Many parallels have been drawn between the COVID-19 pandemic and the 1918 Spanish Flu, which killed at least 50 million people worldwide and infected around a third of the global population. But if there’s anything to give us respite from the current crisis, it’s the reminder that the world has survived a pandemic before. From the US to Spain, South America to India, click or scroll through to see how countries bounced back after the Spanish Flu.

Spanish Flu was a deadly strain of influenza with symptoms that included a fever, persistent cough, excessive sweating and respiratory problems, with some infected people developing pneumonia. A first, less severe outbreak began in Spring 1918, with the first known case reported in Fort Riley, Kansas on 11 March 1918, although cases could have appeared earlier. A second, more severe wave spread in the autumn of 1918 and it was this that caused the high death tolls associated with the Spanish Flu today.

Despite its name, the Spanish Flu did not originate in Spain, although it was the first place to receive media coverage of it as Spain was neutral in the war and had greater freedom of the press. It was also one of the worst affected countries by the pandemic. In an article on 22 May 1918, Madrid's ABC newspaper nicknamed the disease Soldado de Nápoles (Soldier of Naples) after a popular song at the time, which paved the way for the illness not to be taken seriously – until it was too late. When the government became aware of the disease’s true danger, it implemented policies including school and university closures, cancellation of public transport and imposing stay-at-home measures.

But by the time many of these restrictions came into place it was too late. The health system couldn’t cope with the sudden influx of cases and medical students had to be recruited to make up doctor numbers. In total, the death toll was more than 186,000 between 1918 and 1920, according to El País. The high death rate caused the Spanish population to shrink by 4% in the year 1918, and Spain had a sharp drop in life expectancy, from 42.5 years in 1917 to 30.3 years in 1918. Pictured is an illustration of a hospital set up in Madrid in 1890 to deal with a previous epidemic.

Data on the economic impact of Spanish Flu is limited, although Spain’s death toll likely brought long-lasting fiscal consequences. Spain had been slower to industrialise than other European countries including Belgium, France, Germany and Austria, only entering the second stage of industrial development – characterised by surge in manufacturing and capital goods industries – in the 1920s. The pandemic is estimated to have reduced real per capita GDP and consumption of the typical country by 6.0% and 8.1%, respectively, according to a recent economic research paper.

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As German troops began a series of attacks known as the Ludendorff Offensive, starting in March 1918, the first wave of the influenza pandemic hit. It reduced the number of troops in combat and undermined the strength of the offensive – although the fact that it also impacted French, British and US troops makes it impossible to attribute the offensive’s failure solely to the influenza virus. During the deadlier second wave in the autumn, 14,000 German soldiers reportedly died of the Spanish Flu, yet that figure could be much higher when wartime censorship is accounted for.

The German economy faltered throughout the early 1920s although this probably had more to do with the Treaty of Versailles, which ordered Germany to pay sizeable reparations to France and Britain, than the influenza outbreak. The 1920s saw an unprecedented rise in social spending which, combined with lower revenues, resulted in increasing deficits. On top of that, inflation rose rapidly. Hyperinflation in 1923 was caused by the closing of factories in the French-Belgian occupied Ruhr valley, which meant that idle workers were paid with a currency that was rapidly losing its value.

What’s more, other countries put protective tariffs on German exports, making it harder for Germany to sell goods to other countries and worsening the impacts of the depression that ensued. The economy began to recover when the German currency was re-stabilised in 1923, followed by the Allies’ agreement to end its occupation of the Ruhr in 1924 and to make repayment terms for the Treaty of Versailles more manageable. It wasn’t until 1927 that German industrial production returned to pre-war levels. Ultimately, Germany’s path to economic recovery after the First World War and the Spanish Flu was long and slow.

The flu initially entered the UK through the port of Glasgow, where the first case was recorded in May 1918, and had spread to London by June. Measures taken to curtail its spread included closure of some schools and local press adverts against shaking hands and making contact with others. Yet in many cases it was business as usual – most schools, factories and churches remained open. It wasn’t until October 1918 that there was any real response from parliament. Pictured is a man spraying a bus with soap to prevent the spread of the disease.

By the summer of 1919, around 228,000 people had died from the influenza in Britain and a quarter of the population had been infected. The spread of the disease had also been worsened by the lack of medical staff, as a large number of doctors remained on the front lines at the end of the war. There was a brief post-war economic boom between 1919 and 1920, but after that economic growth throughout the 1920s was stagnant, while unemployment rose to 10% and remained high until the Second World War.

By the middle of the 1920s more than 2 million people were unemployed. The reintroduction of the gold standard by Winston Churchill in 1925, which linked the currency’s value to the value of gold, made British exports more expensive and less competitive on a global market. Meanwhile, deflation meant that people were less inclined to spend money and increased the debt burden. The UK recovery from the war and influenza was slow, and it wasn’t until around 1934 that the economy began to improve thanks to the decision to leave the gold standard, cutting interest rates and targeting higher inflation.

The pandemic hit the US badly, killing 500,000-675,000 people. Yet its effects varied between cities – those that went into lockdown fastest were most effective at reducing the death rate according to a 2007 research paper. The city of St. Louis, Missouri quarantined citizens two days after the first case arrived and had a low death toll of 358 people per 100,000. In comparison, Philadelphia’s first case was recorded on 17 September 1918 and it didn’t implement social distancing measures until 3 October, after allowing a city-wide parade to take place on 28 September. The death toll was high at 748 deaths per 100,000.

After studying 17 US cities, researchers concluded that the first peak in excess pneumonia and influenza death rates during the 1918 influenza pandemic "was 50% lower in cities that implemented multiple NPIs (non-pharmaceutical interventions) to control disease spread...than in cities that made such interventions late or not at all”. Strikingly, a disproportionate number of victims were aged between 15 and 44, meaning the disease killed people who were at prime working ages. This led to wage shortages and labour increases, while greater strain was put on social security.

Yet just as the implementation of social distancing had varied across US cities, so too did the economic fallout. According to a recent paper by two Federal Reserve economists and an MIT professor, those cities that put lockdown measures in place soonest did not have adverse economic impacts over the medium term. The researchers concluded, “cities that intervened earlier and more aggressively do not perform worse and, if anything, grow faster after the pandemic is over. Our findings thus indicate that NPIs (non-pharmaceutical interventions) not only lower mortality; they may also mitigate the adverse economic consequences of a pandemic.” Pictured is an open-air court being held in San Francisco.

In Canada, the Spanish Flu claimed the lives of an estimated 55,000 people, out of a population of 8.7 million. For comparison, the First World War killed approximately 60,000 Canadians. The disease first arrived in the port cities of Montréal, Québec City and Halifax in the spring of 1918, before spreading west across the country. In September 1918 the city of Victoria hosted a Eucharistic Congress attended by 40,000 people, which undoubtedly helped the disease to spread.

Despite the fact that health authorities had been accustomed to tracking infectious diseases, they were slow to emphasise the seriousness of the disease. According to historian Mark Humphries, speaking to the New York Times, “what’s remarkable about the Spanish Flu is how little worry it caused within professional circles. It was very much treated as just another of many different public health problems.” Factors including overcrowding, poor sanitation and prevalence of health conditions such as tuberculosis worsened the impacts of the disease in Canada.

The government responded to the crisis by founding the Department of Health in 1919, which aimed to take shared responsibility for controlling, preventing and managing diseases across all levels of government. As for the Canadian economy, real income per capita in Canada fell nearly 15% between 1919 and 1921. Fortunately, the economy bounced back quickly, and by 1923 per capita incomes were almost back to pre-recession levels, and up until 1929 the country experienced a period of economic expansion, technological advancement and improvement of living standards.

Among the hardest-hit countries in Europe, Italy had an estimated 466,000 deaths from influenza. Schools were shut after the first serious case was reported, although health and educational authorities did not immediately accept this decision. Matters were worsened when the country’s largest and most influential newspaper, the Corriere della Sera, was forced by the government to stop reporting daily death tolls in Milan as it was thought to be too negative.

The censorship of the press led to public misunderstanding of disease control measures, while there was little transparency about government decision-making. The Italian economy faltered in the post-war years of 1919-1920, although this had more to do with the impacts of the war than the pandemic. The government had printed more money to manufacture weapons quickly during the war, only to find that inflation intensified and by the end of 1920, the lira held just one-sixth of its 1913 value.

As the government was no longer putting in orders to large manufacturing and shipbuilding firms, many of them went bankrupt and unemployment rose to 2 million as former troops returned looking for work. There was an economic downturn between 1920 and 1921 which resumed in the early months of 1922. Economic recovery was driven by an increase in energy production and consumption, as well as an increase in imports of raw materials. (Poster reads: "Hygienic precautions to be taken against the flu")

Poland had between 200,000 to 300,000 influenza-related deaths between 1918 and 1920, according to recent estimates. News of the pandemic first arrived in Poland in the summer of 1918 and it had begun to spread rapidly by September. It was exacerbated by poor sanitation, with Poland’s rural areas hit particularly hard as the government failed to warn villages of the disease’s dangers and provide adequate medicines.

Cities were not spared Spanish Flu’s brutal impacts either. In Kraków the disease spread very quickly, and people demanded that sanitation was improved, such as cleaning large public areas which were believed to be the source of infection. In a recent paper published in the online journal Epidemiology: Open Access, author Jan Wnęk says of public attitudes, “they did not believe in taking the preventive measures recommended by doctors, such as isolation of patients, disinfection of premises, considering them superfluous”.

Poland underwent significant inflation between 1918 and 1923, which then shifted into hyperinflation. The cost of the Polish-Soviet War (1919-1920) was the main reason for hyperinflation, with the country undergoing short stints of stabilisation, followed by an economic slump and a brief banking crisis in the two years that followed. The economy began to bounce back from 1926 and the Polish złoty, although devalued by around 41%, finally stabilised in 1927, becoming one of Europe’s most stable currencies.

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As it was not involved in the First World War, Sweden has become a useful example for looking at the isolated impacts of the Spanish Flu. It took the lives of 38,000 people, representing around 1% of the Swedish population at the time, with the first case reported in southern Sweden in late June 1918. In a research paper published in the Journal of Health Economics, authors argue that the pandemic led to lower capital returns and an increase in the number of people using poorhouses.

Even though the war had given rise to a period of economic growth in Sweden, the country was hit by a sharp downturn in 1920-1921 where GDP decreased 5% in just one year, and there were large increases in unemployment. After the economic crisis, Swedish industries improved their production and distribution methods, increasing production and quality of goods. The strength of Swedish industry later helped its economy to fare better in the Great Depression.

Death rates for the Spanish Flu were higher in African and Asian countries, compounded by overcrowding and poor healthcare. India was the worst affected country in the world, with between 17 and 18 million people killed by the influenza outbreak – around 6% of the population. The disease was thought to have first entered the country through the port of Bombay (pictured), now Mumbai, in June 1918.

The country’s poor healthcare, combined with a drought that led to widespread famine, worsened the impacts of the disease. There were inequalities between different castes, with the death rate among lower-caste Hindus at 61 per 1,000, while among higher-class Hindus a much lower death rate of 18.9 per 1,000 was recorded. The jobs held by these lower caste Hindus, including cleaning and sweeping, made them more susceptible to the disease.

The impact on the economy was striking. In the year 1918, India’s real GDP growth reached its lowest level in recorded history (10.5%), while inflation reached all-time highs (only to be topped during the Second World War) according to the Central Statistics Office and OECD data. The economy took a long time to recover and dissatisfaction with the colonial government's handling of the pandemic fuelled India’s independence movement, led by Mahatma Gandhi (pictured), who contracted the influenza in its second wave.

Among the worst-hit countries was South Africa, where 300,000 people – or 6% of the population – died within six weeks. In September 1918, two ships arrived in Cape Town carrying soldiers suffering from influenza. Upon their arrival, troops were either put in isolation at a military hospital or quarantined in a military camp. Then soldiers were given three medical examinations before being demobilised, around three days later.

However, local newspaper reports suggest that distancing measures weren’t put in place very strictly while soldiers were in quarantine, and medical examinations may have been less than thorough. Not long after the soldiers were discharged, cases began to spring up elsewhere in the country. The outbreak worsened the impacts of inflation from the First World War, as well as the droughts of 1914 to 1916 and the floods of 1916 to 1917.

During the 1920s, the economy began to recover thanks to the Mineral Revolution, where the country continued to industrialise and the mining sector flourished. However, prosperity wasn’t equally spread. Many young men from villages moved to work in mines or work camps, leaving rural areas deprived of labourers to construct buildings, grow crops or hunt. As a result, the rural poor were left behind in terms of development.

In Australia, around two-fifths of the population were infected with influenza and 15,000 died. This translates to a mortality rate of 2.7 per 1,000 people, which was one of the lowest recorded. Authorities put a strict maritime quarantine in place from October 1918, after learning of the outbreak in South Africa and New Zealand. The other measures that were put in place included street patrols of volunteers, making face masks mandatory in public, and Sydney closed all places of entertainment and schools.

One silver lining that came from the crisis was the formation of a federal Department of Health in 1921, which was created as a response to the differences in measures across the country. As with many other countries, Spanish Flu tended to affect working-age people hardest, which caused significant economic disruption. It also disproportionately impacted Aboriginal communities – for example, at one Aboriginal reserve in Queensland, 590 people were infected and 90 of them died, a death rate of just over 15%. 

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