Although many commentators and scholars have looked back to the 1918-19 influenza pandemic for insights into our current predicament, it seems clear by now that SARS-CoV-2 is not as deadly a virus as H1N1 was just over a century ago. Estimates of the infection fatality rate of Covid-19 still range widely, from 0.02% to 0.4%, according to one recent survey (though some recent European serological studies imply higher rates), but the fatality rate of the so-called “Spanish Flu” was probably between 1.8% and 2.2%. Put differently, 675,000 deaths in the U.S. were attributed to influenza and pneumonic complications in 1918-19 of which around 550,000 were “excess deaths.” An equivalent excess death toll in 2020 would be greater than 1.7 million, compared with a figure to date of around 100,000.
Closer in terms of likely mortality is the less well-known “Asian Flu” pandemic of 1957-58. That caused up to 116,000 deaths in the U.S. (the estimates for excess morality vary widely), which would translate into 215,000 deaths in 2020, roughly what I expect the final U.S. Covid-19 death toll to be.
It is quite probable you have never heard of that pandemic, even though its worldwide death toll was between 700,000 and 1.5 million. This is all the more surprising as, unlike SARS-CoV-2, the H2N2 virus of 1957-58 killed young people. As in most influenza pandemics, significant numbers not only of the very old (over 65) but also of the very young (under 5) died. In terms of excess mortality relative to baseline expected mortality rates, however, it was teenagers who suffered the heaviest losses.
The biggest difference between 1957 and 2020, however, lies in the government and public response to the new pathogen. President Dwight D. Eisenhower did not declare a state of emergency in the fall of 1957. There were no state lockdowns and no school closures. Sick students simply stayed at home, as usual. Work continued more or less uninterrupted; AT&T reported peak absenteeism of 8%. Nor did the Eisenhower administration borrow to the hilt to fund transfers and loans to citizens and businesses. The president asked Congress for a mere $2.5 million (around 0.0005% of 1957 GDP) to support the Public Health Service in case of an epidemic.
True, there was a recession that year, but it had little if anything to do with the pandemic. Eisenhower’s job approval rating deteriorated, declining from about 80% to 50% between January 1957 and March 1958, and his Republican Party sustained severe losses in the 1958 midterms, but no serious historian of the period would attribute these setbacks to the pandemic.
The national mood of insouciance in the face of a new and contagious disease might be summed up in the phrase coined the year before by Mad magazine’s second editor, Al Feldstein: “What, Me Worry?” Huey “Piano” Smith and His Clowns even had a minor hit with “Rockin’ Pneumonia and the Boogie Woogie Flu.”
Whereas public health officials reached a consensus in March of this year that only full “lockdowns” could avert disaster, the Association of State and Territorial Health Officers declared on Aug. 27, 1957, that there would be “no practical advantage in the closing of schools or the curtailment of public gatherings as it relates to the spread of this disease.” As a Centers for Disease Control official later recalled, “ASTHO encouraged home care for uncomplicated influenza cases to reduce the hospital burden and recommended limitations on hospital admissions to the sickest patients … most were advised simply to stay home, rest, and drink plenty of water and fruit juices.”
As today, there was a race to find a vaccine. Unlike today, however, the U.S. had a head start, thanks to the acumen of one exceptionally talented and prescient scientist, Maurice Hilleman, who was chief of the Department of Respiratory Diseases at the Army Medical Center (now the Walter Reed Army Institute of Research) from 1948 to 1957. The first New York Times report of the outbreak in Hong Kong — three paragraphs on page 3 — was on April 17. The Army Medical Center received its first influenza specimens from Hong Kong on May 13. Nine days later, Hilleman had identified the new strain. As early as July 26, doctors at Fort Ord in California began to inoculate military recruits. Approximately 4 million one-milliliter doses were released in August, 9 million in September, and 17 million in October.
It was a different America, no question. For one thing, many Americans today would appear to have a much lower tolerance of risk than their grandparents and great-grandparents six decades ago. As Clark Whelton has recalled:
For those who grew up in the 1930s and 1940s, there was nothing unusual about finding yourself threatened by contagious disease. Mumps, measles, chicken pox, and German measles swept through entire schools and towns; I had all four. Polio took a heavy annual toll, leaving thousands of people (mostly children) paralyzed or dead. There were no vaccines. Growing up meant running an unavoidable gauntlet of infectious disease. For college students in 1957, the Asian flu was a familiar hurdle on the road to adulthood … We took the Asian flu in stride. We said our prayers and took our chances.