Can the aftermath of Spanish Flu help us know what comes next?

Bidets never really made it in North America. I’ve actually only been at one house that ever had one, and it was sort of a running joke at parties. People just don’t see them as a real option in their hygiene routine here. Well, with the panic buying and hoarding of toilet paper in reaction to the pandemic, there’s been a bit of a shortage in supply.

So, you’re faced with an empty stock of toilet paper. Those empty shelves are coupled with uncertainty about when the supply will catch up to demand. Do you go home empty handed or do you grab a bidet attachment for your toilet and give it a whirl?

This isn’t a significant change in the world, but it is interesting the way these major shared experiences open the door to major collective changes in behaviour and norms. I’m sure “Big-Bidet” has been looking to crack the North American market forever, and all they needed was a shortage of toilet paper to make their mark.

So will a proliferation of bidets in North America happen? I certainly can’t proclaim to know, but the door is at least open for bidets to become a norm (or at least significantly less odd) in North America.

Okay. Yes, I’m making a half-serious joke. Poking fun at the truth really. I’ve seen the term “Big-Bidet” a few times and I just couldn’t resist.

But the serious reality is that our experience with Coronavirus will change all of us.

COVID-19 will change our world.

History and Uncertainty

When we face uncertainty, sometimes it helps to look back at history for similar situations. You can observe how the situation played out, who was impacted and how, and see what experts with the benefit of hindsight have to say about the phenomenon. Basically, the past serves as data from which we can find clues about what happens next.

In the face of the COVID-19 pandemic, experts have looked at the outbreak of the Spanish flu just over 100 years ago, between 1918 and 1919.

So how did Spanish flu change the world?

What was the impact on public institutions and human behaviour?

What did the newfound appreciation for the invisible threat of pandemics and the fear of pestilence look like?

It’s interesting to read tidbits from the past about the measures officials recommended to curb the threat of the virus: Eat healthy, exercise, rest well. It’s obvious they simply didn’t have a clue (Kamradt-Scott, 2010).

Currently we are in a state where self isolation and social distancing are being recommended, and it has seemingly been followed fairly well by most of us. In the past, the idea of recommending anything close to quarantine was scoffed at. It was simply accepted as fact that there wouldn’t be compliance on the part of the public, and thus it wasn’t worth the headache of trying to enforce these measures (Kamradt-Scott, 2010). Maybe it’s just easier to ask people to stay home in the age of the internet.

Watershed Moment

I’m really not looking to compare and contrast the way the two pandemics are handled.

I want to look at what happened after the Spanish flu for clues to the ways that our experience with Coronavirus might change our world.

A ‘watershed moment‘ describes a moment or instance that has wide ranging effects, a moment that changes everything. The Kennedy Assassination changed the course of American politics for the following half century. The horrendous attacks on 9/11 changed the way we experience all aspects of public life in terms of security. These moments changed the course of History.

A watershed moment is the instant at which nothing is the same. Are we in the midst of one of these such moments? Coronavirus has exposed an evident lack of resilience provided by our modern way of life to the threat of pandemics. COVID-19 virus may be exposing the limits of globalized and highly connected world.

How the Spanish Flu Changed Our World

The Spanish flu killed somewhere between 20 and 50 million people worldwide. In Canada, the Flu was estimated to have infected one in every six people, and somewhere between 20,000 and 50,000 people were killed. While commercial air travel had yet to proliferate, the conditions of trench warfare that characterized World War I provided the perfect conditions for the spread of disease. The transportation of soldiers from all over the world to hotspots in Europe, and their subsequent journeys back home provided a conduit for the transmission of the virus.

Locally, it is rumoured that there is an unreported mass grave at the cemetery at Nipissing Junction, where CNR would have allegedly buried quickly growing number of cadavers. One story I found describes the spread of Spanish flu through the small cottage community of Brent, ON located in the North of Algonquin Provincial Park. The park was a destination for soldiers transitioning home from the war, and almost everyone in the community caught the virus. The CNR doctor came in a special train to bring the community back to North Bay for treatment, but everyone except the park ranger refused. Fearing the conditions in the city would be more dangerous, they took their chances. Fortunately, everyone survived.

Indigenous communities were hit particularly bad, experiencing a mortality rate 5x that of the rest of the population. While the virus itself didn’t discriminate, the vulnerability of working-class people to the primary and secondary effects of the pandemic was high.

“Nothing else- no infection, no war, no famine- has ever killed so many in such a short time”

Alfred Crosby, Historian, speaking on the Spanish flu pandemic

After much devastation across the world, the Spanish flu pandemic subsided eventually. Next Nations worldwide, Canada, the provinces, and municipalities had to react to the threat of a return to pandemic. People, had to react to the pandemic.

Would people go about their lives exactly the same as before?

Had the experience changed everything?

In terms of institutional reactions, the general lesson learned by governing bodies in the Spanish flu was simple: health is a collective issue. A newfound understanding of the way collective behaviour, and societal vulnerabilities, shaped the devastation of the pandemic armed the international community with better information to address vulnerability to future pandemics. Rather than the previous belief that people were simply responsible for their own health, the paradigm shifted to look at health in terms of the herd.

After the pandemic, it was clear that the poor working conditions for the blue collar members of the community, as well as the high unemployment restricted the resilience to the virus. Governments in many nations reacted to the pandemic and these realizations of vulnerability by socializing healthcare. This policy would allow for everyone to seek a base level of health care regardless of their socioeconomic standing.

Many countries created new governing bodies and ministries related to health, or increased their importance within the governmental structure. In Canada, Robert Borden ordered the February 3, 1919 National Conference on Hygiene in response to the pandemic and the spread of VD, which lead to the legislation founding the Department of Health (Rutty & Sullivan, 2010). When one considers that less than a century before this, people simply did not see a role for the government in health care, this represents a major shift in the perspective of government and their role in society(Kamradt-Scott, 2010).

Studies have found that new hospitals and other health related items were at the forefront of the agenda in post Spanish flu Canada, garnering votes and concerns that simply weren’t there prior to the pandemic (McGinnis, 1977). Health care, obviously, was at the forefront of the public consciousness, and public health education leaned into this concern, with organizations spreading information aimed at keeping the public healthy at a rate not seen before in Canada’s history (McGinnis, 1977).

Another realization was that individual nations or governments were not going to be able to stop the threat of pandemic acting unilaterally. They would need to act in conjunction with each other in the event of another pandemic. Spanish Flu didn’t respect international political borders, and neither would whatever was to follow. The League of Nations, an early precursor to the United Nations, formed an international Health Organization in 1920 in response to the pandemic, recognizing the need of the collaboration of many nations to combat the threat of a return of a pandemic.

Into the early 20th century, the miasmatic theory of illness (greek for bad air) was beginning to subside in popularity to germ theory, which states that small organisms “germs” were a threat to human health rather than poisonous air. The experience with Spanish Flu further entrenched the burgeoning germ theory, as well as entrenching the health care practitioners response in the use of thorough hand washing and other sanitization measures to stop the spread of infectious disease (Tomes, 2010).

Prior to the Spanish flu, women of households were often trained in basic home-care aimed at offering basic treatment to members of households of illness. The experience with the Spanish Flu largely did away with this norm, stressing instead early warning signs of illness so that the sick would be brought to health care practitioners in a timely manner(Tomes, 2010).

In addition to these institutional changes, the experience with Spanish flu lead to a newfound importance in medical research, with a huge increase in the efforts and funding for projects aiming to isolate influenza and other viruses (Kamradt-Scott, 2010).

Overall, the Spanish flu changed the world in a myriad of ways, most of the changes relate to the shift in paradigm from health being understood at the level of the individual, to a perspective that regarded health as a collective issue. The Spanish flu had made it evident that when it came to health the fate of individuals was linked by societal factors and the potential for transmission through contact.

How might COVID-19 Change Our World?

While the context is different, because the world has changed completely since 1918, these examples of changes after Spanish flu can inform us on what’s to come. Below, I make a few guesses on what comes next, informed by some research on the Spanish flu aftermath, paired with observations about our modern world, and the reaction to COVID-19 thus far.

A Contactless World

Dunder Miflin once advertised for “limitless paper in a paperless world“. Are we on the verge of a contactless world?

Everyday we interact with handles, touch pads, touch screens, railings, etc, the list is endless. We touch things all the time, then we touch our phones, our faces, and our food. In the face of COVID-19, it seems obvious that our behaviours are risky in terms of the spread of germs.

Right now, our fear of pestilence and the spread of disease is at an all-time high. We have lots of great educational material on the internet, and the information has spread far and wide. People are being as mindful about what they touch in public as they are about how often they touch their faces. Businesses like Skip the Dishes are promoting ‘contactless’ service, while others are refusing cash payments for the time being.

The question is, as this fear fades, will the behaviours we develop over the course of this pandemic stick? Will businesses continue to advertise “contactless” services as a hygienic norm? Honestly it’s sort of hard to tell when the situation is so fresh. Studies of the Spanish flu have found that fear as an emotional reaction waxed and waned, and that behaviour change with these shifts (Balinska & Rizzo, 2009). We can probably expect the fear of contact to fade overtime, but for now, the world is ripe for change in this regard.

The Growth of Online World

One joke you’ve probably seen floating around is how now we’ll understand how many meetings could have been emails. The joke pokes fun at the culture of meetings in the corporate and public sectors. Well, there’s truth in most jokes, and the structure of work world might change forever in the aftermath of COVID-19

Consider the number of people being told right now to work from home. Millions of people around the globe are completing their work responsibilities remotely, with no need to go into the office. This is like one huge laboratory experiment about what happens when people work from home.

I suspect you’ll see a lot of businesses be more open to the idea that workers can work remotely after this experience and seeing that generally the responsibilities are fulfilled. It might become a big part of contract negotiations, with people ensuring the right to work at home a certain number of days a week. An emerging culture of remote work is bound to have some effects, both positive and negative.

One negative of working online is the reduction of informal discussion amongst colleagues. Much innovation at work comes from casual conversations between colleagues, as information is shared informally and ideas synthesize. Without the physical workspace where these more causal interactions can occur, it’s possible we’ll see less innovation moving forward.

That said, there are negatives to the physical work space. Commuter culture has become a huge thing in North America, with many people working up to two hours from home and driving back and forth five days a week or more. This has major psychological implications in terms of mental health, and creates a great deal of practical inconvenience as people lose up to 4 hours of the part of their day not devoted to work. Hard to have the energy to cook healthy and exercise with a routine like that. More work from home would reduce this mental stress, in addition to the reduction in greenhouse gases emitted by personal automobile use associated with the commutes.

Speaking of congregating online, what impact will we see of this experience on online education? Well, there will be probably disappointment in the capacities we have for online education as it stands. Additionally, it will probably be realized by more people outside of the education profession that the interactions created in attending a physical school is essential in the social development of students. School is an opportunity for students to learn how to treat people, and if homeschooling online becomes big, that benefit will be reduced systemically.

That said, this experience of being forced to learn online might lead to innovations in the platform, like virtual reality(VR) classroom to immerse students in their learning.

Imagine being at home, class is starting. You put on the VR goggles and suddenly you’re surrounded by peers in a state of the art (and sterile) classroom. The teacher starts talking about whales, and all of a sudden the classroom is in the sea and you’re watching a Blue Whale pass by. Pretty cool.

There’s definitely some potential for improvement to online education, and this experience for many students of being boxed into online learning might teach us some lessons on just what might accomplish that improvement.

Another bright side is that ‘higher-learning’ institutions like universities and colleges may innovate and improve their own online capacity, allowing for increased flexibility for learners seeking a degree, potentially reducing costs and access barriers to would-be students.

For most North Americans everyday life consists of work, or school, or both, and this experience of a pandemic is bound to bring change to these realms in terms of the capacity for online operations.

Changes to Health Care

Well, one obvious one for our American neighbours is universal healthcare. Will they finally join the rest of the advanced nations in the world and guarantee a baseline of healthcare for their citizens that doesn’t cripple unlucky parties with loads of debt?

It sure seems like if it’s not now, when the collective element of health has never been more obvious, it’s never.

Long has the notion that the health care of others “ain’t my responsibility”, but maybe, like the change in paradigm experienced by most nations after the Spanish flu, the idea that health is a collective issue might proliferate in the United States in reaction to the COVID-19 pandemic. I sure hope they figure it out.

With the nudge to a perspective on health in terms of the collective, it wouldn’t be surprising to me if in the next few years the issue of pharma-care coverage doesn’t get some spotlight in Canada. Universal pharma-care, proposed by the Federal NDP party in the last federal election, would ensure those without health insurance through work aren’t paying a fortune for prescription medication. The COVID-19 has reminded people of the role of luck in health and wellness, and brought vulnerabilities of people to light. I would imagine, thinking more collectively, we can expect a more liberal policy in terms of universal pharma-care in the aftermath of Coronavirus.

Another shift following the Spanish flu was the aforementioned increase in funding and research aimed at keeping populations healthy. Given what is spent on the military every year, it wouldn’t be surprising if more funds are allocated at preserving wellness rather than the external threat of war. I fully expect grant money towards healthcare related research to skyrocket in the aftermath of this situation.

Overall, expect to see a huge emphasis on our healthcare systems, their capacity, organization, strengths, and weaknesses. COVID-19 has rudely reminded us that we have a lot to learn if we’re going to stay healthy, and that we have to work together to turn that learning into results.

Beliefs About the Role of Government

There has always been much debate about the role of government in our society. The left side of the political spectrum tends to see the role in terms of the responsibility to offer services like health care, education, transportation, etc., while the right tends to see the role of government as preserving freedom and stepping out of the way.

Well in the current context, the whole political spectrum is looking at the government to act responsibly and protect its citizenry, both from the virus itself and the aftershocks to the economy. Even Mitt Romney was proposing a relief cheque in the amount of $1,000 to every American to assist in the resiliency to the effects of the virus and the measures employed to stop the spread. Now it’s not the Universal Basic Income(UBI) Andrew Yang was proposing in his short-lived bid for the Democratic nomination, but that’s still a prominent member of the Republican party advocating for the use of federal funds as a social safety net.

But here’s the thing about safety nets:

they work a lot better if they’re in place before the fall.

Governments need to recognize that there is a lack of resiliency in the average family to shocks to the economy, and that vulnerability has knock-on effects all the way up the market. If social safety nets like UBI were in place in advance of environmental and economic shocks, the public would be far less vulnerable. Right now, many people (myself included) do not know when their next pay cheque is coming. The expenses don’t go away, the debt doesn’t go away, but the income does. This vulnerability, in addition to the obvious consequences of closing businesses, slows the economy to a halt.

If the safety net were in place before the fall it’s intended to catch, it’s just a lot more effective. I hope this lesson is learned by institutions, businesses, and the public, and that the resiliency of the everyday person and their family is considered in economic policy decision making, especially concerning social safety nets.

Outdoors is ‘In’ Again

When it’s safe to do so again, people will want to get out. Sports entertainment and other big, indoor, crowded events will no doubt rebound. But in general, for many I imagine there will be an aversion to close quarters and big crowds. So I suspect people will want to get out, and will chose to do so in wide open public spaces more often than before. Maybe we’ll find a new appreciation for walks in the park. Maybe we’ll see increased camping and day-use in Provincial and National Parks might emerge as people seek out activities they can do with people at a reasonable distance.

When this is over, when we can all stretch out our legs and get out, I would think the demand for outdoor recreation experiences will increase in response to our collective isolation.

Faith in Experts

One really encouraging thing we’ve witnessed throughout this experience is that people in general are adhering to, and spreading, the word of experts. I’ve heard the phrase: “well, the CDC…” more in the last two weeks than ever before. While there have been many examples of a lack of common sense in the media, it seems like in general, citizens and governments alike have decided to listen to the people who know what they’re talking about rather than some weird lady on facebook that claims to have all the answers and all the right essential oils to stop the pandemic in its tracks.

So, in terms of implications for the world moving forward after COVID-19, will this renewed belief in experts persist beyond the pandemic?

I would imagine it will, at least for a little while. Well people might find the social distancing and isolation unnerving and inconvenient, it’s really not a question of comparing the effects of doing it with not doing it, it’s much more a question of the impacts of doing this now or doing it later.

In the aftermath, when we compare the trajectories of the virus for those nations who practiced preventative measures early to those who waited longer, the public will have a tangible example with immediate feedback of the way that listening to the advice of experts mitigated the risk.

This experience, and the lessons learned about the benefits of seeking expertise, should be present in the collective when faced with future world, national, and local issues.

Belief in Collective Action

For the past two decades or so, we’ve been well aware of the scientifically studied phenomena of climate change, and the risks and threats to humanity associated with it. That said, even stringent environmentalists can easily fall into the belief that their actions are a drop in the bucket. This feeling can lead to learned helplessness, and apathy, causing people to ignore the advice of experts believing that their actions alone could never move the needle, so “why bother?”.

Climate change, being a prolonged issue, bound to gradually take effect in the future until a tipping point is reached and feedback cycles cause major changes to our world, poses challenges. People will not get timely feedback of the effect of their efforts, and are therefore less likely to feel encouraged by their effects and continue to make efforts.

COVID-19 on the other hand is sweeping the globe quickly, and wreaking havoc in it’s path. People have been asked to do their part as individuals for the preservation of the herd; stay home, limit your contact, and help “flatten the curve” to help ensure health care institutions have the capacity to handle the issue.

Well it might feel like it will take forever before we see the effects of these actions, relative to climate change, the feedback is pretty immediate. Areas that do well to social distance and self isolate will slow the spread of the virus and ensure health care practitioners are able to keep time with the people infected.

With luck, we’ll have many examples of places that do well to reduce the spread and mitigate through individual contributions to collective action. This will serve as an experience in the collective consciousness that supports the notion that:

through the small actions of many, great change can grow.

Final Thoughts

I can’t pretend all, or even any, of my predictions will be correct. I haven’t given odds or percentages, or even a tangible mark where one might say it came true or didn’t.

The goal of this article was to take a look into our past and consider the future. I found the research for this to be thought-provoking, and I hope you find this article to be the same.

Nobody can be sure what will happen next, but the one certainty is that in the aftermath of the Coronavirus watershed moment, the world will be a very different place.

RM

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Sources:

Balinska & Rizzo (2009). Behavioural responses to influenza pandemics: What do we know?

Kamradt-Scott (2010). Changing Perceptions: of Pandemic Influenza and Public Health Responses.

McGinnis (1977). The impact of endemic influenza: Canada 1918-1919.

Rutty & Sullivan (2010). This is Public Health: A Canadian History.

Tomes (2010). “Destroyer and Teacher”: Managing the Masses During the 1918–1919 Influenza Pandemic.

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