Spanish Flu: Overview

It is estimated that about 675,000 and over 50 million people died from the Spanish flu in the U.S. and globally. Below is a high level overview of the Spanish flu, and its comparison to the Coronavirus.

Fatality Numbers of Spanish Flu

  • Estimates vary regarding the exact number of Spanish flu fatalities, but many authoritative sources, including Live Science, NPR, the CDC, the U.S. National Archives, and the History Channel, report that there were at least 50 million deaths from the pandemic. However, while some studies have produced much lower numbers (17.4 million and 24.7-39.3 million), other sources state that the numbers were as high as 100 million.
  • The widely-cited 2002 Johnson and Mueller study, which estimated the number of deaths at 50 million, suggested that even this vast figure may be an underestimation by 100%. This means that it is likely that the number of fatalities was between 50-100 million. and NPR agree with this estimate.
  • An expert from the John Hopkins Center explains that all the available Spanish flu mortality statistics are ‘best estimates’ since “death certificate recording and epidemiology was really in its infancy” in 1918. This made it difficult or impossible to get data from resource-poor geographies of the time.
  • Although researchers differ on the global data, many sources (including Live Science, NPR, the CDC, and the History Channel) seem to agree with Nancy Bristow’s estimation that the Spanish flu killed about 675,000 Americans, which represented about 0.8% of the population at the time. The National Bureau of Economic Research (NBER) estimate is lower at 550,000, or 0.5% of the population.
  • NBER, which estimates the global death toll at 40 million, reports that the Spanish flu killed 5.8%, 5.22%, 1.87%, 1.43%, 0.96%, 0.72%, 0.69%, 0.46%, and 0.3% of the 1918-20 population in Kenya, India, Russia, China, Japan, France, Brazil, the United Kingdom, and Australia, respectively. India was the hardest hit country with a death toll of over 16.7 million due to its high population. Another report, which quotes the Johnson and Mueller study, states that Asia, Africa, Europe, and North America recorded 36 million, 2.5 million, 2.3 million, and 1.6 million deaths, respectively.
  • Although the mortality rate was highest in Kenya, according to NBER, the Spanish flu killed only about 150,000 people since the population was much lower at the time. Spain had a comparably lower mortality rate of 1.4%, or 300,000 deaths. There is no reliable global data on the number of infections by the Spanish flu with the most common figure, 33%, or 500 million, of the population, being more of a representation of U.S. data than global data.

Economic Impact of Spanish Flu

  • According to NBER Researchers, the Spanish flu pandemic cut per-capita gross domestic product (GDP) by 6% and private consumption by up to 8% in the typical country. In the U.S., the pandemic’s toll on the economy was comparably lower; a 1.5% drop in GDP and a 2.1% decline in private consumption.
  • Another study by the Center for Economic and Policy Research’s (CEPR’s) VoxEU estimated that lower-income nations experienced twice as much loss to per-capita GDP (9.8%) compared to higher-income ones (4.7%). Also, the study found that lower-income countries experienced immense macro-economic risks; although the risks to higher-income nations were also quite large.
  • Elevated inflation combined with the economic decline also led to “large declines in the real returns on stocks and short-term government bonds.” On average, countries with a 2% death rate experienced a 26% drop in real stock returns. The United States’ decline in stock returns was about 7%.
  • This report by the Federal Reserve Bank of St. Louis provides further reading on the economic impact of the Spanish flu in the United States. It also provides a breakdown of the number of deaths by regions. Although research on the economic impact of the Spanish flu is limited, these resources by VoxEU, the Reserve Bank of Australia, and The Conversation also contain useful and relevant information.

Decline of the Spanish Flu

  • There seems to be no consensus regarding the origin of the Spanish flu, and it was only named so because the Spanish media reported it first. The CDC’s timeline shows that the first case was reported in March 1918 in Fort Riley, Kansas, and scattered flu activity was seen across the U.S., Asia, and Europe in the following six months. Other theories point to Britain and France, and a 2014 theory claimed that it came from China.
  • The 1918 pandemic spread in three waves. The first wave was experienced in Spring 2018, and the second and deadliest between September 1918 and January 1919. The third wave happened from February 1919 and lasted throughout the year.
  • According to reports, medical professionals were unsure as to how to diagnose and treat the Spanish flu since technology was not as advanced as it is today. Also, effective flu antivirals and vaccines were invented/discovered in the 1940s. It also did not help that World War I had caused a shortage of physicians.
  • Some doctors recommended remedies such as wine, beef broth, and cinnamon, and most doctors advised people to avoid crowded areas and to cover their noses and mouths. Shaking hands and touching library books was discouraged and people were encouraged to stay at home. Theaters, schools, and other public facilities closed, and some authorities, such as New York City’s Health Department, made public spitting illegal.
  • History Channel reports that while aspirin would have been useful in fighting the flu, the high dosage prescribed (up to 30 grams per day instead of the recommended four grams) may have hastened or caused a significant number of the second-wave deaths.
  • The Spanish flu ended in Summer 1919 as the infected either developed immunity or died. Recent reports also suggest that the flu morphed into other milder flu viruses, including the seasonal flu. A study found that “the virus was most virulent or most readily communicable when it first reached the state, and thereafter it became generally attenuated.”
  • Experts also believe that the 1918 flu never went away, and that the pandemics that have happened since 1918, including in 1957, 1968, and 2009, were derivatives of the Spanish flu.

Comparison to Covid-19

  • The Conversation states that the Spanish flu is the ‘closest parallel’ to the COVID-19 pandemic in terms of fatalities and economic implications. It should be noted that while coronaviruses and influenza viruses are different, the transmission mechanisms and containment measures are similar. However, the “age-specific mortality” seems to differ since the Spanish flu was especially deadly to younger people and infants, compared to COVID-19 that is more dangerous to the elderly.
  • According to World Health Organization (WHO) data, there have been over 16.45 million and 72.58 million confirmed cases of COVID-19 in the United States and globally, respectively. There have been over 301,536 and 1.64 million reported deaths in the U.S. and globally, respectively. India, which suffered the largest blow during the 1918 pandemic, has recorded the third-largest death toll at 144,451 deaths.
  • Based on projections published by Statista, COVID-19’s death toll might reach between 2.5 million and 3.4 million globally by end of March 2021. The death toll will be dependent on scenario with the best case scenario (95% mask usage) limiting the number of deaths to the minimum estimate.
  • According to a Bloomberg report, the economic impact of COVID-19 will last longer than that of the Spanish flu because of the high global debt levels and the fact that “international supply chains are unwinding across the globe” with countries offshoring less production due to the realized risks. Here is a url link for the Bloomberg report since it could not be properly linked:
  • Both reports from Bloomberg and NBER agree that the economic cost of COVID-19 will be higher and may last longer since the 2020 economy is more vulnerable than that of 1918. However, the both project that the human cost will be significantly less due to the current advances in medical technology.
  • While there is no way to determine exactly how much the economy will be impacted by COVID-19, early estimates found that the global GDP will drop by 2.4%.

Spanish Flu: Memories

This research highlights how people who lived through the Spanish flu describe that time in history. Survivors describe the 1918 pandemic as a period of widespread deaths, isolation and confinement, fear and uncertainty, and weakened social bonds. Details on these memories have been presented below.

Widespread Death

  • The Spanish flu is remembered as a pandemic with very high morbidity and mortality, infecting as many as 500 million people and causing nearly 50 million deaths globally. According to Edna Register Boone, a survivor of the 1918 pandemic, if a sick person was taken to a hospital, that patient was likely to be dead by the time they got to the hospital.
  • Boone further revealed that in cases where a patient did not end up dead before reaching the hospital, there would be no room to admit that patient. Hospital rooms would be filled and the doctors would be overwhelmed. During this time, most families simply buried their dead. Boone added that there were no church burials within that time and entire families died from the virus.
  • Another survivor, Charles Murray, also described the period as a time when a lot of people died. Murray recalled going to a funeral almost every day for a week.
  • Fredie Blom, a 106-year-old South African man who also survived the Spanish flu, remembers losing a sister in 1918 when the sickness arrived.

Isolation and Confinement

  • Annie Laurie Williams, a Spanish flu survivor, remembers being confined to the house. In a recent interview, Williams mentioned how they were confined to the house. This was not a legal imposition; however, people just confined themselves almost voluntarily to avoid going out.
  • News reports from that time indicate that public places like churches and schools were closed when the pandemic began.
  • In describing the situation during the 1918 pandemic, Glenn Holler said it was a really tough time when people would peep through a window and say hello just to see if the person was still alive. Besides these routine checks, visitors (or concerned neighbors) would not go into the house.
  • Typically, a white scarf was tied to the door of an apartment to alert the community that an infected person was residing within. This isolation and quarantine also led to boredom as people were compelled to either try out new routines, hobbies, or skills against their wish.

Feelings of Fear and Uncertainty

  • The catastrophic impact of the flu on almost all aspects of human life including transportation, commerce, law enforcement, and civic life made people afraid and uncertain of what the future holds. According to one survivor, during that time, “[everyone] suffered losses, one way or the other, if not through war, then through the epidemic.”
  • According to Steven Austad, 1918 was still a period of medicine where doctors were not adequately equipped to handle such a pandemic. Therefore, in the words of Steven Austad, these doctors were “probably killing more people than they were saving.” At the time, doctors did not have a clue what to do.
  • Another reason why people felt afraid and uncertain is the fact that countries were at war at the time and governments were censoring information. Countries did not want to cause panic or put their troops at a disadvantage. However, this further delayed efforts to reassure the public and slow the spread of the flu.
  • This fear was so strong that it is still evident in survivors today. For instance, José Ameal Peña, a Spanish survivor of the 1918 pandemic, is still having a hard time now. Peña is “afraid that something similar will happen again, even though [we are] living in very different times.”
  • According to one influenza survivor, Daniel Tonkel: “People were actually afraid to talk to one another.” Tonkel added: “It was almost like [don’t] breathe in my face; don’t look at me and breathe in my face, because you may give me the germ that I don’t want, and you never knew from day to day who was going to be next on the death list.”

Weakened Social Bonds

  • During the Spanish flu, many people quickly became furious as a result of the inconveniences of isolation. A letter written by a soldier read: “We were [quarantined] on account of the Spanish Influenza and everyone is mad.”
  • Another soldier was angry that the quarantine prevented him from sending a Christmas gift to his family. The closure of schools, bars, movie theaters, and public sporting events made people worried about the ways in which those public-health measures were disrupting their daily routines.
  • Due to the isolated nature of quarantine, the Spanish flu was suffered mostly in private. Unable to lean on their neighbors and friends for support, people experienced the pandemic alone in houses with shuttered windows. Violet Harris, a survivor of the pandemic, wrote in her diary: “I stayed in all day and didn’t even go to Rena’s.” “Mama doesn’t want us to go around more than we need to.”
  • These individual feelings of loneliness compounded. In some cases, the isolation eventually eroded previously strong community bonds.

Spanish Flu: Global Recovery

The 1918-1921 Spanish flu led to about a 6% drop in the global GDP and it took about 2 years for the global economy to recover from the impact of the pandemic. The Spanish flu pandemic came to an end during the summer of 1919 and social life returned to normal. People infected by the flu had either succumbed or had developed immunity and most countries adopted the practice of socialized medicine.

Economic Recovery

Return to Normalcy

  • The World Economic Forum reported that during the Spanish flu pandemic of 1918, several public health measures were enforced in parts of the globe, including quarantine, isolation, and the wearing of masks.
  • Reports indicated that America implemented public health measures better than Europe because the latter was more involved in the First World War.
  • According to History, the Spanish flu pandemic came to an end during the summer of 1919 and life returned to normal. People infected by the flu had either succumbed or had developed an immunity.

The New Normal

  • The measures that were put in place to contain the Spanish flu included a ban on public gatherings, spitting on sidewalks, handshakes, careless sneezing, and coughing. The use of handkerchiefs was both encouraged and was taught in schools.
  • Before the Spanish flu of 1918, the elite in society despised the underprivileged, because the elite thought the underprivileged lacked the drive for a good life. After the Spanish flu pandemic, it was realized that it was not prudent to blame the underprivileged for getting infected and to treat them in isolation. Most countries are now practicing socialized medicine.
  • NCBI reported that the use of handkerchiefs when coughing and sneezing started during the Spanish flu pandemic in September 1918.
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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