More than a hundred years later, is Coronavirus the next Spanish Flu?

A new coronavirus arose in Wuhan Province, China, at the end of December 2019. Provisionally referred to as 2019-nCoV, the virus’s quick spread and growing death toll has some people claiming that it is poised to become the next Spanish Flu—a global pandemic that began in 1918 and killed up to 40 million people.

In fact, 2019-nCoV does not appear to be nearly as threatening as the Spanish Flu. But that doesn’t mean it isn’t a global health emergency. How are these two diseases different, and why is the new coronavirus such a concern?

Differences between the coronavirus and the Spanish Flu

While both the new coronavirus and Spanish Flu are human-infecting viruses that result in fever and pneumonia-like symptoms, 2019-nCoV has some important differences that suggest a decreased risk of causing a global devastating pandemic.

Death Rate

The Spanish Flu was notorious for having the highest death toll in young adults in their 20-40s, with some estimates putting the mortality rate as high as 20%. In the case of this virus, the robust immune responses of young, healthy adults actually further accelerated the disease. The loss of the young adult generation, particularly in the wake of World War I, made the infection all the more traumatic for societies.

But the new coronavirus currently demonstrates no such predisposition to young adults. In a paper studying forty-one hospitalized patients in Wuhan, the median age of patients was 49 and no adolescents were infected. Furthermore, the vast majority of deaths reported during the outbreak have been older individuals with preexisting conditions, such as cancer, COPD, or diabetes. While the loss of older individuals is no less disturbing, it is reassuring to know that young, healthy individuals appear to be capable of recovering from the virus.

In terms of the virus’s overall mortality rate, recent reports from China cite more than 800 infections and 26 deaths, and a quick calculation shows this rate is far below the 20% of the Spanish Flu. It is additionally likely that minor cases of 2019-nCoV are not being reported as patients choose not to visit a hospital, meaning that the death rate could be even lower.

While a significant concern with viruses is the threat of mutation—more on that later—it currently appears unlikely that the coronavirus is as deadly as the virus seen in 1918.


Both the Spanish Flu and 2019-nCoV are zoonotic infections. Zoonotic viruses are those that are originally found in animals, but at some point in transmission, the virus mutates and becomes capable of infecting humans. This typically happens when there is frequent exposure between humans and the original animal host.

The Spanish Flu most likely descended originally from birds, and some of the descendants of the disease (like H1N1) now exist in pigs. These two species appear logical as transmission points for human disease: both birds and pigs are consumed frequently and are sold in large, population-dense urban markets. The slaughtering of animals is often the point at which a virus has a chance to jump to humans.

In comparison, it appears that the viral ancestor of 2019-nCoV might actually be snakes. Soon after the outbreak, scientists analyzed the “spike” proteins that surround the outside of the coronavirus, the same proteins that create the halo of particles which give the family of coronaviruses their name. These spike proteins were most similar to coronaviruses that infect snakes.

Snakes as the original host is surprising for a few reasons. First, 2019-nCoV’s most well-known viral cousins are SARS and MERS, two severe acute respiratory coronaviruses that have caused more than 10,000 infections in the last two decades. Both of these diseases jumped from bats to humans, which had led scientists to assume that the animal host for 2019-nCoV was also most likely bats. It now appears that the virus may have jumped from bats to snakes before jumping to humans, a jump that could have occurred either in a market where both were being sold, or naturally as snakes hunt bats in the wild. Snakes are also a surprising host given that they are cold-blooded. It is as yet unclear how the virus would have adapted from a warm-blooded host to a cold-blooded host.


It took only 18 months from the first known case of Spanish Flu for the virus to infect a third of the world’s population and reach even Australia and the Pacific Islands. While the world didn’t have the threat of constant global passenger airlines acting as transporters of the virus as we do today, neither did they benefit from modern epidemiological containment and monitoring measures that have so far kept the Coronavirus confined to six countries.

By the time the Spanish Flu was realized for what it was, it was already a global presence. 2019-nCoV, in comparison, was quickly reported to the WHO by China even before the virus was fully identified. This has sparked a level of international collaboration not seen even with the previous SARS and MERS outbreaks in the last few decades.

While it is extremely likely that more cases will continue to be reported in new countries, the early identification of the virus allows governments to be on full alert, screening travelers and initiating awareness campaigns that will limit the spread of infection.

Ability to respond

Perhaps the most important difference between the Spanish Flu and the new coronavirus are the modern methods of epidemiology, genetic screening, and medicinal treatments available that give medical professionals and governments significantly better chances in combating the virus. The response to 2019-nCoV has been swift and thorough, with governments and researchers collaborating to both better understand the nature of the virus and provide the most effective level of care to individuals at risk. These resources were simply not available a hundred years ago, cloaking the Spanish Flu in a sense of mystery that only added to its societal burden.

How the two viruses are similar

While 2019-nCoV does not appear to pose the same level of global risk as the Spanish Flu, it is still capable of inciting similar levels of fear and trauma in populations. China has instituted travel lockdowns on tens of millions of people in the Wuhan Province. While an admirably huge effort to contain the virus, lockdowns can also induce a sense of panic as citizens feel trapped at the source and unfairly blamed for a situation out of their control.

There is also the psychological fear entrenched in viral diseases. These invisible, infectious agents could be carried by any individual, making everyone a potential threat. This resting anxiety and sense of helplessness is a toxic component of epidemics and can be even more damaging to the structure of society than the disease itself.

The 1918 Flu left emotional scars as much as physical, and as the coronavirus continues to spread, it has the capacity to do the same. That is why it is so critical to provide accurate and timely information to individuals who are at risk and clearly explain the measures being taken for their protection before panic can overwhelm the efforts of containment.

Why the coronavirus is still a major concern

The primary reason is that, while it may not be as deadly as the 1918 pandemic, the coronavirus has still killed dozens of individuals and will likely take more lives before the outbreak is stopped. The sudden death of these victims is traumatic for their loved ones and devastating in its apparent randomness. While the overall death toll will hopefully remain low, no death toll is truly low enough.

A secondary reason is that viruses are known for their frequency of mutations. These mutations are what allow them to jump between species, but they can also result in an existing virus becoming more deadly. The first wave of the Spanish Flu was not as lethal as the second, suggesting some kind of mutation in the original virus that led to a greater mortality rate in subsequent waves.

It is unclear how quickly 2019-nCoV may mutate, but the good news is that the genetic sequence of existing cases have all been very similar, suggesting that individuals are being infected by the same virus rather than multiple different mutated versions. This could suggest that the virus was caught early in its existence, which is promising for preventing further spread before it can adapt again.

The banner image of this post is an image of Walter Reed Hospital during the Spanish Flu epidemic.

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Sonja K. Eliason

January 26, 2020