“Churches, Schools, Shows closed.” “Flu epidemic ravages fast.” “Lid to go on city today.”
Those headlines are familiar today, but they screamed across newspapers more than 100 years ago during the Spanish Flu of 1918.
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That virus was the first of five global influenza pandemics of modern times and remains by far the most deadly. Estimates vary, but according to the federal Center for Disease Control, it infected a third of the world’s population, or about 500 million people, and killed 50 million people with at least 675,000 fatalities in the U.S.
While indications are COVID-19 will not be nearly that deadly, countries around the globe are mandating social distancing techniques and stay-at-home orders to fight the virus for the first time in more than a century.
Another common headline associated with COVID-19 and Spanish Flu came last week: a technique used to stop the spread in 1918 is being used to today. Basically, convalescent plasma therapy involves taking plasma from a person who had the virus, and during the course of recovery developed antibodies, or proteins that counteract a pathogen, according to Albany Medical Center Hospital. That plasma is injected into a body still infected to help its internal battle.
Albany Med got its first plasma donation from an employee who was infected with the virus and who recovered. The hospital, one of the first in the nation to get an OK from the federal Food and Drug Administration to proceed with the treatment, is seeking other donors and anyone who tested positive but has not had any symptoms for at least two weeks can call 518-262-9340.
Unlike today, social distancing 102 years ago was a far less concerted effort, but involved many of the same basic techniques: closing all mass gatherings and businesses and telling people to isolate inside.
According to a story in the Wall Street Journal which cited a book by John Barry called “The Great Influenza: The Story of the Deadliest Pandemic in History” President Woodrow Wilson never publically mentioned the pandemic, and Chicago’s public health commissioner said at the time: “It is our duty to keep the people from fear. Worry kills more people than the epidemic.”
There are other significant societal differences, too, that exacerbated the spread of the Spanish Flu. In 1918, the country was just coming out of World War 1 and soldiers were coming home after travelling the world while living in close quarters. Also, unlike today, there was no unemployment insurance and limited social services so people had to work, despite the health risks, or face the chance of starving on the streets. It was also more difficult to get the word out in 1918 — there was no Facebook.
It did, though work then just like it appears to be working now. As has been widely published, Philadelphia had its first reported case on Sept. 17, 1918 but waited until Oct. 3 before it began shutting things down. St. Louis, by contrast, had its first case on Oct. 5 and by Oct. 7 began its version of what is now known as a stay-at-home order. At the virus’s peak, five times as many people were dying in Philly than St. Louis.
One of the early questions regarding our response to COVID-19 is the striking difference between the fatalities in California and New York.
California has about twice the population but a fraction of deaths compared to New York, which on April 13 was 651 and 10,056, respectively. New York state accounts for nearly half of the deaths across the country, which on April 13 stood at 22,151.
There are some universal demographic reasons for the difference, like New York being more dense as a whole — California has about 239 people living per square mile while New York has about 411, according to the U.S. Census Bureau — and New York City being the most dense city in the country.
Another possible reason, though, according to a number of accounts, relates to social distancing. It’s indisputable California acted quicker in shutting things down than New York.
On March 16, San Francisco County and five neighboring counties announced a stay-at-home order similar to what New York has in place now. Three days later, Gov. Gavin Newsom made it statewide. On March 18, Gov. Andrew Cuomo mandated 50 percent of the workforce to stay home, a day later it was upped to 75 percent and on March 20 he closed all non-essential businesses and the regional stay-at-home order went in effect on March 22 which included New Jersey and Connecticut.
It was just six days, but when a virus as contagious as COVID-19 is ripping through a population as dense as New York it can spread very fast.
“If I infect two other people and each of them infects two people, it doubles and doubles and very soon you have very large numbers,” Dr. Arthur Reingold, professor of epidemiology and biostatistics at UC Berkeley, told the Mercury News.
While social distancing was employed to a small degree, the first line of defense for the other three pandemics in the last 102 years was vaccination. But, they don’t, collectively, come close to the number of deaths attributed to the H1N1 Spanish Flu.
In 1957-58, an H2N2 virus killed as many as 1.1 million around the world and in 1968 an H3N2 virus killed up to 1 million people. In 2009, as many as 575,000 died in the first year of that H1N1 outbreak. A precise number is difficult to pinpoint, according to the CDC, and those figures are the high end of the spectrum.
In 1957, a vaccine was well on its way to mass development in this country thanks to a rogue respiratory doctor at Walter Reed Hospital, Maurice Hilleman. He bypassed federal regulations, which can slow matters by months, and developed a vaccine before the pandemic hit this country, according to historical accounts.
In 1968, the virus was a byproduct of other strains so there was at least a partial natural immunity to it that was relatively widespread, according to the CDC, and the widespread use of penicillin and other medications to help treat the symptoms. In 2009, the first reported cases of that outbreak came in April and clinical trials of a vaccine were happening by July with little disruption to society, as a whole, in between.
Any vaccine is not a cure, and the only recourse to treat even seasonal flu is to treat the symptoms. Furthermore, any vaccination, even a seasonal flu shot, is far from infallible protection even if the vaccine is perfectly aligned with the strain of virus. According to the CDC the seasonal flu shot is between 40 and 60 percent effective.
The problem with using a vaccine to fight a pandemic, according to the CDC, is it takes about 20 weeks to develop a vaccination and, as in the case of COVID-19, it can spread exponentially in a matter of days rather than weeks.
That is differentiating characteristic between the seasonal flu virus and a pandemic virus — the latter is new, or novel, and it inflicts damage to varying degrees before the population can develop a “herd” immunity, which humans, as a species, do to combat any virus. The more terrifying aspect of a pandemic, though, is it spreads between humans before that survival mechanism evolves and well before a man-made vaccine can be made to the scale necessary to benefit the world’s 5.5 billion people, or at least the 10s of millions most susceptible to the virus.
For decades scientists were baffled by the Spanish Flu, and what made it so deadly. A perfect storm of societal circumstance was part of it, but that wasn’t enough for a 25-year-old microbiologist at the University of Iowa, Johan Hultin.
In 1951, he learned of a mass grave containing 72 bodies of people who were living in the tiny village of Brevig Mission, Alaska.
Later that year, he obtained permission from village elders to excavate the gravesite, according to a CDC account, and found the well-preserved body of a girl. He took a piece of her lung — like COVID-19, the Spanish Flu was particularly ferocious on the lungs — and attempted to bring it back to Iowa for examination. Technology and transportation logistical challenges at the time were formidable, however, and he was unable to make much progress.
Forty-six years later, in 1997, Hultin read about a colleague, Jeffrey Taubenberger, and his work on rebuilding the 2018 virus using preserved lung tissue of a U.S. serviceman. After one correspondence, Hultin, now 72, went back to Alaska for another excavation.
After spending his own money to hire a local crew, he found Lucy, a native in her mid 20s who died of the virus and who had a “perfectly frozen and preserved” set of lungs, according to the CDC.
Study of Lucy’s tissue, along with preserved remains of two servicemen, were exhausted, in 1999 with some knowledge of the virus’s inner workings used today in the development of vaccinations.
In 2005, though, scientists began an effort to recreate the 1918 virus.
In what sounds like a Jurassic Park movie, microbiologist Dr. Terrence Tumpey, under the watchful eye of a number of health organizations, began the tedious task of bringing the virus back to life by injecting it into the cells taken from a human kidney.
In laboratories at the CDC headquarters in Atlanta, abiding by unprecedented safety precautions including working alone after hours when everyone else had gone home in an air-controlled room with primary and secondary isolation barriers, he succeeded in reincarnating a virus dormant for at least a century.
Study of the virus showed its impact was, not surprisingly, vicious. For example, according to the CDC, “four days after infection, the amount of 1918 virus found in the lung tissue of infected mice was 39,000 times higher than that produced by one of the comparison recombinant flu viruses.” Similarly, “the 1918 virus produced as much as 50 times the amount of virus in human lung cells as one of the comparison viruses.”
The world is still in the grip of COVID-19, and it will be months before a true comparison can be made. But, thanks to advances in medicine, social and governmental programs and awareness, every indication is the final numbers will be far less tragic.