Pandemic Parallels: Unveiling The Legacy of 1918 Flu in the Light of COVID-19

Are you aware that every 100 years marks a new pandemic globally? The last pandemic we saw was the H4N2 influenza virus illness in the year 1918, right during the wrap-up of the first world war. Let us look into it more deeply!

Introduction

Between 1918 and 1920, following the conclusion of World War I, there was a tremendous wave of H4N2 influenza virus illness and death worldwide. Around 100 million people died from this pandemic, which also infected 500 million people globally. Additionally, it made numerous changes to public health practices that are still applicable today. We will argue that the 1918-1920 influenza pandemic changed public health by exposing the shortcomings of conventional approaches, promoting scientific enquiry and advancement, and promoting social fairness and international cooperation. In addition, we will compare how the present COVID-19 epidemic has affected public health in similar and distinct ways.

The Weaknesses of Existing Healthcare Control Methods

The 1918-1920 influenza pandemic taught us, among other things, that the public health measures in place were insufficient and ineffective for coping with such a massive and unexpected outbreak (Britannica, 2018).

Eugenics, which believed that some categories of individuals, such as the poor, workers, and immigrants, were immoral and poorer, significantly influenced public health at the time. Policies about public health were frequently unjust and intended to shield the ruling class from the affliction of the masses. For instance, several cities quarantined and restricted movement to specific districts or ethnic groups, while others neglected or downplayed the severity of the pandemic (Spinney, 2017).

Additionally, public health was not properly integrated or organized across various governmental levels, industries, or disciplines. A comprehensive communication plan to inform and educate the public about the disease and how to prevent it was lacking, as was a single authority or organization to oversee and direct the pandemic response. Because many of them either worked independently or were employed by nonprofit or religious organizations, many had no access to doctors or nurses.

Furthermore, there was a lack of scientific agreement and knowledge regarding influenza's cause, transmission, diagnosis, progression, and prevention (Parmet & Rothstein, 2018).

Public health activities were, therefore, of diverse quality and efficacy, ranging from reasonable actions like isolation, sanitation, and mask use to dubious or hazardous ones like bleeding patients, consuming alcohol, or giving patients vaccinations made from microorganisms. (Spinney, 2017).

The Stimulus for Scientific Research and Innovation

The pandemic highlighted the need for better infectious disease, diagnostic and surveillance methods, vaccines, and treatments. It also spurred curiosity in viruses' nature and evolutionary history, which had not yet been differentiated from bacteria. New methods for acquiring and analyzing epidemiological data, such as mortality rates, case reports, and serological surveys, were also developed as a result of the pandemic.

Another instance is creating mathematical models to comprehend and forecast the dynamics of infectious disease outbreaks. William Hamer, a pioneer in the discipline, employed differential equations to study the trends in illness and mortality during the epidemic. He suggested that infections may be divided into two categories: primary diseases brought on by contact with the influenza virus and secondary infections brought on by contact with bacteria that prey on compromised immune systems.

Additionally, he argued that there are two types of immunity: specific immunity, brought on by prior exposure to a particular influenza virus strain or vaccination against it, and broad immunity, brought on by maintaining excellent health and hygiene. He calculated the rates of infection, recovery, death, and immunity in various populations during the pandemic using these ideas (Spinney, 2017). On the basis of these learnings, more scientific studies and research on the viruses spread through the pandemic were conducted.

The Promotion of Social Justice and Global Cooperation

In a world where infectious diseases could spread swiftly and extensively across borders and continents, the pandemic also highlighted the interdependence and vulnerability of nations (Spinney, 2020).

These insights caused a shift in public health concept and policy, moving it away from an exclusive and constrictive emphasis on personal cleanliness and health and towards a broader and more inclusive focus on population health and social welfare. Improving the general populace's living and working situations and ensuring everyone has access to health care and social services became more important concerns for public health.

Additionally, there has been an increase in collaboration and cooperation in public health between various governmental levels, industries, and disciplines, as well as between other nations and regions. Additionally, the public was involved in decision-making and education in public health, making it more democratic and participatory (Spinney, 2017).

Examples of Social Justice and Global Cooperation

Some of the examples of social justice and global cooperation initiatives that started or grew after the pandemic were the creation of national health services in many countries, such as the United Kingdom, France, and Canada; the development of international health organizations, such as the League of Nations Health Organization, the predecessor of the World Health Organization; and the adoption of social security and welfare programs, such as unemployment insurance, old age pensions, and child benefits (CDC.GOV, 2020)

The Parallels with the COVID-19 Pandemic

The COVID-19 pandemic, which started in late 2019 and is still going on at the time, has challenged and changed public health practice in similar and different ways as the 1918-1920 influenza pandemic (Cucinotta & Vanelli, 2020). On the one hand, there are many parallels between the two pandemics, such as:

• Both have affected millions of people worldwide, causing significant morbidity and mortality, especially among older adults and people with underlying conditions.

• Both have shown the weaknesses of existing public health approaches, such as insufficient preparedness, coordination, communication, testing, tracing, isolation, quarantine, treatment, and vaccination (Hellewell et al., 2020).

• Both have encouraged scientific research and innovation in various fields related to public health, such as virology, immunology, epidemiology, biostatistics, pharmacology, and vaccinology.

• Both have supported social justice and global cooperation in dealing with health issues, such as showing the social factors that affect health, the differences and inequalities in health outcomes, and the connection and vulnerability of nations.

On the other hand, there are also many differences between the two pandemics, such as:

• The COVID-19 pandemic has a lower death rate than the 1918-1920 influenza pandemic (around 2% vs. around 10%), but it has a higher reproduction number (around 3 vs. around 2), meaning that it can infect more people per case.

• The COVID-19 pandemic affected younger adults more than children, while the 1918-1920 pandemic affected children more than younger adults (Hellewell et al., 2020).

Conclusion

The 1918-1920 influenza pandemic significantly impacted public health practice throughout the 20th century, and that continues to be felt today. We have also compared and contrasted the current COVID-19 pandemic, which has challenged and changed public health similarly and differently. We have discussed how both pandemics showed the weaknesses of existing methods, encouraged scientific research and innovation, and supported social justice and global cooperation.

We have also pointed out some of the differences between the two pandemics, such as their causative agents, death rates, reproduction numbers, age distributions, technological contexts, and public health interventions.

References

• Britannica. (2018). influenza pandemic of 1918–19 | Cause, Origin, & Spread. In Encyclopædia Britannica. Britannica. https://www.britannica.com/event/influenza-pandemic-of-1918-1919 

• CDC.GOV. (2020). Establishment and Management of Public Health Rapid Response Teams FOR DISEASE OUTBREAKS 2 ACKNOWLEDGEMENTS. In cdc.gov. cdc.gov. https://www.cdc.gov/globalhealth/healthprotection/errb/pdf/RRTManagementGuidance-508.pdf 

• Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta Bio-Medica: Atenei Parmensis, 91(1), 157–160. https://doi.org/10.23750/abm.v91i1.9397 

• Hellewell, J., Abbott, S., Gimma, A., Bosse, N. I., Jarvis, C. I., Russell, T. W., Munday, J. D., Kucharski, A. J., Edmunds, W. J., Sun, F., Flasche, S., Quilty, B. J., Davies, N., Liu, Y., Clifford, S., Klepac, P., Jit, M., Diamond, C., Gibbs, H., & Zandvoort, K. van. (2020). Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. The Lancet Global Health, 7(0). https://doi.org/10.1016/S2214-109X(20)30074-7

• Parmet, W. E., & Rothstein, M. A. (2018). The 1918 Influenza Pandemic: Lessons Learned and Not—Introduction to the Special Section. American Journal of Public Health, 108(11), 1435–1436. https://doi.org/10.2105/ajph.2018.304695

• Spinney, L. (2017, September 27). How the 1918 Flu Pandemic Revolutionized Public Health. Smithsonian; Smithsonian.com. https://www.smithsonianmag.com/history/how-1918-flu-pandemic-revolutionized-public-health-180965025/

• Spinney, L. (2020, March 7). The World Changed Its Approach to Health After the 1918 Flu. Will It After The COVID-19 Outbreak? Time. https://time.com/5797629/health-1918-flu-epidemic/