Historians: ​“Distancing” Worked In 1918, Works Now

Naomi Rogers and Jason Schwartz offered that historical perspective Tuesday during the latest episode of WNHH’s ​“Dateline New Haven” radio program.

Rogers is a professor in the history of medicine at Yale University. Schwartz is an assistant professor of public health and assistant professor in the history of medicine at the Yale School of Public Health.

Both have spent much of their academic careers researching exactly the issues that have been at the forefront of many Americans’ minds as COVID-19 infections rise throughout the country and the world:

How have and should governments and medical communities respond? Which public health strategies have been tried and are most effective at ​“flattening the curve?” Who is most vulnerable during a flu pandemic? Are we truly living in historically unprecedented times?

“It’s not an exaggeration in terms of the scale of what we’re encountering and the uncertainty surrounding what the coming weeks and months look like as well as the level of response we’re seeing in our communities, in our nation, and around the world,” Schwartz said when asked if it is appropriate to compare the COVID-19 pandemic with the 1918 – 1919 Spanish flu. 

That latter pandemic infected an estimated 500 million people worldwide and killed an estimated 50 million around the globe, including around 675,000 in the United States.

The COVID-19 infection and mortality numbers are significantly lower than those. As of Tuesday afternoon according to Johns Hopkins University, 194,217 people around the world had been infected and 7,864 had died.

Nevertheless, Rogers said, both then and now, this is one of the first pandemics since 1918 that ​“has really been conceived of as an ​‘everyone issue.’”

While the spread of HIV/AIDS in the 1980s and 1990s was a global pandemic, she said, ​“it really was not conceived that way by many countries, including ours.” It was more seen as a problem for certain places, certain communities, certain demographics.

She said it would be a mistake for younger people to dismiss today’s pandemic as only affecting the elderly, or for relatively healthy people to feel that this will only affect the immunocompromised.

“I think it’s very hard to convince an entire population that everyone is at risk,” she said. But that’s what public health experts show and what public health history has proven: that even those who are least likely to suffer the more serious consequences of the pandemic can contribute to prolonged suffering by continuing life as usual, going to large social gatherings, and inadvertently transmitting the virus that they may not even know they’re carrying.

“We think about crowds as the accelerants for allowing epidemics to transfer among communities,” Schwartz said. That was the case 100 years ago. That’s the case today.

Schwartz said that some of the most effective public health responses in 1918 were similar to the ​“social distancing” techniques being preached by public health experts and cautious political leaders today. 

Waiting for a ​“magic bullet” vaccine to cure the flu in one fell swoop was also a public fascination a century ago as much as it is today — and as much as it was during the AIDS epidemic, and as much as it was during the 1976 swine flu outbreak.

Much more effective at reducing the spread of the Spanish flu was the ​“aggressive use of these social distancing strategies.” The aggressive closing of social spaces and limiting of public gatherings.

“Giving individuals space from one another is a low-tech but effective strategy to help with the response.” As disruptive as these methods are to the economy and to the regular course of society, he said, they do work at reducing infections.

Rogers looked even further back to the 1916 polio epidemic that came just a few years before the Spanish flu and was the biggest epidemic the United States had seen at that time.

“There was a massive effort to isolate children and to institute public health measures to enforce social distancing,” she said. That’s because children were the most vulnerable populations for that particular disease.

She said that movie theaters were closed to children, but remained open for adults. New Jersey cancelled its ​“baby parades.” Circuses barred children from attending, and played only for adults.

Schwartz said that similar, broader measures during the Spanish Influenza were also practiced — and largely worked.

“There’s lots of evidence to show that cities who accelerated those responses earlier in the 1918 pandemic tended to have better outcomes, relatively speaking, than cities that were more cautious or arrived at these tools late in the game.”

Watch the video above for the whole conversation, which included discussions of Democratic presidential candidates Joe Biden and Bernie Sanders’ approaches to tackling the pandemic, how governments have responded to the economic crises caused by past pandemics, and which parts of the quickly evolving COVID-19 stories these two historians are most closely monitoring.