May 2020 - Catherine Jenkins

We’re hearing a lot of rhetoric around COVID-19, including the word unprecedented. Unprecedented means unparalleled, something that has never been seen before. While it’s true that most of us haven’t seen anything on the scale of a pandemic in our lifetimes, to assert that COVID-19 is unprecedented is to ignore centuries of human history and suffering, as well as hard-won knowledge about disease control.

We could go back to various Medieval plagues, including the Black Death of the mid-1300s that killed an estimated 75-200-million people in Europe and Northern Africa over five years. This highly infectious bacterial disease (yersinia pestis) was contracted from flea bites, but could also be contracted via human-to-human contact; the pneumonic strain is airborne. In this pre-antibiotic era, when notions of disease transmission were still unclear, little could be done for those who contracted the plague. Quarantining in houses or away from others, for instance on Lazzaretto Vecchio island in the Venetian lagoon, decreased the spread. Untreated, pneumonic plague has a 100% death rate, while bubonic plague has a death rate of about 50%. While plague can now be successfully treated with antibiotics, the plague still exists. Every year the World Health Organization (WHO) reports a few hundred cases, mostly in Africa and South America.

17th-century European ‘plague doctor’ The beak distanced the physician from the smells of the plague and the stick allowed for socially distanced patient exams.

Evidence of smallpox has been found dating to the third century BCE in Egypt; from here it spread around the world thanks to various travelling invaders and colonists. The Crusaders brought smallpox to Europe in the 11^th century; in the 16^th and 17^th centuries, Europeans brought smallpox to the Americas, decimating 90-95% of the Indigenous population ; in the 18^th century, the British brought smallpox to Australia, having a similar impact on the Aboriginal population. Smallpox is an airborne virus, with a death-rate of 20-30% of those who contract it. In the 20^th century alone, an estimated 300-million people died of smallpox. Edward Jenner began experimenting with a vaccine in 1796, and published a paper on his success in 1801. It wasn’t until 1959 that the WHO launched its Global Smallpox Eradication Program; when this failed, the program was relaunched in 1967. On May 8, 1980, the WHO finally declared the world free of smallpox.

The most obvious comparison with COVID-19 is the Spanish Flu global pandemic of 1918-19. We now know that the Spanish Flu was H1N1, a strain of flu that still exists and is often part of the annual flu shot. At the time, this too was a novel virus, so no one had immunity. Soldiers who survived World War I subsequently died of the flu in crowded camps while waiting to be demobilized, or unwittingly brought the virus home. Although more was known about disease transmission by the early 1900s, antibiotics still didn’t exist. Little could be done to treat the Spanish Flu other than isolating, quarantining, disinfecting, wearing masks, and limiting crowds. According to the Centre for Disease Control (CDC) as estimated 500-million people, a third of the world’s population, contracted the disease, and an estimated 50-million people died.

1918 Alberta Government Telephones operators in High River wear masks during the 1918 Spanish flu pandemic.

But as author Ferris Jabr recently suggested, Covid-19 Is Not the Spanish Flu. Although the numbers used by the CDC in their discussion of the Spanish Flu have often been cited, Jabr and others have recently disputed them as mathematically impossible. While it’s fair to assume that the numbers for the plague and smallpox are estimates based on historical data, we would like to think that statistics for something as recent as the last century would be fairly accurate. That they aren’t raises concerns about historical rates of infection and death, but also about current and future reporting of COVID-19 numbers.

The first issue is that not every jurisdiction will test its overall population to the same degree, or using the same type of test, making it impossible to be definitive about the infection rate. Already some countries have recognized that deaths initially attributed to other causes, were actually caused by the coronavirus, but it’s impossible to know whether all deaths due to coronavirus will ever be accounted for. While we may assume that we can be more accurate now than we were earlier in human history, we may be flattering ourselves. While we’re still trying to hit a moving target, what we do have now is greater knowledge and better tools for dealing with a pandemic.

So unprecedented? No. But what we can take away from the history is knowledge about disease spread and control. What is unprecedented is the amount of funding and brain power now focused on the single task of trying to create a vaccine. We’re witnessing science in action, and that will take the time it takes to ensure vaccines are both safe and efficacious. Meanwhile, we’re looking at isolation and hygiene—just like in the old days.

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