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Spanish Flu versus Covid19 pandemic

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Dutch Josh View Drop Down
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    Posted: January 21 2021 at 11:30pm

DJ, 

When one compares two major pandemics there are lots of things to say. When the first pandemic was over a 100 years ago and the second pandemic is ungoing there are lots of unknown factors. 

Still the Spanish Flu did kill between 20 and 100 million people in a timespan some historians start in 1917-may have ended in 1923 (and the H1N1 becoming a "more normal" flu). On a global population of around two billion between 1 and 5% of that population died in that pandemic. 

To look a bit further in 2000 years of history-the Spanish Flu was "mild" a lot of other pandemics did kill much more people. It is very likely that allthough the area was restricted-therefor it was maybe not a "worldwide" pandemic both in later Roman times and 14th century Plague between 33 and 50% of the population died. 

Conquest of the America's may have killed up to 90% of the native nations in these continents. They died from European imported illnesses. Those diseases also were a major cause of death and suffering in most of Europe at the time. Mixing with wars did not improve the situation. 

So-Yes the Spanish Flu may have been the worst pandemic in recent history-on a longer time line it was a "mild pandemic". The last 2000 years may have had much more of these "mild pandemics" noticed only in chronicles as "a bad year". There was till 1750/1800 no "global view"on events-so the idea of increased mortality often was seen as a local event. People did not link these local events to realize it may have been "many local events forming a pandemic". 

Is this historical review important ? YES ! We may think of the Spanish Flu as a "worst case" while history may be "full"of much worse pandemics !!!!

We may think we are "safe", better of with improved knowledge on treatments, medication, care...better surveilance also. But it can become arrogant self delusion ! 

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We discovered the basis for the Spanish Flu being the A-H1N1 variant in the 60's. The "Flu" before that-the 1890 Russian Flu may not have been a flu at all ! It may have been another Covid-Corona Viral Disease ! We do not realy know ! And basicly-most of science did not realy care...Pandemics as a major factor in history at best were something for a few historians...A Roman expedition maybe importing ebola into the Roman Empire from deep in Africa were "good stories" not a warning sign !

It would have been wise to have better pandemic surveilance for all kinds of virusses, diseases...because if we did learn something of history we should have known pandemics were a real risk !

It is often claimed massive troop movements did start and spread the Spanish Flu in 1917 or 1918. The general idea is that US soldiers did bring the virus from the US to France. Allthough there are also stories on a very similar flu showing up in Austria around that time-so it may have been a flu-virus was developing in the same direction at more locations. 

I believe the idea a virus developing in more or less the same direction in more locations now has been widely accepted. It may also explain why Covid-19 virus parts showed up in Europe before the major january 2020 Wuhan outbreak. The virus was "on its way" in more places..

The latter part of World War 1 did see a lot of mobilty in Europe-eventhough the frontline itself got stuck in the mud. But also in the Middle East where the Ottoman Empire was collapsing and Arab nations did fight for their own destiny (and were helped by the British with an eye on Arab oil and strategic position between the UK and British India). In the US military parades for war-bonds- did spread the virus. All in all a major war means a major challenge for production and logistics..

But the mobility in 2020 puts the mobility in 1917/1918 far far behind. Maybe we "spent less time together"today in airplanes then in those days in ships but we fly all over the planet-at least the 10% "better off" of the global population does. Virusses fly for free. The idea of "Freedom" did lose its connection with the sense of responsibility...

In my idea responsibility is the other side of the freedom-coin. I do not realy know why such a large group of people do not see the relation between "freedom and responsibility", is it commercialized culture to sell products even when production is "eating up the planet"at the cost of next generations, other species ? 

In 2019, 2020 the idea of "freedom"was linked to an idea of unlimited mobility if you had the money to "jump around the planet". But also over shorter distances mobility did increase since 1918. 

A lot of people living most in urban area's going often daily tens of kilometres to and from job, school, entertainment...

Of course a global population of 7,5 billion-over 4 billion in Asia-most in mega cities/urban area's with a population of over 1 million is a different picture from the 2 billion people in 1918-much more rural, self supporting, live-where-you-work situation..

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At this moment the Covid19 pandemic in official numbers claimed over 2 million deaths...excess deaths may add another 2 million worldwide-but with a high degree of uncertainty. Due to a lack of testing and reporting in many places the real impact of Covid19-for now is unclear. And to be realistic-with variants just starting to spread-we may be moving towards what was called "the second wave in the Spanish Flu". An increase of non-Covid deaths is in the excess deaths numbers; people who died from other illnesses that would have survived if this pandemic did not take all the care away from non-Covid patients. 

It is quite likely the Spanish Flu had 20 million deaths with "diagnosed Spanish Flu"-the excess number-worldwide-may have been closer to the 100 million. Most people were not "citizens" but "subjects" -did not have the nationality of their colonizer-just had to work for the "motherland". Apartheid was the rule allthough formal slavery did end in the latter 19th century...

Inequality had a different face back then. There were more rich people but not a 0,1% claiming to "own half the planet". 

Healthcare was very basic. Access to that healthcare limited. Hospitals only had very limited means for diagnostics and treatment. Logistics were poor-some ambulances were cargo-bikes, most horses were "in the war" (and dying by the millions..). Even the rich had limited benefits from healthcare-simply because doctors could not do much-most of the deaths were in a few months with hospitals unable to deal with the number of cases..

Some people may have had some immunity from earlier flu-infections-flu was not new. Every year people did catch a flu virus, dead was part of life. Till 1900 life expectency for most "better of countries"was around 40. Lots of young children died from all kinds of illnesses. Due to the war there were food problems in many countries. Food production was needed for the military-the men in the war could not work on the land..

In 2020 obesity is a bigger problem-still-then starvation. The problem with this corona-virus is the at best-limited-immunity. Corona virusses do cause colds in humans-some of these corona-cold infections may provide a very limited protection against the SARS-2 Covid19 corona virus. Maybe it is telling we do not (even) know that part of the story..

Another issue is communications and restrictions. Today a lot of governments themselves give the impression they do not see this pandemic as a serious matter. Mass media do reach almost all the people, "social"media developed into a digital sewage system...with "freedom of expression" not in balance with any kind of sense of responsibility...

The global population of 2020 is the best educated population we have had in history...still education is a tool easy to misuse...

"Experts" often without basic education manage to catch massive following-while real experts hardly make the news. An anti intelectualism is making good communications as good as impossible...Like in climate collapse-both the message and the messager are unwelcome...There is a widespread sense of insane expectation "if we ignore the facts the facts will go away"-even to the highest (White House) level...

In 1918 war-like conditions around the globe did not leave much room for "jokes or jokers". Government communications during the pandemic improved. At first in war-torn countries news on the Spanish Flu was suppressed by censorship. Therefore the flu became Spanish not American-Flu...Later on communications-at local levels-did make a difference. Mask wearing was not a (political) point of discussion-you did what was needed...A much less educated population made wiser decissions based on live experience...illness was something to fear...people you knew died...it was "next door"...

Since most people did not travel much, were part of smaller community news of people dying did translate to faces of known people-not "just statistics on the unknown" . There was hardly any need for travel restrictions-most people did not travel much anyway... Also  a need for social distancing was different from 2020. 

Of the two billion people in 1918's world most lived in smaller villages. Some more remote area's only did get infections in 1920 or later on...some more remote places even did not see a case of that flu...

When you compare that part of the story with 2020 the SARS-2 virus did manage to reach almost all parts of the globe within months...Most of the cases and deaths so far are in urban area's and in age groups that were very exceptional during 1918. 

Back then you were "old"at 55, 60...now that is considered as "middle aged"...

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Is there a point in making comparisons with the Spanish Flu and Covid 19 ? 

YES ! Both the Spanish Flu and Covid 19 are spread over several years. In many ways these "modern times" pandemics still share other factors. They both managed to get "all over the globe"-earlier pandemics were more regional or did see peaks in different years. The Spanish Flu had a global peak in 1918. SARS-2/Covid 19 most likely will peak in 2021.

Both the Spanish Flu and SARS-2 will see a lot of deaths due to hospitals/healthcare being overrun...

Since the present SARS-2/Covid19 pandemic is still ongoing we have to learn from the Spanish Flu-and the differences between 1918 and 2020/2021...NPI/social distancing, masks worked back then and will be effective now. 

The flu in 1918 did develop to a much milder flu-that is also expected from the Covid19-virus...but not yet there..

Vaccination in 1918 was very limited-the flu virus not understood. Today-even with much better knowledge there are still lots of questions and discussions. What is the role of small parts/is the virus "airborne"? Do young children spread (much) of the virus ? Even the kind of infections is not fully understood-often lungs get infected but since ACE-2 receptors are all over the body inflamation can also be "all over the body". Multi Inflamatory Syndrome, chronic Covid are not fully understood aspects...

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A new pandemic was expected in many area's. Virologists did warn for (H5) flu types, historians did mention pandemics as part of history, terrorism experts warned for bio-warfare... This pandemic should not have been a surprise. 

The 1918 flu also was expected back then. If there was no World War 1 it would very likely not have become a pandemic . Both the Spanish Flu and SARS-2 are "man-made". In 1918 for military reasons news was censored, ill soldiers transported spreading the virus. 

In 2020 a lot of "leaders" simply were not able to realize a new pandemic did start. It did not fit in their scenario's and plans...adjusting to that new reality took to much time. Even experts failed to recognize the dangers and risks in time. "If there are no direct flights from Wuhan the virus will not reach us" ...more based on hope then science...

Wishfull thinking, hoping summer will change events-still is a main risk. With variants spreading and the UK showing even strict rules may not be as effective in a short time still many countries fail to take the right-very strict-steps.. Even China is facing an increase of cases. With new rules on massive testing (cities with population<5 million able to test ALL in TWO days !!! Larger cities like Bejing, Shanghai in FIVE days-all of the population !!) China may be an example of how to deal with this pandemic. 

We may not like a "police state" but we may not have that much alternatives left... 




We cannot solve our problems with the same thinking we used when we created them.
~Albert Einstein
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: January 23 2021 at 2:36am

DJ

Both the Spanish Flu and the present pandemic are "man made". Stricter measures in the early phase could have prevented the virus from becoming that far spread. World War One military priorities were in the way of preventing virus spread in 1917/1918. It was important to get US soldiers to Europe. 

In 2020 "saving the economy" prevented taking steps in time to stop the spread. Both may have underestimating the risks in common. The wrong people were able to make the wrong decissions...It is very likely there was enough information available on how the flu developed in 1918 to see things going wrong. Based on experiences from earlier pandemics/flu seasons other decissions may have slowed down or prevented the pandemic. Sharing information, better communications were less possible due to the war. 

Some sources;

[url]https://onlinelibrary.wiley.com/doi/10.1111/nuf.12534[/url] or https://onlinelibrary.wiley.com/doi/10.1111/nuf.12534 ;

As we close our pages, …influenza is rampant in the United States and according to the statements given out …, it has now reached practically every state. Never within the recollection of people living today has there been an epidemic so wide‐influenza is rampant in thespread or so disastrous in its results. It has reached people in their own homes not only in the cities and towns, but it has even spread into the rural areas.


Were the aforementioned comments written in 1918 or 2020? They could have been written at either time; however, they were actually written by Sophia Palmer1 (p. 83), Editor of American Journal of Nursing in the November 1918 issue.

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Robinson2 provided a glimpse of the role of nursing during the influenza epidemic of 1918–1919 in which nurses were well aware there were no medicines or vaccinations available to give; therefore, a great deal depended solely on their nursing care. In spite of the influenza taxing nurses to the ultimate, nurses demonstrated they could mobilize their power to maximize their efforts to combat the epidemic.

Bristow3 and Crosby4 declared the Spanish flu as the “forgotten pandemic” because in spite of causing massive disruption in many lives, few changes occurred after this catastrophic event with no further thought given to future planning. However, by investigating a variety of sources (e.g., seminal works, survivor stories, healthcare literature), valuable lessons can still be acquired from both pandemics which will benefit nursing and future pandemic planning.

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There were three waves of the “Spanish” flu epidemic that infected 500 million people in less than one year. According to the Centers for Disease Control and Prevention (CDC),8 it was caused by an H1N1 virus with genes of avian origin. The first wave, in the spring of 1918, was regarded as mild with the mortality rate not unusually high.


 The second wave spread from France to England and then on to Spain where it killed eight million people, and became known as Spanish flu, or the “Spanish Lady.”2, 9 In the fall of 1918, the second wave arrived in the United States with military personnel being among the first inflicted. It was described as the most spectacular outbreak of any disease for hundreds of years. A unique feature was that about half of the deaths worldwide were in the healthy 20–40 year old age group. During the last four months of 1918, the United States reported 380,996 deaths.10 


The third wave in early 1919 was less severe, but the age distribution of deaths was similar.11 The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.3, 4, 8 This particular pandemic killed more people than World Wars I and II as well as the Korean and Vietnam Wars combined.

DJ-That number is also proberbly lower then that of the US civil war. [url]https://en.wikipedia.org/wiki/American_Civil_War[/url] or https://en.wikipedia.org/wiki/American_Civil_War ; Intense combat left between 620,000 and 750,000 soldiers dead,[14] along with an undetermined number of civilians.[h] The Civil War remains the deadliest military conflict in American history,[i] and accounted for more American military deaths than all other wars combined until the Vietnam War.[j]

 DJ-The US population in 1860 was 31,5 million [url]https://www.census.gov/history/www/through_the_decades/fast_facts/1860_fast_facts.html[/url] or https://www.census.gov/history/www/through_the_decades/fast_facts/1860_fast_facts.html so the US civil war killed over 2% of the US population. 

We may be facing a second wave of the SARS-2 pandemic with variants bringing a lot more cases worldwide. The US did have over 380,000 deaths in the last four months of 1918. Another 295,000 deaths in the US make up for a total of 675,000 US deaths within a year/18 months...

[url]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740912/#:~:text=The%20estimated%20population%20of%20the,generally%20put%20at%2020%20million.[/url] or https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2740912/#:~:text=The%20estimated%20population%20of%20the,generally%20put%20at%2020%20million. 

The US had a population of 103 million in 1918-in 2020 that number was just over 330 million. Translating the 675,000 US deaths to todays population number would see 2,2 million. If 0,5% of the population died one would end up at 1,65 million. Since we are still in the middle of the present pandemic these numbers give some comparisons to estimate pandemic severity. 

Since there was minimal understanding of the influenza and no antiviral medications to slow its progression, therapies, such as Vicks VapoRub, aspirin, cough medicines, clean linen, ventilation, and hot soup were often prescribed.13 Hospitals were unable to accommodate all of the patients, even the most serious cases; therefore, visiting nurses experienced an enormous demand.

DJ-Learning by doing, trying to create the best possible conditions to the best of our knowledge is also now common practice. 

Unlike the Spanish influenza pandemic in which more than half of its deaths were healthy people ranging in age from 20 to 40 years, the COVID‐19 has killed people over the age of 65 years with chronic health conditions, such as cardiovascular disease and diabetes.

DJ-This goes for the first wave of Covid 19-since we are in the middle we have to see how things further develop. Variants seem to hit younger age groups harder. 

3 SIMILARITIES BETWEEN THE PANDEMICS

Though occurring more than 100 years apart, there are similarities facing frontline nurses between the 1918–1919 Spanish influenza and the current COVID‐19 pandemics such as:

3.1 Shortage of nurses

As the Spanish influenza struck, most skilled nurses were supporting their country's armed forces in World War I; thus, resulting in a worldwide shortage of nurses in their native countries. For instance, many nurses from the United States were abroad including approximately 80% of nurses from East Coast cities, such as Philadelphia.

DJ-Today worldwide HCW-ers fight getting infected, are overstretched, exhausted. There may be beds, ICU's-staff is the problem. HCW-ers are willing to go where the job is but often face other problems. Housing can be problematic, but also "red tape" having diploma's/certificates in one country may not allow HCW-ers to work in another country. 

3.2 No available vaccine

Unfortunately in both pandemics, there was no vaccine to protect against the virus, so control efforts worldwide were limited to non‐pharmaceutical interventions, such as quarantine, hand washing, wearing face masks, limitations of public gatherings, and school closures.341322 The economy suffered as businesses and factories were forced to close due to magnitude and community spread of the virus. People were instructed to avoid using public transport to prevent overcrowding.

DJ-Today vaccines and NPI have to make the difference. If one would put the start of the Spanish Flu pandemic on january 1 1918 (just to put a date) the peak in the last four months of that year-and the third wave in the first half of 1919 one could claim the "main part"of the Spanish Flu pandemic lasted 1,5 years. For SARS-2/Covid 19 one also could put the start at january 1 2020-it would be very welcome if we would be out of the worst part by july 1 2021. 

In 1918 nurses wore gauze masks as their protection, but the spread of this pandemic influenza showed the need for additional respiratory protection to healthcare workers and research.13, 36 Originally designed for industrial use, the N95 respirator became a healthcare standard in the mid 1990s when scientist Peter Tsai developed material to block viruses and 3M designed the medical mask.37 At the beginning of the COVID‐19 pandemic, countries around the world were desperate to increase their PPE supply in an effort to slow or prevent the coronavirus transmission in their region.

DJ-Since production of PPE, masks etc was in China for over 90% in early 2020 there was a very serious problem. Countries did create their own PPE, mask production but it started slow. The EU is trying to get more vaccines, tests production inside their borders. Also medication-outsourced to low income countries-is moving back to western(a.o.) countries that re-discover it is better to have a grip on "strategic products" then to go for the lowest price..

In both pandemics, there was a lack of global preparation and plan regarding the process to follow when masses of people became stricken by a killer virus. Initially there was not a clear definition of priorities, resource allocation, healthcare worker protection, training, or measures to decrease the communicable spread.3, 4, 52 As a response to reduced reimbursement, competition, and higher labor and supply costs, Kennedy52 proposed the healthcare industry, in the last 20 years, worked to optimize bed space and equipment in an effort to deliver “just in time” services. Unfortunately, this can leave healthcare systems short of resources when they really need them as we saw in the current pandemic. Effective preparation and planning must occur with public health, healthcare, and emergency management partners working together to develop new approaches to provide protection, both nationally and globally, against the next influenza pandemic.

DJ-In 2020 knowledge on treatments, medications etc. are a big difference to the 1918 situation. Monitoring, ventilation, ECMO all-at best-were primitive in those days. Healthcare has become "high tech" and "just in time" with that less able to deal with very high number of cases. In 1918 there may have been more room for flexibility. So "progress"has good and bad sides...In 1918 a "healthy person" could be of much greater meaning in providing assistance. Today HCW-ers get help from other HCW-ers normally doing related jobs-this leaves gaps in other healthcare sectors. 

Another major factor may be animal spread. Covid19 must have infected millions of minks, thousends of cats...

Comparing this pandemic with 1918 is much to early for the total picture. There are some differences (2020 health care is high tech, minks/animals-link) but a lot of things almost look the same. 

In a next part I will look at regions. For Africa it is relatively easy-lack of data as well during the 1918 as the 2020 pandemic. Still will try to get some info...




We cannot solve our problems with the same thinking we used when we created them.
~Albert Einstein
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