Three experts on covid and how the Spanish flu ended

Despite the name, the Spanish flu probably originated in the United States. The first known death affected an American soldier in Kansas, in March 1918. It was probably an influenza virus in a pig, perhaps on one of Iowa’s many pig farms, which had mutated so that it could cross the species line and start infecting humans. In that case, it was then easy for the virus to travel to Europe and further out into the world with the help of American soldiers in the First World War.

That plague came to be called the Spanish disease, instead of, for example, the American disease, is due to the fact that Spain was neutral during the war. There, the press was free to report on the new disease. In the war-torn countries, however, everything that could make the country appear weakened was kept quiet. So you could say that it was in Spain that the disease made its public world premiere.

During the Spanish flu, there were also lively discussions about the extent to which public events should be limited and closed.

Photo: TT

Regardless of the name, the disease swept across the world in three deadly waves from 1918 to 1920. A total of 25-50 million people died, and at least a third of the earth’s population is estimated to have been infected.

Then passed the disease to become a milder seasonal flu. Why?

– The simple answer is that a sufficiently large part of the world’s population had been infected and received good basic protection, at the same time as the virus mutated so that it became kinder, says Annika Linde who has a PhD in clinical virology and was Sweden’s state epidemiologist 2005–2013.

A makeshift emergency room in Kansas, USA.

A makeshift emergency room in Kansas, USA.

Foto: National Museum of health and medicine/TT

She explains that a virus that has recently crossed the species barrier and causes severe diseases in humans often has the dangerous property of infecting tissue deep into the lungs. Many who contracted Spanish flu died of pneumonia, as the virus paved the way for bacteria that could infect the damaged lung tissue.

– Gradually, the virus mutated and began to settle higher in the airways. It then did not give as severe symptoms. This is often the natural development for a virus, because it can spread effectively from people who are relatively healthy and can meet other people, says Annika Linde.

Although the virus itself was still unknown, the advice during the Spanish flu is reminiscent of current infection control measures.

Although the virus itself was still unknown, the advice during the Spanish flu is reminiscent of current infection control measures.

Foto: National library of medicine/TT

She points out that it maybe something similar is now visible for covid-19. From the beginning, the new coronavirus sars-cov-2 bit deep into the lungs. But now there are reports that the omicron variant binds higher up in the airways.

– It may very well be so, and that is what you could expect. But I have not seen it verified yet, says Annika Linde.

Influenza pandemics in modern times

(millions killed)

Influenza pandemics in modern times

* Swine flu. About 18,500 laboratory-verified deaths according to the WHO. The US Centers for Disease Control and Prevention (CDC) has estimated the number of deaths worldwide between 151,700 and 5,75,400 in the first year.

Although Spanish the disease ceased to be a pandemic around 1920, the virus remained. It reappeared in milder form year after year for a long time to come. Most often it only appeared as a mild seasonal virus, but for example in 1922, 1927 and 1929 there were slightly more severe outbreaks, which in Sweden led to an excess mortality of a few thousand people, in the same way that seasonal flu still varies in mortality.

Red Cross paramedics made significant contributions during the Spanish flu.

Red Cross paramedics made significant contributions during the Spanish flu.

Photo: Red Cross / TT

In 1957, the milder variant of the Spanish flu virus was finally pushed aside by the new Asian pandemic. Thought one. But almost 20 years later, in 1976, the virus suddenly reappeared. Strangely enough, in a form that was identical to a variant that circulated in the 1950s. It should have changed much more if in all these years it had been hidden in the animal world or in some hidden place, the researchers reasoned.

Nowadays, the most reasonable explanation is considered to be that the virus had escaped from a laboratory, where it was frozen and saved for research purposes. It explains how it could appear unchanged almost twenty years later, as if no time had passed. Fortunately, this did not lead to a really serious outbreak, which is otherwise a risk as immunity has begun to disappear in the population.

Temporary tent hospital in Massachusetts, USA, 1919.

Temporary tent hospital in Massachusetts, USA, 1919.

Foto: Courtesy Everett Collection/TT

– It is not really so strange that it was a laboratory leak, because at that time they had not realized that you have to deal with a lost flu virus that no one has immunity to anymore with great care and accuracy. Now there are very strict restrictions, says Annika Linde.

When the swine flu appeared in 2009, the Spanish descendant was pushed away, perhaps for good, she adds.

The temporary “Spanish Hospital” in Östersund in 1918, which was housed in the Old School’s gymnasium, in the autumn of 1918.

Photo: TT

The Spanish flu struck against the world in three waves with high death rates before the pandemic ended. The corona pandemic is now in its fourth, or even fifth wave – at least if you look at the number of infected. But Jonas F Ludvigsson, pediatrician in Örebro and epidemiologist and professor at Karolinska Institutet, points out that it may be wrong to compare the number of waves in that way.

– If someone completely outsiders had only looked at the number of dead now, they might not have called this a fourth wave. So the question is what we define as waves, he says.

The Spanish flu hit younger adults the hardest.  The older population probably still had some immunity from the 1890s Russian cold.

The Spanish flu hit younger adults the hardest. The older population probably still had some immunity from the 1890s Russian cold.

Foto: National Library of Medicine/TT

– We know that the Spanish flu had three waves with many dead, but we do not know if it then had several waves with a large number of infected who did not die. It was not possible to make that kind of exact diagnosis at that time, and I do not think the government paid much attention to whether people just had a cold and had a fever, as long as they did not die or become seriously ill.

Spanish flu, 1918-1919

About 50 million people died. Almost everyone who died was younger than 45 years.

Spanish flu, 1918-1919

So the question is whether we may now have begun to see the end of the corona pandemic. Fredrik Charpentier Ljungqvist, who is an associate professor of both history and natural geography at Stockholm University and author of the book “Corona: a historical perspective on the pandemic of our time”, points out that the end of a pandemic is about more than just the spread of infection.

– To say when a pandemic is over also becomes a bit of a semantic question, or a question of attitude. When the reactions to the pandemic and measures to reduce the infection cease, it eventually also depends on pandemic fatigue and public opinion. It is, so to speak, also about an opinion and political will, and not just the spread of infection and mortality per se.

Report in the New York Times from 1918, about the fight against the new pandemic.

Report in the New York Times from 1918, about the fight against the new pandemic.

Foto: Granger/REX

At that point, there is a big difference between today’s pandemic and the Spanish flu, he says.

– Then they were more used to the fact that serious diseases were rampant. What is unique to us is that we have not had a serious pandemic in the near future, and that we have a perhaps unrealistically high expectation that we will be able to cure or at least alleviate almost all diseases through modern medicine, says Fredrik Charpentier Ljungqvist.

A hospital in Sveg around 1918. In Sweden, approximately 35,000 people died of Spanish flu.

A hospital in Sveg around 1918. In Sweden, approximately 35,000 people died of Spanish flu.

Photo: TT

What traces did the Spanish disease leave in people’s minds?

– Despite the fact that more people died in the Spanish flu than in the First World War, it did not leave as enormously deep traces as one might imagine. It does not seem to have been such a big trauma but became almost a small anecdote that ended up in the shadow of the First World War, something that was more or less forgotten quite quickly during the “happy 20s”.

How do you think people will think back on the corona pandemic?

– It has hit different people so differently. Some, for example, have been hit hard, while others rather think that limited social interaction and teleworking have been nice. But historically we know that pandemics usually do not make a particularly strong impression, so I’m not sure there will be such strong memories at all. Overall, I think people around the world will mainly remember different types of restrictions, says Fredrik Charpentier Ljungqvist.

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