Spanish flu: 5 health habits that changed after the flu pandemic that ravaged the world in 1918

It was such a traumatic event that for half a century no one wanted to remember it.

The flu pandemic that occurred between 1918 and 1919 was the biggest the world suffered in the entire 20th century and one of the worst recorded in human history.

Known as the “Spanish flu”, this disease has caused around 25 million deaths — but the real number, by some estimates, could be 40 to 50 million.

“In the United States alone, 675,000 people died, or even more. It was a huge loss, but you can’t separate it from the fact that it happened at the same time as World War I. These two events were completely linked.” said historian Kenneth Davis, author of the book More Deadly Than War (“More deadly than war”, in free translation), to BBC News Mundo (BBC Spanish service).

He says that while the war ended in November 1918, the flu continued to kill and caused more deaths worldwide than the conflict itself.

“Life came to a complete halt in the United States and many other places around the world. People couldn’t go to church or move around freely, they had to wear masks, etc. All the things we associate today with the current pandemic happened in 1918, although on a different scale because the country was much less urbanized at the time.”

Society then reacted with a tremendous desire to “return to normalcy”, an idea that was the campaign slogan of Warren Harding, who won the US presidential election in 1920.

“People wanted to forget about the war, the pandemic and their terrible losses, but they also wanted to have fun,” says Davis, who sees a clear link between these traumas and the emergence of the mythical “20s”, a time associated with jazz and agitation. Night life.

Pandemic and war caused a change in women and in the way society perceived them, because to deal with these events they now participated in productive activities, working in factories, offices and hospitals. “It is not by chance that it was at this time that the amendment giving women the right to vote was passed in the United States”, says the historian.

In the case of the US, this double trauma brought with it other controversial changes: the growth of supporters of isolationism before the world and the resurgence of the Ku Klux Klan.

“People thought that dangerous ideas, like the pandemic, came from abroad, so many wanted to close the country. In fact, there were people who believed that the Germans caused the pandemic as a tactic of war. This attitude was later reflected. in a tough immigration reform that restricted European immigration. They saw immigrants as dangerous, dirty and sick,” says Davis.

As for the Ku Klux Klan, he explains that its rise was due to the population’s fear that African-American soldiers who went to fight in the war in Europe would return to the country demanding more rights.

“The growth of the Ku Klux Klan was also driven by the rejection of foreigners and immigrants, as there was a strong nativist movement in the country that reflected the isolationist trend,” he adds.

But what were the main health changes that the 1918 pandemic brought to people’s lives? Check out five health habits that have changed since then.

1. The use of disposable cups

Before the 1918 flu pandemic, it was common for US public buildings and train stations to have a kind of metal cup known as a “tin ladle” that was used to serve and drink water. It was the same cup for everyone, so dozens or hundreds of people used it every day.

This unsanitary habit was only eradicated with the arrival of the pandemic when these metal cups were replaced by the Dixie disposable cups, which have become ubiquitous ever since.

Although they were created in 1907 and promoted as a way of protecting health against germs under the name Health Kup, these disposable cups have not won over consumers.

With the pandemic, they were renamed Dixie and aggressively promoted in advertisements as a necessary measure to protect against the disease. Since then, they have become a hit that would be exported all over the world.

2. Cover your mouth when coughing and sneezing

The habit of covering the mouth or nose with a tissue when coughing and/or sneezing was another health habit that became widespread during the influenza pandemic.

“Coughs and sneezes spread disease” was one of the slogans adopted by US health officials during the pandemic.

The message was printed on posters warning that coughing and sneezing were “as dangerous as a poison bomb”.

3. Avoid spitting in public places

Until the arrival of the 1918 flu pandemic, spitting in public places was seen as a socially acceptable habit.

Although for some decades, thanks to campaigns against tuberculosis, there were movements in favor of banning this practice and even in some cities sanctions were passed, it was not possible to eradicate it.

“You were fined $1 if you spit on the NYC subway and had to appear in court. Across the country, especially in places like Philadelphia where the pandemic had been strong, there were signs everywhere warning that spitting kills,” says Kenneth Davis.

The historian recalls that at that time many people were in the habit of chewing tobacco, so they used to spit it often, but that after the pandemic many people became aware that spitting in public was not recommended or acceptable from a health point of view.

4. Ventilate spaces

Although in 1918 doctors began to understand that there were certain diseases that were transmitted through the air, Davis explains that there was still some confusion about how this happened.

“If you were on a streetcar in a city like Philadelphia or New York and it was cold, you wouldn’t want to open the windows, and besides, there were some doctors who recommended keeping them closed because they feared the viruses would spread through the air. [circulando]. And that really was how it was, but because of the close breathing of others, not because of the wind,” says Davis.

“The question of whether to keep windows open or closed was a controversial topic of debate among physicians. Over time, it was understood that fresh air and sunlight were really good for patients, but for a long time the practice was to close the windows. When there was a sick person, she was locked in a room, covered with blankets and often ended up dehydrated because of the fever. Sometimes the cure was worse than the disease”, he says.

But in 1918 and 1919, the idea of ​​keeping windows open to prevent contagion gained great traction. “Keep your bedroom windows open! Avoid flu, pneumonia and tuberculosis,” read posters that were placed on public transport.

5. A heater under the window

The practice of opening windows to keep rooms airy led to another practice that transformed American home design: placing a steel heater under the windows.

As health authorities recommended keeping windows open even on the coldest days of winter, engineers looked for ways to keep rooms warm even under these circumstances. The result was to place the radiator in that location. A practice that continues to this day.

“The heater was placed under the window because they thought it would be the most effective way to heat the cold air coming in through the window,” says Davis.

A final health habit that emerged during the flu pandemic was wearing masks, although this has not continued over time.

The historian points out that they were a bit “primitive” compared to today’s. People were expected to wear them at home with layers of gauze or cloth and wash them after use before putting them back on.

“Clearly they weren’t as effective as an N95 and few people bothered to make and wash them properly,” says Davis.

However, there have been very successful cases, such as in San Francisco, where authorities enforced strict regulations on the use of masks and managed to maintain a low rate of infections and deaths.

“Then they relaxed the rule and had a huge increase in deaths because people didn’t want to put their masks back on after they stopped using them. They refused using many of the same arguments we hear now. It was very clear that the masks were very effective in places where their use was necessary”, he says.

Although these public health habits have been incorporated into everyday life based on what was learned during the 1918 pandemic, Davis points out that the trauma caused by it was so great that, at least in the US, this episode was ignored for decades and that only half century later, the scientific community wanted to revisit the subject.

“American society went through something terrible that I didn’t want to repeat, but I didn’t want to think about it either, and I think that’s why this pandemic was long forgotten.” says Davis.

“While writing my book, I met many families who told me that they knew their grandmother had died of the flu, but that no one knew much about it because it was something that was not talked about, dangerous family secret that you wanted to hide. And that’s how the Spanish flu was treated for almost half a century”, he concludes.