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Generational Dynamics Web Log for 22-Mar-2020
22-Mar-20 World View -- Today's Wuhan Coronavirus (Covid-19) pandemic vs 1918 Spanish Flu

Web Log - March, 2020

22-Mar-20 World View -- Today's Wuhan Coronavirus (Covid-19) pandemic vs 1918 Spanish Flu

Why the Covid-19 crisis won't be over by summer

by John J. Xenakis

This morning's key headlines from GenerationalDynamics.com

The history of the 1918 Spanish flu
Saving lives with mitigation strategies
Today's Wuhan Coronavirus (Covid-19) pandemic vs 1918 Spanish Flu
Alternative strategies: 'Burn Through' and 'Herd Immunity'
Why the Covid-19 crisis won't be over by summer
The most dangerous problem: Crowding and poverty
The search for a vaccine

The history of the 1918 Spanish flu

A man wearing a mask uses a pump to spray an unknown 'anti-flu' substance in the United Kingdom, following the Spanish flu pandemic (Getty)

A man wearing a mask uses a pump to spray an unknown 'anti-flu' substance in the United Kingdom, following the Spanish flu pandemic (Getty)

I've now written several articles and almost daily reports, on my web site and in the Generational Dynamics forum, on the Wuhan Coronavirus (Covid-19) crisis, and unfortunately the most pessimistic of the predictions are coming true on a daily basis. In this article, I'm comparing Covid-19 pandemic to the 1918 Spanish flu pandemic, and showing that there's no material difference between the two pandemics.

Using round numbers, the Spanish flu pandemic of 1918 infected about 500 million people worldwide, almost one-third of the world's population. It killed about 2% of the world's population, or 36 million people.

The Spanish flu (which, incidentally, originated in Kansas, not Spain) first appeared in March 1918. American troops carried the virus with them when they went to war in Europe, and it spread quickly to England, France, Spain and Italy. However, it wasn't much more deadly than the ordinary seasonal flu at first.

Cases of flu dropped off in the summer of 1918, and it was hoped that the virus had run its course. However, a second wave of the Spanish flu began in August, and the second wave was far deadlier than the first. The deadliest month was October 1918. Tens of millions of people worldwide were killed during the next few months.

Saving lives with mitigation strategies

The Spanish flu death rate in America was far lower than the death rate for the world as a whole.

The Spanish flu killed about 2% of the world population, but killed only 675,000 Americans, or 0.7% of the American population. Why was the death rate for Americans so much lower?

The reason is that Americans were using the same containment and mitigation strategies that are being recommended today. People wore face masks. WW I victory parades and events were canceled. Schools were closed. Theaters and businesses were closed. There are anecdotal stories about people who were forcibly locked into their homes to prevent them from infecting other people. In these stories, the patient would lower a basket with a rope from a second story window, and his neighbors would fill it with food.

Containment and mitigation strategies are being used today for the same reason. The phrase "social distancing" is on everyone's lips. Tens of millions of Americans are in states that have been "locked down" in the last few days, meaning that they're told to stay in their homes (or "shelter in place"). Those people will not be getting infected with Covid-19, nor will they be infecting other people.

Today's Wuhan Coronavirus (Covid-19) pandemic vs 1918 Spanish Flu

It's always tempting to believe that we're so far advanced and so sophisticated today, that anything older than yesterday is ancient and out of date and only of interest to historians and Boomers.

But in fact, it's very hard to see any material difference between the 1918 Spanish Flu and today's Wuhan Coronavirus, except that today we have some electronic devices like ventilators for treatment.

However, everything else is the same:

There was no vaccine in 1918, and there's no vaccine today.

The Spanish flu virus was completely new and previously unseen, so no one had developed any previous immunity to it. The same is true of today's Covid-19 virus. (Paragraph added, 22-Mar)

People were physically locked in their homes in 1918, and people are required to "self-quarantine" today.

Exactly the same containment and mitigation strategies that are being used today were being used in 1918. Schools, events, restaurants, bars, etc., have been closed.

There's even another similarity that's really eerie: In the late 1800s, the European "Scramble for Africa" was made possible by the development of the drug quinine, which could treat malaria. In 1918, quinine and aspirin were the two treatments available for Spanish flu. Today, doctors are experimenting with chloroquine, a derivative related to quinine, to treat Covid-19.

So not only are the containment and mitigation strategies the same as in 1918, even the same anti-malarial drug is being used.

So far, today's Covid-19 pandemic appears to be materially the same as the 1918 Spanish flu pandemic. The two won't really diverge until a vaccine becomes available, and that's not expected until late in 2021.

Alternative strategies: 'Burn Through' and 'Herd Immunity'

I described the containment and mediation strategies in earlier articles, and their purpose in "flattening the curve." ( "17-Mar-20 World View -- Stock market plunges 13% on Monday, as investors begin to accept reality")

In the containment strategy, the country tracks and tests people and uses contact tracing to identify infected people, and isolate them. When that fails, the mitigation strategy is used, where schools and stores are closed, and large gatherings are illegal, in order to reduce the number of infections.

I'm using the phrase "burn through" to describe a strategy where no mitigation is done, and the infections are allowed to take their course. A variation of this strategy that I've described in the past is the "Herd Immunity" strategy, where all the old people and people with existing health conditions are first locked up for safety, and then the infection is allowed to spread through the population, after which the old people can be let out.

There are a number of people on TV and on the internet who say that the mitigation strategies we're using -- closing all the schools, businesses and restaurants, for example -- are panic reactions that are worse than the disease. Many of these people say that they would like to see the "burn through" strategy used, believing that it would only kill elderly people who, as one person wrote to me, "they are going to die anyway."

Some people in the Generational Dynamics forum expressed the same view. One wrote:

"I think shutting down the economy to keep drug addicts and elderly people alive who will all be dead within five years anyway is stupid. I'm an older person (70) and I am willing to take my chances if it means my grandchildren won't have to live in abject poverty for the rest of their lives."

Another person agreed:

"I think that in general terms you are quite right. We are doing an inordinate amount of damage to our economies in order to save a very small percentage of the population. ...
We cannot cover the cost of intensive care needed for say 5% of the population. That would be about 15 million people in the US in ICU for a couple of weeks.
Panic is causing drastic measures that we just cannot afford."

This is the kind of policy that might be possible today in China or Russia, but there's no chance that any Western democracy today would adopt a policy of letting one group of people die, even old people, any more than it would adopt a policy of allowing all blacks or all Jews to die.

But it's more than that. The mitigation strategies are not just trying "to save a very small percentage of the population."

If we look at the Spanish flu figures, we can see the difference. Most of the world in 1918 used the "burn through" strategy, and 2% of the world population died. But in America, only 0.7% of the population died, and that can be attributed to the mitigation strategies.

Using round numbers, 45 million Americans get the seasonal flu each year. 200,000 are hospitalized, and the number of deaths is roughly 0.1% x 45 million = 45,000.

If we use the "burn through" strategy with Covid-19, and just let it spread without taking any remediation steps, then there will be roughly 200 million infections. The number of people hospitalized will be roughly 20% x 200 million = 40 million. The number of deaths will be 2% x 200 million or 4 million.

So just leading Covid-19 spread without mitigation would be a lot worse than just letting a few old people die. At the very least, hospitals and funeral homes would be overwhelmed by a factor of ten, and there would be dead bodies in the streets and in dump sites. This is the not the direction that America or any Western country wants to go.

That's not to say that remediation is an easy out. If we assume the 0.7% figure from the Spanish flu, and apply it to the American population of 300+ million, we still get over two million deaths. This is a speculative figure, and with curve flattening, the number of deaths would be spread over a long period of time.

Why the Covid-19 crisis won't be over by summer

A lot of people would like to believe that the Covid-19 crisis will be over by summer, or even earlier, in April or May. This is a total fantasy. Let's take a look at some of the reasons why this crisis will last well into next year.

A lot of people are looking to South Korea as an example of how the outbreak can be contained. The number of cases has been decreasing day after day, and there were fewer than 100 new infections for several days in a row. However, on Thursday, there were 152 new cases, reversing the trend. At least 139 cases were linked to a Seoul-based call center run by an insurance company, while another 64 cases were traced to a Protestant church in Seongnam, south of Seoul.
The point is that even when the virus appears to be contained, there can be a rebound at any time because of a new infection. It's possible, for example, for an asymptomatic person to spread the virus to a dozen other people. These new outbreaks may be contained through contact tracing, but they'll keep occurring.

Some people are looking to China to see how Covid-19 can be contained. China is claiming no new infections at all for several days in a row. China's claims are widely disbelieved. That claim may be true for Hubei province, but there are provinces all across China where no testing has been done. As I described in my previous article, reports from Thailand indicate that the Chinese are covering up Covid-19 cases in Helionjang, Xinjiang, Henan, Shanxi and other provinces. These covered up cases can explode into new outbreaks at any time.

Another issue is that the public will tire of mitigation restrictions. Right now, almost 100 million Americans in California, Illinois, New York state, and elsewhere are restricted to their homes, all in the fantasy hope that they'll be able to return to normal life by April. How will they react when the learn that April will turn into May, June and July? As soon as they start violating the self-quarantine and self-isolation restrictions, the number of cases can surge again.

Another issue is a "second wave" in the fall. This is what happened with the Spanish flu, with most of the deaths occurring in the second wave. The hope is that the summer weather will reduce the number of new cases, although this is uncertain. But even if that happens, the weather will be cold again in the fall, and there will be a resurgence of cases. And there could be a "third wave" in the spring of next year.

Another issue is reinfection. It has not been proven, and is being debated, that a person who recovers from Covid-19 is immune from reinfaction. This belief could turn out to be completely wrong. Even if a person is immune immediately after recovery, the immunity may not last. And so there may be a new wave of reinfections next year.

Some of these issues are more speculative than others, but the belief that the virus crisis will end this summer is the most speculative assumption of all.

The most dangerous problem: Crowding and poverty

There is one more issue, and this is perhaps the most dangerous issue at all.

There are deeply overcrowded refugee camps in Bangladesh, Greece, Syria, Yemen, Venezuela and other countries. Sooner or later, there will be a Covid-19 outbreak in each of these camps. People in these camps are crowded together, living in filth. There's almost no water at all, and certainly no clean water. If there's a Covid-19 outbreak in one of these camps, then it will quickly burn through the entire camp, and fleeing refugees will spread it to other countries.

In fact, any place where crowding and poverty are so great that containment and mitigation strategies will not work represent a risk to an entire region. If someone lives in a small home with a large family, and must go to work every day to feed his family that day or they'll starve, then "self-isolation" and "self-quarantine" don't even make sense. He'll go to work anyway, and risk contaminating the entire neighborhood. This is true in many "supercities," from Mumbai to Lagos to Mexico City.

In each of these cases, attempts will be made to blockade these cities and refugee camps, to trap people inside and keep them from leaving. But this will be unsuccessful, if only because the virus will create a massive humanitarian disaster, and outside world will demand some kind of relief.

These situations probably will trigger regional wars, and this may be the scenario that leads to World War III.

Finally, another major problem area is that many prisons, even in Western countries, are overcrowded, and the spread of virus could kill many inmates. As a result, there are calls to release large numbers of prisoners. This is already a major political issue in many countries, including the United States.

The search for a vaccine

It seems that hundreds of companies around the world are working to create a Covid-19 vaccine. There are new developments almost every day, and a couple of new candidates have already gone into first phase testing.

But every expert that I've heard says the same thing: these vaccines will have to go through multiple test phases to make sure that they're safe and effective. You don't want to be saved from Covid-19 by a vaccine that kills you anyway. Every expert I've heard says that it will be well into 2021 before any vaccine can be widely deployed.

In this article, I've compared the Covid-19 pandemic to the 1918 Spanish flu pandemic, and I've shown that there's really no difference at all. The remediation techniques are the same, the medicines are the same, and there's even no vaccine for now. Covid-19 is being handled in the same low-tech way as the Spanish flu. So those who want to understand how Covid-19 will affect the world should study the history of the Spanish flu.

Sources:

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(Comments: For reader comments, questions and discussion, see the Generational Dynamics World View News thread of the Generational Dynamics forum. Comments may be posted anonymously.) (22-Mar-2020) Permanent Link
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