Laura Spinney: What Does The 1918 Flu Teach Us About Our Response To Pandemics? A century after the 1918 flu, we see similar patterns in the ways we're responding to COVID-19. Laura Spinney reflects on the Spanish flu and how societies learn to move forward after pandemics.

Laura Spinney: What Does The 1918 Flu Teach Us About Our Response To Pandemics?

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MANOUSH ZOMORODI, HOST:

Hey, everyone. It's Manoush here. You're going to notice this episode sounds a little different than usual. I'm trying to stay safe by recording myself at home. And we are so grateful to our guests for recording themselves at home, too, and helping us bring this episode to you.

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ZOMORODI: It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. And to start the show, I want to travel back for a moment to a time you've probably been hearing about a lot lately - to the 1918 Spanish flu.

LAURA SPINNEY: Yeah. So, I mean, just to give you a tiny bit of perspective, around 18 - one, eight - million people are thought to have died in the First World War. And the numbers we work with today, though they are uncertain, are between 50 and 100 million dead for the Spanish flu, which means that the Spanish flu probably killed more than either World War and possibly more than both of them put together.

ZOMORODI: This is Laura Spinney.

SPINNEY: I am a science journalist, also a novelist and a writer. And I wrote a book called "Pale Rider: The Spanish Flu Of 1918 And How It Changed The World."

ZOMORODI: And just like today with COVID-19, New York City was hit hard by the Spanish flu.

What was New York like in 1918?

SPINNEY: So New York in 1918 was quite a modern city. It was quite atomized. It's the peak of the pandemic. People are dying left, right and center.

ZOMORODI: And the city is papered with advice on how to prevent and treat influenza - things like...

SPINNEY: Handwashing.

ZOMORODI: Masks.

SPINNEY: Quarantine.

ZOMORODI: And self-isolation.

SPINNEY: What we call social distancing - you know, the collective term for all those measures that keep the sick and the healthy apart and so slow the spread of the disease.

ZOMORODI: Public gatherings were discouraged. Some were restricted. Sounds familiar, right? But that didn't always stop people from going out, like on October 28, 1918, when Charlie Chaplin's new film was released. For some New Yorkers, the opening night ticket was too hot to resist.

SPINNEY: Oh, Charlie Chaplin was so hot. And he made this film called "Shoulder Arms," in which a tramp kidnaps the Kaiser - good, stirring stuff for wartime. And it premiered at the peak of the pandemic in New York City.

ZOMORODI: A bunch of people crowded together in a movie theater during a pandemic - not the best idea. And yet...

SPINNEY: Harold Edel, who was the manager of that cinema - I think he wrote in a newsletter something like - he just congratulated people for turning out in such impressive numbers to watch the film.

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UNIDENTIFIED ACTOR: (As Harold Edel) We think it a most wonderful appreciation of "Shoulder Arms" that people should veritably take their lives in their hands to see it.

ZOMORODI: So crowds of people came out to see the film. And Harold, the cinema manager...

SPINNEY: By the time his words were published, he himself had died of the Spanish Flu.

ZOMORODI: Wait a minute. So despite the fact that the flu was ravaging New York City at the time, people thought, you know what? Those of us who are healthy, we want to go see Charlie Chaplin. He's the hottest thing out there. Let's get on with our lives and go to the movies.

SPINNEY: Yeah, I think so. And, you know, maybe you were seeing a little bit of the mentality we're seeing today where people are finding it hard to tolerate self-isolation over time. Maybe it's OK at the beginning, but sustaining it gets hard. You know, we find ourselves - I mean, this is a different world. This is a different germ. This is a different disease. But now while I'm living through it, what I'm feeling is something very ancient about this. There's something ancient about the way we react, about the way we behave well, behave badly. It doesn't feel like it's changed since Greek time, since the Greeks described hysteria in these kinds of situation and good behavior in these kinds of situations. It all feels very ancient.

ZOMORODI: There is something ancient about all of this, something almost eerie in the way that history repeats itself. Pandemics have always been one of the most dangerous threats to humanity. The 1918 flu wasn't the first, and unfortunately, COVID-19 likely won't be the last. So what lessons can we learn, and what questions do we need to ask about pandemics and how we humans should respond to them? And is it possible to move toward a world where we protect ourselves against another global outbreak?

Well, today on the show, we're talking about inoculation on a big scale - how everything from innovative vaccines to changing the way we think and talk about pandemics can help us move toward a safer future because solving such a massive problem requires us to look at it from all angles so that the next time a pandemic strikes, we will all be more prepared to fight it.

SPINNEY: You can feel there's a we in that. It's a threat to us all as a species.

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ZOMORODI: What I found fascinating about 1918 was, yes, it was the flu, but there were sort of three stages to the illness. Can you walk us through them?

SPINNEY: So the pandemic is generally considered to have struck in three waves. It kind of depended where you were in the world. But in general, there was a kind of initial mild wave in the early months of 1918, which wasn't that different from seasonal flu. That went away in the sort of late spring, early summer of 1918. And then a second wave kind of emerged in the last weeks of August of the same year. And that was by far the most vicious wave when most of the deaths took place. It receded towards the end of 1918. And then there was what's usually considered a third wave in the early months of 1919 that was intermediate in severity between the other two.

ZOMORODI: I mean, hearing that is terrifying. We know it's a different time. We know it's a different virus right now. But the thought of going through multiple waves of this is just kind of awful.

SPINNEY: Yeah, absolutely.

ZOMORODI: And so right now, though, we are seeing that older people seem to be particularly at risk. Were there groups in 1918 who were more vulnerable than others?

SPINNEY: In most of the world, overall, the most vulnerable age group were adults aged 20 to 40, which is unusual for flu. But it was one of the reasons why that pandemic was so devastating because it basically purged communities of their breadwinners, of their pillars, you know, fathers and mothers at a time when there was no real safety net socially in terms of social welfare. And this to me is why it's so fascinating because a pandemic is not just a biological thing. It's social as well.

ZOMORODI: So how did societies pull themselves back together again after the Spanish flu finally died down in the summer of 1919?

SPINNEY: So, I mean, they were pretty devastated because they also had to rebuild after the war in many parts of the world. It was, you know, it was a humanity-wide trauma. But at the population level, what's really interesting is that humanity quickly bounces back. So you see there's a big dent in the demographic profile of the people who died at that time. But in the 1920s, there was a baby boom. And one of the reasons for that boom we think is that the Spanish flu basically purged the world of people who were already sick with other diseases, notably tuberculosis. And so what it left behind was a smaller but healthier population.

ZOMORODI: Wow, Darwinian.

SPINNEY: Yeah, totally. So humanity replenishes itself but at the cost of huge amounts of individual suffering, of course.

ZOMORODI: Can we talk about the people's mental health after the pandemic? I mean, you mentioned the trauma...

SPINNEY: Yeah.

ZOMORODI: ...This sense of uncertainty. Long, like, slow-moving uncertainty is something that I have never experienced in my lifetime. And I can only imagine that sort of - the way that society functioned after the 1918 pandemic with the flu, I mean, it must have changed the way people thought of being human in the world.

SPINNEY: So there's quite good evidence to suggest that there was a kind of wave of depression that went over the world after the pandemic. I think a lot of people - and not just military, civilians as well - were left with a similar kind of post-traumatic stress disorder by this pandemic. I think there was also a sense of sort of survivor's guilt because it was so random. You know, some died. Some didn't. But then at the same time, of course, people were just sort of in a state of shock after the war. I mean, it must have been an extremely strange time.

ZOMORODI: So in your book, you actually bring up this term collective memory, which refers to how we as a society remember our past and remember defining moments like the Spanish flu or now with COVID-19. And I wonder if it sort of serves one of the themes that we're talking about on this episode, which is the concept of inoculation, this idea of being able to protect the population from something that you know is out there, whether that's with a vaccine or potentially a story, a warning that a society can say, you know, look what happened. We have to protect ourselves, make sure it doesn't happen again. It sounds as though the flu of 1918 was not much of an inoculation for generations ahead of it. The memory of it is very flimsy, frankly.

SPINNEY: Yeah.

ZOMORODI: Whereas, you know, I've heard people talk about World War II all the time. We can't let that happen again. We have to protect ourselves, never let it get to that point.

SPINNEY: Yeah, we do say that a lot. I mean, I tend to be quite cynical about that. I think that just remembering these things unfortunately doesn't stop us doing them again. So I was speaking the other day to Jonathan Quick, public health expert, who wrote a book called "The End Of Epidemics." And he says, well, when it comes to pandemics, we just are in this cycle of panic and complacency.

We'll see if this one puts an end to that. I personally doubt it, but it remains to be seen. We panic when it happens and then we forget as soon as it's gone and don't do all the things, which, for example, the WHO's been telling us forever to do outside of pandemics in order to protect ourselves better against them.

ZOMORODI: Tell me if I'm being too Pollyanna-ish, but in times like this, is there something that can help us maintain a positive and hopeful outlook on life? I mean, I guess I'm looking for words of wisdom for our listeners. The ancient lesson, I guess, is that we survive (laughter).

SPINNEY: We do survive. And we know the shape of a pandemic curve, an epidemic curve. We'll definitely come out of this. We'll just be a different humanity. And, you know, lots of us who are here now may not be here then.

I mean, I think that pandemics bring out the very worst and the very best in human nature - in both the extremes. You know, I mean, so virology was not a field of science before the 1918 pandemic. It took off in the 1920s. We had our first flu vaccines as a result from the 1930s. You know, good things come out. But a lot of people pay the price for it.

ZOMORODI: That's Laura Spinney, science journalist and author. Her book is called "Pale Rider: The Spanish Flu Of 1918 And How It Changed The World." On the show today, ideas about inoculation. I'm Manoush Zomorodi. And you're listening to the TED Radio Hour from NPR.

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