What Exactly Did We Learn from the 1918 Flu Pandemic?

Actually, there was much to learn from the Influenza pandemic of 1918. Some of the lessons it taught, however, have been lost through the attrition of time, as a result of people (except for professionals in the life sciences and healthcare) losing interest in scientific events outside of their short attention span, and because of a general lack of interest in historical events.

Fortunately, the scientific community has taken many of those lessons to heart. This is demonstrated in the infectious disease containment protocols that have been developed, the wisdom that has been passed down to present-day life science instructors/professionals, and the fact that communicable diseases are no longer the main killers of people in developed countries.

Clearly, the flu pandemic of 1918 has had somethingto do with our now better understanding of viral diseases and the pathogens that cause them.

On the other hand, apparently, there are still some things which we either did not learn or learned only imperfectly. This is clearly demonstrated by the following illustrations:

1. “Whatever you do, keep the military away from these viruses!" When President Obama decided to send troops to Africa, had he been informed that it was the military which essentially spread the virus in 1918? In fact, some think that the flu may have originated in British military camps, later spreading to Spain. Even if that is not the case, we know for sure that American soldiers helped to spread the virus once it reached American shores. It's hard to believe that none of Obama's advisors knew this and that, if they did, they did not tell the President about this historical factoid.

2. “Isolate (if infected) and quarantine (by force, if necessary) anyone that comes in contact with infected individuals." The healthcare workers, though, who treated the Americans flown from Africa were allowed to go home after they completed their shifts; they were even allowed to fly to visit family members! Other people who came in contact with infected persons were later “monitored" by the authorities; it would have been better, though, if these people had been forcibly quarantined.

3. “Immediately place limitations on travel to/from countries with infected individuals." This was not done in 1918 quickly and aggressively enough; consequently, the disease was literally air-mailed (though boats and trains were also used) to countries that, quite frankly, should have never become involved. Clearly more from political considerations than scientific wisdom, the US has fought the need to place limitations on travel to/from affected countries.

4. “Put science ahead of politics if sincerely interested in containing a potentially deadly contagion." There are many indications that this has not been the case with the present outbreaks of Ebola. States that have wanted to take aggressive action against Ebola, for example, have supposedly been antagonized by the federal government, in sharp contradiction to what 1918 taught us.

5. “There is no such a thing as a stable, predictable infectious virus (especially one that starts killing people)." If we learned nothing else from the 1918 pandemic, we learned this much. Many people back then underestimated the flu because previous episodes (strains) had not been as virulent; consequently, they did not take appropriate steps to protect the populace. When the CDC and government officials have spoken publicly about Ebola, it does not seem as if they grasp the inherent dangers of a virus capable of mutating (as was apparently the case with the flu virus of 1918).

6. “Ignorance is not a good enough excuse for underestimating a highly contagious and infectious pathogen." Even if they were not fully aware of viruses, lacked the equipment/training scientists possess today, or did not immediately realize that they were dealing with a new disease, scientists in 1918 could have still done a much better job of containing the epidemic (possibly, thereby, keeping it from becoming a pandemic). Once people start dying from a disease in significant numbers, measures need to be taken to contain the pathogen(s) using any means necessary.

7. “Carefully coordinate an aggressive response to any disease outbreaks." In 1918 people were forced to act on their own. There was simply no well-coordinated, organized campaign. This lack of leadership was as fatal as the virus' pathogenicity.

8. “Work to prepare all segments of society to deal with national disasters such as disease epidemics." One cannot wait until a disaster develops to implement such plans. The CDC has talked about helping hospitals to prepare for future epidemics but, frankly, that is not enough. All segments of society (teachers, funeral directors, policemen, firemen, drug manufacturers, restaurant managers, etc.) also need to be trained in what roles they will have to play during such emergencies.

9. “Create (and give power and authority to) a government agency that can play a leading/commanding role during disease epidemics." The CDC is supposed to play such a role but their response during the Ebola outbreaks has left many people scratching their heads as to whether the CDC is ready/prepared to play such a role. If anything, it appeared as if the CDC was reacting to events rather than being proactively prepared for such events.

10. “Be realistic in terms of the resources that will be necessary to effectively fight a major disease epidemic/pandemic." The CDC wants all hospitals to be equipped with appropriate protective equipment but have they considered that many hospitals are already financially in dire straits? It may also be more productive to be forthcoming, officially admitting that, were a major epidemic to arise, the healthcare establishment in the US will likely be quickly overwhelmed—why prevention is always a better option than making unrealistic predictions and plans.

Conclusion

While much has indeed been learned from past epidemics, an equal or greater amount of information has yet to be learned. There are, for example, basic things that one would have thought have been learned for sure but, when the rubber meets the road, that does not appear to be the case. The examples given herein are, unfortunately, only a small sampling of this reality.

Copyright, 2014. Fred Fletcher. All rights reserved.

References

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/

2. http://evans.amedd.army.mil/PandemicFlu/1918.htm

3. http://www.flu.gov/pandemic/history/

4. http://www.washingtonpost.com/wp-dyn/content/article/2006/12/12/AR2006121201628.html

5. http://www.nejm.org/doi/full/10.1056/NEJMp058281

6. services.medicine.uab.edu/publicdocuments/peds/casg/annual_meeting/...

7. http://www.uofmhealth.org/news/1315lessons-from-1918-flu-pandemic