We underestimated the severity of Covid-19 in its early days
As I walked briskly today on the concrete pathways of my community in Miramar, I realized eerily, that I was alone in my journey. There was not a soul in sight. These walkways are usually busy places, in the backdrop of pleasant Floridian evenings, with gusts of wind rushing past the passersby across the shores of the huge lake, and its beautiful landscape.
Streets are empty today. This city has remained in a lockdown.
Businesses have closed for the last 10 days, as people waited anxiously to embrace the deadliest week of the coronavirus pandemic. Only the other day, the president of the United States had cautioned a restive nation that more people were going to die in the country in this week than ever imagined, under the threats.
I had understood the implications. The death toll had now crossed into five digits, in less than a week. Another Armageddon? Perhaps yes ... if this curse was allowed to go unchecked.
A similar humanitarian crisis had loomed in Europe, nearly 400 years ago -- from the advent of another deadly contagion they had called bubonic plague. I checked my reference records, to stop at the extract from Londoner’s Diary.
He was an unfortunate “victim,” known as Samuel Pepys: “16 October 1665. But Lord, how empty the streets are, and melancholy, so many poor sick people in the streets, full of sores, and so many sad stories overheard as I walk, everybody talking of this dead, and that man sick, and so many in this place, and so many in that. And they tell me that in Westminster there is never a physician, and but one apothecary left, all being dead -- but that there are great hopes of a great decrease this week.”
Mother Nature had been harsh, because this was the worst outbreak of plague in England since the black death of 1348. London lost roughly 15% of its population. While 68,596 deaths were recorded in the city, the true number was probably over 100,000. This was a massive number, at the time. Other parts of the country had also suffered badly.
The earliest cases of this debilitating disease had occurred in the spring of 1665 in a parish outside the city walls called St Giles-in-the-Fields. The death rate began to rise during the hot summer months and peaked in September when 7,165 Londoners had died only in one week.
Rats had carried the fleas that caused the plague. They were attracted by city streets filled with rubbish and waste, especially in the poorest areas. Those who could, including most doctors, lawyers, and merchants, fled the city. Charles II and his courtiers left in July for Hampton Court and then for Oxford. Parliament was postponed and had to sit in October at Oxford, the increase of the plague being so dreadful. Court cases were also moved from Westminster to Oxford.
The lord mayor and aldermen (town councillors) remained to enforce the king’s orders to try and stop the spread of the disease. The poorest people had remained “imprisoned” in London with the rats, along with other people who had been infected by the plague.
Watchmen locked and kept guard over infected houses. Parish officials had provided food. Searchers looked for dead bodies and took them at night to plague pits (mass graves) for burial.
All trade with London and other plague-ridden towns had been stopped. The Council of Scotland declared that the border with England would be closed. There were to be no fairs or trade with other countries. This meant that many people had lost their jobs --from servants to shoemakers to those who worked on the River Thames. How did Londoners react to this plague that had devastated their lives?
Of the variations of the disease, worse still had been the pneumonic plague, which attacked the lungs and spread to other people through coughing and sneezing, and the septicaemic plague, which occurred when the bacteria entered the blood. And in these cases, there was little hope of survival.
Treatments and prevention at the time did not help. Sometimes, patients were bled with leeches. People thought impure air caused the disease and could be cleansed by smoke and heat. Children were encouraged to smoke to ward off bad air. Sniffing a sponge soaked in vinegar was also an option.
As the colder weather set in (1665-1666) the number of plague victims started to fall. This was not due to any remedies used. Nor was it due to the fire of London that had destroyed many of the houses within the walls of the city and by the River Thames. (Many plague deaths had occurred in the poorest parishes outside the city walls.)
Some scientists have suggested that the black rat had started to develop a greater resistance to the disease. If the rats did not die, their fleas would not need to find a human host and fewer people would be infected. Perhaps, people had started to develop a stronger immunity to the disease. Also, in plague scares after 1666, more effective quarantine methods were used for ships coming into the country. There was never an outbreak of plague in Britain on this scale again.
The total of the burials in one particular week had risen to 8,252 plague victims from 6,978 -- an increase of 756 parishes, with infected people who had numbered 118. This bill had numbered one more but for a remarkable providence which was thus. A butcher in Newgate Market had been overlooked by the searchers. He had been given up to be dead from the deadly London plague, and by the neglect of the boarders, had not been carried away the same night.
Assumed dead, he was laid out in an upper room. With his daughter going next day, the father beckoned to her and bade her bring him ale for he was cold. The daughter called up her mother who gave him clothes. The man took a pipe of tobacco, ate a rabbit, and on Sunday went to church to “give God thanks” for his preservation!
Fast forward three centuries into the future. Our world had seemed to be in the grip of a deadly virus,at the close of the last century. The world’s response to the H1N1 flu pandemic for well over six weeks was indicative of the fact that the lessons learned from dealing with severe acute respiratory syndrome (SARS) and the threat of H5N1 avian flu still lacked in spirit.
Researchers worldwide had freely shared and published data covering the genetics, virology, and epidemiology of the H1N1 virus in almost real time. Most national and international health agencies were unable to react swiftly and generally communicated openly with the media and the public. But the response had also revealed serious and underlying weaknesses.
The sobering fact had been that humans got off cheaply that time. Perhaps, they were lucky with this pandemic. Most cases had been mild, yet health services were still often stretched to capacity. And the fact that vaccines were too few, too late, would have been catastrophic if the virus had been more lethal, or continued for further time.
Health authorities in Mexico had deserved credit for promptly alerting the world to the first outbreaks and acting to slow the spread of the disease, despite clear economic impacts from lost tourism and closed businesses. The transparency of the US Centres for Disease Control and Prevention (CDC) in Atlanta, Georgia, also deserved due recognition. The agency’s open sharing of data obviously had helped set the tone of the international response.
Such moves had given many other nations a head start in reinforcing surveillance efforts and trying to slow the initial spread of the virus to win time for a vaccine to be prepared.
More waves of variant viruses of H1N1 flu will likely infect us in the future, but its health impact would certainly diminish, as more people obtained natural immunity. Public health officials around the globe can take some comfort in the fact that, for now, the virus had seemed less deadly than they had feared. They could also take pride in having struck a good balance between uncertainty, taking action, and minimizing economic impacts and social disruption.
Informing the public about the nature and severity of the disease was a tremendous challenge -- especially when it came to explaining the uncertainties surrounding the severity, epidemiology, and pathology of the virus. In the US, the initial communications were overseen in large part by Richard Besser, acting director of the CDC at the time. It was a challenge he and the agency had risen to, quite admirably.
The news media and flu bloggers also generally had responded well. Despite their well-known fascination with worst-case scenarios, mainstream news outlets for the most part had performed well, and did a good job of not sensationalizing the threat. And, of debunking individuals and organizations looking to sow unfounded doubts about vaccine safety and the necessity of a robust public health response.
Unfortunately, official efforts to build trust in the pandemic response were not helped by overly optimistic predictions of how much and how quickly vaccines would be available. This had underscored a significant technological deficiency: The reliance on a small number of suppliers, with almost all vaccines made by growing the virus in eggs, a process that takes around six months to get shots into production.
The spread of H1N1 flu around the world in a matter of weeks highlighted the need to develop novel vaccines, which would provide a quicker turnaround, and for government incentives that would encourage manufacturers to move away from egg-based production.
Analysis of the H1N1 virus has suggested that this new strain had been circulating in pigs for almost a decade, and probably jumped to humans months before it was detected in Mexico. That it was not spotted earlier is rather unacceptable. Don’t the public -- and animal-health communities -- need to assist in increasing surveillance for emerging diseases, with pandemic potential?
The danger now lay in the fact that the last, relatively mild pandemic had somehow created a false sense of security and complacency. The reality had also been that next time our world might not be so lucky -- especially given that this time most of the world’s population, living as they do in developing countries, had no access to either vaccines or anti-viral drugs.
Perhaps governments and scientists would have done well to redouble efforts to reinforce their pandemic defenses, and to draw what lessons they could from this outbreak as a dry run for a more severe pandemic. The prophecy of an ongoing, repetitive curse has materialized. As the world continues to grapple with the evil of coronavirus, we are reminded once again of the lessons. Those who fail to learn from history are condemned to repeat the catastrophe. λ
Nazarul Islam is an educator based in Chicago.