Anyone following the 1918 Spanish flu pandemic through the eyes of community pharmacists who lived through it will readily see parallels with the 2020 COVID-19 pandemic. But there were also big differences, not least in the information available.
Without social media, television or radio, the population depended on local and national newspapers for their information. For pharmacists, the weekly C+D reports provided essential updates. The journal had a well-oiled machine for gathering news, using an army of unpaid correspondents; on July 6, 1918 the editor invited subscribers to “send in marked copies of newspapers containing items of interest for insertion”.
Early on, it carried reports speculating about what the disease was (“a severe type”) and what caused it (“blamed on the weather”). By the time it published its editorial on June 29, 1918, the disease had already spread throughout the country.
It was followed by an announcement from the chief medical officer about the best prophylactic measures (“antiseptic lozenges, mouthwash or throat spray”). But there was no NHS – just a limited insurance scheme – and the Ministry of Health was only established in 1919, after the pandemic. And the country was still at war.
Official guidance on how to lessen the risks of infection – with some familiar advice – came very late in the day. The C+D reported in March 1919 that the Local Government Board advised “healthy living” as the best way to avoid infection, while suggesting that “avoiding crowded gatherings and close, ill-ventilated rooms”, along with “wearing a mask and glasses when nursing or in attendance on a person suffering from influenza”, were desirable.
The pandemic continued well into 1919 in some parts of the country, with recurring issues such as the closure of schools, and sickness among healthcare staff. On March 1, the C+D reported that “influenza is widespread in Glasgow, and pharmacists are overwhelmed with work”. Belfast reported that “a number of national schools are now closed”, and difficulties occurred in many pharmacies due to the “large number of cases” among employees. The pandemic also saw the resurfacing of “snake oil” salesmen – those who “scorn to deceive” with their “influenza cures”.
With reports from its correspondents overseas, the C+D also kept its readers informed about developments elsewhere in the world. The situation in Cape Town, South Africa clearly indicated what happened when the disease was allowed to proceed unchecked. The result was a death rate of over 6% (1 in 16), but a surviving population with a high level of protection through herd immunity.
Once it was over, a review of how the country had performed was undertaken by Sir George Newman, who published his report in 1920. There was little sign of reflection about pharmacy; but for community pharmacists the lessons were clear enough. When pandemics strike, pharmacists take on a frontline role, and they need to prepare early for the challenges ahead.
Pandemics create exceptional demand for prescription and over-the-counter medicines, and pharmacists need to plan how they will maintain supplies. For the profession as a whole, pandemics throw up opportunities as well as challenges, and it must capitalise on them rather than squander the goodwill created during them.
Comparisons have inevitably been made of the clinical responses to the two pandemics. If Spanish flu was introduced today, mortality would be greatly reduced since the majority of deaths resulted from bacterial co-infections with common species. Historians have also reflected on recent events, although my colleague Virginia Berridge cautions against making “historical parallels” when comparing pandemics, and others have argued that sometimes history has no lessons to teach.
By the end of the Spanish flu epidemic, the ready availability and accessibility of community pharmacists had done much to reassurance a frightened and susceptible public – something that will surely also be a legacy of COVID-19.
Stuart Anderson is emeritus professor of pharmacy history at the Centre for History in Public Health, London School of Hygiene & Tropical Medicine