--- title: The 1918 Flu Pandemic's Urgent Lesson for the 2018 Flu Season description: As bad as the flu is in 2018, it's not a pandemic. Here's what we can learn from the 1918 Spanish Flu pandemic that swept the world canonical: https://time.com/5116388/flu-pandemic-1918/ author: Lily Rothman article:opinion: false article:content_tier: free article:published_time: 2018-01-26T16:26:43.000Z article:modified_time: 2026-05-11T04:58:11.307Z article:section: History og:title: The Worst Flu Pandemic of the 20th Century Has an Urgent Lesson for Today og:description: The Spanish flu pandemic of 1918 may have killed as many as 100 million people og:url: https://time.com/5116388/flu-pandemic-1918/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt0e5c73a14f0a3e9c/6988f966fb4eac8c918956cd/flu.jpeg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 og:image:width: 2402 og:image:height: 1351 og:image:alt: Flu of 1918 og:type: article twitter:card: summary_large_image twitter:title: The Worst Flu Pandemic of the 20th Century Has an Urgent Lesson for Today twitter:description: The Spanish flu pandemic of 1918 may have killed as many as 100 million people twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt0e5c73a14f0a3e9c/6988f966fb4eac8c918956cd/flu.jpeg?branch=production&width=1200&quality=75&auto=webp&crop=16:9 ---  # The Worst Flu Pandemic of the 20th Century Has an Urgent Lesson for Today > Sponsored content. 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They are at time.com/newsletters and are separate from a paid subscription.  by [Lily Rothman](https://time.com/author/lily-rothman/)  ## Lily Rothman Rothman is managing editor at TIME. Jan 26, 2018 4:26 PM UTC  Warehouses were converted to keep infected people quarantined during the 1918 Influenza pandemic. Warehouses were converted to keep infected people quarantined during the 1918 Influenza pandemic. Universal History Archive / Getty Images  by [Lily Rothman](https://time.com/author/lily-rothman/)  ## Lily Rothman Rothman is managing editor at TIME. Jan 26, 2018 4:26 PM UTC If you’ve been reading about [how bad the flu is this year](http://time.com/5111158/flu-season-gets-worse/), it’s hard not to worry, and with good reason. The 2018 influenza season has hit hard in the U.S. and elsewhere, [spreading far and wide](http://time.com/5112677/flu-death-count-2018/) and leading to the [deaths of at least 30 children.](http://time.com/5113281/flu-death-toll-children-2018/) But when Laura Spinney hears the news about this flu season, she has an extra layer of context. Spinney’s recent book [_Pale Rider_](https://www.publicaffairsbooks.com/titles/laura-spinney/pale-rider/9781610397674/) explores the legacy of the 1918 Spanish flu pandemic, a devastating episode 100 years ago that killed [perhaps as many](http://time.com/5018802/spanish-flu-death-toll/) as 100 million people across the globe. “Although this does seem to be a particularly bad flu, it is still seasonal flu, not pandemic flu,” Spinney tells TIME, when asked what goes through her mind when she reads about this year’s flu. “At the same time, we always seem to be taken by surprise. Part of the reason for that is that we have a tendency to underestimate flu as a disease. It’s not trivial even if it is ‘just,’ in quote marks, seasonal flu.” The distinction Spinney draws is important. By the [standards](http://www.who.int/csr/disease/swineflu/frequently%5Fasked%5Fquestions/pandemic/en/) of the World Health Organization, a pandemic must involve the global spread of a new disease. It is that novelty, and the corresponding lack of immunity among patients, that explains why a pandemic is more likely to make otherwise healthy people so ill. There were [three](http://www.who.int/csr/resources/publications/influenza/CSR%5FISR%5F2000%5F1/en/) known flu pandemics in the 20th century, of which [1918’s was the worst](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850175/table/T0001/). In contrast, the Centers for Disease Control and Prevention has found that this year’s seasonal flu is heavy on [H3N2](https://www.statnews.com/2018/01/08/flu-virus-h3n2/), a known variety of influenza A. Even though the flu vaccine is only effective against about a third of those viruses this year, seasonal variation still doesn’t mean it’s an entirely new disease. While the flu has officially reached epidemic levels in places — a standard that has to do not with novelty but with numbers — the CDC notes that such a designation is [common](http://time.com/5105929/why-is-the-flu-so-bad-2018/) at the height of flu season. And, while [as many as 650,000 people](http://www.who.int/mediacentre/factsheets/fs211/en/) worldwide may be killed by the flu during the annual epidemics of modern times, the estimates Spinney uses for the Spanish flu (which are higher than earlier estimates) would mean its death toll was more than 150 times greater. The difference between then and now isn’t just pandemic versus epidemic. Nor is it solely a matter of the technological and scientific advances that came after 1918\. Many people 100 years ago, as Spinney points out, lacked even the vocabulary to discuss what was happening. Despite those differences, we can still apply lessons of the 1918 pandemic to the 2018 epidemic, Spinney says. ### The 1918 Flu Pandemic: Scenes From a Cataclysm  Red Cross volunteers fight the flu pandemic, 1918. Apic—Getty Images  St. Louis Red Cross Motor Corps on duty during the influenza pandemic, 1918. Universal History Archive/UIG via Getty Images  Influenza victims crowd into an emergency hospital near Fort Riley, Kans., in this 1918 file photo. AP Photo—National Museum of Health  A patient wearing a "flu mask" during the influenza pandemic which followed the First World War. Topical Press Agency—Getty Images  Unidentified baseball players wearing masks which they thought would keep them from getting flu during the influenza epidemic of 1918. Underwood And Underwood/The LIFE Images Collection—Getty Images  A doctor inoculates Major Peters of Boston against the Influenza virus during the pandemic, 1918. Hulton Archive—Getty Images  Inspecting Chicago street cleaners for influenza, 1918. Bettmann/Corbis  Court is held outdoors in a park due to the influenza pandemic, San Francisco, 1918. Hulton Archive—Getty Images One such lesson can be found in the way we see our communal responsibilities when it comes to disease prevention and treatment. In 1918, among the many other elements of confusion about the pandemic, there was widespread misinformation about the reasons for a disease’s spread. At the time, the idea of [eugenics](http://time.com/4081760/margaret-sanger-history-eugenics/) was quite mainstream, and with it the idea that some people were genetically “better” than others. Along with that misconception came the belief that inferior people were more likely to catch and spread disease — and even that they were somehow to blame for doing so. The widespread nature of the 1918 pandemic, however, helped teach scientists and doctors that this could not be the case. After all, it felled people of all ranks of society. The pandemic showed that, rather than looking for a eugenic solution, scientists would have to focus on the virus itself and the conditions that helped it spread. In other words, they’d have to see disease as something that happened to the community as well as to specific people. Spinney argues that this shift in viewpoint, a process that is still ongoing to this day, could have a powerful impact on our collective ability to come to terms with a disaster such as the 1918 flu pandemic — and that it could also help us prepare for next time. After all, [people who fear vaccines](http://time.com/4832369/john-oliver-anti-vaxxers-last-week-tonight/) for the flu and other diseases, in spite of the [evidence](http://time.com/4696950/flu-vaccine-side-effects/) that many fears are misplaced, may say that vaccination should be an individual decision. But, as the world learned in 1918, contagious disease is never about just one person. “Vaccination of course is a personal choice, but it’s also a civic duty,” Spinney says. “If we got into the habit of thinking that way, we’d be better armed in the case of a pandemic.” What would happen if such a pandemic did arise? Nobody really knows for sure. Scientists and doctors are immeasurably better prepared to face a flu pandemic than they were in 1918 — but, on the other hand, the world is vastly more populous than it was back then, and that larger population is much better connected, so disease might spread much more quickly. That’s why, faced with a fearsome flu season, Spinney turns to an old adage: forewarned is forearmed. And there are few warnings as potent as that of the Spanish flu. “The way we remember our past and what we remember in our past, our collective past and our individual past, shapes the way we act now and our decisions in the future,” Spinney says. “We definitely won’t be ready if we don’t remember what happened then and take aboard some of the lessons.” ```json [{"@context":"https://schema.org","@type":"NewsArticle","@id":"https://time.com/5116388/flu-pandemic-1918/","mainEntityOfPage":{"@type":"WebPage","@id":"https://time.com/5116388/flu-pandemic-1918/"},"headline":"The Worst Flu Pandemic of the 20th Century Has an Urgent Lesson for Today","datePublished":"2018-01-26T16:26:43.000Z","dateModified":"2026-05-11T04:58:11.307Z","description":"As bad as the flu is in 2018, it's not a pandemic and its effect is much smaller than that of the flu that swept the world a century ago","url":"https://time.com/5116388/flu-pandemic-1918/","keywords":["health","healthytime"],"thumbnailUrl":"https://static.time.com/v3/assets/bltea6093859af6183b/blt0e5c73a14f0a3e9c/6988f966fb4eac8c918956cd/flu.jpeg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","author":[{"@type":"Person","name":"Lily Rothman","jobTitle":"Rothman is managing editor at TIME.","url":"https://time.com/author/lily-rothman/"}],"articleSection":"History","image":[{"@type":"ImageObject","url":"https://static.time.com/v3/assets/bltea6093859af6183b/blt0e5c73a14f0a3e9c/6988f966fb4eac8c918956cd/flu.jpeg?branch=production&width=1200&quality=75&auto=webp&crop=1200:675&height=675","width":1200,"height":675,"headline":"Flu of 1918","caption":"Warehouses that were converted to keep the infected people quarantined.","creditText":"Universal History Archive / Getty Images","representativeOfPage":true}],"publisher":{"@type":"Organization","name":"Time","url":"https://time.com/","logo":{"@type":"ImageObject","url":"https://time.com/images/logo.png","width":528,"height":156},"foundingDate":"March 3, 1923","sameAs":["https://www.facebook.com/time","https://www.instagram.com/time/?hl=en","https://twitter.com/time","https://www.pinterest.com/timemagazine"]}},{"@context":"https://schema.org","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"item":{"@id":"/section/history/","name":"History"}},{"@type":"ListItem","position":2,"item":{"@id":"/tag/health/","name":"health"}},{"@type":"ListItem","position":3,"item":{"@id":"https://time.com/5116388/flu-pandemic-1918/","name":"The Worst Flu Pandemic of the 20th Century Has an Urgent Lesson for Today"}}]}] ```