Two Pandemics, One Century Apart
By Dr Syed Amir
Bethesda, MD
Wuhan, the capital of China’s Hubei province, is located some 3,900 kilometers east of Islamabad. Although a major industrial and commercial center, few had heard of it until recently. Now, the name is constantly in the news, being the home of a new, potentially lethal, strain of coronavirus that has never been encountered before.
While knowledge about it is being gathered by scientists, we already know that it belongs to a large family of viruses that cause a constellation of diseases, ranging from the common cold to the deadly acute respiratory syndrome (SARS) and Middle East respiratory syndrome coronavirus (MERS-CoV). Meanwhile, Wuhan has become a virtual ghost town with strict quarantine restrictions imposed by the Government.
Coronaviruses share a common feature. At some stage, they jumped from animals, often bats and birds, and mutated to infect humans. The new coronavirus, formally named COVID-19 by the World Health Organization (WHO), is believed to have moved from bats, via an unknown intermediary, to humans and is extremely contagious. In societies, where humans and animals live and interact in close proximity, such as rural China, such transitions are more frequent.
The disease has now spread from China to countries as far away as Italy, South Korea and Iran, and at the time of this writing more than 83,000 cases have been documented and approximately 2,800 deaths recorded, prompting the WHO to declare it a World global health emergency. In addition, 62 coronavirus cases have been confirmed in the US. Some 1,700-health workers in China have also become infected, raising the specter of breakdown of the country’s health care system.
Currently, no effective treatment or vaccine exists to combat the disease, although frantic efforts are underway in both the US and China to develop a vaccine against it. Worried about importing the virus, many countries have discontinued airline services to China, removed their citizens, and instituted strict screening for those returning from China. Pakistan Government apparently has decided not to undertake these measures. It may have been a wise course, given the country’s moribund, ramshackle medical system which would be unable to cope with any large-scale outbreak. Some critics, however, attribute the policy to an excessive obsequence to the Chinese Government.
The clinical symptoms of the coronavirus infection are similar to flu, although their causative agents are quite different. New data from China suggest that the rate of mortality noted, especially among the weak and elderly, may be higher than caused by seasonal flu (0.1 to 0.2%), approaching 2 percent. These data are, however, only tentative as the full extent of how many people have been infected by the coronavirus but not diagnosed remains unknown.
The current outbreak of coronavirus has resurrected memories of the pandemic of 1918, often termed Spanish influenza, that devastated mankind and ravaged the world more than a century ago. The 1918 Spanish flu, its name notwithstanding, did not originate in Spain. The name resulted from the exigencies of the First World War. During the height of the war in Europe, propagation of the news of the pandemic was not allowed by the censors, lest it demoralizes the troops. However, when the contagion reached Spain, which was one of the few European nations not involved in the war, the news was extensively reported by the local media. It received further notoriety when the S panish King Alfonso XIII suffered a devastating flu attack. Since that time, the illness became known as the Spanish Flu.
Although no one alive today experienced the Spanish flu, its nightmarish details have been well documented and preserved. It infected an estimated 500 million people, nearly one-third of the planet’s population and killed between 50 to 100 million of them. In its virulence and mortality rate, the pandemic is unparalleled in history and dwarfed the number killed in the two world wars combined.
Initially, the destructive potential of the illness was not fully realized. The City of Philadelphia, where in September 1918 a huge parade was being organized to sell bonds to support the ongoing war, went through a harrowing experience. Despite advice by several doctors against the parade, the organizers went on with it. A week later, 636 new cases of flu and 139 deaths were recorded in the city. Within a few months, the number of dead had climbed to a staggering 12,191. The pandemic quickly travelled around the world. India was particularly hard hit, as some 18 million people perished. Curiously, for some unknown reason, China remained largely unaffected by it.
The Spanish flu had some unpredictable effect on the geopolitics of the time. American president Woodrow Wilson was in Paris in January 1919 to negotiate the Treaty of Versailles to settle terms for Germany to pay reparations for unleashing the war. There were major differences in the terms proposed by the Americans and the French. The gulf between the two was so wide that the American president nearly walked out of the conference. But then Wilson caught severe flu that greatly weakened him and sapped much of his energy. He acquiesced and signed the treaty on French terms.
Why was the Spanish flu so deadly, surpassing in viciousness all previous pandemics except for the bubonic plague of the Middle Ages? The question has puzzled many scientists over the years, and even after a century of investigation, no definitive answer has emerged. Meticulous research carried out on preserved specimens drawn from flu patients and those extracted from frozen corpses that had remained sealed in Alaskan earth failed to provide unambiguous answers. Most likely, there was more than one reason for the observed high mortality rate.
To start with, the state of knowledge of the infection process was relatively primitive at the time. Viruses had just been discovered and there was only meagre understanding of their role in causing diseases. And there were no preventive vaccines. Augmenting the virus’ virulence, was its tendency to infect the upper respiratory system, thus, promoting its ready transmission through sneezing and coughing. There were no antibiotics to fight the secondary bacterial lung infections, such as pneumonia, that resulted.
The battle between humans and pathogens--viruses, bacteria and parasites--has been ongoing ever since humans appeared on the face of the earth. Pathogens have been evolving into newer strains to avoid and overcome natural human defenses. Many have now become resistant to antibiotics, our most potent weapon against bacteria. It is hoped that medical sciences will be successful in discovering newer and more sophisticated tools to fight these ever-changing ancient adversaries.
(Dr Syed Amir is a former Assistant Professor, Harvard Medical School, and a health science administrator, US National Institutes of Health)
