Infectious Diseases

COVID-19 and Spanish Flu: Learning From the Mistakes of the Past

Posted on 17 April 2020

The 1918 Spanish flu pandemic is considered the most deadly in modern history, killing anywhere from 50 million to 100 million people worldwide. While medicine has advanced in the last hundred years, our main tool for preventing the spread of a pandemic in the absence of a vaccine remains social distancing.

If governments in 1918 employed similar methods to the measures being implemented now, then surely something can be learned from their effectiveness. Past studies examining the death rates in different U.S cities suggested that timing is key; cities that implemented social distancing early had death rates around 50% lower than those that were late.

How some cities ‘flattened the curve’ during the 1918 flu pandemic. (2020). Retrieved 17 April 2020, from

Unfortunately, many countries did not learn the lessons of the flu pandemic, and hesitated to enforce social distancing at the start of the coronavirus outbreak, even as their neighbours were forced into lockdown by mounting cases. If we cannot learn from the mistakes of last week, what hope do we have of learning from the mistakes of last century, one might wonder? However, we may have another opportunity – avoiding a second peak. Studies suggest that that not relaxing measures too early is important. Cities that were encouraged by low death rates and chose to lift restrictions early experienced a second wave of high mortality, while none of the cities that maintained their interventions experienced this second wave.

Today, in a world that allows infectious diseases to spread with unprecedented speed, we would do well to remember that humanity has faced this challenge before. Learning from past mistakes will help us prevent history from repeating itself.


Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic: doi:10.1001/jama.298.6.644

Public health interventions and epidemic intensity during the 1918 influenza pandemic:

How some cities ‘flattened the curve’ during the 1918 flu pandemic:

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