Some one , some where at some time said  “those who forget their history are doomed to relive it”. A case in point is the great “Spanish Flu Pandemic” of  one hundred years ago.  Despite a monumental growth in the knowledge of viral diseases and the use of Public Health measures  to combat them, the roll out of the current Covid-19 pandemic is a virtual replay of 100 years ago. From a readily defined ground zero infection  both pandemics have spread across the world infecting and killing millions of people. Against very similar backgrounds of disorganization, lack of political will, disinformation and the unwillingness of the general population to play by some very basic public health rules both pandemics have played out in remarkably similar fashion. This video review of “The   Spanish Flu” of the early part of the 20th century is well worth watching to clear our heads and get a grip on how to deal with the current pandemic.

Here is my take on the video and and the current state of the Covid-19 pandemic.

• Ground Zero. In both instances the ground zero infections have been more or less identified. Despite its name the Spanish Flu did not originate in Spain. Its origins can be traced to a Military camp in Fort Riley in Kansas in the USA . Covid-19 first appeared in Wuhan China. In both instances international travel played a part in the spread of the disease. In the first instance troops moving between the US and Europe and their involvement in various theaters of war was a major spreader of the virus. In the second instance international air travel in the modern world was a major contributing factor in the rapid spread of Covid-19.
• Racial slanders. A virus does not have a race. The Spanish Flu was not Spanish and only became so named because of wide spread reporting of the disease in Spain. This reporting was due to the war time press restrictions in the countries at war. Spain was neutral with no press restrictions on the reporting of the disease. In 2020 attempts to tag the Covid-19 as a Chinese virus are misplaced political attempts to shift blame away from failed local policies.  Accusations that China suppressed knowledge of the virus are not strictly true. At the beginning there were some minor missteps by the Chinese but once the  disease was recognized the Chinese were very quick to get the word out and disseminate the genetic knowledge of the virus. This action and the rapid response of a number of nations is responsible for the slowing the spread of the virus in a number of jurisdictions.
• Denial. In both pandemics there were serious attempts to dismiss the viruses as nothing worse than the common cold or flu. Six months into the Covid-19 pandemics the notions that it is no worse than a cold or flu are still being circulated.
• Waves of infection. In the Spanish Flue Pandemic there were at least three waves of infection. The second wave was complicated by a mutation of the virus into a more  virulent form. Although there are no indications (yet) of a deadly mutation of Covid-19 there is every indication that a second wave and possibly a third wave is on the way. There is also no knowledge of the long term effects of the infection and viruses do have a nasty way of coming up with surprises that are easily overlooked at the beginning. Look how long it took to recognize the relationship between the “harmless”  childhood disease German Measles and the birth defects in children born from infected pregnant women?
• Social Distancing and treatment. In both pandemics there was (is) no natural immunity and treatment options were (are) limited and there were (are) no developed vaccines. In the absence of a vaccine the most effective means of restricting the spread of viruses relies on public health measures such as face masks, social distancing and contract tracing. Jurisdictions with the most success in slowing the spread of the virus in both pandemics were the ones that went into hard and fast lock downs of local populations. By restricting travel and social gatherings, the promotion of the wearing of masks and improved hygiene protocols, the “locked down” jurisdictions fared much better in controlling the diseases and resulted in better economic outcomes. In the current pandemic the urge to hastily end lock downs and get life back to “normal” should be resisted. The old story “short term gain that leads to long term pain” needs  to be remembered.
• Immunity and Vaccines.  President Donald Trump has almost got it right. Without a vaccine the Covid-19 virus it will probably “disappear”, not exactly the right word to use,  in a couple of years but the question is at what cost?. The population of the USA in 1919 was roughly 106 million and over the two year plus time span of the pandemic the death toll in the USA from the virus was 675,000. The current population of the USA is around 328 million. That is three times the population of 1919 and three times more potential infections. Over the current ten months of the Covid-19 pandemic the death toll in the USA  is 230,000.   There was no vaccine available during the Spanish Flu pandemic and the virus “ran it’s course”. The situation with Covid-19 is similar. Although there are vaccines on the horizon it may take several years to roll them out to the general population and, given the current political climate, there are significant sections of the population who may be unwilling to use the vaccines. Even if accepted the potential effectiveness of any  vaccine is unknown. Without effective public health measures and the public’s compliance with “the rules” the total deaths in the USA over the next twelve months could go well beyond 400,000.  For the Covid-19 virus we do have a bit of a head start in vaccine development. The actual viral cause of the Spanish Flu was not really identified until the 1930s. At the beginning they did not even know it was a viral disease. The first potential causative agent was a bacteria eventually identified as Hemophilus influenzae. Although no longer considered the agent  causing Spanish Flu  Hemophilus influenzae remains a significant  cause of bacterial infections. The final identification of the causative agent of Spanish Flu occurred years after the pandemic had run its course. The Covid-19 virus was identified within weeks of the first infections and the genetic mapping of the virus was rapidly shared around the world. This mapping is an essential tool in developing appropriate vaccines.  So vaccine development will probably advance very quickly but there are still many unknowns that need to be investigated. The earliest roll out of a vaccine is at least another year, possibly two, into the future. Will it be effective? Will it be a one shot dose or will it require follow up shots every year? These are only a few of the unknowns out there.
• Disorganization and political turmoil. One hundred years ago, given  the lack of knowledge of viral infections and the havoc of World War I an organized response to the pandemic was less than satisfactory. In 1919 that was understandable. In 2020 the same excuse cannot be made and yet the response in some highly developed and normally well organized counties is a virtual replay of what happened 100 years ago. Various jurisdictions implemented conflicting  policies and procedures, or failed to implement policies that could  slow the spread of the virus. Responses have become politicized and even the simple wearing of masks has become a political issue. This has impeded the implementation of a very simple tool for slowing the spread of the virus.  The shame of it all is that Public Health Authorities had been warning governments around the world for years that it wasn’t a case of  “If” but rather “when” the next pandemic would hit. They were ignored and in some instances pandemic planning was dismissed and even dismantled.
  

Every body wants to get back to “normal”. That is, the way it was before the pandemic struck. That is not going to happen. We have to recognize there are now two worlds. The world before Covid-19 and the world after Covid-19. They are two very different worlds and no amount of wishful thinking is going to change that. As my buddy Douglas Francis Mitchell would say “Better get used to it folks”.

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