Catherine M. O’Meara’s Optimism in Crisis, and Comparison between the 1918 and 2019 Pandemics

“Pandemics can have substantial economic costs, and non-pharmaceutical interventions can lead to both better economic outcomes, and lower mortality rates”, wrote Sergio, Correia, Stephen Luck, and Emil Verner of the MIT Sloan School of Management, in a blog about their findings on pandemics.

Over a century ago (100 years), there was a deadly pandemic, worse than COVID-19 due to its wildfire spread, and fatalities. It was called “Spanish Flu”. Many argued about the estimated number of the fatalities, while others raised questions about its origin. There were reports from historians, and researchers to clarify certain claims. Today, many are likening the Spanish Flu to today’s COVID-19, when there have been many pandemics such as the Asian flu of 1957, Hong Kong flu of 1968, Aids of 1981 till date, HPAI Asian H5N1 Bird flu of 1997, H1N1 Swine flu of 2009, West African Ebola of 2014, Zika virus of 2015 till date etc. 

Differences between the Two Pandemics

Origin 

The 2019 coronavirus originated in Wuhan, China. There was no argument over its origin, but there was an inaccurate geographical stigmatizing from the press. Many referred to it as “Chinese virus” or “china’s coronavirus” etc. On February 11, 2020, the WHO Director-General, under agreed guidelines between WHO and UN, announced a name for the new strain of the coronavirus to be COVID-19.

Spanish flu, on the other hand, got its name from assumptions. Spain was a neutral country during the war. When the flu moved from France to Spain in 1918, the government did not enforce strict censorship on the press. There was free publication of the flu which led to the general assumption that it was relative to Spain, hence the name “Spanish flu”.

Alfred W. Crosby, a historian, stated in 2003, that the flu originated in Camp Fonston, Fort Riley, Kansas in the United States. Andrew Price-Smith suggested the influenza began in Austria in early 1917. Claude Hannoun, the leading expert on the 1918 flu for the Pasteur Institute, insisted the virus was likely from China. Mark Humphries, a historian found evidence that a respiratory illness that struck northern China in November of 1917, was identified a year later by Chinese health officials as identical to the Spanish flu. A report published in 2016 by the Chinese medical association, asserted no such evidence was found, and that the low mortality rate among the Chinese, and South-East Asian workers in Europe at that time, proved it. This was also supported by Professor Michael Worobey’s reports, that the Chinese workers entered Europe through other routes that didn’t result in the significant spread of the flu.

Demographics

Reports show that the most affected groups for COVID-19 are adults over 65 years of age, especially those with underlying health conditions. Though it is not conclusive, as children are also affected, they seem to have much milder symptoms.

The reverse is the case of the Spanish flu. Young adults under the age of 40 were the ones most affected. 

Treatment

According to CDC and WHO, there is no known vaccine or endorsed antiviral treatment yet for the treatment of COVID-19. The primary treatment used by health care professionals is symptomatic treatment, supportive care, or supportive therapy. 

On the other hand, the primary curative treatment for the Spanish flu was aspirin. Aspirin was trademarked by Bayer Pharmaceutical in 1899, a patent that expired in 1917, giving many companies opportunities to manufacture aspirin during the pandemic. Many medical professionals at the time, prescribed up to 30g of aspirin for patients daily. As medicine evolved, it was discovered that aspirin doses above 4g are unsafe. Thus, the 30g of aspirin prescribed to patients were toxic, and caused aspirin overdose, and poisoning during the flu pandemic. Many scientific historians believed this attributed to the increased number of fatalities during the Spanish flu. 

Fatality

COVID-19 pandemic started on December 1, 2019, and is still on-going. Mortality of more than 70,600 and about 1.26 million infected people have been recorded globally. The current world’s population is almost 8 billion. This shows that the percentage of both mortality, and infected people, is less than 0.02% of the world’s population for now.

The Spanish flu lasted from January 1918 to December 1920. Mortality was estimated to have been 17-100 million, making it one of the deadliest pandemics in human history. Infected people were about 500 million from the South Seas to the North Pole, which was about a quarter of the world’s population (1.8 billion) at that time. This shows that the mortality rate was about 1-3%, and that of the infected persons was about 25% of the world’s population.

The lower fatality rate for COVID-19 may be attributed to a better awareness of how viruses and pandemics work. Advanced health care, number of healthcare professionals and volunteers available now, availability of antibiotics, and antiviral drugs used in treating the symptoms, general personal hygiene, and environmental sanitation. 

This was not the case in 1918 where many hospitals were not only dealing with the flu patients but also casualties of war. Medical professionals on ground were few. Some were at war acting as the troops’ physicians, while others were ill and quarantined. This left the young medical students, student nurses, and volunteers to cater to flu patients.

Control

To curb the spread of COVID-19, travel restrictions (international and local) was implemented by the governments, remote working was initiated by many organizations, churches and schools were closed, ceremonies like burials, weddings, awards, were cancelled and postponed, salons, cinemas, dancehalls were closed. A complete lockdown was enforced by the governments of many countries.

During the time of the Spanish flu, soldiers and migrant workers kept moving from one country to the other until the flu spread to many countries. There was nothing like remote working. Churches were allowed to open, people were advised to walk to work instead of using cramped public transports, and closing of schools was not universally accepted. According to the Journals of the American Medical Association, most of the controls mentioned for COVID-19 were later put in place. But it was after much damage had been done, making no much difference even though they still helped in controlling the spread of the flu. Citizens in San Francisco were fined $5 if they were caught in public without their masks, regulations against spitting in public were passed, libraries stopped lending books, people were advised to stop shaking, and kissing hands. Everyone was asked to stay indoors.

Preventive Measures

For COVID-19, CDC and WHO recommended for both medical professionals and individuals, hand washing with soap and water for at least 20 seconds, covering of the mouth when coughing or sneezing, social distancing (at least 6 feet), use of face masks, use of alcohol-based hand sanitizers, cleaning of surfaces with disinfectants and bleach, good oral and personal hygiene, and self-isolation. In the hospitals, patients are quarantined, medical professionals wear scrubs and hand gloves, which they discard while leaving the ward.

According to the Journal of the American Medical Association, during the Spanish flu, people were advised to stop the use of common drinking cups and other utensils, have enough rest, eat a balanced diet, wear warm clothing, avoid the cold, practice good oral and personal hygiene, gargle with warm water mixed with chlorinated soda, spray the nasopharynx with a weak solution of Carbolic acid and combine with quinine, blow a mixture of boric acid and sodium bicarbonate into the nose and air passages, be in well-ventilated places or in the open under the sunlight, gauze face masks were used to cover the mouth, nose and chin. 

In the military camps, they were advised to sleep head to foot to reduce the sharing of air space, reduced number of soldiers go to the mess at once. In the hospitals, cotton sheets were hung in between beds to mimic isolation, disinfectants like Izal were used in mopping the floor, antiseptic hand solutions were used by the medical staffs on duty, and they wore clothes which they discarded while leaving the ward.

Pharmaceuticals and Clinical Trials

Today, researchers and public health experts are carrying out mega clinical trials to introduce a curative treatment for COVID-19. This hopefully will contain mortality rate, and save mankind from another deadly pandemic like the Spanish flu. According to BioPharma update on coronavirus, published by Biospace on April 1, 2020;

Researchers in Australia are looking at tuberculosis (TB) vaccine called the Bacillus Calmette-Guerin (BCG). Chinese researchers are looking at Interferon alfa-2b which has been used for dengue fever, hepatitis, and HIV. Regeneron and Sanofi are looking at Kevzara, a rheumatoid arthritis drug, as a second global clinical trial. British Tobacco is looking at proteins extracted from tobacco leaves. The vaccines in preclinical studies use a cloned portion of SARS-CoV-2’s genetic sequence to create an antigen that is then inserted into the tobacco plants for reproduction. Ostrich Pharma USA is looking at antibodies purified from ostrich eggs (they injected genetically engineered pseudovirus into ostriches), as they demonstrated strong ability to neutralize SARS-CoV-2 viruses. 

Novalead Pharmaceutical is looking at 42 already existing drugs that may help in treating COVID-19. Neurimmune AT and Ethris GmbH partnered to develop mRNA-enclosed neutralizing anti -SARS-CoV-2 antibodies, administered by inhalation for the treatment of COVID-19. Roche is looking at Actemra (tocilizumab), a drug used for rheumatoid arthritis. Fosun Pharma exports its diagnostics kits to Europe, and the rest of the globe, while working towards its vaccine research. CRISPR Therapeutics is looking at CTX001, a drug used for severe hemoglobinopathies like transfusion-dependent beta-thalassemia, and severe sickle cell diseases. A Chinese team at Tsinghua University in Beijing partnered with Brii Biosciences to advance a clinical trial, after identifying COVID-19 antibodies. 

CytoDyn is running a phase 2 trial on mild and moderate COVID-19. DeCODE is testing people with symptoms, and those without symptoms as data suggests the virus spreaders may be asymptomatic. Microsoft and Immunity Bio are looking at the 3D model of SARS-CoV-2 virus to help battle COVID-19. Cambridge Mass-based nference is looking at a software resource that synthesizes disparate single-cell RNA-sequencing data sets. UBS still has “inconclusive” results from their clinical trials using hydroxychloroquine.

During the Spanish flu, the American Public Health Association Committee members believed that the best way to prevent infections were through the use of vaccines. However, they acknowledged that what caused the flu was unknown to them. This left them with the option of leaving out vaccines and delving into curative treatment and antiviral drugs.

Communication and Technology

CDC, WHO, UN, UNICEF, and the Department of Public Health, is doing a great job so far in keeping everyone informed on the cause, symptoms, transmission, preventive measures, control, management, and on-going vaccine and antiviral drug trials for COVID-19. This was made possible through the advanced technologies of this time. Social media e.g. Twitter, LinkedIn, Telegram, WhatsApp, and Facebook), Newsletters from the Organization’s Websites, Newspapers (online and print), Radio and Television Broadcasts, Webinars, and You-Tube videos.

Many countries all over the world, for instance, China and Dubai, used drones to spray disinfectants in their cities especially the affected ones, while their citizens were on lockdown. They monitored movements around neighbourhoods with CCTV cameras, while security personnel patrolled the streets. Tested and certified free from COVID-19 individuals were assigned to share disinfectants and toiletries, and deliver groceries to citizens (most were paid for by the citizens while other small items like disinfectants and masks were free).

This was not the case during the Spanish flu. Cover up by the government (allied countries and the central powers had wartime censors who covered up news of the flu to keep the morale of the soldiers and the citizens high), lack of knowledge and proper dissemination of information on preventive measures and control, aided the spread of the flu. The German road system was still testing wireless telephony on military trains, and handheld radio receivers were not available until the 1940s. The development of broadcast radio and BBC came after the war ended. Most countries used telegraph cables and telephones, and also radiotelephony (voice-over radio), small daily and weekly newspapers (print), and postal systems were primary sources of information.

Similarities between the Two Pandemics

  • Both are caused by viruses
  • Both are considered novel
  • Both are transmitted from person-to-person in almost the same ways
  • Both have almost the same symptoms
  • The same controls and preventive measures can be employed for both
  • Both are pandemics
  • Adverse effects are usually the same for most pandemics

Despite these similarities, COVID-19 and the Spanish flu are quite different in so many ways. You only have to look beyond the obvious. 

Adverse Effects of both pandemics

For COVID-19, there was a global socioeconomic meltdown, for instance, restaurants and hotels (except those housing healthcare workers) closed up, non-essential travels stopped, reducing revenue for airlines, cruise-ship operators, and tourism reliant businesses, manufacturers outside the medical and food production fields receive little to no orders as people are inclined to sustaining their health and stomach during the lockdown, banks absorb more loan defaults, prices of oil company products plummeted. There is a halt in entertainment, discontent among the religious, some religions started burying their dead in ways contrary to the old ways, gross fear is seen all over the world, inflation in the prices of goods and services, scarcity of medical supplies, infodemic of fake news are all over the internet, cybercrimes, and staff layoffs.

According to an analysis by the Federal Reserve Bank of St Louis, the 1918 pandemic saw many service-based businesses suffer double-digit losses, until the end of the pandemic. Domestic services like mail delivery, milk delivery, and garbage collection were hindered. Entertainment became a thing of the past. Schools, homes, and empty buildings were converted to makeshift hospitals. There were many widows, widowers, orphans, and childless couples, which led to piling up of bodies in funeral homes. 

Optimism in Crisis

Catherine M. O’Meara, a retired teacher and chaplain from Madison, Wisconsin, United States, published a poem on her blog (The Daily Round) on March 16, 2020. Her words were like a balm to the soul, and also a reminder that it will all get better with time.

And people stayed home

And read books

And listened

And they rested

And did exercises

And made art and played

And learned new ways of being

And stopped and listened

More deeply

Someone meditated, someone prayed

Someone met their shadow

And people began to think differently

And people healed

And in the absence of people who

Lived in ignorant ways

Dangerous, meaningless and heartless

The earth also began to heal

And when the danger ended and

People found themselves

They grieved for the dead

And made new choices

And dreamed of new visions

And created new ways of living

And completely healed the earth

Just as they were healed

Message of Hope

Ross Douthat wrote in The New York Times on March 28, 2020, “Rational hope is not the same as reckless optimism. It doesn’t require, for instance, quickly lifting quarantines based on outlying projections of low fatality rates, as some return-to-normalcy conservatives have been doing in the last week. Rational hope accepts that the situation is generally dark, but then it still looks around for signposts leading up and out. It recognizes that things are likely to get worse, but keeps it alert to the contexts in which they seem to be getting better or at the very least, getting worse more slowly”.

We all can agree on one thing, and that is, COVID-19 is new and unique. It presents a challenge to the world which we must win. The marathon continues but still, it will surely end, just like all pandemics do end. Director-General of WHO, Dr Margaret Chan announced on August 10, 2010, that H1N1 influenza virus has moved into the post-pandemic period, soon it will be so with COVID-19. Governments in many countries are doing their utmost in containing the virus. Scientists all over the globe are carrying out several vaccines and antiviral drug trials to enable us to have an effective preventive measure and curative treatment for COVID-19. Let us continue to practice safety while we keep our fingers crossed. Let us not give up just yet.

Subscribe to our newsletter for latest news and updates. You can disable anytime.