Down With the 'Spanish Flu'

In 1918, an influenza pandemic swept the world, causing more deaths in a year than any event in human history—a rather broadly estimated 50 million to 100 million, or 3 to 6 percent of the world’s population. The flu, which killed around 20 percent of those who contracted it, became known as the “Spanish flu” or the “Spanish Lady.” The name spread, well, like influenza and has persisted to this day.

But just as Chinese checkers wasn’t invented in China, Australian shepherds aren’t from Australia, and freedom fries aren’t French, the Spanish flu did not originate in Spain nor did Spain bear the brunt of it. In fact, of the millions of influenza deaths, less than 260,000 took place in Spain.

The misnomer, according to an episode of the podcast BackStory, came about as a result of geopolitical forces. When the pandemic broke out during World War I, neither side wanted the other to find out they were sick—nor did they want their own troops to lose morale or their publics to panic. News of the outbreak was suppressed or heavily underplayed in Germany, France, the U.K., and the U.S. But Spain, like Switzerland, was neutral in the war, and its media had no qualms about covering the contagious outbreak weakening its population, creating the false impression that this was a Spanish disease. As virologist John Oxford put it: “And the rest of the world I think looked around and said, ‘What’s going on in Spain?’ And so since that time, much to the annoyance of the Spanish and much to the annoyance of Spanish virologists, I can tell you, we’ve all called the Spanish flu ever since.”

An article in a 2008 issue of the journal Clinical Infectious Diseases tracks the extensive flu coverage in the uncensored Spanish media. It first appeared in a headline in Madrid’s ABC newspaper in May 1918 and was blamed on Madrid’s annual holidays, which saw people gathered in close contact in ballrooms and parties. Soon King Alfonso XIII became ill, as well as the prime minister, and la epidemia reinante (“the prevailing epidemic”) became daily news fodder. Though the flu was striking people ill in a dramatic fashion, mortality was initially low, and the flu became known as the Soldado de Nápoles, named for a catchy Spanish song popular at the time. It soon became clear, however, that this flu was no laughing matter.

Though Spain’s relatively free press and great interest in the flu led to its association with the flu, the country was far from the hardest or the first hit. Spain’s mortality rate (120 per 10,000 people) trailed both Italy’s and Portugal’s among the European countries included in a 2009 paper published in Influenza and Other Respiratory Viruses. In fact, though cases were reported in May, Spain’s official “pandemic period” didn’t even begin until June 1918, while Finland’s began in January, and Germany’s, Bulgaria’s, and Portugal’s in March. To this day, it’s still not agreed where exactly the 1918 H1N1 virus originated. Previous research has suggested China, France, and even Kansas as potential sources, but according to the aforementioned study of European mortality burdens, it likely wasn’t Europe: The authors conclude that “the synchrony of the mortality waves in the different countries … pleads against a European origin of the pandemic, as was sometimes hypothesized.” These days, the flu is believed to have reached Spain via France.

The fairer name in the blame game would probably be the “World War Flu”—or the “Politicians’ Flu.” As Oxford points out on BackStory, politicians hold much of the blame for the flu’s millions of deaths—it wouldn’t have been so deadly had it not been for the war and the large number of troops concentrated in Europe. “I myself put it at the feet of politicians,” he said. “If it had not been for that war, the pandemic would not have arisen.” When the war came to an end and troops began returning to their various corners of the globe, the flu came with them, spreading exceptionally rapidly for 1918. While it’s still unclear where exactly it originated, the war was clearly to blame for its range. Furthermore, wartime censorship meant it took communities by surprise, while wartime conditions of lowered nutrition and sanitation likely inflated the death rate.

Europe was hit hard and early, but truly, the whole world suffered. The U.S. actually fared better than most: According to the Europe mortality burden report, estimates of the American death toll range between 400,000 and 675,000—as little as 0.47 percent of the population (as compared with Europe’s 1.1 percent). Other countries were not so lucky. The flu killed somewhere between 902,400 and 2,431,000 Iranians—between 8 and 21 percent of the total population of Iran. According to estimates, the pandemic killed up to 17 million people in India; 1.5 million in Indonesia; 400,000 in France; 390,000 in Japan; 250,000 in Britain; and 100,000 in Ghana. One of the hardest hit areas was about as far away from the war as one could get: Pacific Islanders had among the highest mortality rates, with Tonga, Tahiti, Nauru, and Western Samoa losing large swaths of their populations in a space of months (Western Samoa lost 20 percent of its population in less than two months). This, along with the tragically high death rate among Maori and Native American populations, is suggested to be in part due to lower rates of previous exposure: their “naïve” immune systems.

What does all this mean for the next global pandemic, which many scientists—including members of this upcoming Future Tense panel—conclude is inevitable? The world is far more connected than it used to be, both physically and technologically, but will globalism hurt or help us? “In some ways, we’re in good shape, and in some ways, we’re in really bad shape,” said Rebecca Katz, a Georgetown global health professor and a pandemic consultant to the Department of State. She points out that over the summer, we had one of the busiest travel days in history, with more than 202,000 flights. “We move around the world pretty fast, which means that anything that emerges from one part of the world can be anywhere else within 24 to 36 hours.” Katz adds that our highly urban and aging society, as well as increased population and food trade, also add up to make today’s world particularly vulnerable to a deadly respiratory virus. But it’s not all bad. “On the plus side, our medical care is much more advanced, our ability to produce medical countermeasures is much more advanced, our ability to treat the secondary bacterial infections is much more advanced,” she added.

There really isn’t, however, any way to contain the spread of something like the Spanish flu in today’s world. (In a piece for Future Tense, Bina Venkataraman explores the history, inefficacy, and stigmatization of forced quarantines.) When the next deadly flu strikes, very few places on Earth will be immune—when I ask Katz where would be the safest place if a global pandemic were to break out tomorrow, she suggests the moon. Hopefully, unless World War III breaks out, such a flu won’t be known by whichever country’s press was free enough to cover it first. Wherever it starts, and whatever it is known by, one thing’s for sure: The 1918 pandemic will always be known as the Spanish flu. Sorry, Spain.

This article originally appeared in Future Tense, a collaboration among Arizona State University, New America, and Slate.