When I wrote the comic book No Ordinary Flu in 2008, we were anticipating a global pandemic from avian influenza, similar to what happened in 1918 (known then as the “Spanish Flu”). I created the comic book with artist David Lasky as a way to help people visualize what a pandemic could look like and how disruptive it would be for everyday life. Ten years later, for the centennial of the great influenza pandemic, David and I collaborated on a serialized web comic, “Pandemic in Seattle,” about what specifically happened in our region at that time and what could happen in a modern pandemic.
And now, two years since that web comic published, we are in a global pandemic. Even though we put a lot of thought into illustrating life during a pandemic, it still has been surreal to see it play out much like the comic book shows. Given the circumstances, there’s little gratification in being so spot-on.
But not everything is the same between 1918 and today. The current COVID-19 pandemic has significant differences from the 1918 pandemic. So what do they have in common and what’s is not the same?
Differences in the virus
The pandemic of 1918 was due to an influenza virus. Like in the current coronavirus outreak, this was a virus that started in animals then jumped to human populations so no one had immunity to it—that’s why it spread so quickly. In 1918, it spread globally with the movement of troops from WWI.
Both influenza and coronavirus cause respiratory illness with similar symptoms of fever, cough, and in more severe cases, pneumonia. But the strain of influenza in 1918 was particularly deadly among young, previously healthy adults. It’s likely that the virus triggered an overreaction by the immune system in this age group, a phenomenon known as “cytokine storm.” In comparison, the current pandemic is due to a new coronavirus, which has tended to result in milder illness in young people but more severe illness for older adults and people with underlying health conditions.
How severe is the COVID-19 pandemic compared to the 1918 influenza pandemic? It’s too early to compare exact case fatality rates since we’re still in the midst of the COVID-19 pandemic, according to Vance Kawakami, a senior epidemiologist in our department (and fellow comics fan).
The case fatality rate during the 1918 pandemic is estimated to be greater than 2.5% (that is, of the confirmed sick people, about 2.5% died). Vance noted that for the current outbreak, the fatality rate is a moving target with case fatality rates varying significantly between countries and over time, making it difficult to compare. Moreover, current testing is not necessarily picking up all the mild cases of illness. If all of the mild cases of illness that have been off the radar were included in the case counts, the case fatality rate would likely drop.
Vance further explained that the comparison of case fatality rates between the two outbreaks need to take into account things like the considerable advancement in modern healthcare to take care of sick people and the public health infrastructure to identify and respond to pandemics.
The bottom line? It’s premature to make exact comparisons on the relative severity of the two viruses, but compared to a century ago, the greater scientific understanding of infectious diseases and vastly improved healthcare systems will significantly influence the outcomes today.
Modern technologies
In 1918, there was no effective vaccine developed for the deadly flu strain. Today, there are scientists around the world working on a vaccine for COVID-19 and there are systems to mass produce vaccine supply. Since this is new virus, it will take more than a year to create a vaccine, test it for effectiveness and safety, and produce quantities for people around the world. Although we wish we could have a vaccine ready now, development and mass production of a new vaccine in a year-and-a-half is a very fast timeline compared to the years it usually takes.
In addition, there are other huge advancements in the medical field that make the current pandemic situation different. In addition to the vast body of scientific knowledge that has developed over this time, and the innovations in treatment and medical technology in hospitals and clinics, even resources that we now take for granted—such as telemedicine and access to accurate information from the CDC and local health departments on the internet—will support better outcomes in today’s pandemic.
The importance of basic actions to protect health
Without a vaccine ready in 2020, we are again relying on good healthy hygiene practices, like frequently washing hands, covering coughs, and staying home when sick to prevent the spread of coronavirus. These “non-pharmaceutical interventions” really do prevent infection. People are also widely adopting the recommendation not to touch their faces since the virus spreads by contact with your eyes, nose, and mouth.
Stay at home orders
Some of the similarities between 1918 and 2020 are remarkable. In 1918, the health officer and the mayor of Seattle took the then radical step of closing down gatherings. Although these measures were unpopular at the time, Seattle fared much better in terms of the number of people who got sick and the number of deaths than other cities who didn’t take such measures. Pittsburgh, a city of comparable size, had a death rate that was nearly double that of Seattle’s.
Does this feel familiar? The 1918 school closures must’ve been rough in the days before screen time.
An aspect of the comic strip about 1918 that is particularly relevant in this moment is what happened when stay at home measures were lifted too soon.
When the closures were lifted while the virus was still circulating, it gave an opportunity for a second wave of the epidemic that lasted for months. That’s why it’s so important that we stay the course in staying home to avoid a spike in illness.
Predicting what a pandemic would look like now
In our 2018 web-comic, we predicted many of the same disruptions to our lives that we’re experiencing now, based on pandemic planning that has been in the works for years in our department and at state and federal health departments.
Pandemic planning has also involved anticipating impacts to the healthcare system. The goal of the Stay Home order is prevent a sudden spike in the number of sick people so that the healthcare system won’t be inundated and can still serve all the people seeking care.
Additional measures are underway to build capacity. In 1918, the top floor of the courthouse served as a makeshift hospital. This week, the Army is setting up a field hospital at CenturyLink Field to take pressure off the hospitals who are providing care for COVID-19 patients. We have also set up facilities to care for people who don’t have permanent housing in case they become ill with COVID-19.
Community supporting community
When I researched the 1918 pandemic in Seattle, I was surprised to learn that women were called upon to sew protective facemasks (then made of gauze and of questionable protection). And here we are in 2020 with a shortage of personal protective equipment (PPE) including masks. Home sewers—now of all genders—are pitching in to help make them at home. Homemade masks may not be of medical grade, but they could provide some protection in some situations, and the mask making efforts are just one of the ways individuals are helping the community.
When I wrote this comic strip, I was thinking about how in every catastrophic disaster, the communities that recover best and show the most resilience are those where people help one another. So the comic included a mention of how we’ll need to be ready to help one another to weather a pandemic, and gave an example of how dropping off groceries could help.
Now that the pandemic is here, I’m amazed, heartened, and moved by all the incredible examples of people helping one another, things I never anticipated: restaurants packing free sack lunches for children out of school, or the Seattle Symphony livestreaming music to keep people’s spirits up, or grocery stores setting aside shopping hours just for those at higher risk. And it’s been amazing to witness the commitment of King County residents in following the Stay at Home order for the sake of everyone in the community, with everyone united to flatten the curve.
Some hard days are still ahead. But I have confidence that we will be resilient and support one another during a pandemic that has already asked more of us than any of us ever anticipated, even someone who wrote a comic strip about it.
For more information
Follow this blog and kingcounty.gov/covid for frequently updated information about COVID-19.
Read all of “Pandemic in Seattle”
This serialized web-comic first appeared on the Public Health Insider in September, 2018 to commemorate the centennial of the 1918 influenza pandemic.
Part One: Seattle a Century Ago – Backdrop for a Pandemic
Part Two: Seattle Faces a Pandemic
Part Three: A City Mourns and Moves on
Part Four: What Would a Pandemic Look Like Now?
Originally posted on April 5, 2020.