spanish flu vs covid 19 essay

National Institutes of Health • Office of the Director | Volume 29 Issue 2 • March–April 2021

The 1918 Flu and COVID-19: A Tale of Two Pandemics

Anthony fauci and jeffery taubenberger launch demystifying medicine’s 2021 season.

BY EIMEAR HOLTON, NIAID

CREDIT: NIAID

Colorized scanning electron micrograph of a cell (blue) heavily infected with SARS-CoV-2 virus particles (red), isolated from a patient sample. Image captured at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland.

The COVID-19 pandemic is not our first rodeo with battling a deadly virus, and it likely won’t be our last. As we continue to process the past year, the juxtaposition of the COVID-19 pandemic and the influenza pandemic of 1918 puts today’s challenges into perspective. Two prominent NIH scientists shared their perspectives (virtually) at the January 12, 2021, launch of the Demystifying Medicine lecture series for its 2021 season: National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci and Jeffery Taubenberger , chief of NIAID’s Viral Pathogenesis and Evolution Section. Fauci gave a state-of-affairs address on what we know about the COVID-19 pandemic and what the future might hold. Taubenberger highlighted the similarities of the COVID-19 pandemic to the influenza pandemic of 1918—the pandemic that “never really went away.”

The State of Coronavirus Affairs

“We have been working with coronaviruses for decades and decades,” said Fauci. He pointed out that many are zoonotic diseases in which animals serve as intermediate hosts and viral reservoirs—such as severe acute respiratory syndrome (SARS), which went from bats to civet cats to humans in 2002, and Middle East respiratory syndrome (MERS), which went from bats to camels to humans in 2012. SARS and MERS, however, didn’t evolve into the pandemic that COVID-19, also a zoonotic disease, has.

At the Demystifying Medicine lecture on January 12, 2021, NIAID Director Anthony Fauci gave a state-of-affairs address on what we know about the COVID-19 pandemic and what the future might hold.

“We in the United States have been hit harder than any other country in the world,” said Fauci. At the end of February 2021, the United States had more than 28 million cases and over 500,000 deaths, compared with 112 million cases and about 2.5 million deaths worldwide. He painted a sobering picture of the reality of the pandemic: about 40–50% of transmissions were attributable to asymptomatic cases; older people and those with underlying medical conditions (representing 40% of Americans) are most at risk of severe disease; and racial and ethnic disparities in health-care access led to an increased incidence of infection and severity of disease among underrepresented minorities. In addition, “we are learning more and more about a very interesting phenomenon of post-acute COVID-19 syndrome,” Fauci continued. Some “individuals, after they clear the virus, have persistence for up to six months and maybe longer of lingering problems dominated by fatigue that’s profound, muscle aches, temperature dysregulation, [and] brain fog, or the inability to focus or concentrate.”

He briefly described the virology of coronaviruses, highlighting the importance of the spike proteins that sit crownlike (or corona-like) around the surface. He moved on to describing how COVID-19 is transmitted from person to person. “It’s respiratory, mainly through exposure to respiratory droplets that tend to drop within six feet,” Fauci said.

Fauci cited therapeutics such as remdesivir as well as the many COVID-19 vaccines as reasons for hope. In less than one year, we’ve gone from the availability of the genomic sequence of SARS-CoV-2, the virus that causes COVID, to the development and administration of efficacious and safe vaccines—it really was warp speed!

A Tale of Two Epidemics

Taubenberger, whose laboratory was the first to sequence the genome of the influenza virus that caused the 1918 pandemic, took us through the not-so-distant history of that cataclysmic global event.

Jeffery Taubenberger highlighted the similarities of the COVID-19 pandemic to the influenza pandemic of 1918—the pandemic that “never really went away.”

“Pandemics have happened, are happening, and will happen again,” but we’ve been caught flat-footed and found ourselves chasing this pandemic as a new coronavirus emerged in 2019, he said. In fact, our response to the 1918 pandemic was surprisingly similar, and it seems that we’re still rather “mystified” by how pandemics form, with Taubenberger pointing to a book written by a German doctor in 1820 that asked essentially the same questions we are asking today: “What is influenza? Where does it come from? How did it behave in the past? How can we predict future occurrence and halt spread?”

He also likened the world’s embrace and resistance of today’s public-health measures to those introduced in 1918—from mask wearing to school closures, as well as a moratorium on handshakes—and spitting! Despite triumphs in technology and science, this past century’s deemphasis of public-health systems have left us in an even more delicate situation than in 1918.

With 80,000 fatalities caused by influenza in 2018, are we now in a twin pandemic? As the media is consumed by the latest global coronavirus outbreak, we have heard comparatively little about this year’s flu season. One explanation for this relative lull in attention could be due to variations in influenza strains from year to year and subsequently when it might peak—we might have a later peak in 2021—and obviously our infrastructure is overburdened right now, resulting in a lack of resources for the surveillance of influenza. Taubenberger poignantly reminded us that all influenza A virus strains trace their origin to the 1918 flu—”the founder virus”—and its zoonotic jump to humans was similar to that of COVID-19. He emphasized our need to be ahead of viruses through surveillance of animal spillover events, to understand better why some viruses are more deadly than others, and to ultimately feel the urgency to develop “universal” vaccines against all viruses, not just influenza and coronaviruses.

Looking to the past for insight for our future, both scientists pointed to important lessons from past eras. Merely 100 years ago the world was devasted by the 1918 influenza, killing 675,000 people in the United States alone, equivalent to 2.5 million in today’s terms. We’ve had outbreaks before, and we’ll have them again. A universal vaccine is the way forward.

To view the videocast of the January 12, 2021, Demystifying Medicine lecture, “COVID-19 and Influenza,” go to https://videocast.nih.gov/watch=41281 . For Demystifying Medicine’s full schedule and links to past lectures, go to https://demystifyingmedicine.od.nih.gov .

Eimear Holton is a social media, web, and outreach program specialist in NIAID. In her spare time, she likes to travel, practice yoga, and run road races and trails with her friends.

This page was last updated on Tuesday, February 15, 2022

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‘The lesson is to never forget’

Harvard Staff Writer

Harvard expert compares 1918 flu, COVID-19

This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.

Olga Jonas, senior fellow at the Harvard Global Health Institute , is an expert in managing the risks of pandemics. During her 33-year stint as an economist at the World Bank, one of her responsibilities was to coordinate the bank’s contribution to the global efforts in 2006‒12 to reduce the avian and pandemic influenza threats. In 2013, Jonas authored “ Pandemic Risk ” for the annual flagship publication, the World Development Report.

As The Gazette spoke with Jonas about what governments can learn from the coronavirus outbreak to be prepared for the next pandemic, the Johns Hopkins Coronavirus Resource Center , was showing that the virus has infected more than 2 million people and killed more than 150,000 worldwide.

GAZETTE: What are the differences between the 1918 flu pandemic and the 2019 coronavirus pandemic? What are the similarities?

JONAS: Fortunately, such pandemics don’t happen very often, but the speed of the virus spread is a most concerning feature. One clear difference is that the world is now much more densely populated than in 1918. There were fewer than 2 billion people in 1918, and now there are 7.5 billion, and the population is much more mobile. In 1918, there was no air travel. People move around much more, and the spread of a virus is much faster than before, when people traveled by ship or horse, or didn’t travel much at all. Another difference is that in 1918, between 50 and 100 million people died within two years.

GAZETTE: What lessons did experts learn from the 1918 flu pandemic?

JONAS : There have been many books and papers written about the 1918 flu pandemic, and one of the main themes is how quickly it was forgotten, how fast it disappeared from the political discourse. I guess the lesson is to never forget because forgetting doesn’t lead to positive public health outcomes. We have had some global public health emergencies since then, but they have been less prominent: HIV/AIDS since the 1980s, SARS in 2003, and the 2009 H1N1pandemic influenza. What’s interesting is that all these events have caught authorities and the general public by surprise, but scientists who have been studying pandemics were not surprised.

A lesson we should remember is that governments have the responsibility to prepare for a pandemic; they have the obligation to invest in public-health systems to protect their citizens from both the threat and the reality of the next pandemic.

GAZETTE: How would you evaluate the U.S. government’s reaction to the coronavirus pandemic?

JONAS:   The U.S. government didn’t react either quickly or adequately back in January, when the first confirmed case of coronavirus was found. Governments have to act early in the outbreak because the contagion spreads exponentially; two infect four, four infect 16, and 16 infect 84, and so on. There were serious lapses at the beginning, like the lack of capacity for necessary testing. When testing began in the United States, it was already too late. In an outbreak, every day counts.

The comparison between the U.S. and South Korea is very telling. The first confirmed case of COVID-19 was found in the United States the same day as in South Korea: Jan. 20. South Korea acted right away by banning mass gatherings, implementing extensive testing, contact tracing, isolating the infected, and quarantining those suspected of being infected. As a result, South Korea was able to contain the spread of the virus; there have been more than 10,000 cases and about 200 deaths. In the United States, the situation is worsening by the day. Today [April 17] there are close to 700,000 cases and nearly 35,000 deaths, and the numbers keep growing.

GAZETTE: What were the measures that could have limited the spread of the virus and were ignored by governments and official financing institutions like the World Bank?

JONAS: To reduce the risk of a pandemic, the main requirement is that the government has to be prepared to react as a soon as a new virus with pandemic potential appears. Governments need to have surveillance, diagnostic, and response systems already in place before an outbreak, and those systems need to be properly funded in a sustained way. That has not been the case in the United States or other countries. These systems are actually treated as a low priority when public funds are allocated, which is ultimately tragic.

Less-developed countries lack core public-health capacities for animal and human health. These are the surveillance systems of virus outbreaks: laboratory systems that can identify pathogens, and a system of rapid-response capacities to implement public health measures to reduce the spread of a virus. They perform three critical functions: to detect, diagnose, and respond to disease outbreaks. Veterinary public-health capacity is important because 75 percent of new infectious diseases originate in animals. To name just a few: influenza, MERS, SARS, COVID-19, and HIV/AIDS.

“Governments have the responsibility to prepare for a pandemic; they have the obligation to invest in public-health systems to protect their citizens from both the threat and the reality of the next pandemic.”

Unfortunately, many governments, even in developed countries, have been reluctant to plan ahead because after the event, it doesn’t seem urgent anymore. They don’t see the need to invest in protecting their citizens from the effects of a pandemic. It’s unfortunate and shortsighted. Experts speak out all the time underscoring the risks, but they’re often sidelined. It’s ironic because these core public-health capacities are also necessary to make the health care system function better. Hopefully, COVID-19 will push the world to increase and sustain investments in public-health systems; it will be the most productive investment on behalf of mankind.

GAZETTE: How do you characterize the White House’s response to the coronavirus health crisis?

JONAS: What we know from the 1918 flu pandemic is that the cities or governments that took early action in imposing quarantines, closing down schools, and banning mass gatherings had lower death rates than the places that did less or did it later. We also know that authorities with a clear strategy to communicate with the general public about what is happening and what people should be doing are very important to prevent economic impacts and the spread of the outbreak. An accurate and effective communications strategy is needed because this will determine how people cooperate or not with the control measures and thus help reduce the spread. Accurate communications also reduce substantial economic costs, especially the large part that is due to changed consumer behaviors even before any quarantines are imposed.

After this pandemic, people are going to be writing papers about inadequate leadership and confusing messages from the White House. Experts know that a lack of clarity during a public health emergency reduces trust, invites rumors, suspicions, and uncertainty, and will have a great negative impact on economic activity. It’s likely that there was a communications strategy written in advance, but it does not seem to have been used.

GAZETTE: What lessons can governments learn from this pandemic?

JONAS: One lesson that I hope we all learn is that governments should invest in the core public health capacities that are required for pandemic preparedness and pandemic prevention efforts. As we now know, a pandemic is not just a health issue; it has serious economic impacts and the effects on society in general can be profoundly damaging. Prevention has much higher benefit-cost ratios than spending money on containment, mitigation, and other after-the-fact emergency responses.

The other lesson we should always remember is that governments should listen to experts and scientists who know how to best prevent the spread of infectious diseases. What’s ironic is that for the last 15 years, nobody paid attention to what experts were saying, and over the past three months, everybody wants to hear from experts and finally care about what we have to say.

This interview has been edited and condensed for length and clarity.

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The 1918 Spanish Flu Pandemic vs. the 2020 Covid-19 Pandemic

• Jason Beavers

The novel coronavirus of 2019-2020 is neither the first global pandemic that the United States has endured nor, unfortunately, is it likely to be the last. 

Truly, besides teaching students how to be engaged in civics, teaching students to think critically, or teaching students historical causation, a primary goal of educating the next generation in history is to equip young adults with the knowledge and wisdom necessary to avoid repeating the same mistakes our ancestors made in the past. 

This lesson seeks to put the 1918 Spanish Flu Pandemic into its historical context, to understand its effects, and to challenge students to examine what lessons a disease that struck over 100 years ago can teach us today.

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Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How.

The fear is similar, but the medical reality is not.

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By Gina Kolata

It was a disease so awful that it terrified people for generations.

The 1918 flu pandemic, thought to be the deadliest in human history , killed at least 50 million people worldwide (the equivalent of 200 million today), with half a million of those in the United States. It spread to every part of the world, affecting populations in Japan, Argentina, Germany and dozens of other countries.

Maybe most alarmingly, a majority of those killed by the disease were in the prime of life — often in their 20s, 30s and 40s — rather than older people weakened by other medical conditions.

As the coronavirus spreads around the world and public anxieties spike, comparisons between today’s situation and the Spanish flu pandemic of 1918 are proliferating in journalistic outlets and on social media .

While the fearful atmosphere — surgical masks, stockpiling of food and avoidance of public gatherings — and potential economic ramifications are like those of 1918, the medical reality is quite different.

“Nurses often walked into scenes resembling those of the plague years of the fourteenth century,” wrote the historian Alfred W. Crosby in “America’s Forgotten Pandemic.” “One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty-four hours since the death and the births, and the wife had had no food but an apple which happened to lie within reach.”

In 1918, the world was a very different place, even without the disruptive influence of World War I. Doctors knew viruses existed but had never seen one — there were no electron microscopes, and the genetic material of viruses had not yet been discovered. Today, however, researchers not only know how to isolate a virus but can find its genetic sequence, test antiviral drugs and develop a vaccine.

In 1918, it was impossible to test people with mild symptoms so they could self-quarantine. And it was nearly impossible to do contact tracing because the flu seemed to infect — and panic — entire cities and communities all at once. Moreover, there was little protective equipment for health care workers, and the supportive care with respirators that can be provided to people very ill with coronavirus did not exist.

With a case fatality rate of at least 2.5 percent, the 1918 flu was far more deadly than ordinary flu, and it was so infectious that it spread widely, which meant the number of deaths soared.

Researchers believe the 1918 flu spared older people because they had some immunity to it. They theorize that decades earlier there had been a version of that virus, one that was not as lethal and spread like an ordinary flu. The older people living in 1918 would have been exposed to that less lethal flu and developed antibodies. As for children, most viral illnesses — measles, chickenpox — are more deadly in young adults, which may explain why the youngest were spared in the 1918 epidemic.

Regardless of the reason, it was a disaster for life expectancy, which plummeted. In 1917, life expectancy in the United States was 51 years. It was the same in 1919. But in 1918, it was just 39 years.

The new coronavirus tends to kill older people and those with underlying medical conditions, and it does not seem to kill children. All of which means it will have far less effect, if any, on life expectancy.

As for the coronavirus case fatality rate, it is not yet known, but the latest data from South Korea, with 7,478 confirmed infections, show a rate significantly higher than the seasonal flu. After testing 100,000 people for the virus, the country appears to have a case fatality rate of .65 percent. (Though the data is evolving as researchers in other countries track cases.)

What the current situation does have in common with 1918, though, is the tenor of public concern.

Among the first places the 1918 flu arrived in the United States was Fort Devens, near Boston. So many young soldiers were sick, and so many were dying, that the Surgeon General sent four of the nation’s leading doctors to investigate.

One of them, Dr. Victor Vaughan, later recalled: “Hundreds of stalwart young men in the uniform of their country, coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

Accounts like these scared Americans deeply.

On Oct. 3, 1918, Philadelphia closed all schools, churches, theaters, pool halls and other gathering places. Undertakers were overwhelmed — some funeral homes increased their prices sixfold and some even made the bereaved bury their own dead.

In Tucson, Ariz., the board of health forbade people to venture out in public without a mask. In Albuquerque, where schools and theaters were closed, a local newspaper wrote, “the ghost of fear walked everywhere.”

Similar actions are being taken today. Seattle has closed some public schools. The South by Southwest festival in Austin, Tex., has been canceled. Apple asked employees to work from home. More than 2,700 people are under some sort of quarantine in New York City. And some Costco stores are having trouble keeping bottled water in stock.

But so far this year, the annual epidemic of seasonal flu in the United States is proving much more devastating than the coronavirus.

The Centers for Disease Control and Prevention reports that there have been at least 34 million infected with flu this season, 350,000 hospitalizations and 20,000 deaths . So far, coronavirus has killed 27 people in the United States.

For the economy, the effects of the 1918 flu, despite factory closings and social disruptions, were hard to disentangle from the profound ones of World War I. The world was not as interconnected as it is today, and by the summer of 1919, the pandemic had ended.

Coronavirus is already having significant impacts on the stock market and other aspects of the economy, but the long-term consequences remain to be seen.

An earlier version of this article referred incorrectly to the case fatality rate of the coronavirus. The case fatality rate for those infected with the coronavirus is significantly higher than that of the season flu; it is not comparable with it. The earlier version also misstated the given name of one of the doctors who visited Fort Devens. He is Victor Vaughan, not William Vaughan.

How we handle corrections

Gina Kolata writes about science and medicine. She has twice been a Pulitzer Prize finalist and is the author of six books, including “Mercies in Disguise: A Story of Hope, a Family's Genetic Destiny, and The Science That Saved Them.” More about Gina Kolata

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The deadliest outbreak in American history

The u.s. is seeing 1,900 people die every day on average from covid-19.

By Herb Scribner

The novel coronavirus has killed as many Americans as the flu pandemic that ravaged the world from 1918 to 1919.

The 1918-1919 flu pandemic killed about 675,000 people in the United States, per The Guardian. The U.S. has now surpassed that number when it comes to COVID-19 deaths, according to The Wall Street Journal.

However, the U.S. population was about one-third its current size back in 1918, so the deaths “cut a much bigger, more lethal swath through the country,” according to The Guardian .

Still, the COVID-19 outbreak “is by any measure a colossal tragedy in its own right, especially given the incredible advances in scientific knowledge since then and the failure to take maximum advantage of the vaccines available this time,” according to The Guardian.

In doing so, the COVID-19 outbreak has become the deadliest pandemic in American history, according to CNBC.

Dr. Howard Markel , a physician and medical historian at the University of Michigan, told CNBC that the outbreak will be taught in schools for years to come.

“This is the pandemic I will be studying and teaching to the next generation of doctors and public health students,” he said.

Of course, you can’t compare the two pandemics apples to apples. They are infecting many different people in different worlds. For example, the 1918 virus tended to feed off of young people, infecting people who were moving across the world due to World War I.

Meanwhile, COVID-19 has been feasting on the elderly and those who have additional medical conditions.

And you can’t forget that the 1918 flu actually killed more people globally. Per The World Health Organization , the 1918 flu killed somewhere between 20 to 50 million people during its full run. It’s still unclear how many people actually died from the flu due to the lack of health records at the time. COVID-19 has killed about 4.7 million people across the world. The 1918 flu clearly had a profound impact overseas and less so in the United States.

So you can’t really compare the two pandemics. The world is a different place, the population is a different size and, probably most importantly, the two viruses are vastly different.

And this pandemic isn’t close to ending. A recent forecasting model  from the  University of Washington predicted there would be another 100,000 deaths  from the novel coronavirus by December, per  The Associated Press. The model suggested there would be about 730,000 total U.S. deaths from COVID-19 by December, meaning there would need to be another 55,000 deaths between now and December.

But Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told  CNN  that these deaths don’t need to happen.

The COVID-19 vaccine is widely available to the public, and it can stop severe COVID-19, hospitalization and death. In fact, a recent round of data from the Centers for Disease Control and Prevention found that people who are fully vaccinated against COVID-19 tend to be safer from death, hospitalization and severe COVID-19 than those who are unvaccinated.

Getting the vaccine can stop the pandemic from spreading even more. It’s not perfect — there are still rare breakthrough cases that can infect you with COVID-19. But the chances of death and hospitalizations are so low that it makes sense to keep you safe from the novel coronavirus.

“What is going on now is both entirely predictable, but entirely preventable,” Fauci told  CNN.  “We know we have the wherewithal with vaccines to turn this around.”

He added that getting more people vaccinated against the novel coronavirus will stop the next 100,000 deaths and bring us back to something that looks like normal. Only time will tell if this will happen or not.

“We could do it efficiently and quickly if we just get those people vaccinated,” he told  CNN. “That’s why it’s so important now, in this crisis that we’re in that people put aside any ideologic, political or other differences, and just get vaccinated.”

Comparing the Spanish flu and COVID-19 pandemics: Lessons to carry forward

Affiliation.

• 1 Office of Nursing Practice, Nurse Research Consultant, Sanford Health, Fargo, North Dakota, USA.
• PMID: 33319388
• DOI: 10.1111/nuf.12534

Just as people living in the early 1900s experienced the horrors of World War I followed by the Spanish influenza epidemic, those of us surviving the coronavirus disease 2019 pandemic will have our lives forever changed. Both pandemics defied the capabilities of prevailing healthcare and public health. Since there was no known cure in either pandemic, much depended on nurses to fight the battle against the viruses. History has shown pandemics are occurring more frequently and are unpredictable in timing and severity. Therefore, we need to place focus on the valuable lessons from the century's two pandemics to prepare for future global disease outbreaks. Lessons that will benefit nursing are the importance of continual preparation and planning, care coordination across communities and healthcare systems, and ensuring nurses have the necessary resources and training to perform their roles in an effective and safe manner.

Keywords: COVID-19 pandemic; Spanish flu; comparing pandemics; pandemic lessons.

© 2020 Wiley Periodicals LLC.

Publication types

• Historical Article
• COVID-19 / complications*
• COVID-19 / epidemiology
• Correlation of Data
• History of Nursing
• History, 20th Century
• History, 21st Century
• Influenza Pandemic, 1918-1919 / statistics & numerical data*
• Nurses / psychology
• Nurses / supply & distribution
• Pandemics / statistics & numerical data

What Can We Learn from the Spanish Flu Pandemic of 1918-19 for COVID-19?

This post first appeared May 18 as an Economic Synopses essay .

The COVID-19 pandemic has spurred intense efforts among researchers to estimate the likely course of the pandemic and its economic effects. Several studies have sought insights from global pandemics of the past, including the Spanish flu pandemic of 1918-19, which is thought to have infected some 500 million persons, or about one-third of the world's population, and killed anywhere from 50 to 100 million people. Johnson and Mueller (2002) estimate 50 million deaths worldwide and provide estimates for several countries. Jorda et al. (2020) report an estimate of 100 million deaths, as well as mortality estimates for other pandemics since the fourteenth century with at least 100,000 deaths. Lessons from the Spanish flu pandemic are relevant and informative. Like COVID-19, the Spanish flu was highly contagious; it was also unusually lethal compared with a typical seasonal flu. As the flu became more widespread and its dangers apparent, many cities sought to contain the virus by imposing restrictions on social and economic interactions. These efforts can provide insights about the economic and public health impacts of government efforts to limit the spread of pandemic diseases. This essay discusses some recent research findings on the effects of the Spanish flu pandemic and measures that cities took to control it.

The Spanish flu pandemic came in three waves beginning in the spring of 1918. The second wave, in the fall of 1918, was the largest by far in terms of total infections and deaths. A third wave occurred in the spring of 1919. Overall, the pandemic is estimated to have infected about 25 percent of the U.S. population, or about 25 million people, and killed 675,000 for roughly a 3 percent mortality rate.  Taubenberger and Morens (2006). See also Garrett (2008) and references therein for data and other information about the origins and spread of the pandemic in the United States. The pandemic began during World War I, and the virus is thought to have been introduced and spread throughout the United States by soldiers returning from Europe. By the end of 1918, some 45,000 U.S. soldiers had contracted and died from the disease, a number only modestly smaller than the 53,000 American combat deaths.  Eric Durr, " Worldwide Flu Outbreak Killed 45,000 American Soldiers During World War I ." As with typical seasonal flu, young children and the elderly were particularly susceptible to the Spanish flu. However, the Spanish flu was especially lethal for young, "prime-age" adults, especially men. In 1918, the mortality rate from the flu and pneumonia among men 15 to 34 years of age was more than 20 times higher than in previous years, and throughout the pandemic, half of all flu deaths were among adults between 20 and 40 years of age. Furthermore, the absolute risk of death from the flu was higher among those younger than 65 years of age than those 65 or older, with those younger than 65 accounting for 99 percent of excess flu deaths in 1918-19. Taubenberger and Morens (2006). The high fatality rate among young adults, especially young adult men, is striking in comparison with both typical seasonal flu and COVID-19, where the case fatality rate has been far higher among the elderly than among the young. These differences in age-related fatality rates are one reason the economic impacts of the COVID-19 and Spanish flu pandemics might differ. The high fatality rate among prime-age males during the Spanish flu pandemic reduced labor supply and boosted real wage rates in locations where the incidence of the disease was high (Garret, 2009, and Correia et al., 2020). Such an effect seems unlikely from the COVID-19 pandemic.  In a study of 15 major pandemics since the fourteenth century, Jorda, Singh, and Taylor (2020) find that real wages are typically elevated for several years after pandemics, while the returns to capital are low, likely because of widespread deaths among the working-age population.

As the COVID-19 pandemic spread across the United States, most state and local governments imposed restrictions on economic activity, such as requiring certain non-essential businesses to close or reduce their in-store services. Many firms have voluntarily reduced their operations to protect the health of their employees or because of weaker demand for their products. At the same time, many households have refrained from non-essential purchases and travel in an effort to protect themselves and to help limit the spread of the virus. To date these measures appear to have helped slow the pandemic and avoid overwhelming the health care system in most locations. However, aggregate economic activity and employment have declined sharply, leading many states and cities to ease restrictions even as COVID-19 cases and fatalities continue to rise.

A similar pattern played out during the Spanish flu pandemic. In an effort to stem the pandemic, many cities adopted measures such as closing schools and churches, prohibiting large gatherings of people, shutting down theaters and other entertainment venues, and temporarily closing non-essential businesses.  Detailed information about the use of NPIs by 50 cities during the pandemic is available from the University of Michigan Center for the History of Medicine . Several studies examine the effects of such non-pharmaceutical interventions (NPIs) on flu incidence and mortality rates. A general finding is that cities that put NPIs in place earlier or took more aggressive action had lower excess mortality rates, later peaks in caseloads and mortality, and, to a lesser extent, fewer total fatalities than cities that moved slowly or adopted fewer measures.  See Barro (2020), Correia et al. (2020), Bootsma and Ferguson (2007), Hatchett et al. (2007), and Markel et al. (2007). Barro (2020) notes that the mean duration of NPIs across 43 cities was 4-6 weeks and suggests that a duration of 12 weeks would have produced a substantially lower total death rate. The experiences of Philadelphia and St. Louis are often compared. Philadelphia was slow to implement measures to stem the pandemic and experienced a surge in cases following a large parade in support of a Liberty Loan drive. St. Louis, by contrast, canceled a similar parade and took other measures soon after the first cases were reported. Philadelphia had among the highest mortality rates of any of the U.S. cities, with a peak weekly excess mortality rate of 250 deaths per 100,000 persons and a total pandemic mortality rate of 748 deaths per 100,000 persons. St. Louis had among the lowest rates of all major cities, with a peak weekly excess mortality rate of just 30 deaths per 100,000 persons and a total mortality rate of 358 deaths per 100,000 persons (Markel et al., 2007).

Most cities relaxed their measures after just a few weeks when flu deaths began to recede. However, many cities faced a surge in cases when measures were eased, which resulted in a second peak—often higher than the first—that led to reactivation of some NPIs (Bootsma and Ferguson, 2007, and Markel et al., 2007). The experience of St. Louis is a case in point. St. Louis's authorities moved quickly to close schools, churches, saloons, theaters, and other entertainment venues when the city's first cases appeared in early October. Businesses and factories were permitted to remain open, but business hours were reduced and police were dispatched to keep shoppers from lingering in stores. On November 9, the health commissioner ordered all non-­essential stores and factories closed for four days, and cases peaked within days. Businesses were permitted to reopen on November 13 and schools opened on November 14. Flu cases continued to decline for the next two weeks but then began to climb sharply. The city closed schools again and reinstated a ban on all public gatherings. The second peak in cases—with a higher excess mortality rate than the first peak—was reached in December. Cases then began to decline and the city lifted all restrictions on businesses on December 28 and reopened schools on January 2. University of Michigan Center for the History of Medicine .

The economic impacts of the flu pandemic and NPIs implemented to contain it are somewhat less clear than the epidemiological effects. Perhaps surprisingly, given the widespread incidence of illness and many deaths, the pandemic did not trigger a major contraction in aggregate economic activity. A mild recession began in September 1918 and continued to March 1919. Federal spending on the war effort might explain why the aggregate economy did not slow appreciably: "[T]he never-ending demand for coal, steel, machinery, textiles, and other products needed for the war effort largely offset the effects of such a severe pandemic on aggregate economic activity" (Benmelech and Frydman, 2020). Industrial production did fall sharply but recovered quickly. Retail sales appear to have been little affected by the pandemic, perhaps because of a surge in consumer purchases after Armistice on November 11, and neither business failures nor other forms of financial distress increased significantly.  Velde (2020) examines a variety of high-frequency economic time series data during the pandemic and concludes that the pandemic had only modest impact on economic activity. Barro et al. (2020) examine the impact of the pandemic across countries and attempt to control for differences in war intensity using data on combat deaths. The study finds that the flu pandemic caused a 6.2 percent decline in GDP in a typical country and a decline of about 1.5 percent in the United States. The pandemic did have a large impact on some sectors, however—notably manufacturing. Correia et al. (2020) estimate that the pandemic caused an 18 percent decline in manufacturing output and a 23 percent decline in manufacturing employment, in part because several cities with large manufacturing industries were among those with the highest flu fatality rates.

Some NPIs, such as temporary closures of non-essential businesses, clearly impose direct economic costs on affected firms and households. However, widespread illness or deaths can also be economically costly, suggesting that, conceivably, the economic benefits of containing a pandemic might outweigh the direct costs imposed on owners and employees of firms that are required to close. During the Spanish flu pandemic, cities with lower excess flu mortality rates had smaller declines in some measures of economic activity, suggesting that the direct cost of NPIs might have been offset at least to some extent by stronger economies. Moreover, there is evidence that cities that imposed NPIs earlier and more rigorously during the pandemic had higher growth in manufacturing output and employment for up to four years after the pandemic. Correia et al. (2020) use a dynamic difference-in-difference regression approach to examine the impact of NPIs on manufacturing across cities. Their model controls for various pre-crisis state and local characteristics, such as total population, urbanization, manufacturing share of employment, and growth of manufacturing output and employment from 1909 to 1914. The study finds that implementing NPIs earlier in the pandemic and using them more intensely produced significantly higher rates of growth in manufacturing output and employment from 1919 to 1923 than did slower activation or less intense use of NPIs. Estimates from the study's base model indicate that a one standard deviation increase in the speed of adopting NPIs (8 days) is associated with 4 percent higher growth of employment after the pandemic, while a one standard deviation increase in NPI intensity leads to 6 percent higher employment growth. The authors estimate several models with different sets of controls, and though not all show a statistically significant impact of NPIs on growth or employment, none indicate that NPIs reduced economic activity. The base specification controls include measures of urbanization, pre-crisis population, manufacturing employment share, and flu mortality in 1917, as well as state-level agricultural employment share. Additional control variables in other specifications include the growth in manufacturing output and employment from 1909 to 1914, census region fixed effects, longitude, WWI servicemen mortality rate, and health and total public spending per capita in 1917.

Clearly, there are limits to the applicability of the Spanish flu episode to the COVID-19 pandemic. In particular, the unusually high fatality rate among young, working-age men suggests that the flu pandemic might have had a larger economic impact, particularly on labor-intensive industries, than will COVID-19. The structure of the U.S. economy and distribution of the population are also very different today than in 1918, which could affect how either a pandemic or the NPIs imposed to contain it affect public health or the economy. For example, because pandemic mortality is strongly associated with population density, increased urbanization suggests that NPIs might have more public health benefit today than in 1918. On the other hand, the substantial increase over time in employment in the service sector suggests that the direct costs of mandatory business closures, which tend to fall more heavily on retail establishments and other service industries, could be higher today than in 1918. In 1918, the U.S. population was split evenly between urban and rural areas in 1918, whereas today the urban population is five times the rural population. Moreover, in 1918, 33 percent of the labor force was employed in agriculture and 28 percent was employed in manufacturing, compared with 2 percent and 8 percent, respectively, today (Velde 2020). As of 2018, some 80 percent of the U.S. labor force was employed in service industries. See Bureau of Labor Statistics Employment Projections data . Still, insights from the Spanish flu and other pandemics should not be dismissed entirely. So long as we remain cognizant of the environmental features in which they occurred, the pandemics of the past can provide useful data points for helping to forecast how the COVID-19 and future pandemics are likely to play out, and in particular for addressing such questions as whether NPIs are likely to be the sole source of economic disruptions in a pandemic, or whether a pandemic would cause an economic downturn in the absence of interventions to slow its spread.

1 Johnson and Mueller (2002) estimate 50 million deaths worldwide and provide estimates for several countries. Jorda et al. (2020) report an estimate of 100 million deaths, as well as mortality estimates for other pandemics since the fourteenth century with at least 100,000 deaths.

2 Taubenberger and Morens (2006). See also Garrett (2008) and references therein for data and other information about the origins and spread of the pandemic in the United States.

3 Eric Durr, " Worldwide Flu Outbreak Killed 45,000 American Soldiers During World War I ."

4 Taubenberger and Morens (2006).

5 In a study of 15 major pandemics since the fourteenth century, Jorda, Singh, and Taylor (2020) find that real wages are typically elevated for several years after pandemics, while the returns to capital are low, likely because of widespread deaths among the working-age population.

6 Detailed information about the use of NPIs by 50 cities during the pandemic is available from the University of Michigan Center for the History of Medicine .

7 See Barro (2020), Correia et al. (2020), Bootsma and Ferguson (2007), Hatchett et al. (2007), and Markel et al. (2007). Barro (2020) notes that the mean duration of NPIs across 43 cities was 4-6 weeks and suggests that a duration of 12 weeks would have produced a substantially lower total death rate.

8 University of Michigan Center for the History of Medicine .

9 Velde (2020) examines a variety of high-frequency economic time series data during the pandemic and concludes that the pandemic had only modest impact on economic activity. Barro et al. (2020) examine the impact of the pandemic across countries and attempt to control for differences in war intensity using data on combat deaths. The study finds that the flu pandemic caused a 6.2 percent decline in GDP in a typical country and a decline of about 1.5 percent in the United States.

10 The base specification controls include measures of urbanization, pre-crisis population, manufacturing employment share, and flu mortality in 1917, as well as state-level agricultural employment share. Additional control variables in other specifications include the growth in manufacturing output and employment from 1909 to 1914, census region fixed effects, longitude, WWI servicemen mortality rate, and health and total public spending per capita in 1917.

11 In 1918, the U.S. population was split evenly between urban and rural areas in 1918, whereas today the urban population is five times the rural population. Moreover, in 1918, 33 percent of the labor force was employed in agriculture and 28 percent was employed in manufacturing, compared with 2 percent and 8 percent, respectively, today (Velde 2020). As of 2018, some 80 percent of the U.S. labor force was employed in service industries. See Bureau of Labor Statistics Employment Projections data .

Barro, Robert J. "Non-Pharmaceutical Interventions and Mortality in U.S. Cities During the Great Influenza Pandemic, 1918-1919." NBER Working Paper 27049, April 2020.

Barro, Robert J.; Ursua, Jose F. and Weng, Joanna. "The Coronavirus and the Great Influenza Pandemic—Lessons from the 'Spanish Flu' for the Coronavirus's Potential Effects on Mortality and Economic Activity." NBER Working Paper 26866, March 2020.

Benmelech, Efraim and Frydman, Carola. "The 1918 Influenza Did Not Kill the US Economy." VOX CEPR Policy Portal, April 29, 2020.

Bootsma, Martin C.J. and Ferguson, Neil M. "The Effect of Public Health Measures on the 1918 Influenza Pandemic in U.S. Cities." Proceedings of the National Academy of Sciences, May 2007, 104(18), pp. 7588-93.

Correia, Sergio; Luck, Stephan and Verner, Emil. "Pandemics Depress the Economy, Public Heath Interventions Do Not: Evidence from the 1918 Flu." SSRN Working Paper No. 3561560, April 10, 2020.

Garrett, Thomas A. "Pandemic Economics: The 1918 Influenza and Its Modern-­Day Implications." Federal Reserve Bank of St. Louis Review, March/April 2008, pp. 75-93.

Garrett, Thomas A. "War and Pestilence as Labor Market Shocks: U.S. Manufacturing Wage Growth 1914-1919." Economic Inquiry, October 2009, 47(4), pp. 711-25.

Hatchett, Richard J.; Mecher, Carter E. and Lipsitch, Marc. "Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic." Proceedings of the National Academy of Sciences, May 2007, 104(18), pp. 7582-87.

Johnson, Niall P.A.S. and Mueller, Juergen. "Updating the Accounts: Global Mortality of the 1918-1920 'Spanish' Influenza Pandemic." Bulletin of the History of Medicine, Spring 2002, 76(1), pp. 105-15.

Jorda, Oscar; Singh, Sanjay R. and Taylor, Alan M. "Longer-Run Economic Consequences of Pandemics." Federal Reserve Bank of San Francisco Working Paper 2020-09, March 2020.

Markel, Howard; Lipman, Harvey B.; Navarro, J. Alexander; Sloan, Alexandra; Michalsen, Joseph R.; Stern, Alexandra Minna and Cetron, Martin S. "Nonpharmaceutical Interventions Implemented by U.S. Cities During the 1918-1919 Influenza Pandemic." Journal of the American Medical Association, 2007, 298(6), pp. 644-54.

Taubenberger, Jeffery K. and Morens, David M. "1918 Influenza: the Mother of All Pandemics." Emerging Infectious Diseases, January 2006, 12(1), pp. 15-22.

Velde, Francois R. "What Happened to the U.S. Economy During the 1918 Influenza Pandemic? A View Through High-Frequency Data." Federal Reserve Bank of Chicago Working Paper 2020-11, April 2020.

© 2020, Federal Reserve Bank of St. Louis. The views expressed are those of the author(s) and do not necessarily reflect official positions of the Federal Reserve Bank of St. Louis or the Federal Reserve System.

David Wheelock is senior vice president and special policy advisor to the St. Louis Fed president. Also an economist, his research interests include U.S. monetary history and policy as well as the performance and regulation of commercial banks. He joined the St. Louis Fed in 1993. Read more about his work .

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Comparing the socio‐economic implications of the 1918 Spanish flu and the COVID‐19 pandemic in India: A systematic review of literature

The focus of the present study is to compare and assess the socio‐economic implications of the 1918 influenza pandemic and the COVID‐19 pandemic in India. Both pandemics are similar in the nature of their disease and spread, and have had a far‐reaching impact on society and economies worldwide. To achieve their objective, the researchers adopted the method of systematic literature review (SLR). The findings of the review have been categorised in four subsections: comparison of 1918 influenza and COVID‐19 pandemics in a global context; economic consequences of a pandemic in India; social consequences of a pandemic in India; and the pandemic mitigation measures adopted by India. The findings suggest there are similarities in the socio‐economic implications of the two pandemics and also indicate that developing countries face more severe implications of such pandemics as compared to developed countries. The research findings from the review of literature are followed by the recommendations made by the researchers.

Introduction

The growth and development of an economy are prone to shocks, which may occur because of a change in the society, political economy, environment, etc. These shocks have an outreaching impact on any economy (Brainerd and Seigler 2003 ; Karlsson et al . 2014 ). Epidemic diseases also have an adverse shock on the economy, as these hamper not only the health of the public, but also the health of the economy. History provides incidences of pandemics, epidemics, and diseases that have occurred in the past, making long‐lasting impacts on the lives of people as well as economic activities (Boxmeyer 2006; Killingray 2003 ). Various nations along with India were impacted by one such pandemic in the year 1918, when the influenza pandemic hit the globe (García‐Sastre and Whitley 2006 ; Gottfredsson et al . 2008 ; Karesh and Cook 2005 ).

The 1918 influenza pandemic was an extremely lethal influenza pandemic caused by H1N1 virus. It was one of the most widespread and deadliest flus that has been witnessed by world economies, which hampered not only lives, but society and trade‐related activities. (Fargey 2019 ; Karlsson et al . 2014 ). Data from the World Economic Forum (WEF) suggests that approximately 500 million people were infected by the influenza – a third of the world's population at the time. The pandemic emerged in four successive waves between the period of February 1918 and April 1920. The death rate was estimated to be 2 per cent of the global population and 5.2 per cent of the population in India (World Economic Forum Report 2020). Though the 1918 influenza pandemic was coupled with the First World War, Figure  1 shows the plague mortality in India:

Plague mortality rate in British India and provinces

Source: Statistical abstract of British India, digital South Asia Library

Reyes et al . ( 2018 ) suggested that the 1918 influenza pandemic entered India by sea route, when the armies returned from European countries after the First World War. As suggested by the Census of India (1921), approximately 8.5 million people in India lost their lives because of the pandemic. Lack of advanced healthcare facilities and lack of technological developments made the situation a lot more critical (Michaela and Kindrachuk 2019; Schoch‐Spana 2001 ).

India and the countries across the world are facing another deadly virus, which is said to have its origin in the city of Wuhan of the People's Republic of China, where the first case was found in December 2019 (Ali and Alharbi 2020 ). The coronavirus disease‐2019 (COVID‐19) is a disease caused by severe acute coronavirus 2 respiratory syndrome (SARS‐CoV‐2). COVID‐19 symptoms are variable, but frequently include fever, cough, weakness, trouble in breathing, and loss of smell and taste. Currently, reported cases are 71 million with almost 2.13 million deaths worldwide (WHO Covid‐19 Database 2021). 1 The deadly novel coronavirus disease has brought the global economies to a standstill. As suggested by Wijdicks ( 2020 ), COVID‐19 and the 1918 influenza pandemic are similar in pattern, as the disease presentation is comparable; however, at the same time, both have dissimilarities too. Both are respiratory diseases that range from asymptomatic or mild symptoms leading to severe death depending on the case. In addition, both of them are contagious in nature through fomites and droplets, yet the speed of transmission and the nature of each virus's re‐productiveness are different.

Comparison between both the pandemics and the two periods – 1918 and 2020 – very clearly indicates similarities, such as shortcomings in medical infrastructure and unavailability of vaccines, which catered to the sustenance of the virus (Barro et al . 2020 ; Jakob 2020 ; Virmani and Bhasin 2020 ). Both the pandemics also impacted the societies and the economies negatively and it is suggested to have widened the bridge between the rich and the poor; where the rich are becoming richer and the poor are becoming poorer (Bennett and Carney 2010 ; Buheji et al . 2020 ; Singh and Misra 2020 ).

Thus, the objective of the current study is to compare and assess the socio‐economic impact of the COVID‐19 pandemic and the 1918 influenza pandemic in India. The researchers aim to provide solutions to the society and the economy to combat the deadly COVID‐19 virus. The structure of the research paper includes a brief outline of the applied methodology of a systematic literature review by the researchers, followed by a detailed synthesis of the literature. The final section summarises the findings, which are complemented by the researchers’ recommendations.

Research methodology

COVID‐19 as well as the influenza pandemic of 1918 are both lethal and have a lot in common. Though the COVID‐19 outbreak has not caused as many deaths as the influenza pandemic of 1918, the lessons learnt from it in economics, policy, finances, health, and mortality can help in managing the effects of today's coronavirus pandemic. Thus, a comparative study of the two pandemics is necessary.

For the comparative analysis, the researchers have adopted the method of systematic literature review (SLR), which is one of the ways of studying extant literature to understand the topic of a discipline through this well‐organised and efficient procedure. In SLRs, the researchers try to identify, critically analyse, and summarise the existing research evidence concerning a clearly defined problem. In the current study, the researchers are focusing mainly on the following:

• • To compare the socio‐economic implications of the 1918 influenza pandemic and COVID‐19 pandemic;
• • Pandemic mitigation measures adopted by India to boost its economy;
• • Measures to improve the socio‐economic conditions of India and other developing nations to overcome the COVID‐19 pandemic.

The researchers have presented this study by following the process of systematic review of literature and by identifying and referring to relevant literature.

Search Strategy and Inclusion‐Exclusion Criteria

The search strategy for the SLR has been depicted in Figure  2 . In the first step, the researchers extracted scholarly articles and included EBSCOhost Research Database, Emerald Insights, Google Scholar, JStor, Sage Journals, Science Direct (Elsevier), Scopus, and Web of Science, among others. In each of the abovementioned databases, the researchers used a combination of keywords such as “1918 pandemic”, “influenza pandemic”, “1918 influenza pandemic”, “influenza pandemic in India”, “Spanish Flu”, “Spanish Flu in India”, “impact of Spanish flu on economy”, “history of 1918 influenza pandemic”, “Spanish flu and its effect on Indian economy”, “healthcare systems and Spanish flu”, “Spanish Flu in developing economies”, “Covid‐19 in India”, “Covid‐19 in developing countries”, “socio‐economic implications of Covid‐19”, ‘Covid‐19 healthcare crisis”, among others. The search yielded more than 500 articles, however, a total of 45 research articles have been included in the systematic literature review. A total of 45 research articles were taken into consideration for the SLR. Most of the research papers included in the study are from recent times; however, older articles have also been included in order to understand the development and phenomenon of the 1918 influenza pandemic in a better manner.

Graphical representation of search strategy for SLR

In the second step, duplicate articles were removed and initial screening of the abstracts was carried out. Book chapters and articles of non‐academic nature, articles from magazine, interviews, newsletters, editorials, and viewpoints were excluded for the review. Scholarly research articles related to the topic have been added in order to compare the situation of India during the two pandemics. Further, the language filter for “English” was used to fetch the research articles. In the third step, 26 articles not matching the criteria were removed, and a total of 45 research articles were taken into consideration for the SLR. In the upcoming section, findings from the literature have been summarised.

Findings from systematic review of literature

In this section, the researchers have compiled the findings after reviewing the literature. This section has been divided into four subsections: comparison of 1918 influenza and COVID‐19 pandemics in a global context; economic consequences of a pandemic in India; social consequences of a pandemic in India; and the pandemic mitigation measures adopted by India.

Comparison of 1918 influenza and COVID‐19 pandemics in global context

A pandemic is a global issue, and from a global perspective, it is important to consider pan‐level preparedness; however, both underdeveloped and developing nations face complex and complicated issues and obstacles during the pandemic (Bell et al . 2009 ; Gerard Imbert and Orkin 2020; Singh and Mishra 2020 ). Global economies during both the pandemics witnessed a shortage of healthcare facilities and medical practitioners; hospitals become overcrowded with patients and makeshift hospitals are created (Barro, Ursua and Weng 2020 ; Chandra 2013 ; Curson and McCracken 2006 ; Gealogo 2009; Jakob 2020 ). Comparison of 1918 influenza and the COVID‐19 pandemics is given in Table  1 .

Comparison of 1918 influenza pandemic and COVID‐19 pandemic

Source: Review of literature

Table  1 has been compiled with the help of extant literature. Though both the pandemics are respiratory diseases, they shook the very foundation of global economies (Aassve et al . 2020). In most of the countries, the second wave of the 1918 influenza pandemic occurred in the last few months of 1918 and proved to be the deadliest; however, it became a seasonal flu later and less deadly (Chandra 2013 ; Spreeuwenberg, Kroneman and Paget 2018 ). Containment measures during the influenza pandemic had little impact on its spread as its peak was achieved before measures could be implemented; however, COVID‐19 is not a seasonal flu and it returns as soon as the containment measures are lifted (Buheji et al . 2020 ; Spreeuwenberg, Kroneman and Paget 2018 ). More lockdowns are expected to have negative health and economic effects (Ali and Alharbi 2020 ; Jakob 2020 ). Unlike the 1918 influenza, the nature and intensity of COVID‐19 within countries and regions varies over time (Ojo 2020 ).

Treatment regarding added infections was not possible in 1918; as the medical system in developing countries was not well‐equipped with the necessary vaccinations, antibiotics, or antivirals; however, in recent years, nations have advanced in terms of technology as well as health infrastructure to deal with the pandemics (Ali and Alharbi 2020 ; Jakob 2020 ). According to Schoch‐Spana ( 2001 ), Mukherjea ( 2010 ), and Scanlon and McMohan ( 2011 ), this is a difficult logistical challenge being faced by many developing nations and might hinder the provision of adequate medical care for patients with pandemic influenza. However, the advancement in technology and improved healthcare facilities such as ICUs have prevented excess mortality, and have helped nations to introduce vaccines against COVID‐19.

Vaccines are generally available by developed nations and developing nations have to rely on the vaccines developed by high‐income developed countries to fight any pandemic. However, it is crucial for developing nations to develop their healthcare systems to reduce mortality and morbidity rates (Chandra 2013 ; Gealogo 2009; Jakob 2020 ; Rosner 2010 ). Even today, not many developing nations have the finances to meet their own basic medical necessities (Delivorias and Scholz 2020).

The loss of societal trust that appeared during and after the 1918 influenza pandemic affected forthcoming generations negatively, and consumption preferences changed significantly (Aassve et al . 2020). From a macroeconomic perspective, consumption and services, demand and their supplies are directly attached, and a fall in overall demand leads to a decline in overall supplies (Fan 2003). Female labourers were hurt severely with discrimination in the job market (Ceylan, Ozkan and Mulazimogullari 2020 ). The demand dynamics and consumption along with purchasing attitudes changed with change in the consumer attitudes, e.g., online shopping (Ceylan, Ozkan and Mulazimogullari 2020 ). A utilitarian welfare maximisation approach was used to forecast the trade‐off between death toll, life expectancy, and consumption differences (Hall et al . 2020).

In a study by Murray et al . ( 2006 ), data was used to calculate excess mortality during the 1918–1920 pandemic using least squared methods, and predicted that the majority of the population in developing countries would get washed away if the 1918 pandemic history was repeated. As suggested by Hacck ( 2019 ), nations must work on enhancing their economy so that funding will be available during pressing pandemic circumstances. However, there has always been a huge gap between the availability of vaccines and the ever‐rising demand for it in the underdeveloped and developing countries (Bennett and Carney 2010 ; Jester et al . 2018 ; Kant and Guleria 2018 ; Martini et al . 2019 ).

Studies by Barro, Ursua and Weng ( 2020 ) and Jakob ( 2020 ) suggests that the medical condition of most of the countries in times of COVID‐19 is similar to that during the 1918 influenza pandemic. Barro, Ursua and Weng ( 2020 ) used regression analysis to assess the country's flu death rate on its economic outcomes, which had a negative correlation of (–) 0.25. Barro, Ursua and Weng ( 2020 ) used regression analysis to assess the impact of the 1918 influenza pandemic and the First World War on economic growth; however, it is suggested that most of the countries which experienced flu were not engaged in war. Findings suggest a possibility of an unprecedented number of deaths and a major global economic contraction, even though the probability of COVID‐19 outbreak reaching anywhere close to the 1918 influenza pandemic is remote, given the mitigation measures being adopted and the advancement in medical infrastructure (Barro, Ursua and Weng 2020 ).

Schoenbaum ( 2001 ), Donaldson and Keniston ( 2016 ), and Reyes et al . ( 2018 ) among others suggest that some of the problems prevalent in less‐developed countries include poor admittance to medical care, embryonic public infrastructure, unhealthy socio‐economic conditions, dense populations, uneducated classes, lack of proper awareness, presence of varied already existing infectious diseases, and malnutrition. Studies by Bell et al . ( 2009 ) and Jester, Uyeki, and Jernigan ( 2018 ) indicate that developing countries fall short in handling the impact of the pandemic as compared to developed countries due to lack of preparedness. Gottfredsson et al . ( 2008 ) suggest that fatalities attributable to a pandemic are significantly greater in developing countries than in developed countries. Many countries have already begun setting up and implementing pandemic preparedness plans; however, the level of preparedness varies from country to country (Chandra, Kuljanin and Wray 2012 ; Chandra and Kassens‐Noor 2014 ). In developing countries, many health programmes are dependent on financial support from donors; however, a more general approach is required to improve pandemic preparedness in developing countries (Gaelogo 2009; Gerard, Imbert and Orkin 2020 ). By simply strengthening preparedness within a single country, it is not possible to prepare for a pandemic (Mukherjea 2010 ; Nickol and Kindrachuk 2019 ; Pak et al . 2020 ).

Economic consequences of 1918 influenza pandemic and COVID‐19 pandemic in India

The 1918 influenza pandemic as well as the COVID‐19 pandemic has caused a lot of stir in the lives of the masses (Nickol and Kindrachuk 2019 ; Pak et al . 2020 ). Developing as well as developed economies have been affected as most of the economic activities have come to an impasse (Brainerd and Siegler 2003 ; Buheji et al . 2020 ; Donaldson and Keniston 2016 ). The economy of India, as mentioned in the introduction section, has more than half of its population engaged in the agricultural and unorganised sector, and that population does not have a stable source of income (Satpathy, Patnaik and Tripathy 2018). Thus in times of a pandemic, when all the sectors and industries including aviation, tourism, and micro‐, small‐, and medium‐sized enterprises (MSMEs), etc. have come to a standstill, the economic downturn greatly affects the people belonging to the lower strata of the society (Dev and Sengupta 2020 ; Kumar et al . 2020 ; Pak et al . 2020 ).

As suggested by Donaldson and Keniston ( 2016 ) and Hacck ( 2019 ), the 1918 influenza pandemic advocated to have forced the poor people of India to extreme poverty, thus forcing them to earn their bread and butter from farming activities, thereby raising income disparity. The impact of the pandemic was prominent in many areas, leading to shortage in food supply on the one hand and rise in prices of food items and other supplies on the other hand (Schoenbaum 2011). During the initial stage of COVID‐19, India and global economies witnessed lockdowns, with few or no economic activities, leading to mass unemployment as a lot of workers work in the informal sector on daily wages (Buheji et al . 2020 ; Pak et al . 2020 ). The nation witnessed mass movement of labour force from urban to rural India (Chaudhary, Sodani and Das 2020 ; Dev and Sengupta 2020 ). The movement is expected to have increased activities in the rural areas such as agriculture and allied activities (Timilsina et al . 2020 ).

During both the pandemics, the economies registered a fall in the per capita GDP. Maddison Project Database ( 2020 ), as depicted in Figure  3 , suggests that during the influenza pandemic, per capita GDP fell from US$1111 in 1917 to US$968 in 1918. However, in the later years, the per capita GDP began to rise. Figure  4 depicts that in 2020, when the COVID‐19 pandemic was at its peak, IMF estimated the nominal per capita GDP of India to be US$1876.53, which was US$2099.6 in 2019. Numerous agencies such as the World Trade Organization, Standard and Poor, and Goldman Sachs have estimated that the GDP of the Indian economy to contract by 10–20 per cent, and the global growth by 8 per cent.

Trend of per capita GDP during 1918 influenza pandemic in India

Source: Maddison project database & World Bank database

Trend of per capita GDP during covid‐19 pandemic in India

According to Chaudhary, Sodani and Das ( 2020 ) and Singh and Misra ( 2020 ) a reduction in customer spending, low level of economic activities during the nationwide lockdown, decline in exports, and reduced allowances are some of the key reasons for this decline in GDP. As suggested by Gopalan and Misra ( 2020 ), the disruption in the jobs of people working abroad is expected to have an adverse impact on remittances from non‐resident Indians, thereby making them take up jobs providing lower incomes, spending restrictions, and living and working in poor conditions (Gopalan and Misra 2020 ). Gopalan and Misra ( 2020 ) predicted that the remittances are going to fall by more than 20 per cent in the year 2020 because of the disruptions caused by COVID‐19.

According to Donaldson and Keniston ( 2014 ; 2016 ), during the 1918 influenza pandemic, the Indian subcontinent was undergoing low population growth clubbed with stable per capita income, popularly known as the Malthusian equilibrium. The authors also suggested that the high death tolls meant that survivors of the pandemic were left with additional land to practice agriculture. Thus, there was no loss in the agricultural yield; however, the high mortality rate during the pandemic created a lot of unrest among the public, which gave rise to an increase in the birth rate (Donaldson and Keniston 2014 ; Donaldson and Keniston 2016 ).

Sen (1967) critically analysed Schultz's statistical test, where the latter had statistically analysed data from Indian agriculture before and after the 1918 influenza pandemic and concluded that surplus labour theory is a false doctrine in India. Sen (1967) argues that the mortality data considered by Schultz for the statistical analysis is more than the actual data, and has ignored the natural increase in population during these four years. According to Sen (1967), this is the reason for the fall in the labour force; however, this was not the case. To counter the critique by Sen (1967), Schultz (1967) replied that Sen's estimates of the agricultural labour coefficient were in the wrong direction. Schultz also clarified the alternative hypotheses, and commented that the tests conducted by Sen are not the appropriate tests for zero marginal product of labour; wherein an appropriate test would indicate a decisive rejection of the null hypothesis, and therefore a rejection, in this case, of the doctrine of surplus labour.

Chaudhary, Sodani and Das ( 2020 ), Nicola et al . ( 2020 ), and Nilima et al . (2020) suggest loss of jobs as one of the biggest repercussions of the COVID‐19 lockdown as millions of migrant workers are expected to have lost their livelihood with almost no hope of a new job in the immediate future. In their research papers, Choudhary ( 2020 ) and Verma and Mishra ( 2020 ) mentioned that people working in the organised sector, such as the multinational corporations, also lost their jobs during the nationwide lockdown. Similar impact of the COVID‐19 lockdown was also witnessed in countries other than India (Gerard, Imbert and Orkin 2020 ).

With reference to India, while the major research focus was on assessing the impact of epidemiological backgrounds and demographic effects of the 1918 influenza pandemic, research on the economic implications are scarce. Killingray ( 2003 ) and Kant and Guleria ( 2018 ) reported that unlike many other developed and developing nations, not many economic activities were restricted in India; however, there is evidence of a shutdown of colleges and schools and restriction on public gatherings for limited times to combat the situation. As suggested by Klein ( 1988 ), Mills ( 1986 ), and Weber and Dalton ( 2020 ), neither the British Government nor the Indian nationalists focused much on these issues, thus the economic activities did not stop at a mass level. However, during the outbreak of the COVID‐19 pandemic, the governments of developing nations such as India took measures and enforced nationwide lockdowns (Dev and Sengupta 2020 ; Gopalan and Misra 2020 ). Though the initial containment measures and the lockdowns were effective to curb the spread of the virus; however, it negatively affected the economy and its people, thereby increasing the bridge between the rich and the poor (Dev and Sengupta 2020 ; Gopalan and Misra 2020 ; Kumar et al . 2020 ; Nicola et al . 2020 ; Singh and Misra 2020 ).

Social consequences of 1918 influenza pandemic and COVID‐19 pandemic in India

There is evidence for developing countries to experience abrupt and swift outbreaks of epidemics or pandemics, which are usually triggered by malnutrition, dearth of sanitation, proper public health schemes, and inaccessibility of ready‐made serums (Ergunay 2014). Effects of a pandemic are far‐fetched, as it is a social phenomenon affecting famine and governance. The predominant circumstances in 1918 were mainly due to the First World War, economic conditions, crowding, and shortage of food supply (Schoenbaum 2001 ). Under such circumstances, it was natural to witness socio‐economic upheaval, which led to imbalance in managing things well across all arenas (Mukherjea 2010 ; Scanlon and McMahon 2011 ). On the contrary, the socio‐economic consequences of COVID‐19 pandemic were mainly due to the nationwide lockdown, in order to control the spread of the deadly virus.

As suggested by Kant and Guleria ( 2018 ), the diffusion patterns of pandemics are better understood when social interactions among people from different places, societal health‐related responses, environments, physiognomies of the pathogens, and national and international travel designs are taken into consideration. In a country like India, where people thrive on their family and friends socially and emotionally, nationwide lockdowns are triggering mental health concerns (Choudhari 2020 ; Nilima et al . 2020). The cases of depression, anxiety, and stress are at an all‐time high, leading to various concerns (Choudhari 2020 ; Dsouza et al . 2020 ; Verma and Mishra 2020 ). Studies by Choudhari ( 2020 ) and Kochhar et al . ( 2020 ) also show an increased mental stress among people with regards to their jobs. There is also an increase in suicidal thoughts among people, especially the ones who lost their jobs and means of livelihood because of COVID‐19 (Dsouza et al . 2020 ).

Singh and Adhikari ( 2020 ) reported that in the heterogeneous Indian population with people belonging to different classes of the society, the COVID‐19 scenario is impacting and changing how these people belong to their different age groups and social classes. The lockdown and stay‐at‐home restrictions have given time for people to re‐bond with their families who are privileged to work from home; however, those who have lost their jobs and became homeless are fighting every single day in order to survive (Singh and Adhikari 2020 ). Studies suggest that mental stress is the highest among the section of people who have lost jobs due to the pandemic (Paital, Das and Parida 2020 ; Verma and Mishra 2020 ).

Another important aspect of the pandemic is the social health of the migrant workers, who moved from cities to villages after the nationwide lockdown because of loss of jobs (Chaudhary, Sodani and Das 2020 ; Choudhari 2020 ; Verma and Mishra 2020 ). The conditions of people living in rural areas with poor access to water and proper sanitation is at its worst; women seem to be badly affected with improper medical facilities, unhygienic surroundings, and lack of toilets, which calls for another health emergency in rural India (Choudhari 2020 ; Ghoshal 2020 ). Responding to this new challenge, various communities and groups, more so in rural areas, have come up with different coping mechanisms and solutions.

As suggested by Ghoshal ( 2020 ), the nationwide lockdown has “locked‐down” all members of the household, with an ever‐increased burden on women for managing household work, care work, as well as office work. Studies also suggest an increase in domestic violence, including sexual, emotional, verbal, economic, and physical abuse, is due to the strict lockdown measures implemented by the Governments in order to contain the spread of novel corona virus (Ghoshal 2020 ; and Nilima et al . 2020).

One major difference between COVID‐19 and the 1918 influenza pandemic is the option to work from remote locations (Nikola et al . 2020 ). The advent of digital technology has paved ways to work from home. It has helped the employers in reduction of recurring costs such as rent and maintenance of office space; it has also helped the employees by reducing travel time and providing them with flexible working hours; and more services than ever have become available online (Ghosh, Nundy and Mallick 2020 ; Nikola et al . 2020 ). Employers are now also able to retain highly talented personnel by providing them the flexibility which was earlier not possible in the traditional work arrangements and during the era of the 1918 influenza pandemic. Though most of the services were available online, people belonging to some sections of the society got negatively impacted with the online culture. Many people lost their jobs and sources of livelihood, as their services were not considered safe during COVID‐19 (Ceylan, Ozkan and Mulazimogullari 2020 ).

There is a significant gap in literature that assesses the societal impact of the 1918 influenza pandemic in India. However, in the wake of the COVID‐19 pandemic, there is a need to draw the attention of healthcare professionals towards creating mental health awareness among people, and for policy makers to pay attention towards the needs of its masses.

Pandemic mitigation measures adopted by India

Pandemic control is not one nation's responsibility; the entire world has to work hand in hand with the World Health Organization (WHO) to overcome the devastating effects that have evolved during occasions such as these two pandemics. Thus, co‐ordinated and determined global policies are the key elements to free nations from the shackles of this deadly virus (Stiver 2004 ). To prepare developing nations face such deadly situations, the Global Pandemic Influenza Action Plan was initiated by the World Health Organization (WHO) in November 2006, where manufacturers from developing nations, including Indonesia, Mexico, Brazil, Thailand, Vietnam, and India, were given grants to develop vaccinations. In 2009, Romania, Korea, Iran, Serbia, and Egypt joined the line of pandemic vaccine development as grant holders (World Health Organization Report 2006 ).

In the wake of the COVID‐19 pandemic, the main priority facing all nations is to ensure the safety of its citizens; thus, understanding the nature of the virus and coming up with a vaccine at the earliest point is of pivotal importance (Jakob 2020 ; Paital, Das and Parida 2020 ; Sarkar, Khajanchi and Nieto 2020 ). The World Health Organization has brought together businesses, scientists, and global health organisations of 172 nations under one umbrella for the development of the COVID‐19 vaccine, with the objective of benefitting all nations and providing medical assistance to nations in need.

Studies suggest that the influenza pandemic of 1918 was a seasonal flu, and containment measures had little impact on its spread; but at the same time, social distancing was the key to flattening the curve as vaccines were not available (Spreeuwenberg, Kroneman and Paget 2018 ). However, COVID‐19 is not a seasonal flu, and its spread increases as soon as the containment measures are lifted (Ghosh et al . 2020 ; Singh and Abhikari 2020 ). In 1918–1919, measures to mitigate the pandemic were limited (McMohan 2011), whereas during the COVID‐19 pandemic, when the vaccines were being developed, measures such as closure of schools, stores and restaurants, the imposition of travel restrictions, the imposition of social‐distancing norms, and the prohibition of public gatherings were necessary to prevent catching the deadly virus (Ceylan, Ozkan and Mulazimogullari 2020 ; Nicola et al . 2020 ).

According to Scanlon and McMahon ( 2011 ), Nicola et al . ( 2020 ), and Singh and Adhikari ( 2020 ), among others, a number of possible interventions, including pharmaceutical interventions such as vaccines and antiviral agents and non‐pharmaceutical interventions such as quarantine, isolation, social distancing, and personal hygiene, can be implemented to control or mitigate the effects of influenza and COVID‐19 pandemics, both of which are respiratory diseases. Studies by Bennett and Carney ( 2010 ), Jester, Uyeki, and Jernigan ( 2018 ), and Sarkar, Khajanchi, and Nieto ( 2020 ), among others, suggest recent efforts to increase the worldwide availability of vaccines and antivirals help boost the global availability of these drug interventions; however, increased availability of a vaccine alone will not solve all the issues in many countries – several other concerns, such as lack of medical professionals, finances, medical equipment and infrastructure, vaccines and other medical supplies need to be addressed in order to implement pharmaceutical interventions.

Apart from medical assistance being provided by the WHO and the local bodies, the global economies are also in need of improving their economic conditions. Agencies such as the International Monetary Fund, United Nations, World Trade Organization, and local governing bodies are providing stimulus in order to boost the economies. In India, the Central Government as well as the State Government are taking numerous measures for public health, socio‐economic, and serious livelihood challenges (Dubey and Sahu 2020 ; Sahoo and Ashwini 2020 ). One of the hallmarks of the Government of India initiative is consistent, evidence‐based, and standard public health communication through various mediums for the entire citizenry of the country.

The Ministry of Finance of the Government of India has been trying to foster the economy by introducing stimulus packages for people, sectors, and businesses that have been badly affected because of the COVID‐19 pandemic (Dubey and Sahu 2020 ). Apart from this stimulus, the Government of India is uplifting key sectors, such as agriculture and allied activities, and the MSMEs (Priyadarshini and Abhilash 2020 ; Sahoo and Ashwini 2020 ). As suggested by Pak et al . ( 2020 ), another key challenge in front of the government is to provide employment opportunities. Loss of jobs and livelihood due to the COVID‐19 pandemic and nationwide lockdown led to mass migration of migrant workers from urban area to rural areas (Chaudhary, Sodani and Das 2020 ; Choudhari 2020 ; Verma and Mishra 2020 ). The Ministry of Housing and Urban Affairs of the Government of India is also planning to extend this scheme in urban areas to put a brake in the surge in unemployment because of the lockdown induced by COVID‐19 (Press Trust of India 2020). In order to promote and export the products that are made locally, the Government of India has also launched the Aatmanirbhar Bharat Abhiyaan (Self‐Reliant India Initiative), and have requested the public to go for locally made products, which is also expected to help in employment generation. Although the aim of the Aatmanirbhar Bharat Abhiyaan is to make India self‐reliant, researchers argue this is India's step against the process of globalisation, which was initiated in the year 1991 (Dubey and Sahu 2020 ).

The immunity of the public to tackle a new virus is not ingrained, and if the virus is as deadly as the Coronavirus, it calls for collective action. COVID‐19 has negatively impacted the health conditions, economies, and societies of nations across the globes, who have been trying to deal with the virus and have been adopting various measures. It is expected that these measures will help the economy of India get out of the pandemic. Similar initiatives are also expected to help other developing nations during the COVID‐19 pandemic. The next section contains the conclusion of the literature review section along with the recommendations by the researchers.

Conclusion and recommendations

The 1918 influenza pandemic was one of the most widespread and deadliest flus that have been witnessed by the global economies (Tsoucalas, Kousoulis and Sgantzos 2016 ; Wijdicks 2020 ). Although there is no clear evidence of the origin of the 1918 influenza pandemic, history suggests that the initial cases were reported by the US Army immediately after the First World War. With the movement of people, the 1918 influenza pandemic also started to spread in different parts of the world in four different waves, where each wave was equally deadly (Brainerd and Siegler 2003 ; Chandra 2013 ; Martini et al . 2019 ; Nickol and Kindrachuk 2019 ). The pandemic infected millions and took lives across the globe, including in India (Johnson and Muller 2002 ; Bala 2011 ; Chandra, Kuljanin and Wray 2012 ; Kant and Guleria 2018 ).

At present, India as well as the world economy is suffering from the COVID‐19 pandemic, the first case of which was reported in the city of Wuhan in the People's Republic of China (Ali and Alharbi 2020 ; Chaudhary, Sodani and Das 2020 ). The 1918 influenza pandemic as well as the COVID‐19 pandemic have similarities in the nature of the diseases and their spread. In the past, during the outbreak of the 1918 influenza pandemic, neither technology nor healthcare were as advanced, thus the researchers and health scientists could not come up with a vaccine to prevent the spread of the pandemic, although the pandemic was over by 1920 (Rosner 2010 ; Jester, Uyeki and Jernigan 2018 ). With advanced technologies and robust healthcare systems, scientists have devised vaccines for protection against COVID‐19 (Ali and Alharbi 2020 ; Jakob 2020 ).

Countries have reported to have faced severe economic catastrophe because of the 1918 influenza pandemic. An epidemic does not impact just the health of the citizens, but the economy as a whole. During the 1918 influenza pandemic, countries started restricting trade with other nations, cancelling public events, and took various measures to prevent the health of the citizens. Another aspect of the pandemic was to combat the pandemic in order to revive the economy. Thus, the current study attempts to understand the pandemics and suggest measures that can help India boost its societal growth and economic development.

Findings from literature suggest that developing countries have faced more severe implications of such pandemics compared to developed countries (Murray et al . 2006 ; Singh and Misra 2020 ). The effects of pandemic are more severe in low‐income countries as compared to high‐income countries. Developing countries generally lack combating skills, so imitating the measures taken in developed nations stands as an important step along with making the nation self‐reliant by focusing on enhancing its inherent capacity (Bell et al . 2009 ; Murray et al . 2006 ). Developing countries must not be underestimated, especially when these nations overcome natural calamities; thus, similar resources that are used during disasters may also be beneficial during a pandemic.

The research findings also suggest the socio‐economic impact of the 1918 pandemic on the Indian economy (Martini et al . 2019 ; Mukherjea 2010 ). It was not among the main interests of most of the national leaders, including the British Government, to put the economy in lockdown and suffer losses. Thus, India did not suffer much economic loss as compared to many other developing as well as developed countries (Garrett 2007 ; Garrett 2008 ; Schoenbaum 2001 ; Verikios et al . 2011 ; and Weber and Dalton 2020 ). The poor health infrastructure during those times led to India's mortality rate in the 1918 pandemic of approximately 5 to 6 per cent of its total population, in which women, the elderly, and children were high at risk from the deadly virus (Martini et al . 2019 ).

A century after the influenza pandemic, the perspective of looking at lives, the healthcare system, and the economy has changed in the context of the COVID‐19 pandemic. Work and life are now based on virtual connections, as social distancing and staying home has become the “new normal”. It is the need of the hour to embrace this “new normal” until the vaccines being tested are proven and supplied. Until then, it is imperative to lead a digitised life, work from home, and avoid socialising (Ojo 2020 ; and Pambuccian 2020 ). Although physical distancing is the key to contain the spread of COVID‐19, there is a growing need to promote awareness of the effect of these measures on mental health.

In order to revive the socio‐economic conditions of India, the researchers have come up with a few recommendations. Firstly, the Government should ensure that the basic amenities are made available to people from all sections of the society at affordable prices, thereby ensuring supply chain effectiveness. If the supply chain gets disrupted because of COVID‐19, leading to supply‐demand disequilibrium, it will negatively affect the economic activities at large. Secondly, medical facilities should be provided to all those who need it. Many other patients suffering from diseases such as cancer and TB are being neglected because of the ongoing pandemic. Ensuring medical aid and understanding the nature of the virus should be the priority of the governing bodies. Thirdly, the government should focus on employment generation, as unemployment and migration from cities to villages has increased because of the nationwide lockdown. The government should focus and prioritise key areas. It is essential for the government to focus on developing means of livelihood for its public in rural areas. The government has already introduced policies for the development of both these sectors, with due focus on job creation. Fourth, there is a need for more stimulus to be pumped into the economy. There is also a need for the government to invest in sustainable infrastructure for a safe and sound future. Finally, the government should focus on putting laws and ordinances into place for the workers in the unorganised sector, as they are neither covered by an employer's social security scheme nor insurance scheme. They are the most neglected and highly exploited workforce with very little legislation to support them. The COVID‐19 pandemic has increased the necessity of attention towards the marginalised population holistically. Thus, the abovementioned measures will be fruitful from health, socio‐economic, growth, and development perspectives.

Biographies

Ms. Aadya Sharma is a Teaching Assistant at Symbiosis Institute of Business Management, Nagpur. She is also pursuing her PhD (part‐time) from Symbiosis International (Deemed University), Pune, India. She has over three years of experience as a researcher in the corporate as well as education industry. Her areas of specialization are economics, international trade and gender economics. Email: [email protected]

Ms. Dibyashree Ghosh is a student at Symbiosis Institute of Digital and Telcom Management, Pune pursuing MBA (2nd Year) in Systems and Finance. She is a B.Tech Computer Science graduate from Manipal University Jaipur and has a work experience of 46 Months as an Application Software Developer with Secure Meters Limited. Email: [email protected]

Dr. Neha Divekar is an Assistant Professor working at Symbiosis Institute of Technology, Pune with Ph.D. in English Literature. She is the faculty head for Literary Club and also runs students and faculty TED Club at SIT. In addition to that, Dr. Neha facilitates GDPI training to students as well as conducts corporate training. Email: [email protected]

Dr. Manisha Gore is an Assistant Professor with the Symbiosis Institute of Health Sciences and Symbiosis Community Outreach Program and Extension (SCOPE), a doctorate in Anthropology from Savitribai Phule, Pune University. An academician and researcher in the area of public health, with a total 20+ years of experience in teaching and research. Email: ni.ude.uis@1epocsreciffohcraeser

Dr. Saikat Gochhait, currently Symbiosis Institute of Digital & Telecom Management, Symbiosis International (Deemed University) Pune, India, is Ph.D and Post‐Doctoral Fellow from the UEx, Spain. Awarded DITA and MOFA Fellowship in 2017 and 2018. Research publication with foreign authors indexed in Scopus, ABDC, and Web of Science. IEEE member. Email: [email protected]

Dr. Shambhulinganand S. Shireshi is an Assistant Professor working in Symbiosis Law School, Pune since 2017. With the Ph.D. degree in 2005, he started his teaching career as a Guest Lecturer in the Department of Gandhian Studies, Karnatak University, Dharwad and continued the same for 10 years. He has also worked as a Guest Lecturer and Guest researcher in the Department of Indology, University of Wurzburg, Germany during the summer semesters of 2007 & 2008. Email: [email protected]

1 The database was accessed on 25 th  Jan, 2021.

Contributor Information

Aadya Sharma, Email: [email protected] .

Dibyashree Ghosh, Email: [email protected] .

Neha Divekar, Email: [email protected] .

Manisha Gore, Email: ni.ude.uis@1epocsreciffohcraeser .

Saikat Gochhait, Email: [email protected] .

S.S. Shireshi, Email: [email protected] .

• Ali, I. And Alharbi, O.M. , 2020. COVID‐19: Disease, management, treatment, and social impact . Science of the Total Environment , More information needed, 138861. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bala, R. , 2011, JANUARY. The Spread Of Influenza Epidemic In The Punjab (1918–1919) . In Proceedings of the Indian History Congress , 72 , 986–996. [ Google Scholar ]
• Barro, R.J. , Ursua, J.F. And Weng, J. , 2020. The coronavirus and the Great Influenza epidemic: Lessons from the “Spanish Flu” for the coronavirus’ potential effects on mortality and economic activity . National Bureau of Economic Research, Inc . Working Paper, 26866.
• Bell, D.M. , Weisfuse, I.B. , Hernandez‐Avila, M. , Del Rio, C. , Bustamante, X. And Rodier, G. , 2009. Pandemic influenza as 21st century urban public health crisis . Emerging Infectious Diseases , 15 ( 12 ), 1963. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Bennett, B. And Carney, T. , 2010. Trade, travel and disease: The role of law in pandemic preparedness . Asian J. WTO & Int'l Health L & Pol'y , 5 , 301. [ Google Scholar ]
• Brainerd, E. And Siegler, M.V. , 2003. The economic effects of the 1918 influenza epidemic . Centre for Economic Policy Research, UK . SSRN 394606.
• Buheji, M. , Da Costa Cunha, K. , Beka, G. , Mavric, B. , De Souza, Y.L. , Da Costa Silva, S.S. , Hanafi, M. And Yein, T.C. , 2020. The extent of covid‐19 pandemic socio‐economic impact on global poverty: A global integrative multidisciplinary review . American Journal of Economics , 10 ( 4 ), 213–224. [ Google Scholar ]
• Ceylan, R. F. , Ozkan, B. And Mulazimogullari, E. , 2020. Historical evidence for economic effects of COVID‐19 . Eur J Health Econ , More information needed, 817–823. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Chandra, S. And Kassens‐Noor, E. , 2014. The evolution of pandemic influenza: Evidence from India, 1918–19 . BMC Infectious Diseases , 14 ( 1 ), 1–10. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Chandra, S. , 2013. Mortality from the influenza pandemic of 1918–19 in Indonesia . Population Studies , 67 ( 2 ), 185–193. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Chandra, S. , Kuljanin, G. And Wray, J. , 2012. Mortality from the influenza pandemic of 1918–1919: The case of India . Demography , 49 ( 3 ), 857–865. [ PubMed ] [ Google Scholar ]
• Chaudhary, M. , Sodani, P.R. And Das, S. , 2020. Effect of COVID‐19 on Economy in India: Some Reflections for Policy and Programme . Journal of Health Management , 22 ( 2 ), 169–180. [ Google Scholar ]
• Choudhari, R. , 2020. COVID 19 pandemic: Mental health challenges of internal migrant workers of India . Asian Journal of Psychiatry , 54 , 102254. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Curson, P. And Mccracken, K. , 2006. An Australian perspective of the 1918–1919 influenza pandemic . New South Wales Public Health Bulletin , 17 ( 8 ), 103–107. [ PubMed ] [ Google Scholar ]
• Dev, S.M. And Sengupta, R. , 2020. Covid‐19: Impact on the Indian economy . Indira Gandhi Institute of Development Research, Mumbai , April, 3–143. [ Google Scholar ]
• Digital South Asia Library , 2020. Statistical Abstract of British India . Available from: https://dsal.uchicago.edu/statistics/ (last accessed: DATE).
• Donaldson, D. And Keniston, D. , 2014. How Positive Was the Positive Check? Investment and Fertility in the Aftermath of the 1918 Influenza in India .
• Donaldson, D. And Keniston, D. , 2016. Dynamics of a Malthusian Economy: India in the Aftermath of the 1918 Influenza . National Bureau of Economic Research, Inc . Working Paper, 27673.
• Dsouza, D.D. , Quadros, S. , Hyderabadwala, Z.J. And Mamun, M.A. , 2020. Aggregated COVID‐19 suicide incidences in India: Fear of COVID‐19 infection is the prominent causative factor . Psychiatry Research , More information needed, 113145. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Dubey, P. And Sahu, K.K. , 2020. MSMEs in COVID‐19 Crisis and India's Economic Relief Package: A Critical Review . AIJR Preprints , More information needed, 207. [ Google Scholar ]
• Fargey, K.M. , 2019. The DeaDliesT enemy . Army History , 111 , 24–39. [ Google Scholar ]
• García‐Sastre, A. And Whitley, R.J. , 2006. Lessons learned from reconstructing the 1918 influenza pandemic . The Journal of Infectious Diseases , 194 ( 2 ), 127–132. [ PubMed ] [ Google Scholar ]
• Garrett, T.A. , 2007. Economic effects of the 1918 influenza pandemic: Implications for a modern‐day pandemic . Federal Reserve Bank of St. Louis . More information needed. [ Google Scholar ]
• Garrett, T.A. , 2008. Pandemic economics: The 1918 influenza and its modern‐day implications . Federal Reserve Bank of St. Louis Review , 90 ( 2 ), 75–93. [ Google Scholar ]
• Gerard, F. , Imbert, C. And Orkin, K. , 2020. Social protection response to the COVID‐19 crisis: options for developing countries . Oxford Review of Economic Policy , 36 ( 1 ), 281–296. [ Google Scholar ]
• Ghosh, A. , Nundy, S. And Mallick, T. K. , 2020. How India is dealing with COVID‐19 pandemic . Sensors International , 1 , 100021. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ghosh, A. , Nundy, S. , Ghosh, S. And Mallick, T. K. , 2020. Study of COVID‐19 pandemic in London (UK) from urban context . Cities , 106 , 102928. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ghoshal, R. , 2020. Twin public health emergencies: Covid‐19 and domestic violence . Indian Journal of Medical Ethics , More information needed, 1–5. [ PubMed ] [ Google Scholar ]
• Gopalan, H.S. And Misra, A. , 2020. COVID‐19 Pandemic and Challenges for Socio‐economic Issues, Healthcare and National Programs in India . Diabetes & Metabolic Syndrome: Clinical Research & Reviews , More information needed, 757–759. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Gottfredsson, M. , Halldórsson, B.V. , Jónsson, S. , Kristjánsson, M. , Kristjánsson, K. , Kristinsson, K.G. , Löve, A. , Blöndal, T. , Viboud, C. , Thorvaldsson, S. And Helgason, A. , 2008. Lessons from the past: Familial aggregation analysis of fatal pandemic influenza (Spanish flu) in Iceland in 1918 . Proceedings of the National Academy of Sciences , 105 ( 4 ), 1303–1308. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hacck, A. , 2019. 100 Years Later: An Analysis into Factors That Affected Mortality During The 1918 Spanish Flu Pandemic . More information needed.
• Jakob, U. , 2020. Norm Conflicts in Global Health: the Case of Indonesia and Pandemic Influenza Preparedness . Peace Research Institute Frankfurt , 47.
• Jester, B. , Uyeki, T. And Jernigan, D. , 2018. Readiness for responding to a severe pandemic 100 years after 1918 . American Journal of Epidemiology , 187 ( 12 ), 2596–2602. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Johnson, N.P. And Mueller, J. , 2002. Updating the accounts: global mortality of the 1918–1920" Spanish" influenza pandemic . Bulletin of the History of Medicine , More information needed, 105–115. [ PubMed ] [ Google Scholar ]
• Kant, L. And Guleria, R. , 2018. Pandemic Flu, 1918: After hundred years, India is as vulnerable . The Indian Journal of Medical Research , 147 ( 3 ), 221. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Karesh, W.B. And Cook, R.A. , 2005. The human‐animal link . Foreign Aff ., 84 , 38. [ Google Scholar ]
• Karlsson, M. , Nilsson, T. And Pichler, S. , 2014. The impact of the 1918 Spanish flu epidemic on economic performance in Sweden: An investigation into the consequences of an extraordinary mortality shock . Journal of Health Economics , 36 , 1–19. [ PubMed ] [ Google Scholar ]
• Killingray, D. , 2003. A new “imperial disease”: The influenza pandemic of 1918–9 and its impact on the British Empire . Caribbean Quarterly , 49 ( 4 ), 30–49. [ Google Scholar ]
• Klein, I. , 1988. Plague, policy and popular unrest in British India . Modern Asian Studies , 22 ( 4 ), 723–755. [ PubMed ] [ Google Scholar ]
• Kochhar, A.S. , Bhasin, R. , Kochhar, G.K. , Dadlani, H. , Mehta, V.V. , Kaur, R. And Bhasin, C.K. , 2020. Lockdown of 1.3 billion people in India during Covid‐19 pandemic: A survey of its impact on mental health . Asian Journal of Psychiatry , More information needed, 102213. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kumar, S. , Maheshwari, V. , Prabhu, J. , Prasanna, M. , Jayalakshmi, P. , Suganya, P. , Malar, B.A. And Jothikumar, R. , 2020. Social economic impact of COVID‐19 outbreak in India . International Journal of Pervasive Computing and Communications , More information needed. [ Google Scholar ]
• Maddison Project Database (2020). Maddison Historical Statistics . Available from: https://www.rug.nl/ggdc/historicaldevelopment/maddison/releases/maddison‐project‐database‐2020?lang=en .
• Martini, M. , Gazzaniga, V. , Bragazzi, N.L. And Barberis, I. , 2019. The Spanish Influenza Pandemic: A lesson from history 100 years after 1918 . Journal of Preventive Medicine and Hygiene , 60 ( 1 ), 64–67. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mills, I.D. , 1986. The 1918–1919 influenza pandemic—the Indian experience . The Indian Economic & Social History Review , 23 ( 1 ), 1–40. [ PubMed ] [ Google Scholar ]
• Mukherjea, A. , 2010. The social politics of pandemic influenzas: The question of (permeable) international, inter‐species, and interpersonal boundaries . Understanding Emerging Epidemics: Social and Political Approaches , 11 , 125. [ Google Scholar ]
• Murray, C.J. , Lopez, A.D. , Chin, B. , Feehan, D. And Hill, K.H. , 2006. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: A quantitative analysis . The Lancet , 368 ( 9554 ), 2211–2218. [ PubMed ] [ Google Scholar ]
• Nickol, M. E. And Kindrachuk, J. , 2019. A year of terror and a century of reflection: Perspectives on the great influenza pandemic of 1918–1919 . BMC infectious diseases , 19 ( 1 ), 1–10. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nicola, M. , Alsafi, Z. , Sohrabi, C. , Kerwan, A. , Al‐Jabir, A. , Iosifidis, C. , Agha, M. And Agha, R. , 2020. The socio‐economic implications of the coronavirus pandemic (COVID‐19): A review . International journal of surgery (London, England) , 78 , 185–193. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nilima, N. , Kaushik, S. , Tiwary, B. And Pandey, P. K. , 2021. Psycho‐social factors associated with the nationwide lockdown in India during COVID‐19 pandemic . Clinical Epidemiology and Global Health , 9 , 47–52. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ojo, O.B. , 2020. Socio‐Economic Impacts of 1918–19 Influenza Epidemic in Punjab . Journal of Asian and African Studies , 55 ( 7 ), 1023–1032. [ Google Scholar ]
• Paital, B. , Das, K. And Parida, S.K. , 2020. Inter nation social lockdown versus medical care against COVID‐19, a mild environmental insight with special reference to India . Science of The Total Environment , More information needed, 138914. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pak, A. , Adegboye, O.A. , Adekunle, A.I. , Rahman, K.M. , Mcbryde, E.S. And Eisen, D.P. , 2020. Economic consequences of the COVID‐19 outbreak: The need for epidemic preparedness . Frontiers in Public Health , 8 , 241–251. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pambuccian, S.E. , 2020. The COVID‐19 pandemic: Implications for the cytology laboratory . Journal of the American Society of Cytopathology , 9 ( 3 ), 202–211. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Priyadarshini, P. And Abhilash, P.C. , 2020. Policy recommendations for enabling transition towards sustainable agriculture in India . Land Use Policy , 96 , 104718. [ Google Scholar ]
• Reyes, O. , Lee, E.C. , Sah, P. , Viboud, C. , Chandra, S. And Bansal, S. , 2018. Spatiotemporal patterns and diffusion of the 1918 influenza pandemic in British India . American Journal of Epidemiology , 187 ( 12 ), 2550–2560. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rosner, D. , 2010. “Spanish Flu, or Whatever it Is….”: The Paradox of Public Health in a Time of Crisis . Public Health Reports , 125 ( 3 ), 37–47. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sahoo, P. , AND Ashwani, 2020. COVID‐19 and Indian economy: Impact on growth, manufacturing, trade and MSME sector . Global Business Review , 21 ( 5 ), 1159–1183. [ Google Scholar ]
• Sarkar, K. , Khajanchi, S. And Nieto, J.J. , 2020. Modeling and forecasting the COVID‐19 pandemic in India . Chaos, Solitons & Fractals , 139 , 110049. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Satpathy, I. , Patnaik, B.C.M. And Tripathy, S.N. , 2018. A Study on Workers in Organized and Unorganized Sectors in Automobile Industry: A Review of Literature . International Journal of Mechanical Engineering and Technology , 9 ( 5 ), 481–487. [ Google Scholar ]
• Scanlon, J. And Mcmahon, T. , 2011. Dealing with mass death in disasters and pandemics . Disaster Prevention and Management: An International Journal , 20 ( 2 ), 172–185. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Schoch‐Spana, M. , 2001. “Hospital's full‐up”: The 1918 influenza pandemic . Public Health Reports , 116 ( 2 ), 32. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Schoenbaum, S.C. , 2001. The impact of pandemic influenza, with special reference to 1918 . International Congress Series, Elsevier , 1219 , 43–51. [ Google Scholar ]
• Singh, A. K. And Misra, A. , 2020. Impact of COVID‐19 and comorbidities on health and economics: Focus on developing countries and India . Diabetes & Metabolic Syndrome: Clinical Research & Reviews , 14 ( 6 ), 1625–1630. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Singh, R. And Adhikari, R. , 2020. Age‐structured impact of social distancing on the COVID‐19 epidemic in India . arXiv e‐prints , arXiv‐2003. [ Google Scholar ]
• Spreeuwenberg, P. , Kroneman, M. And Paget, J. , 2018. Reassessing the global mortality burden of the 1918 influenza pandemic . American Journal of Epidemiology , 187 ( 12 ), 2561–2567. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Stiver, H.G. , 2004. The threat and prospects for control of an influenza pandemic . Expert Review of Vaccines , 3 ( 1 ), 35–42. [ PubMed ] [ Google Scholar ]
• Timilsina, B. , Adhikari, N. , Kafle, S. , Paudel, S. , Poudel, S. And Gautam, D. , 2020. Addressing Impact of COVID‐19 Post Pandemic on Farming and Agricultural Deeds . Asian Journal of Advanced Research and Reports , More information needed, 28–35. [ Google Scholar ]
• Tsoucalas, G. , Kousoulis, A. And Sgantzos, M. , 2016. The 1918 Spanish Flu Pandemic, the Origins of the H1N1‐virus Strain, a Glance in History . European Journal of Clinical and Biomedical Sciences , 2 ( 4 ), 23–28. [ Google Scholar ]
• Verikios, G. , Sullivan, M. , Stojanovski, P. , Giesecke, J.A. And Woo, G. , 2011. The global economic effects of pandemic influenza . Centre of Policy Studies (CoPS) , More information needed, 1–46 [ Google Scholar ]
• Verma, S. And Mishra, A. , 2020. Depression, anxiety, and stress and socio‐demographic correlates among general Indian public during COVID‐19 . International Journal of Social Psychiatry , 66 ( 8 ), 756–762. [ PubMed ] [ Google Scholar ]
• Virmani, A. And Bhasin, K. , 2020. “ Growth Implications of Pandemic: Indian Economy ”. Available from: https://egrowfoundation.org/research/growth‐implications‐of‐pandemic‐indian‐economy/ (last accessed: 12th Jan 2021).
• Weber, T. And Dalton, D. , 2020. Gandhi and the Pandemic . Economic & Political Weekly , 55 ( 25 ), 35. [ Google Scholar ]
• Wijdicks, E.F. , 2020. Historical Lessons from Twentieth‐Century Pandemics Due to Respiratory Viruses . Neurocritical Care , More information needed, 1. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• World Bank Database , 2020. GDP per capita (current US$) – India . Available from: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?locations=IN (last accessed: 21st Jan 2021).
• World Health Organization , 2006. Global pandemic influenza action plan to increase vaccine supply (No. WHO/IVB/06.13) . Geneva: World Health Organization. [ Google Scholar ]