We’ve been here before . . .

. . . and, no doubt, we will be again.

The last global pandemic did not occur a century ago. The 1918 “Spanish Flu” was epic, but there have been more recent versions that were widespread and devastating, causing more than one million deaths worldwide and upwards of 100,000 deaths in the United States. But hardly anyone remembers.

It is important to point out that the Coronavirus crisis of 2020 is not without precedent; only the actions we have taken are unprecedented.

Dr. Deborah Birx said as much in the Good Friday Coronavirus Task Force Briefing. “We’ve never before taken a national, or a global, approach to mitigation. This is unprecedented,” she said.

Dr. Birx did not specify what was done during the 1957-58 Pandemic and the 1968 Pandemic. I cannot help but assume that, during her career, she studied those health crises, and that she is familiar with the statistics. Granted, the country was not shut down, and widespread stay-at-home orders were not issued.

However, schools and businesses in some states were closed, makeshift hospitals and treatment centers were mobilized in some cities, citizens were urged not to travel if it was not necessary. Fear and uncertainty were widespread, and the number of infections grew steadily over the course of several months. In the fall of 1957, at the start of the school year, localized outbreaks resulted in high absenteeism, and businesses reported that between 10 and 20% of the work force was affected.

In 1958, there was a second wave in the United States, more devastating than the first the previous fall. There are normally second, and even third, waves of infection. Some, like AIDS and Ebola, never go away but are ultimately controlled. They are hardly newsworthy, but they are often devastating.

News coverage, however, was very different in the mid-20th Century, described as “low key,”  and social media did not yet exist. There was no daily death count reported by the media, even though it is now conceded that about 40,000 Americans died in the fall of 1957 due to the flu. The first wave of infection was more deadly for children and young adults, while the second wave in 1958 seemed to target people over age 65.

A Century of Pandemic Experience

The 1957-58 pandemic is known as the “least deadly” of the three major 20th Century pandemics. Statistics vary, but the official estimate by the U.S. Centers for Disease Control and Prevention (CDC) reports an estimated 1.1 million deaths globally, with approximately 116,000 in the United States. A vaccine had been made available in late August 1957, but it was deemed to be only 45 to 60% effective. Officials still recommended that Americans take advantage of the “flu shot.”

This particular influenza, identified as an H2N2 strain, disappeared after only 11 years, according to an article, “Influenza Pandemics of the 20th Century,” by Edwin D. Kilbourne.

In 1968, however, another virus would appear, this time a new strain that would prove more troublesome and more deadly. Once again, it spread rapidly, but its severity would depend on a variety of factors. Now categorized as an H3N2 virus, it remains to this day the “major and most troublesome influenza A virus in humans,” according to Kilbourne. First identified in the United States in September, this pandemic also claimed the lives of approximately 100,000 Americans and at least one million people worldwide.

Another flu made an appearance less than a decade later, in November 1977. Although it was generally mild, it was again a variant of the previous H3N2, termed a “juvenile age-restricted, global pandemic.” It appeared first in the Soviet Union, and was initially termed the Russian flu. It targeted children and young people, thought to be susceptible because they had not developed antibodies to this particular strain of virus. About the same time, a return of the H1N1, which was the virus that caused the 1918 pandemic, was noted, but in slightly different, mutated form. Interestingly, the 1977 virus continues to confound researchers.

CDC reporting of infections and deaths has changed over the years, but by looking quickly at available statistics, the range of American deaths during the 1977 flu season could be placed between 6,000 and 43,000.

The Reality of Pandemics

Anyone age 70 or older might have a faint recollection of the Asian Flu in the late 1950s.  Some memory of the 1977 Hong Kong Flu should linger with most Americans who have reached about age 50. The Russian Flu seems perfectly forgettable unless a family was personally affected by it. Finally, we should not forget the 2009 flu that circulated the globe in 2009 and 2010. That one, unlike the two previous, was most serious in children and young adults. Older adults, particular those over 65, were more likely to have some immunity from the virus, even though it was a novel strain of H1N1.

Why is it, then, that there seems to be an American amnesia about these previous events? The “seasonal flu” that causes little alarm these days is a sobering reminder that these old viruses are still around. Also, every year, the flu claims the lives of between 6,000 and 70,000 Americans, based on CDC estimates. Every new epidemic has similarities to past pandemics. According to epidemiologists and infectious disease specialists, many seasonal viruses are just enough different that previously-developed treatments and vaccines may offer some relief, but they are not foolproof. And no sure prevention or cure exists for any viral infection.

Like everyone else, I have never seen anything quite like this. I do, however, have some memories of 1957, 1968 and 1977. Recently, through research, I have learned more than I ever wanted to know about plagues, pandemics and the recurrent spread of virulent viruses.

It’s not the current number of infected, nor even the number of deaths that has me most concerned. I feel for those who become seriously ill, and I weep with those families who lose loved ones to a new respiratory virus, one for which there is no known treatment, and about which little is known. All of us are affected. I know with certainty that our “normal” will never be as it was.

But I also lived through the polio scare, measles and chicken pox, and knew of smallpox and tuberculosis. Even the plague. Yes, it too still exists. Bubonic plague cases are not uncommon, to this day, in the Mountain states, but it is a bacterial infection and it is spread differently, through direct contact with infected fleas. *(There are some researchers who now believe that the Black Death of the Middle Ages was not the plague at all, but a rapidly-spreading, highly-infectious virus instead.) 

Looking Ahead to Post-pandemic life

What is most memorable about the 2020 pandemic may very well be the international reaction to it, the effect on global economies, and the disruption of every aspect of our lives. It was informally tagged COVID-19 because it was first reported to the World Health Organization office in China as a novel form of pneumonia on December 31, 2019. On February 11, 2020, is was officially christened as SARS-CoV-2, because it is a “genetic cousin” of the 2002 SARS virus. 

Just in case you didn’t know, there are only seven coronaviruses that have been identified: Four cause the “common cold,” and three are the triggers for SARS, MERS and the current pandemic. Whether that should make us all feel better or lead to additional worries is debatable.

However, whether there is a second wave of the current novel Coronavirus, or it continues to be a seasonal viral infection much like the H1N1, it’s foolish to assume there will be no more epidemics — even serious pandemics — in our lifetime. They happen regularly. And there may be more novel coronaviruses identified in the future.

To return to Dr. Birx’s statement about global response. No, governments have never before acted even remotely as they did at the onset of this infection. (Well, maybe the Black Plague?)

The response in 2020 is unprecedented not only in scale, but in geography, economic upheaval, and in disruption of normal activity. Self-isolation, mandated shutdowns, cancelled classes and closed schools, shuttered businesses, perceived shortages of healthcare equipment, sickness and death are by no means localized phenomena. But we have become a mobilized and global society, and that allowed the virus to spread quickly throughout the world.

Statistics and Sadness

The truth is that we have been here before, even though we have forgotten. Is it perhaps more normal than we think?

On Wednesday afternoon, April 2, the number of confirmed cases worldwide of COVID-19 surpassed one million. The number of deaths related to this new virus stood at not quite 51,500. Nine days later, at about noon in my time zone on Saturday, April 11, the statistics were horrifically different: 1,724,736 cases confirmed globally, and 104,938 deaths.

One week later, according to the daily statistics, there were 2,256,844 confirmed cases worldwide, with 154,350 deaths. On April 18, the number of fatalities in the United States was edging toward 33,000. To my horror, this morning, just one day later, the number of deaths has passed 39,000 in this country, with 742,637 confirmed cases in the United States alone. Global deaths now are over 162,000, with 2,355,676 confirmed cases.

Thankfully, the number of new infections seems to be slowing. American hospitals have not been overwhelmed as originally feared, but in other nations, the outlook has been grim. Still, though, it’s necessary to compare the number of deaths with the totals from other 20th-Century pandemics to gain a better perspective.

It’s a terrible thing to feel quite this helpless in a time so filled with scientific knowledge and modern technology, isn’t it? 

Note: This is the fourth in a series of posts I have dubbed Corona Chronicles.” The first was Twists of fate, published February 14, 2020, before the spreading viral infection had actually been declared a pandemic, followed by Faraway and the here & now March 23, 2020, and Look for the silver lining on April 17, 2020. There are more to come.

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