Unquestionably, we won't be making the same mistakes as last time and we're definitely doing better than last time, and most certainly wouldn't be doing any worse. Absolutely.
And so it begins. Or better yet, began.
A century and just a little bit more ago, the major countries of the world were involved in a historically bloody and seemingly endless conflict, the Great War. I think such a name is ridiculous, because nothing about pointless motives, stagnant front lines, miserable conditions, shortages of goods, colossal sums of money wasted or millions of lives squandered is worthy of the term "Great". We didn't even get any good video games out of it, so what's the use in that?
By 1918, the Very Bad and Unproductive and Not Fun or Nice War #1 had entered its fourth miserable year. Countless young people were being mobilized for military service, and citizens rationed their goods and intently waited on newspaper headlines or mail from relatives on the frontlines. With such a rosy backdrop, our story begins with reports in an army camp in Haskell County, Kansas. Medical records show the detection of a new strain of influenza among army recruits, cases in particular being more contagious and deadly than a seasonal flu. Starting with a handful of cases, the number of infected soldiers quintupled within a week and was soon becoming too pervasive to contain within the military encampment. As one can imagine, soldier training isn't just for fun & wargames, and from there, the movement of troops and wartime goods handily assisted the virus in spreading to across state lines, bodies of water, reaching civilians and fighting forces in Europe and North America.
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An emergency hospital in Camp Funston, where some
epidemiologists believe to be the primary source of the virus |
The first public health report indicated an abnormal and dangerous situation, but publication came up against a little piece of wartime legislation; The Sedition Act. As America's version of the many national wartime censors put in place at the time, it criminalized the publication of any information that might hinder the war effort, and as such media outlets were restricted from circulating detailed, factual reports unfounded rumours of disease to the public. After all, it's unpatriotic to gossip about succumbing to illness in a miserable, muddy trench! Think of what such loose-lipped gossip would to to undermine a population's willingness to get shot, gassed, bombed or otherwise senselessly killed in a miserable, muddy trench!
Such restriction of information had the wonderful effects of suppressing the legitimate risk of the virus while dishonestly or mistakenly sensationalizing it as a piece of propaganda. In Brazil, newspapers blamed the Germans for allegedly spreading the virus to their country via submarine, while the Senegalese called it the Brazilian flu. As they were defending themselves against Soviet invaders, the Poles called it the "Bolshevik disease", despite it having spread to them from Germany & Western Europe. Newspapers published articles blaming jazz music, dancing, bomb craters, immigrants, and Jewish people as the source of this new malady. Despite subsequent research identifying the first documented cases and successive spread within its own borders, America remained somehow unscathed in the storm of nasty nicknaming and finger pointing.
One unassuming nation, however, would not be so lucky. In Europe, having sat out the Really Not Great In Any Respect War, the neutral country of Spain would have the misfortune of being stuck with the virus's popular name. Having no wartime press restrictions, Spanish press outlets published the first candid and widely circulated reports of the pandemic's extend. While these articles provided the public with invaluable insight, it also gave the misleading impression that this new "Spanish" Influenza was the starting point of the epidemic.
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| A publication from the Alberta board of health |
It sure is great that in the 21st century, we take such good advantage of our access to information! We value what advice scientists and medical professionals to face these challenges, instead of taking part in brash, sensationalist finger pointing. It's incredible how crude, rude and stupid we used be, we sure have come a long way in 100 years!
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A newspaper comic outlining the dangers of misinformation
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Once the medical community had declared the devolving international situation as an official pandemic, the next major challenge was to provide guidance with preventative measures and educate the public to the dangers and pervasiveness of this new influenza. Misinformation and good old-fashioned human stubbornness continued to frustrate efforts to take action on a large scale, including a common perception that this was "just the seasonal flu". At the time, common ailments such as smallpox, cholera, or being a character in a Charles Dickens novel had higher mortality rates than influenza, making this assessment all the more dismissive in effect. Others would capitalize (sometimes maliciously) on unfolding events to sell heavily-alcoholic or even toxic concoctions touted as "elixirs", or marketing of "flu-chaser" goods such as hot water bottles, winter clothing, or unrelated pharmaceuticals.
Whether prepared or not, the first wave of influenza would travel the world at a rate that would put most obnoxious travel bloggers to shame. Within 4 weeks of discovery, the novel strain had become rampant throughout European frontline troops, and would reach North Africa, India and Japan in another month's time. Cases were so pervasive in Europe that major war operations were delayed due to overwhelming rates of illness. Whether in the trenches or back at home, it was not health advisories or media outlets that would change public perspective, but the virus itself appearing in undeniable surges, bringing tangible and sober meaning to the term 'pandemic'.
With so much proven, evidence-based proof in the Age of Information, we can say goodbye to crockpot conspiracy theories and virus-deniers! Certainly, no one could deny a pandemic with so much data at their disposal.
Like our own coronavirus pandemic, influenza cases levelled off after a springtime spike, but stubbornly lingered within the population like that friend at a party who refuses to go home even as you stand in your pajamas and pour them the last of your wine. The ever-present danger of the virus was especially acute as it predated the discovery of antiviral drugs or antibiotics. Without a vaccine to immunize one's self, and the biological possibility of a more dangerous resurgence or mutation, defensive measures had to be adopted to combat infection rates. Predating any public healthcare system or whatever they have in America that seems to be getting such bad Yelp reviews, cities shouldered the responsibility to plan ahead and safeguard themselves against the pandemic. This free-for-all shitstorm decentralized approach, most optimistically put, leaves us with a variety of strategies and corresponding results to compare. Revolutionary ideas included maintaining distance from others, quarantining the sick, banning mass gatherings, closing places of gatherings such as theatres, schools, and houses of worship, and legislating the wearing a small piece of cloth on your face as a barrier against germs. While they weren't perfect, these methods helped to prepare the world for what was soon to come.
California rail commuters wearing masks
A boy outside a closed theatre in Toronto
A Minnesota newspaper announcing restrictions
The stories of three major American cities illustrate how to (or how not to) fight a pandemic, as well as show how great and fantastic and definitely very good our own response has been.
In the fall of 1918, Philadelphia began to experience the sudden increase in cases that had been seen along the east Coast of the U.S., the origin being federal army & navy installations packed with wartime traffic. This was especially worrying as the city was a major mobilization hub and housed one of the country's largest naval bases. The city's public health director, Wilmer Krusen, was absolutely confident that these were just examples of a seasonal cold, but maybe if it might not be it would absolutely certainly be contained before it reached the civilian population. Within a week's time, new cases were reported within the city itself. Krusen reassured locals that they could remain flu-free by practicing effective, modern and definitely proven strategies like staying warm, drying their feet, and keeping their "bowels open".
<<insert poop meme here>>
The upcoming Liberty Loans parade (one of many held throughout the country to help pay for the Very Bad and Tremendously Expensive War #1) was deemed too important to cancel, despite loudening concerns from the wider medical community. Roughly 200,000 people from in and around the metro area packed the streets as uniformed soldiers, brigades of auxiliary personnel and cutting-edge armoured vehicles proudly progressed to the steady beat of marching bands, while confetti tumbled from on high on the jubilant scene.
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These scenes from Philadelphia were similar to those in
other cities around the U.S. and Canada, and were a
distinct aspect of life on the Home Front |
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New military technology or captured equipment was often
displayed to help drum up support for purchases of war bonds |
Three days later, every hospital in the city was overwhelmed, packed to capacity with newly infected patients. By the end of the week, 2,600 people were dead due to influenza. Within a month, a further 47,000 cases and 12,000 deaths marked the high water mark of Philadelphia's second wave as the city was unable to cope with a completely uncontained spread of the virus. Sick workers caused labor shortages in industries and a sharp drop in business essentially put a freeze on the local economy. Epidemiologists later discovered an abnormally high mortality rate amongst young adults, a group that would normally be more healthy and resilient suffered due to increased exposure risk at their places of work. Families left without breadwinners, and orphaned children also led to a regional humanitarian crisis in the following months.
The case of Philadelphia is one of "learning the hard way". The decision to downplay and dismiss the growing threat meant the opportunity to act had already passed once the scope of the pandemic was evident. Too late for any significant preventative measures, a total of 500,000 cases and 16,000 fatalities accrued in only six months. On a national scale, 198,000 Americans succumbed to the flu in October alone as America and the world struggled to cope with a second, more deadly wave of influenza.
What wonderful and useful lessons that we have collectively learned from. We'll never make those mistakes again... World leaders will definitely take things very seriously and not be so foolish as to dismiss an international pandemic as a "Hoax" or "media trick", which would only serve to worsen an already terrible sh*tstorm of conspiratorial garbage and put millions more people at risk.
At the same time, St. Louis took a different approach. Even before the first cases reached the city, the local health commissioner wasted no time in preparing the city for what was expected to come. Local physicians were put on on high alert, healthcare personnel were mobilized with new ambulances, and editorials were published about the importance of distancing and avoiding crowds.
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| The St. Louis Red Cross Motor Corps on duty |
Like Philadelphia, the first cases of influenza were detected among enlisted men and women. Unlike Philadelphia, the local government immediately responded by mandating the closures of schools, pool halls, theatres and banning public gatherings. Even as there was pushback against these seemingly oppressive measures, the mayor closed ranks with the commissioner and held their ground. As cases swelled, a system of volunteer nurses were ready to treat patients with in-home care. A proactive and consistent response to the pandemic meant that St. Louis was one of the most successful municipalities in flattening their curve and keeping case numbers within a manageable quantity. Even though a third wave would return in the coming spring, records show that mortality rates were half of Philadelphia's, and eight times lower during the peak months of October and November.
The city was not alone in its pre-emptive planning or prompt response. However, the pushback from these restrictions would produce undesirable consequences for other municipalities.
San Francisco had endured its 2nd wave of influenza as the same time as most American cities, experiencing rapid infections and instituting new safety mandates the fall of 1918. Much like in other cities across the country, the mayor acted on advice from the medical community and mandated mask-usage to combat the spread of the flu. The local police department issued $5 tickets for a failure to comply, with all proceeds going to the Red Cross.
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| Customers lining up to purchase masks |
The public at large had already begun to use masks well-before they were mandatory, but arrests and fines became a focal point for some. 127 people were charged with "disturbing the peace" on the first day, and courts cases began to back up with those challenging the legality of their charge. Some were careless, such as commuters travelling through the city with masks hanging from their chins as they smoked on train station platforms. Others were obstinate, as a local attorney alleged in claiming the mayor's decree unconstitutional. Even the mayor himself was photographed without a mask while attending a boxing match with several prominent locals; his own Chief of Police charged him $50 for his indiscretion.
Through the second wave of the virus, citizens increasingly resented the restrictions, despite case numbers levelling off and some public entertainment venues reopened. Eventually, dissent was mobilized in the form of a political action committee, coincidentally headed by a staunch opponent of the mayor with the support of city councilmembers who had frequently voted against him in the past. Disunity within the local government and the conspicuous participation of well-known individuals set the stage for the Anti-Mask League of San Francisco to be founded in January of 1919.
As one of the most organized anti-mask movements of the time, the League held rallies and advocated for the end of tyranny and the resignation of an oppressive mayor. While cases were beginning to level off and the public had desired a return to normalcy, influenza cases still remained in the city. The mayor was reluctant to concede, as there were still numerous known cases in the city. Pressure mounted as leaders such as suffragettes, anti-immigration advocates, and other public figures joined the call. Protesters claimed a "lack of scientific evidence" of the effectiveness of covering the germ-filled hole in one's face, and challenged the seemingly unconstitutional basis of making mask usage compulsory during a deadly, widespread viral outbreak.
After weeks of lobbying, the mayor acquiesced and repealed the city's mask ordinance. Many San Franciscans triumphantly stripped off their masks and tossed them into the streets the following day once the measure was officially repealed. Unfortunately, this set the stage for the next wave of the virus to re-circulate in the coming months and ravage the city again with tens of thousands of cases. Law enforcement had to start again from square one as dissenters and Despite initial precautions, more preparation time and instituting safety measures, an inability to stick to the plan resulted in the city eventually becoming one of America's hardest hit communities, with the 5th highest mortality rate in the country (closely behind Pittsburg, Philadelphia, Boston and New Orleans).
Harnessing the frustrations of living in the midst of a pandemic for political traction was ultimately effective and successful. However a useful tactic it was, it worked against the common goals and medical advice of the times. Accepting the new realities of the pandemic was unquestionably difficult; Changing daily habits, feelings of powerlessness, and going without many of the fulfillments of everyday life. Freedom of association, public advocacy, and choosing one's own path are abilities citizens enjoy in individualistic and democratic societies, but came at a cost when their means were divisive a time of crisis. The cost of politicizing a pandemic can be measured in the case of San Francisco, as the virus cared not for leaders or ideological affiliation, only ways to more easily spread to new hosts.
With a plethora of evidence and the same goal in mind, we know that no sensible political leader would lend credibility to an anti-movement that would undo. In a time when it is more imperative than ever to work together, our elected officials will ultimately cooperate to fight the flu and end the pandemic as soon as possible. What other productive option is there?
Ultimately, the 1918 Influenza pandemic would infect approximately a third of the world's population over the course of two years, with a final mortality rate of roughly 2.5% (though this rate was much higher in areas that experienced rapid case surges). Some countries experienced up to four waves of infections, bringing the total loss of life to between 17 and 50 million lives by most credible sources. Vague census information and inaccurate recordkeeping in underdeveloped countries & Communities, as well as fatalities being lumped in with wartime casualties means that in all likelihood, we'll probably never know the exact number.
So where does that leave us in 2020? If you've made it this far, I'm sure you feel like you deserve a concrete answer, or at least an educated guess. Studies of similar novel influenza epidemics give us a framework to use:
Major influenza pandemics, such as the "Spanish", "Hong Kong", and "Asian" flus endured on a significant scale for approximately two years. In all of these cases, the first year of the pandemic was by far the most potent with rampant spreading, economic slow-downs, and healthcare facilities struggling to cope with the crisis. Afterwards, new strategies, better understanding and improved treatments helped to prevent influenza from resurging. Often, while a more contagious virus poses many risks, it also exhausts the number of hosts it can spread to. Recovered patients with levels of immunity, effective vaccinations, and a population motivated into practicing effective habits will most often deprive the virus of its wide variety of honeymoon hotspot destinations it requires to sustain itself.
Vaccines are complicated and vary wildly in their development and applications, different types often being developed for a single virus. Most take at least six months to develop, plus manufacturing and distribution times. Early vaccines may have unreliable effectiveness rates (such as in the first one available for swine flu) but are generally safe for administration.
Defensive measures are effective so long as the public & governments are willing to do so. Later studies of the pandemic of 1918 by American epidemiologists would conclude that U.S. cities that restricted public gatherings and mandated mask-wearing cut casualty rates by roughly half, but only if communities enacted measures early on and refrained from lifting them prematurely. In general, pandemics take a very long time to accurately assess. Some viruses are not properly understood for years after their outbreaks and subsequent recession. Factors such as long incubation periods and frequent asymptomatic cases further complicate this. In the case of the 2009 "swine" flu, lab-confirmed test results marked the international total of confirmed cases at 491,000. This strain was effectively milder and less deadly than even the typical seasonal flu, and many cases would go unreported and untested. In fact, post-pandemic studies eventually concluded that up to an estimated 1.4 billion people (a fifth of the world's population) had likely contracted the illness.
There exist a few viruses that have transformed from a pandemic to simply endemic; The equivalent of that aforementioned lingering party guest becoming a seasonal roommate who is impossible to permanently evict. Malaria and HIV-AIDS are both unpleasant maladies to which there exist no vaccine, and so we have focused our efforts to treating the sick and preventing future cases. Chicken pox is now a common part of childhood, as the risk of contraction in adulthood is significantly higher. While this is certainly not a victory , better scientific knowledge and medical treatments will let us work smarter instead of harder to reduce fatalities.
A gambling man may wager that a vaccine is on the horizon, that a tested "cure" will put the brakes on the spread of the pandemic. One might say that, until then, we might improve our strategies to live with the virus to reduce risk and adjust the ways we satisfy our need for "normal life". Predictions could be made that countries that are consistent in their truthfulness to facts, adherence to science, and endurance against backlash may come out of this sooner than those who do not.
[Take note, leader of the free world and greatest country on Earth]
I, however, am not a gambling man. I am an amateur blogger and historical enthusiast. Consequently, history shows us, there are adverse consequences when we are unable or unwilling to work together; Negative effects of publishing misinformation or conspiracy theories, and tangible costs of arrogance, dismissiveness, or obstinance to doing one's part to when called to serve our communities in crisis. At the time of authoring this (October 2020), we are very much in the thick of it, so to speak. Times today seem almost worse than any other in living memory, and one has little individual effect on the wider course of events. As history also shows us, however, is while a pandemic is one of humanity's most pernicious and deadly adversaries, it is ultimately one that we can understand, adapt to, and overcome.
Until then, I hope that this perspective might provide you with a bit of brightness until this dark and difficult time is itself relegated to the chapters of history.
