Coronavirus in Context: How This Might End: Lessons From the Spanish Flu | WebMD

[Music] welcome everyone you're watching coronavirus in context i'm dr john white chief medical officer at webmd i've been talking about covet 19 since march and everybody wants to know when will this end can we learn anything from the spanish flu many people have been talking about the pandemic that occurred over 100 years ago so to help provide some insights in how this pandemic may end i've asked dr howard markell he's the director for the history of medicine at the university of michigan dr markel thanks for joining me hi john well take us back a hundred years in terms of a lot of people are mentioning the spanish flu but everyone doesn't really know what was going on so can can you give us a quick history lesson of the pandemic of 1918 well um probably in the summer but not necessarily there was a short mild wave of influenza since we don't have viral samples we can't really prove that but we do know that in the fall of 1918 influenza which we have since discovered was the h1n1 strain of influenza ripped through the world basically in particular the united states and then there was a second wave or surged in the january to april uh part of 1919 which was pretty darn bad but not as bad as the fall one and then it was another surge by the way that nobody talks about in the winter of 1920. well by the time it was over uh probably uh 40 million people around the world died uh in the united states alone anywhere from 550 to 750 000 people died and at least 10 million americans got very very sick with influenza which as you know is not a common cold not a mild infection it makes you quite ill indeed there was very little medical care as we understand that a hospital was basically a bed and maybe somebody feeding you hot liquids there's no ivs no antibiotics and a lot of people who got the flu got a secondary bacterial pneumonia and that's what killed them because there was no uh medication for that so it was quite uh quite virulent no one had experience with it and it particularly affected unlike most seasonal flus which tends to affect and kill very little babies and very old people it was a w shaped curve of mortality that in the middle v were people from the age from 20 to 45 and they were dying like flies and that was very odd for influenza were people wearing masks was there social distance was there hand washing people say they're issues with sanitation back then there were of course issues with sanitation not everyone had running water uh 1918 is around the time in the united states where there were finally more people living in a city than living out in the country uh there were soldiers because you know there was world war one gearing up and they were in army camps where they dug the jeans and washed their hands from perhaps a well so that was an issue face masks were really in its infancy and when they were worn by a few play in a few places such as san francisco and seattle and los angeles they were made out of four or five layers of gauze you know how porous a layer of gauze so it was not exactly the most definitive way to prevent contracting influenza but there were social distancing measures that in essence was public health back then quarantine and isolation so you isolate the ill and you quarantine those you suspect of having contact with the ill public gathering bans you know the closure of bars of amusement theatrical events of bars and so on and school closures and in fact we at the center for the history of medicine at the university of michigan work with the cdc to do a rather comprehensive study of this that was published in the journal the ama in august of 2007 but we found that those cities that did those social distancing measures enacted early did more than one or layered them and did them for a long period of time did far better in terms of morbidity and mortality than those that did not and in fact that is the essence that is where flattening the curve came from it was our work that was the first historical evidence base of that concept is that the lesson that we've learned from the pandemic because people will say well you know what it's so different back then can we really make the same comparisons you just reference their issues with running water so is it is it fair to make the comparisons because everyone keeps talking about 100 years ago well as a historian i'm well aware of the differences between now and then that's what i do for a living and of course the nation was smaller the federal government had very little involvement at all in health issues back then uh it's a very different medical context and uh everything was different but what was the same was that you had big populated cities that use these measures against an easily transmitted respiratory virus and what's incredible is that it's not just the historical example of flattening the curve that seemed to bear out it was also other modeling studies that were developed later and then in the 2009 influenza pandemic in the early weeks in mexico where they did not yet know it was not terribly lethal they thought it was highly lethal as you may recall in those first few weeks they too did a social distancing program and their epi curves their epidemic or identical if you will to the ones that we found and of course we have the best experiment of all sadly uh we've been doing social distancing measures all around the world nature magazine called it the the one measure that saved more lives in a shorter period of time than anything ever uh concocted by humans and i think that's absolutely true i mean if you look at the lies that were saved and the infections that were prevented when it was being done it was working but you have to remember social distancing is really a form of hiding from the virus it doesn't prevent the virus it doesn't treat the virus it doesn't make you immune from the virus and it's it's not an issue of waves as much as the virus is circulating and circulating widely so when you go out there whether you're wearing a mask or not when you interact with more people for longer periods of time you are increasing your risk of contracting covid19 it's as simple as that and the virus we have to remember humans are the host so it goes to to your point about if that if you're hiding and you can't find a host is it just going uh to fizzle out and die and i wanted to ask you about how the pandemic of 1918 resolved you mentioned that you know it came back in 1920 so was it hurt immunity that everyone's talking about recognizing they killed tens of millions of people we didn't have a vaccine we didn't have treatments let's be clear about this of herd immunity and i'm telling you this is an old pediatrician okay hermione was never developed as a population uh kind of a measure when a virus spreads through a particular community it was based on active immunity giving people immunizations giving lots of children immunizations for example for measles mumps and when you immunized actively 90 or more percent of the community then when that infection came into that community subsequently it would not spread the notion of letting it rip and letting a lot of people get it first of all you would never get levels of 60 to 90 percent which is what people are estimating you would need 20 simply wouldn't do it and what is the point of living in the 21st century if we're relying on 13th century methodologies of letting it spread throughout a community to protect us not to mention the incredible expense of taking care of people and the terrible tragedy of those who would die so it wasn't i mean there were some people who were immune to be sure but of course as you know with flu just like probably with coronavirus you're not immune for that long of a period of time maybe four or five months but that's why we give flu vaccines every year some of it's because it's a different strain but also some of it is that your your immunity is worn down strains last because there was talk that you know ultimately the pandemic of you know 1918 really you know morphed into something else do we have a sense of how long respiratory i mean because these these are issues of mutations so um and where is the virus coming from influenza by the way you said well 1918 is very different from 2020. well of course it is but what nobody's saying is that the main historical actor in these two pandemics are quite different influenza is a very different virus than coronavirus 19 with the exception that they're both respiratory transmitted viruses influenza tends to burn itself out when the cold weather gets warmer we know that we were hoping that was the case with coronavirus because we saw that with sars for example in 2003 but this this virus does quite well in warm weather as we're finding out but it probably will rage better in cold weather especially as we're all indoors and crowded and we use artificial forms of heat which can cause little breaks in your mucosa your nose and your mouth and so on but it probably burned itself out because the weather changed there were people who were immune and uh you know the virus might have just attenuated and gotten more mild but influenza every year changes because it depends on the animal host and the human host and the level of mutations and are those mutations more than just typographical errors in the genome uh i mean the real story i call this the mutation that was heard around the world was when coronavirus 19 mutated from whatever animal it was a host in to the point that human beings could not only contract it but easily transmitted to other humans by breathing on them that that was the killer mutation well you study the past but i'm going to ask you about the future how do you think this all ends oh my you know historians like me are uncomfortable with the whole concept of the future that's why we live in the past i know but i can push you anyway as a doctor i make prognoses all the time however you know there's a wonderful poem by um t.s yet um this is the way the world ends with a whimper not a bang and it was written in 1925 and i'm blanking on the title of the poem but um will it just go away will it just vanish like a miracle well hopefully i think what the magic bullet that will protect us and then end this nightmare will be a safe potent and effective vaccine once we do achieve herd immunity the old-fashioned way which was based on vaccines i think then we have a fighting chance of ending this chapter in human history but there's and there's a huge but not just for industry or doctors or scientists or medicine to come up with this safe vaccine but is all of our responsibilities say here in the united states or in germany or england or other countries around the world to roll up our sleeves and take that vaccination and we already have an amazing amount of politicization with this pandemic more than any i've ever seen or studied that's a lot of epidemics over a lot of time and we have anti-vaccinationists and we have libertarians we have this and that and so it'll be essential to have leadership from the govern government and in science and in medicine who demonstrates that the vaccine is safe and effective and that we as a community all get vaccinated because it's a socially mediated disease i can get you sick and i won't get you sick and you won't get me sick if you're both vaccinated okay in the history of pandemics where does covet 19 in your mind rank not just in terms of human fatalities but also on the impact on life during that time that's that's a great dual measure i think you know the black death of the 13th and 14th century of course uh if you don't believe in it go to italy and look at all the frescoes in various churches and so on uh i would i would count the black death of the 13th and 14th centuries really high on my list maybe number one 1918 1919 number two but certainly the greatest in terms of death and cases and i would put covet as a close third maybe not number one or two but it's certainly up there in the top five and a lot depends on how long this goes on sure and certainly not a ranking we want um like other pandemics that you've studied in general you think it lasts a period of two years three years a year what's what's what's historical reference well we don't have a historical reference because when you're using a very old pandemic for example like the black death you know there was no medicine and then the doctors who did exist had a completely different uh idea of what caused infectious diseases and of course even with 1918 you had still you had germ theory but it was still a theory yeah you have no medications to end it and certainly no vaccines um when i wrote a piece for the new yorker magazine this august about just that and i said we would be measuring this not in weeks or in months but in years could it be only a year i hope could it be more than that if it may um and as i said it really depends on when we get this vaccine dr markell i want to thank you for providing your insights to giving us a history lesson so we can learn from the past and not repeat as you know that the the line about we don't want to repeat the mistakes those who ignore the past are destined to repeat it that that keeps people like me gainfully employed actually there you go well thank you for sharing your insights thank you and thank you for watching coronavirus in context

Channel: WebMD

Views: 9,159

Keywords: coronaivrus, covid-19, covid pandemic, pandemic, 1918 flu, 1918 flu pandemic

Id: 27g0kajcDL0

Length: 16min 31sec (991 seconds)

Published: Wed Nov 11 2020