the coronavirus pandemic prohibited or recommended people to maintain a physical distance from each other and stay home as much as possible (e.g. shelter-in-place orders). Retail businesses either shut voluntarily or by government order. Medically, antibiotics “to treat secondary bacterial infections that often accompany the flu had yet to be discovered” by 1918.[7] In addition to antibiotics, physicians in 2020 could put patients struggling to breath on ventilators.

It cannot be assumed, however, that people in 2020 could not have improved their chances of staying healthy by learning more about the 1918 societal protocols. During the Spanish Flu, it was thought “that keeping windows open would deter the spread.”[8] Trolley cars in Cincinnati, Ohio displayed fliers encouraging the practice, “which was utilized nationwide.”[9] In contrast, bus drivers in Phoenix, Arizona kept the bus’s narrow upper windows closed during the coronavirus pandemic a century later. Missing the larger point, the bus company’s management claimed that even open slits were unsafe because passengers could throw small objects out of the buses. Even though medical knowledge was clear that the coronavirus stays airborne relatively long due to its small size among flus and could even be transmitted by normal breathing, the bus company in the desert did not bother to read up on how trolley companied had dealt with the pandemic in 1918. Nor did the passengers figure that physical distancing applied to getting on the bus (i.e., giving deboarding passengers some space). In grocery stores in Phoenix, employees and customers alike overwhelmingly ignored the store policies on keeping at a distance from other people. In spite of the signs and announcements, the managements did not have control over their own employees.



In grocery stores in Phoenix, employees and customers alike overwhelmingly ignored the store policies on keeping at a distance from other people. In spite of the signs and announcements, the managements did not have control over their own employees.

Arizona at the time had one of the worst public education systems in the U.S.; even bad judgment could be traced back to this factor. Perhaps it is too idealistic to assume that everyone can be educated enough to reason his or her way to better secure even self-interested self-preservation. Even with historical knowledge and advances thereof available, human nature presents a limit as to how much actual progress can be made against infectious diseases.


[1] Marak Cartwright, “Black Death,” Ancient History Encyclopedia (accessed on April 18, 2020).
[2] Ibid.ev
[3] Tedros Ghebreyesus, press briefing of March 3, 2020. As Director-General, he headed the World Health Organization at the time.
[4] Aaron Kassraie, “Spanish Flu: How America Fought a Pandemic a Century Ago,” AARP (accessed April 18, 2020).
[5] Ben Westcott et al, “Global Coronavirus Death Toll Passes 158,000,” CNN.com, April 18, 2020.
[7] Ibid.
[8] Ibid.
[9] Ibid.