• Raffaele Scarpa, Francesco Caso, Luisa Costa, Saverio Passavanti, Maria Grazia Vitale, Claudia Trojaniello, Antonio Del Puente, and Paolo A Ascierto.
• Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio, Pansini 5, 80131, Naples, Italy. rscarpa@unina.it.
• J Transl Med. 2020 Dec 22; 18 (1): 489.

BackgroundIn 1918 an unknown infectious agent spread around the world infecting over one-third of the general population and killing almost 50 million people. Many countries were at war, the First World War. Since Spain was a neutral country and Spanish press could report about the infection without censorship, this condition is commonly remembered as "Spanish influenza". This review examines several aspects during the 1918 influenza pandemic to bring out evidences which might be useful to imagine the possible magnitude of the present coronavirus disease 2019 (COVID-19).MethodsIn the first part of this review we will examine the origin of the SARS-Coronavirus-2 and 1918 Spanish Influenza Virus and the role played by host and environment in its diffusion. We will also include in our analysis an evaluation of different approaches utilized to restrain the spread of pandemic and to treat infected patients. In the second part, we will try to imagine the magnitude of the present COVID-19 pandemic and the possible measures able to restrain in the present environment its spread.ResultsSeveral factors characterize the outcome in a viral pandemic infection. They include the complete knowledge of the virus, the complete knowledge of the host and of the environment where the host lives and the pandemic develops.ConclusionBy comparing the situation seen in 1918 with the current one, we are now in a more favourable position. The experience of the past teaches us that their success is linked to a rapid, constant and lasting application. Then, rather than coercion, awareness of the need to observe such prevention measures works better.

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