Covid-19 – warnings ignored

I’ve heard it said, we have not experienced a pandemic since the Spanish flu of 1918 so how could anyone predict Covid-19? Just about everything in that statement is wrong.

Everyone has heard of Spanish flu, but how many have heard of the 1957 flu pandemic, or the one in 1968? We see an annual upsurge of influenza every year which on average kills about half a million people worldwide. The United States sees about 20,000 deaths a year and Europe(1) about 70,000 due to influenza. Spanish flu was far more deadly, killing an estimated 17 million to 50 million people – and possibly many more. It was by far the worst flu pandemic in over a hundred years, but it wasn’t unique. The 1957 flu pandemic, also known as Asian flu, was first identified in Singapore in February of that year. It rapidly spread around the world and resulted in about one to two million deaths. Here in the UK it killed an estimated 30,000 people, making it comparable with the death rate of Covid-19. The 1968 flu outbreak was first identified in Hong Kong and killed around a million people worldwide.

It’s difficult – and potentially misleading – to classify influenza viral potency by simply comparing death rates because there are many confounding factors, such as modern vaccines for seasonal flu, susceptibility and age of the fatalities, the proportion of survivors left with lasting medical conditions and the measures taken to stem the rate of infection. They took very few measures to prevent the spread of Spanish flu and in 1918, there were no flu vaccines of any kind. In 1957, the UK were very slow to react, eliciting outrage from scientists such as John McDonald at the Public Health Laboratory Service (later to become director of the Epidemiological Research Laboratory and then chair of the Department of Epidemiology and Health at McGill University in Montreal). He wrote to the Royal College of General Practitioners, “Although we have had 30 years to prepare for what should be done in the event of an influenza pandemic, we have all been rushing around trying to improvise. We can only hope that at the end it may be possible to construct an adequate explanation of what happened.”

The 1968 flu pandemic was a little different in that it was more contagious than previous outbreaks, and the morbidity rate in younger people was higher. There was yet another influenza pandemic in 2003 (SARS) and then MERS in 2012, both of which fizzled out before they became major pandemics. In the historical context of flu outbreaks therefore, the idea Covid-19 came “out of the blue” and no one could have predicted it, seems ridiculous. Scientists have in fact been warning for years that a viral pandemic wasn’t just likely but inevitable. Papers have been published in the scientific literature including the most prestigious journal Nature in 1997, there were reports from the World Heath Organisation, the United States Federal Emergency Management Agency report 2019 and the UK’s Exercise Cygnus in 2016 to give just a minimal number of examples.

Despite this, in the main, warnings were ignored and the collective governments of the world were caught with their pants down. The warnings of John McDonald’s letter have been repeated and instead of having a well-prepared plan, the world just tried to improvise. Some countries improvised more than others, and some became the proverbial headless chickens. And realise when Covid-19 is over, the next pandemic is just as inevitable. The scientific outcry of 1957 have been largely ignored, and so let’s hope we don’t make the same mistake again. The German philosopher Friedrich Hegal wrote, “we learn from history that we do not learn from history”. Regarding viral pandemics, so far Hegal has been proven right. Let’s hope in the future he’s proven wrong.

1 – As defined by the WHO European area