The Spanish Flu of 1918

Many of us have become glued to the news about the coronavirus crisis.  We read about it online, listen to reports on the radio, and watch the news coverage on television.  In New York, we tune into Governor Andrew Cuomo’s daily lunchtime briefings as well as the federal press conferences, which feature the President, Vice President, Dr. Anthony Fauci and Dr. Deborah Birx.  Regardless of the source, references to the Spanish Flu of 1918 are often made, but never truly explained.  This is why I spent a little time today Googling in order to put together this quick description of what happened about one hundred years ago.


The Spanish Flu of 1918 was an H1N1 virus with an avian origin. There never was any consensus as to where it started, although many people assume it was first reported in Spain, hence the name.  The fact of the matter, however, is that the first officially reported case was in the United States and related to military personnel.

The virus was referred to as the Spanish Flu because all of the early news coverage came out of Spain.  Coverage in the United States and most of the other European countries was censored as governments tried to maintain morale during the wartime years—the Great War, which later became referred to as World War I, ran from 1914 – 1918.  Spain remained neutral throughout the war and had a media that was free of wartime censorship.  Given the heavy news coverage of the virus coming out of Spain, people assumed it to be the origin of the disease.  Spaniards, however, referred to the virus as the French Flu.

The 1918 influenza pandemic was the most severe pandemic in recent history.  It is estimated that 500 million people were infected with about 50 million deaths (675,000 in the United States). The death toll was so high, in fact, that more U.S. soldiers died from the Spanish Flu than were killed in battle during the Great War.

Medical Treatments

The Spanish Flu was particularly deadly for children under five-years-old, young people from 20 – 40, and those 65+.  Oddly, those who were between 41 and 59 appeared to have a lower mortality rate.  No vaccine was available to protect against infection, no antivirals existed to treat the root disease, and no antibiotics were available to treat secondary infections.  In addition, the war created a shortage of physicians in many parts of the United States.  Hospitals were so stressed that schools and other buildings were converted into temporary medical facilities staffed by medical students.

Due to the limited options for treatment, many physicians prescribed aspirin, which had been trademarked by Bayer in 1899, as a way to address the symptoms.  With the expiration of their patent in 1917, other companies were able to produce aspirin making it readily available.  Doctors over-prescribed it, however, sometimes at a level of 30 grams per day.  Modern guidance limits aspirin consumption to 4 grams per day.  As a result, many patients who were already struggling with the Spanish Flu developed aspirin poisoning, which contributed to the build-up of fluids in the lungs.  Some of the deaths attributed to the virus were actually the result of this overuse of aspirin.

Government Efforts

Due to the lack of medical treatments, government interventions were limited to isolation, quarantine, use of disinfectants, and controls on public gatherings.  In some cases, people were ordered to wear masks and advised to avoid shaking hands.  Some cities and states handled it better than others, however.  Philadelphia, for example, made the mistake of permitting a large parade with tens of thousands of people to take place in September of 1918.  Within ten days of that parade, 200,000 people became sick and over 1000 died.  In contrast, St. Louis was a good example of effective governmental controls as the authorities closed schools and movie theaters and banned public gatherings.  The mortality rate in St. Louis was just one-eighth of Philadelphia.

The Four Waves and The End

The first wave of the pandemic was mild and occurred in the spring of 1918.  Infected people typically recovered after several days and the death rate was low. A second and more contagious wave of the virus appeared in the Fall, however, and many people died a short time after developing symptoms. The highest fatality rate of the pandemic took place in October of 1918.

The third wave of the flu began in early 1919 and lasted through mid-year impacting a few European countries and Mexico.  This wave was less severe than the second, but worse than the first.  A fourth and final wave hit selected areas like New York City and the U.K. later in 1919.  Very few people died in this last wave.  By the summer of 1920, the flu pandemic came to an end, as those who were infected either died or developed immunity.