COVID-19: Reminders of yesterday and today
Updated: Jun 15, 2020
By Michael Whaby
“Social distancing does not mean social disengagement” – Jerome Adams, 20th Surgeon General of the United States
I don’t want to compare COVID-19 (caused by the SARS-CoV-2 virus) to the 1918 flu (Spanish Flu caused by H1N1 influenza A) because they are not the same thing. However, each has led to its own global pandemic. Regarding virology, there are certainly differences between the two: origin, genetic material (i.e. DNA or RNA), mode of infection, and resulting symptoms, to name a few. Disregarding virology, there are also differences—one of which is the obvious fact that the 1918 pandemic occurred over a century ago.
The simple fact that the 1918 pandemic occurred over a century ago highlights that there are many more astounding differences from the COVID-19 pandemic occurring in 2020. Even so, as the Centers of Disease Control and Prevention (CDC) suggested in an article from 2018, the lessons learned from the 1918 pandemic still apply today. As of the present, the U.S. is in a state of emergency in response to the COVID-19 pandemic, and many people, including me, are going on week number I lost count of working from home; others not as fortunate have been laid off. This makes me wonder: What did people do in 1918?
Reminders of yesterday: Did people in 1918 buy all of the toilet paper?
History tends to repeat itself, which we are constantly reminded of by movie re-makes, wars, and, oh, I don’t know, viruses causing global pandemics. The way in which history is repeated, however, is always altered. New movies might be in color and have new actors; accordingly, novel viruses, too, develop new attributes with time.
Time, in fact, is the main factor that allows for change to evolve. Time allows for evolution of new genetic species (i.e. by changes in genetic material); time has also brought greater learning, understandings, and development of technologies through research, innovation, discovery and implementation of different works or ideas. Here are some changes, and reminders, that time brought from 1918 to 2020.
It shouldn’t take much effort to think of reasons why a virus could have spread so quickly during 1918. With WWI concluding, many soldiers would be on the move—maybe returning home from war or relocating. You don’t think that these soldiers that traveled and lived in crowded conditions could have: 1) contracted the virus, 2) spread it to other soldiers in the same and different troops, and then 3) individually contributed the Spanish Flu outbreak by dispersing after the war concluded, do you?
This actually is a running explanation. It does a great job explaining how that particular pandemic occurred in 1918, when the world’s population was less than two billion people—about a quarter of today’s population—and transportation, communication, and scientific and medical knowledge staggered dramatically compared to today. Crowded living conditions, or overpopulation of a species, is what contagious pathogens dream of. Overpopulation might indicate the success of a species, but risk factors like contagious diseases will always challenge them.
The lack of understanding of viruses and treatments for people with viral infections was probably the biggest challenge when dealing with the 1918 pandemic. To put in perspective, there wasn’t even a flu vaccine until the 1940s! Doctors could see the symptoms, but they were out of their leagues trying to treat something they didn’t really understand. Not to mention, hospitals were severely overwhelmed. This made it even more complicated to communicate to the public what was going on and what to do about it.
As the CDC suggested, the measures that we are taking right now during the COVID-19 pandemic are partly learned from measures taken back in 1918—social distancing, for example. Unfortunately, the communication from health care leaders, politicians, and the media in 1918 was limited to their means of communication—they weren’t checking Facebook for news updates. People were uncertain and concerned, and many were scared to leave their homes.
Sounds too familiar.
Reminders of today: Toilet paper and information consumers
Even with the knowledge, technology and resources we have today, there will always be risk of viral pandemics. The raw risk factors (i.e. overcrowding and mass transportation) that led to the 1918 pandemic are the same ones we experience with COVID-19. I mentioned before that, today, the world’s human population is about four times more than what it was in 1918. Since then, we have obviously been busy (or got busy, if you know what I mean). This increase in population along with the advancements in transportation—people can travel transcontinental in hours instead of days—provides astounding potential for a novel virus to cause a global pandemic.
As it turns out, at the same time the raw risk factors for a global pandemic were increasing over time, our scientific and medical knowledge about viruses, treatments and drug developments like vaccines and antibiotics have grew as well. The 1918 flu (again, H1N1 influenza A) wasn’t truly understood until a century after the pandemic; SARS-CoV-2 (causes COVID-19) was identified, had its full genome sequenced and described within months of the “first cases” of people being diagnosed with COVID-19. This allowed for tests to be rapidly developed to identify people infected with the virus and for drug discovery research efforts to be launched for vaccines and other potentially effective treatments.
To talk for a brief moment about a common technique used to test for COVID-19, I want to talk about polymerase chain reaction (PCR). PCR is a method used to detect specific sequences of DNA—the genetic code that your cells use to make everything about you. PCR can detect a specific sequence of DNA by making many copies of the sequence. The then “amplified” DNA sequence can then be prepared and detected visually.
Viral genomes, in contrast to humans, can be made up of DNA or RNA. Both SARS-CoV-2 and H1N1 are RNA viruses. In humans, cells use DNA to make RNA—a process known as transcription. In contrast, RNA viruses use reverse transcription to make DNA (referred to in this context as complementary DNA, or cDNA) from their RNA sequence. RNA viruses must do this to infect other cells. Thus, RNA viruses may be detected through a method called reverse transcription-PCR (RT-PCR). So, RNA can be isolated from a patient nasopharyngeal swab—way back in the nose—and an RT-PCR can be used to detect if the patient is positive for COVID-19 (Figure 1).
The structure of DNA wasn’t discovered until the 1950s, and it wasn’t until 1983 that PCR was invented. The advantage to accurately and efficiently identify people carrying the virus is important. This significantly reduces the chance of misdiagnosis, and necessary treatments and precautions can be implemented rapidly. Importantly, having a test also allows for more efficient tracking of the virus as it spreads. This all being true, you would think that these advantages would also increase the transparency and quality of information that the media provides the public. There are obvious advantages of today vs 1918: television, social media, smartphones, etc. Everyone knows everything right when it happens, right?
The media attention that COVID-19 received, and is still receiving, is incredible. Everyone and their mothers have their two cents, or at least a meme, about “the coronavirus” on social media. The problem with the media coverage of the virus is that the important, and accurate, messages are diluted by every other twisted version of the truth. With so much information out there, we tend to often attract to appeal rather than truth. The problem in 1918 was that there was too little information reaching too few people; the problem today is quite the opposite.
Learning from yesterday with the advancements of today
If you’ve read this far, I’m sure you realized that this was not necessarily an informational article about COVID-19 (sorry if this is what you had anticipated, but thanks for seeing it through anyways). Instead, I wanted to shed light on some of the things that are all too underappreciated, or even forgotten. We’re living through a challenging time. Many of us stuck at home trying to keep it together—and by it, I mean sanity, relationships, jobs, school, bodies, minds, communities, companies, add some others: _______________________. At the same time, we have to keep reminding ourselves that we’re are all playing part in fighting the virus and trying to bring this pandemic to an end.
I posed a question earlier: What did people do in 1918? I know people weren’t taking online classes or signing into virtual conference meetings. Business was down. Today, we are able to continue classes and even work virtually. We can still keep in touch with loved ones and still see what people are doing (from home, hopefully) on Facebook or any other social media platform. As the United States Surgeon General stated, “social distancing does not mean social disengagement.” However, this probably wasn’t the case in 1918.
Momentum may have been disrupted, and COVID-19 may have caused a much larger problem than anticipated by those with authority to enforce laws earlier, but we are carrying on much better than could have been done in the past. To thank for this are the many advancements that we’ve made over the years. And we aren’t done advancing, because time will always bring challenges. Look how far we’ve come in just a century. We can be pretty smart sometimes, us people.
The 1918 Flu Pandemic: Why It Matters 100 Years Later. (n.d.). Retrieved from https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu/
The Deadliest Flu: The Complete Story of the Discovery and Reconstruction of the 1918 Pandemic Virus. (2019, December 17). Retrieved from https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html
Barry, J. M. (2017, November 1). How the Horrific 1918 Flu Spread Across America. Retrieved from https://www.smithsonianmag.com/history/journal-plague-year-180965222/
History.com Editors. (2010, October 12). Spanish Flu. Retrieved from https://www.history.com/topics/world-war-i/1918-flu-pandemic