The 1918 Influenza Pandemic Versus COVID-19

A Historical Perspective From an Italian Point of View

Andrea Cozza, MD; Giuseppe Maggioni, MD; Gaetano Thiene, MD; Maurizio Rippa Bonati, MD

Disclosures

Am J Epidemiol. 2021;111(10):1815-1823. 

In This Article

Abstract and Introduction

Abstract

The ongoing COVID-19 pandemic has a major precedent almost exactly a century ago: the world-famous H1N1 influenza virus pandemic, sometimes known to the general public as the Spanish flu. From a history of medicine perspective, it is possible to underline many potential common traits between the two. In this article, hygiene and prophylaxis strategies are analyzed in a review of the most popular Italian general medical journals at the time of Spanish flu, Il Policlinico being the most representative of them. The analysis included 40 original journal articles as well as important references to the most influential coeval national manuals and international journals. The main issues in the context of public hygiene are prophylaxis with quinine and quinine derivatives, vaccinations, face masks, disinfection, and social distancing. We draw a comparison between these and the most recent international World Health Organization and Italian national guidelines on the topic. Sadly, little has changed since those times in terms of most of the prevention techniques, even with technical improvements, showing how shortsighted doctors and physicians can be when dealing with medical history.

Introduction

From a medical history perspective, it is possible to underline many similarities and differences between the COVID-19 pandemic and the 1918 influenza pandemic, sometimes known to the general public as the Spanish flu.[1] Between 1918 and 1920, the influenza pandemic killed an estimated 50 million people worldwide—circa 460 000 in Italy alone, according to a recent Italian study—a greater death toll than the recently ended World War I.[2]

Because the US experience in 1918 to 1919 has been well reviewed in the historical literature, for a comparative view, we reviewed the most important Italian medical journals on the 1918–1919 pandemic outbreak onward, to assess the state-of-the-art knowledge at the time, notably focusing on public health and prophylaxis issues in terms of plans and measures put in place to fight the advance of the infection. A comparison with the most recent international World Health Organization (WHO) and Italian national guidelines on the topic is drawn to consider the evolution of knowledge in the field.

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