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Similarities and Differences: 2009 Flu Pandemic Versus 1918 Pandemic

The History of H1N1


Updated August 19, 2009

As of mid-August, the 2009 H1N1 pandemic has claimed hundreds of lives around the world. Experts are predicting an even more virulent strain of the virus to pop up later in the year. The current pandemic has been compared to the 1918 pandemic that killed more than 50 million people. But is this a justified comparison? Let's take a look.

Not Much Known about 1918 Flu Virus

The flu virus responsible for the 1918 pandemic has never truly been isolated for study. In fact, some questioned whether the virus was influenza at all. But, in the 1930s, the H1N1 influenza virus was isolated (in pigs, and later humans), and linked to the 1918 virus by epidemiologists. And in 1997, autopsies of people who died in the 1918 epidemic appeared to show H1N1.

According to experts, the 1918 virus was transferred to pigs while sporadically infecting humans up to about 1957. Around that time, it virtually disappeared from circulation among humans, although it continued to circulate among pigs. In 1976, H1N1 infections were again documented in humans.

A Key Similarity: The Viruses Are Related

While the current H1N1 virus is a descendant of the 1918 virus, it is different in some key ways. The current H1N1 virus and other descendants have not been found to be as deadly or dangerous as their parent virus that caused so many deaths in 1918. However, some experts fear and speculate that the H1N1 virus may mutate and become more like the virus it descended from.

As to date, there is not much understood about the current H1N1 virus. It is known that many individuals born before 1953 have some immunity to the current H1N1 virus. This may account for the fact that the current H1N1 virus has been causing deaths in a younger than normal population.

Other Similarities Between 1918 and Current H1N1 Viruses

The current H1N1 virus first began to appear in humans in the spring of 2009. This is inconsistent with most influenza viruses that have a tendency to appear in the fall and winter. Likewise, the 1918 pandemic occurred in three waves beginning in the spring of that year. The first wave was not as deadly as the second and third waves, which occurred in fall and winter of 1918. Like the 1918 virus, the current H1N1 virus seemingly appeared out of nowhere. It was not present in recent flu seasons -- which would have allowed people to gain some immunity to the virus. Experts are waiting to find out if the current H1N1 virus will show a similar pattern, meaning that infection and deaths will increase in fall and winter 2009. The 1918 virus also caused a higher than normal number of deaths in the younger (age 5 to 59) population, just as with this current outbreak.

Also, it seems that the current H1N1 virus and the 1918 virus both affect the respiratory tract in a manner that is inconsistent with other flu viruses.

How the Current H1N1 Pandemic Is Different

So far, most of the differences can be attributed to large improvements in medical care and communication.

    Modern Medicine

    Modern medicine has made huge advances since 1918. Currently, there are multiple antiviral drugs used to treat H1N1 illness that give us an advantage over the 1918 pandemic; they include Tamiflu. While Tamiflu will not cure flu symptoms, it can decrease the duration and severity of symptoms and perhaps even more importantly, decrease the amount of time in which an individual is contagious.

    In addition to antiviral drugs, the race for a vaccine is on. Clinical trials in humans have already begun.

    Moreover, most people today have better access to adequate medical care than in 1918. This includes access to IV fluids to treat dehydration and oxygen to treat pneumonia.

    Enhanced Communication

    With the invention of modern conveniences such as the internet and the telephone, messages can be sent around the globe with a click of a button. This allows medical officials to communicate with the rest of the population easily. Hence, better education regarding the illness is available to the public. This includes ways to prevent its spread -- such as hand washing and disinfecting household surfaces.

Since the 1918 pandemic, officials have been preparing for another epidemic. Experts predict that such a pandemic could kill more than 100 million people. To date, the United States government has ordered approximately 12.8 million doses of the H1N1 vaccine in addition to stock piling Tamiflu. The United States is also providing other countries with the vaccination and anti-viral drugs.

Bottom line: While the 2009 flu pandemic has some key similarities to the 1918 pandemic (and it's impossible to predict what will happen with the current virus), overall, we are much better prepared for a flu pandemic than anyone was in 1918.


CDC. Antiviral Drugs and H1N1 (Swine) Flu. Accessed: August 18, 2009 from http://www.cdc.gov/H1N1flu/antiviral.htm

CDC. 1918 Influenza: The Mother of All Pandemics. Accessed: August 18, 2009 from http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm

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