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ALAMY; KATHARINE LOTZE/GETTY IMAGES (BOOKS)
In 1918, the Spanish flu killed more than 50 million people
around the world. The lessons of that outbreak could
save countless lives in the fight against the coronavirus.
By Jonathan D. QuickProvide effective leader-
ship.In 1918, Philadelphia was
one of the hardest-hit Ameri-
can cities, partly because it
was, as the muckraker Lincoln
Steffens put it, “the worst-governed city
in America.” In his book “The Great In-
fluenza,” the historian John M. Barry de-
scribes the efforts of Dr. Wilmer Krusen,
director of Philadelphia’s
Public Health and Chari-
ties department, a well-
intentioned man who
lacked public health ex-
perience and was prone
to inaction. On Sep. 28,
1918, he allowed the city
to proceed with a Liberty
Loan parade to sell mil-
lions of dollars in war
bonds, despite warnings
that the event would
spread illness. The parade drew 200,000
people; within 72 hours, every bed in the
city’s 31 hospitals was filled.
By contrast, Mr. Barry shows, St.
Louis had the most success of any large
American city in fighting the pandemic.
Dr. Max Starkloff, the city’s health com-
missioner, said that his goal was to
“keep the epidemic out of the city, if
possible, and if that fails, to use every
means to keep it down to the lowest
possible number of cases.” He created an
advisory body that included representa-
tives of the city’s chamber of commerce,
schools, medical society, university, Red
Cross and local public health services.
He pursued what he called “intelligentcitizen cooperation” through
active outreach to the com-
munity. And he engaged
health department staff, pol-
icy makers and teachers to
implement individual quarantines and
bans on public gatherings. Thanks to
Starkloff’s rapid, inclusive and system-
atic efforts, St. Louis’s mortality rate
from the flu was half of
Philadelphia’s.
Leadership mattered
even more at the na-
tional level. President
Woodrow Wilson was so
focused on winning
World War I that he
would not listen to re-
peated warnings about
the pandemic from the
chiefs of the Army and
Navy,orevenfromhis
own personal physician. The U.S. ended
up losing 675,000 lives to influenza,
compared with 53,000 killed in combat
in World War I.
PleaseturntothenextpageA third
of the world’s
population
was infected
within
months.An Army flu
ward in Kansas
during the 1918
pandemic.WhatWeCanLearn
Fromthe20thCentury’s
DeadliestPandemic
T
he “Spanish” flu of 1918was one of the deadliest pandemics
in human history. Seeming to come from nowhere in the wan-
ing days of World War I, it spread through a war-ravaged world
like wildfire. In a matter of months, a third of the world’s popu-
lation was infected, 50 to 100 million people died, and the
global economy shrank by 5%.
The world of 1918 was very different from today’s, where the
new coronavirus is emerging as another potential pandemic. A century
ago, antibiotics, modern hospitals, intensive care units and instant
communication did not exist; most people lived in rural communities;
intercontinental travel took weeksrather than hours. Now the world’s
population is four times larger, with more than half living in urban ar-
eas. National economies are heavily intertwined because of globaliza-
tion. Health services are highly sophisticated in wealthy countries,
though their quality varies greatly in the rest of the world.
From a public health perspective, however, there are important simi-
larities between the 1918 flu and the 2019 coronavirus. Both were pre-
viously unknown viral strains for which there was no existing vaccine
or proven medical treatment. Both spread through respiratory droplets
and killed primarily by means of pneumonia and other complications.
Both caused severe economic disruptions. With the growing risk of a
full-blown pandemic, applying the lessons of the 1918 flu could save
countless lives in 2020.Dr. Quick, an adjunct professor at
the Duke Global Health Institute,
is the former president of Management
Sciences for Health, a global public
health organization, and served as
Director of Essential Drugs and
Medicines Policies at the World Health
Organization. His books include “The
End of Epidemics: The Looming Threat
to Humanity and How to Stop It.”