What We Still Haven’t Learned Since the 1918 Pandemic
By Katrina Meyer
In recent weeks, a number of people have made comparisons between the current COVID-19 pandemic and the Spanish flu outbreak of 1918. While the degree to which these deadly disease outbreaks mirror each other is difficult to determine so early into the coronavirus pandemic, parallels between the pandemics can reveal lessons for the coming months as the whole world attempts to shift their habits and the economy shutters sector by sector.
The 1918 pandemic was incredibly deadly. It killed more people in 15 months than the bubonic plague killed in the entire 14th century. The lethality of this particular disease can be attributed to the limited medical technology available at the time. Physicians adopted ineffective and even deadly treatments like bloodletting – the surgical removal of some of a patient’s blood. Further, large scale deployments of soldiers to the trenches of World War I sped up the spread of the disease. These factors worsened the outbreak in 1918 but wouldn’t affect most of the world today. But there is one common variable between the outbreaks that continues to threaten our capacity to combat the disease: governmental limiting of accurate information and the spread of misinformation.
Even the name we attribute to the 1918 outbreak reveals a clear connection. At the time of the outbreak, Spain was the only country that allowed its papers to accurately report on the disease. To this day, scholars are not entirely sure where it started (though the majority of experts believe that it started in Kansas in troop barracks waiting to be sent abroad) because the Wilson White House imposed strict silencing of accurate medical reports. How did the United States impose such strict limitations on public access to information? The answer: the Espionage and Sedition Acts, passed in June of 1917. The Acts were designed to limit the expression of dissent and dissatisfaction on the homefront. Newspapers could be shut down, and individuals faced steep fines and jail sentences for any remarks or reports that targeted the government, which used what was perceived to be “disloyal, profane, scurrilous, or abusive language” targeted at the government, the constitution, the army, or the flag. This allowed the government to do three troubling things: silence newspapers, ignore doctors, and spread false information.
After the passage of the acts, the White House’s first action was to authorize the Army to prosecute newspapers like the Jefferson County Union of Wisconsin. The Army prosecuted the paper for hurting morale on the homefront after they ran a report indicating that the illness was potentially more serious than people thought on September 27, 1918. Just a few months later, the Supreme Court upheld the sentences of Eugene Debs and Charles Schenck in a pair of unanimous decisions showing that the Espionage and Sedition Acts did in fact override First Amendment rights to free speech in the eyes of the courts. Anything that presented a “clear and present danger” to the US was not protected speech. This clear and present danger test was interpreted widely by courts. Ultimately, Debs and Schenck were among more than 2,100 individuals prosecuted under the Acts. The consequences of the court’s wartime dismissal of first amendment right concerns were clear. The government had the power to limit speech it felt compromised morale on the homefront, and the government decided that real information about the pandemic was a threat.
As the crisis unfolded, doctors’ warnings were ignored which was another critical mistake. The response in 1918 Philadelphia represented one tragic case study. A pro-war parade was scheduled for September 28. Doctors begged Public Health Director Wilmer Krusen to cancel the parade given serious concerns about the speed with which the influenza was spreading. People in Philadelphia had already been dying, but Krusen was unmoved. Doctors went to journalists to get their warning out, but fearful editors refused to publish stories. The parade went ahead and was the largest in Philadelphia’s history. More than 14,000 people ended up dying in Philadelphia alone. But in St. Louis, which did cancel its parade, the death total in the city did not rise above 700, clearly showing the benefits of heeding doctors’ warnings.
Not only were people and doctors silenced, but the government was also responsible for the spread of false information. President Woodrow Wilson, concerned with strictly containing information, created the Committee on Public Information. The idea behind the office was inspired by an advisor who wrote, “Truth and falsehood are arbitrary terms. The force of an idea lies in its inspirational value. It matters very little if it is true or false.” There are many examples of public health officials deliberately and misleadingly downplaying the threat of the virus from the US Surgeon General to Public Health Directors like Krusen. An Army bulletin claimed in July 1918 that the “epidemic is about at an end…and has been throughout of a benign type.”
Today, we see a disturbingly similar pattern. Doctors and other individuals are facing censure while misleading and contrary statements have been issued. One medical professional, an employee with the Department of Health and Human Services blew the whistle on how the first coronavirus quarantine patients were treated by doctors who were not prepared for what they faced. After this disclosure, the individual faced retaliation, which causes a chilling effect on others who might want to come forward. Additionally, the office of Vice President Mike Pence has ordered all government employees to run all public communication through his office. Finally, President Donald Trump has made statements that directly contradict earlier statements from his office. After initially and repeatedly claiming that the coronavirus was not a threat to Americans, he recently stated that he knew it would be a serious pandemic from the beginning.
While there is certainly more information available today than in 1918, these trends are concerning, and should not be taken lightly. Transparency and accurate information are always critical, but in times of crisis, they can literally save lives. The lesson from 1918 is clear. Restricting information or spreading misinformation can have disastrous consequences. For the sake of public health, we cannot continue to repeat mistakes of 1918 as we confront the COVID-19 crisis.