How Did The 1918 Pandemic End? I’m Not Sure You Want To Know

Short Of A Vaccine Or Drugs, The Pandemic Ends Only After Mass Illness and Death, Or Dumb Luck

Those who don’t remember history are doomed to repeat it. We hear that tired idiom often, and we heard it again at the start of the pandemic when comparisons were made to the 1918 Spanish Flu pandemic, the deadliest in modern history.

Mask-wearing women hold stretchers near ambulances during the Spanish Flu pandemic in St. Louis, Mo. in October 1918 (National Archives)

On Thursday morning, Ross Barkan, a New York journalist and writer who has written a lot about New York’s COVID-19 response asked a pertinent question: How did the 1918 pandemic end, and why aren’t we talking about that more?

Early on, the comparisons to 1918 were focused on how quick to respond with mitigation efforts and how long they should be in place. But we never talked about how the pandemic played out. The reason, I believe, is simple: We don’t want COVID-19 to end the way the Spanish Flu did.

There was an implication in comparing this to 1918 that a few weeks, or at worst months, of social distancing and the pandemic would end. That was never going to be true, nor was it true a century ago.

In the end, 675,000 people died in the United States during the Spanish Flu epidemic, and that was almost entirely within a 14-month span: March 1918-May 1919. The country’s population was almost less than a third of what it is now. The death toll from the 1918 pandemic in America per capita would equal about 2.3 million today. That was with 3 to 4 months of mitigation tops, some places like Philadelphia only did mitigation efforts for a few weeks, and 6 months or so of mask wearing. New York City held a ticker-tape parade celebrating the end of World War I only a few weeks after the second wave of the Spanish Flu peaked. Eventually, 50 million Americans, or HALF the population of the country, came down with the virus in about a year’s time. Only then did it stop.

There are two theories as to why it stopped. One is that the world reached a level of herd immunity that allowed transmission to slow down to a trickle, and though H1N1 continued circulating beyond the end of the pandemic in 1920, it did so slowly, allowing the annual flu season to be manageable. Another is that it mutated to a less lethal strain.

When we talk now about rolling lockdowns, mask wearing and social distancing, we’re no longer talking about eradicating COVID-19. We are basically talking about managing herd immunity in a way that our healthcare system can handle it, and in a way that saves as many lives as possible. That was always what it meant, but it was never clearly communicated to the public. Studies done by Imperial College in London in March and by Dr. Mike Osterholm and a team of Harvard researchers back in May suggested lockdowns would not eradicate the virus, but just slow transmission, and we would have to go in and out of lockdowns for as long as two years until herd immunity is reached. Experts pretty early on realized that the virus wouldn’t be eradicated through social distancing and lockdowns, it was already doomed to become endemic. The World Health Organization’s Mike Ryan said as much in May. Osterholm and Chicago Health Commissioner Dr. Allison Arwady both suggested the virus would never go away this past week.

“If COVID were going to be over in a month or two, this would be an easy decision. Of course we would we would we would all hunker down and wait two months, but it’s not. At the health department we’re planning two to three years where we think about sort of the COVID response and throughout that whole time,” Arwady was quoted as saying. “I don’t know we’ll ever get to a point where COVID will be eradicated.”

In other words, another lockdown won’t eradicate the virus. It’ll still be here when we open up, as it was in Croatia, Israel and Vietnam, which all at one point appeared to eradicate COVID-19 from their borders. Any restrictions now are purely about preventing exponential growth that will overwhelm hospitals, not achieving eradication.

Any restrictions now are purely about preventing exponential growth that will overwhelm hospitals, not achieving eradication.

Which means we have one of three options to end this pandemic:

  • An effective vaccine and high number of people being vaccinated
  • 50 to 70 percent of the country getting the virus with a lot of death and permanent illness coming from it
  • Luck – the virus mutates and disappears

That’s it. Those are our options. Everything in between is just about spreading the illness and death over a longer period of time, to learn more about the virus so we can treat it better and save lives and perhaps make it a less serious illness.

It makes sense that experts won’t openly admit this. If we knew we were going to live like this for years and most of us will still get sick anyway, would we be more inclined to just let it happen now and get it over with so we can move on with our lives? Would governments, facing falling tax revenue and longtime economic and social unrest, think that’s a “better” strategy? Sweden did. Brazil did. India now has, as as the United States, and increasingly other countries, such as Croatia and Mexico, that are seeing new spikes and not shutting down again,

It was always a mistake to compare this to 1918. This isn’t a flu virus, it’s much more contagious and does not mutate nearly as fast. And the ugly truth is, odds are, unless we are all vaccinated soon, you are probably going to get COVID-19 eventually, either now, or a few years from now, unless you plan to spend perhaps the rest of your life in quarantine.

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