The Book of Revelation is the final text of the New Testament and contains one apocalyptic passage after another, none more famous than the Four Horsemen of the Apocalypse.  Revelation ‒ because of its almost exclusive use of symbols ‒ is one of the most commented upon books of the New Testament and engenders multiple and differing interpretations.  The Eastern Orthodox Church remains skeptical about Revelation and does not read from it during the church year, a position that strikes me as prudent given the nonsense that is regularly bandied about concerning Revelation’s “symbols.”  For example, there are many who identify the “Harlot” or the “Whore of Babylon” riding the “Beast” as the Roman Catholic Church.  Those individuals apparently have no knowledge of geography.  When Revelation was written, the author understood that the City of Babylon had existed in present day Iraq and that St. Peter’s Rome was, even then, in Italy.

The Four Horsemen of the Apocalypse are often identified as Pestilence, War, Famine and Death.  The Four Horsemen are standard features of religious dispute (who is the First Horseman ‒ Christ or the Antichrist?).  They even once appeared in what may be the best lede in American sports writing history (reprinted at end).

Most of us are now “sheltering in place” because both Pestilence and Death have arrived – not only at our doorstep – but at the world’s doorstep.  The world has not seen anything like the present Covid-19 pandemic since the Spanish flu of 1918.  Because of the omnipresence of television and the Internet, the details of COVID-19 are better known than was the case with the Spanish flu.  The naming of the 1918 pandemic did not accurately identify the original source of the virus which may have been an embarkation site for World War I troops at Fort Riley, Kansas, where the first case was reported.  From there, it was likely introduced into Europe by American soldiers joining World War I.

Why the “Spanish flu” instead of the “Kansas flu”?  This probably occurred because Spanish journalists first reported on it as Spain was a neutral nation in World War I and its journalists were not censored.

Even given the grim current death toll and future prognostications with respect to COVID-19, society’s ability to deal with this virus is considerably improved over what was available in 1918.  However, both then and now, there was not a protective vaccine.

Over 675,000 Americans died as a result of the Spanish flu and the worldwide death toll was 20-50 million, greatly in excess of those killed in World War I.  To place this in perspective, the American population in 1918 was 30% of its current number.  Hence, if COVID-19 were to kill the same percentage of Americans as the Spanish flu did, the death count would be more than 2,000,000 people. 

A short while ago, it was estimated that 100,000 to 200,000 Americans would die from Covid-19 but the current projection is 60,000.  This is still a staggering number and the numbers do not tell the pain and suffering caused by a single death to friends and family left behind.

In the midst of it all, what are we to do?  We are saturated with news on COVID-19.  Every daily newspaper story relates to it; the networks and cable stations are consumed by it; the Internet is filled with do’s and don’ts.  Normally, in times like these, we turn to the “experts” to learn how to muddle through.  But what if the experts either don’t know or change their minds?

In the New York Times of April 7, 2020, Ross Douthat published an opinion piece entitled “In the Fog of Coronavirus, There Are No Experts”.  The gist of the column was that the “experts” have not been reliable ‒ ranging from the World Health Organization (WHO), which was politically motivated in providing false and misleading information ‒ to our own Centers for Disease Control (CDC), which seems to have had more misses than hits.  Given this, Douthat wrote that each person was on his or her own, although it was clear that quarantines were the only thing that seemed to work both now and in the past.

Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Diseases since 1984, has been a consistent voice of reason to the American public.  He has tamped down expectations for the immediate delivery of the vaccine and has cautioned that, while the administration of anti-malarial medicine may help, it comes with risks and has not been adequately tested.  Dr. Fauci received the Presidential Medal of Freedom, the nation’s highest civilian honor, from President George W. Bush in 2008 as witness to his exemplary life (see Fauci for a picture of the ceremony and the President’s words.)

What worked in the past?  When the Spanish flu hit, there was no Dr. Fauci.  Antibiotics did not exist.  It would not be until the 1930s that a microscope could “see” a virus.  There were no pharmaceutical interventions.  So tried and true methods going back centuries had to be employed:  masks, banning large gatherings, closing places of public accommodation, quarantines.  Unlike COVID-19, there was no gestation period.  A healthy young person would experience a first symptom like a cough and be dead within 24 hours.  In October 1918 alone, 185,000 Americans died and a disproportionate number were young healthy people.

The national response was misleading and was informed by the support for the war effort which discouraged “bad news.”  While there was not censorship, the press pretty much fell into line as did the public health leaders who indicated that it was just a common form of influenza.  Surgeon General Rupert Blue said “there is no cause for alarm if proper precautions are observed.” 

The proactive responses were local and haphazard.  St. Louis experienced a death rate many times less than Philadelphia.  The difference:  St. Louis immediately outlawed gatherings of more than 20 and closed public venues within two days of its first death.  Philadelphia did this as well but not until much later in the game and not until a patriotic parade attended by 200,000 people had occurred.  St. Louis suffered 1/8 of the deaths which occurred in Philadelphia.  San Francisco required the use of masks and its death rates were substantially less that other cities. Seattle required masks as well (1918 pandemic).

So, in sum, non-pharmaceutical responses slowed the spread of the virus.  World War I ended on November 11, 1918 and, as everyone returned home, the Spanish flu lost its carriers.  Then, sometime in 1919, it was gone as those infected had either died or developed immunity.

The lessons from 1918 seem to be the same that we are hearing daily.  Wash your hands, wear a mask, avoid gatherings in public venues, self-quarantine and the like.  A hundred years later, we are well ahead of the game because of the advances in medical treatment.

But as serious as it is, it is sobering to contemplate that COVID-19 is not remotely close to what the world faced with the Spanish flu.

“The Four Horsemen” by Grantland Rice

Outlined against a blue-gray October sky, the Four Horsemen rode again.  In dramatic lore they are known as Famine, Pestilence, Destruction and Death.  These are only aliases.  Their real names are Stuhldreher, Miller, Crowley and Layden.  They formed the crest of the South Bend cyclone before which another fighting Army football team was swept over the precipice at the Polo Grounds yesterday afternoon as 55,000 spectators peered down on the bewildering panorama spread on the green plain below.

New York Herald Tribune, 18 October 1924