4 January, 2021
A Comparison of the Transmission, Responses and Effects of the Global Pandemics
Dr. Braden Moluccas
University of New South Wales
Caused by the SARS-VoV-2 virus, also known as the coronavirus, Covid-19 is an ongoing pandemic and enigma that has brought much change globally in the past year. People have tried to unearth and understand the historical experience with global pandemics to try to demystify COVID-19. This is for good reason since the current human generation has never experienced a global pandemic. Much reference has been made to the 1918 influenza flu pandemic caused by the H1N1 virus. There is no known origin for this virus, but it managed to spread worldwide within a year. It has been described as the most severe global pandemic in humanity’s recent history.
Both the 1918 flu and coronavirus share basic similarities in the way they are transmitted. The main cause of infection from one person to another is close contact. The virus could be spread from the infected person’s nose or mouth in tiny fluid fragments or particles when they speak, sneeze, cough, sing or breathe out heavily. These fluid particles vary in size, from easily visible respiratory droplets to minute aerosols. The next person can catch the virus if they are in close or direct contact with an infected person, through their mouth, nose and even eyes. Infection can also happen if they touch surfaces where the fluids land on and proceed to touch their mouth, nose or eyes. This pubic knowledge on transmission may not have been available in 1918, thus the high number of infections and fatalities. In the era of Covid-19, people took similar precaution against infections by limiting direct and close contact with others through social distancing, leading to fewer transmissions.
Infection and Fatality
The 1918 flu is believed to have spread to about half a billion people, one-third of the entire world's population. The number of deaths was one of the most outrageous within a short span of time, at least 50 million fatalities worldwide. Mortality was higher in children under the age of 5, those between 20 and 40 years old and the elderly above the age of 65. What was surprising about this particular statistic was the high mortality even within the population thought to be physically healthy – those in the 20 to 40-year-old age group. This, however, can be attributed to their lifestyle and livelihoods which required them to be out in public amongst other people, and therefore at risk of infection.
Similarly, Covid-19 has been estimated to have infected over 92 million people across the world. Almost 2 million of these infected persons have died due to Covid-19 complications. The population at greater risk is the elderly and those who have other health complications prior to infection. These complications include diabetes, asthma, cardiovascular disease, high blood pressure, chronic kidney disease, chronic obstructive pulmonary disease and cancer. Another term for these pre-existing conditions is co-morbidities.
Lowering the Curve
There was less information in 1918 regarding containing the spread of influenza apart from the isolation of those who exhibited symptoms of infection. The same applies to today, including the preventative measures taken, such as face masks and social distancing. To date, there are no proven vaccines against influenza. There are also no antibiotics that could be used to treat secondary influenza bacterial infections linked to influenza. In both cases, the infection curve was lowered through isolation, keeping symptomatic and asymptomatic persons in quarantine, maintaining good personal hygiene, using disinfectants and limiting public gatherings.
During the Covid-19 pandemic, one defining factor is the mandatory lockdown, curfew and health and safety laws set and implemented by governments across different countries. These non-pharmaceutical interventions have contributed significantly to lowering the curve. However, this has drastically affected the economy since it brought movement and most services to a standstill, leaving only essential services to operate. While most governments have been trying to open up the economy, sudden surges due to 'waves' of the disease characterized by the dramatic mortality of the virus have led to intermittent lockdown periods. This is quite similar to the 1918 flu, whereas the numbers began to reduce by mid-1918 in the United States; there was a sudden surge by the time autumn kicked in.
It may seem like most governments had underestimated the unforeseen risks of Covid-19. Their response in the form of lockdowns, curfews and limited movement was mostly a reactive response, having learnt nothing from the 1918 flu. There is a clear need for investments in public health systems, collective epidemic preparedness and proactive international plans to save lives in future better and even sustain the economy since pandemics are still likely to exist. As populations reacted according to government instructions, there was reduced productivity, trade disruption and a near-halt an international movement.
General Population’s Attitude
Since the world was significantly more densely populated in 2020 than in 1918, the pandemic's widespread was inevitable. Coupled with the existence of air travel and increased cross-border movement, people were more mobile. Back in 1918, the movement was by ships in the sea, the horse on land or no movement at all. However, the number of people who got infected and died during the 1918 pandemic was over 20 times the ones who have died from Covid-19 so far. Humanity seemed to have forgotten this part of history, most of which came to be known by the current generation only after Covid-19 was declared a pandemic. One major lesson is never to forget. There have been public health emergencies that have gone global since 1918 such as HIV/AIDS since the 1980s, SARS in the year 2003 and H1N1 influenza in 2009. Not to forget Ebola. These have often caught the general public by surprise, but scientists have always been aware of and warned us against pandemics.
Most important is for authorities and the general public not to forgo the lessons, structures and strategies set in interventions during the Covid-19 pandemic. Information on the 1918 influenza pandemic is just as important as the research being carried out today. There are lessons to be picked about global pandemics that have informed responses to Covid-19, the most important ones being the non-pharmaceutical approach to containing an outbreak that has no vaccine or antibiotic yet.
Rogers, K. 2020. What we can learn from 1918’s deadly second wave. CNN Health. Retrieved Jan 2020: https://edition.cnn.com/2020/10/29/health/1918-pandemic-vs-2020-pandemic-fall-wave-wellness/index.html
Webel M, Freeman M. 2020. Compare the Flu Pandemic of 1918 and Covid-19 with Caution. The Conversation. Retrieved Jan 2020: https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895
World Health Organization. 2020. Transmission of SARS-CoV-2: implications for infection prevention precautions. Retrieved Jan 2021: https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895