What can we learn from the Spanish flu?
西班牙流感留给人类的经验教训

One hundred years ago, a world recovering from a global war that had killed some 20 million people suddenly had to contend with something even more deadly: a flu outbreak.

100年前，造成2000万人死亡的一次世界大战才刚刚结束，突然之间人们又必须面对另一场更致命的危机：流感大爆发。

The pandemic, which became known as Spanish flu, is thought to have begun in cramped and crowded army training camps on the Western Front. The unsanitary conditions – especially in the trenches along the French border – helped it incubate and then spread. The war ended in November 1918, but as the soldiers returned home, bringing the virus with them, an even greater loss of life was just around the corner; between 50 million and 100 million people are thought to have died.

被世人称为西班牙流感（Spanish flu）的那场疫情据信是从交战前线拥挤的军营里开始爆发的，当时前线的卫生条件极差，尤其战壕里更是病毒肆虐散播的温床。战争在1918年11月结束，但是随着士兵返回家乡，病毒也被带回去，导致最后因为流感而死的人数——据信介于5000万至1亿之间——比死于战争的人数还要更多。
 

The world has suffered many pandemics in the years since – at least three serious flu outbreaks among them – but no pandemic has been as deadly, nor as far-reaching.

从那之后，全球出现多次大规模流行病，至少有3次流感大爆发，但是都没有像西班牙流感传染规模如此之大，如此致命。

Pneumonia is often the killer

致命肺炎

Many of the people dying from Covid-19 are succumbing to a form of pneumonia, which takes hold as the immune system is weakened from fighting the virus.

许多感染新型冠状病毒的人免疫系统无法抵抗病毒，最后引发肺炎而死亡。

This is something that it shares with Spanish flu – though it must be said that the death rate from Covid-19 is many times lower than that of Spanish flu. Older people and those with compromised immune systems – who make up the majority of those who have been killed by the disease so far – are more susceptible to infections that cause pneumonia.

西班牙流感致死的情况也是一样，但必须指出的是，新型冠状病毒的死亡率比西班牙流感低了好几倍。到目前为止，死于新型冠状病毒的以老年人和身体免疫系统不好的人居多，这类人群感染后更容易并发肺炎。

Few places escaped

少数地方幸免于难

Air travel was in its infancy when Spanish flu struck. But there are few places on Earth that escaped its horrific effects. Its passage across the world was slower, carried by railway and passenger steamer rather by airliners. Some places held out for months, or even years, before the flu arrived and wreaked its terrible toll.

100年前航空业基本不存在，但是西班牙流感仍然在全球范围内散播，只不过散播速度较慢，主要途径是火车和轮船，有些地方在好几个月，甚至一、两年之后才出现病例。

But some places did manage to keep the flu at bay, often by using basic techniques that are still being used 100 years later. In Alaska, one community on Bristol Bay escaped the flu almost unscathed. They closed schools, banned public gatherings, and shut off access to the village from the main road.

也有些地方最终成功隔绝西班牙流感疫情，基本方法和100年后的现在一样。例如，当时在阿拉斯加的布里斯托尔湾（Bristol Bay）地区，当地关闭了学校，取消公共集会，封锁了通往村落的主要道路，最后成功将疫情阻断在外。

Different viruses target different populations

不同年龄段的人病情不同

Doctors have described the Spanish flu as the “greatest medical holocaust in history”. It was not just the fact it killed so many, it was that so many of its victims were young and healthy. Normally, a healthy immune system can deal reasonably well with flu, but this version struck so quickly that it overwhelmed the immune system, causing a massive over-reaction known as a cytokine storm, flooding the lungs with fluid which became the perfect reservoir for secondary infections.

有医生说西班牙流感是“医学史上最大屠杀”，不仅是因为死亡人数之多，而且是因为死者当中有很多年轻健康的人，通常这类人群免疫系统足够应付流感，但西班牙流感导致这些人免疫系统过度反应，造成所谓的细胞素风暴，年轻力壮的人反而因此而死。

With the new coronavirus, the elderly and people with pre-existing illnesses are considered to be most at risk. Although still low, deaths have been highest in those aged above 80 years old.

而新型冠状病毒疫情，老年人和本身就有健康问题的人属于高危人群，虽然死亡率仍低，但80岁以上患者死亡率最高。

Public health is the best defence

公共卫生是最佳防线

The Spanish flu broke out in a world which had just come out of a global war, with vital public resources diverted to military efforts. The idea of a public health system was its infancy – in many places, only the middle class or the rich could afford to visit a doctor. The flu killed many in slums and other poor urban areas, among populations with poor nutrition and sanitation, and often those with underlying health conditions.

西班牙流感爆发当时人们刚从一场世界大战中走出来，主要的公共资源都已经被战争消耗殆尽，基本的公共卫生系统并不存在，很多地方只有中产阶级或富人才看得起医生，因此流感肆虐于贫民窟，城市低下穷人居民区，营养不良和卫生条件不佳的人群之中。

The flu spurred the development of public health systems across the developed world, as scientists and governments realised pandemics would spread more quickly than they had in the past.

在西班牙流感疫情平息之后，已开发国家的公共卫生系统获得了进一步的发展，政府和科学家都意识到，未来发生的全球性流行病散播速度会比过去更快更猛。

Treating people on a case-by-case basis would not be enough – to deal with pandemics in urban settings, governments would have to mobilise resources as if they were at war, quarantining those showing signs of the disease, keeping minor cases separate to those suffering more serious illness, and limiting people’s movements so the disease would burn itself out.

对付新的全球性流行病，一个一个的治疗病人已不足够，政府必须向战争一样动员所有资源才能对抗疫情，采取一切必要手段，隔离有症状患者，将轻微症状和严重患者区分开来治疗，限制人员流动，让疫情慢慢平息。

The public health measures we see being enacted today across the world as efforts to contain the spread of coronavirus are one of the Spanish flu’s most enduring effects.