What history can teach us about COVID-19 and future pandemics

Posted on Tuesday, April 21, 2020

Thirteen 1918 Red Cross female workers making anti-influenza masks.

Red Cross workers making anti-influenza masks for soldiers in 1918. Boston, Massachusetts. Credit: National Archives, 165-WW-269B-26

The emergence of a new global contagious disease like COVID-19 is not historically surprising, say several University of Ottawa experts. In fact, the study of previous pandemics sheds light on the current crisis and its possible aftermath.

“Pandemics tend to occur about every 40 years, but they do not conform to a schedule,” says Professor Tracey O’Sullivan of the Interdisciplinary School of Health Sciences. “We were overdue when H1N1 occurred in 2009, but here we are, 10 years later, with another one.”

Robert Smith? (the question mark is part of his name), a professor of mathematics who specializes in modelling infectious diseases, predicts that “we’ll see multiple waves of COVID-19, meaning multiple lockdowns.”

Professor Susan Lamb, who holds the Jason A. Hannah Chair in History of Medicine, says humans have always reacted with fear and irrational behaviour when faced with an outbreak of a deadly disease that appears inexplicable and unstoppable. “This often leads to sudden changes in social norms such as voluntary isolation or hoarding resources, and accusations that one social or ethnic group in particular is to blame for the scourge.”

These troubling insights show that people around the world must continue to improve their response to the current pandemic and those to come.


1918: The “Spanish flu”

The “Spanish flu” was the first true pandemic of modern times, and it was terrifying evidence of just how much the world had shrunk by the beginning of the 20th century, says Lamb.

The period between 1880 and 1918 saw a transatlantic boom of immigration and international trade. Increased global connections, accelerated by the events of World War I and deployment of large numbers of troops around the globe, had begun. “As if to advertise the consequences of these massive changes and movements for human health,” explains Lamb, “the year 1918 brought the most mobile pandemic in recorded human history.” A wave of influenza swept the globe and infected upwards of 500 million. “We estimate it killed between 20 and 50 million people in less than two years.”

Deaths from this disease surpassed those caused by the war, which was still being waged at the time, adds Lamb. It circled the world twice before Spain acknowledged that it had thousands of cases and deaths. “Spain was a non-combatant that could reveal its state of crisis—something warring nations were unwilling to do.” Spain’s role was to alert the rest of the world to the magnitude of the problem. “This is how the misnomer ‘Spanish flu’ took hold.”

Three 1918 men are wearing masks in a field.

In 1918, the practice of wearing surgical masks in public became commonplace as people feared a killer they could not see. Credit: Library and Archives Canada, RPA-025025

A number of measures were taken to attempt to contain the influenza pandemic.

“Public gatherings were banned. Schools, churches, theatres and businesses were closed indefinitely. People wore face masks, but those measures did not stop the disease,” says Lamb. “There were new cases and more deaths every day.” Bacteriologists worked frantically to isolate the pathogen and find an antidote, with no success.

The 1918 influenza, the deadliest epidemic since the 14th century plague, mysteriously disappeared within two years. “The crisis helped end World War I and highlight the need for global cooperation. After the war, the League of Nations was formed with a subdivision called the Health Organization of the League of Nations, which became the World Health Organization (WHO) after World War II.”



Lessons from SARS

Less than a century after the influenza pandemic, another global outbreak arose: severe acute respiratory syndrome (SARS). According to Smith?, that epidemic was, in many ways, an easy disease to eradicate. “We acted quickly and efficiently with SARS,” said Smith?. “Contact tracing was implemented early in the pandemic, and the hospital system adapted to isolate SARS cases so as to reduce cross-infections.”

In a late 2019 article published in the American Journal of Biomedical Science & Research, Smith? says that “mathematical models are already using the SARS case as a motivating example for successful intervention strategies, illustrating that multiple intervention strategies are required, that school closures, contact tracing and quarantine are effective tools and that delays between the onset of symptoms and hospitalization are critical and can be reduced when health workers and the public are alert.”


COVID-19 and the aftermath

While rates of infection and mortality of COVID-19 pandemic do not yet come close to the 1918 influenza pandemic, they are already much higher than those for SARS. So what comes next?

A woman holding a phone wears a surgical mask.

COVID-19 is the first global pandemic of the Digital Age, when public health policies rely on virtual connectedness to sustain physical distancing.

Distinguished University Professor Chad Gaffield of the Department of History notes that the repercussions of COVID-19 in societies around the world “illustrate the potential value of knowledge from past experiences, whether in terms of robust preparation (for example, prudent stockpiling of masks and hospital supplies), immediate action (most notably, intensive testing and contact tracing), or other effective strategies such as coordinated management.”

This is the first global pandemic of the Digital Age, when public health policies rely on virtual connectedness to sustain physical distancing. Gaffield’s concern is that “the historic pattern in which pandemics have a socially differential impact within societies may worsen without special attention to digital divides in confronting COVID-19.”

This fall, Lamb will teach a course called History of Global Health and Disease. “Historical knowledge of past epidemics draws our attention to the harmful potential of any novel virus,” she notes, “but also encourages us to reflect on our emotional and behavioural reactions (noble and despicable), so like our human ancestors.”

When COVID-19 disappears from the media spotlight, “it will be important for people, especially employers and decision makers, to remember that social systems disrupted to this extent do not recover quickly,” concludes O’Sullivan. “Frontline workers, for instance, are at risk of burnout and will need time to recover.”

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