Historically, quarantine was used as a drastic method to contain the spread of diseases for which medicine had no recourse. It was the last step in a world much more connected than is often believed, where the spread of disease was often global. In 1918, the Spanish flu killed, in just one year, between 40 and 100 million people worldwide. That means between 3% and 6% of the world population. COVID-19 and The Spanish Flu have curious similarities, like the little importance they had at the beginning. But there are also some aspects that are impossible to know, as today we continue the fight against this new type of virus which emerged in December 2019 from Wuhan, China. The current pandemic has spread to more than 2,000,000 people worldwide and more than 100,000 people have died, however some studies by important epidemiologists testified that both numbers are much higher.
Where does The Spanish flu come from? In 1918, the flu was mistaken for other diseases and was not given due importance. From 1919 the viral origin of the epidemic began to be suspected, a theory that would begin to take shape solidly ten years later. The Spanish press, at that time, decided to occupy much of its attention; more than in the rest of Europe. The reason was that Spain was not involved in the war and did not censor information about the virus. However, some countries attributed it as a Spanish weapon against other countries. Today, this hypothesis lacks a scientific basis and the diffusion of such a name was attributed to the interest of the French and English countries, on the one hand, and of the Germans, on the other, in diverting attention towards Spain, given its neutral position during the warlike conflict.
The first case was recorded at Camp Funston (Kansas) on March 4, 1918. At the end and after World War I, millions of people had to emigrate which helped the spread throughout the world. Current studies blame the cause on an outbreak of influenza virus A, subtype H1N1. The Spanish flu had another cruel characteristic: the most affected group was young people between 20 and 40 years old, the main reason was because they had not been exposed to the virus in their childhood, so they did not develop natural immunity. Unlike the new coronavirus which mainly affects older people and appears to have no fatal consequences for children.
Resources for treating the disease, at that time, were also very limited compared to today: there were no vaccines, antiviral medications, or antibiotics to treat secondary influenza-related bacterial infections such as pneumonia. Hospitals did not have enough medical equipment: there were no intensive care units, no respirators, and the importance of isolating the sick was not understood. To prevent its spread, non-pharmaceutical interventions were implemented, such as the promotion of good personal hygiene, the isolation of those affected, the quarantine and the closure of public places. Although these methods helped contain the disease in some cases, the social and economic costs were very high. The health system was much more overwhelmed, and they had to ask, as at the present, for help among medical students. The influenza virus has no curative treatment and nobody is immune. The therapies are symptomatic and are focused on improving and alleviating the symptoms that this pathology produces.
Until this year, the most common human coronavirus known was SARS-CoV, which infects the respiratory tract both on its upper part as inferior, and was identified in February 2003, after the outbreak Acute and Severe Respiratory Syndrome (SARS). As with many other viruses, there is no specific treatment for the new coronaviruses. However, many of the symptoms can be managed clinically, it means that treatment should be individualized based on the patient’s condition and must ensure life support in case of complications. Recently, some studies like the Health Department of Catalonia or the Treatment Action Group show the possibility of using antiretroviral drugs such as lopinavir or ritonavir. These antiretrovirals are normally used for HIV, however we do not currently have conclusive results about its effectiveness. Nowadays, there are multiple clinical trials around the world developing a vaccine. According to Ifpma (International Federation of the Pharmaceutical Industry), there are currently around 80 clinical trials underway for new experimental treatments and vaccines under development for coronaviruses. Some of the best companies situated are CureVac (Germany), GSK Laboratory (United Kingdom), CSL Limited (Australia), Novavax (EEUU), and Pfizer (EEUU).
According to the human behavior patterns when humans face a pandemic, the Swiss psychiatrist Elisabeth Kubler Ross proposed a cycle divided into five stages: denial, anger, negotiation, depression and acceptance. These denote some consequences in the society. The response to an epidemic begins in society in the same way that individually we generally give a bad omen, denial or minimization. We believe that it is only a temporary setback that will not affect daily life. “It is a problem for the Chinese” said some. The 1918 pandemic with which many voices compare the current situation is known as the “Spanish flu” not because it originated in Spain or because it was its epicenter there, but simply because while Great Britain, France and Germany were hiding their statistics to keep up the morale of the troops in the World War One, neutral Spain told the truth of what was happening. In this way, it would not be improper to consider when Donald Trump with his recurring reference to the “Chinese virus” (already clearly outdated) promotes the anchoring of society at the adjudication stage. In the next stage we consider fear. The name of Spanish influenza does not mean it comes from Spain, but some people are confused with the name, and they blamed it on Spain. Today, we are seeing in some places around the globe how some people are discriminating against others because they think they have some influence in the COVID-19. For example, some human beings with Asian descent have suffered racist acts in supermarkets, restaurants or social media from people that think they are the problem, so they point them out without any type of clear explanation. The fourth stage is manipulation. Throughout the last few weeks, all the media has stories about the new coronavirus pandemic. Radio and television shows have uninterrupted coverage of the latest death figures, and depending on who you follow, social media platforms are full of scary statistics, practical advice, or dark humor. In social networks, there is a bit of everything: rigorous content, and intentioned content. Some of the content is created with a malicious purpose of misinforming. Misinformation is particularly calamitous, especially in the political and health areas, because without being aware, fake news can change our decisions contrary to our own interests. The worst case scenario on social media is how false information circulates more widely and faster than true information, so its impact is difficult to stop. This constant bombardment of information can lead to increased anxiety, with immediate effects on our mental health. But the constant feeling of threat can have other more treacherous effects on our psychology. And finally, the last stage is organization in which societies achieve their greatest successes in the face of epidemics. From the closure of the water pump that transported cholera to London’s neighborhoods, to the mass vaccination of the population when effective vaccines exist, or the use of preventive medicines in particularly vulnerable populations. It is also attributed to the measures of isolation and restriction of interpersonal contact as in the case we have to live with today.
Lack of coordination between governments and the waste of time have been able to play against people’s health and future economic recovery. In the case of Spain, the preventive measures could have come too late. Despite having the advantage of seeing what was happening in Italy or the measures that were being successful in other countries (massive tests in Germany), the closure of schools occurred two weeks later than in Italy, while the programs of massive tests to isolate those who were infected have not started rolling out until this week. All of this has a human and economic cost that could hinder the exit from the recession. Experts from the New York Federal Reserve in a study in which they studied the measures adopted during the 1918 Spanish flu in various states of the USA, reflect that the short-term economic effects of the 1918 influenza pandemic and the restrictive measures taken in the USA caused serious disruptions to companies in many sectors of the economy. It is clear that regions that decided to close schools, avoid crowds, or promote the use of face masks, reduced the mortality rate while benefited from a stronger economic recovery than regions that did not. Areas with the highest exposure to influenza experienced a relative increase in wages, consistent with labor shortages. However, real GDP fell about 8% per year, a decrease that could be less than the one caused by the recession of the coronavirus.
The real difference is that the Spanish flu had a severe impact on the young population, in an economy in which human capital was an essential asset. Today, globalization has aggravated contagion and it is containment measures that have caused the economic slowdown. In the case of the current coronavirus, countries such as Taiwan or Singapore, which took the most restrictive measures at the beginning of the pandemic, limited the spread and seem to have mitigated the economic consequences. More than others like Italy or Spain, who fell behind in the race.
There are a few lessons from the 1918 influenza epidemic that we can apply today. Firstly, the COVID-19 pandemic can have a serious impact for the next few years everywhere, but especially in places that are geographically isolated. In these places, what can determine the impact of COVID-19 is the interaction between the pandemic and the quality of the health system and the way the population can reach it. Secondly, given the quality of medical training and the low access to tests for patients, the impact of the pandemic is underestimated for developing countries and health systems can end up congested due to misinformation. One of the best examples is the case of Mexico, where the authorities minimized the spread of Covid-19, decided not to do large-scale tests, and today, its population is suffering an unexpected increase in the health services, especially intensive care.
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