In 1918, Spokane officials mandated substantial social distancing measures to limit the spread of an influenza outbreak. 

(Note: I am not a scientist, virologist, epidemiologist, or even a historian of science, but I am a local historian interested in how our region dealt with and was impacted by previous pandemics. This blog post and timeline is an evolving work that will be continuously updated and I encourage any comments or suggestions. I received some excellent feedback from Dr. Monica H. Green, including a tip to explore the Influenza Archive)

On October 5, 1918, James Alphea Howe died after a bout with pneumonia. Howe, a retired merchant and farmer, was 79 years old. Due to his age and the prevalence of respiratory illness, not much thought was put into the cause of his death. The 1918 flu virus had been spreading across the country and western Washington, but there were still no confirmed cases of the virus in Spokane. But, two weeks later Spokane doctors would connect the dots, James Howe was the first Spokanite to die from the 1918 influenza outbreak. Spokanites were dying before local health officials knew the virus had arrived.

The Spokane Regional Health District announced the first three confirmed cases of COVID-19 in Spokane County on March 14, 2020. This announcement and the resulting interventions to reduce the rapid spread of COVID-19 (#flatteningthecurve) are scary and panic-inducing, but they are not unprecedented in our city. And, most importantly, the measures Spokane took in 1918 seem to have been effective at slowing the spread of a deadly disease that was transferred in the same ways as COVID-19.

In 1918, the world experienced one of the largest pandemics in modern history. The 1918 influenza, often erroneously referred to as the “Spanish Flu,” was a worldwide pandemic that killed at least 675,000 Americans and 50 million people worldwide. The 1918 flu was caused by an H1N1 virus, much like the virus that caused the 2009 “Swine Flu” outbreak. From a virology perspective, the H1N1 virus is notably different from the novel coronavirus COVID-19. However, despite the differences, the viruses have three important similarities that allow for meaningful historical comparisons. First, both viruses spread primarily via droplets transferred from one person to another while in close contact or by touching the virus when it is present on surfaces. Second, neither virus had a known vaccine or approved treatment at the time community spread was identified, meaning that controlling the virus was primarily limited to non-pharmaceutical interventions. Third and finally, before both viruses arrived in Spokane they had spread rapidly in Europe, the east coast of the United States, and even western Washington, providing Spokanites an opportunity to intervene before the pandemic arrived in the Inland Northwest.

Washington State and Spokane initiated non-pharmaceutical interventions to slow the spread of COVID-19 and there will likely be more mitigation efforts announced in the coming days. So far, all gatherings larger than 50 people were banned, schools and universities were cancelled for six weeks, and bars and restaurants were limited to to-go orders only. These social distancing efforts were not initiated until the first cases of COVID-19 were confirmed in Spokane. How do these interventions compare to the measures taken in 1918? 

The transfer of communicable diseases in 1918 was not accelerated by international air travel, but the spread was still incredibly rapid. Spokane newspapers began warning readers about the 1918 H1N1 virus in August of 1918. On October 6, 1918, Spokane Health Officer, Dr. John B. Anderson, announced that there were still no confirmed cases in Spokane. On October 7, 1918, Spokane announced its first confirmed case of the virus (Although, much like COVID-19, it had almost certainly been spreading in Spokane for some time). The same day that the first case was announced, Dr. Anderson, enacted “quarantine regulations” by ordering the cancellation of all public gatherings including schools, universities, churches, mining and stock exchanges, all club and social meetings, YMCA activities, and all jury trials in superior court. As the virus progressed, Dr. Anderson put limits on public transit and elevator capacities, and he even banned Halloween masks.

Taking these actions were swift and effective, but they were met with some resistance. On October 11, 1918, health inspectors arrested a clairvoyant and a pool hall operator for hosting groups of over 10 people. Dr. Anderson took one of the most notable enforcement actions on October 21, 1918, when he was issued a warrant for the arrest of A. R. Wilson, the Superintendent of Washington Water Power’s streetcar company. As part of Dr. Anderson’s mandated “quarantine regulations”, streetcars were ordered not to fill beyond their seating capacity with standing-room-only riders, but W.W.P. cars had been ignoring that directive. (For more details on Spokane’s 1918 H1N1 response, read Nick Deshais’ excellent piece.)

I have updated the curve for 3-17-2020. Spokane announced the 4th case of COVID-19. I made an error the first time I graphed the curve by plotting the total number of cases instead of the new cases per day. I fixed the error.

Despite the social distancing measures, the number of Spokanites with the virus quickly exploded. The first case was announced on October 7. One week later, Spokane reached 500 cases, and two weeks later the count had surpassed 1000. By the end of the October 1918, Spokane was counting over 3000 cases of the 1918 H1N1 virus including 76 deaths. The total number of cases doubled every seven days, a stunning rate of spread. (I will continue to update the epidemiological curve as more COVID-19 numbers are announced, and I will add more to the 1918 curve as we get closer to Day 25.)

I have created the timeline below in order to show the speed in which the situation changed in 1918 Spokane and to offer comparisons with the COVID-19 pandemic as it progresses. As you flip through the slides, it is important to remember that October 7, 1918 is equivalent to March 14, 2020. (If you would like the sources for any of the newspaper articles, email me or leave a comment.)