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Spanish Flu vs COVID-19: medical technology and health system resilience

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Photo by Louis Reed on Unsplash

“… the worst and most distressing occurrence of my professional life”

- Dr Basil Hood, Medical Superintendent, St Marylebone Infirmary, London, commenting on 1918 Spanish flu pandemic

“Strong and resilient health systems are the best defence not only against outbreaks and pandemics, but also against the multiple health threats that people around the world face every day.”

- Dr Tedros Adhanom Ghebreysus, Director-General, World Health Organization, 6 May 2020

“Next Generation EU will help make our health systems more resilient for future crises”

- Ursula von der Leyen, President, European Commission, 27 May 2020

Even in the last few weeks, the language about health system strengthening and reform has changed.

Everyone from the World Health Organization to the European Commission is now stressing the importance of investing in the resilience of our health systems.

This is a good thing and long overdue.

But the future resilience of our health systems does not just rest on beating COVID-19.

It rests on investing in healthcare, including by investing in medical technologies. We cannot forget this.

Medical technologies need to be seen as a key part of making health systems resilient. Whether it is medicines, vaccines, devices or diagnostic tests, these all play a critical role in making a country’s health system and population resilient to health shocks.

Medical technology in fighting the Spanish flu vs Covid-19

When the Spanish flu epidemic hit the world about a century ago, doctors didn’t even know influenza viruses existed.

Even in the years following its initial outbreak as it went around the world for a second and third time, people were not quite sure exactly what was going on.

The Spanish flu outbreak killed between 50 and 100 million people, more than the entire death toll from the First World War which was coming to an end around the time the outbreak started.

A century ago, there were no flu vaccines to prevent influenza, no anti-viral medicines to treat viruses, no antibiotics to treat secondary bacterial infections, no ventilators to help patients with severe respiratory illness to breathe, no diagnostic tests to test for the flu and no genetic sequencing to identify its composition and source.

It throws into stark contrast the role that medical technology plays today in fighting COVID‑19, whether we are talking about vaccines, pharmaceuticals, medical equipment or diagnostic tests.

For example, we did not have genetic testing in 1918. It took 80 years for the genetic sequence of the Spanish influenza virus to be identified, but with COVID-19 it took only four weeks from the first case to the identification of the virus’ genetic sequence.

The first vaccines for influenza were not developed until the 1930s, almost two decades after the Spanish flu pandemic. There just simply were not any vaccines with which to vaccinate people at the time.

Compare that to today where, at the time of writing, within months of the first notification of the disease in December 2019, according to the WHO there are already 13 COVID-19 vaccines undergoing clinical trial and a further 128 candidates in pre-clinical evaluation.

The point being that 100 years later medical technology — be it vaccines, pharmaceuticals, medical devices and diagnostics — plays a critical role in fighting pandemics and diseases like COVID-19.

Imagine what our chances would be of fighting COVID-19 today if we didn’t have any of these ….

Estimates are that if a pandemic of the size of the Spanish flu pandemic hit the world today it would lead to an 5 % fall in the economy and up to 80 million deaths.

One of the reasons we can do a much better job of dealing with COVID-19 than with the Spanish flu outbreak is the availability of medical technology that simply didn’t exist 100 years ago.

Looking beyond pandemic emergencies

But consider for a moment how the more widespread use of medical technology over time has been fundamental in preparing us for our fight with COVID-19.

Medical technology has helped improved the ‘stock’ of health in the community and has likely helped us ward off some of the effects of COVID-19.

Take, for example, cardiovascular medicines, something one might not have initially thought about.

Medicines to lower blood pressure, reduce cholesterol and prevent strokes have been developed over the last century. These days there are over 200 medicines registered to treat cardiovascular disease whereas 100 years ago there none, the first being registered with the US FDA in 1937.

The death rate from cardiovascular disease has fallen in most regions of the world over many years and, while there are a number of reasons for this, the use of cardiovascular medicines to treat things like high blood pressure and high cholesterol has helped prevent cardiovascular events.

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One question that warrants further research is the extent to which this treatment of the population over decades with cardiovascular medicines has helped prevent deaths from COVID-19.

We know from early studies that the highest death rates from COVID-19 are those patients who are older and with comorbidities such as cardiovascular disease, diabetes, high blood pressure and respiratory disease.

During the current COVID-19 outbreak, medical authorities are warning that people with chronic conditions are more at risk.

We have also seen chronic conditions like obesity being a factor in hospitalisation and death rates during the earlier 2009 H1N1 influenza pandemic.

The links between the incidence of non-communicable diseases and susceptibility to infectious disease pandemics is, thankfully, being discussed but needs more attention.

While it is early days — COVID-19 has only been known about as a disease for about six months — it may be that studies will find that those patients that were better managed in terms of their non-communicable diseases had better survival outcomes for COVID-19 than those that were not.

And medical technology will have played a part in this.

Moreover, what would the death toll of COVID-19 have been today if the prevalence of cardiovascular disease had been at the same levels as 50 or 100 years ago?

What role have medicines, devices and diagnostics to treat non-communicable diseases developed in the last 100 years played in averting deaths from COVID-19 today?

The same questions could be asked for other classes of medicines to treat diseases like cancer, diabetes and asthma: what role did medicines for these conditions play in medical outcomes from COVID-19?

Medical technology’s role in future health system preparedness and resilience

In the aftermath of the COVID-19 outbreak, when everyone is starting to look for solutions to improve our health systems and address the economic impact, it is imperative that we do not forget the role that medical technology has played in helping fight COVID-19.

The future preparedness and resilience of our health systems relies on the long-term adoption of medical technology and goes beyond the immediate mad scramble for vaccines and ventilators.

In the inevitable post-COVID-19 debate about future health care and funding in the months to come, we need to factor in the role that medical technologies play in protecting the world’s population from pandemics and their contribution to a lower death rate.

Investing in the scientific and industrial base supporting these technologies is vital.

A case in point is the more than 140 COVID-19 vaccine candidates currently under development.

These have not just appeared out of thin air. Rather, these 140 or more potential vaccines have come out of a research and industry base that has enabled these technologies. Investing in this is important.

In the coming debate about next generation resilient health systems, it will be critical to ensure that our health systems are able to embrace new medical technologies.

Resilience in healthcare does not mean trying to negotiate the best deal to save a buck in the short term — it is this sort of thinking that got us into this mess in the first place. Instead, going forward resilient health systems will need to develop a culture of technology adoption and be prepared to invest in science for the benefit of patients in the long term.

Despite our current problems, we are much better placed today to fight pandemics than we were 100 years ago due to advances in medical science and technology.

We should not forget this in the debates going forward.

The author consults to life science companies, business groups, governments and non-government organisations in the health sector. This blog post was supported through an unrestricted grant from Amgen. The author has retained full editorial control. The views expressed here are those of the author and should not be interpreted as the views of any other organisation.

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