Spanish Flu - A Historical Quiz

Answer: 1918-1920 During and immediately after WWI

The epidemic started in March 1918 during the last few months of the first World War. Troop movements were responsible for much of the spread of the disease in such a short amount of time. There were four distinct but successive waves of infection before the epidemic ceased in 1920.

Answer: One third

The number of people who were infected is internationally agreed at an estimated 500 million people. With a world population 1.8-1.9 billion at the time, (compared with over seven billion when the COVID-19 pandemic hit in 2020), which corresponded to one third of the world which was infected with influenza during the three years of the pandemic. What is not known is how many people died.

There are various reports published over the years with the figures ranging between 17 to over 100 million. This represented 1-6% of the world's population.

At that point in time the only epidemic that killed more people was the Bubonic plague (Black Death) of the middle ages where up to 50% of people in Eurasia died from this disease.

Answer: Lack of news censorship in Spain

The name "Spanish Flu" was coined early in the first wave. As Spain was neutral and not involved in WWI, it had little or no wartime news censorship. Therefore, unlike nations involved in the war, particularly France, Britain, USA and Germany, this country freely reported the epidemic's effects on the country, in particular the influenza illness of King Alfonso XIII.

As a result it appeared that Spain was particularly heavily affected when in fact it actually suffered less than its European neighbours who conveyed many troop movements which contributed, greatly, to the spread of the epidemic.

Answer: Military base, Kansas, United States

The pandemic is by consensus marked as having started on 4th March 1918. Case zero was Albert Gitchell, an army cook at Camp Funston in Kansas. Cases in the surrounding county could be traced back to January 1918. Within a few days 522 men at the camp were sick.

The disease was reported in Queens NY as early as the 11th March, becoming an epidemic in the Mid-West and the East Coast very rapidly. As troop movement was vast, the disease reached the western front in April and spread even more quickly in Germany which at the time, very late in WWI, had little infrastructure to slow the spread. Released POWs went back to Russia and took the disease with it.

It reached India, Japan and China by May. During this first wave was relatively mild with mortality rates only slightly above normal.

The first wave ended in July 1918.

Answer: The second wave was far more deadly than the first

The second wave was a far more deadly period than the first wave. The wave probably started in the ports of eastern France and spread quickly with troop movements to North America, the rest of Europe and Africa. It then spread very quickly to South America and Asia.

In the USA there were 292 000 deaths in the US alone in the last quarter of 1918. There were 13-20 million deaths in India in the same time period. Ironically the celebrations of the Armistice of 11 November 1918 also caused outbreaks in several countries.

Answer: Young-middle aged adults

The first wave was a typical flu epidemic with respect to age distribution of sufferers. Those who died were babies and toddlers, the infirm and the elderly, while young adults generally recovered without complications. However at the time, due to the disaster of four years, this was the the major age group affected by the war: malnourishment, overcrowding in medical camps and hospitals, and lack of hygiene promoted secondary bacterial superinfection (after they were debilitated with the initial influenza infection).

As there were no known effective antibiotics against the bacterial infections, young people died indirectly from influenza but were counted as part of the overall death toll.

Answer: Australia

Australia had been spared the ravages of the first two waves of the Spanish Flu because, like many other Pacific Island nations it had established a maritime quarantine. (Sound familiar?). As there was no immunity, 12 000 Australians lost their life to the pandemic and this next wave quickly spread through Europe and North America causing hundreds and thousands of deaths.

The death rate was a little less than the second wave and this third wave lasted until June 1919. A fourth wave hit particularly countries in the first four months of 1920 before the disease stopped spreading in May 1920, presumably as herd immunity had been 'achieved' on a global scale.

Answer: Adding fluorine to municipal water supplies

Masks were worn and were very common in Japan, though there is doubt about their efficacy. Social distancing was introduced through school, places of worship and theatre closures. Maritime quarantines were enforced on island nations such as Iceland, Australia, and American Samoa (and initially proved very effective).
Vaccines were available but these were for patients with bacterial super-infections. There was no vaccines available effective against the Influenza Virus itself.

Answer: True

The Spanish Flu pandemic faded from public consciousness until the bird and swine flu pandemics of the 1990s and early 2000s. While there were other influenza epidemics in the interim, notably Hong Kong Flu in 1968 and Russian Flu in 1977, these did not become true global pandemics. There were various reasons for Spanish Flu not getting media coverage. Most deaths, at the time, in the US at least, occurred within nine months during the second wave. The public had just gone through four years of WWI where thousands of deaths were reported every day. As well, people of the era were used to epidemics and pandemics with such diseases as typhoid, yellow fever, diphtheria, and cholera were daily occurrences in an era before antibiotics discovery.

Some historians listed the 1918-20 Pandemic as "The Forgotten Pandemic" Indeed, Alfred Crosby's 2003 book, "America's Forgotten Pandemic: The Influenza of 1918" shows in great detail how this strange situation arose.

Answer: Medical: The dire need for a vaccine accelerated such programs resulting in a vaccine being available less than 12 months after the pandemic was over.

The influenza virus was first isolated in 1933. This was somewhat of a surprise, as previously it was though that the flu was caused by a bacterium called Haemophilus influenzae (hence the name).The first flu vaccine was invented in 1938. Its primary use was to inoculate United States defence forces during WWII.

In a 2020 paper written arguably as a response to the 2020 Corona virus pandemic, "Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu", Correia el al argue that "non-pharmaceutical interventions" (public health measures), if implemented soon enough had no long lasting economic detriment on a region's economy.

In 2006, Douglas Almond argued that "Data from the 1960-80 decennial U.S. Census indicate that cohorts in utero during the [Spanish Flu] pandemic displayed reduced educational attainment, increased rates of physical disability, lower income, lower socioeconomic status, and higher transfer payments compared with other birth cohorts. These results indicate that investments in fetal health can increase human capital".

In 2008, Kenneth Kahn, in his paper "The 'Spanish' Influenza pandemic and its relation to World War I", that the greater mortality in the troops of the Central Powers tipped the balance causing Germany to surrender "earlier" than it would have been expected.

In June 2020 when this quiz was written the WHO Coronavirus Dashboard reports: "COVID-19 pandemic... more than 178 million cases have been identified and more than 3.87 million deaths recorded worldwide"

Could lessons have been learned from the Spanish Flu pandemic of 1912-20 before 2020? You be the judge.