• In 1918, social distancing measures like school shutdowns and travel restrictions were put into place in order to avoid spreading the Spanish flu, one of the deadliest events in history.
• In 2020, over 100 years later, we are following the same social distancing measures to mitigate the effects of COVID-19.
• From hourly workers panicking about lost wages to a cultural obsession with face masks, historians told Insider that both pandemics have a lot in common.
• Visit Insider's homepage for more stories.

Closing stores, shutting down schools, wearing masks, and self-quarantining. In 1918, these were the social distancing methods used to mitigate the effects of the Spanish flu pandemic, and they're the same methods being used to mitigate the spread of the novel coronavirus more than 100 years later. 

Global pandemics tend to occur every 30 to 40 years, but experts have been warning for years that the world isn't prepared for the next one. In fact, some say the world today is about as well-prepared for an outbreak as people were in 1918. 

"What we're hearing now, in terms of washing your hands or stay home if you're sick, are almost the same measures that were recommended in 1918," said Tom Ewing, history professor at Virginia Tech.  

"When you don't have a vaccine, and when you don't have a treatment, you don't have the medical countermeasures," said medical anthropologist Monica Schoch-Spana, currently a Senior Scholar with the Johns Hopkins Center for Health Security. "So you have very little left in your toolkit."

That's hardly the only similarity historians are seeing.

In many American cities in 1918, retail hours were cut short, public transportation was limited, and essential services including mail delivery, garbage pickup, courts, and grave digging were interrupted. Schools, universities, dance halls, pool rooms, and theaters closed. Parades and social club gatherings were cancelled. American life ground to a virtual halt, and influenza became one of the deadliest events in history, killing an estimated 50-100 million people.

Historians told Insider there are many similarities between the events of 1918, which many public health experts often examine as the worst case scenario for a pandemic, and the events of 2020, from the hourly workers concerned about losing wages to the cultural obsession with masks.

People called it 'the Spanish flu,' even though it had nothing to do with Spain or Spanish people. Similarly, the coronavirus has been falsely associated with China.

Pandemics are defined by their global reach, and this was true for the flu and the novel coronavirus.

"The flu spread quickly across the United States, cities, towns, rural communities, and I think we're seeing that today with the coronavirus," said Ewing. "This is not concentrated within a particular geographic region or among certain populations."

The sickness was first noticed in the United States in Fort Riley, Kansas, and then in Europe in the summer of 1918. But the disease picked up the name "Spanish influenza" because Madrid seemed to have the first major widespread outbreak in the world, during World War I.

Since, it's become clear that Madrid's outbreak was not much greater than other cities'. Rather, unlike the nations embroiled in a world war, Spain, which had remained neutral, was free to report on the outbreak in detail, without worrying about affecting morale. Because most of the accounts of the flu came from Spanish news sources, people assumed the outbreak began in Spain, and it became known as the Spanish flu.

Similarly, the novel coronavirus was long closely associated with Wuhan, China, where the virus first emerged in December 2019. Though it has since spread globally, President Donald Trump has referred to the virus as the "Chinese Virus" — an inaccurate phrase, public health experts say, is a misnomer, and fuels xenophobia.

There was a lot of backlash to the closure of schools and shops.

Many schools shut their doors in 1918, but New York and Chicago refused to. Their thinking was that they had been working on hygiene and public health for decades already, and reasoned that children, many of whom lived in tightly packed tenement homes, were likely to be better off in a clean school building, where nurses could see if they were sick.

"I believe that the children are better protected in the schools than they would be in the streets," New York City health commissioner Dr. Royal S. Copeland said. Chicago public schools also remained open, although school nurses were eventually instructed to drop all their other work and concentrate solely on student inspections.  

As the current pandemic took hold and reached the US, there was concern that closing schools would mean children did not have access to food or the internet, to take their online courses.

But as the virus has progressed, there has been broad support for school closures. 

The shutdown of religious institutions angered many.

The suspension of worship upset many people in 1918. The city of Baltimore delayed postponing closing houses of worship for as long as they could, until the cases began to surge.

"People felt that at the very moment they needed comfort and spiritual guidance, that was taken away from them," said Schoch-Spana. "So there were major complaints in the newspaper and from the pastors at the time, saying that you are taking away a very important source of solace for people when they're seeing people get sick and die."

Likewise, in 2020, some people have railed against the idea of canceling religious gatherings. The Diocese of Rome pushed for churches in Italy, a country under lockdown, to remain open. In Iran, Shiite Muslims stormed shrines that had been closed due to coronavirus, demanding to enter. Thousands of Hindu people attended Holi celebrations, despite the Indian government suggestion that they avoid public gatherings.

But most religious groups in America pivoted to digital services in the wake of the new coronavirus. Many rabbis, priests, and imams turned to digital meeting services like Zoom for to provide inspiration to worshippers.

Hourly workers worried about losing income due to closures.

When store hours were curtailed in Baltimore, hourly workers at retail stores and groceries were upset.

"These restrictions came in the fall, and in the winter when it was cold," said Schoch-Spana. "People argued at the time, how am I supposed to buy fuel to heat my house when I don't have an income? There was worry that you could catch cold, literally, because you were cold."

At the time, people thought it didn't make sense to cancel work for hourly workers, creating a burden that was both financial and health-related.

In 2020, many hourly workers without a safety net voiced similar concerns.

"Missing shifts for an illness would have definitely affected our ability to pay for our expenses," one woman previously told Business Insider.

For the easily-fired hourly employees of the gig economy, the new coronavirus meant they might soon be without an income. And it wasn't just hourly workers that were concerned. Millions of Americans with full-time jobs worried about losing their jobs due to the coronavirus, as the financial markets saw the effects of American life shutting down. 

A surge of cases overwhelmed the medical system.

In 1918, a surge of cases swamped the American healthcare system.

"There just weren't enough doctors or nurses," said Navarro. Because the pandemic occurred during wartime, there was a severe shortage of doctors and nurses, as many of them had been sent to military camps abroad. And of the nurses and doctors that remained, many of them were getting sick. In Chicago, the American Red Cross called for volunteers and in Massachusetts every able-bodied person in the state with medical training was asked to help.

There weren't enough beds in the hospitals for all the new influenza cases, so schools and other buildings were converted into makeshift hospitals.

In 2020, makeshift hospitals are being hastily constructed constructed around the world. China built one in six days, using a prefabricated module, and four sites in New York are quickly being converted into hospitals. The US Navy is also planning to deploy two of its hospital ships into action, and experts say the process of quickly building hospitals is likely to extend to California and other states.

Many experts are warning the public that the American healthcare system isn't ready for a surge in COVID-19 cases. There are fewer than 100,000 intensive care unit beds in America, and on an ordinary day, most of them are in use. If the coronavirus continues to spread, American doctors will soon be faced with the weighty ethical dilemmas doctors in Italy are facing, of how to ration their limited resources.

"Starting now, everyone should try to avoid going to the ER," one emergency physician wrote.

They were constantly changing estimates of how long the outbreak was going to last.

"In 1918, there were a lot of swings in public perception, of people saying things were going to pass quickly, and then changing estimates of how long the process would take," said Navarro. It was a balancing act between trying to reassure the public and inform the public.

"Early on, there were a lot of recommendations to not panic, this isn't going to be really dangerous," said Ewing. "Once the number of cases and the number of deaths go up, then you see health officials really sounding the alarm with front page articles in newspapers."

In America, warnings about COVID-19 followed a similar pattern. In January and February, many public health experts were telling Americans not to panic. Many news outlets, like the Washington Post, Yahoo Finance, and the LA Times, wrote pieces advising people not to panic.

By March, that tone was gone, and many news outlets had shifted their tone to sounding the alarm and advising people to be cautious when leaving the house, and mindful of the fact that not social-distancing could harm many people.

On Sunday, Donald Trump reignited confusion over the timeline by saying he planned to reopen the country on April 12, which public health experts say is an unrealistic goal. 

People were obsessed with masks.

As people began to panic about influenza, face masks became a symbol of American patriotism. "The man or woman or child who will not wear a mask now is a dangerous slacker," a Red Cross public service announcement said.

Very few places made it compulsory, said Ewing, but in San Francisco there was a $5 fine and jail time for those who didn't. At a Congressman's wedding in St Louis, the wedding guests wore face masks.

At the time, department stores advertised veils as masks for women, said Ewing, and New York Health Commissioner Copeland told people to kiss their spouses or children through a handkerchief.

Experts believe that the masks were not very useful. They were often made of gauze, which allowed droplets to pass through, and few wore them in private, where diseases are more likely to spread.

In 2020, the CDC has advised healthcare workers to wear bandanas or scarves if they can't get masks, since the general public has been buying them in droves, for extortionate prices on Amazon and Ebay, leading to a shortage.

There was a state-by-state patchwork of responses, rather than a federal mandate to cancel public gatherings.

Then, as is the case now, there was no mandate handed down from the federal government telling all the states what to do, said Navarro. It made for an uneven patchwork of state responses.

Some mandates were enforced by law enforcement, Navarro said, though it's hard to quantify exactly how well that worked.

In Baltimore, the state's attorney said he would indict any business owner who didn't restrict hours. In Oakland, the city commissioned 300 people to act as undercover cops and take down the names and addresses of those walking outdoors without masks on. Albany declared anyone sneezing or coughing in public without covering their mouths would receive a $500 fine.

In America in 2020, mandating and enforcing health measures has also been left to individual states, though governors have been asking for federal help.

China enforced a complete shutdown due to coronavirus, with police patrolling the blocks to ensure no one left their homes without permission, but in the US, people were still gathering in large numbers for spring break.

Medical misinformation flourished, as people desperately looked for answers.

"Human nature has always been the same," said Navarro, "and people have always tried to profit off of these things." In 1918, people considered alcohol and qiuinine, a soda water, to be medicinal, and thought rubbing half an onion on your chest could have healing properties, he said. 

In 2020, influencers are shilling colloidal silver,  herbal remedies, and antiviral essential oils on Instagram, and people mistakenly thinking vitamin C can help prevent COVID-19. QAnon supporters even claimed that drinking bleach could kill COVID-19. Misinformation was so prevalent that the World Health Organization had to address a few wrong claims on its site, writing that alcohol, saline solutions, garlic cloves, and antibiotics were not viable coronavirus treatments. 

There were disparities in treatment for the wealthy and the poor.

"As it's been for the history of the American healthcare system, the rich had access to better treatment," said Navarro. While the Spanish flu outbreak occurred during wartime, meaning people were already rationing food, the wealthier were able to stock up on necessities, although there was no panic-buying at the time.

The 1918 pandemic also happened during Jim Crow segregation, when African Americans could only go to certain hospitals. "Everyone was sick, but there were more healthcare facilities that were open to whites than there was for blacks," said Schoch-Spana. "And so there was an unevenness of evenness and the availability of healthcare."

If you were of a higher class, you would likely have a family doctor who could tend to you or get you into a hospital, or you could flee the city, said Ewing.

In 2020, as thousands of Americans with symptoms waited for an opportunity to get tested for COVID-19, celebrities, athletes, and Congressmen announced that they had gotten tested quickly and easily. Wealth also enabled some people to stock up on necessities like toilet paper and hand sanitizer, or even pay price gougers for what they needed, and the super-wealthy were able to jet off to private disaster bunkers in the midst of the outbreak. 

"While they didn't have a cure in 1918, money made for a more comfortable experience with the disease," said Navarro. The same could be said for 2020.

Both now and then, the US heavily relied on volunteers to bolster an overwhelmed healthcare system.

In 1918, visiting nurses were often dispatched to check on families that had people sick with the flu, to clean and feed the children. If the nurses took the trolley, their routes would be limited. So people with cars lent their cars so nurses could cover more ground in a day, said Spoch-Spanos. People also brought foods like custard and broth to households where people were sick with flu.

In 2020, thousands of people have volunteered to work at the coronavirus testing drive thrus. Medical volunteers have stepped up to offer their support during the pandemic, with some even emerging from retirement to do it. 1,000 formerly retired healthcare volunteers vowed to offer their services in New York City in March. Many Americans are also virtual volunteering from home at organizations like Crisis Text Line, BeMyEyes, and BookShare.

And, just like in 1918, volunteers are sewing face masks for the healthcare workers that need them.

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