With COVID-19 came statewide shutdowns, increased hospital admissions, and a rush to find a cure. Many lines have been drawn to similarities between COVID-19 and the 1918 Spanish Flu epidemic that swept across the United States.
Blair Gifford, a professor in the University of Colorado Denver Business School, recently published an article in Health Management, Policy, and Innovation on Chicago hospital responses to the 1918 influenza epidemic. Using unique archival historical data, Gifford studied what the city of Chicago changed to increase hospital function and accessibility.
At its height, the city of Chicago saw over 600 deaths per day from the flu, and over 14,000 Chicagoans died between 1918 and 1920. Unlike COVID-19, which has hit older populations especially hard, the 1918 epidemic brought death to young adults. For example, 2,000 more U.S. soldiers returning from World War I battlefields in Europe died from the epidemic than from in battle.
To combat the spread of this deadly illness, Chicago’s public health leaders closed down various businesses and facilities, but schools and churches remained open on reduced schedules. Spatial distancing was practiced and masks were worn, especially by health professionals.
“Deciding between public health lockdowns and keeping the economy going was a primary consideration for government officials in 1918, just like it is today,” said Gifford. “Public health officials put policies in place for spatial distancing, mask wearing, and business and dance hall closures. Schools, churches, and taverns were allowed to stay open, but with much reduced hours.”
As archival data shows, hospitals and health professionals responded with valiant efforts. According to Gifford’s research, Passavant Hospital recorded in their annual meeting that “all the physical parts of the hospital were overtaxed.” The meeting notes stated that there should be a budget deficit, and that a large one will be no surprise. All epidemic patients were admitted, regardless of their ability to pay.
This is similar to how hospitals and health insurance companies are handling COVID-19. According to NPR, most health systems participate in a program through the Centers for Medicare and Medicaid Services in which “uninsured patients with COVID-19 have their bills covered.” This program was set up through the pandemic relief legislation, known as the CARES Act.
Gifford found that most private hospitals had moved away from admitting contagious patients and those with chronic diseases in the early 1900s. These diseases included alcoholism, insanity, and sexually transmitted diseases such as syphilis and gonorrhea, as well as contagious diseases like tuberculosis, as they were not seen to be “worthy” due to social implications. However, the 1918 epidemic changed this as hospitals recognized that their communities needed all available help. Staff at private hospitals filled their rooms beyond capacity and made makeshift arrangements in hallways, while doctors and nurses worked around the clock.
“A majority of charitable community hospitals had stopped caring for contagious patients in the 1910s, leaving them for quarantine in public hospitals,” according to Gifford. “However, as hospitals saw a surge of flu patients, they reaffirmed their community institutional role by admitting as many flu patients as they could, contagious or not.”