Are There Lessons from Other Pandemics?

By March 31, 2020 Commentary

One useful exercise in looking at appropriate mitigation measures is to look at past epidemic episodes.  Circumstances are always different but it can be helpful for people to just see what occurred.  I started out wondering why this time seemed to be handled so differently from the swine flu epidemic of 2009 to 2010.  At this point it is apparent to me, and I would assume others, that this pandemic is likely significantly more lethal, at least to older patients, than the virus responsible for the 2009 epidemic, although it may be responsible for fewer infections.  So I am not sure you would employ the same mitigation measures if the number of deaths is anticipated to be much higher, but it is still worth examining events around that most recent pandemic.

The 2009 swine flu or H1N1 epidemic actually appears to have started in the US.  You can view information on that pandemic, and others, at the CDC website, here.  (2009 Epidemic)    In particular, if you poke around a little there, you can see statistics on cases, hospitalization, and deaths.  You will also find a timeline of events and actions.  That epidemic, which began in early April, according to the CDC, resulted in 61 million cases, 275,000 hospitalizations and 12,500 deaths in the United States.  Existing flu vaccines did not offer protection to this strain.  A new vaccine was developed and used, but by the time it was available the epidemic had largely passed.  Unlike the coronavirus, this flu strain predominantly affected younger people.  Older people appeared to have antibodies due to infection to a similar strain early in their lives.  Look at the timeline, and you will be struck how none of the measures now being employed were widespread.  Even though children were at significant risk, schools were only closed if they had a large cluster of cases.  By early July, no more than ten weeks after the first case, there were over a million infections in the United States.  There was no national emergency declared and there was no business shutdown.  In the summer, children’s camps were kept open, even though a number had significant infections.  The CDC just issued guidance on how to reduce prevalence.  A second wave began in August.  This version of the flu virus continues to appear every year but many people have antibodies now and the vaccine offers additional protection.  Interesting how low-key the reaction was.

Now, let’s look at the 1968 influenza pandemic.  Less detailed information is available from the CDC on this epidemic, but it caused an estimated 100,000 deaths in the United States and one million around the world.  This epidemic, as is more typical with the flu, did primarily affect elderly persons. I found no evidence of any widespread economic or social shutdowns in response to this epidemic.  There was another serious pandemic in 1958.  This one resulted in about 116,000 deaths in the United States.  And again, no shutdowns.  And there have been other troublesome epidemic related issues.  In 1976 a feared epidemic of a strain of influenza related to the 1918 virus led to development of a vaccine that may or not have caused Guillane-Barre disease, and ultimately to suspension of the vaccination program.  That might be considered another form of over-reaction to a potential epidemic and certainly is an exemplar of the need for caution in testing before widespread deployment of a coronavirus vaccine.

It is useful to look at all these past pandemics and ask what is different this time.  We do live in a much more globally connected world now, so I suspect that infectious agents travel much faster.  In general, the world has more and better health resources and better infrastructure for information gathering and exchange and research.  In terms of the responses, however, there are factors which are much more negative to good decision-making and action.  The omnipresent social and traditional media, with the inclination to present the most dire, sensational aspects of any stories to gather eyeballs and ears, has created a harsh environment for calm and reasoned decision-making.  This method of information presentation and absorption encourages consideration of only the most immediate events and a severe underweighting of medium and longer-term negative, or positive, impacts.  And media self-awareness of its own behavior and role in poor decision-making is non-existent.  Politicians generally seem to have lost any quality of statesmanship.  They are constantly fearful of accusations of not taking every possible step to save even a single life.  So they too don’t do what should be regarded as a very appropriate weighing of relative benefits and harms.  It is up to the public to change this.  We all have to be more rational than our politicians and we have to force them to do a better job of making decisions on appropriate mitigation measures.

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