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The third takeaway: Despite those differences, the parallels between 1918 and 2020 are still striking. In both cases, there was no vaccine and no treatment for the disease along with an overriding fear that a besieged health care system might crack.
And here’s takeaway No. 4: In both pandemics, the most effective immediate response was — and is — social distancing, Nichols said.
“It was called ‘crowding’ control” back then, he said. “But whatever you call it, limiting contact worked in 1918 — and it works today.”
And the faster comprehensive closures and social distancing are put into place, the quicker a pandemic can be brought under control, Nichols added.
Those who lived through the Spanish flu learned that lesson the hard way, according to Carolyn Orbann, a medical anthropologist at the University of Missouri, in Columbia.
“As with all pandemics, in 1918 you had a tension between biological reality and socioeconomic reality,” she said. “Biology is not changeable. But behavior is. So yes, social distancing was absolutely a thing in 1918, and where it was practiced, it worked.”
But out of fear, panic, mistrust, special interests — and even sheer boredom, Orbann said, many were too slow to get on board and too quick to jump ship. Historians see the evidence in letters written at the same time by the same families.
“The mother is saying, ‘We all need to be patient, lay low and wait it out,’ while the daughter is saying she’s had enough of no school and no friends, and she’s planning a Halloween party, just as the highest number of deaths are happening,” Orbann explained.
That tension helps explain the absence of an early and forceful federal response in 1918, according to Nichols and Ewing. Instead, officials played down the risk and stalled for time.
Why? Some reasons were unique to 1918. “The Spanish flu hit during a pivotal stage of World War I,” Nichols explained.
By the time the first presumed U.S. case was identified in March 1918 at a Kansas army base, there was great concern about troops getting sick. That concern was well-founded: The close quarters of Army camps were petri dishes for illness, Orbann said.
