In relation to the COVID-19 pandemic, what can we learn from the experience of the influenza of 1918-1919?

What insights can we draw from this historical experience? First, despite the old adage that history makes men wise, it is often extremely difficult for humans to learn from history. When the influenza pandemic broke out in 1918, World War I was still in full swing. The belligerent countries deliberately concealed the danger of the pandemic. The United States, which had an early flu outbreak, deliberately concealed the status of the epidemic and blocked the news, even requiring medical authorities to reassure the public that there was no danger of a large-scale influenza outbreak. When we look at the human response to the 1918–19 pandemic, the central salient aspects are arguably captured by the terms “unexpected” and “mystifying” virus. Likewise, today, the central challenge that lies before us is to confront an “unheralded” and “novel” virus.

Spain was a neutral state during World War I and maintained relatively open and transparent reporting on influenza cases. In particular, there was plenty of media coverage of the pandemic. This is why the virus came to be misrepresented as the “Spanish flu.” The attitude of the Spanish government was crucial in the fight against the flu. Therefore, the first lesson humans learned from the 1918-1919 pandemic was to be open and transparent about the outbreak. At the very outset of COVID-19, the Chinese government shared information openly and in a very timely manner. For example, it immediately shared the genetic sequence of the virus with the entire world, something other countries have seldom done in the past. Moreover, it informed the World Health Organization (WHO) and relevant countries and regions, including the United States, of the outbreak. Finally, the Chinese government was quick to call for strengthened cooperation with the international community, thus contributing to the global response to the virus.

The second insight we can glean from the experience of the 1918–19 influenza pandemic is that humans tend to underestimate the destructiveness of disease and overestimate their ability to cope. In a sense, the course of human history is the process of continuously improving the ability to resist infection, even as the cunning and destructive power of viruses have often far exceeded human understanding and imagination. We know, for example, that the 1918-1919 pandemic came in three waves, the second of which had a particularly high death rate. We also know that the flu challenged the common sense of the time. The fatalities in the second wave were often concentrated in the healthiest cohorts, those between 15 and 40 years old. According to common sense, one would assume that the elderly and the very young—those with less resistance to the infection—would have suffered the most.

The explanation given by scientists until today is that the abnormal death pattern of “the Spanish flu” was caused by the immune system overreacting. The relatively young and robust immune systems of those aged 15–40 produced dead cells that blocked the pulmonary artery and caused suffocation as the body sought to fight off the virus. The fact that Germany, the enemy of the Allies, recorded fewer civilian deaths among young adults than any other part of Europe may serve as additional evidence. The smaller number of civilian deaths in Germany might be related to the food supply at the time and the particular pattern of death of the pandemic. In the last year of the war, food shortages in Germany led to mass weight loss. As a result, plenty of people might not have been in an immunity condition to overact to the flu. Therefore, the second lesson we should learn is to analyze the first wave of the coronavirus, discussing the characteristics of its morbidity and mortality, and the possibility of a second or third wave, to provide a correct response.

The third lesson is that the path of disease development is closely related to culture. Especially in the 21st century, it is a common feature of all civilizations and cultures that human life is precious and that unnatural death is to be lamented and avoided. During the 1918-1919 pandemic, Japan’s mortality rate was relatively low, which was probably closely related to good hygiene. Moreover, Japan’s response to the influenza included a combination of previous blocking and subsequent re-treatment, distributing masks everywhere, and carrying out large-scale vaccinations. A large proportion of those who died from the pandemic was felled by related complications, so vaccination likely played a certain role in reducing overall mortality. Japan’s handling of the flu crisis was characterized by local initiative and effective mobilization within the civil society.

In this present crisis, the United Kingdom has been grappling with the need for quarantine and masks, missing the opportunity to get ahead of the situation early. During the influenza of 1918-1919, the Royal Society for Public Health had stressed the unfeasibility of quarantine, that isolation would waste many resources, and that these resources should actually be invested in public health promotion and vaccine development. Wearing masks and being isolated, though primitive, are often the most effective methods. However, many Western countries are hesitant. Western cultures tend to place more emphasis on business as usual. When choosing between maintaining the status quo and protecting people’s lives, the balance tends to favor the former, and the inadequacy of medical resources emerges as the limiting factor. Therefore, the third lesson we should learn is that all countries across the globe should have the necessary medical resources—and the capacity to surge quickly—to be able to deal with significant infectious diseases as the bottom line and organizing principle. To this end, we might consider diverting additional military expenditures to the construction and reinforcement of medical readiness instead.

The fourth insight that emerges out of the pandemic of 1918–19 is that we should pay attention to changes in the course of world history caused by unforeseen factors and be good at transforming risks into opportunities for enhanced global governance. The earlier pandemic hastened the end of World War I. Wars, and global infectious diseases prompted politicians to think rationally about the establishment of a new world order. The outbreak of the great influenza of 1918-1919 coincided with the end of World War I, and the establishment of the League of Nations was closely associated with the construction of a post-war order, coming after deep reflection by the leading politicians of the time on how to safeguard peace and international cooperation. Moreover, President Wilson of the United States, Prime Minister Clemenceau of France, and Prime Minister Lloyd George of Britain were all infected with influenza to varying degrees, which also accelerated the signing of the Treaty of Versailles. In 1920, League of Nations set up International Health Organization to share information and fight against epidemic locally and internationally.

The current new pandemic shows that infectious diseases rapidly affect every family, and every individual, as well as their perceptions of life and the condition of the planet, which we all must treasure sincerely. The former US Secretary of State, Henry Kissinger, recently pointed out that even the United States cannot defeat this virus simply through its own efforts, and should combine its vision and plan to cope with the challenge of the virus with global cooperation. Failure to do both in tandem will lead to the worst outcome of all: a double failure of epidemic prevention and international cooperation. Kissinger’s view was an early warning to the United States and the world. At present, COVID-19 may be regarded as the starting point of a new historical phase, the last straw that crushes economic globalization, or the third major event in the 21^st century that shifts the global agenda. Today, however, there are few signs of genuine international cooperation in the fight against the epidemic. Therefore, in the post-coronavirus pandemic era, restarting globalization and ensuring international cooperation should be the most serious discussions. This is precisely the fourth lesson that mankind should learn.

The fifth lesson from the events of a century ago is the perils of nationalism and parochialism. Nationalism has had a severe impact on the global health governance system and has weakened the global ability to fight the present crisis. In the face of the COVID-19 pandemic, we are witnessing the rise of nationalism and prejudice, and what we need more is the cooperation of the international community and tolerance among different groups of people. In the early stage of the development of the coronavirus, the UK seriously misjudged this virus. Even after seeing the rapid spread of the outbreak in China, Iran, and Italy, the British government opted for a response that foregrounded developing “herd immunity” and refused to consider China’s experience and approach seriously. This reflected nationalism and ideas of Western superiority at a deep level. As a side note, it also demonstrates how hard it is to learn from history.

The United States government has directly criticized the WHO, and falsely blamed China. Humans have become accustomed to associating threats and crimes with foreign cultures, seeking scapegoats for their own failings, and so it is with diseases. In the context of the new epidemic, the popularity of “blame geography” or “buck-passing geography” also underscores the relationship between disease and parochial nationalism. Looked at from this angle, we can point to the fact that the 1918-1919 pandemic likely originated in the United States. The United States also covered up the truth of the pandemic flu. Here, we might ask: is this not merely a problem of openness and transparency but whether the international community should claim compensation from the US? In fact, tracing the source of significant infectious diseases is extremely difficult and has nothing to do with conspiracy theories. Therefore, the correct way to deal with large-scale infectious diseases is a global solidarity response, rather than becoming entangled in the theory of responsibility, which just squanders precious time in containment and rescue. Without recognizing this, it is challenging to learn the lesson, let alone improve on it, and the likely penalty is a severe response from the natural environment.

Sixth, in the face of the epidemic, the big powers—especially their political leaders—have the most to answer for. On the one hand, in the face of viruses, it is particularly important to emphasize the division of labor among different occupational groups in society. One of the critical tasks of history is to underscore that the world is always complex and uncertain. The task for scientists is to find the most effective response, especially for vaccines. The task of politicians is to coordinate the overall situation and promote cooperation and problem solving based on the research of historians and scientists, rather than creating trouble.

On the other hand, in this process, the big powers should take the initiative to assume responsibility, rather than leaning into prejudice and hindering the possibility of mankind’s joint response to infectious diseases. In the era of globalization, global cooperation is needed to deal with cunning and catastrophic viruses. On the evening of March 26, President Xi Jinping attended the G20 Leaders’ Summit on COVID-19 in Beijing. He delivered an important speech entitled “Working Together to Defeat the COVID-19 Outbreak”, in which he stressed the need to “to pull up, hand in hand, the tightest zone spreading network”, to “actively support the role of international organizations”, and to “improve the morale of the world economic recovery”. These points exemplify the responsibilities and mindset that the great powers require, given the leading role they play in fighting the epidemic worldwide.

Finally, it should be emphasized that the number of deaths caused by “the Great Flu” in 1918-1919 far exceeded the number of deaths during “the Great War”, proving that nature’s punishment exceeds even that of the slaughter inflicted by humans themselves. It has been found that—in punishing human error—nature has “the bigger hand”. The frequent occurrence of natural disasters in recent decades is a serious warning issued by nature to humankind. The mode of the human response determines nature’s subsequent actions. In other words, the harmonious coexistence of humanity and nature seems more urgent than ever, and it needs to be put on the agenda of international politics. The various choices of humanity today will converge into a cooperative force that jointly determines our future. Therefore, we who are responding to this new pandemic will also write the history for future generations.

Bingzhong Li (李秉忠in Chinese), Professor of World History, Director of the Center for Turkish Studies, Shaanxi Normal University, Xi’an, China and also an honorary staff of Exeter University, United Kingdom.