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EALTHY Blog

Pandemic fatigue

Virginia Allum

September 2020

As we move further into the Coronavirus pandemic, I started wondering how the world’s populations felt at a similar stage of the 1918 Influenza pandemic. An article titled ‘”Destroyer and Teacher”: Managing the Masses During the 1918-1919 Influenza Pandemic’ (1) highlighted some interested social behaviours.  

I recommend reading the entire article especially the epilogue which may have you shaking your head sadly, especially George Soper’s comment in his 1919 article, The Lessons of the Pandemic (2)that : “.. . This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”  

In her article, Nancy Tomes gives a summary of the responses to the 1889-1890 Russian Influenza Pandemic and the 1918-19 Spanish Influenza Pandemic. As you read through the events of the timeline, you’ll no doubt have some ‘light bulb’ moments as you identify some examples of current behaviour patterns which are occurring. 

1889-1890 Russian Influenza 

  • flu thought to be caused by ‘microorganisms floating in the air’ 
  • contagiousness of influenza (the ‘grip’) not appreciated: Public Health (PH) authorities downplayed the importance of the virus coming to the US from Russia and left its treatment to private physicians 
  • medical advice generally to stay home and recover and keep infected people from others. No advice on how to avoid contagion 

1918-1919 

  • bacteria causing cholera, syphilis, typhoid and TB discovered; public health movement expands 
  • flu identified as a ‘germ disease’, named ‘x-germ’. 
  • flu described as a respiratory disease which could be transmitted through coughing, sneezing and spitting. 
  • advice for minimising spread: quarantine, isolation, disinfection, ventilation and personal hygiene 
  • other ideas still current – spread of flu on library books and postage stamps 
  • expanding mass media – newspaper reading at an all-time high 

By the 1918s, some of the issues facing current PH authorities and economists were starting to become evident: 

  • flu was seen as a ‘crowd disease’. More people packed into crowded cities.  
  • increase in mass gatherings, e.g. troop ships and theatres. During the 1918 pandemic, a ban on mass gatherings for people of all ages was instituted.  
  • By 1918, it was noted that the US relied on large cities for their expanding economy. Businessmen resisted quarantine measures like the shutting of factories. So, the question is raised about contagion control versus a stable economy (Familiar?) 
  • Comments suggesting people were affected more by fear than influenza started to appear in newspapers. Words such as  ‘fear’ and ‘panic’ were found in newspaper articles (Familiar?) 
  • the public appeared confused by the PH message: unsure about terms such as ‘essential versus non-essential services’ 
  • The pandemic revealed how economically important public amusements had become to local economies.”: in addition, it was clear that city dwellers relied on theatre, cinema and concerts for their social life.  

There were so many parallels in the article with our current situation that I was keen to read the author’s conclusion and/or forecast about any future pandemics, remembering that the article was published in 2010. I think it is worth adding the entire epilogue. Areas in bold are mine and refer to points which may not have played out as the author suggests or which I think the author foretells with unfortunate accuracy. 

Even now, nearly 100 years later, the image of the influenza pandemic as “destroyer and teacher” remains a compelling one. For all the greater knowledge we now possess about its genetic makeup and natural history, the influenza virus still retains the capacity to remind us how difficult disease prevention and control remain in modern societies. Do we have any better chance of controlling a “crowd disease” such as influenza in the early 21st century, compared to 1919? 

In some important ways, the answer is probably yes. To begin with, we have a new line of defense that was missing in 1918–1919, in the form of antivirals such as Tamiflu® and the capacity to produce effective flu vaccines. These measures play an essential role in the modern approach to influenza pandemics. Yet they have their limitations: stockpiles of Tamiflu can be quickly used up by physicians seeking to calm panicky patients, and the manufacture of flu vaccine depends on a complicated and in some ways antiquated system of production. Thus, the discovery of flu wonder drugs and vaccines has by no means diminished the need for nonpharmaceutical interventions. As the Centers for Disease Control and Prevention guidelines for pandemic control make evident, they have an essential role to play in slowing down influenza’s spread long enough for these measures to be perfected and distributed.62 

It may also be easier for people to understand the rationale for social-distancing measures now than it was in 1918. First, the proliferation of fictional and journalistic portrayals of killer epidemics has created a popular apprehension of pandemics in general and influenza in particular that did not exist in 1918. Inventive film makers and novelists have spun dramatic scenarios, some entirely hypothetical, some loosely based on real diseases, about the dangers of rapidly spreading plagues. Books and films, among them Michael Crichton’s Andromeda Strain, Stephen King’s The Stand, Richard Preston’s The Hot Zone, Terry Giliam’sTwelve Monkeys, and Francis Lawrence’s I Am Legend, to name only a few, have taught successive generations of movie and TV watchers to fear the microbe. Real-life pandemics, including HIV/AIDS and SARS, have taught their own lessons about the difficulties of disease prevention in modern mass societies. Along with climate change, pandemic disease has become part of an apocalyptic set of worries far beyond what E. O. Jordan’s generation could have imagined.63 

Yet despite our renewed fear of the germ, the implementation of social-distancing measures still faces many challenges today. Public-gathering bans, school closures, and transportation restrictions are difficult to enforce for the same reasons they encountered resistance in 1918–1919. Nor are we any more likely than our World War I forbears to be able to sustain an exacting hygiene of nose/mouth/hand prevention. Consider, for example, the many studies that show the difficulties of getting health-care professionals to practice proper hand-washing protocols, a problem that has helped make hospital-based infections such as methicillin-resistant staphylococcus aureas so common. Like the mayor who let his face mask dangle and the TB expert who coughed into his hand, even people who should know better forget to be careful. Health-care professionals still have to be reminded to wash their hands frequently.64 Studies have also found that men tend to be more careless about hygiene protocols than women, suggesting that the man/boy problem has yet to be solved.65 

Perhaps fortunately for us, the resources of late modern industrial culture will conceivably make it easier for us to tolerate staying sequestered at home at least on a short-term basis. Compared to troop ships and railroads, air travel is easier to regulate from a public health perspective, especially since the terrorist precautions enacted in 2001. With the expansion of the modern welfare state, local and state governments can order employees to stay at home and assure them they will be paid. Businesses serving health-conscious customers may be slightly more willing to conform to public health directives. Our capacities to stockpile food and entertain ourselves at home with cable television, computer games, and the Internet (so long as the electricity holds out) have grown enormously since 1918. We have become far more familiar with sneezing into tissues and wearing face masks while mowing the lawn or using aerosol sprays. 

Still, should pandemic influenza return in its guise as “destroyer and teacher” we would no doubt have many humbling lessons to learn. Nearly 100 years after the great pandemic, we have no program of national health insurance. Enormous racial and class disparities in health status and access to health care persist. Despite a far greater degree of scientific sophistication, we have been unable to stop the spread of HIV/AIDs, which has generated its own bitter lessons. We still have many reasons to study the great influenza pandemic. To conclude with George Soper’s still-relevant observation from 1919: This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”16

 

 

References 

Soper GA. The Lessons of the Pandemic. Science. 1919;49(1274):501-506. doi:10.1126/science.49.1274.501 

Tomes N. “Destroyer and teacher”: Managing the masses during the 1918-1919 influenza pandemic. Public Health Rep. 2010;125 Suppl 3(Suppl 3):48-62. doi:10.1177/00333549101250S308 


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