Remembering a pandemic 100 years ago

There are important lessons for the Subcontinent from the 1918 Spanish Flu outbreak

American Red Cross volunteers carrying a Spanish Flu victim in 1919. Photo: RED CROSS

The current COVID-19 pandemic has forced many to Google other historic outbreaks, and the search usually brings them to the 1918 influenza epidemic that killed between 20-40 million people – half of them in South Asia.

Just over 100 years ago, as Europe was coming out of a ruinous four-year trench warfare, American soldiers brought the flu to the front lines from where it had spread like wildfire across Europe.

Although it is called the ‘Spanish’ Flu, the virus first appeared in North America and crossed the Atlantic on US troopships bound for the front lines. It is called Spanish Flu because the virus was making people sick in the Pyrenees long after it had subsided elsewhere.

After the war, British Army soldiers returning to India (some of them could very well have been Gurkhas) brought the virus to Bombay from where it spread along India’s vast railway network. 50 in every 1,000 Indians died of the virus.

There were two waves of the influenza epidemic. It was probably transferred from returning migratory waterfowl to humans in Kansas in spring of 1918 before jumping across the Atlantic to Europe. The spread slowed over the summer, but returned with a vengeance in the autumn that year.

Although there are many books about the Spanish Flu in Western literature, in South Asia there is no properly archived documentation about the tragic pandemic that took many lives.

Even Mahatma Gandhi was stricken by the bug, and bodies were piled high along river banks in India as cremation sites ran out of firewood. Unlike COVID-19, the 1918 influenza virus struck people in the 20-40 age group.

While it affected 28% of all Americans, killing 675,000 – of the US soldiers killed in World War I, half died of influenza. But surprisingly, the pandemic had very little effect on China.

Many viruses have an animal reservoir, and the Spanish Flu was associated with ducks and pigs as is usual for influenza viruses. The MERS coronavirus that affected the Gulf region in 2012 is associated with camels, and the SARS coronavirus of 2003 transferred from civet cats. While the COVID-19 probably originated in bats like the other coronaviruses, its host is believed to be the pangolin.

As the ‘Spanish’ flu clearly showed, there is no evidence to show that we in South Asia have better immunity towards the novel coronavirus COVID-19. So, what can be done?

First thing is to increase tests for COVID-19 in suspected patients even without a travel history to affected areas. The more tests we do, the more we will know about the spread of  the actual disease.

Read also: This is a test, Editorial

It is also crucial to do cross-sectional serological studies in communities to see if the virus has been introduced there. This test (unlike the RNA-based diagnostic test for a patient) can be done on asymptomatic people in the community to check for COVID-19 antibodies in the blood, and could give us an idea about the extent of the exposure to the community.

Many of these antibody tests are new, and the Chinese have vast experience with them in treating COVID-19. The Nepali government would be well advised to seek Chinese help with antibody testing so that we are better prepared in the days and months ahead. Without more diagnostic and serological tests, we may continue to have a false sense of security as the virus continues to sneak up on us in South Asia.

The silver lining (if there is one) in this unfolding COVID-19 pandemic is the attention that it has attracted to the importance of rapid diagnostic tests for other neglected infectious diseases in South Asia like tuberculosistyphoid, typhus, or leptospirosis.

The tests need to be accurate, simple, affordable, and quick. Rapid diagnostics will not just help find infected people, but also to decide on specific therapy so that unnecessary antibiotics and other treatment are not administered. Proper diagnosis will lead to control of antimicrobial resistance, another medical crisis affecting the world today.

At present, diagnostic tests take many hours if not days, so hopefully, after the dust from COVID-19 settles, there will be more work on rapid tests for these still-rampant ‘biblical’ afflictions that plague us.

Another positive effect of the COVID-19 pandemic may be the restoration of people’s faith in effective tried and tested vaccines in the western world.

Rumours about side-effects of vaccines going viral on social media have convinced many parents not to inoculate their children, leading to outbreaks of vaccine-preventable diseases like diphtheria, polio and whooping cough in the West. If successful, the COVID-19 vaccine would set the record straight for the proliferation of ‘anti-vaxxers’.

Pandemics are like earthquakes, they cannot be wished away. It is best we prepare for a potential COVID-19 outbreak as best and resourcefully as we can. This is not optional, since there will be more pandemics in future.

Buddha Basnyat is a clinical researcher at Patan Academy of Health Sciences and a frequent health columnist for Nepali Times.

Buddha Basnyat


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