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Comparisons between responses to Influenza 1918, and covid -19

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Comparisons between responses to Influenza 1918, and covid -19

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This article highlights the similarity in responses to covid-19 and those of the 1918 Influenza pandemic, to attempt to persuade other medical professionals of the appropriate course of action. Specifically, the author highlights the concerns of shutting down businesses and restricting people to their homes as happened in both pandemics to raise concerns about the socio-economic impact leading to a wider overall public health catastrophe. Additionally, the author finds that there has been a second pandemic 'of fear and anxiety' sewn by the media after beginning the piece with 'The death of one man: this is a catastrophe. Hundreds of thousands of deaths: that is a statistic! '. Therefore the author is using history to argue that the real impact of pandemics is the sensationalism and extreme measures taken in response, which create a long term public health impact.

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The war? I cannot find it to be so bad! The death of one man: this is a catastrophe. Hundreds of thousands of deaths: that is a statistic!

For well over a year now, the world, in general, and the medical community, in particular, have been transfixed by coronavirus disease (COVID-19). From the beginning, the media have controlled the narrative and have sown a second pandemic of fear and anxiety through sensationalism and exploitation. The principal weapons employed have been the highlighting of worst-case predictions produced by models based on multiple broad assumptions, and the use of unadjusted big numbers, too often presented without context or denominators to define the overall medical impact of COVID-19. The weapon of choice was the reporting of "cases" per day without regard to the presence of signs or symptoms but rather relying on a positive lab value that did not necessarily indicate infection or transmissibility. Compounding this lack of construct validity is the inability to make reliable comparisons due to a lack of consistency in data collection and reporting.

Another hallmark of the coverage of COVID-19 has been its comparison to the 1918 influenza pandemic, not only in terms of relative medical impacts, but also to the imposition of public health interventions without regard to the validity or effectiveness of such interventions based on inferences of uniformity in the expression of the 2 viruses. School and business closures, stay-at-home orders, quarantine, masking, and so forth, were almost universally imposed in the name of science, and the only outcome criterion used was self-validation; think of how much worse it would have been if we had not done such and such. This would be all well and good save for the fact that every intervention has a cost, and, as we are learning, these can be quite profound across the socioeconomic spectrum. This puts us in an ethical dilemma; as health professionals, we have a duty to do all that we can to minimize the medical impacts on individuals but just as strong a duty to minimize the overall population health impacts. If we are to optimize outcomes, we need to have some health measure that will enable at least a rudimentary cost-benefit analysis and provide some objective justification for our interventions other than sentiment and conjecture, no matter how well intended.

The generally accepted measures for cost-benefit analyses in health services have been life years (LYS) and quality adjusted life years (QALYS). As the latter construct is much more complex and subjective and often does not significantly alter the comparisons under consideration, we will focus our attention on LYS, first, as a measure of comparing overall pandemic mortality and, second, as a means of assessing individual public health interventions. Morbidity impacts are not to be ignored in measuring the overall costs of a pandemic but cannot be used for valid comparisons because of extreme variation in definitions, data collection and reporting, laboratory capabilities, and diagnostic sensitivities and specificities.

The first comparison will present the overall mortality impacts of the 1918 influenza pandemic with those of COVID-19 through June of 2021. The mortality figures will be presented in 3 ways: estimated gross deaths, estimated deaths adjusted for population, and, last, deaths expressed in terms of estimated total life years lost. Because many values used in the calculations had to be estimated, the resulting numbers can, of course, be challenged as to their precise numerical accuracy. What cannot be so easily challenged is the gross difference in the relative mortality impacts of the 2 pandemics, as shown in . To help control for bias, all estimates were based on the Centers for Disease Control and Prevention (CDC) published figures and mid-points used when a range of values was given. The average age of pandemic deaths used for 1918 was 28 years and that for COVID-19 was 75, which was extrapolated from CDC data. For life expectancy, the corresponding figures used were 50 and 78 years for a US population of some 105 million in 1918 and 330 million today. The overall tabulations are presented in the accompanying table.

Obviously, these mortality data presentations could lead to markedly different interpretations of the comparative severity of the same events and may explain some of the marked differences of opinion on the validity and effectiveness of various pandemic policies and interventions. This is unfortunate, as these differences derive from the varying perspectives of individual medical care and overall public health, both of which have the same ultimate goal of mitigating morbidity and mortality. Rather than being divisive, both perspectives need to be addressed and optimal solutions formulated to better our overall lives; we cannot maximize 1 at the expense of the other.

To better optimize our policies, we need to first accept the fact that every derivative intervention has some cost in terms of direct and indirect negative health impacts, and, in many cases, those impacts can be quite profound. Second, we need to develop a more objective way of assessing the benefits of a given intervention versus the overall costs in terms of some common measure of overall mortality impact. As the impacts of the interventions cover a broad spectrum of conditions (suicide, overdoses, delayed diagnoses, socioeconomic damage, etc.) over individual life spans, a measure of life years lost versus those lost to the pandemic would afford a comparable measure. The overall life years lost from the pandemic can, in most cases, be readily calculated from available epidemiological data. Calculating the effect of individual interventions is much more complex because of inconsistencies in definitions and data collection as well as the extreme variation in their application and enforcement. The result is a mass of data that can be used to support conflicting positions and policies that are more reflective of individual bias than science.

What we can calculate with increasing accuracy over time is the negative health impacts associated with specific interventions, such as school and business closures and stay-at-home orders, which have been manifested in well-documented increases in mental health issues, drug and alcohol abuse, limited access to acute and chronic medical care, lost academic years, and, often, severe, socioeconomic injury to our most disadvantaged. All of these negative health outcomes will have some impact on overall mortality, some immediately measurable, but most in terms of future life years lost leading to decreased individual life expectancy for a significant component of the population. If such interventions are to be used to control and mitigate future pandemics, we must be able to make a reasonable assessment that the overall benefits achieved outweigh the cumulative harm done and that we are protecting individual lives without undue injury to the public health.

To be able to accomplish this with some degree of validity, we need to have a compilation of studies that assess the individual impacts of specific interventions and allow a reasonable estimate of actual or projected life years lost. One such study recently published measured the increase in opioid-involved deaths in Cook County during the pandemic lockdown period and reported that they increased to a mean of 44 deaths from 23 for the pre-lockdown period and declined sharply in the weeks following. Age data were not reported but can be extrapolated from national estimates provided by the CDC. Another recently published paper estimated excess mortality from drug overdoses, homicides, unintentional injuries, motor vehicle crashes, and suicide for the first 6 months of the pandemic. Following the first publication of this paper an additional study addressing the overall morbidity and mortality impacts of our interventions from a global perspective has been published and should be of interest to the reader. Going forward, a compendium of such studies would be an extremely useful decision-support tool to inform policy development and implementation in future events.

Of course, the intervention that should not need such justification is vaccination, and, despite the strong vaccine hesitancy and refusal that we have seen with the COVID-19 vaccines, there has been a clear demonstration of their effectiveness with the result that most other interventions have been discontinued or scaled down. This is certainly a welcome relief from the anxieties and stresses of the past year, but we must not become too complacent regarding either the current pandemic or the next one. From a global perspective, with vaccine supplies in short supply, COVID-19 continues to be a major killer and the only available defense for many continue to be the non-pharmaceutical, social-distancing interventions. In addition, the virus continues to produce new variants, 1 or more of which might become vaccine-resistant and result in yet another wave.

Finally, we must be wary of the next pandemic and not assume that we will be able to replicate producing a safe and effective vaccine in little less than a year as we have done for COVID-19. Even if we could accomplish that same feat, other interventions would be required to control and mitigate well before the availability of a vaccine. As a case in point, we can juxtapose the COVID-19 vaccine timeline on the epidemiological mortality curve for the 1918 influenza pandemic. As noted, it took just under a year to have an approved vaccine, but it took an additional 4 months (mid-Dec 20 to mid-April 21) to even partially vaccinate 50% of the US population. As seen from the graph in , this timeline, as rapid as it was, would have had essentially no effect on the 1918 pandemic mortality. If we are again faced with a major event, such as COVID-19, and we must depend again on non-pharmaceutical interventions awaiting vaccine fielding, hopefully, we will be better prepared to optimize saving lives and protecting public health while mitigating self-imposed, debilitating, socioeconomic impacts.

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Of Lives and Life Years: 1918 Influenza Versus COVID-19

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The war? I cannot find it to be so bad! The death of one man: this is a catastrophe. Hundreds of thousands of deaths: that is a statistic! For well over a year now, the world, in general, and the medical community, in particular, have been transfixed by coronavirus disease (COVID-19).

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This article discusses how effective measures to counter covid-19 can be implemented by looking at the responses to older pandemics, such as the flu of 1918. Evidence from the past is used to support measures such as social distancing and quarantine.

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On March 11 the World Health Organization officially designated the novel coronavirus outbreak a pandemic. Defined as the worldwide spread of a new disease, such a declaration is the first to be made since the 2009 H1N1 swine flu. As of this writing, there have been approximately 336,000 confirmed cases of the new disease, called COVID-19, resulting in more than 14,600 deaths worldwide.

Although a coronavirus-a family of viruses that cause illnesses ranging from the common cold to severe acute respiratory syndrome (SARS)-had not previously triggered a pandemic, this is not the first time we have seen the global transmission of a serious disease. Studying past outbreaks can help scientists better estimate the trajectory of COVID-19 and identify the best measures to slow its spread.

"Historically, we could look at everything back to the 1918 influenza pandemic. But in more contemporary times, we'd be looking at the 2015-2016 Zika outbreak in Central and South America, the global SARS outbreak from 2002 to 2003 and the Ebola outbreak in West Africa from 2014 to 2016," says Jeremy Youde, dean of the College of Liberal Arts at the University of Minnesota Duluth and an expert on global health politics.

Whereas COVID-19 is caused by a coronavirus and not an influenza virus, the 1918 flu pandemic-which caused at least 50 million deaths worldwide, according to the Centers for Disease Control and Prevention-might be the best model to understand this novel pathogen's behavior. It is also an outbreak for which massive social interventions were undertaken.

"Past influenza pandemics give some sense of what the overall [trajectory] of a virus like this would be because the reproductive number of this virus"-defined as how many people each infectious person transmits the disease to in a completely susceptible population-"is pretty similar to that of a pandemic flu," says Marc Lipsitch, a professor of epidemiology and director of the Center for Communicable Disease Dynamics at Harvard University. Although it is difficult to determine exact figures for an emerging disease, reports put the reproductive number of COVID-19 between 2 and 2.5. The median reproductive number for the 1918 flu pandemic was around 1.8. Lipsitch estimates that between about 20 and 60 percent of the global population will ultimately become infected with the novel coronavirus, or SARS-CoV-2.

Although every virus and resulting disease is different, a look at epidemic dynamics of both COVID-19 and the 1918 flu points to similar successful containment procedures. In a 2007 study published in JAMA, Howard Markel of the Center for the History of Medicine at the University of Michigan Medical School and his co-authors analyzed the excess deaths from pneumonia and influenza (meaning how many more there were than usual during nonpandemic years) in 43 U.S. cities from September 8, 1918 through February 22, 1919. Despite the fact that all of the cities implemented nonpharmaceutical interventions, it was the timing of activation, the duration and the combination of measures that determined their success. The researchers found "a strong association between early, sustained, and layered application of [such] interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States."

The most effective class of nonpharmaceutical control measures were those related to social distancing: canceling public gatherings, closing places of worship, schools, bars and restaurants, isolating the sick and quarantining those they came in contact with. (Many cities around the world have adopted such measures in the current outbreak.) "In my opinion, that is probably the most important single class of things to do, as quickly as possible, to slow the spread" of a pandemic, Lipsitch says. "Waiting until you can see that you have a problem is waiting too long, because there's a delay in seeing the fruits of the measures."

By undertaking these steps early, populations can also prevent peak demands on their health care systems and flatten the pandemic curve-that is, have a gradual increase in cases over time rather than many all at once. This slowdown is especially important because it can take two or three weeks before those infected with SARS-CoV-2 are sick enough to require intensive care, so demand could spike quickly. In a 2007 Proceedings of the National Academy of Sciences USA paper, Lipsitch and two other researchers showed that during the 1918 influenza pandemic, cities that intervened early and intensively to slow transmission through social distancing, such as such as St. Louis, Mo., had slower epidemics with smaller peaks, compared with those that waited longer to act, such as Philadelphia.

Similarly, in a preprint report, Lipsitch and his colleagues analyzed the timing of control measures and of community spread of COVID-19 in the Chinese cities of Wuhan and Guangzhou from January 10 to February 29, 2020. Wuhan implemented measures such as strict social distancing and quarantining contacts of infected individuals six weeks after sustained local transmission was observed, whereas Guangzhou implemented these measures within one week. The researchers found that early intervention, relative to the course of the disease in the population, resulted in Guangzhou having "lower epidemic sizes and peaks" than Wuhan in the first wave of the outbreak.

Intense public measures are also one reason SARS, which resulted in around 8,000 cases with a global case fatality rate of 11 percent, was eliminated from the population. One difference, however, is that with SARS, those who were infected were likely quite sick before they became very infectious, whereas with COVID-19, people appear to be fairly infectious when they first start developing symptoms-or even before then-according to Lipsitch. In fact, in a paper published last week in , researchers note that with the novel coronavirus, "undocumented infections often experience mild, limited or no symptoms and hence go unrecognized, and, depending on their contagiousness and numbers, can expose a far greater portion of the population to virus than would otherwise occur." So despite the lower fatality rate, COVID-19 has resulted in more deaths than SARS and Middle East respiratory syndrome (MERS)-which has a 34 percent case fatality rate-combined.

Other disease countermeasures include making buildings less favorable to viral transmission by humidifying and ventilating them and implementing ongoing communication with the public so it can understand and react appropriately. One issue during the SARS outbreak was that, for a number of months, the government in China actively denied the existence of the disease. Instead people relied on text messages and rumors about a new killer flu.

"Because the government wasn't proving itself to be reliable, it became that much harder to actually address the outbreak. And it allowed the disease to really take more of a hold than it might otherwise have," Duluth's Youde says.

In order to slow down epidemics and pandemics, either the conditions for transmission need to become unfavorable over a long period of time or enough people have to become immune so that transmission cannot pick up again if the virus is reintroduced. The latter scenario, of course, means the fraction of the population that is immune has to be high enough so that each contact and infected case creates fewer than a single new one.

Regular flu and cold viruses have a strongly seasonal pattern of infectiousness in temperate regions such as the continental U.S. This seasonality is partly related to changing weather conditions and how easily the pathogens are transmitted, but it is also because of the number of susceptible hosts as people are made immune by past exposure. The same is not true of new viruses, such as the one that causes COVID-19, however.

"Pandemics happen out of season. And pandemic viruses have the whole world before them," says Lipsitch, who explains that the advantage for novel viruses is that almost no one is immune to them. Seasonal viruses, on the other hand, operate on a thinner margin-meaning the majority of people have some immunity. So those pathogens are most successful when conditions for transmission are most favorable, which is usually winter. With COVID-19, Lipsitch adds, "I think [it's] more likely seasonal changes will modestly reduce the rate of transmission and maybe slow things down-but probably not to the point of making the number of cases [decrease but rather] go up more slowly."

For now, a coordinated global effort among researchers, countries, and nongovernmental and international organizations is necessary to address the current pandemic itself while learning basic information about the virus and its spread dynamics. "In terms of having some sort of international response, we're trying to build the airplane as we're flying it," Youde says.
Read more about the coronavirus outbreak .

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Lessons from Past Outbreaks Could Help Fight the Coronavirus Pandemic

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On March 11 the World Health Organization officially designated the novel coronavirus outbreak a pandemic. Defined as the worldwide spread of a new disease, such a declaration is the first to be made since the 2009 H1N1 swine flu.

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How past pandemics have changed the world, and why COVID-19 is no exception

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How past pandemics have changed the world, and why COVID-19 is no exception

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This article was written by Liam Fox MP, comparing COVID-19 with past pandemics, from the Justinianic Plague to the Spanish Flu. Fox uses the past to argue that pandemics aren't the exception in human history, rather, they are the rule. Note the article was written 1 day before the first UK lockdown, a time when relatively little was known about COVID. Fox is both a former GP and a notable politician; using the past in this comparative manner gives a dependable reference point to readers, who were much less informed at the time.

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The Coronavirus: how pandemics of the past have changed the world

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Throughout history, mass outbreaks from the Black Death to the Spanish Flu have heralded brave new worlds, writes the former defence secretary. He explains why the coronavirus is no exception

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Comparisons drawn between the Plague in London in 1665 and the Covid-19 Pandemic

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Comparisons drawn between the Plague in London in 1665 and the Covid-19 Pandemic

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This article highlights the comparisons between London during the Plague in 1665 and the Covid -19 Pandemic. It discusses the similarities between Covid and the Plague, through both social means and the death toll.  Jessica Otis uses the past as a reflection upon today's society to describe an eerie similarity of human behaviour during times of crisis that appeared during both outbreaks of disease - an example of this that is discussed is the breaking of quarantine rules. History, therefore, has been utilised in this article to highlight the repetition of historical events.

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he year is 1665 and the plague is in London. A man riding through Essex finds "all the way people, citizens, walking to and again to enquire how the plague is in the city this week". He dutifully tells one person after another there have been 2,020 new plague deaths.

Flash forward to 2020 and Covid-19 is everywhere. People are once again clamoring for numbers - confirmed cases, hospitalizations, deaths and positivity rates - and for exactly the same reason.

Like the people of early modern London, we see the numbers as a way to understand the severity of the pandemic and the current danger we face. We worry about the accuracy of the numbers. When the numbers rise, we consider steps to protect ourselves and our families. When the numbers fall, we think hopefully about resuming our former lifestyles. And when the numbers rise again, we wonder how long we can go on like this?

Covid-19 is not the plague, but many of our experiences today would have been familiar to anyone who survived one of the plague epidemics that routinely swept through early modern Europe. Plague was generally understood to be contagious, either through touching infected objects - mainly cloth - or through breathing infected air. People's symptoms could vary widely and there were no real treatments. But at least there were some reliable preventive measures: quarantines, contact-tracing and self-isolation. And while it wasn't a widely embraced practice, in later epidemics some doctors also wore the infamous plague masks.

In early modern epidemics, we see some of the same confusion, denial and posturing that has marked the Covid-19 pandemic. In April 1599, a physician warned the city government of Valladolid, Spain, that he had treated a patient who died of plague. They refused to believe him, declaring the city's diseases could be "easily cured" as they were only "common and light illnesses". They were not unique. Later in that same epidemic, the cities of San Sebastián and Bilbao denied the presence of plague among their residents to avoid shutting down their economies. Others spread false rumors and the city of Estella pursued legal action against those who (allegedly) slandered its healthiness.

Then, as now, people with the means to do so fled as soon as it became evident that plague had reached their city, town or village. Often, as was the case in 1625 when the English parliament removed itself from plague-stricken London to a series of nearby towns and cities, these travelers carried the plague with them, spreading the epidemic even further.

Similarly, those left behind struggled to contain the outbreak and suffered from the economic consequences of those containment measures. During the 1630 outbreak in Florence, Italy, soldiers were sent to a nearby village to enforce quarantines, contact-trace and supply food to those self-isolating after exposure, but food and medicine were in short supply. Those doctors who answered the call to tend to plague-stricken overworked themselves and fell ill. With almost everyone quarantined or self-isolating and movement throughout the area limited, unemployment rates soared (and taxes plummeted). The government housed beggars, expelled poor foreigners and gave a loaf of bread a day to some of its worst-off residents, but people still starved to death.

Just as we see today, public health guidelines were not always followed and not without controversy. People failed to report plague cases to avoid being forced to self-isolate, afraid of the economic, interpersonal or reputational consequences. They broke quarantine out of boredom, out of carelessness, out of arrogance, out of fear, out of familial duty and out of the desire to commemorate traditional life milestones like weddings and funerals. Some people refused to stay at home in order to survive, going to work and risking both their lives and those of their neighbors because they had no real choice. Some people might have stayed home if they hadn't been deemed essential to food supply lines or the functioning of government. They worried that measures taken to contain the plague would kill more than the disease itself.

History can help us see how others' decisions are similar to the ways people have acted in the past

Above all, hundreds and thousands of small decisions - both sensible and selfish - added up to make the difference in how deadly and economically devastating each epidemic would be.

The past does not determine the future. Humans have free will and can make their own decisions. But we can combine our scientific advances in understanding how diseases work with our study of how historical people acted in similar situations. History can help us see how others' decisions - even ones that seem strange or irresponsible to us - are similar to the ways people have acted in the past. And it can help us guess at what the future might have in store for us, given what we know today.

The year is 1666 and plague has been in London for 19 months. Eager to finally return to normal - and to reopen the theatres - the authorities officially declare the epidemic is over. But the numbers tell a different tale: "Lord! how the towne do say that it is hastened before the plague is quite over, there dying some people still."

The year is 2021 and there is a Covid-19 vaccine. Eager to finally return to normal - and to reopen the economy - the authorities officially declare the pandemic is over. But the numbers will have the final say. And in however many months it will take for the vaccine to be distributed widely enough to lessen the severity of the disease or achieve herd immunity, there will die some people still.

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History need not repeat itself when we write the journal of our plague year | Jessica Otis

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Accounts of earlier pandemics eerily echo our coronavirus crisis but teach us that small decisions can affect the outcome

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Comparisons between China's mass mobilisation during COVID and those in the past

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Comparisons between China's mass mobilisation during COVID and those in the past

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The article, written by an independent American policy-researching organisation, focuses on the Chinese society's response towards the growing mass outbreak of COVID-19. In particular, it mentions how China's civil society responded as a corporate body. Comparisons are then drawn between other past campaigns of public mobilisation by other governments, as well as how advocacy groups are now forced to act differently compared to in the past. It utilises the past to reveal the increased extent of China's control over the its citizens during its fight with COVID.

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How the Chinese state mobilized civil society to fight COVID-19 | Brookings

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The COVID-19 crisis pushed to the frontlines a civil society that is mobilized and led by the Chinese Communist Party, whether directly or indirectly. This piece originally appeared in the Diplomat.

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This article draws direct comparisons between the AIDS pandemic of the 1980s and Covid-19, and especially the decisions of wealthy countries around vaccination and medication. It uses the past to show that lessons aren't necessarily learnt from history as similar issues faced the world during Covid-19 despite the previous experience and solutions found during AIDS.

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This is a POLITICO case study, a look at what works - and what doesn't - in the fight against HIV. The article is part of Telescope: The New AIDS Epidemic, a deep-dive investigation into the modern face of a disease that transformed the world.

THE BIG PROBLEM

For years after lifesaving antiretrovirals were widely available in rich countries, poor countries struggled to get them, leading to millions of deaths.

THE BIG IDEA

Take on Big Pharma and enshrine the right to health in international trade law. Under the 2001 Doha Declaration, countries affirmed that patent protections - and resulting high prices - shouldn't stand in the way of saving lives.

Though written in response to inequalities in HIV treatments, the language was aimed to apply to any health challenge going forward.

WHY IT MATTERS

For activists focused on access to medicines, the COVID-19 pandemic is starting to look a lot like the bad old days of HIV.

Medically, HIV stopped being a death sentence in 1996, when effective antiretroviral medications were first introduced. But while the U.S., Europe and other wealthy countries embraced the pricey drug cocktails, it would be another decade before they were fully rolled out in hard-hit parts of Sub-Saharan Africa.

Many more people died of AIDS after the discovery of these drugs than before - annual deaths in South Africa wouldn't peak until 2008, roughly a decade after they had plummeted in wealthy countries.

IN THEIR VOICES
Winnie Byanyima, UNAIDS Executive Director, on how many lives were cost before the cost of HIV drugs was reduced:
When it comes to the coronavirus, history seems to be repeating itself. This time it's vaccines that are in short supply. While the U.S. and EU are on track to vaccinate some 70 percent of adults this summer, and are preparing to vaccinate adolescents at low risk of serious illness, Africa is facing a third wave. Just 1 percent of that continent's 1.3 billion people had received a first dose as of June 10, according to the World Health Organization.

IN THEIR VOICES
Byanyima on the "nationalistic" response to COVID-19 so far:
HOW THEY DID IT (FOR HIV)

When AIDS was first discovered forty years ago, it was equally horrible for everyone. With no treatment and no cure, an HIV diagnosis meant eventual death. That changed in the mid-1990s, when a three-drug cocktail proved to keep the virus under control. The drugs were hard on the body, but people lived.

In terms of raw costs, the cocktail could be produced cheaply - less than a dollar for a day's dose - but in countries with patent protections, drugmakers could name the price tag. In South Africa, this amounted to about $800 a month in a country where the average annual income was $2,600.

So in 1997, South Africa introduced a new law that would allow it to buy drugs from the lowest bidder - rather than the patent holder. In response, 39 drug companies sued, saying it defied global patent treaties. It turned out to be a major strategic blunder for Big Pharma.

IN THEIR VOICES
Thomas B. Cueni, director general of the global pharmaceutical lobby IFPMA, on the industry's regrets:
AIDS activists mobilized to play up the David vs Goliath fight. And when Western governments backed the industry, protesters pounced. For example, when Bill Clinton's vice president, Al Gore, launched his own bid for the White house, protesters unfurled a banner onstage declaring "GORE'S GREED KILLS: AFRICA NEEDS AIDS DRUGS." The Clinton administration soon announced it would back more flexible IP rules for poor countries.

By 2001, as the EU (and especially France) and the WHO backed the South African law, the companies withdrew their complaint.

That year also saw the adoption of the Doha Declaration. The clarification to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) was meant to allow countries to override a patent to make a generic version of a drug - known as compulsory licensing - or import cheaper medicines. The impetus was HIV, but the language made clear that TRIPS "does not and should not prevent members from taking measures to protect public health," and gave governments wide latitude to decide when those measures are needed.

In retrospect, however, the flashy political victories may have created a false sense of accomplishment, said James Love, an architect of the strategy to push for compulsory licensing.

IN THEIR VOICES
James Love, director of Knowledge Ecology International, on the risks of a "Hollywood Ending":
HOW IT WENT (FOR COVID)

When the pandemic struck, there were some early signs of global solidarity. But then-U.S. President Donald Trump started an inexorable race to fulfill domestic needs first.

As the novel coronavirus spread from China to Europe and the United States, paralyzing the world's top economies, vaccines were the obvious solution. And there was some early political buy-in to the idea that a future inoculation should be accessible around the world: Both Chinese President Xi Jinping and European Commission President Ursula von der Leyen called vaccines a "global public good." The EU backed COVAX, a new global initiative to dole out vaccines to all countries rich and poor, with words and financing.

Oxford University teamed up with AstraZeneca to make its adenovirus vaccine, and they promised to provide the shot-at cost during the pandemic. Johnson & Johnson made a similar commitment for their single-dose possibility.

AstraZeneca also took the unusual step of teaching the Serum Institute of India to make the jab, with the idea that the Pune-based company would produce billions for the developing world.

Yet rather than lessons from AIDS, it was reactions to Trump that set the trajectory for coronavirus vaccines. In March 2020, German media reported on rumors that Trump wanted to buy exclusive rights to an experimental shot by the German biotech CureVac. The White House and the company both denied the rumors, but they set the course for a hoarding frenzy by the EU.

RESULTS

As with AIDS, the response to the coronavirus has been defined by inequality. Those with more buying power are snapping up the limited supply, regardless of price. As of mid-May, low-income countries received less than one percent of the world's supply of vaccines.

Me first: The ambition behind COVAX was to pool all buying, for countries rich and poor. So when an effective shot hit the market, jabs would be distributed first to health workers in each country, then the elderly.

That never happened. In rich, vaccine-producing countries, domestic concerns took priority. The U.S eschewed COVAX completely, and the EU opted for its own advance purchase plan. By September, rich countries representing 13 percent of the world's population had already reserved 51 percent of the expected output. The U.S. banned exports of vaccines and ingredients, and EU doses not reserved for the bloc went primarily to other rich countries.

Though the EU offered COVAX substantial loans early on, it wasn't able to raise funds fast enough to sign early contracts - especially for the more expensive mRNA vaccines. Dependence on one Indian mega-producer also proved disastrous. When the subcontinent faced its own devastating wave, the government shut down vaccine exports, leaving COVAX high and dry.

Too little, too late: By June, as the U.S. and EU were close to satisfying domestic demands for vaccines, the G7 announced a plan to donate 870 million doses over the next year. Yet 11 billion doses are needed over the next 12 months to end the pandemic, according to the WHO's chief. There's no clear path for getting there.

Meanwhile, China and Russia offered doses to strategically important countries, but that vaccine diplomacy pushed those without much geopolitical relevance farther back in line.

Back to the 1990s: Given the trouble with COVAX and other efforts, much of the debate has now returned to old ground: intellectual property.

Activists - not to mention U.S. President Joe Biden and the current chiefs of the WHO and World Trade Organization - endorsed a TRIPS waiver for coronavirus vaccines so other parts of the world can ramp up their own production. Meanwhile, manufacturers around the world are volunteering to help produce shots.

But on sharing trade secrets, industry is pushing back. Medicines in pill form are easy to reproduce. You just need the recipe. Vaccines are much more complicated: patents aside, the developer basically needs to teach a manufacturer how to make them.

Not every plant is up to the task of producing the complex biological products needed for modern jabs. According to Cueni, the lobbyist, Big Pharma is teaming up on its own wherever it can to speed manufacturing, with some 218 partnerships involving this sort of knowledge-sharing, but they need to be picky. The U.S. government ordered a manufacturer to dump 60 million poorly made doses of the Johnson & Johnson jab.

IN THEIR VOICES
Cueni on why companies want to control who makes their vaccines:
The result, for those who watched the response to AIDS unfold, is dispiriting. Life has started to return to normal in the West, with plans in place to secure booster shots and inoculate adolescents at low risk of disease, just as poor countries faced fresh surges.

Lieve Fransen, a Belgian physician who coordinated the European Commission's global HIV policies in the 1990s before going on to help found the Global Fund to Fight AIDS, Tuberculosis and Malaria, recently returned home from India. She was helping the country deal with a surge that has claimed the lives of thousands of unvaccinated medical professionals - and found it jarring to see life in Belgium returning to normal.

What's missing now, Fransen said, is the constant pressure of AIDS-era activism.

IN THEIR VOICES
Fransen on how coronavirus fatigue in rich countries could increase inequality:
THE TAKEAWAY

The repeated rich-poor divide shows there's still no clear way to legislate for public goods: It's still essentially up to the haves whether to share with the have-nots. AIDS-era IP changes proved irrelevant to COVID-19, and the political momentum for equity was nonexistent.

For activists, frustration is especially acute because of the potential to escape from a profit-driven approach. After all, vaccine development is heavily fueled by public funding. Yet without global leadership, everything devolved into a competition for resources among different international initiatives, as Fransen sees it, and a fallback to old IP arguments that, while valid, may do little to move the ball, Love fears.

IN THEIR VOICES
Fransen on divisions and competition within the global response:
IN THEIR VOICES
Love on the IP "food fight":
To hear Cueni tell it, however, those early AIDS activists did help drive a sea change: Private companies have been more willing to team up with other manufacturers, and price tags for the economy-saving vaccines have been relatively low.

IN THEIR VOICES
Cueni (coarsely) on how Big Pharma knew early on they couldn't have 'business as usual' on vaccine prices:
Yet ultimately, political factors in rich countries may continue to be decisive. Biden, for example, promised to re-engage with multilateral health efforts like the WHO, on the campaign trail. Yet there was no daylight between him and Trump on the idea Americans should be vaccinated before sharing doses and ingredients.

IN THEIR VOICES
Love on the persistent political appeal of inequality for those who have access:
THE BIG QUESTION

Will the lessons of the COVID-19 and HIV pandemics prompt genuine preparations for an equitable rollout of lifesaving innovations - or will history keep on repeating itself?
Audio production by Cristina Gonzalez. Carmen Paun contributed reporting.
This article is produced with full editorial independence by POLITICO reporters and editors. about editorial content presented by outside advertisers.

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Why AIDS history is repeating in COVID-19

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Millions died in poor countries because effective antiretrovirals were out of reach. The same could happen with coronavirus vaccines.

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This article focuses on the need for long term solutions to the pandemic, whilst politicians focus on the short term aspects. This is then compared to previous events, particularly in American history, such as the post 9/11 anthrax attacks and people's reactions to both these events, highlighting how significant people are as actors in history and the consequences, both immediate and long-term.

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Hopkins Bloomberg Public Health Magazine

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The post-9/11 anthrax attacks-when spore-laced letters were delivered to victims in the mail-terrorized the country. The government ordered millions of doses of the antibiotic ciprofloxacin to prevent the life-threatening disease-and then replenished the nation's stockpile so that it might have enough in the event of a future attack.

But after a few years, memory of the attacks began to fade from America's collective psyche, and funding to maintain the cipro in the stockpile dropped off. Five years after the anthrax attacks, the nation's stash of cipro had returned to its pre-2001 level.

For Gerard Anderson, PhD, a professor in Health Policy and Management, this cycle confirmed his belief that governments tend to fund public health only in the immediate wake of an emergency. Before long, the money gets redirected to other projects and the country reverts to its usual, unprepared state.

So Anderson was hardly surprised when the U.S. struggled with its response to COVID-19. The problem isn't so much a lack of policy on issues like stockpiles, he says, but rather a lack of funding and a clear delineation of which agencies are in charge of what aspect of the emergency response. And when the threat of a future pandemic seems nebulous, politicians feel little urgency to rectify the matter.

"Policymakers tend to emphasize what is happening today instead of planning for the future," Anderson says. As a result, public health represents just 2.5%-$274 per person-of all health spending in the country, according to a 2019 report by the Trust for America's Health.

One of the most recent bellwethers of these policy shortcomings occurred in January 2017. A week before President Trump's inauguration, his team and Obama administration officials convened for a roundtable on pandemic influenza that illustrated weaknesses in the nation's preparedness. In the summary of the exercise's discussion points, Obama administration planners noted that, as cases of respiratory illness flared across the U.S., the country would begin running short of medication, ventilators, and personal protective equipment. Shoring up the supplies in the Strategic National Stockpile would have been a smart response, but politicians have historically had little stomach for such funding allocations.

Shoring up the supplies in the Strategic National Stockpile would have been a smart response, but politicians have historically had little stomach for such funding allocations.

The anecdote illustrates the paradox of American public health preparedness: Everyone wants a national stockpile, but no one wants to pay for it. As a result, the supplies actually stockpiled tend to dwindle until an emergency alerts everyone to our shortsightedness. Then, as happened after 9/11, funding will increase for a period before hubris-and tightfistedness-takes over once again. The reason is simple. If two politicians are running for office and one says she will spend money on PPE and another says she will build a community center, most voters will prefer the latter, according to Anderson. Ditto for politicians wanting to beef up spending for surveillance, emergency operations capabilities, or any of the other 15 preparedness core competencies outlined by the CDC. The results: More than 55,000 jobs at local health departments were lost from 2008-17, according to the Trust for America's Health. And CDC funding dropped by 10% from fiscal years 2010 to 2019, after adjusting for inflation.

But since pandemics are rare, the chances that the lack of preparedness will come back to bite the politician are pretty slim.

"Something that might happen in 10 years is not given much importance because it is probably going to occur after they leave office," Anderson says.

Another factor that has hindered America's response to COVID-19 is that the country's public health system is a combination of local, state, and federal government programs. The bulk of public health work is done at the local level, Anderson says, but the challenges of responding to the pandemic have overwhelmed their limited resources. The federal government has also been accused of hoarding resources, and Trump administration officials have asserted that the Strategic National Stockpile is not for state use, despite laws indicating otherwise. In this confusion, Anderson says, limited resources don't get to where they are needed.

This lack of focus on the larger picture characterizes other health-related policies as well. The U.S. is one of the only industrialized nations with no universal health care and no paid sick leave-two factors that underlie not just pandemic preparedness but basic public health, says Keshia Pollack Porter, PhD '06, MPH, associate dean for Faculty and a professor in Health Policy and Management.

The U.S. has been debating paid sick leave for more than a century. But, Pollack Porter says, disagreements about the government's role in providing social services to its citizens has meant that many social services are seen as a privilege rather than a right.

This creates immediate problems during a pandemic, especially in the early days when social distancing is the best first step for mitigating transmission. Instructions to stay home when ill are helpful, but if a job doesn't offer sick pay, many workers are forced to choose between a paycheck and their own (and everyone else's) health.

"Paid sick leave is a public health policy," Pollack Porter says.

With unemployment estimated at 20% a result of COVID-19, Pollack Porter says that a solid policy response to this secondary crisis will be key to helping the U.S. recover from the pandemic.

"This pandemic has illustrated vast systemic failures, including an underfunded public health system, lack of safety for frontline workers, and the absence of social policies like paid sick leave," Pollack Porter says. "Things will only get better if we learn from the failures and address them. And if we don't, these same failures will be present for the next outbreak that is sure to come."

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The Pandemic Response That Wasn't | Hopkins Bloomberg Public Health Magazine

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Preparedness policies require a long view-but politicians tend to think short-term.

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Boris Johnson evokes Blitz Spirit to combat Covid 19

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Boris Johnson evokes Blitz Spirit to combat Covid 19

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The article, written by a staunchly pro government tabloid, highlights the WW2 referencing which Boris Johnson was espousing as he sought to convince the nation of the importance of his emergency laws. The WW2 messaging could also likely have been used to reassure Britons in the face of an impending unprecedented viral outbreak and the idea that because the nation had risen to challenges of a similar scale before, they could (and in fact, had a responsibility) to do so again.

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BORIS Johnson has evoked the Blitz spirit as he declared the coronavirus a "national challenge" for the British public.
The Prime Minister issued a rallying cry to the public to keep calm and carry on in the midst of the crisis.

Read our coronavirus live blog for all the latest news and updates

Unveiling the Government's battle plan, Mr Johnson was asked if the nation "still have that bulldog spirit to fight this on the beaches".

Boris today backed Brits to do their bit, labelling it a "national challenge".

In a rally cry, he said: "The potential is there for something that our country has to get through.

"I have absolutely no doubt we have the resources, the health services, the expertise to do it.

"I am very confident that British public understand that and can see exactly what the balance of risk is.

"I think we will get through it in very good shape."

DELAY PHASE
RESEARCH PHASE MITIGATE STAGE
The PM has this morning launched his battle plan to save as many lives as possible while ensuring Britain goes about business as usual.

It includes sweeping measures which will be considered in the coming weeks, such as shutting down schools, banning mass gatherings, cancelling NHS operations and encouraging people to work from home.

The PM told a packed press conference at No10 earlier as the number of cases stood at 39: "The army is of course always ready as and when, but that is under the worst case scenario."

Mr Johnson insisted the most important thing was washing your hands for at least 20 seconds - or the time it takes to sing Happy Birthday twice.

He said: "Crucially, we must not forget what we can all do to fight this virus, which is to wash our hands, you knew I was going to say this, but wash our hands with soap and water.

"And forgive me for repeating this but there will be people who will be tuning into this for the first time: wash your hands with soap and hot water for the length of time it takes to sing Happy Birthday twice.

"It's simple advice but it's the single most important thing we can do, as I think our experts would attest."

Mr Johnson also insisted the vast majority of people who get the disease will be fine.

He said "Let me be absolutely clear that for the overwhelming majority of people who contract the virus, this will be a mild disease from which they will speedily and fully recover as we've already seen.

"Our country remains extremely well prepared, as it has been since the outbreak began in Wuhan several months ago.

"But at this stage, and with the exception of all of the points I have just mentioned, I want to stress that for the vast majority of the people of this country, we should be going about our business as usual."

His battle plan includes:

Urging millions of Brits to work from home to reduce the risk of catching it

Schools could be shut for up to three months

Pensioners who are most at risk from the disease could be advised to stay away from public events like the VE Day celebrations in May

Large scale events like concerts and sports matches could be cancelled

Plans to call retired doctors and nurses back into the NHS

Giving schools permission to have larger class sizes

Emergency laws to tackle the outbreak - including allowing border officials to refuse entry to Britain of anyone accused of carrying the viru

There will be a focus on helping vulnerable groups as medical experts think this is best way to reduce the number of deaths.

Local authorities will have advice on how deal with increased deaths if the outbreak reaches a crisis point.

One in one hundred Brits could die from the virus - and older people face even higher risks, the Government's top doctor said today.

Professor Chris Whitty said "probably around 1 per cent of people who get this virus might end up dying".

The PM added: "Most people will unquestionably get through it."

Officials think the virus could take six weeks to peak before gripping the country for months.

A 12-week window is being examined from the start of a possible epidemic, until the country is able to get it back under control.

Multiple peaks could be possible too, the top scientists warned.

Today Matt Hancock revealed there are now 53 cases in the UK.

He said: "We prepare for the worst and work for the best. We commit to ensuring that the agencies responsible for tackling this outbreak are properly resourced, have the people, equipment and the medicine they need and that any new laws they need are brought forward as and when required.

"This is a national effort, we need everyone to listen to and act on the official medical advice. We need employers to prioritise the welfare of their staff and the single most important thing that everyone can do and I make no apologies for repeating this, is to use tissues when you cough or sneeze and wash your hands more often.

"It's in your interest, your family's interest and in the national interest. We will get through this and everyone has a part to play."
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Boris Johnson evokes Blitz spirit as he says coronavirus is 'national challenge' for British public

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BORIS Johnson has evoked the Blitz spirit as he declared the coronavirus a "national challenge" for the British public. The Prime Minister issued a rallying cry to the public to keep ca...

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Parallels between responses to Covid-19 and WW2

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Parallels between responses to Covid-19 and WW2

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The article gives multiple examples of how there are similarities between the wartime effort and international responses to Covid-19. There is an emphasis on mobilisation, with discussions of how companies worked to produce necessary products in short supply, e.g. Louis Vuitton began manufacturing hand sanitiser. This is compared to how companies such as car manufacturers began to produce vehicles for the army. The article also discusses "collective anxiety", something that was felt both during WW2 and the pandemic. Examples are also given of government officials using wartime analogies and "combative language" in their briefings. The article uses these comparisons of global efforts to demonstrate the importance of collective efforts to face a common enemy, and to give hope - stating that through these collective efforts, "nations could ultimately recover."

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In January 1941, Winston Churchill gave a sombre address to the House of Commons, the UK's parliament. "Our Empire and indeed the whole English-speaking world are passing through a dark and deadly valley," he remarked in one of World War Two's bleakest periods. "But I should be failing in my duty if, on the other wise, I were not to convey the true impression, that a great nation is getting into its war stride."

Comparisons between World War Two and the current coronavirus pandemic are prolific. New York Governor Andrew Cuomo, who has been compared to a wartime president, has peppered his daily briefings with combative language, describing the apex of the disease's curve as "the next battle at the top of the mountain", and proclaiming "ventilators are to this war what bombs were to World War Two".

European leaders, meanwhile, talk of an inevitable "D-Day" when the outbreak will overwhelm the hospital system, and allude to war with an invisible enemy. Healthcare workers are on the frontlines, scientists are the new generals, economists draw up battle plans, politicians call for mobilisation. Just a few weeks ago, Queen Elizabeth II urged Britons to adopt the same discipline and resolve that the people had showed during WWII. "It reminds me of the very first broadcast I made in 1940, helped by my sister," the monarch recalled during a rare televised address.
You might also like:
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* How global outbreaks get beaten

The coronavirus pandemic, though different from the war in many crucial respects, seems to demand some of the same measures used during that global emergency. From boosted production to rapid redeployment of resources, increased governmental oversight and stimulus plans to potential rationing, 2020's battle against a virus might force great nations to once again adopt their war strides.

Are there lessons we can learn from the collective anxiety, the contingency measures, the calls for national cohesion and the dramatic changes to society that defined WWII? Is there is a fallacy in the modern conception of the immediate "united front" - a fallacy that will continue to play out against the backdrop of the pandemic? What does shared sacrifice look like, and how will it shape our future this time around?

The extent to which wartime psychology is relevant to our understanding of the coronavirus pandemic is, like the trajectory of the disease itself, unclear and rapidly evolving. When politicians (or journalists) reach for convenient parallels between the pandemic and those wartime battles, they may make dangerous assumptions. Comparisons that rely on militarisation, organised violence or the threat of civilian control aren't useful, and can even be harmful, especially as new information becomes available and data changes by the hour.

"If we mount a war on coronavirus, that doesn't solve fundamental problems in the healthcare system or in global trade, for example," says Mark R Wilson, professor of history at the University of North Carolina. "We constrain our imagination by thinking about a short-run war mobilisation." Insidious global problems such as equipment shortages, health care disparities, lack of emergency protocols, confusion between federal and local policies, poverty and societal inequity can't be neatly addressed by a rapid offensive against Covid-19, even if that battle is metaphoric. "There is no automatic formula for what happens during and after a crisis," Wilson adds. "But right now, people can and should still take an interest in the past."

During World War Two, a dire need to radically accelerate the output of items such as ships, tanks and bombers led to a mobilised wartime economy. The United States and Great Britain, in particular, converted existing factories that once made civilian products into those that could produce military equipment. Car manufacturers built army trucks instead; clock companies and plumbing industrialists designed ammunition cartridges; silk stockings were repurposed for parachutes.

Over the past month we've once again seen this phenomenon of conversion, as companies across the globe repurpose production lines in an effort to turn the tide of the outbreak. In just 72 hours, luxury brand Louis Vuitton began manufacturing hand sanitiser with alcohol normally used in its perfume distillery, which it then distributed to hospitals across France. General Motors, the US auto manufacturer that mass-produced tanks in World War Two, has pivoted once again, this time producing thousands of ventilators, while clothing retailers in the UK have turned from fashion to manufacturing in-demand surgical N-95 masks.

Airlines across the globe have begun chartered flights to repatriate stranded nationals abroad and transport health care workers and medical supplies to deeply impacted regions. Hospital ships such as the USNS Comfort, designed to treat casualties of war, now offer a relief valve for hospitals overwhelmed with Covid-19 patients.

This redeployment calculus applies not just to goods and services but to human capital as well. Neurosurgeons, cardiologists, medical student - all have been pulled into emergency rooms and intensive care wards. Receptionists who normally deal with billing are suddenly tasked with screening coronavirus patients, making up for an acute shortage of personnel. Restaurant workers prepare and deliver meals in bulk to exhausted emergency care nurses, parents have become full-time teachers to their children, hotel managers are being trained in hospital protocol as they open their doors to health care workers.

During World War Two, the measures used to ramp up production took months to implement; today, it would appear that we had not months, but weeks. And our current efforts seem patchwork at best. World War Two's unprecedented mobilisation effort, by contrast - its dramatic output, profit control and federal regulation - might serve as a blueprint during the next phase of the coronavirus outbreak. As they did during the war, officials could opt to fund brand new factories and equip them with machinery and tools (in this case, ventilators or personal protective gear).

By establishing dedicated Covid-19 facilities rather than converting existing ones, governments would expand capacity and absorb risk. Over the next several months, these factories could implement production lines to speed the creation of antibody tests and a vaccine. And authorities could further regulate the crisis standard of care - allocating treatment to certain patients - and ration medical equipment or even food.

The short-term financial cost of these measures would be enormous, but the payoff could be too. Indeed, rapid government intervention in the months following the coronavirus outbreak has already shown signs of success. In China, for example, thousands of workers built a field hospital on government orders; modular construction and rapid mobilisation meant that thousands more Covid-19 patients could be treated in a matter of days.

Federally mandated social distancing has also worked to compress the timeline - a kind of individual sacrifice reminiscent of wartime strain on the home front. World War Two's iconic message of "equality of sacrifice," emphasised by labour leaders and union officials and propagated through steep progressive taxes and government regulations, would be hard to sustain in today's political and financial landscape. But in recent weeks, people have shown a desire to comply, even to make personal sacrifices for the greater good.

"People are turning to war as a metaphor because of the mobilising aspects of war," says Mary L Dudziak, a law professor at Emory University who has published widely on the concept of wartime in US history. "But a pandemic is not a 'war'. A country responds to war by killing other people: death is the means of war. In a pandemic, the means of responding is not killing other people but instead trying to preserve life."

The desire to comply, to make personal sacrifices, these are no longer for the purpose of destruction, but for a greater good that is truly good: mutual assistance across nations and the safeguarding of human life

"Moments of crisis can provide opportunities for reform," says Wilson. World War Two brought national healthcare reforms, gave rise to international organisations like the United Nations and the International Monetary Fund, and in the US led to the introduction of the GI Bill, which detailed important benefits for soldiers returning from war.

Of course, not all reforms at the time were sweeping in scope. While the UK's universal health care system, the National Health Service (NHS), emerged out of World War Two, the US ended up with a far less robust system; many were left uninsured. The coronavirus crisis might bring about similar reforms; for example, targeted compensation packages for health care workers or grocery store staff. Or it might engender an entirely restructured economy, resulting in universal health care or increased job security. At the very least, we can expect to see a new generation of political leaders and thinkers to come out of it.

Consider the scientific experts now on the front lines. Just as generals take the lead in giving daily briefings in wartime, medical experts like Anthony Fauci are at the microphone to explain complex ideas like epidemic curves, social distancing and off-label use of drugs. Healthcare professionals are perhaps the new wartime generals.

After World War Two, much of Europe and Asia lay in ruins. The figures are difficult to grasp - nearly 60 million dead. Indeed, 1945 has often been referred to as Year Zero: a new way to mark time before and after the war's destruction. People the world over confronted a landscape that had been changed forever, marked by deprivation but also by hope. Government expenditures helped bring about the business recovery that had eluded President Roosevelt's New Deal .

Throughout the US and Europe, wartime mobilisation and ingenuity secured employment and a fairer distribution of income, while creating entirely new technologies, industries and associated human skills. Old ideological constraints collapsed, but new ideas about capital, entrepreneurship, and social bonds emerged. These extraordinarily ambitious efforts - civilian and federal, at home and abroad - meant that nations could ultimately recover.

To misquote a post-war US presidential candidate, there will be no "return to normalcy" after the coronavirus pandemic. From the comfort of our homes, we may sit and leaf through the pages of history, imagining various after-lesson actions - but we know for certain only that nothing can be certain.

Yet, this crisis has arguably spurred mobilisation on an international scale not seen since the war 80 years ago. The pandemic demands quick crash efforts with high stakes, has united people across the world, and promises to accelerate seismic global changes which could last for years to come.

Then, as now, we might take some courage in the Queen's wartime vow: "We will be with our friends again. We will be with our families again. We will meet again."

--
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Covid-19: What we can learn from wartime efforts

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In January 1941, Winston Churchill gave a sombre address to the House of Commons, the UK's parliament. "Our Empire and indeed the whole English-speaking world are passing through a dark and deadly valley," he remarked in one of World War Two's bleakest periods.

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Parallels drawn between Covid-19 and past pandemics  

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Parallels drawn between Covid-19 and past pandemics  

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This article helps emphasise the importance of history when tackling worrying global events like Covid-19. Parallels are drawn with the Great Plague of 1665 and how many measures taken at that time are similar to social distancing during Covid. This shows that despite having various differences it is extremely valuable to look at past pandemics to see what actions were taken. This will allow us to identify what was successful at the time and how to build on past mistakes. Historical insight will allow us to be better equipped to deal with the current threat and to minimise damage caused by it.

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Self-isolation, lock-downs, economic chaos and closed borders: responses to today's COVID-19 pandemic have their roots in history. In the past, there has also been panic-buying, attempted flight, fake news, quack remedies, beleaguered health authorities and a race for vaccines - all in the face of millions of deaths.

From earliest history to the SARS epidemic, the world has endured plagues, viruses and infections that have inspired panic among populations, rulers and politicians alike - as well as countless untimely deaths. From the Black Death of 1348 to the London plague of 1665, from the repeated impact of cholera in the 19 th and 20 th centuries, to the millions lost in the 1918 'Spanish' flu, leaders have often struggled to know what to do while populations have reacted with fear and later, occasionally, fury. The reaction to COVID-19 can be seen very much in this tradition, as concern has turned into pressure for the strictest containment measures, alongside the determined - and unprecedentedly rapid - pursuit of a cure.

During cholera epidemics, propaganda was used to urge people to pursue physically and morally 'healthy' habits from staying calm and washing their hands - just as it has been today - to praying for salvation and quitting alcohol. In the 1918 epidemic, face masks were in common use and, in earlier times, people were ordered to quarantine. In the distant past, though, civil disorder sometimes followed. Public compliance eventually turned into public dissatisfaction with measures, which included infected people literally being shut into their houses.

In the 1918 epidemic, face masks were in common use and, in earlier times, people were ordered to quarantine

As in the past, in the current crisis there will be 'pinch points', according to historians, for instance if the number of cases rises despite social distancing and the authorities will need to issue reassurance or adjust the measures being taken. While social distancing is an internationally agreed approach, as the situation changes, governments around the world will be under pressure to put in place policies for an eventual move to less draconian measures. At that point, Oxford Professor of the History of Medicine, Mark Harrison, maintains international leaders will need to look for an 'exit strategy' or an end in sight from the current lockdown approach. Professor Harrison says: 'Governments will need to ask, how do we de-escalate? What measures do we put in place and can we re-escalate at a later point?'

Although the threat to life from the plague was in a completely different order to that presented by COVID-19, the measures taken in London in 1665 were not dissimilar to current international social distancing. From the beginning of the plague outbreak, there was strict quarantine of infected people, trades closed down and many fled the city. But, in chaotic Restoration-era London, crime and disorder followed harsh restrictions. Samuel Pepys wrote in his diary: 'This day, much against my will, I did in Drury Lane see two or three houses marked with a red cross upon the doors, and 'Lord Have Mercy upon Us' writ there - which was a sad sight to me, being the first of the kind... that I ever saw.'

Although the threat to life from the plague was in a completely different order to that presented by COVID-19, the measures taken in London in 1665 were not dissimilar to current international social distancing

Opposition was swift. In the documents of a case discussed at court at Whitehall in the presence of Charles II, 28 April 1665, it states: 'Upon Information given unto this Board, that the house, the Signe of the ship in the New buildings in St.Giles in the fields, was shutt up as suspected to bee infected with the Plague, & a Cross and paper fixed, on the doore; And that the said Cross & paper were taken off, & the door opened, in a riotious manner, & the people of the house permitted, to goe abroad into the street promiscuously, with others.'

This was not an isolated incident. In a letter from a civil servant, 1665, also in the National Archive, it states: ' Death is now become so familiar, and the People soe insensible of danger, that they look upon such as provide for the publick safety, as Tyrants and Oppressors. '

Government experts are already talking about scaling back the strict measures over time. The current lockdown is initially going to last three weeks. And over the next 12 months greater and lesser restrictions may be applied, depending on the course of the virus.

Widespread use of testing offers a way of relaxing measures but GPS monitoring advocated in South Korea is proving controversial there. Professor Harrison says: 'Maybe they [the government] will have to communicate with people that they will have to accept some risk as a price for their freedom. Maybe they will have to make available more intensive care beds, in expectation of more cases....The prime minister said there was light at the end of the tunnel of 12 weeks. That is the target. But there could be dissatisfaction if de-escalation doesn't happen...Resentment could build up.'

In one important respect parts of the COVID-19 response are very different from previous centuries - or even decades. This includes the speed with which scientists have been able to identify, sequence, and share information about a completely novel pathogen, the development of promising diagnostics, vaccines, and treatments within just over three months of the virus being identified, and global real-time disease surveillance

Problems could arise, if, as happened in 1665, there are secondary waves of infection. The plague raged in the City for more than 12 months, but according to the Bills of Mortality, the peak was not reached until September 1665 - a full year after the first reports of illness. And there were still deaths after this peak, affecting some people who had returned to London, in the expectation it had ended. Professor Harrison says: 'It is still too early to say what is working and what isn't [in terms of the fight against the virus]. There's a reasonable high probability that there will be some immunity [for people who have had the virus] but we don't know how long that would last.'

Careful studying of how countries such as China and South Korea, which rapidly implemented strict social distancing early on and then balance a de-escalation of measures, will provide valuable lessons for the rest of the world.

Dr Claas Kirchhelle, lecturer in the history of medicine at University College Dublin and fellow of the research and policy unit, the Oxford Martin School, says: 'Restricting the movement of people and implementing other rudimentary forms of social distancing have been mainstays of disease responses for centuries - alongside rumours, stigmatisation, and often desperate attempts to find remedies ranging from charms to quack medicines'.

Responses often varied according to cultural precedents and the specific biological profile of the pathogens involved. But, he says, in one important respect parts of the COVID-19 response are very different from previous centuries - or even decades. This includes the speed with which scientists have been able to identify, sequence, and share information about a completely novel pathogen, the development of promising diagnostics, vaccines, and treatments within just over three months of the virus being identified, and global real-time disease surveillance.

Dr Kirchhelle says the response to COVID-19 marks a dramatic acceleration of disease response strategies, which gradually emerged from the second half of the 19th century onwards. During this period, the discovery of germ-theory gradually revealed the biological causes and transmission modes of previously mysterious and untreatable diseases.

Resulting blessings were manifold: from increasingly reliable diagnostics and more targeted non-therapeutic interventions like chlorination or campaigns against flea-bearing rats to the development of effective vaccines and specific therapies like antibiotics. At the same time, nation states also became better at coordinating their response to international disease outbreaks. Convened in response to the cholera pandemics sweeping the globe, a series of international sanitary conferences began to lay the legal groundwork for standardised quarantine periods, disinfection methods, and international information sharing on infectious disease.

At the time of the 1918 flu pandemic, many people expected that science and officials would be able to take action. But the tried-and-tested approaches of traditional bacteriology failed. The disease was not caused by a bacterium but by an unusually deadly influenza virus. Not knowing what this was meant 'they didn't know what they were facing'. Coming at the end of the Great War and with actual incidence rates often censored by wartime and post-war governments, the 'flu' was able to move quickly around the world and across a broken Europe. And, as now, many people thought it was 'just flu'. Dr Kirchhelle says: 'There seemed no way to stop it spreading; it was explosive and devastating.' Many people actually died of bacterial superinfections, which spread easily in malnourished bodies and in mass wards and could today have been treated with antibiotics.

Concerted international action has been critical in terms of tackling COVID-19. Although the current advice is very much in line with traditional attempts to starve a disease of susceptible new bodies, the rapid scientific response to a rapidly spreading infection has been ground-breaking. According to Dr Kirchhelle: 'There has been a radical sharing of information and a very rapid sequencing of the pathogen's genetic code.'

He concludes: 'The WHO in particular has worked well, despite chronic underfunding, and the fact that it has few actual powers to enforce compliance. The COVID-19 pandemic shows that new pathogens can rapidly spread globally. Hopefully, our current experience of vulnerability will lead to a long-term strengthening of international cooperation when it comes to tackling infectious disease and improving health systems in all parts of the world.'

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Self-isolation, lock-downs, economic chaos and closed borders: responses to today's COVID-19 pandemic have their roots in history. In the past, there has also been panic-buying, attempted flight, fake news, quack remedies, beleaguered health authorities and a race for vaccines - all in the face of millions of deaths.

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The history of pandemics is used both to show how far we have advanced in the medical field but also to reflect how pandemics such as Covid 19 remain dangerous and predictable. Walsh draws comparisons with the past to highlight how our responses to pandemics still need to improve, for example he compares the Covid lockdown response as not “that different from what our ancestors might have tried to halt an outbreak of the plague”.  The current circumstances of this article reinforce this use of the past, as Covid was rapidly spreading and was just declared a pandemic by the WHO, emphasising how infectious disease remains a threat and how there is therefore still more to improve on in healthcare.

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The novel coronavirus pandemic, known as Covid-19, could not have been more predictable. From my own reporting, I knew this first-hand. In October 2019, I attended a simulation involving a fictional pandemic, caused by a novel coronavirus, that killed 65 million people, and in the spring of 2017 I wrote a feature story for TIME magazine on the subject. The magazine cover read: "Warning: the world is not ready for another pandemic".

There was little special about my insight. Over the past 15 years, there has been no shortage of articles and white papers issuing dire warnings that a global pandemic involving a new respiratory disease was only a matter of time. On BBC Future in 2018, we reported that experts believed a flu pandemic was only a matter of time and that there could be millions of undiscovered viruses in the world, with one expert telling us, "I think the chances that the next pandemic will be caused by a novel virus are quite good." In 2019, US President Donald Trump's Department of Health and Human Services carried out a pandemic exercise named "Crimson Contagion", which imagined a flu pandemic starting in China and spreading around the world. The simulation predicted that 586,000 people would die in the US alone. If the most pessimistic estimates about Covid-19 come true, the far better named "Crimson Contagion" will seem like a day in the park.

As of 26 March, there were more than 470,000 confirmed cases of Covid-19 around the world and more than 20,000 deaths, touching every continent save Antarctica. This was a pandemic, in reality, well before the World Health Organization finally declared it one on 11 March. And we should have seen it coming.

Covid-19 marks the return of a very old - and familiar - enemy. Throughout history, nothing has killed more human beings than the viruses, bacteria and parasites that cause disease. Not natural disasters like earthquakes or volcanoes. Not war - not even close.
Mass killers
Take the mosquito-borne disease malaria. It has stalked humanity for thousands of years, and while death tolls have dropped significantly over the past 20 years, it still snuffs out nearly half a million people every year.

Over the millennia, epidemics, in particular, have been mass killers on a scale we can't begin to imagine today - even in the time of the coronavirus.
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The plague of Justinian struck in the 6th Century and killed as many as 50 million people, perhaps half the global population at the time. The Black Death of the 14th Century - likely caused by the same pathogen - may have killed up to 200 million people. Smallpox may have killed as many as 300 million people in the 20th Century alone, even though an effective vaccine - the world's first - had been available since 1796.

Some 50 to 100 million people died in the 1918 influenza pandemic - numbers that surpass the death toll of World War One, which was being fought at the same time. The 1918 flu virus infected one in every three people on the planet. (Read more about how the 1918 flu changed the world). HIV, a pandemic that is still with us and still lacks a vaccine, has killed an estimated 32 million people and infected 75 million, with more added every day.

If these numbers shock, it's because today epidemics are rarely discussed in history classes, while in the not so distant past, they were simply a terrible fact of life. There are few memorials to the victims of disease. The historian Alfred Crosby was the author of America's Forgotten Pandemic, one of the great books on the 1918 flu. But Crosby was only prompted to begin researching the pandemic when he stumbled on the forgotten fact that American life expectancy had suddenly dropped from 51 years in 1917 to 39 years in 1918, before rebounding the following year. That plummet in 1918 was because of a virus just 120 nanometers wide.
Viral advantage
Pathogens make such effective mass killers because they are self-replicating. This sets them apart from other major threats to humanity. Each bullet that kills in a war must be fired and must find its target. Most natural disasters are constrained by area: an earthquake that strikes in China can't directly hurt you in the UK.

But when a virus - like the novel coronavirus - infects a host, that host becomes a cellular factory to manufacture more viruses. Bacteria, meanwhile, are capable of replicating on their own in the right environment.

The symptoms created by an infectious pathogen - such as sneezing, coughing or bleeding - put it in a position to spread to the next host, and the next, a contagiousness captured in the replication number, or "R0" of a pathogen, or how many susceptible people one sick person can infect. (Imperial College London has estimated the novel coronavirus's R0 at 1.5 to 3.5.) And because human beings move around - interacting with other human beings as they do so in every manner from a handshake to sexual intercourse - they move the microbes with them. (Read more about what makes viruses so difficult to outsmart).

No wonder militaries have long tried to harness disease as a tool of war. No wonder that, until recently, far more soldiers died of disease than died in combat. A pathogen is a perfectly economical weapon, turning its victims into its delivery system.

The constant threat of disease, as much as any other factor, kept the reins on human development and expansion. At the dawn of the 19th Century, global life expectancy was just 29 years - not because human beings couldn't live to much older ages even then, but because so many of us died in infancy from disease, or from infection during childbirth or after a wound. (Read more about whether our life spans are really longer than that of our ancestors).

The cities of the pre-modern era were only able to keep up their populations through a continual infusion of migrants to make up for citizens who died off from disease. The development first of sanitation, and then of countermeasures like vaccines and antibiotics, changed all that.

"The defeat of infection overcame these barriers and allowed us to have these great global cities," says Charles Kenny, a senior fellow at the Center for Global Development, a think tank in Washington DC, and the author of the forthcoming book Winning the War on Death: Humanity, Infection and the Fight for the Modern World.

It was a victory that won us the modern world as we know it.
A better era
It can be difficult to comprehend how quickly that war was seemingly won. My great-grandparents could have fallen victim to the 1918 flu. My grandparents lived their infancy and youth before penicillin was developed. My parents were born before the polio vaccine was invented in 1954. Yet by 1962, the Nobel Prize-winning virologist Sir Frank Macfarlane Burnet could note that "to write about infectious disease is almost to write of something that has passed into history".

In the developed world, and increasingly in the developing world, we are now far more likely to die from non-communicable diseases like cancer, heart disease or Alzheimer's than from a contagion. The decline of infectious disease is the best evidence that life on this planet truly is getting better.

While reporting my book End Times, I visited the epidemiologist Marc Lipsitch at his office at the Harvard T.H. Chan School of Public Health in Boston one rainy morning in the spring of 2018. Lipsitch is one of the most influential epidemiologists in the United States, and one who takes seriously the possibility that disease pandemics might constitute a true global catastrophic risk - which is why I was there to see him.

But that morning Lipsitch showed me something I wasn't expecting: a chart that graphed infectious disease mortality in the United States over the course of the 20th Century.

What it shows is a drastic decline, from around 800 deaths from infectious disease per 100,000 people in 1900 to about 60 deaths per 100,000 by the last years of the century. There was a brief spike in 1918 - that would be the flu - and a slight and temporary upturn during the worst of the AIDS epidemic in the 1980s. But, Lipsitch told me, "death rates from infectious disease dropped by nearly 1% a year, about 0.8 % per year, all the way through the century."
Not over yet
That's the good news. The bad news, as Covid-19 reminds us, is that infectious diseases haven't vanished. In fact, there are more new ones now than ever: the number of new infectious diseases like Sars, HIV and Covid-19 has increased by nearly fourfold over the past century. Since 1980 alone, the number of outbreaks per year has more than tripled.

There are several reasons for this uptick. For one, over the past 50 years, we've more than doubled the number of people on the planet. This means more human beings to get infected and in turn to infect others, especially in densely populated cities. We also have more livestock now than we did over the last 10,000 years of domestication up to 1960 combined, and viruses can leap from those animals to us.

As Covid-19 is painfully demonstrating, our interconnected global economy both helps spread new infectious diseases - and, with its long supply chains, is uniquely vulnerable to the disruption that they can cause. The ability to get to nearly any spot in the world in 20 hours or fewer, and pack a virus along with our carry-on luggage, allows new diseases to emerge and to grow when they might have died out in the past.

For all the advances we've made against infectious disease, our very growth has made us more vulnerable, not less, to microbes that evolve 40 million times faster than humans do.

Antibiotics have saved hundreds of millions of lives since the serendipitous discovery of penicillin in 1928, but bacterial resistance to these drugs is growing by the year, a development doctors believe is one of the greatest threats to global public health. In fact, 33,000 people die each year from antibiotic resistant infections in Europe alone, according to a 2018 study. The "antibiotic apocalypse", as England's former chief medical officer, Sally Davies, called it, puts us in danger of returning to a time when even run-of-the-mill infections could kill.

Back in 2013, a World Bank estimate of how much the 1918 flu could cost our now much richer and more connected global economy put the figure at more than $4 trillion, nearly the entire GDP of Japan. Early estimates of the economic damage from Covid-19 have already crossed the trillion-dollar mark.

The World Health Organization, which performed so well under the stress of Sars, has botched more recent outbreaks so badly that experts have called for the entire organisation to be overhauled. Climate change is expanding the range of disease-carrying animals and insects like the Aedes aegyptimosquitoes that transmit the Zika virus.

Even human psychology is at fault. The spread of vaccine scepticism has been accompanied by the resurrection of long-conquered diseases like measles, leading the WHO in 2019 to name the antivaccination movement one of the world's top 10 public-health threats.

Covid-19 is very much a disease of the moment, emerging in a crowded city in a newly prosperous and connected China before spreading to the rest of the world in a matter of months. But our response to it has been both hyper-modern - and practically medieval. Scientists around the world are using cutting-edge tools to rapidly sequence the genome of the coronavirus, pass along information about its virulence, and collaborate on possible countermeasures and vaccines, all far quicker than could have been done before.

But when the virus arrived among us, our only effective response was to shut down society and turn off the assembly line of global capitalism. Minus the text alerts, the videoconferencing and the Netflix, what we were doing wasn't that different from what our ancestors might have tried to halt an outbreak of the plague. The result has been chemotherapy for the global economy.

Just as the eventual emergence of something like Covid-19 was easily predictable, so too are the actions we should have taken to shore ourselves against its coming.

We need to strengthen the antennae of global health, to ensure that when the next virus emerges - which it will - we'll catch it faster, perhaps even snuff it out. The budget of the WHO, the agency ostensibly charged with safeguarding the health of the world's 7.8 billion citizens, is somehow no more than that of a large urban hospital in the U.S.

We need to double down on the development of vaccines, which will include assuring large pharma companies that their investments won't be wasted should an outbreak end before one is ready.

We need to build more slack into our public health systems. Just as the US military is designed - and funded - to fight a war on two fronts, so our health care systems should have the surge capacity to meet the next pandemic.

One ongoing challenge in pandemic preparation is what experts call shock and forgetting. Too often politicians make funding promises in the immediate aftermath of a crisis like Sars or Ebola, only to let those pledges lapse as the memory of the outbreak fades.

Somehow, I expect that won't be the case with Covid-19. We need to do all we can to not just survive this pandemic, but to ensure it remains a throwback from the past, not a sign of things to come.
* Bryan Walsh is the Future Correspondent for Axios and the author of End Times: A Brief Guide to the End of the World, from which this story was adapted and updated. End Times is published by Hachette Books.
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Throughout history, nothing has killed more human beings than infectious disease. Covid-19 shows how vulnerable we remain - and how we can avoid similar pandemics in the future.

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Parallels were drawn with the Spanish Flu to highlight that Covid-19 was a much more manageable disease and less deadly, possibly to reassure the public and emphasise how far public health had come since 1918.

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Coronavirus: What can we learn from the Spanish flu?

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After World War One, a flu pandemic swept the world, killing at least 50 million people. What lessons can it teach us about Covid-19?

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During the pandemic, parallels with WW2 were commonly deployed by public figures to invoke a sense of collective struggle and national unity. Elizabeth II highlights how as a princess she first addressed the nation in 1940, and in perhaps the most obvious reference to that era tells the British public 'we will meet again'.

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The Queen has promised the nation that better days are ahead, during a special address on Sunday.

In a rare speech, she acknowledged the grief and financial hardships Britons are facing during the coronavirus pandemic.

Echoing the words of the Vera Lynn wartime song, she said that "we will meet again".

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The sovereign promises "better days will return" in her address to the nation during the coronavirus pandemic.