In the climate of international conflict and turmoil, in 1918, a disease began to spread across the globe. It hit the United States on the way to becoming a worldwide pandemic. While most infected survived, the fatality rate is well above that of the ordinary flu. Eventually, one in three humans on earth was infected. At least 17 million people, and maybe as many as 100 million, perished.
It’s natural to want to compare the two outbreaks, and it can be only responsible to do so if the comparison is done with nuance and shading the distinctions.
1918 Spanish flu
Comparisons to the 1918 H1N1 flu pandemic outbreak have been rife since the novel coronavirus outbreak began in December 2019. While Spanish flu is categorized as avian flu, based on studies as recent as 2016, nevertheless fear of a repeat pervades discussions of the current outbreak.
But even granting that we are early in the history of the coronavirus outbreak, there are important differences between our current predicament and the Spanish flu. The underlying diseases are subtly different, and from what we know at this point, the case fatality rate of the coronavirus is lower, by some estimates, than that of the Spanish flu, though rising.
The Spanish flu is one of the worst, if not the worst, pandemic humanity ever went through, and it’s really anomalous in the history of flu pandemics. We have had fifteen flu pandemics in the last 500 years, and the last five since the 1890s have been properly calculated in a scientific way. None, save the Spanish flu, has killed more than 3 million people.
Spanish flu came in waves, three to be exact. The first one supposedly originated in China or America, claims differ, got through to trenches of the French Infantry. It travelled to the French-German faceoff, then to the Spanish side of the conflict and before the estimates arrived, it had equally affected both sides’s war ferocity.
In the second wave, Russian POWs returning from Germany spread the disease to the Soviet Union, and by May and June 1918, British imperial ships spread it around the country’s African holdings, as well as India, China, and Japan, all had outbreaks.
In Australia, a “third wave” of the flu hit in late 1918 eventually.
Common to all above was the fact of the congregation of people, either in trenches, or ships, or PoW camps. Else crowded countries and communities like India, China, and African tribes were easy target.
Uncommon was the fact that by then, the antibiotic for ancillary bacterial infections had not come. Medical facilities were absent and the intent in the third world countries to have a concerted effort for widespread mitigation was absent. However, a third of world’s population was infected.
Spanish flu died with social distancing of then, though done mainly by the elite, end of trench warfare and the onset of warmer months.
Coronavirus Disease 2019
The contrast with the coronavirus, which causes the disease COVID-19, could not be greater. From the very start of the outbreak, scientists suspected a virus. Within two weeks, they had identified it as a coronavirus, sequenced its genome, and discovered that the most likely animal hosts were bats. This information, which was published by a Chinese team, was instantly shared across the scientific community, allowing research labs around the world to begin the long and complicated process of understanding the virus, and finding a vaccine and a cure.
Today we live in a world that is swamped with antibiotics. And although there is concern that bacteria are becoming ever more resistant to them, antibiotics remain an overwhelmingly powerful tool to treat secondary bacterial infections, predominantly pneumonia. Early case reports describe these infections in COVID-19 patients, and it can be safely believed that for many, though sadly not all, antibiotics will provide a cure.
We also have another class of drugs available today: antivirals, which directly target the virus responsible for a disease. There are at least four approved antiviral medications, some given orally and others intravenously, Chloroquine being the established front runner. They are not as effective as we would like, but they have been given to a number of very sick COVID-19 patients, and has consistently shown positive results.
Whether those antiviral medications or the antibiotics that are often given in tandem are responsible for successful outcomes is hard to determine. But we have options that were simply undreamed of a century ago, remains a pertinent fact, and an even glaring difference.
What is Different Now
Firstly, the ferocity with which Spanish Flu impacted the body was devastating. There were instances where mortality was effected within 24 hours of developing the first symptoms. It implies that the virus had the capability to shock the body’s response system, in some cases body had no previous gradient of response which DNA was exposed to. Means naturally, like previous epidemics and pandemics, this one jumped few gradual steps of virus’s adaptation to the host, before availing the virulence in humans.
Secondly, the age group, the Spanish Influenza severely impacted was 10-36 years. People beyond 45 were more or less considered to be less affected/immune. It is a baffling statistics, to this date. It is believed that older people have been developing immunity over all these years, given the fact that all the infections, the body keeps battling in lifetime, enables to keep making anti-bodies and that information is stored in the DNA (routine genome modification information). And this finding was not localized, however, panned the entire spectrum of disease geographically.
This is where COVID-2019 is exactly opposite, very like the devil it is.
COVID-2019 should have been very closer to routine adaptations by viruses happening characteristically around the world, each viral season. Even discounting it to be another host shift, where a pathogen jumps species, the mortality rate is very negligible. But just enough to get the economy to a grinding halt.
Where it smells a rat, is the fact that this very subtle tightrope the virus is taking, in affecting the elderly only(given the subdued immune response given the age), which is odds opposite to what should be expected, if it were a natural evolutionary adaptation of the virus to the antibodies, and the other aspect of it very closely resembling the already available virus banks under study.
It could be easily a lab experiment, while controlling and modulating its severity, nefariously. We shall have to wait, how behavior of COVID-19 evolves in the next six months.
Meanwhile, for immediate concerns, the most effective class of non-pharmaceutical control measures, were those related to previous pandemic of the Spanish Flu of 1918 viz social distancing, canceling public gatherings, closing places of worship, schools, bars and restaurants, isolating the sick and quarantining those they came in contact with.
It worked then, it has been found to be working in few countries like South Korea, China, and Russia. Is the step taken in time in India, it seems like very much that.
Do we expect second wave and more, yes? And the answer, other than medicinal research, is in social distancing, maintaining ongoing hygiene and the aspect of self-quarantine.
24 Mar 20/Tuesday Written By: Fayaz