Influenza in 1918 Versus Coronavirus in 2020: What We Can Learn

People talk about coronavirus as though it is will soon be eliminated: a temporary disaster which will be all over within a few months or a year at most. Sadly, that likely won’t be the case. Coronavirus will be here in 2021, in 2022 and probably beyond. By then – hopefully – we will have developed a vaccination.

Theoretically, it is possible to eliminate the virus with a single vaccine if enough people get vaccinated and if the virus does not mutate and change its antigens to stay ahead of vaccine immunity. However, experts say another future possibility is that coronavirus will become a seasonal virus like the flu, recurring each year in a slightly different form. Dedicated medics would update the vaccine each year to adapt to antigenic changes, just like the flu vaccine. It is hard to say what the outcome will be at this point, but respiratory viruses are generally the most difficult to completely eradicate, so COVID could be here to stay. Like flu, is an RNA virus, which is more prone to mutation than DNA viruses, although it doesn’t appear that SARS-CoV-2 mutates as rapidly as influenza.

What can we learn – or, perhaps, what should we have learned – from the influenza pandemic over a hundred years ago?

A vaccine for COVID-19 is on its way

What was the 1918 influenza pandemic like?

The flu tore through the world – just as coronavirus is tearing through the world right now – just over a century ago. It infected around 500 million people in four successive waves between February 1918 and April 1920: around a third of the global population. It is estimated that around 10% (50 million) of those affected were killed by the virus. The epidemic was unique in that a disproportionate number of its victims were men and women aged 15 to 44.

It was first observed in Europe, with the first reported cases in Spain, landing it the nickname ‘The Spanish Flu.’ It then swiftly spread around the world. No country was untouched. Since then, the flu has become a seasonal phenomenon.

In the first half of the twentieth century, there was limited medical knowledge surrounding viruses so there were no effective drugs or vaccines to treat the this deadly strain of flu. British researchers were the first to identify the human flu virus by experimenting with ferrets in 1933, but it wasn’t until 1945 that the first license to produce an influenza vaccine for civilian use was granted.

Later mutated strains of the virus have been less deadly, especially since vaccines were developed. Now, the death rate of the flu is around 0.1%. It kills around half a million people every winter (estimates vary between 250,000 and 600,000).

Perhaps it will be a similar story with coronavirus; time will tell.

How was the influenza pandemic contained?

The influenza pandemic was more severe than coronavirus. It affected a larger proportion of the world population and killed a higher proportion of those infected. Lockdown-style public health measures and restrictions were implemented, similar to those in place today, and perhaps societies across the globe a century ago coped better with this better than we are because they were less commercialised and consumer-driven.

In the UK, there was no centralised lockdown, but many theatres, dance halls, cinemas and churches were closed, in some cases for months. Pubs mostly stayed open and football matches continued. Public health advice and recommendations sent mixed messages and – like today – conspiracies and misinformation abounded.

In the U.S., measures were somewhat stricter, but there was no coherence across the different states. Schools, theatres, churches and dance halls in cities were closed in some states. Kansas City banned weddings and funerals if more than 20 people were to be in attendance, while New York City’s health commissioner mandated businesses to open and close on staggered shifts to avoid overcrowding on the subways. Seattle’s mayor ordered his constituents to wear face masks.

Recent studies of the varied responses to the 1918 pandemic show that a critical factor in how much death rates were reduced was how soon the measures were put in place.

Face masks were used in 1918 too

What are the similarities and differences between influenza and coronavirus?

Although there is arguably a lot we can learn from the influenza pandemic, it is important not to conflate the two. Furthermore, there is still a lot about COVID-19 which remain unknown even to scientists and health experts.


  • Both are respiratory viruses
  • They cause similar symptoms: fever, cough, shortness of breath, fatigue, sore throat, muscle pain, headache
  • For both, it is possible to spread the virus for at least 1 day before experiencing any symptoms
  • Both are RNA viruses, which means they tend to mutate
  • Both are spread mainly by droplets made when people with the illness (COVID-19 or flu) cough, sneeze, or talk – this means similar measures to prevent transmission can be applied.
  • There are complications which are associated with both illnesses, including pneumonia, respiratory failure and acute respiratory distress syndrome


  • While COVID-19 and flu viruses are thought to spread in similar ways, COVID-19 is more contagious among certain populations and age groups than flu and spreads more quickly and easily.
  • The risk of complications for healthy children is higher for flu compared to COVID-19. However, infants and children with underlying medical conditions are at increased risk for both flu and COVID-19.
  • Although it is far less deadly now, influenza had a higher death rate during the 1918 pandemic than coronavirus today. However, there were four waves of influenza in total, and we are only just approaching the second wave of COVID-19.
  •  It appears that SARS-CoV-2 does not mutate as rapidly as influenza.

COVID-19 has changed the world

How should governments prepare for a pandemic?

There is a lot we could have learned from the influenza pandemic in 1918. Knowledge of how different nations responded to the pandemic in 1918 – what worked and what didn’t – could have informed a concrete strategy for dealing with a future pandemic. Scientists and medics were not surprised by the arrival and escalation of COVID-19, but governments and citizens were; this is a gap which needs to be bridged. There should be more communication between the health experts and the politicians to formulate coherent strategies in order to avoid the inconsistency and chopping-and-changing which has characterised the UK’s response to the pandemic.

Governments have an obligation to invest in public-health systems to protect their citizens from both the threat and the reality of the next pandemic. Perhaps now, we will finally learn. The next pandemic could arrive in ten years, or a hundred years. We cannot know, but we can be prepared.