What Came Next?: Reflections on the Aftermath(s) of the 1918–19 Flu Pandemic in the Age of COVID

The causes for pessimism are many: despite modern medical knowledge and a robust public health infrastructure, in fall 2021 the United States tragically surpassed the 675,000 estimated total flu deaths in the 1918–19 pandemic (models suggest the United States will reach one million cumulative COVID-19 deaths early in 2022);too few are being or have been vaccinated, particularly among marginalized groups and the young, in a process that has taken longer than anticipated;in non-industrial, non-Western, non-urban, and less affluent areas, vaccine access had been woeful. In the United States, more than virtually anywhere else in the world, public health responses to the COVID-19 virus were politicized in new ways, weaponized to reject public health measures from closures policies and social distancing to mask and vaccine mandates. The wartime context in 1918 had generated a sort of patriotic language and push for homogeneity that, however problematic, also pressured citizens to conform to public health measures—casting those who rejected wearing masks as “mask slackers,” just as those who dodged the draft for World War I had been labeled and castigated as “draft slackers.” Over the following years, public health measures came and went, often pushed by special interests, but starting roughly after the winter season of 1920, when a fourth wave was more deadly than either the first or third waves, influenza became something to be managed and weathered without resorting to emergency public health measures.