Unpacking Pandemics: Are We Learning From Our Mistakes?

The Spanish Flu

The date is Friday, April 5, 1918. The Official Bulletin published an article entitled “Campaign to prevent spread of disease through the mouth and nasal secretion is launched.” Within this column, the Surgeon General of the U.S Army makes several comments to curtail what was known then as the Spanish Flu.

He says, “The sickness rate in camps throughout the country could be cut to the minimum if the soldiers and the general public as well stopped “promiscuous coughing“, sneezing and spitting.”

What Dr Gorgas couldn’t possibly know was that this ‘sickness’ would go on to be one of the most devastating pandemics in human history, infecting a third of the population of the globe and sending approximately 17 million people to their graves.

The language may be archaic, but the message is clear, as well as frighteningly familiar at this stage in our history.

As a species, the human race are no strangers to pandemics having endured the ravages of HIV, Swine Flu, The Black Death and the Spanish Flu among others.

But are we learning from them?

Learning from the Ghosts of the Past

While the Spanish Flu was an issue over 100 years ago, many of the contributing causes of the spread of the illness match our current situation with COVID-19.

Let’s investigate these together.

The Challenges of the Spanish Flu

21st Century medical knowledge is light year’s ahead of where it was in 1918 when the poor beleaguered physicians battled with a global war and an unfathomable illness with broad symptoms of chills, fatigue and fever. They knew nothing of viruses.

However, they still had the presence of mind to put certain measures in place to slow the spread of this efficient killer.

Of the Spanish Flu, doctors of the time said, “The contributing causes of influenza include such factors as overcrowding, universality of travel, promiscuous coughing and sneezing of individuals suffering from the disease, etc. The exciting cause of influenza, i.e., the particular germ responsible for setting up the infection, is not known.”

Doctors understood that the transmission of this virus was through respiratory droplets which made the case for what was called “crowding control” while they worked frantically on a cure or a vaccination.

While the concept was sound, the prevailing circumstances were tricky.

• Social inequalities meant that a large percentage of the population lived in close quarters to each other making the spread of the virus an easy hop from one person to the next.
• Personal hygiene wasn’t as valued as it is now, and possibly not as practicable depending on your social level.
• The global war machine was sending military personnel from one area to another which allowed the indiscriminate spread of the virus.
• The war took a devastating toll on the world’s economy forcing millions into a malnourished state making them even more susceptible to illness.

Social or physical distancing was an obvious recommendation to stop the spread of the Spanish Flu, but not everyone realised the efficacy of this simple process.

“In Philadelphia, PA, officials downplayed the significance of the first cases in the city. Mass gatherings continued and schools remained open. The city only implemented physical distancing and other measures around 14 days after the first cases appeared. This had significant consequences.

“In contrast, within 2 days of its first reported cases, St. Louis, MI, moved quickly to implement physical distancing measures. As one author writes, “The costs of [Philadelphia’s] delay appear to have been significant; by the time Philadelphia responded, it faced an epidemic considerably larger than the epidemic St. Louis faced.”

Meanwhile, officials in New York in 1918 took measures to prevent crowding on public transport by staggering working hours which allowed more personal space. Even theatres withheld 50% of their tickets to allow for adequate room in the auditorium.

The situation in the UK wasn’t vastly different.

A comparative article on the Spanish Flu versus COVID-19 from the BBC notes:

• In 1919, a public recommendation for people to stay home if they were ill was buried by the government, one that was more concerned with the war effort than the flu.
• News of the spread and virulence of the illness was muted by many governments wanting to keep morale up, which meant that the full impact of this pandemic was not made public or fully understood.
• There was no centrally imposed lockdown on the general public.
• Fake news and conspiracies abounded.
• Face masks were recommended, but not mandatory.

Essentially, not enough was done to prevent the spread of the flu by limiting personal contact — the simplest and most obvious start.

Without finding a cure or creating a successful vaccination, the Spanish Flu disappeared in December 1920 almost as quickly as it had come, leaving a shocking trail of bodies in its wake.

How do these responses compare to the current COVID-19 outbreak? Are we doing any better with the power of hindsight?

Unravelling COVID-19 responses

The furious spread of COVID-19 blind-sided even the most advanced first-world societies.

With our greater medical understanding and more sophisticated health systems, we should be able to combat — or at least curb — this virus.

Sadly, the fundamental problems which plagued our early 20th Century counterparts are still thriving and causing as much, if not more, harm in the process.

The fact that history is riddled with examples of bureaucracy and political wrangling which have stood in the way of necessary and decisive actions should be a red flag for everyone.

Consider the information from the New York Times on the handling of the coronavirus outbreak in China. It states bluntly, “Aggressive action just a week earlier in mid-January could have cut the number of infections by two-thirds, according to a recent study whose authors include an expert from Wuhan’s Municipal Centre for Disease Control and Prevention. Another study found that if China had moved to control the outbreak three weeks earlier, it might have prevented 95 percent of the country’s cases.”

It further states of the suppression of data, “Others tried to fill the void of information when the early warning system failed. The medical community found other, informal ways to alert others, disclosing government directives and hospital reports on the internet. During a rare burst of relative transparency early in the epidemic, Chinese journalists did much to expose the problems, but censors closed that window.”

Too little information, and too late for many people.

With history telling us in no uncertain terms to distance ourselves from each other, many countries have gone into lockdown with strong measures in place while they figure out what to do next.

However, even with this information, the UK government has been criticised for a ‘muddled response’ to the pandemic, with Time commenting “Despite Johnson announcing that Britain’s new focus was to “delay” the spread of the disease on March 12, it took four more days before he formally advised the public to begin socially distancing on March 16.”

How has the U.S dealt with the pandemic? The Guardian tells us, “Donald Trump’s response to the coronavirus pandemic, which he once dismissed as a hoax, has been fiercely criticised at home as woefully inadequate to the point of irresponsibility.”

Also, they comment, “Trump’s surreal televised Covid-19 briefings are further undermining respect for US leadership. Trump regularly propagates false or misleading information, bets on hunches, argues with reporters and contradicts scientific and medical experts.”

The Bottom Line

The sad facts show that we share much in common with our 1918 predecessors in their challenges with the Spanish Flu.

• We don’t fully understand why the virus behaves as it does.
• We don’t have a cure or a vaccine.
• Many of us live in close proximity to each other in built-up areas, and others live in desperate poverty with multiple families under one roof.
• Many governmental authorities are less concerned about human lives than they are about public perception and the economic impact of the virus.
• Available information is contradictory and subjective.
• Not everyone is adhering to the directives of their government to stop the spread of the virus.

So, what can we do?

Let’s each of us, as an individual, be cognizant of the grim lessons of the past.

According to The Lancet, the severe acute respiratory syndrome (SARS) outbreak of 2003 was contained “by means of syndromic surveillance, prompt isolation of patients, strict enforcement of quarantine of all contacts, and in some areas top-down enforcement of community quarantine. By interrupting all human-to-human transmission, SARS was effectively eradicated.”

Let’s do our part in interrupting the spread of the virus. Let’s use the technology available to us to monitor our own health and that of our loved ones. Let’s do our homework on the symptoms of COVID-19 from reputable sources and think twice before disseminating controversial information.

We may have very little control over government policy or even the actions of our neighbours, but we can be aware and responsible in our own right.

• Promiscuous coughing can be defined as indiscriminate, unrestricted or casual coughing.
• This piece was originally published at blog.hyfeapp.com