COVID19

Why was the 1918 flu pandemic more frightening than COVID-19?

The Spanish Influenza. Chart showing mortality from the 1918 influenza pandemic in the US and Europe. Wikipedia commons.

According to the CDC, as of September 10, 2021, 652,480 Americans had died of COVID-19. This is nearly as many as the perhaps 675,000 Americans who died in the 1918 flu pandemic. But there seems to be much less fear of COVID-19 now than there was of the influenza pandemic then, at least in some parts of the United States. Why?

Of course, the first point to make is that there was certainly denial and minimizing in the United States in 1918, which people used to justify holding everything from war-bond rallies to weddings. Still, after the terrible month of November 1918 this declined. Is the difference between then and now in part that we live in social media bubbles? I think that there is some truth to this, but there are a few factors that explain the different attitude that many people had towards influenza then.

In 1918, there was a “W” shaped mortality curve, as most people who died were infants, young adults and the elderly. Before the arrival of the delta variant, there was a perception that those people most at risk of COVID-19 were over 65, and perhaps their deaths were less shocking. In contrast, younger people felt relatively safe. In 1918 it was people in the prime of their life who were dying, as well as their children. This made people feel more vulnerable.

Today, people typically die in the hospital. In 1918, if you lived in a rural area -as did most of the population- a trip to the hospital would take time and might not be easy. More people were cared for –and died– at home. I think that this meant that people saw the results of outbreak much more directly. Today, the ill vanish into hospitals. Their suffering leaves nurses and doctors traumatized, but isn’t visible in the same way that the 1918 pandemic was, when family members and neighbors would see the bodies taken out the front door.

There were three distinct waves to the 1918 influenza pandemic. But the fall 1918 wave had a much higher peak in the death rate. Of course, the spring 1918 influenza outbreak was terrible in some places such as the military camps in Kansas. But by November 1918 the number of deaths was so crushing that denial was no longer an option in many communities. People were too busy taking care of their neighbors; everyone could watch the gravediggers. COVID-19 has been more spread out, which has changed how people have talked about it.

The US population was much smaller in 1918 than now, at just over 103 million people, versus 328.2 million. So although the total numbers of deaths are similar, the death rate was roughly three times higher a century ago. People saw much more death during the 1918 pandemic.

I also wonder if people didn’t have a different attitude towards medicine. The 1918 pandemic took place before most childhood vaccines, antibiotics, and modern therapies. People had more limited expectations for what a doctor might do. Now, it might be that many people expect that if they go to the hospital they will be saved, because they have often seen sick family members or friends healed in a hospital. I can’t prove this, but I suspect some COVID-19 patients are shocked when they find out that they will die. In 1918, people respected and valued doctors, but the life expectancy for men was 36.6 years, and 42.2 for women. People didn’t feel as invulnerable -and didn’t assume that the hospital would save them- because they were more familiar with death. In 1917 -the year before the pandemic- the second most common cause of death in the US was pneumonia and influenza.

Of course, in 1918 people relied heavily on newspapers and the government for information, whereas now people turn to social media. But I think that people were more familiar with infectious illness in 1918, and experienced the pandemic in a different way than with COVID-19. This difference perhaps helps to explain why in many states people seem to be much less afraid of COVID-19 than their great-grandparents were during the 1918 pandemic.

Shawn Smallman

Historical photo of the 1918 Spanish influenza ward at Camp Funston, Kansas, showing the many patients ill with the flu- U.S. Army photographer

New light on the mystery of COVID-19’s origins

Photo by Vladimir Fedotov on Unsplash

Over the last year and half there has been a bitter debate over the origins of COVID-19, specifically whether it began as a spill-over event from a wild animal to humans (the natural origins hypothesis) or because of an accident at a science facility (the lab leak hypothesis). We now have some new information to shed light on this debate. We’re all familiar with Freedom of Information Requests in the United States. These often don’t lead to the release of information, because in practice individuals or the media often have to take the government to court to get this information. That’s exactly what the Intercept did, and the results were worth it. The Intercept received 900 pages of documents regarding two grants, which they discuss in an article, written by Sharon Lerner and Mara Hvistendahl, “New Details Emerge about Coronavirus research at Chinese Lab.”

One of the key issues with the lab leak hypothesis was whether work with bat coronaviruses was being done at a lab in Wuhan, including gain of function work. Yes, yes it was, although there is a significant debate about what constitutes gain of function work. And it turns out the documents that prove this come from a U.S. based health organization called Ecohealth Alliance, which used federal funds to finance this research. This has been suspected for some time, but we didn’t have much information to clarify the details of this work. Now we know that a US researcher, Peter Daszak, had a grant to screen bats for novel coronaviruses. This in and of itself might be valuable research, if undertaken under adequate safety conditions. The work was done at the Wuhan University Center for Animal Experiment, not The Wuhan Institute of Virology, which has received the most attention in the press. And there are concerns about the kind of work researchers were doing with bat coronaviruses. According to Richard Ebright, they were doing more than just infecting ordinary mice with this virus: “The viruses that they constructed were tested for their ability to infect mice that were engineered to display human type receptors on their cell(s)’.” According to this article, the grant to do this work ran from 2014 to 2019.

I was initially skeptical that the work of the Ecohealth Alliance could have contributed in any way to a lab leak. But there does seem to have been a contradiction of interests in the early investigation of COVID-19’s emergence. Peter Daszak was one of the scientists who signed a letter to the Lancet on February 19, 2020 in which scientists denounced as conspiracy theories the idea that a lab leak began the pandemic. He also was part of the WHO’s inquiry commission that went to China in January 2021 to try to uncover the origins of the virus. Since he was involved with work at question in China, his presence would seem to undermine the potential impartiality of this investigation. More recently, he has withdrawn from at least one effort to investigate the pandemic’s origins: “Dr Peter Daszak, president of the US-based EcoHealth Alliance, has “recused himself” from the inquiry by leading medical journal the Lancet after he failed to declare ties to the Wuhan Laboratory of Virology, which was conducting research into coronavirus in bats.” The point is that the early investigation of the lab leak theory may not have been fully impartial, and key evidence was missing.

Some scientists say that what these newly-revealed documents demonstrate is shocking. As Richard H. Ebright (Board of Governors Professor of Chemistry and Chemical Biology at Rutgers University) has said, the “materials further reveal that one of the resulting novel, laboratory-generated SARS-related coronaviruses –one not been (sic.) previously disclosed publicly– was more pathogenic to humanized mice than the starting virus from which it was constructed. . .”

We need to have better information on multiple questions: did miners in southern China (specifically the Mojiang mine in Yunnan) suffer from an acute pneumonia similar to COVID-19 in 2012? Was this pneumonia caused by a coronavirus which was then brought to a laboratory in Wuhan for further research? Was gain of function work with coronaviruses done at one or more labs in Wuhan, and what -precisely- were the biosafety practices and procedures? Was there a major move at one of these labs in December 2019, and what were the safety practices at the lab during the move, particularly for bats and other animals, as well as coronavirus samples? Were any employees of these labs ill with a pneumonia-like illness in November/early December 2019? Is it true that one U.S. based scientist, Ian Lipkin of Columbia University, heard of the outbreak on December 15, 2019, well before China revealed the outbreak to the WHO? If so, does this mean that the Chinese authorities knew of the outbreak, but did not share this information in a timely fashion, so that the world could try to prevent the disease from escaping China? Increasingly, the answer to most of these questions would seem to be a plausible yes.

As Alina Chan (a postdoctoral fellow at the Broad Institute) points out, COVID-19 wouldn’t be the only example of a leak at a facility in China causing a significant disease outbreak. Elizabeth Shim’s article on this outbreak, “Brucellosis cases in China exceed 10,000 after vaccine factory accident,” is well worth reading. So we know that such accidents happen, including in China, at the same moment that COVID-19 itself emerged.

While we cannot yet know the truth, as others have said, it seems a strange coincidence that the outbreak began in the same city in China where -as these documents from the Intercept show- work was being done on bat coronaviruses. And how can we trust any denials, when much of the information that we had was not originally released by EcoHealth Alliance or the Chinese government, but rather by a small band of digital detectives scouring the web, as well as journalists, such as those at the Intercept?

Of course the lab leak hypothesis is not proven. Most epidemics begin with a natural cross-over event from animals to humans. But the irony is that if, indeed, the virus emerged from a lab leak, it not only did so unintentionally, but also because scientists were trying to study coronaviruses to avoid and prevent epidemics. If the lab leak hypothesis is correct, I can’t help but feel empathy for the scientists and funding agencies, which must have been horrified as they realized what they might have unleashed. But it is long past time for transparency, so that everyone can understand the data and evidence regarding whether a lab-leak in Wuhan, China began this pandemic.

If you want to see the documents (two grant applications) themselves, Mara Hvistendahl (@Mara Hvistendahl) has Tweeted the links, which you can for yourself here. The first one is the key document:

“Understanding the Risk of Bat Coronavirus Emergence”
https://t.co/FrOP7tSs4D

“Understanding Risk of Zoonotic Virus Emergence in Emerging Infectious Disease Hotspots of Southeast Asia”
https://t.co/YDmfbcHcoN https://twitter.com/marahvistendahl/status/1435180983754579973?s=27

I want to thank both Sharon Lerner and Mara Hvistendahl for their careful investigative reporting, and making these documents public.

Shawn Smallman, 2021

The strange, sad story of Ivermectin

Photo by Thomas M. Evans on Unsplash

Ivermectin is an old medicine used to treat parasitic infections in humans, for everything from river blindness to scabies. It is better known, perhaps, as a deworming medication that farmers and pet owners use to treat everything from cattle to dogs. The medicine has been used around the globe for 40 years. With the onset of COVID-19 -as people were desperate for some treatment, they have seized on different medications as a possible cure-all. The first was hydroxychloroquine, a medication commonly used to treat malaria. I first heard about this medicine from a neighbor, who told me that her spouse was obsessed with it. This was in the spring of 2020, when people in Boston and Cambridge were watching a tent being set up outside of of Massachusetts General Hospital to treat COVID-19 patients. People were desperate for a treatment. After being trumpeted by the Presidents of the United States and Brazil, a series of well-designed scientific studies showed that the medicine had no clear advantages while holding significant risks. As it fell out favor, people then turned to Ivermectin.

Of course, Ivermectin has been shown to have some antiviral properties. But so have many other medications. The question was- what was the evidence that it was useful against COVID-19? Very quickly my timeline on Twitter was filled with people talking about Ivermectin. The most common comment was perhaps that big pharmaceutical companies were hiding their knowledge about Ivermectin because it was off-patent and cheap. Dr. John Campbell -who has an excellent YouTube channel with daily updates on the COVID-19 pandemic- began to highlight Ivermectin as a potential treatment. An Indian state encouraged its use. Desperate people began to go to farmer’s Co-ops to obtain medicine intended for cattle for their use. Countries put Ivermectin into their national guidelines for the treatment of COVID-19, especially in hard-hit Latin America. People with Long COVID reported remarkable recoveries after taking the medicine. But what is the evidence for Ivermectin? …

Did a strange lab leak cause the COVID-19 pandemic?

Photo by KOBU Agency on Unsplash

In November and December 2019 a novel corona virus began circulating in China. The world -and China’s citizens- first learned of this thanks to a group of Chinese whistle blowers , including Opthamologist Dr Li Wenliang, who would ultimately die of the virus. These whistle blowers were denounced by their administrators and some of them -such as Dr. Wenliang- received a police warning. After he died from COVID-19 on February 7, 2020 there was a wave of popular outrage, and sympathy for his pregnant widow, which caused authorities to censor Chinese social media platforms. So the Chinese state sought to conceal the COVID-19 outbreak in its early stages, much as it once did with SARS. But where did the virus come from? And what do we know about its origins?

Wet markets have often been associated with the start of earlier outbreaks of infectious diseases, such as avian influenza and SARS. This makes sense because these environments bring together a diversity of wild animals that may carry unknown pathogens. Packed into cages in poorly ventilated areas, viruses can passage across the species barrier in a way that would be difficult to achieve in the wild. When the outbreak first appeared in China, many people first looked at cases that appeared to be associated with a local wet market. But as earlier cases became known, the tie to the wet market lacked strong support in the data, although a recent study perhaps strengthens this case.

Attention turned to the Wuhan Institute of Virology (WIV), which reportedly had collected novel bat viruses, including some from a cave in Yunnan. Lab leaks have caused pandemics before. For example, in 1977 an influenza pandemic swept the world. Because the virus was nearly identical to historical samples from an earlier outbreak, there have been suspicions that it began as a result of a lab leak in the Soviet Union. Gain of function experiments -in which scientists deliberately increase either the transmissibility or infectiousness of an infectious agent have been controversial for many years for this reason. Accidents have happened.

Nearly a decade ago I was attending an influenza conference in Oxford, and happened to have breakfast with three well-known figures in the field of influenza virology. One of the people at the table was an outspoken advocate for gain of function research. This person’s work had attracted international controversy on this issue. He/she was an outspoken, confident person, who was more than willing to talk about the gain of function debate, and appeared to enjoy both the attention and the controversy. I thought that this person was eloquent, informed and generous in sharing their thoughts with a complete nobody like me. I was enjoying the conversation immensely. But as the discussion went on, another person at the table -a legend in influenza virology- became increasingly glum looking as he or she picked at their eggs. I felt increasingly awkward, and noticed that my charming colleague didn’t seem to be noticing their colleagues’ withdrawal from the conversation.

Finally, the gain of function researcher turned to another person -a German colleague- and said words to the effect: “You understand how these constraints are maddening.” And this German researcher said (as best as I can recall): “Yes, but I don’t do anything nearly as dangerous as you do.” One thing that I loved when I used to lecture in Germany (actually, I loved everything about Germany) was how frank my students were in giving feedback, and this response was true to form. What I took from the debate was the extent to which gain of function research worried even those people with the best practical knowledge of laboratory work with influenza viruses. As time has passed, there has been increasingly skepticism that gain of function research will produce knowledge at all worthy of the risks. But did the Wuhan Institute of Virology in fact have novel corona virus sequences, and -if so- what kind of research was being done with these strains? …

Britain’s vaccine success in the midst of a pandemic

The early story of Britain’s reaction to COVID-19 was an unmitigated disaster, driven in part by uniformed cabinet discussions of herd immunity. Even Prime Minister Boris Johnston himself was infected with COVID-19. As if this story was not difficult enough, a new variant of COVID-19 appeared in Essex towards the end of 2020. We now know that not only is this variant more communicable, but also may be more deadly. In late December this virus came to dominate all the COVID-19 clades in Britain, and caused a remarkable surge in infections.

In spite of this difficult history, Britain has pulled of two remarkable achievements. First, it has conducted outstanding genomic surveillance. While Denmark was also doing so, it was the British tracking which revealed the extent of the threat these new variants posed. Now other nations, such as the United States, are playing catch-up, as they try to create an effective system for genomic surveillance. Even more remarkable, Britain has joined a short list of nations (along with Israel and the United Arab Emirates) leading the global race to vaccinate their populations. How was this success achieved?

Paul Waldie has a remarkable article in Canada’s Globe and Mail, titled “How Britain became a world leader in COVID-19 vaccine distribution – despite other pandemic problems.” In Waldie’s narrative one remarkable woman, Kate Bingham, and the task force that she led, managed to identify the likely winners in the vaccine race, negotiate contracts, and bring vaccine production home to Britain. What is most impressive is how proactive the task force was. Britain has had many missteps and still faces many challenges. Yet when the history of this pandemic is written, I think that -based on Waldie’s description- this task forces’ actions will be held up as a case-study of effective leadership during a crisis.

Shawn Smallman

Cyber, Cities and COVID-19- why urban leaders need a digital strategy

Photo by Isabella Mori, who provides this context: In traditional Taiwanese night markets, since people and sellers are in close contact, most people / vendors wear masks now, in order to protect themselves and others.

The 1918 Influenza pandemic likely killed between fifty and one hundred million people globally. While the case fatality rate varies with circumstances, the current outbreak of COVID-19 may be as deadly unless vaccines are developed in time. Since the start of this year global cities like New York have faced immense strains. As always during a pandemic, one of the concerns that leaders face is how to prevent panic and discrimination, which can be spread by social media and other digital platforms. At the same time, the internet provides a host of tools that can help during a pandemic, with everything from telemedicine to mass collaboration. While cyber tools -such as digital tracking apps for individuals under quarantine- are powerful, they also come with human rights questions. In adapting these cyber tools for telemedicine, digital health communication, outbreak modeling and other uses (Liu and the HIMSS Greater China Health Team, 2020), city leaders and health authorities must address issues of transparency, privacy and public trust, which will require them to have a strategy for digital issues.

The 1918 pandemic and COVID-19

Food market in Taiwan. Note the plastic partitions separating customers. Photo taken by Isabella Mori in May 2020.

Like many people, I’ve been struck by the parallels between the current COVID-19 pandemic and the 1918 pandemic.  In 1918 many media outlets in Europe and the United States did not initially give the outbreak adequate coverage, because they were censored during the war, or did not want to reveal their nation’s weaknesses. In the United States and Brazil now, populist leaders are dismissive of the news and data on COVID-19, because it reveals their failures. For this reason, their followers tend to view all COVID-19 information through the lens of partisan politics. Indeed, President Bolsonaro of Brazil has called his followers to storm hospitals to take photos and videos to show whether COVID-19 patients are truly filling hospital beds, as the hospitals and state leaders claim. Such denial has caused painful climbs in COVID-19 deaths in both Brazil and the United States. …

COVID-19 in Latin America

Flyer for our upcoming presentation

Next Tuesday my department will be having a presentation on Zoom  about COVID-19  in Latin America. During this discussion I’ll be talking about Bolsonaro’s leadership in Brazil, and the current pandemic trends in that country. Dr. Rodriguez will be talking about Argentina’s response, while Dr. Young will be discussing the experience of both Cuba and Mexico. Since I know little about the COVID-19 situation outside of Brazil in Latin America, I am particularly interested to hear what my co-presenters will say. The talk will be 2pm West Coast (US) time. Please RSVP if you are interested in participating.

Shawn Smallman

The power of smartphones in online teaching

Before entering restaurants in Taiwan people sanitize their hands and have their temperature taken. Image courtesy of Isabella Mori.

One of the great lessons in life is the power of radical simplification. Everyone who has traveled has had the experience of realizing that even the most basic statements and vocabulary can allow you to exchange key information. Right now, many people are radically simplifying their lives in self-quarantine, whether it be having a family member cut their hair, or using an old sewing machine to make face masks. The number of people rediscovering the value of even a small garden reminds me of England during World War Two. Our grandparents and great-grandparents already did this.

So it’s interesting to learn that the same trend is happening in online education, where people are interested in how to use phones as a learning tool. The idea alone might make some of my senior colleagues’ heads’ spin around much like Linda Blair’s in the 1973 American horror film “the Exorcist.” They believe that phones are responsible for the decline of civilization and culture, much as Plato and Socrates once argued that the invention of writing had destroyed memory skills and damaged learning. Nonetheless, in some developing nations smart phones are playing a key role in permitting online learning during the COVID-19. I recommend this article by Anya Kamenentz in NPR on “How Cellphones Can Keep People Learning Around The World.” It turns out that phones may also be an appropriate technology in many educational contexts. …

Fear, Fact and Fiction: COVID-19’s Origins and Spread

 

Photo by Isabella Mori, who provides this context: In traditional Taiwanese night markets, since people / food stands are in close contacts, most people / vendors wear masks now, in order to protect themselves and others.

I gave a talk yesterday for WorldOregon on COVID-19, and what we know about it’s origins and spread, as compared to conspiracy theories. What you might not know when you watch this is that I wrote a talk before asking how long it should be. So I wound up having a fifty minute talk for a twenty minute delivery. Throughout the whole talk I was trying to summarize. My bad. But I had a good time and enjoyed hearing the questions. Thanks WorldOregon! …

Privacy & Cookies: This site uses cookies. See our Privacy Policy for details. By continuing to use this website, you agree to their use. If you do not consent, click here to opt out of Google Analytics.