It’s 1918 All Over Again

With theaters closed for the foreseeable future, I have spent my fair share of time lately watching online movies. The masochist instinct within me led me to view some films on disease epidemics. But I consciously avoided those featuring zombies. They just didn’t seem relevant to our current situation—at least not yet.

One of my favorite sayings goes something like this: Experience is the ability to recognize the mistakes we continue to make. So, I focused on fact-based movies, wondering if we are learning from past errors or merely repeating the same ones.

I started by comparing our current pandemic to the influenza outbreak of 1918. Unfortunately, there are not too many movies about that epidemic, fact-based or otherwise. There are two insightful documentaries[i] about it, both less than an hour long. You can find them on YouTube. Here is a short clip from the CDC that summarizes the devastating effects of the 1918 flu pandemic:

Wow! The 1918 flu pandemic led to more than 50 million deaths worldwide and 675,000 deaths in America—more than all the Americans who died in combat in all the wars in the 20th century. The vast majority of those deaths came within a single year. In October 1918 alone, over 195,000 Americans lost their lives as a result of the pandemic. Amazingly, in WWI, more American soldiers died from the flu than in battle. And interestingly, the 1918 flu hit Americans between the ages of 19 and 30 the hardest.

Let’s put those numbers into perspective.

So far, the U.S has had over 4,000 deaths from the coronavirus. Compare that to the flu where each year, on average, over 30,000 Americans die. And each year, 35,000 to 40,000 people die from automobile accidents in the U.S.

But the coronavirus is far from finished. Health experts say, without our current preventative measures, COVID-19 might be the country’s worst pandemic since 1918.

So, what can we learn from the 1918 pandemic that might help us during our current crisis? At least three lessons have emerged.

Lesson No. 1: Early action is critical.

Sadly, most government officials in early 1918 failed to recognize the growing threat. Royal Copeland, the health commissioner of New York City, said, “The city is in no danger of an epidemic. No need for our people to worry.” That statement sounds eerily similar to some of the first messages from the White House. President Trump initially dismissed the potential pandemic as “the new hoax,” stating that he wasn’t worried about it, “Not at all. We have it under control.” He claimed news outlets like CNN and the Democratic Party were “doing everything they can to instill fear in people,” and they were “trying to gain political favor by saying a lot of untruths.” Now, with our late start, we can no longer control the spread of the virus; we can only hope we can “flattened the curve” to the point where our medical resources are not overwhelmed.

Lesson No. 2: Social distancing works—at least to slow the spread of a pandemic.

As we look back on the history of the 1918 pandemic, we find those cities that practiced social distancing were the places least affected by the virus. The opposite was true. Philadelphia was one of the hardest-hit locations. Immediately before its surge in outbreaks of the flu, the city held a massive parade to sell war bonds. People lined the streets like sardines to watch the participants march arm-in-arm through the downtown streets.

At least some Asian countries heeded the warnings from 1918. For example, experts predicted Taiwan, only 81 miles from mainland China, would be among those with the highest number of cases. Instead, by February 1, it had implemented travel restrictions from the mainland, as well as other social distancing techniques. Those efforts have resulted in only 77 cases as of last week—fewer than even Iceland. Hong Kong and Singapore have had similar results by instituting the same restrictions.

America has now done the same, but far too late to prevent the spread of the disease. 

Lesson No. 3: Vital Resources Become Scarce

If you have seen old photos of what hospitals looked like in 1918, you would have noticed beds, barely inches apart, crammed in warehouses, hospital hallways, and just about any place where space was available. But the most significant shortage of supplies in 1918 were caskets. Today, fortunately, we still have plenty of coffins to handle the demand. But the need for ICU beds, respirators, masks, and face shields are testing the limits of our medical readiness. Planners or government officials underestimated the extensiveness of the disease or didn’t heed the warnings. But it is fruitless now to cast stones, other than to ensure we are ready for the next one.

We can also learn a few things from a deadly pandemic that hit a significant portion of the U.S. populations during the 1970s and 1980s, and which continues today worldwide. That is the spread of AIDS. Although we don’t talk much about AIDS anymore, its numbers remain staggering. In 2018, there were approximately 37.9 million people across the globe with HIV/AIDS. Of those, 36.2 million are adults, and 1.7 million are children ( under 15 years old). An estimated 1.7 million individuals worldwide became newly infected with HIV in 2018. Fortunately, deaths from AIDS-related illnesses peaked in 2004, but still, in 2018, 770,000 persons died from the disease (down from 1.7 million in 2004).

There are several great fact-based films about AIDS that can provide insight into our current pandemic. While there were scattered AIDS cases before 1970, it became an epidemic by the mid-1970s. Sadly, since in the beginning, the disease hit mostly gays, few people noticed what was happening. Worse, not many cared. President Reagan did not even say the word “AIDS” in public until 1985—five years after taking office. Here is a scene from the film, The Normal Heart,[ii] which illustrates the frustration of researchers studying AIDS in those early days to get anyone, especially those in government, to pay attention to their work:

One scene from the movie, And the Band Played On, shows a newspaper headline quoting a person with AIDS: Let not my epitaph read, “He died of red tape.” Sadly, though, many did.  

Those who had AIDS in the late 1970s found it difficult, if not impossible, to get the treatment and drugs they needed. Although early drug trials had obtained encouraging results from some medications, and other countries had made those drugs available, the FDA had not approved them, so the only way an AIDS patient could get them was illegal. But if you had AIDS, you would do almost anything to get them. Here is a scene from The Dallas Buyer’s Club,[iii] in my opinion, Matthew McConaughey’s finest two hours as an actor:

I love the line, “Screw the FDA; I’m going to be DOA.” Fortunately, in today’s crisis, we have already approved some drugs used for other illnesses that are showing promise against COVID-19.

But as we see COVID-19 overrun the medical systems of Italy and New York City, tough choices are being made. If you have two patients, one an otherwise healthy twenty-year-old, and the other, a ninety-year-old, with pre-existing medical conditions, who should receive the bulk of the medical resources? Most people, when faced with such an unwanted Sophie’s Choice, would pick the younger and more healthy of the two.

But does similar logic apply when we attempt to balance a person’s life against a faltering economy? Currently, some economists are predicting that unemployment in the U.S. might reach 37 percent. Dan Patrick, the Lieutenant Governor of Texas, recently said this on Fox News:

 “My message is that let’s get back to work. Let’s get back to living. Let’s be smart about it. And those of us who are 70 plus, we’ll take care of ourselves. But don’t sacrifice the country.”

President Trump has taken a similar stance, although he has said it more subtly. He originally wanted the country “open for business” by Easter, despite the advice from his medical experts and other government officials that such a move would be premature and disastrous to the health of U.S. citizens. Further, the President has proclaimed in a Fox News town hall meeting:

“You can destroy a country this way by closing it down. You’re going to lose more people by putting a country into a massive recession or a depression. You’re going to have suicides by the thousands. You’re going to have all sorts of things happen. You’re going to have instability. You can’t just come in and say, ‘Let’s close up the United States of America.’”

Recently, President Trump pushed back his target date, wanting the country to be open for business by April 30.

I acknowledge that some, maybe many people will be ruined if the “shelter-in-place” orders remain in effect for a prolonged period. Hopefully, the recent economic stimulus legislation will ease at least some of that burden. And I agree the economy needs to get back on track as soon as it is practical. And with commentators fussing over Dan Patrick’s comments, most have failed to focus on his statement, “Let’s be smart about it.” Perhaps that means certain age groups or specific geographic areas open before others. I will leave it to those much smarter than me to develop a workable plan. But like the AIDS epidemic, our priority should be saving as many lives as possible. Here is an excellent scene from the film, And the Band Played On:[iv]

This scene not only focuses on the fight between health and the economy, but it also emphasizes that, in crisis, it is typically the marginalized parts of our society that are the most impacted. Will it be the same with COVID-19? I hope not.

Admittedly, I am a person of privilege, and it is much, much easier for me to sacrifice economically than most other Americans. I also believe, as did the poet, John Donne, “that every man’s [and woman’s] death,” regardless of age, race, economic status, or health, “diminishes me, for I am involved in mankind.” The great uncle of the best friend of one of my grandchildren recently died from the virus. He was 70 years old but otherwise healthy. And although I had never met him, I left that loss, for I know my granddaughter’s best friend and her family. That same week, the father of the best friend lost his job. I don’t know which news he took the hardest, but I suspect, like me, he would always prefer unemployment over the loss of a family member.  

I have watched this scene from The Normal Heart repeatedly, but I am moved to tears every time I do. With the death of anyone—whether from COVID-19, the flu, AIDS, an automobile accident, or even natural causes—I contemplate what humanity has lost.

 In a recent editorial, The Dallas Morning News said this:

“This is a moment when we can look back and say we did what was selfless and right, or a time when we can say we left others to look after themselves and thereby needlessly accepted the loss of life.

“The nation we will be when we emerge from this depends on that choice.

“We want to be the nation where the strong among us determined that it was our time to make the greatest sacrifice for the good of all. That is the America that budded in the revolution and saw us through the Great Depression and the second World War.

“That is the America we can and want to be.”

I am not so naïve to think that we can save all people all the time. Some will still die from the flu and other diseases. We will lose lives through automobile accidents, and the coronavirus will claim many of us, despite our best efforts. But in crises such as these, we need real leadership, creative ideas, and a compassionate heart to help everyone get through it, especially those who are most vulnerable, whether medically, economically, or otherwise.

So, let’s all do our part to be part of the solution.

[i] The documentaries are (1) We Heard the Bells: The Influenza of 1918; and (2) PBS’s American Experience: Influenza 1918.

[ii] The Normal Heart:

  • Production Companies: HBO Films, Plan B Entertainment, and Blumhouse Productions
  • Director: Ryan Murphy
  • Screenwriter: Larry Kramer
  • Starring: Mark Ruffalo, Jonathan Groff, Frank De Julio, and Julia Roberts  
  • Release date: May 25, 2014

[iii] The Dallas Buyer’s Club:  

  • Production Companies: Truth Entertainment (II), Voltage Pictures, and r2 Films
  • Director:  Jean-Marc Vallée
  • Screenwriters: Craig Borten and Melisa Wallack
  • Starring: Matthew McConaughey, Jennifer Garner, and Jared Leto
  • Release date: November 22, 2013

[iv] And the Band Played On:

  • Production Companies: HBO Films and Spelling Entertainment
  • Director: Roger Spottiswoode
  • Screenwriters: Arnold Schulman (based on the book by Randy Shilts)
  • Starring: Matthew Modine, Alan Alda, and Patrick Bauchau
  • Release date: September 11, 1993

1 thought on “It’s 1918 All Over Again

  1. Robert J Ludlow

    Wow. This post really hit home with me as we all grapple with these trying times. Literally each film clip brought tears to my eyes and brought light to previous struggles and how people were ignored. The richest country in the world was so unprepared.

    “I am not so naïve to think that we can save all people all the time. Some will still die from the flu and other diseases. We will lose lives through automobile accidents, and the coronavirus will claim many of us, despite our best efforts. But in crises such as these, we need real leadership, creative ideas, and a compassionate heart to help everyone get through it, especially those who are most vulnerable, whether medically, economically, or otherwise.
    So, let’s all do our part to be part of the solution.”

    That paragraph is one of the best you have ever written! And ive read most of your work.

    Really a moving post with such great performances. Thanks for doing it.



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