Dr Narbada Thapa
Hundred years ago in 1918 AD, immediately after the end of FIRST WORLD WAR, almost 50 million people died worldwide due to Spanish Flu and 500 million infected, a world recovering from a global war that had killed 20 millionpeople suddenly had to face even more deadly “a Flu Outbreak”.The H1N1 influenza strain emerged to cause the “Spanish flu pandemic”, a disaster that has been called one of the ‘greatest medical holocaust in history” (CDC, 2016).
All of the deadly outbreaks and pandemics in the past such as Flus, SARS and MERS hadexhibited almost similar history of disease transmission including COVID-19 today. In 1918, Spanish flu was spread rapidly through the respiratory droplets ofINFECTED TRAVELERS. Because of the end of World War-1 (WW1), the population mobility was high – The Traders, Laborers, Soldiers, Migrants travelled from one town or country to another. Harbor towns, Sea ports, Stations, Ships and Trains transported the infection. Poor sanitation, overcrowding, and homecoming soldiers after WWI intensified the spread of infection. Once an outbreak exploded, it was out of their hand. Unprepared Public health system for a NEWinfluenza strain of such pandemic potential, No tests kit for the diagnosis, Immunization and antibiotics to treat secondary bacterial pneumonia were still decades away. They did recognize, however, that the routes of transmission were via infectious respiratory droplets. All resources were scarce due to WW1 (Pathogens 2016)
Where was the MISTAKE and the LESSON?
To get rid of any infections/ diseases, either we prevent or treat the diseases. But when the disease causing agent is new or unknown, we cannot use any immunization and the medicine without research. BUT In this scenario, if we recognize the nature of disease transmission “The first and the foremost steps to control the infection is STOP/ DELAY THE INFECTION TRANSMISSION”, as early as possible.
BUT, in 1918 pandemic, local outbreaks were ignored in early stage, and action was not taken until it was too late to achieve containment”. “DELAY ACTION” was the major pitfall in 1918 pandemic. Only after the first wave of pandemic, “non-pharmaceutical intervention (NPI)” was implemented to stop Virus transmission – such as Closure of Schools, Bans on public gatherings, Quarantine, Isolation, infection prevention practices like cough and sneeze etiquette etc.As NPIs alone may not affect susceptibility to, or infectivity of Virus, it is for this reason, if NPIs are discontinued prematurely, infection may quickly return to its normal transmission patterns. Thus early and proper NPI for longer duration had a greater impact onflatten pandemic peaks
SUCCESS STORIES - Who died and who survived?
In 1918, the city of Philadelphia, Ignoring warnings of influenza among soldiers preparing for World War I, the march to support the war effort drew some 200,000 people who crammed together to watch the procession. Three days later, every bed in Philadelphia’s 31 hospitals was filled with sick and dying patients, infected by the Spanish flu. And by the end of the week, more than 4500 were dead. By the time Philadelphia’s politicians closed down the city, it was too late.
In St. Louis, within two days of detecting its first cases, the city closed schools, playgrounds, libraries, courtrooms, and even churches. Travel and movement of people were strictly limited, Public gatherings were banned which kept per capita flu-related deaths less than half of those in Philadelphia.
Many communities basically shut themselves down. “No one came in and no one came out. Schools were closed and there were no public gatherings. Healthy group of people are shielded from the risk of infection from outsiders.In Island, few arrivals were allowed and confined to quarantine, were given three times daily throat sprays, and had to maintain a distance of 20 feet from one another.
A similar story unfolded on the on the Australian island of Tasmania, which implemented strict quarantine measures for boats arriving on its shores that required all passengers and crew to be isolated for seven days. The death rate on Tasmania was one of the lowest recorded worldwide.
Overall, analysis showed that cities banned public gatherings, closed theatres, schools and churches early had far lower peak death rates and infection.
Importance of Social distancing, Quarantine and Isolation. Lesson from the past and present - COVID-19 TODAY?
The History is always great! It tell us many stories to ease our today if we listen.It is interesting that, the approach adopted in 1918 Spanish flu outbreak was almost similar to COVID-19 today?Hundred years ago, the scenario was totally different. Today we are better equipped with established system, knowledge, experience, resources and communication.BUT, again we have NOvaccine and medicine for this newly emerged Virus SARS-COV-2. … If we don’t have weapon then we better STAY AWAY FROM THE ENEMY. Hide yourselves by keeping away from social gathering, stay at home, use mask, maintain distance at least 2 meters (Newly recommended) from each other, hand washing more frequently with soap or the hand sanitizer, Disinfect/ Clean surrounding, don’t stays in crowed, adhere to lockdown. Don’t touch cash directly while buying and selling goods. Use tissue/newspaper then clean it afterward.For the detail you can find in Internet website, CDC/WHO guideline COVID-19.
Conclusion:The increasing number of new infection and death toll of COVID-19 pandemic has been a deadly threat for human kind. The natural history of the disease and the true nature of virus is still not known completely. TheRo (Reproduction number) of 1.7 to 6.49 and mean range of Case fatality of2% - 3% indicates a high infectivity and virulent of this virus which is an extremely alarming for today’s world - populous and interconnected. Some recent studies, claimed the presence of COVID-19 RNA in air samples (preliminary data from China, Singapore).
Not only from the history, present outbreak also taught us lesson – as how world is suffering because of delay in NPI – Europe and America. When such level of contagious virus travel via respiratory droplets then it has always been disaster if we don’t BLOCK / BREAK the travel route of infectious agent urgently. The more humans at any given place and the more they get into contact with each other, the more infections there will be - propagate infection. Along with preventive measures including Quarantine and Isolation, screening test and contact tracingare very important to save lives. Otherwise, in such propagated outbreak, it will be too late and we can just wait helplessly until the larger peaks sweep the people.
BE RESPONSIBLE FOR YOURSELF, FOR YOUR FAMILY, FOR YOUR COMMUNITY AND THE WORLD.