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COVID-19: The Lessons We Haven’t Learned From the Spanish Flu of 1918



 In April 1918, a group of around 20 sumo wrestlers on tour in Taiwan became mysteriously ill, with some requiring hospitalization. Three died, including the highly popular Tokyo wrestler Masagoishi. The initial diagnosis was colitis, while other reports cited bronchitis and pneumonia. In truth, however, these were just secondary effects; the real culprit was influenza. Given its apparent origin, it came to be known within Japan as sumo flu.


The wrestlers’ fate seemed alarming to the Japanese, but not overwhelmingly so. Most people back then understood that influenza spreads easily within closely confined groups, and they realized that flu could be fatal. Therefore, this particular strain did not at first seem to be cause for serious concern. But then the illness spread.


This was, in fact, the first hint of a pandemic popularly known as the Spanish flu. Over the next 18 months it would affect 500 million people, or roughly one-third of the world’s population, and kill 50 million (according to the numbers quoted the CDC), making it deadlier than both world wars combined.


In Japan, according to estimates by Hayami Akira who pulled results in The Influenza Pandemic in Japan 1918-20 (2015), 23 million people were affected, with at least 390,000 fatalities. However, accurate figures are impossible because of poor record keeping, and as we have learned recently, counting casualties is a pursuit frequently riddled with politics. 


In fact, there was nothing distinctly Spanish about the Spanish flu, nor indeed anything sumo-esque. The reason the pandemic came to be identified with Spain has to do with censorship during the First World War.


Governments in belligerent countries, fearing mass panic, at first suppressed reports of the disease. Since Spain was neutral, there were no press controls, so the first news to emerge came from Spain. In fact, the first known case in the epidemic was reported at the Camp Funston military base in Kansas, where an army cook named Albert Gritchell fell ill on March 4, 1918, or about one month before Masagoishi.


Here we have a phenomenon which has become familiar in recent weeks, namely the tendency in any country to promote the idea that flu is always “foreign.” In 1918, most governments were only too happy to blame the Spanish. Americans, however, also tended to blame the Chinese, just as they do today. Americans seem fond of attributing influenza epidemics to Asians. A mysterious, skulking disease seems to fit in with Western stereotypes of “the Orient.” On Twitter over the past week, I’ve seen many comments to the effect that flu always comes from Asia, where they eat strange things.


Strains of flu vary from year to year, but the behavior they inspire is a constant. Hysteria goes hand in hand with xenophobia. Panic is the default position. We seem to learn nothing from past experience. As a historian of 40 years’ standing, I sometimes wonder why I bother writing scholarly books and articles, since, in times of crisis, the public prefers prejudice to dispassionate, rational analysis.


Over the past month, conspiracy theories have blossomed like the daffodils in my garden.


One conspiracy theory alleges that there’s a biolab in Wuhan that’s partially owned by Bill Gates and George Soros. (He’s the go-to guy for any such theory.) According to the scenario, that lab synthesized COVID-19, which was then spread around the world according to a plan mapped out by Barack Obama, Hillary Clinton, the Pope, and Greta Thunberg. The first time I witnessed this narrative was when it was retweeted by a conservative politician running for office in California.


Since this is a pandemic, the conspiracy theories have varied from place to place, usually reflecting local political concerns. In Egypt, for instance, the minister of religious affairs, Mohammad Mukhtar Juma, has accused the Muslim Brotherhood of using the virus as a weapon against the military, police, government, and judiciary.


While I, as a historian, get frustrated at the disintegration of rationality that occurs during a pandemic, I can’t imagine what doctors must feel. During the Spanish flu pandemic, established medicine was unable to offer a cure or significantly limit the spread of the disease. As a result, the reputation of doctors and scientists suffered.


Quack cures grew enormously popular. Quinine, arsenic, camphor, digitalis, strychnine, mercury, castor oil and iodine were widely prescribed by charlatans. Naturopaths doled out mustard poultices, herbal infusions, and kerosene. When rumors circulated that the disease was vulnerable to alcohol, sales of booze skyrocketed. The therapeutic properties of cigarettes and opium were also promoted.


The flu also inspired a minor religious revival. Churches were packed, with inevitable consequences for contagion. Every culture and every religion offered a defense against the contagion. In Japan, a farmer named Zenji recorded how, after he became ill, he visited the divine image of the Stop-Coughing Priest south of Kannonji village, to pray for a cure to his cough. A short time later he was back ploughing his fields, so there’s your proof of divine intervention.


In the 1918 epidemic, the American Surgeon General advised worried citizens to avoid tight shoes. When reading about quack cures like that, it’s so easy to be smug. We’re so much more sophisticated now. 


Or are we? In truth, nothing has changed. In America, the disgraced televangelist Jim Bakker is currently peddling a silver solution, which he swears provides a defense against the disease. Trump’s “spiritual adviser” Paula White has been using coronavirus prayer sessions to solicit donations to her church, as in a video which trended on Twitter she said: “Maybe you’d like to sow a $91 seed ... Or maybe $9. Or whatever God tells you to do.” 


Over the last few weeks, I’ve come across a plethora of wacky cures and avoidance strategies. These include drinking water every 15 minutes, swabbing the nostrils with saline, bathing with alcohol or chlorine, taking saunas and — this from an Iranian cleric — rubbing the anus with violet leaf oil.


The Scots are fond of alcohol as a cure, just as in 1918. On YouTube, a young Ghanaian evangelist named Addai argues, on the basis of “extensive research,” that frequent sex would prevent infection. (Just to be clear: he’s advocating not just every day, but for hours every day.) He might be onto something, but not quite in the way he believes. Staying in bed and constantly copulating will, at the very least, reduce one’s exposure to the public.


Epidemics provide a built-in advantage to charlatans and snake-oil merchants. That was certainly true of the Spanish flu. Since the disease killed fewer than 10% of those afflicted, that meant that 90% survived. Rather than attribute their survival to mere luck, the fortunate were inclined to credit their favorite quack remedy — the strychnine, mercury, cigarettes, opium, alcohol, or Stop-Coughing priest. That logic is difficult to refute.


Thus, as far as pandemics are concerned, the more things change, the more they stay the same. Our current hysteria might differ in its manifestations to that of a century ago, but not in its intensity.


But lest we despair, it has to be said that epidemics also seem to inspire sublime responses — creativity, charity, compassion. Some great literature has emerged from the miasma of plague, including Camus’ The Plague (1947), Garbriel García Márquez’s Love in the Time of Cholera (1985), Mushanokōji Saneatsu’s Ai to Shi (Love and Death, 1939) and, more recently, the superb Station Eleven (2014) by Emily St John Mandel. If you’re self-isolating, you might want to read a selection of plague books. Or maybe not.


In the epidemic-related novel Kai (Oar, 1985), Tomiko Miyao tells how his protagonist Iwago is morally transformed by the crisis, devoting himself to helping those least equipped to cope, namely the poor on Shikoku Island.  As such, Miyao reveals a phenomenon common to all crises, namely the blossoming of compassion.


Most of us are good people, even though we often forget to be good. A crisis, however, focuses the attention, providing an opportunity for goodness to surface. My Twitter feed is currently dominated by stories of ordinary people doing extraordinary things for their neighbors. Human kindness is overflowing.


So, there’s much to learn from the 1918 experience. The current epidemic might not be as deadly as a century ago, but its economic consequences will undoubtedly be much worse. Beyond the deaths and economic catastrophe, we’re going to see some truly wacky behavior — human beings at their craziest.


But we’ll also see them at their best. And that, I hope, will be the most important legacy of COVID-19.



Author: Professor Gerard De Groot