Tale of two epidemics

The Spanish flu pandemic of 1918, the deadliest in history, infected approximately 500 million people worldwide, which was one-third of the planet’s population and killed an estimated 20 million to 50 million. This tale is finding its relevance again 100 years later with the emergence of another noxious Novel Virus (SARS CoV2) and this pandemic known as COVID 19 is following the relentless path of devastation with  approximately 2258725 infectious cases and loss of 154381 human lives so far, destruction of world economy and damage to the world order beyond repair.

The pandemic warriors from both the eras fought on similar lines and faced almost the same situation. The physicians were devoid of effective drugs and a preventive vaccine against the pandemic diseases. Administrators in both times relied heavily on traditional epidemiological measures like quarantine, isolation, social distancing, use of masks, closing of gatherings etc.

The effectiveness of which cannot be undermined (notwithstanding the inadequate supply of protective gear both then and now), for if left unchecked a staggering number of susceptible individuals world over will get infected which on the one hand could present the possibility of the population achieving herd immunity, however the human cost would be colossal and since little is known at this point about such a possibility and that if immunity is indeed achieved whether it would be long lasting.

However COVID 19 pandemic has advanced scientific knowledge which could be used to swift our response to the global crisis. The dissemination of information on preventive measures through electronic, print and social media is an unparalleled  advantage we have today over the past. However data should be presented as it is without over tuning it. Media also has to ensure not to sensationalise the information.

With the global fight against COVID 19 entering a critical phase with the curve showing an initial decline, another  lesson to be learned from the Spanish Flu pandemic is the much feared “Second Wave”. It was this second wave which returned in September of 1918  to wipe off the global population and succeeded in killing 1/3 of it.

A second wave is almost inevitable considering when restrictions are lifted those who are still susceptible will trigger this second wave of infections. Hence it is imperative to learn our lessons from the past and build on it with the knowledge and advancements we have made in a century to mitigate the effect of the current pandemic.

Like the H1N1 inlfuenza which has now attained the status of an endemic disease globally we could expect COVID 19 too to become endemic at some stage. Hence it would be naïve to expect that the disease will just vanish. Future strategy should rely on scientific research into the structure and behaviour of the virus, the development and availability of a effective vaccine (The first licensed flu vaccine appeared in America in the 1940s), delving into the pathogenesis of the disease and bringing forth an emphatic drug therapy.

Governments around the world should plan future strategies with this in mind. A long battle will require much tactical change in strategies from time to time. Not the least of which would be an increased spending on health by governments all over the world.

Robust epidemiological data will guide the way forward (Unified Global response to Pandemic with WHO leading the way with resolute surveillance systems), however the true picture will only appear after the “wave” is over. Until then we would have to depend on our own and our peers experiences with the virus and the patients and deal with the situation in accordance to our best judgement.

Authors are Senior Residents, Department of Community Medicine, SKIMS MCH, J&K.