Spanish Influenza vs. COVID-19

sketch of a man distanced from a crowd with the caption, "coughs and sneezes spread diseases, as dangerous as poison gas shells"Imagine being able to sit down with the Surgeon General of the United States during the Spanish Influenza outbreak of 1918 and a top doctor from the Centers for Disease Control and Prevention (CDC) during the current COVID-19 crisis at the same time and ask them a few questions about the pandemic du jour. Well, we can, thanks to the Oct. 15, 1918 article “Uncle Sam’s Advice on the Flu” in The Quill [i] from the Illinois Digital Newspaper Collection and the CDC’s extensive website dedicated strictly to COVID-19.

The diseases are different; the questions are the same. What about the answers? What can we learn from how the Spanish Flu pandemic was handled?

Get a drink, grab a seat, and let’s interview Surgeon General Rupert Blue and the experts at the CDC.

What is Spanish Influenza?

Spanish Influenza (SI) is a flu that resembles a cold, with a fever, pain in the head/eyes/ears/back/other parts of the body, and a feeling of severe sickness.

What is COVID-19?

COVID-19 is a disease caused by a new coronavirus in 2019 (CO=corona; VI=virus; D=disease). Human coronaviruses were first identified in the mid-1960s.  Sometimes coronaviruses that infect animals can evolve and make people sick and become a new human coronavirus.[ii] A novel coronavirus is a new coronavirus that has not been previously identified.[iii]  There are many types of human coronaviruses including some that commonly cause mild upper-respiratory tract illnesses. COVID-19 is a new disease, caused by a novel (or new) coronavirus that has not previously been seen in humans.[iv]

Is it like other flus?

SI:  That is not yet known.

Is it like other coronaviruses?

COVID-19: The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.[v]

 Did it originate in Spain?

SI: There is no reason to believe this. Germans mention this flu occurring along their eastern front (during WWI) in the summer and fall of 1917; it was believed to have started in the Orient.

Did it originate in Wuhan?

COVID-19: The sequences from U.S. patients are like the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir. However, the exact source of this virus is unknown.[vi]

How do identify you it?

SI: We have no way to determine if an individual case is this flu; the way it is done is to spot it by groups of cases (NOTE: hot spots, in more current terms). This flu can strike during any season, is much more severe than the average cold, and spreads rapidly. There is little or no increase in white corpuscles. The National Research Council and the United States Hygienic Laboratory are looking into creating a blood test to recognize this flu.

COVID-19: Two kinds of tests are available for COVID-19:  viral tests and antibody tests. A viral test tells you if you have a current infection. An antibody test tells you if you had a previous infection. An antibody test may not be able to show if you have a current infection, because it can take 1-3 weeks after infection to make antibodies.[vii]

What are the symptoms?

SI: The flu comes upon the patient suddenly; they may become weak, sore, dizzy, and vomit. Fevers of between 100 and 104 are common. Bloodshot eyes, a cough and runny nose all add to the overall appearance of a very sick person.

COVID-19: People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness. People with these symptoms or combinations of symptoms may have COVID-19: Cough, shortness of breath or difficulty breathing, or at least two of these symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, new loss of taste or smell, This list is not all inclusive.[viii]

What is the course of the disease: how long does it last and do people die from it?

SI: Typically, it lasts for three to four days, then the patient has a rapid recovery. The proportion of the deaths is relatively low. In some places the outbreak has been severe, and deaths have been numerous. When death occurs, it is usually the result of complications (developing pneumonia, ear inflammation or meningitis).

COVID-19: For most people, symptoms last a few days, and people usually feel better after a week.[ix]  People do die from COVID-19.  This page provides a weekly summary of deaths with COVID-19 by select geographic and demographic variables.[x] People with some underlying heath issues face a higher risk of severe illness (including death) from COVID-19.[xi]

How is it spread?

SI: It is now believed it is spread from person-to-person, the germs being carried with the air along with very small droplets of mucus, expelled by coughing or sneezing, forceful talking and the like by one who already has the disease. They may be carried in the air in the form of dust from dried mucus. A person with only a mild form of the disease may pass a severe attack to others.

COVID-19: The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).  Someone who is actively sick with COVID-19 can spread the illness to others.[xii]

What should be done by those infected?

SI: Go home at once and go to bed. This will protect the sick person from complications and well people from catching the illness from ‘scattering the disease far and wide.’

COVID-19: If you have a fever, cough, or other symptoms, contact your healthcare provided immediately. [xiii]

Tips for the nurse/attendant/caretaker

SI: Only but the nurse should enter the room. Mucus should be collected in rags or gauze and burned. Only take medicine prescribed from the doctor; do not ask the druggist for other medicines not prescribed; this would be dangerous. Do not take advertised patent medicines. The attendant to the patient, particularly if they interact with others in the home, should wear a wrapper, apron, or gown over their ordinary clothes while in the room and remove it when leaving the room. Nurses and attendants would ‘do well’ to not breathe in the dangerous disease germs by wearing a simple fold of gauze or mask while near the patient.

COVID-19: Use a separate room and bathroom for sick household members (if possible; clean the sick room and bathroom as needed, to avoid unnecessary contact with the sick person).[xiv] The person who is sick should wear a cloth face covering when they are around other people at home and out (including before they enter a doctor’s office). The cloth face covering helps prevent a person who is sick from spreading the virus to others. It keeps respiratory droplets contained and from reaching other people. The caregiver should wear gloves when you touch or have contact with the sick person’s blood, stool, or body fluids, such as saliva, mucus, vomit, and urine. Throw out gloves into a lined trash can and wash hands right away. The caregiver may also wear a cloth face covering when caring for a person who is sick. To prevent getting sick, make sure you practice every day preventative actions: clean hands often; avoid touching your eyes, nose, and mouth with unwashed hands; and frequently clean and disinfect surfaces.[xv]

Does the patient develop immunity after having had the disease?

SI: Although those that catch measles or scarlet fever will not catch it again, that does not appear to be this case with this flu. The King of Spain caught the Spanish Influenza 30 years ago when it overtook his country and caught it again recently.

COVID-19: We do not know yet if having antibodies to the virus can protect someone from getting infected with the virus again, or how long that protection might last.[xvi]

What can I do to avoid catching this flu/COVID-19?

SI: Keep the body strong by consuming good food (milk is touted as an excellent food to consume), keep a balance in work, play, and rest, and dress properly for the weather.  Authorities have noted a link between overcrowded homes and the spread of the disease. Overcrowding should be avoided. Fresh air is encouraged through opening the windows. When crowding is unavoidable, such as on street cars, one should turn their head, particularly from those sneezing or coughing. Keep out of crowded or stuffy places. Walk outside.

COVID-19: The best way to prevent illness is to avoid being exposed to this virus. You can take steps to slow the spread. Maintain good social distance (about 6 feet). This is very important in preventing the spread of COVID-19. Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Routinely clean and disinfect frequently touched surfaces. If you share space, make sure the room has good air flow.[xvii] Open the window and turn on a fan (if possible) to increase air circulation. Improving ventilation helps remove respiratory droplets from the air.



[i] “Uncle Sam’s Advice on the Flu.” The Quill, Volume 27, Number 24, 15 October 1918, page 1.

[ii] “Human Coronavirus Types.” . Accessed 5/12/2020.

[iii] “Coronavirus Disease 2019 Basics.” . Accessed 5/12/2020

[iv] “Coronavirus Disease 2019 Basics.” . Accessed 5/12/2020

[v] “Prepare your Health.”

[vi] What is the source of the virus?” . Accessed 5/12/2020.

[vii] “Testing for COVID-19.”

[viii] “Symptoms of Coronavirus.” Accessed 5/12/2020.

[ix] “Caring for Someone Sick at Home.” Accessed 5/12/2020.

[x] “Provisional Death Counts for Coronavirus Disease (COVID-19).” Accessed 5/12/2020

[xi] “Groups at Higher Risk for Severe Illness.” . Accessed 5/12/2020

[xii] “How to Protect Yourself and Others.” . Accessed 5/12/2020.

[xiii] “What to do if you are Sick.” . Accessed 5/12/2020.

[xiv] “What should I do if someone in my house gets sick with COVID-19?” . accessed 5/12/2020.

[xv] “Caring for Someone Sick at Home.” Accessed 5/12/2020.

[xvi] “Testing for COVID-19.” Accessed 5/12/2020.

[xvii] “Caring for Someone Sick at Home.” Accessed 5/12/2020.

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