…an outbreak which has spread throughout the world. This according to the World Health Organization (WHO). The worst pandemic of the last century was the “Spanish” flu of 1918 which infected one-third of the world’s population and killed 50 to 100 million people, including nearly 700,000 in the U.S.
No one expects this one to be anywhere near as deadly. The reason to bring up the Spanish flu is there are lessons to be learned from 1918 which may help us today. The Wall Street Journal discussed three of these in its March 7–8 edition.
First, fighting a pandemic requires effective leadership. China whiffed at the start of this outbreak covering up as best it could. But it subsequently attacked aggressively, locking down 60 million people in Hubei Province including the entire city of Wuhan (11 million). Only China can do a complete lockdown at this level of magnitude. Right now the strategy seems to be working. New infections have dropped dramatically. At the other end of the spectrum is Iran, which is woefully unprepared for a pandemic. The government has bounced between outright denial and medical chaos. In fairness, they just don’t have the resources.
The other two countries with major outbreaks, Korea and Italy, have responded with variations of the China model. Korea has tried to keep its economy operating while aggressively testing residents. Like China, Korea is winning the battle, having brought down the number of new incidents significantly. Italy is just starting its total country lockdown. It will be interesting to see if a more ‘democratic’ country (certainly more democratic than China and arguably, Korea) can manage a quarantine. Quarantines require a level of discipline not always accepted or adhered to in democracies.
How has U.S. leadership performed? Mixed at best I feel. Initially there was denial. President Trump tweeted, “hopefully everything is going to be great.” More recently the situation has been dealt with professionally but the budget for virus research and control was cut in the early years of the administration so we just don’t know how well we can pull this off.
A second lesson from 1918 is the importance of accurate and timely information and building trust in the community. No sugar coating the message. Be blunt in the assessment and transparent about the challenges. Angela Merkel has stated that 70% of Germans could eventually be infected. Britain has gone further, stating that 80% of the population may catch the virus. Here in the U.S. we are not in denial but until just recently there was not the sense of extreme urgency that many say is necessary. Politics can also play a role. When Nancy Messonier, Director of the CDC’s National Center of Immunization and Respiratory Diseases, said in February that the community spread of the virus was inevitable in the U.S., President Trump was outraged and acting Chief of Staff Mulvaney said her remarks were trying to get Trump defeated. Not good ‘team’ chemistry.
A final lesson is you have to rely on classic public health measures. Isolation policies and social distancing work. Philadelphia let a 200,000-person march go forward right in the middle of the 1918 flu outbreak. Within 72 hours every bed in the city’s 31 hospitals was filled. In contrast St. Louis came down hard on the outbreak with individual quarantines and a banning of public gatherings. The city’s mortality rate was far less than Philadelphia’s.
A recent Atlantic article was titled: “Cancel Everything.” We have no immunity to the novel coronavirus and there is no cure (so far), so it will spread. The best strategy is to institute extreme social distancing. The good news is we have antibiotics today that didn’t exist in 1918 and modern hospitals and intensive care units. All of these will hopefully help. And the best news is that during the 1918 Pandemic the reflex to help others shone through strongly in America. We will certainly look for scapegoats today to blame, but neighbors helping neighbors was very much alive in 1918 and still is.