Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How.

In 1918, it was impossible to test people with mild symptoms so they could self-quarantine. And it was nearly impossible to do contact tracing because the flu seemed to infect — and panic — entire cities and communities all at once. Moreover, there was little protective equipment for health care workers, and the supportive care with respirators that can be provided to people very ill with coronavirus did not exist.

With a case fatality rate of at least 2.5 percent, the 1918 flu was far more deadly than ordinary flu, and it was so infectious that it spread widely, which meant the number of deaths soared.

Researchers believe the 1918 flu spared older people because they had some immunity to it. They theorize that decades earlier there had been a version of that virus, one that was not as lethal and spread like an ordinary flu. The older people living in 1918 would have been exposed to that less lethal flu and developed antibodies. As for children, most viral illnesses — measles, chickenpox — are more deadly in young adults, which may explain why the youngest were spared in the 1918 epidemic.

Regardless of the reason, it was a disaster for life expectancy, which plummeted. In 1917, life expectancy in the United States was 51 years. It was the same in 1919. But in 1918, it was just 39 years.

The new coronavirus tends to kill older people and those with underlying medical conditions, and it does not seem to kill children. All of which means it will have far less effect, if any, on life expectancy.

As for the coronavirus case fatality rate, it is not yet known, but the latest data from South Korea, with 7,478 confirmed infections, show a rate significantly higher than the seasonal flu. After testing 100,000 people for the virus, the country appears to have a case fatality rate of .65 percent. (Though the data is evolving as researchers in other countries track cases.)

What the current situation does have in common with 1918, though, is the tenor of public concern.

Among the first places the 1918 flu arrived in the United States was Fort Devens, near Boston. So many young soldiers were sick, and so many were dying, that the Surgeon General sent four of the nation’s leading doctors to investigate.

One of them, Dr. William Vaughan, later recalled: “Hundreds of stalwart young men in the uniform of their country, coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

Accounts like these scared Americans deeply.

On Oct. 3, 1918, Philadelphia closed all schools, churches, theaters, pool halls and other gathering places. Undertakers were overwhelmed — some funeral homes increased their prices sixfold and some even made the bereaved bury their own dead.

In Tucson, Ariz., the board of health forbade people to venture out in public without a mask. In Albuquerque, where schools and theaters were closed, a local newspaper wrote, “the ghost of fear walked everywhere.”

Similar actions are being taken today. Seattle has closed some public schools. The South by Southwest festival in Austin, Tex., has been canceled. Apple asked employees to work from home. More than 2,700 people are under some sort of quarantine in New York City. And some Costco stores are having trouble keeping bottled water in stock.

But so far this year, the annual epidemic of seasonal flu in the United States is proving much more devastating than the coronavirus.

The Centers for Disease Control and Prevention reports that there have been at least 34 million infected with flu this season, 350,000 hospitalizations and 20,000 deaths. So far, coronavirus has killed 27 people in the United States.

For the economy, the effects of the 1918 flu, despite factory closings and social disruptions, were hard to disentangle from the profound ones of World War I. The world was not as interconnected as it is today, and by the summer of 1919, the pandemic had ended.

Coronavirus is already having significant impacts on the stock market and other aspects of the economy, but the long-term consequences remain to be seen.

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