COVID-19: Lessons from the past can point the way forward

“You have to know the past to understand the future”

Carl Sagan, astronomer, science communicator (November 9, 1934 – December 20, 1996)

The following is a guest post by Bertha Serwa Ayi, M.D., FACP, FIDSA, MBA.

A good look into the rear view mirror at the Spanish Influenza pandemic that began in 1918 will offer great understanding of the future.

Predating the discovery of penicillin by a decade, it came at a time when neither antiviral medicines to treat the flu, nor antibiotics to treat the infections that could accompany it, existed. There was no vaccine available. There were no diagnostic tests. It would take another 37 years before invasive ventilation was first used in Massachusetts Hospital in 1955, so there were no ventilators to save lives. Transmission ended when the influenza had killed an estimated 50 million people and affected 500 million of the world’s 1.8 billion people, leaving some degree of herd immunity in its wake. A record 8 million people had died in Spain in May 1918, giving Spain the dubious honor of being credited as the source of a pandemic. Neutral during World War I – which was still ongoing as the spread of disease began -- Spain could divulge its numbers without the information being used against it. Other nations hid information.

Home-made masks were made in abundance, just like now. Some refused to wear masks, just like today. Some leaders refused to listen to the sanity of scientific thought and acted contrary to wise counsel leading to the loss of many lives, just like today. It arrived in Europe, West Africa, and East Africa, via ships as COVID-19 has arrived by planes today.

At the onset of the outbreak people scoffed at it just like today, until they could see bodies being buried in mass graves. There were school closures, church closures and signs were put up to avoid large crowds, just like today. Leaders of cities that included Philadelphia placed economic gain over public health and guidelines to stay indoors, led to the death of many people, as governors are doing now. The cost was clear then, with more than 675,000 Americans estimated to have died in that epidemic. It is clear now, as the death toll from COVID-19 here rises to meet the number of total cases in China.

Nations focused on themselves instead of taking a global approach and so the disease left the shores of America and returned to the shores of America. The second wave of influenza was greater than the first.

As countries and states ignore the science and chose to open in the absence of evidence transmission has ceased, and until we have the tools we need to diagnose, treat, prevent and cure this disease, we must ask ourselves, “Do we want another 600,000 Americans to die as they did back then, before we understand how pandemics evolve, just like back then?”

As America doles out economic stimulus packages in the trillions of dollars it needs to remember that it is a pandemic and not an American epidemic. Should the world be focusing on a global stimulus package instead of local stimulus packages? Can we not see it is a neighborhood fire instead of a one household kitchen fire we are trying to quench?

In 1957 and 1968, the H2N2 and H3N2 influenza pandemics claimed 1 million lives each. The 2009 H1N1 pandemic has been estimated by the U.S. Centers for Disease Control and Prevention to have taken as many as 300,00 lives worldwide. The world should be experts at managing pandemics by now. But we are not.

There is a global influenza laboratory network to monitor for influenza pandemics. But it is not enough. The corporate world, pushing for the world to return to normal because they are in the red, could be looking at how to prepare for the next pandemic by investing in healthcare around the world. Should we not have a rapid communication system in place between the health systems of all countries? Should we not have pandemic preparedness centers in every nation? After this pandemic, another pandemic is not a question of if, but, looking in the rearview mirror, a question of when. Are we ready?