tag:theconversation.com,2011:/fr/topics/1918-flu-pandemic-50734/articles1918 flu pandemic – The Conversation2023-11-02T14:20:44Ztag:theconversation.com,2011:article/2166492023-11-02T14:20:44Z2023-11-02T14:20:44ZBird flu could be eradicated by editing the genes of chickens - our study shows how<p>Recent advances in gene editing technology could potentially be used to create disease-resistant animals. This could curtail the spread of avian influenza, commonly known as bird flu. </p>
<p>In a recent <a href="https://www.nature.com/articles/s41467-023-41476-3">gene editing</a> study, my colleagues and I showcased the potential of gene editing to protect chickens from the threat of bird flu. This disease is caused by an ever-evolving virus that gets around numerous <a href="https://www.daera-ni.gov.uk/articles/biosecurity#:%7E:text=Biosecurity%20is%20the%20prevention%20of,quality%20of%20a%20food%20product.">biosecurity</a> measures such as good hygiene, restricting bird movements, surveillance through appropriate testing, and selective elimination of infected birds.</p>
<p>A gene editing breakthrough would stem the huge economic losses currently suffered as a result of bird flu outbreaks. It would also be a significant step in controlling a disease that can cause serious sickness and death in humans.</p>
<h2>Why managing bird flu matters</h2>
<p>Outbreaks of bird flu around the world cost <a href="https://www.nature.com/articles/d41586-022-03322-2">billions of dollars</a> in losses. The United States Department of Agriculture reported that up to <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/avian-flu-outbreak-wipes-out-5054-mln-us-birds-record-2022-11-24/">50 million birds</a> died from bird flu in 2022. Recently, the South African Poultry Association said more than <a href="https://www.thepoultrysite.com/news/2023/10/avian-influenza-forces-south-africa-to-cull-2-5-million-broilers">7 million</a> chickens were destroyed after outbreaks were detected in the first half of 2023.</p>
<p>Beyond the economic implications, bird flu outbreaks also pose a risk to <a href="https://www.who.int/news/item/12-07-%202023-ongoing-avian-influenza-outbreaks-in-animals-pose-risk-to-humans">human health</a>.</p>
<p>Prior to the COVID-19 pandemic, bird flu was considered a possible trigger for a devastating human pandemic. This prompted international surveillance led by the <a href="https://www.woah.org/en/home/">World Organisation for Animal Health</a>, the <a href="https://www.who.int/">World Health Organization</a> and the <a href="https://www.fao.org/home/en">Food and Agricultural Organisation of the United Nations</a>.</p>
<p>The fear is well-founded as the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291411/#:%7E:text=Three%20worldwide%20(pandemic)%20outbreaks%20of,and%20Hong%20Kong%20influenza%2C%20respectively.">three flu pandemics</a> of the 20th century – including the <a href="https://www.cdc.gov/flu/avianflu/timeline/avian-timeline-1880-1959.htm">1918 flu pandemic</a> that
claimed tens of millions of lives – originated from birds.</p>
<h2>Vaccinations can only do so much</h2>
<p>Vaccination is a primary method for preventing bird flu outbreaks in chickens. </p>
<p>However, the effectiveness of vaccines is limited because the bird flu virus rapidly evolves. This makes existing vaccines less effective over time. Also, there are multiple strains of the bird flu virus but a vaccine is effective against a specific strain only. </p>
<p>It’s necessary to match a <a href="https://doi.org/10.2903/j.efsa.2023.8271">vaccine</a> with the prevailing strain causing an outbreak. Using vaccines may also involve substantial costs and practical hurdles of distribution.</p>
<h2>Gene editing to improve animal welfare</h2>
<p>In contrast to vaccinations, gene editing targets a protein or proteins within chickens that are vital for all strains of bird flu, effectively stopping the virus in its tracks.</p>
<p>Gene editing refers to the process of making a precise change in a specific gene in an animal to introduce <a href="https://genomebiology.biomedcentral.com/articles/10.1186/s13059-018-1583-1">traits</a> such as resistance to a particular disease, increased productivity and characteristics that enhance animal welfare. </p>
<p>A beneficial genetic change introduced into an animal using gene editing may already occur naturally in another animal. </p>
<p>For example, gene editing was used to make dairy cattle hornless by introducing into them a <a href="https://www.nature.com/articles/nbt.3560">genetic change</a> found in naturally hornless cattle. This is important as many dairy cattle have horns, resulting in the painful practice of <a href="https://www.sciencedirect.com/science/article/abs/pii/S1090023304000486">dehorning</a> calves to reduce the risk of injury to the animal and the farmer.</p>
<p>It’s important not to confuse gene editing with genetic modification, which entails transferring a gene from one species to another. This distinction is necessary for regulatory purposes, especially as the older genetic modification technology has faced <a href="https://www.sciencedirect.com/science/article/abs/pii/S0956713522003863?via%3Dihub">stringent regulations</a> in many countries, hampering its development.</p>
<p>To produce the gene-edited chickens in our study, we used the powerful molecular scissors known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975809/#:%7E:text=Go%20to%3A-,Overview%20of%20CRISPR%2FCas9,genome%20(see%20figure%201).">CRISPR/Cas9</a> to make a single gene edit. We targeted the <a href="https://www.ncbi.nlm.nih.gov/gene/8125">ANP32A</a> protein in chickens. </p>
<p>Compared to normal chickens hatched simultaneously, these gene-edited chickens reached maturity without any discernible adverse consequences on their health and wellbeing.</p>
<p>To test their resistance, we exposed the gene-edited chickens to a low dose of the bird flu virus. Remarkably, 9 out of 10 of these birds displayed complete resistance, and no transmission occurred to other chickens. </p>
<p>Taking a more ambitious step, we inoculated the gene-edited chickens
with a high, unnatural dose of the virus – 1,000 times the low dose. This time, 5 out of the 10 inoculated gene-edited chickens became infected. </p>
<p>We also found that the bird flu virus was capable of adapting to use the edited ANP32A protein, as well as two related proteins – <a href="https://www.ncbi.nlm.nih.gov/gene/10541">ANP32B</a> and <a href="https://www.ncbi.nlm.nih.gov/gene/81611">ANP32E</a>. But we demonstrated through experiments in cells that simultaneously editing all three proteins could completely suppress the virus. </p>
<h2>What’s next?</h2>
<p>Ongoing research aims to identify the specific combination of gene edits needed to create the next generation of gene-edited chickens, providing complete and permanent protection against bird flu.</p>
<p>Gene editing should be regarded as an essential tool for preventing and controlling deadly animal diseases. </p>
<p><a href="https://www.nature.com/articles/s41538-019-0035-y">Supportive government regulations</a> will be required to promote the development of gene editing aimed at enhancing animal health and welfare. </p>
<p>The potential for disease resistant animals to protect global food security and public health is a compelling reason to pursue this innovative path in biotechnology.</p><img src="https://counter.theconversation.com/content/216649/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alewo Idoko-Akoh was supported in the highlighted study by funding from the UK Research & Innovation's BBSRC </span></em></p>The three flu pandemics of the 20th century originated from birds, making it critical to fight bird flu. Breakthroughs in gene-editing chickens show promise for eliminating the disease in the future.Alewo Idoko-Akoh, Research associate, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150042023-10-16T19:25:47Z2023-10-16T19:25:47ZMemory in action: what the UK’s official COVID commemoration should look like<p>Whether an <a href="https://theconversation.com/why-are-those-lost-to-covid-not-formally-memorialised-how-politics-shapes-what-we-remember-213170">actual bereavement</a> or a loss of experience, everyone has lost something to COVID. From early on in the pandemic, grassroots memorials sought to acknowledge this collective experience, including the <a href="https://www.theguardian.com/world/2021/jul/18/wall-of-love-the-incredible-story-behind-the-national-covid-memorial-led-by-donkeys">national COVID memorial wall</a> in London and the <a href="https://www.mariecurie.org.uk/get-involved/day-of-reflection/reflect#:%7E:text=On%2023%20March%202023%2C%20let's,a%20minute's%20silence%20at%20noon.">annual national day of reflection</a> organised by the Marie Curie charity.</p>
<p>In September 2023, the <a href="https://www.gov.uk/government/organisations/uk-commission-on-covid-commemoration">UK Commission on COVID Commemoration</a> released its <a href="https://www.gov.uk/government/publications/the-uk-commission-on-covid-commemorations-final-report">final report</a> on how a more official reckoning with the pandemic’s legacy should be shaped. It outlines ten recommendations. </p>
<p>The pandemic has affected people in vastly different ways. How governments, institutions and the wider public have responded has varied enormously, too. It is also still ongoing, which complicates things further.</p>
<p><a href="https://theconversation.com/fall-covid-19-update-will-there-be-a-new-surge-who-should-get-the-new-mrna-vaccines-are-they-safe-and-effective-213445">New variants</a> of the virus are on the rise. And nearly <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">two million people</a> in the UK alone continue to suffer with <a href="https://theconversation.com/long-covid-symptoms-can-improve-but-their-resolution-is-slow-and-imperfect-212015">long COVID</a>. </p>
<p>As immunologist Sheena Cruickshank <a href="https://www.theguardian.com/commentisfree/2023/oct/07/covid-19-uk-variants-testing-monitoring-drugs">put it recently</a>, “it may feel like we should all be done with COVID-19, but sadly COVID-19 is not done with us”. </p>
<p>My <a href="https://edinburghuniversitypress.com/book-commemorative-modernisms.html">research</a> into memorial culture and modernism shows how the lack of a clear or coherent narrative for an event like a pandemic makes commemorating it that much harder. The official and cultural memory of the 1918 flu pandemic was subsumed into that of the first world war – and it remained largely unremembered, until COVID brought it back to public attention.</p>
<figure class="align-center ">
<img alt="Archival photograph in black and white of nurses in a hospital with a patient during the first world war." src="https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553688/original/file-20231013-15-q5vpxj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Nurses began erecting memorials early on in the first world war.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/d/d5/World_War_I%3B_photograph_of_nurses_dressing_wounds_Wellcome_L0009198.jpg">Wellcome Collection Images</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<h2>Remembrance and preparedness</h2>
<p>From October to December 2022, the UK Commission on Covid Commemoration held a six-week period of public consultation. It conducted surveys, garnering 5,000 responses. It also met with affected groups, including bereaved families and long-COVID sufferers, as well as groups that are sceptical about the illness and lockdown strategies. </p>
<p>The report is, to my mind, admirably well considered, sensitive to the difficulties of the task. It firmly establishes why memorialising all deaths that have occurred during the pandemic – COVID-related or otherwise – is necessary. This chimes with previous <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9052814/">research</a> that has found that <a href="https://www.lse.ac.uk/News/Latest-news-from-LSE/2020/j-October-20/The-way-COVID-19-is-officially-commemorated-will-shape-our-ability-to-respond-to-a-second-wave">COVID-related grief</a> is particularly difficult and that public commemoration is necessary for social cohesion. </p>
<p>The 11 members of the commission suggest a range of commemorations, which will now be considered for implementation by the British government. These include an annual day of reflection on the first Sunday in March, a new symbol to represent the pandemic, the establishment of a commemoration trust to organise and promote these initiatives, along with a commemoration website and an online book of remembrance. </p>
<p>The commissioners suggest creating ten green spaces across the country, each boasting a sculpture created by local artists. They recommend preserving those grassroots initiatives already in place, including the national COVID memorial wall. </p>
<p>Finally, they propose various educational initiatives. These include teaching the history of the pandemic in schools and college and collating oral histories from a wide range of groups, to, as the report puts it, “serve as a historical record of this period of our time and as an educational tool for future generations”. A postdoctoral fellowship programme is suggested, too, to enable future researchers to work with policy makers on national preparedness for natural hazards.</p>
<p>Most of these recommendations are fairly standard commemorative gestures. The decision to create disparate pockets of remembrance across the UK rather than one large-scale memorial is expected, as there is no consensus or agreed-upon version of the pandemic. </p>
<p>The choice of green spaces is usefully open-ended in terms of meaning. The memorial sculptures destined for each will, doubtless, be similarly open-ended, in keeping with the <a href="https://modernismmodernity.org/forums/posts/kelly-covid-commemoration-and-cultural-memory">minimalist, abstract and predominantly secular tendencies</a> in modern contemporary memorials in the UK. </p>
<p>The report also proposes council funding for local commemorative spaces in existing parks or green spaces, not unlike the many community-led first world war memorials. </p>
<p>The COVID symbol the commission suggests is a zinnia flower. Associated with remembrance, this floral design has similarities to the poppy which has <a href="http://ww1centenary.oucs.ox.ac.uk/war-as-revolution/poppies-paris-and-the-power-of-objects/">long symbolised</a> the first world war.</p>
<p>Large-scale commemorative gestures have already been seen in other nations. Most notably, Joe Biden’s first act as US president was, during his inaugural address, to lead a <a href="https://www.youtube.com/watch?v=9rbIUXy3E0U">moment of silence</a> to remember the then 400,000 Americans lost to the pandemic.</p>
<p>By contrast, the UK public has felt left down by its government’s response. The news, that <a href="https://www.bbc.co.uk/news/uk-politics-56890714">former prime minister Boris Johnson</a> reportedly said, in autumn 2020, that he would rather see “bodies pile high” than impose a third lockdown on the UK, has left a bitter taste. </p>
<p>Johnson’s subsequent <a href="https://www.theguardian.com/world/2021/apr/29/boris-johnson-night-time-visit-memorial-angers-covid-bereaved">clandestine evening trip</a>, in April 2021, to the COVID memorial wall, as well as public scandals such as <a href="https://theconversation.com/boris-johnsons-evidence-to-mps-partygate-investigation-the-key-points-of-disagreement-explained-202190">Partygate</a>, have further angered the public. Bereaved family groups such as <a href="https://covidfamiliesforjustice.org/">COVID-19 Bereaved Families for Justice</a> are understandably anxious to see that their loved ones are remembered officially as names and not as numbers.</p>
<p>The commission is eager to distinguish itself from the contentious <a href="https://www.bbc.co.uk/news/health-66951800">COVID-19 Inquiry</a>. This report is a useful corrective to the inadequacies of the British government in commemorating the pandemic to date. </p>
<p>Some may wonder if it is too early to commemorate a pandemic that isn’t yet over. After 1914, nurses began to create memorials as soon as the first deaths happened. The British government established the <a href="https://www.iwm.org.uk/corporate/IWM-history">Imperial War Museum</a> in 1917, while the war was still ongoing. I <a href="https://edinburghuniversitypress.com/book-commemorative-modernisms.html">have shown</a> how necessary these commemorative gestures were. They ensured that the dead were not forgotten. </p>
<p>Whether the government will now do is yet to be seen. In its insistence both on remembrance and on preparedness – for the next pandemic that, experts agree, will happen – this report is a good first step.</p><img src="https://counter.theconversation.com/content/215004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Kelly received a British Academy Rising Star Engagement Award from 2017-19 for a seminar series entitled "Cultures and Commemorations of War."</span></em></p>Memorialising a pandemic that is still underway is a challenge. Official commemoration needs to be about remembrance and preparedness.Alice Kelly, Assistant Professor of Literature and History, University of WarwickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057222023-05-17T12:41:07Z2023-05-17T12:41:07ZPivotal points in the COVID-19 pandemic – 5 essential reads<figure><img src="https://images.theconversation.com/files/526612/original/file-20230516-37571-gp5zr6.jpg?ixlib=rb-1.1.0&rect=43%2C28%2C9547%2C5161&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2, the virus that causes COVID-19, has evolved over time into multiple variants and sublineages. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-royalty-free-image/1366654397?phrase=covid+virus&adppopup=true">loops7 / E+ via Getty Images</a></span></figcaption></figure><p>Experts have made it clear that the <a href="https://theconversation.com/what-does-ending-the-emergency-status-of-the-covid-19-pandemic-in-the-us-mean-in-practice-4-questions-answered-205165">end of the COVID-19 national emergency</a>, which was lifted on May 11, 2023, <a href="https://www.statnews.com/2023/05/10/public-health-emergency-ashish-jha/">does not mean an end to the pandemic</a>. But this shift signals a remarkable turning point in a pandemic that is well into its fourth year – something that few could have imagined when the U.S. national emergency went into effect in March 2020. </p>
<p>Likewise, the World Health Organization’s announcement on May 5 that it was <a href="https://www.statnews.com/2023/05/05/who-declares-end-to-covid-global-health-emergency/">ending the COVID-19 public health emergency of international concern</a> that had been in place since January 2020 is indicative that the pandemic has entered a new chapter. </p>
<p>It’s daunting to look back at our coverage and narrow it down to just a handful of standout stories amid all the twists and turns of the pandemic. But here are five stories from The Conversation’s archives that resonated with us, written by scholars who helped to illuminate complex issues at pivotal moments in the pandemic.</p>
<h2>1. A whole new vocabulary</h2>
<p>It’s a little hard to remember the days when words like pandemic, endemic diseases, mRNA, variant and spike proteins were not a part of our vernacular or everyday conversations. But I vividly recall the day that the COVID-19 pandemic was declared and a friend asked me “What exactly is a pandemic?” It turns out a lot of people were asking that question and wondering about the difference between an outbreak of an infectious disease, an epidemic and a pandemic.</p>
<p><a href="https://public-health.tamu.edu/directory/fischer.html">Rebecca S.B. Fischer</a>, an assistant professor of epidemiology at Texas A&M University, <a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">put it in straightforward terms</a>: An outbreak is a small but unusual increase in the expected number of cases of a given disease, while the term epidemic is used when an infectious disease outbreak is getting bigger and spreading over a broader geographic area. A pandemic, on the other hand, is used when a disease is “international and out of control.”</p>
<p>She went on to say that some epidemiologists reserve the term pandemic for when a disease is being sustained in newly affected regions through local transmission – a good characterization of the state of COVID-19 in March 2020.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/whats-the-difference-between-pandemic-epidemic-and-outbreak-133048">What's the difference between pandemic, epidemic and outbreak?</a>
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<figcaption><span class="caption">Epidemic, pandemic and endemic viruses explained.</span></figcaption>
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<h2>2. Comparisons to the 1918 flu ran rife</h2>
<p>From the earliest days of the COVID-19 pandemic, it was impossible to miss the haunting similarities between it and the 1918 flu pandemic, which led to at least 50 million deaths worldwide between 1918 and 1920. Health care experts and the media made frequent comparisons between the two, pointing to similarities in attitudes about mask-wearing and school closures as well as in the patterns of disease waves, spikes and surges.</p>
<p>But while the two once-in-a-century events have shared plenty of likenesses, the comparison also sometimes <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">led to public misunderstandings about how the COVID-19 pandemic could play out</a>, wrote historian <a href="https://www.history.pitt.edu/people/mari-webel">Mari Webel</a> and pediatric infectious disease specialist <a href="https://www.pediatrics.pitt.edu/people/megan-culler-freeman-md-phd">Megan Culler Freeman</a>, both from the University of Pittsburgh. They explain that key differences in the sociopolitical context of the 1918 flu period, as well as marked differences between the virology behind the two diseases, set the 1918 flu and COVID-19 on different paths.</p>
<p>“People seek answers from the experiences of influenza in 1918-19 for a fundamental reason: It ended.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">Compare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction</a>
</strong>
</em>
</p>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two men wearing and advocating the use of flu masks in Paris with a crowd of people behind them." src="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526295/original/file-20230515-19800-9b9897.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">French men in 1919 Paris holding signs urging others to wear masks and to fight the flu. Much like in the COVID-19 era, wearing masks to protect against the deadly influenza was embraced by some, while others resisted and refused.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/two-men-wearing-and-advocating-the-use-of-flu-masks-in-news-photo/3333532">Topical Press Agency / Hulton Archive via Getty Images</a></span>
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<h2>3. How and when pandemics end</h2>
<p>In late 2020, people were naturally wondering when and how the COVID-19 pandemic would end, and how we would know it was over.</p>
<p><a href="https://sasn.rutgers.edu/about-us/faculty-staff/nukhet-varlik">Nükhet Varlik</a>, a historian from Rutgers University who studies disease, medicine and public health, wrote an astute piece in October 2020 about the difficulties of <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">predicting how the pandemic might play out</a>. She presciently noted that “whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them.” These include diseases like tuberculosis, leprosy, measles and plague.</p>
<p>“Hopefully COVID-19 will not persist for millennia,” Varlik wrote. But she went on to say that politics are crucial, noting how when vaccination programs are weakened, infections can “come roaring back.”</p>
<p>“Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.”</p>
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Read more:
<a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">How do pandemics end? History suggests diseases fade but are almost never truly gone</a>
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<h2>4. The midway point</h2>
<p>The summer of 2021 felt like a particularly grueling moment in time – when excitement and optimism over the launch of the first vaccines to protect against COVID-19 had given way to despair over the stronghold of vaccine resistance and general exhaustion with all things COVID. And then came the delta variant. </p>
<p>Epidemiologist <a href="https://scholar.google.com/citations?user=t3nqdNQAAAAJ&hl=en">Katelyn Jetelina</a>, formerly from the University of Texas Health Science Center at Houston, captured <a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">18 months of the COVID-19 pandemic in a series of seven retrospective charts</a> that put all of the high and low points into stark relief. “The race between vaccination and variant spread was upon us,” Jetelina wrote. “The fight was far from over.” </p>
<p>The same may still be true today.</p>
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Read more:
<a href="https://theconversation.com/18-months-of-the-covid-19-pandemic-a-retrospective-in-7-charts-166881">18 months of the COVID-19 pandemic – a retrospective in 7 charts</a>
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<h2>5. How omicron altered the course of the pandemic</h2>
<p>When the omicron variant arrived on the scene in late 2021 and spread globally in early 2022, it soon became clear that it could bring about a shift in the pandemic. With its ability to spread easily and to also cause milder disease than prior variants, omicron had the potential to act as a natural vaccine of sorts – producing widespread immunity with the help of the existing COVID-19 vaccines.</p>
<p>But the omicron variant had plenty of surprises in store. For one, it gave rise to a family of variants and sublineages that to this day are keeping researchers guessing, with the latest omicron subvariant, XBB.1.16, gaining ground across the U.S. and worldwide as of mid-May 2023.</p>
<p>In January 2022, immunology researchers <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_prakash.php">Prakash Nagarkatti</a> and <a href="https://sc.edu/study/colleges_schools/medicine/about_the_school/faculty-staff/nagarkatti_mitzi.php">Mitzi Nagarkatti</a>, from the University of South Carolina, <a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">explained how the immune system responds to infections</a> and how it remembers those threats through “immunological memory.” </p>
<p>This left room for hope, they wrote, that “when new variants of SARS-CoV-2 inevitably arise, omicron will have left the population better equipped to fight them. So the COVID-19 vaccines combined with the omicron variant could feasibly move the world to a new stage in the pandemic – one where the virus doesn’t dominate our lives and where hospitalization and death are far less common.” </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/is-the-omicron-variant-mother-natures-way-of-vaccinating-the-masses-and-curbing-the-pandemic-175496">Is the omicron variant Mother Nature’s way of vaccinating the masses and curbing the pandemic?</a>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/205722/count.gif" alt="The Conversation" width="1" height="1" />
With the emergency phase of the COVID-19 pandemic in the rearview mirror, at least for now, we look back on a handful of stories that provided sharp insights at key moments in the pandemic.Amanda Mascarelli, Senior Health and Medicine EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1957182022-12-16T13:13:54Z2022-12-16T13:13:54Z1918 flu pandemic upended long-standing social inequalities – at least for a time, new study finds<figure><img src="https://images.theconversation.com/files/499388/original/file-20221206-16-lo9q7q.jpg?ixlib=rb-1.1.0&rect=0%2C220%2C3000%2C1742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In this November 1918 photo, a nurse tends to a patient in the influenza ward of the Walter Reed hospital in Bethesda, Md. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak1918InfluenzaCOVID19/97d84472fcad44449444ae3b7cc5f539/photo?Query=1918%20flu&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=91&currentItemNo=29">AP Photo/Harris & Ewing via Library of Congress</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Racial disparities in <a href="https://doi.org/10.1215/00703370-10235825">influenza deaths shrunk by 74% in U.S. cities</a> during the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">1918 flu pandemic</a> due to an odd coincidence of virus and history. That’s the key finding of our recently published study in the journal Demography. </p>
<p>This conclusion contradicts the <a href="https://tidsskriftet.no/2017/05/global-helse/social-inequality-forgotten-factor-pandemic-influenza-preparedness">common claim</a> that crises like pandemics <a href="https://doi.org/10.1073/pnas.2020685118">make social inequalities worse</a>. The 1918 influenza pandemic was a surprising exception. </p>
<p>Prior to the 1918 pandemic, Black people in the U.S. died of respiratory diseases <a href="https://doi.org/10.1007/s13524-019-00789-z">at vastly higher rates</a> than white people. But our study found that urban white people in their 20s and 30s were especially vulnerable to the 1918 virus, dying at rates that were up to 20 times higher than normal. While the death rates of Black people in urban settings also spiked during the 1918 pandemic, they did so by a much smaller rate than in white populations. On average, across all age groups, white mortality increased fivefold, while Black mortality increased threefold.</p>
<p>Overall, Black people <a href="https://doi.org/10.7326/M20-2223">still died at higher rates</a> than white people during the 1918 pandemic, but the ratio of Black-to-white mortality – a measure of racial inequality – <a href="https://doi.org/10.3390/ijerph16142487">shrank dramatically</a> compared with other time periods. So while 1918 was wildly deadly across the world, the death rate among urban white young adults in the U.S. was truly unprecedented.</p>
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<h2>Why it matters</h2>
<p>One anomalous feature of the pandemic is well known: It <a href="https://doi.org/10.1371/journal.pone.0069586">killed many young adults</a> alongside children and elderly people, who are traditionally at risk from flu viruses.</p>
<p>But the unusually small racial inequality in flu deaths in the U.S. in 1918 is a little-known puzzle that contrasts with modern pandemics <a href="https://doi.org/10.1073/pnas.2205813119">like COVID-19</a> <a href="https://doi.org/10.2105/AJPH.2009.170241">and HIV</a>, which have hit Black communities especially hard. It also contrasts with a global tendency for <a href="https://doi.org/10.1186/s13643-018-0931-2">poorer populations to be more likely</a> to die from the flu.</p>
<p>Our study considered several hypotheses to explain the surprising patterns in the U.S. during the 1918 pandemic. One such potential explanation was that policies like school closures especially benefited Black populations because of their higher risk of dying from the flu in nonpandemic years when such measures were absent.</p>
<p>But only one explanation fits our evidence: Urban white young adults in the U.S. were deeply vulnerable in 1918 because of the way their immune systems had been programmed during childhood in the late 19th century. This is because the first flu people encounter as children is special: <a href="https://doi.org/10.1126/science.aag1322">It teaches the immune system</a> how to respond to future flu infections. However, research shows that this so-called immunological imprinting <a href="https://doi.org/10.1016/j.jaut.2017.04.008">can be harmful</a> when the virus someone later encounters is very different from the virus their immune system has been trained against.</p>
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<figcaption><span class="caption">The 1918 flu pandemic killed at least 50 million people worldwide.</span></figcaption>
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<p>The last flu pandemic to hit U.S. cities before 1918 was a <a href="https://doi.org/10.1073/pnas.1000886107">devastating global pandemic</a> that began in 1889. Exposure to that virus would have taught children’s immune systems to expect <a href="https://doi.org/10.1073/pnas.1324197111">what was probably an H3N8 flu</a>. But the devastation in 1918 was caused by the world’s first H1N1 pandemic. The two strains belong to two different groups of influenza viruses, and immune protection from H3N8 would not have conferred protection against H1N1. </p>
<p>To the contrary: People whose first flu exposure occurred in the 1890s would have likely had a compromised immune response to the 1918 pandemic because their immune system produced the wrong kind of antibodies that <a href="https://doi.org/10.1038/s41467-021-23977-1">crowded out more effective ones</a>.</p>
<p>In <a href="https://doi.org/10.1371/journal.pone.0069586">2013</a> and <a href="https://doi.org/10.1073/pnas.1324197111">2014</a> studies, two groups of virologists and demographers proposed and tested the hypothesis that 1890s imprinting explains the unusually high mortality of young adults during the 1918 pandemic. We adapted their argument to explain unusually small racial disparities as well. </p>
<p>This hypothesis suggests that the pattern of Black and white deaths in 1918 revolves around a historical coincidence. Black young adults were more often spared this fateful imprinting because they spent their childhoods in rural areas. As a result, though they often lived in deep poverty, they did not encounter some of the respiratory diseases that were rampant in cities. So while they were vulnerable to 1918’s novel flu, they were less so than people whose immune systems were primed to meet a virus like the one that circulated in the 1890s. </p>
<h2>What still isn’t known</h2>
<p>Immunologists are only beginning to understand the exact mechanisms through which imprinting affects long-term immune responses. Recent studies about the <a href="https://doi.org/10.3390/v11020122">early 20th century</a> and the <a href="https://doi.org/10.1038/s41467-021-23977-1">COVID-19 pandemic</a> support the idea that imprinting can significantly affect immune responses later in life. We all carry in our bodies the memories of our past disease exposures. </p>
<p>Those exposures <a href="https://doi.org/10.1007/s13524-019-00789-z">changed radically</a> during the 20th century, and the full consequences for population immunity in the COVID-19 era remain to be unraveled.</p><img src="https://counter.theconversation.com/content/195718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Wrigley-Field receives funding from the Minnesota Population Center, which is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number P2C HD041023).</span></em></p><p class="fine-print"><em><span>Martin Eiermann does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During the 1918 flu pandemic, white people died at similar rates to Black Americans, according to a new study – a very different pattern than what occurred during the COVID-19 pandemic.Elizabeth Wrigley-Field, Assistant Professor of Sociology, University of MinnesotaMartin Eiermann, Postdoctoral Fellow in Sociology, Duke UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1761822022-02-16T13:17:11Z2022-02-16T13:17:11ZThe Ancient Greeks also lived through a plague, and they too blamed their leaders for their suffering<figure><img src="https://images.theconversation.com/files/446365/original/file-20220214-25-8vvcch.jpg?ixlib=rb-1.1.0&rect=145%2C5%2C3687%2C2636&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A painting by Nicolas Poussin titled 'The Athenian Plague' shows people dying of the plague.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/painting-by-nicolas-poussin-entitled-the-athenian-plague-news-photo/517398440?adppopup=true">Bettmann / Contributor via Getty Images</a></span></figcaption></figure><p>Since the beginning of the COVID-19 pandemic, as <a href="https://www.brandeis.edu/facultyguide/person.html?emplid=1be7ee967d45605afddf7da9ad4ca2c049a26c0b">a scholar of ancient Greek literature</a>, I have returned again and again to the Greek historian Thucydides to try understand the historical parallels to the American response to the health crisis. </p>
<p>Thucydides – a onetime general and historian of the Peloponnesian War, a generationlong struggle between Athens and Sparta – presents one of the most famous accounts of a plague from antiquity. </p>
<p>Then, as now, the story forms the backdrop for tragedy and conflict as Thucydides focuses on the emotional impact of living through a plague.</p>
<h2>Parallels with plague</h2>
<p>At the beginning of its conflict with its historical adversary, Sparta, Athens pulled its people and forces within <a href="https://www.jstor.org/stable/499185">the long walls</a> that protected the central city’s access to the sea. With Athens’ maritime and economic supremacy, its leader Pericles believed that with such a strategy, the city-state would be impossible to conquer. </p>
<p>An unintended consequence of this strategy, however, was that the crowded confines of the city made it a fertile ground for a novel pathogen. The emergence of plague led to a temporary suspension of Athenian life, but it did not change the policy on the war or its strategy, despite the death toll.</p>
<p>Thucydides’ account <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0200%3Abook%3D2%3Achapter%3D49">records vividly</a> the onset and progress of the disease as it fell on Athens. Some of what he wrote might sound familiar today: The <a href="https://doi.org/10.1002/msj.20137">symptoms of what was then an unidentified disease</a> included chest pain, a cough, fever and diarrhea; if the disease was not fatal, it often left scars and a loss of memory.</p>
<p>Just as the spread of COVID-19 across the world led to a heightened focus on its origins, Thucydides tracked how the plague <a href="https://www.nationalgeographic.co.uk/history-and-civilisation/2021/05/the-plague-of-athens-killed-tens-of-thousands-but-its-cause-remains-a-mystery">allegedly moved </a> from <a href="https://sententiaeantiquae.com/2020/03/13/an-eyewitness-to-useless-prayers/">Egypt through the Persian Empire and into Greece</a>. </p>
<p>Thucydides also noted another fallout – despair. He described despair as the “<a href="https://sententiaeantiquae.com/2022/01/12/the-worst-part-of-a-plague-despair-2/">most terrible feature of the sickness</a>” and recorded that depression and fear were common. Like today, families lost their loved ones to the disease, and any kind of social order dissipated.</p>
<h2>The despair of disease</h2>
<p>I have also been deeply affected by Thucydides’ ability to talk about the plague from his own experience. As he notes at the beginning of his narrative of the disease, he <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0200%3Abook%3D2%3Achapter%3D48">became sick himself</a> and watched others suffer. </p>
<p>Few people I know made it through 2020 and 2021 without anxiety about their own or their loved ones’ health. But the despair of actually contracting the disease and the feeling of utter powerlessness of watching one’s family getting it as well was something I personally evaded until January 2022.</p>
<p>Even though my spouse, my two older children and I were all vaccinated, we all contracted the virus. Our “mild” COVID experience left me winded going up stairs for weeks. And over a month later there is no one who can say what the long-term effects will be for us or our children.</p>
<p>Thucydides describes not just the despair of getting sick but the danger faced in “caring for one another.” My wife and I considered ourselves lucky that our fevers peaked at different times, leaving one of us to comfort our 9-month-old through four days of fever and a worrisome cough. </p>
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<a href="https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People dressed in coats holding burning candles for a memorial." src="https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=477&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=477&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446372/original/file-20220214-19-1hu7ueh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=477&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Friends and family light candles for COVID-19 victims during a memorial and vigil in Wilkes-Barre, Pa.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/friends-and-family-of-victims-holding-burning-candles-news-photo/1231564876?adppopup=true">Aimee Dilger/SOPA Images/LightRocket via Getty Images</a></span>
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<p>While we were sick, an average of <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">3,000 people died a day</a> in the United States. Local and federal officials in many areas have pushed for a return to normal by planning to <a href="https://www.cnn.com/2022/02/10/health/mask-mandates-best-practices-wellness/index.html">drop mask mandates</a> and <a href="https://www.nytimes.com/2022/02/08/us/politics/new-york-mask-mandate.html">other restrictions</a>. <a href="https://www.telegraph.co.uk/global-health/science-and-disease/leaving-poorer-countries-unvaccinated-reckless-approach-public/">Experts have cautioned</a> about the risk of new variants emerging as a large number of people in low-income countries <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">remain unvaccinated</a>.</p>
<h2>Plague and leadership</h2>
<p>The stories we tell and don’t tell about COVID-19 follow a pattern familiar to those who have spent time with ancient literature. <a href="https://theconversation.com/plagues-follow-bad-leadership-in-ancient-greek-tales-133139">Greek plague narratives</a> take little interest in the nameless suffering masses and instead focus on the leaders who allow it to happen. </p>
<p>In Homer’s “Iliad,” the Greeks suffer a plague because their leader Agamemnon refuses the divinely sanctioned custom of accepting a ransom in exchange for a prisoner; the plague is sent as a <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0134%3Abook%3D1%3Acard%3D33">punishment</a>. Sophocles’ famous tragedy puts an Oedipus on stage. He wants to save his people <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0192%3Acard%3D58">but can’t see that he is the main cause</a> for the spread of the disease. </p>
<p>Faulty public policies in the <a href="https://www.scientificamerican.com/article/how-the-u-s-pandemic-response-went-wrong-and-what-went-right-during-a-year-of-covid/">U.S.</a>, the <a href="https://www.theguardian.com/politics/2021/oct/12/covid-response-one-of-uks-worst-ever-public-health-failures">U.K.</a>, <a href="https://reliefweb.int/report/brazil/toll-bolsonaro-s-disastrous-covid-19-response-enpt">Brazil</a> and elsewhere have <a href="https://www.nytimes.com/interactive/2022/02/01/science/covid-deaths-united-states.html">led to a large number of deaths</a> that many experts considered preventable. The virus is only the beginning of the problem. </p>
<p><a href="https://theconversation.com/plagues-follow-bad-leadership-in-ancient-greek-tales-133139">Plague stories provide settings</a> in which fate pushes human organization to the limit. Leaders almost always play a pivotal role, as Zeus observes in <a href="http://www.perseus.tufts.edu/hopper/text?doc=Perseus:text:1999.01.0136">Homer’s “Odyssey,”</a> saying, “Humans are always blaming the gods for their suffering / but they experience pain beyond their fate because of their own recklessness.” </p>
<h2>Leading for the public good</h2>
<p>The Athenians lost the war with Sparta not because of the plague, but the plague did reveal the fault lines beneath the surface of Athenian culture. As Katherine Kelaidis, a scholar at the National Hellenic Museum, frames it, the disease was a <a href="https://www.theatlantic.com/ideas/archive/2020/03/great-plague-athens-has-eerie-parallels-today/608545/">moral test of the physical and political structures of Athens</a>. </p>
<p>The Athenians lost tens of thousands of their citizens and soldiers and uncounted numbers of enslaved peoples and resident aliens, but they continued to fight for another 20 years. In the end, political factions and civil strife undermined their efforts to defend their state.</p>
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<a href="https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two young scientists wearing protective masks and caps working on their computers that have an image of the coronavirus." src="https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446369/original/file-20220214-13-nr3467.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Amid despair, the pandemic has shown the remarkable work of scientists.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laboratory-team-working-on-coronavirus-vaccine-royalty-free-image/1251892829?adppopup=true">janiecbros/Collection E+ via Getty Images</a></span>
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<p>COVID-19 has shown the deep divisions among Americans, the lack of concern many of our neighbors show for one another, the fragility of the public health system and the limits of the leadership to meet collective challenges. But it has also shown the <a href="https://www.nature.com/articles/d41586-020-03626-1">remarkable speed and creativity of scientists</a> and <a href="https://www.cfr.org/backgrounder/guide-global-covid-19-vaccine-efforts">the benefits of collaboration across international boundaries</a> in helping us meet the unexpected. </p>
<p>Ancient Greek history and literature can help us understand the long-term social impacts of disease. They also show how fractious politics can undermine even heroic responses to public health challenges.</p>
<p>[<em>This Week in Religion, a global roundup each Thursday.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-global-roundup">Sign up.</a>]</p><img src="https://counter.theconversation.com/content/176182/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Christensen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A scholar of ancient Greek literature goes back to the account of Greek historian Thucydides on the spread of plague and finds parallels in the American response to the health crisis today.Joel Christensen, Professor of Classical Studies, Brandeis UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1755872022-01-26T13:26:24Z2022-01-26T13:26:24ZWhen will the COVID-19 pandemic end? 4 essential reads on past pandemics and what the future could bring<figure><img src="https://images.theconversation.com/files/442590/original/file-20220125-21-10zigar.jpg?ixlib=rb-1.1.0&rect=650%2C42%2C4116%2C3030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Wishing won't be enough to make the pandemic history.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-wearing-a-face-mask-walks-past-digital-displays-news-photo/1212048671">David Cliff/NurPhoto via Getty Images</a></span></figcaption></figure><p>More than two years after the first cases of COVID-19 were diagnosed, people are exhausted by the coronavirus pandemic, ready for all this to end. When – if ever – is it realistic to expect SARS-CoV-2 will recede from the headlines and daily life?</p>
<p>That’s the unspoken question beneath the surface of many of The Conversation’s articles about COVID-19. None of our authors can see the future, but many do have expertise that offers insights about what’s reasonable to expect. Here are four such stories from our archive. Written by historians and scientists, they each suggest a way to think about what’s at the end of the pandemic tunnel – and paths to get there.</p>
<h2>1. Past pandemics are not a perfect prediction</h2>
<p>Almost as soon as it hit, people were trying to figure out how the COVID-19 pandemic would proceed. It was tempting to look for clues in the course of the 1918 flu pandemic that killed as many as 50 million people worldwide. Could the waves of disease seen in the 1900s provide a road map for what could be expected a century later?</p>
<p>Daily deaths from COVID-19 were declining in the U.S. when historian <a href="https://scholar.google.com/citations?user=41RCe6UAAAAJ&hl=en&oi=ao">Mari Webel</a> and virologist <a href="https://scholar.google.com/citations?user=ubfhdQwAAAAJ&hl=en&oi=ao">Megan Culler Freeman</a> from University of Pittsburgh Health Sciences cautioned against reading too much into how things had gone for people generations ago. </p>
<p>It was so tempting to superimpose a timeline of flu surges on the modern calendar to get even a blurry forecast of what the coronavirus might have in store for us. “Scanning the historical record is one way to draw our own lives into focus and perspective,” wrote Webel and Culler Freeman. “Unfortunately, the end of influenza in summer 1919 <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">does not portend the end of COVID-19 in the summer of 2020</a>.”</p>
<p>And for reasons ranging from biology to demographics to politics, that is one prediction that most certainly came true.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">Compare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction</a>
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<h2>2. Calling it over before it’s really over</h2>
<p>While the 1918 flu pandemic wasn’t an exact template for how the coronavirus would sweep the world, the earlier pandemic provided plenty of parallels when it came to human behavior.</p>
<p>University of Michigan historian <a href="https://scholar.google.com/citations?user=gzhca9MAAAAJ&hl=en&oi=sra">J. Alexander Navarro</a> described how in the early 20th century Americans essentially <a href="https://theconversation.com/people-gave-up-on-flu-pandemic-measures-a-century-ago-when-they-tired-of-them-and-paid-a-price-156551">quit on effective social distancing precautions</a> when they got fed up with living constrained lives. Sound familiar?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked clerks at desks in early 20th century" src="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=567&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=567&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442592/original/file-20220125-15-a46ov6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=567&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">During the 1918-1920 influenza pandemic, many people eventually tired of taking precautions, like wearing masks.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/women-wear-cloth-surgical-style-masks-to-protect-against-news-photo/515181868">Bettman via Getty Images</a></span>
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<p>As case numbers declined, “People clamored to return to their normal lives. Businesses pressed officials to be allowed to reopen,” Navarro wrote. “Believing the pandemic was over, state and local authorities began rescinding public health edicts.”</p>
<p>With the burden of public health resting on individual choices, additional waves of flu crashed over the population. Some amount of wishful thinking, along with a premature return to “normal,” was likely to blame. People’s choices can affect whether an infectious disease outbreak ends or drags on.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-gave-up-on-flu-pandemic-measures-a-century-ago-when-they-tired-of-them-and-paid-a-price-156551">People gave up on flu pandemic measures a century ago when they tired of them – and paid a price</a>
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<h2>3. Once a virus comes, it never really leaves</h2>
<p>Infectious diseases are as old as humanity. Pointing to examples such as malaria, tuberculosis, leprosy and measles, Rutgers University – Newark historian <a href="https://scholar.google.com/citations?user=dKrEwMkAAAAJ&hl=en&oi=ao">Nükhet Varlik</a> wrote, “Once added to the repertoire of pathogens that affect human societies, <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">most infectious diseases are here to stay</a>.” Only smallpox has been completely eradicated, thanks to an intense global vaccination campaign.</p>
<p>Varlik’s own research has focused on plague, a bacterial disease that’s caused at least three pandemics in the past 5,000 years – including the 14th century’s Black Death – along with many more localized outbreaks over the years. Outbreaks wound down based on factors like “changes in temperature, humidity and the availability of hosts, vectors and a sufficient number of susceptible individuals,” Varlik wrote. “Some societies recovered relatively quickly from their losses caused by the Black Death. Others never did.” </p>
<p>The responsible bacterium, <em>Yersinia pestis,</em> is still with us today.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">How do pandemics end? History suggests diseases fade but are almost never truly gone</a>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="socially distanced line waiting at testing site" src="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442595/original/file-20220125-17-uqruw6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Someday mass testing sites won’t be necessary.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/free-covid-19-testing-site-was-hosted-by-reliant-nhealth-news-photo/1365460079">Brittany Murray/MediaNews Group/Long Beach Press-Telegram via Getty Images</a></span>
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<h2>4. The endemic endgame</h2>
<p>A post-pandemic world may still have COVID-19 in it. Many researchers suspect that the SARS-CoV-2 coronavirus will become endemic, meaning it’s always around, with some level of constant ongoing transmission. The viruses that cause the flu and the common cold, for instance, are endemic.</p>
<p><a href="https://scholar.google.com/citations?user=XY7DNtgAAAAJ&hl=en&oi=ao">Sara Sawyer</a>, <a href="https://www.colorado.edu/pac/arturo-barbachano-guerrero">Arturo Barbachano-Guerrero</a> and <a href="https://scholar.google.com/citations?user=l2lpnYkAAAAJ&hl=en&oi=ao">Cody Warren</a>, a team of virologists and immunologists from the University of Colorado Boulder, wrote that SARS-CoV-2 might hit the sweet spot for a virus to become endemic by being just the right degree of transmissible: “Generally speaking, viruses that are highly contagious, meaning that they spread really well from one person to the next, <a href="https://theconversation.com/is-covid-19-here-to-stay-a-team-of-biologists-explains-what-it-means-for-a-virus-to-become-endemic-168462">may never die out on their own</a> because they are so good at finding new people to infect.”</p>
<p>[<em>More than 140,000 readers get one of The Conversation’s informative newsletters.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140K">Join the list today</a>.]</p>
<p>SARS-CoV-2 spreads easily through the air. Even people who aren’t experiencing any symptoms can pass the coronavirus to others. These factors, along with today’s heavily interconnected global society, make it unlikely COVID-19 is going away completely anytime soon.</p>
<p>For now, these scholars write, the best we can likely hope for is stabilized rates of SARS-CoV-2 that settle down into predictable patterns, like flu season. If you want to help hurry things along toward this end stage, do what you can to make yourself an inhospitable host for the coronavirus – most notably, <a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">keep up to date with recommended COVID-19 vaccinations</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-covid-19-here-to-stay-a-team-of-biologists-explains-what-it-means-for-a-virus-to-become-endemic-168462">Is COVID-19 here to stay? A team of biologists explains what it means for a virus to become endemic</a>
</strong>
</em>
</p>
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<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/175587/count.gif" alt="The Conversation" width="1" height="1" />
None of our authors can see the future, but many do have expertise that offers insights about what’s reasonable to expect.Maggie Villiger, Senior Science + Technology EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1715362021-11-25T17:21:35Z2021-11-25T17:21:35ZMask wearing wasn’t disputed in previous crises – so why is it so hotly contested today?<figure><img src="https://images.theconversation.com/files/433754/original/file-20211124-13-1eynnjs.jpg?ixlib=rb-1.1.0&rect=71%2C229%2C2276%2C1589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men wearing masks outside a military hospital in New York during the 1918 influenza pandemic.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-men-wore-masks-avoid-flu-248206198">/Shutterstock</a></span></figcaption></figure><p>Across <a href="https://www.liberties.eu/en/stories/europe-mask-war-culture/18901">western countries</a>, people are <a href="https://www.theguardian.com/world/2020/jun/29/face-masks-us-politics-coronavirus">polarised</a> over <a href="https://www.politico.com/news/2020/07/15/masks-britain-culture-war-365370">wearing masks</a>. While some support wearing them as an <a href="https://www.theguardian.com/world/2021/nov/17/wearing-masks-single-most-effective-way-to-tackle-covid-study-finds">effective counter to the virus</a>, others believe having to mask up is a <a href="https://theconversation.com/face-mask-rules-do-they-really-violate-personal-liberty-143634">contravention of their human rights</a>.</p>
<p>Our <a href="https://gtr.ukri.org/projects?ref=AH%2FW003813%2F1">interdisciplinary team</a> is currently exploring the role the media plays in influencing the British public’s thoughts and decisions on mask wearing. We’ve found that these polarised opinions have been reflected and reinforced by the media, where a clear divide has appeared. </p>
<p>Pro-mask messages are more present in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989238/">mainstream media</a>, including in public health adverts and on TV. Conversely, anti-mask wearing sentiments are more common in personalised sources <a href="https://journals.sagepub.com/doi/full/10.1177/0957926520970385">like social media</a>. </p>
<p>Here, mask wearing is often associated with the historical commands of authoritarian governments. Some have even <a href="https://edition.cnn.com/2021/05/21/politics/marjorie-taylor-greene-mask-mandates-holocaust/index.html">compared mask mandates</a> to the Nazi policy of forcing Jews to wear distinguishing yellow stars.</p>
<p>This split in attitudes is a relatively new development. People were more cooperative when asked to wear masks in response to earlier health epidemics and other dangers in the 20th century.</p>
<p>Indeed, a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252315">2021 study</a> outlines how approval rates for face coverings during earlier crises were far more collectively positive. During <a href="https://pubmed.ncbi.nlm.nih.gov/33319388/">influenza in 1918</a>, the <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30342-4/fulltext">Blitz in Britain in 1941</a>, and the <a href="https://www.telegraph.co.uk/global-health/science-and-disease/wearing-face-mask-not-new-backlash-against-say-historians/">smog outbreaks</a> that occurred in the UK from the 1930s to the 1960s, masks weren’t contested like today. What explains this change?</p>
<h2>The tangibility of past crises</h2>
<p>The coronavirus is invisible to the human eye, and its worst effects aren’t seen publicly – they occur at home or in hospital wards away from people’s gaze. </p>
<p>Smog, on the other hand, could be seen. Similarly, the threat of a <a href="https://theworld.org/stories/2016-01-08/londons-forgotten-network-massive-underground-air-raid-shelters-being-found-again">Nazi attack in the 1940s</a> was manifested in smoke, debris and dust in the air after German bombing, as well as physical destruction and rubble. Even influenza in 1918, despite its symptoms being very similar to COVID’s, had arguably more publicly visual characteristics (such as vomiting and diarrhoea) that allowed it to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752013/">resist public scepticism</a>.</p>
<p>It may be that the actual visibility of these earlier crises made them seem more threatening, and so wearing a mask seem more necessary. Indeed, in a bid to make the dangers posed by COVID appear more tangible, <a href="https://www.aljazeera.com/news/2021/5/24/un-chief-says-world-at-war-against-covid-19">politicians</a> and the <a href="https://www.cgdev.org/blog/us-losing-global-war-against-covid-19-and-national-security-issue">media</a> have invoked the language of war when discussing COVID, or used <a href="https://www.campaignlive.co.uk/article/will-governments-new-emotive-covid-ad-people-obey-rules/1705634">images of people on ventilators</a> to materialise the threat.</p>
<p>But such tactics have yielded significant debates among health professionals and linguists, as these produce questionable implications, such as potentially identifying infected people as <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1844989">“enemies” who bear and spread the virus</a>.</p>
<h2>Variety of the media</h2>
<p>A second factor is that formerly, media was restricted to channels controlled or influenced by government, and these all gave positive depictions of masks. Today, however, there are many other channels, which allow for resistance. </p>
<p>During earlier crises, the media promoted mask wearing as a patriotic act. However, the media’s scope in the first half of the 20th century was far more limited than it is today. Promotion of mask wearing was mainly limited to <a href="https://journals.sagepub.com/doi/pdf/10.1177/00333549101250S308">government-approved posters</a> and newsprint in the 1910s. </p>
<p>Mainstream radio didn’t exist until a decade later. And TV was only introduced in the 1930s but wasn’t widespread <a href="https://dspace.library.uu.nl/handle/1874/373997">until much later</a>. Radio, print and newsreels were the main sources of public information during past eras of mask wearing. </p>
<p>By contrast, today’s media landscape – especially <a href="https://www.rollingstone.com/culture/culture-features/mom-influencers-instagram-covid-19-coronavirus-mask-propaganda-misinformation-1033154/">social media</a> – allows for individual and personalised voices to be heard to an extent unthinkable in earlier decades. Media has become a way of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250817">denigrating</a> as well as endorsing mask wearing. </p>
<p>Even music videos provide an opportunity for people to speak out against masks, providing a stark contrast to the <a href="https://archive.org/details/ATishOo">propaganda films of the 1940s</a>. For example, in the video for <a href="https://www.youtube.com/watch?v=eOkkWIOkWl8">Living the Dream</a> by US rock band Five Finger Death Punch, mask wearing is depicted as a way of enforcing people’s compliance in an authoritarian reimagining of America. Eventually, though, the public rebel, and are shown ripping their masks off as they head into battle against their hypocritical unmasked leader.</p>
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<h2>Pressure to wear a surgical mask</h2>
<p>Although <a href="https://publichealth.jmir.org/2020/2/e18444/?utm_source=TrendMD">public information from the NHS and UK government</a> specifically promotes the use of any “face coverings” (including bandannas, scarves, old clothes and so on), such messages are nearly always <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252315">accompanied by images of surgical masks</a>. Graphics that represent the need to wear a face covering nearly always depict a surgical mask. </p>
<p>And when looking at a <a href="https://www.lexisnexis.co.uk/">database of British newspaper reporting</a> from the COVID pandemic, it’s also clear that journalists refer to “masks” more often than to “face coverings”. Despite <a href="https://www.gov.uk/guidance/regulatory-status-of-equipment-being-used-to-help-prevent-coronavirus-covid-19?utm_source=Gov&utm_medium=Email&utm_campaign=MHRA_COVID-19_updates&utm_content=HCP7#face-masks-and-face-coverings">official guidance</a> only requiring proper masks to be used in medical settings, the way they are spoken about and depicted suggests other forms of face covering aren’t as broadly acceptable.</p>
<figure class="align-center ">
<img alt="An NHS poster telling people to 'wash hands, cover face, make space'" src="https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=330&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=330&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=330&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=415&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=415&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=415&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A typical NHS poster from during the pandemic, with its face covering depicted as a surgical mask.</span>
</figcaption>
</figure>
<p>While there’s good reason for this – surgical masks have been <a href="https://www.caymancompass.com/2021/10/02/study-surgical-masks-more-effective-than-cloth/">shown to be more effective</a> than other forms of face covering – in the mind of the public, this may limit the scope of what is proper to wear. This may then lower people’s willingness to wear a mask, as it’s known that people are <a href="https://books.google.com/books?hl=en&lr=&id=Z6iYwTFY5mIC&oi=fnd&pg=PA1&dq=restricted+choice+leads+to+rebellion+authority&ots=i38bbVGsn_&sig=Iq14oINjC_pTHzWNSu68sk6LxoA">more likely to accept</a> doing something if they <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.134.2.270">perceive that there is choice</a> involved. </p>
<p>Yet in the past, the same pressure didn’t exist. During the influenza and smog outbreaks, attitudes towards <a href="https://www.bbc.co.uk/news/uk-england-london-56085529">alternative face coverings</a> were more permissive, with non-standard masks even being celebrated among the <a href="https://trove.nla.gov.au/newspaper/article/52412108">fashion-conscious cultures</a> of London and Manchester that were impacted by the smog epidemic. Surgical masks of the day would also not have so widely available. The leeway this offered may also have led to a less controversial response to mask mandates compared to today.</p><img src="https://counter.theconversation.com/content/171536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Abrams, Thora Tenbrink, Anaïs Augé and Maciej Nowakowski receive funding from the Arts and Humanities Research Council. </span></em></p><p class="fine-print"><em><span> </span></em></p>How the pandemic is reported by the media can influence people’s behaviour.Nathan Abrams, Professor of Film Studies, Bangor UniversityAnaïs Augé, Assistant Researcher at the School of Arts, Culture and Language, Bangor UniversityMaciej Nowakowski, Research Assistant in Media Communications and Critical Discourse Analysis, Bangor UniversityThora Tenbrink, Professor of Linguistics, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1619452021-06-10T14:25:35Z2021-06-10T14:25:35ZFrom the great plague to the 1918 flu, history shows that disease outbreaks make inequality worse<figure><img src="https://images.theconversation.com/files/405628/original/file-20210610-19-4e9jj8.jpg?ixlib=rb-1.1.0&rect=150%2C1525%2C1983%2C1245&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two men discover a dead body in the street during the Great Plague of London.</span> <span class="attribution"><a class="source" href="https://wellcomecollection.org/works/v5q884pm">19th-century wood engraving. Herbert Railton/Wellcome Collection</a></span></figcaption></figure><p>In May 2021, virologist Angela Rasmussen <a href="https://www.sciencemag.org/news/2021/05/human-tissue-preserved-world-war-i-yields-new-clues-about-1918-pandemic">reflected</a> how “if the last 18 months have demonstrated anything, it’s that we would do well to remember the lessons of past pandemics as we try to prevent future ones”. This includes ensuring we come out stronger.</p>
<p>Witnesses of past disease outbreaks can help with this. While they don’t offer definitive answers on what to do next, they warn us rising inequality is inevitable after a pandemic and needs to be actively confronted if it’s to be avoided.</p>
<p>Consider the great plague of London in 1665. As it began to abate, naval official and diarist Samuel Pepys <a href="https://www.pepysdiary.com/diary/1665/12/">noted</a> that his wealth had more than tripled that year, despite the terrible times many were experiencing.</p>
<p>Even so, he regretted the expense of leaving London to avoid the danger. Pepys had had to fund lodgings for his wife and maids at Woolwich and for himself and his clerks at Greenwich. His experience stood in stark contrast to those Londoners who lost their livelihoods – and the <a href="https://www.nationalarchives.gov.uk/documents/education/plague.pdf">100,000</a> who died.</p>
<p>We can see the same social and economic inequalities becoming more pronounced today. Amazon’s <a href="https://www.bbc.co.uk/news/world-55793575">Jeff Bezos</a> and Tesla’s <a href="https://www.theguardian.com/world/2021/jan/15/billionaires-net-worth-coronavirus-pandemic-jeff-bezos-elon-musk">Elon Musk</a> have increased their net worth by billions of dollars during the pandemic, while many of their employees <a href="https://www.theguardian.com/commentisfree/2020/dec/12/jeff-bezos-amazon-workers-covid-19-scrooge-capitalism">have faced coronavirus risks</a> in the workplace for little extra pay.</p>
<p>Similarly, during and after the 1918 influenza outbreak – in which it’s estimated a third of the world’s population was infected and around <a href="https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm">50 million people died</a> – purveyors of medicines <a href="https://exhibits.lib.unc.edu/exhibits/show/going-viral/profiting">sought to make a profit</a>. In western countries, this was accompanied by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867839/">panic buying</a> of <a href="https://www.theguardian.com/commentisfree/2020/apr/05/1918-flu-pandemic-coronavirus-drug-trials-scientists-treatments-evidence">quinine</a> and other products for treating and avoiding the flu.</p>
<p>Today, there’s controversy as wealthy nations stockpile vaccines and promising <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717394/">potential treatments</a>. Despite Covax being created to spread vaccines equitably, distribution has been <a href="https://www.bbc.co.uk/news/world-55795297">strongly in favour</a> of wealthy countries. In modern ways, we’re replicating the problems of the past.</p>
<h2>Charity increases too</h2>
<p>Yet in such crises, alongside greed and inequality there’s also the chance for acts of charity. In Daniel Defoe’s A Journal of the Plague Year – a fictional account of the great plague, published many years later in 1722 and written in voice of someone who lived through the event – the narrator, H.F., <a href="https://www.gutenberg.org/files/376/376-h/376-h.htm">comments</a>:</p>
<blockquote>
<p>This misery of the poor I had many occasions to be an eyewitness of, and sometimes also of the charitable assistance that some pious people daily gave to such, sending them relief and supplies both of food, physic, and other help, as they found they wanted.</p>
</blockquote>
<p>H.F. notes that while private citizens were sending funds to the mayor to distribute, they were also taking it upon themselves to give “vast sums” to those in need.</p>
<figure class="align-center ">
<img alt="A hall of influenza patients in bed." src="https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405378/original/file-20210609-14721-1e4sngw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The US was keen to consign the horrors of the 1918 pandemic to the past.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Camp_Funston,_at_Fort_Riley,_Kansas,_during_the_1918_Spanish_flu_pandemic.jpg">US National Museum of Health and Medicine/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>And according to real-life accounts of the 1918 flu pandemic, this crisis also saw many <a href="https://www.americamagazine.org/faith/2020/03/31/sisters-work-during-1918-flu-epidemic-seen-model-crisis-today">acts of charity</a>. Such kindnesses have also been found during this pandemic, with a surge in <a href="https://www.civilsociety.co.uk/news/donations-surged-800m-during-national-lockdown.html">charitable donations</a> and <a href="https://www.bbc.co.uk/news/uk-51908023">projects to support those in need</a>. Around the world, giving practices have become more <a href="https://ssir.org/articles/entry/household_generosity_during_the_pandemic">local and expansive</a>, and <a href="https://www.theguardian.com/world/2020/may/14/mutual-aid-coronavirus-pandemic-rebecca-solnit">mutual aid</a> – the practice of helping others in a spirit of solidarity and reciprocity – is increasing.</p>
<p>Yet such practices risk dissolving after the current crisis.</p>
<p>After the 1918 pandemic, the US <a href="https://tomdispatch.com/the-great-forgetting/">quickly forgot</a> the disease that had killed about 675,000 of its citizens. The economic boom that became known as the roaring 20s erased memories. Few social and historical memorials exist.</p>
<p>Katherine Porter’s 1939 short novel Pale Horse, Pale Rider is an exception. It describes Miranda’s experience of the 1918 outbreak, as she becomes ill and delirious with influenza, but recovers. Yet she finds that the pale rider, or death, has taken her soldier love Adam, who probably became ill from caring for her. It’s a reminder that the trauma of pandemics is deeply personal and shouldn’t be forgotten.</p>
<h2>Inequalities persist</h2>
<p>As economies today start to recover and <a href="https://www.ey.com/en_uk/growth/ey-item-club/why-the-uk-economy-looks-well-placed-for-a-post-pandemic-recover">growth is expected</a>, we need to remember both the individual suffering and social upheaval the pandemic has caused – and use this to make better decisions about moving forward. History suggests that inequalities so recently exposed and exacerbated will simply reappear again unless we make an effort to fight them.</p>
<p>Consider, for example, a long-unresolved inequality in pandemics: that women and children are especially hard hit. Defoe’s narrator H.F., when considering that poor women had to give birth alone during the plague, with no midwife or even neighbours to help, called it one of the most “deplorable cases in all the present calamity”.</p>
<p>H.F. also argued that more women and children died of the plague than records suggest, because other causes of death were recorded even when the plague was involved. The 1918 flu pandemic also hit under-fives and those aged 20-40 hardest, leaving many <a href="https://www.scientificamerican.com/article/stories-from-a-past-pandemic/">infants motherless or orphaned</a>.</p>
<figure class="align-center ">
<img alt="A woman home-schooling her daughter" src="https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/405639/original/file-20210610-22-15zpms.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As with previous pandemics, COVID-19 has had a disproportionate effect on women and children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-mother-helping-daughter-doing-644960089">LightField Studios/Shutterstock</a></span>
</figcaption>
</figure>
<p>In the current pandemic, mothers have too often had to give birth with far less support than desired. They have also borne a greater burden in terms of having to balance <a href="https://www.nytimes.com/interactive/2021/05/17/upshot/women-workforce-employment-covid.html">employment, childcare and home schooling</a>. The number of children in poverty has also risen, with an estimated <a href="https://www.theguardian.com/uk-news/2020/dec/09/britains-child-poverty-exposed-by-pandemic-mps-children-commissioner">14% of British children</a> having faced persistent hunger at some point during the pandemic.</p>
<h2>Planning for the future</h2>
<p>Yet looking at the literature from the past does not mean being doomed to repeat patterns of inequality. Hopefully, it can inspire the opposite. The £20 weekly <a href="https://www.bigissue.com/latest/universal-credit-what-is-it-and-why-does-the-20-increase-matter/">universal credit uplift</a> introduced in the UK at the start of the pandemic is currently only extended until September. As we emerge from the crisis, perhaps it’s time to consider radical changes to the status quo, like <a href="https://theconversation.com/support-is-growing-for-a-universal-basic-income-and-rightly-so-161309">universal basic income</a> and heavily subsidised childcare.</p>
<p>Now is the time for policymakers and society to think big and be bold. Should we be so lucky as to have a swift and strong economic recovery as after 1918, let’s not forget that another disaster, whether a pandemic or something else, will bring the weaknesses exposed throughout history back to the fore.</p>
<p>Maybe we should not look forward to the day when normal is back, but remember the hope from early in the pandemic – that it might catalyse a new and better normal.</p><img src="https://counter.theconversation.com/content/161945/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Greenlees has received funding from the Wellcome Trust, Economic and Social Research Council, British Academy and various charities within the US and Great Britain. This piece does not directly relate to any funded projects.</span></em></p><p class="fine-print"><em><span>Sara Read has received funding from the Arts and Humanities Research Council. This piece does not relate to any funded project.</span></em></p><p class="fine-print"><em><span>Andrea Ford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Accounts of previous epidemics – by Samuel Pepys, Daniel Defoe and Katherine Porter – warn of mistakes that we risk repeating.Janet Greenlees, Associate Professor of Health History, Glasgow Caledonian UniversityAndrea Ford, Researcher in Medical Anthropology, The University of EdinburghSara Read, Lecturer in English, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1590172021-04-29T20:51:08Z2021-04-29T20:51:08ZWill the end of the COVID-19 pandemic usher in a second Roaring ’20s?<figure><img src="https://images.theconversation.com/files/397941/original/file-20210429-23-29mtq6.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C3028%2C1920&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the wake of COVID-19, the 2020s may be a time when we reconsider how we work, run governments and have fun, just as the 1920s were. This illustration of a flapper girl, created by artist Russell Patterson in the 1920s, captures the style of that era. </span> <span class="attribution"><span class="source">(Library of Congress)</span></span></figcaption></figure><p>While some places remain <a href="https://www.theguardian.com/news/2021/apr/28/crime-against-humanity-arundhati-roy-india-covid-catastrophe">mired in the third wave</a> of the pandemic, others are taking their first tentative steps towards normality. Since April 21, <a href="https://www.reuters.com/world/europe/denmark-speeds-up-reopening-epidemic-stabilises-2021-04-16/">Denmark has allowed indoor service</a> at restaurants and cafes, and football fans are returning to the stands. In countries that have forged ahead with the <a href="https://www.bbc.com/news/health-55274833">rollout of vaccines</a>, there is a palpable sense of optimism. </p>
<p>And yet, with all this looking forward, there is plenty of uncertainty over what the future holds. <a href="https://www.theguardian.com/world/2020/nov/29/life-after-covid-will-our-world-ever-be-the-same">Articles on what the world will look like</a> post-pandemic have proliferated and nations worldwide are considering how to recover financially from this year-long economic disaster. </p>
<p>Almost exactly a hundred years ago, similar conversations and preparations were taking place. In 1918, an influenza pandemic swept the globe. It infected an estimated <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">500 million people</a> — around a third of the world’s population at the time — in four successive waves. While the end of that pandemic was <a href="https://theconversation.com/the-end-of-the-pandemic-is-coming-just-dont-set-a-date-for-the-party-157205">protracted and uneven</a>, it was eventually followed by a period of dramatic social and economic change. </p>
<p>The <a href="https://www.pbs.org/wgbh/americanexperience/features/crash-roaring-20s/">Roaring ‘20s</a> — or “années folles” (“crazy years”) in France — was a period of economic prosperity, cultural flourishing and social change in North America and Europe. The decade witnessed a rapid acceleration in the development and use of cars, planes, telephones and films. In many democratic nations, some women won the <a href="https://www.nytimes.com/2019/08/15/arts/design/womens-suffrage-movement.html">right to vote</a> and their ability to participate in the public sphere and labour market expanded. </p>
<h2>Parallels and differences</h2>
<p>As a historian of health care, I see some striking similarities between then and now, and as we enter our very own '20s it is tempting to use this history as a way of predicting the future. </p>
<p>Vaccine rollouts have raised hope for an end to the COVID-19 pandemic. But they’ve also raised questions about how the world might bounce back, and whether this tragic period could be the start of something new and exciting. Much like in the 1920s, this disease could prompt us to reconsider how we work, run governments and have fun. </p>
<p>However, there are some crucial differences between the two pandemics that could alter the trajectory of the upcoming decade. For one, the age-profile of the victims of the influenza pandemic was unlike that of COVID-19. </p>
<figure class="align-center ">
<img alt="Black and white image of a nurse in a hospital ward" src="https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=626&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=626&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397665/original/file-20210428-15-hhkvje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=626&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Walter Reed Hospital flu ward during the Spanish Flu epidemic of 1918-19, in Washington D.C. That pandemic primarily affected younger people, posing an immediate risk of death to those in their 20s and 30s.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The 1918 flu — also called the Spanish flu — predominantly <a href="https://www.smithsonianmag.com/history/why-did-1918-flu-kill-so-many-otherwise-healthy-young-adults-180967178/">affected the young</a>, whereas COVID-19 has mostly killed <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html">older people</a>. As a result, fear probably refracted through the two societies in different ways. </p>
<p>Young people have certainly been affected by the COVID-19 pandemic: the virus has posed a threat to those with underlying health conditions or disabilities of all ages, and some of the variants have been <a href="https://www.ctvnews.ca/health/coronavirus/younger-healthier-people-need-intensive-care-quickly-with-variants-of-covid-19-tam-1.5376666">more likely to affect younger people</a>. A year of lockdowns and shelter-in-place orders has had a damaging effect on mental and emotional health, and young people have experienced increased anxiety. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19s-parallel-pandemic-why-we-need-a-mental-health-vaccine-155198">COVID-19’s parallel pandemic: Why we need a mental health 'vaccine'</a>
</strong>
</em>
</p>
<hr>
<p>However, the relief of surviving the COVID-19 pandemic might not feel quite the same as that experienced by those who made it through the 1918 influenza pandemic, which posed an immediate risk of death to those in their 20s and 30s. </p>
<h2>1918 vs. 2020</h2>
<p>Crucially, the 1918 flu came immediately after the First World War, which produced its own radical reconstitution of the social order. Despite the drama and tragedy of 2020, the changes we are living through now might be insufficient to produce the kind of social transformation witnessed in the 1920s. One of the key features of the Roaring '20s was an upending of traditional values, a shift in gender dynamics and the flourishing of <a href="https://www.npr.org/2014/12/17/371424790/between-world-wars-gay-culture-flourished-in-berlin">gay culture</a>. </p>
<figure class="align-right ">
<img alt="Josephine Baker on stage." src="https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&rect=8%2C1377%2C2898%2C2236&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=824&fit=crop&dpr=1 600w, https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=824&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=824&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1036&fit=crop&dpr=1 754w, https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1036&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/397673/original/file-20210428-21-wpilc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1036&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Josephine Baker’s verve, performance style and daring outfits made her a star in 1920s Paris.</span>
<span class="attribution"><span class="source">(National Portrait Gallery, Smithsonian Institution 1926)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>While the prospect of similar things happening in the 2020s might seem promising, the pandemic has reinforced, rather than challenged, traditional gender roles. There is evidence for this all over the world, but in the United States <a href="https://www.americanprogress.org/issues/women/reports/2020/10/30/492582/covid-19-sent-womens-workforce-progress-backward/">research suggests</a> that the risk of mothers leaving the labour force to take up caring responsibilities at home amounts to around US$64.5 billion per year in lost wages and economic activity.</p>
<p>When most people think of the Roaring '20s they probably call to mind images of nightclubs, jazz performers and flappers — people having fun. But fun costs money. No doubt, there will be plenty of celebration and relief when things return to a version of normality, but hedonism will probably be out of reach for most. </p>
<p>Young people in particular have been hard hit by the financial pressures of COVID-19. <a href="https://www.epi.org/publication/young-workers-covid-recession/">Workers aged 16-24</a> face high unemployment and an uncertain future. While some have managed to weather the economic storm of this past year, the gap between rich and poor has widened. </p>
<h2>Inequality and isolationism</h2>
<p>Of course, the 1920s was not a period of unadulterated joy for everyone. <a href="https://www.forbes.com/sites/jessecolombo/2019/02/28/americas-wealth-inequality-is-at-roaring-twenties-levels/">Economic inequality</a> was a problem then just as it is now. And while society became more liberal in some ways, governments also enacted harsher and more punitive policies, particularly when it came to immigration — specifically from Asian countries. </p>
<p>The <a href="https://www.smithsonianmag.com/history/1924-law-slammed-door-immigrants-and-politicians-who-pushed-it-back-open-180974910/">Immigration Act of 1924</a> limited immigration to the U.S. and targeted Asians. <a href="https://nzhistory.govt.nz/page/white-new-zealand-policy-introduced">Australia and New Zealand</a> also restricted or ended Asian immigration and in Canada, the <a href="https://www.leg.bc.ca/dyl/Pages/1923-Federal-Government-Prohibits-Chinese-Immigration.aspx">Chinese Immigration Act of 1923</a> imposed similar limitations. </p>
<p>There are troubling signs that this might be the main point of similarity between then and now. <a href="https://www.ctvnews.ca/canada/reports-of-anti-asian-hate-crimes-are-surging-in-canada-during-the-covid-19-pandemic-1.5351481">Anti-Asian sentiment</a> has increased and many countries are using COVID-19 as a way of justifying <a href="https://theconversation.com/closed-borders-travel-bans-and-halted-immigration-5-ways-covid-19-changed-how-and-where-people-move-around-the-world-157040">harsh border restrictions</a> and isolationist policies. </p>
<p>In our optimism for the future, we must remain alert to all the different kinds of damage the pandemic could cause. Just as disease can be a mechanism for positive social change, it can also entrench inequalities and further divide nations and communities.</p><img src="https://counter.theconversation.com/content/159017/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Arnold-Forster is a co-PI on the Wellcome Trust funded project Healthy Scepticism.</span></em></p>A century ago, the end of the 1918 flu pandemic was followed by a period of prosperity, cultural flourishing and social change known as the Roaring ‘20s. Will the end of COVID-19 launch a similar era?Agnes Arnold-Forster, Researcher, History of Medicine and Healthcare, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565512021-03-23T12:33:02Z2021-03-23T12:33:02ZPeople gave up on flu pandemic measures a century ago when they tired of them – and paid a price<figure><img src="https://images.theconversation.com/files/391004/original/file-20210322-21-1ubeke9.jpg?ixlib=rb-1.1.0&rect=0%2C517%2C2700%2C1669&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Armistice Day celebrations on Nov. 11, 1918, worried public health experts as people crowded together in cities across the U.S.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ArmisticeDay1918/4a5c7026339b41feabd1d798f98af262/photo?boardId=d7f2514f50804466b15dfb81ed00d9cd&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=36&currentItemNo=0">AP Photo </a></span></figcaption></figure><p>Picture the United States struggling to deal with a deadly pandemic.</p>
<p>State and local officials enact a slate of social-distancing measures, gathering bans, closure orders and mask mandates in an effort to stem the tide of cases and deaths.</p>
<p>The public responds with widespread compliance mixed with more than a hint of grumbling, pushback and even outright defiance. As the days turn into weeks turn into months, the strictures become harder to tolerate.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/7520flu.0016.257/1/--protest-is-made?rgn=full+text;view=image;q1=Protest+is+Made+by+Theater+Men">Theater and dance hall owners complain</a> about their financial losses.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/9660flu.0001.669/1/--wants-churches-open?rgn=full+text;view=image;q1=Wants+churches+open">Clergy bemoan church closures</a> while offices, factories and in some cases even saloons are allowed to remain open.</p>
<p><a href="https://quod.lib.umich.edu/f/flu/1240flu.0006.421/1/--clash-over-school-order-due-monday?rgn=full+text;view=image;q1=Clash+Over+School+Order+Due+Monday">Officials argue whether children are safer in classrooms</a> or at home.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="men with a streetcar" src="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=823&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=823&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=823&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1034&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1034&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391006/original/file-20210322-17-1xdndpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1034&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No mask, no service on streetcar in 1918.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/precautions-taken-during-spanish-influenza-epidemic-would-news-photo/1223011380">Universal History Archive/Universal Images Group via Getty Images</a></span>
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<p><a href="https://quod.lib.umich.edu/f/flu/1320flu.0009.231/1/--new-cases-of-influenza-at-low-record?rgn=full+text;view=image;q1=New+Cases+of+Influenza+at+Low+Record">Many citizens refuse to don face masks while in public</a>, some complaining that they’re uncomfortable and others arguing that the government has no right to <a href="https://theconversation.com/mask-resistance-during-a-pandemic-isnt-new-in-1918-many-americans-were-slackers-141687">infringe on their civil liberties</a>.</p>
<p>As familiar as it all may sound in 2021, these are real descriptions of the U.S. during the deadly 1918 influenza pandemic. <a href="https://scholar.google.com/citations?user=gzhca9MAAAAJ&hl=en&oi=sra">In my research as a historian of medicine</a>, I’ve seen again and again the many ways our current pandemic has mirrored the one experienced by our forebears a century ago.</p>
<p>As the COVID-19 pandemic enters its second year, many people want to know when life will go back to how it was before the coronavirus. History, of course, isn’t an exact template for what the future holds. But the way Americans emerged from the earlier pandemic could suggest what post-pandemic life will be like this time around.</p>
<h2>Sick and tired, ready for pandemic’s end</h2>
<p>Like COVID-19, the 1918 influenza pandemic hit hard and fast, going from a handful of reported cases in a few cities to a nationwide outbreak within a few weeks. Many communities issued several rounds of various closure orders – corresponding to the ebbs and flows of their epidemics – in an attempt to keep the disease in check.</p>
<p><a href="https://doi.org/10.1001/jama.298.6.644">These social-distancing orders worked</a> to reduce cases and deaths. Just as today, however, they often proved difficult to maintain. By the late autumn, just weeks after the social-distancing orders went into effect, the pandemic seemed to be coming to an end as the number of new infections declined.</p>
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<a href="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked typist at work" src="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391007/original/file-20210322-15-aqbh8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People were ready to be done with masks as soon as it looked like the flu was receding.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/typist-wears-mask-while-working-at-her-office-desk-during-news-photo/108882651?adppopup=true">PhotoQuest/Archive Photos via Getty Images</a></span>
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</figure>
<p>People clamored to return to their normal lives. Businesses pressed officials to be allowed to reopen. Believing the pandemic was over, state and local authorities began rescinding public health edicts. The nation turned its efforts to addressing the devastation influenza had wrought.</p>
<p>For the friends, families and co-workers of the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">hundreds of thousands of Americans who had died</a>, post-pandemic life was filled with sadness and grief. Many of those still recovering from their bouts with the malady required support and care as they recuperated.</p>
<p>At a time when there was no federal or state safety net, charitable organizations sprang into action to provide resources for families who had lost their breadwinners, or <a href="https://quod.lib.umich.edu/f/flu/07z0flu.0000.070/1/--caring-for-little-ones-left-orphans?page=root;rgn=full+text;size=150;view=image;q1=orphan">to take in the countless children left orphaned</a> by the disease.</p>
<p>For the vast majority of Americans, though, life after the pandemic seemed to be a headlong rush to normalcy. Starved for weeks of their nights on the town, sporting events, religious services, classroom interactions and family gatherings, many were eager to return to their old lives.</p>
<p>Taking their cues from officials who had – somewhat prematurely – declared an end to the pandemic, Americans overwhelmingly hurried to return to their pre-pandemic routines. <a href="https://quod.lib.umich.edu/f/flu/7900flu.0004.097/1/--big-increase-in-flu-feared-as-result-of-packed-city-streets?rgn=full+text;view=image;q1=Big+Increase+in+Flu+Feared+as+Result+of+Packed+City+Streets">They packed into movie theaters</a> and dance halls, crowded in stores and shops, and gathered with friends and family.</p>
<p><iframe id="VfjzK" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/VfjzK/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Officials had warned the nation that cases and deaths likely would continue for months to come. The burden of public health, however, now rested not on policy but <a href="https://quod.lib.umich.edu/f/flu/2770flu.0007.772/1/--measures-taken-to-again-combat-epidemic-of-flu?page=root;rgn=full+text;size=150;view=image;q1=Measures+Taken+to+Again+Combat+Epidemic+of+Flu">rather on individual responsibility</a>.</p>
<p>Predictably, the pandemic wore on, stretching into a third deadly wave that lasted through the spring of 1919, with a fourth wave hitting in the winter of 1920. Some officials blamed the resurgence on careless Americans. <a href="https://quod.lib.umich.edu/f/flu/6090flu.0000.906/1/--anxious-rumors-about-recurrence-of-influenza-not-sustained?page=root;rgn=full+text;size=150;view=image;q1=Anxious+Rumors+about+Recurrence+of+Influenza+Not+Sustained+by+Facts">Others downplayed the new cases</a> or turned their attention to more routine public health matters, including other diseases, restaurant inspections and sanitation. </p>
<p>Despite the persistence of the pandemic, influenza quickly became old news. Once a regular feature of front pages, reportage rapidly dwindled to small, sporadic clippings buried in the backs of the nation’s newspapers. The nation carried on, inured to the toll the pandemic had taken and the deaths yet to come. People were largely unwilling to return to socially and economically disruptive public health measures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="masked barber shaves a customer" src="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/391008/original/file-20210322-21-m1jb0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No matter the era, aspects of daily life go on even during a pandemic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-an-unspecified-barbershop-a-man-receives-a-shave-from-a-news-photo/1219167388">Chicago History Museum/Archive Photos via Getty Images</a></span>
</figcaption>
</figure>
<h2>It’s hard to hang in there</h2>
<p>Our predecessors might be forgiven for not staying the course longer. First, the nation was eager <a href="https://chroniclingamerica.loc.gov/lccn/sn83030193/1918-11-07/ed-1/seq-1/#words=Ended+end+End+War+war+Peace+peace">to celebrate</a> the recent <a href="https://chroniclingamerica.loc.gov/lccn/sn83030214/1918-11-11/ed-1/seq-1/#words=over+end+surrendered+Over+war+ENDED+War+armistice+SURRENDERED+End+surrender+WAR+Armistice">end of World War I</a>, an event that perhaps loomed larger in the lives of Americans than even the pandemic.</p>
<p>Second, death from disease was a much larger part of life in the early 20th century, and scourges such as diphtheria, measles, tuberculosis, typhoid, whooping cough, scarlet fever and pneumonia each routinely <a href="https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1918.pdf">killed tens of thousands of Americans every year</a>. Moreover, neither the cause nor the epidemiology of influenza was well understood, and many experts remained unconvinced that social distancing measures had any measurable impact.</p>
<p>Finally, there were no effective flu vaccines to rescue the world from the ravages of the disease. In fact, the influenza virus would not be <a href="https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm">discovered for another 15 years, and a safe and effective vaccine</a> was not available for the general population until 1945. Given the limited information they had and the tools at their disposal, Americans perhaps endured the public health restrictions for as long as they reasonably could.</p>
<p><iframe id="wEFff" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/wEFff/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>A century later, and a year into the COVID-19 pandemic, it is understandable that people now are all too eager to return to their old lives. The end of this pandemic inevitably will come, as it has with <a href="https://theconversation.com/how-do-pandemics-end-history-suggests-diseases-fade-but-are-almost-never-truly-gone-146066">every previous one humankind has experienced</a>.</p>
<p>If we have anything to learn from the history of the 1918 influenza pandemic, as well as our experience thus far with COVID-19, however, it is that a premature return to pre-pandemic life risks more cases and more deaths.</p>
<p>And today’s Americans have significant advantages over those of a century ago. We have a much better understanding of virology and epidemiology. We know that <a href="https://www.sciencedaily.com/releases/2020/09/200910110824.htm">social distancing</a> and <a href="https://doi.org/10.1038/d41586-020-02801-8">masking work to help save lives</a>. Most critically, we have multiple safe and effective vaccines that are being deployed, with <a href="https://www.nytimes.com/live/2021/03/18/world/covid-19-coronavirus/us-vaccine-pace-eligible">the pace of vaccinations increasingly weekly</a>.</p>
<p>Sticking with all these coronavirus-fighting factors or easing off on them could mean the difference between a <a href="https://www.statnews.com/2021/03/20/rising-covid19-cases-in-some-states-highlight-precarious-position/">new disease surge</a> and a quicker end to the pandemic. COVID-19 is much more transmissible than influenza, and <a href="https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant-cases.html">several troubling SARS-CoV-2 variants are already spreading</a> around the globe. The deadly third wave of influenza in 1919 shows what can happen when people prematurely relax their guard.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/156551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Alexander Navarro does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Americans were tired of social distancing and mask-wearing. At the first hint the virus was receding, people pushed to get life back to normal. Unfortunately another surge of the disease followed.J. Alexander Navarro, Assistant Director of the Center for the History of Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1509402020-11-26T19:02:18Z2020-11-26T19:02:18ZDevastated by disease in the past, Samoa is on high alert after recent coronavirus scares<figure><img src="https://images.theconversation.com/files/371435/original/file-20201126-23-8cz86o.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5449%2C3744&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Apia harbour on the island of Upolu, Samoa, where the deadly influenza virus came ashore in 1918.</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Within minutes of <a href="https://www.rnz.co.nz/international/pacific-news/430617/ship-with-covid-19-cases-off-loads-cargo-in-american-samoa">news</a> that crew members of the cargo ship Fesco Askold had tested positive for COVID-19, a social media storm broke across Samoa. COVID-free until then, the island nation’s anxiety was understandable. More so when you consider its history.</p>
<p>Memories of the deadly 2019 <a href="https://www.theguardian.com/world/2019/dec/18/these-babies-should-not-have-died-how-the-measles-outbreak-took-hold-in-samoa">measles outbreak</a> were still fresh. But more distant events resonated just as much. Next to images of the cargo ship in the harbour, people were posting pictures of the <a href="https://nzhistory.govt.nz/culture/1918-influenza-pandemic/samoa">Talune</a>, the infamous “ship of death” that brought the Spanish influenza virus to Samoa in 1918, devastating the population.</p>
<p>The Fesco Askold had docked in Apia, Samoa, on November 7, before sailing to Pago Pago in American Samoa, where the crew apparently tested positive. Panic increased when a hoax email claimed a school child was a direct contact of a port worker and all parents should immediately collect their children.</p>
<p>The government later corrected the arrival date of the cargo ship in Apia to November 8. None of the crew had left the ship and there was no contact between them and Samoan harbour pilots. Offloaded containers had been sterilised.</p>
<p>The crisis passed, but within weeks another positive COVID-19 test was <a href="https://www.rnz.co.nz/international/pacific-news/430952/samoa-records-first-positive-covid-test-result">reported</a> in a quarantined sailor who had arrived in Samoa on a repatriation flight from New Zealand on November 13. </p>
<p>When further tests showed negative results, swabs were <a href="https://www.stuff.co.nz/national/health/coronavirus/123477437/sailors-show-no-symptoms-as-samoa-awaits-covid19-test-results-from-new-zealand">sent to Wellington</a> for more analysis. When these were inconclusive, <a href="https://www.rnz.co.nz/international/pacific-news/431353/still-no-clarity-other-samoan-covid-tests">blood samples</a> were sent, with results still pending.</p>
<p>Meanwhile, a chartered flight from the US was due to arrive in Samoa with up to half of the 300 passengers returning sailors. The flight was <a href="https://samoaglobalnews.com/repatriation-fight-from-usa-postponed/">postponed</a> this week. Two more repatriation flights from New Zealand scheduled for early December are still to be confirmed.</p>
<figure class="align-center ">
<img alt="old steamship at sea" src="https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/371437/original/file-20201126-19-1bmml53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The SS Talune docked in Apia in 1918, bringing the Spanish flu to Samoa.</span>
<span class="attribution"><span class="source">Alexander Turnbull Library</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
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</figure>
<h2>The influenza and measles tragedies</h2>
<p>Both New Zealand and Samoa are highly sensitive to the risks of disease spreading. The Talune was quarantined in Fiji in 1918, but no such precautions were taken in Samoa, then under New Zealand administration. Infected passengers were allowed to disembark. Over a fifth of the Samoan population died as a result.</p>
<p>In 2002, the then New Zealand prime minister, Helen Clark, made a <a href="https://www.nzherald.co.nz/nz/full-text-helen-clarks-apology-to-samoa/65TV2LDV6S7HHIYRDCFSC5YOZI/">formal apology</a> in person to the people of Samoa for the grievous error of a past government. But in 2019 a measles epidemic that began in New Zealand rocked Samoa, killing 83, nearly all young children. Official inaction by New Zealand was <a href="https://www.nzherald.co.nz/nz/government-inaction-left-door-open-to-measles-outbreak-ministry-of-health-report/7LXR56NQU6AD377QHMUY2RKY3Q/">blamed</a> for the tragedy.</p>
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Read more:
<a href="https://theconversation.com/buying-and-distributing-a-covid-19-vaccine-will-involve-hard-ethical-and-practical-choices-149980">Buying and distributing a COVID-19 vaccine will involve hard ethical and practical choices</a>
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<p>While Aotearoa New Zealand has done well controlling COVID-19, Samoa is not nearly as well resourced. Health facilities and expert staff are stretched at best. Furthermore, there are many existing health problems, making the population particularly vulnerable to the virus.</p>
<p>Pictures from other countries of <a href="https://www.nzherald.co.nz/world/covid-19-coronavirus-mass-graves-dug-as-brazil-hits-grim-new-toll/4D7WDYXNQ62TVHOM2A2GLOV3TA/">mass graves</a> being prepared for COVID-19 victims trigger traumatic memories in Samoa. Many were buried in this way in 1918 — and even more recently after the devastating <a href="https://www.smh.com.au/world/mass-burial-for-samoas-tsunami-victims-20091003-gh2e.html">2009 tsunami</a>.</p>
<p>My own family was not spared in what is known as the great <em>Faamai</em> — plague — of 1918. One of my great grandfathers and one of my great, great grandfathers died — two generations in one event.</p>
<p>For Samoans, as for all Pasifika people and Māori, a mass grave is particularly soul-destroying. To be buried without identification and acknowledgement of who the dead are, and their many familial connections, goes against custom and culture.</p>
<p>Samoans mark every rite of passage from the womb to the tomb. This is the basis of our communal structure, embedded in the customs and practices of the <em>Faamatai</em> — more commonly known as the Faa-Samoa or “the Samoan way”.</p>
<h2>The lasting effects of 1918</h2>
<p>The impact of the 1918 epidemic is also still felt in the laws and political systems of Samoa. In the Land and Titles Court, for example, people represent themselves in an inquisitorial forum reflecting Samoa’s history as a German colony from 1900-1914.</p>
<p>Since 1918, it is not unusual to hear (or read in written petitions) a heartbreaking phrase: <em>Ua tuua ia tama lenei aiga</em> — in our family only the children remained.</p>
<p>For many Samoan families the tragedy resulted in the loss of <em>matai</em> (chiefly) titles and the customary lands owned by those names. The fight by later generations to reclaim their heritage has, rightly or wrongly, given the court its contemporary power, influence and value.</p>
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<strong>
Read more:
<a href="https://theconversation.com/new-cyclone-forecasts-why-impacts-should-be-the-focus-of-hazardous-weather-warnings-149358">New cyclone forecasts: why impacts should be the focus of hazardous weather warnings</a>
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<p>Right now, Samoans are preparing for a <a href="https://www.rnz.co.nz/international/pacific-news/429068/two-hundred-candidates-register-for-samoa-election-2021">general election</a> in April 2021. The government’s handling of the pandemic is likely to play a major part in campaigning and voting. As a recent Newsline Samoa opinion column was <a href="https://newslinesamoa.com/my-say-covid-19-is-a-deadly-virus-not-an-election-winner/">headlined</a>: COVID-19 is a Deadly Virus Not an Election Winner.</p>
<p>Given the current situation and the country’s history, the panic of November 9 was to be expected. Prayers and pleas that this latest plague will pass over Samoa and spare its people are still on the lips of every Samoan, whether they live there or elsewhere.</p>
<p>They know their country could not withstand the ravages of COVID-19 should it reach their shores. In Samoa, 1918 is not a distant memory.</p><img src="https://counter.theconversation.com/content/150940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tootoooleaava Dr. Fanaafi Aiono-Le Tagaloa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After recent suspected COVID-19 cases and with repatriation flights postponed, Samoa takes no chances.Tootoooleaava Dr. Fanaafi Aiono-Le Tagaloa, Law Lecturer and Convenor of Pacific Engagement, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1437972020-10-05T12:07:18Z2020-10-05T12:07:18ZRemote learning isn’t new: Radio instruction in the 1937 polio epidemic<p>A <a href="https://data.unicef.org/resources/remote-learning-reachability-factsheet/">UNICEF survey</a> found that 94% of countries implemented some form of remote learning when COVID-19 closed schools last spring, including in the United States. </p>
<p>This is not the first time education has been disrupted in the U.S. – nor the first time that educators have harnessed remote learning. In 1937, <a href="https://www.newspapers.com/clip/59888554/children-to-be-taught-by-radio-dixon/#">the Chicago school system used radio to teach children during a polio outbreak</a>, demonstrating how technology can be used in a time of crisis.</p>
<p>I’ve <a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">documented outbreaks</a> of scarlet fever, measles, diphtheria, influenza and other communicable illnesses that regularly closed schools <a href="https://jamanetwork.com/journals/jama/fullarticle/209448">before vaccines</a> greatly reduced childhood diseases. </p>
<p>Responses varied from district to district. During the <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.28.6.w1066">1918-19 influenza pandemic</a>, school boards held special meetings to debate the best way to proceed. Chicago, New York and New Haven were among the cities that never closed, using medical inspection and individual quarantine instead, while <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.28.6.w1066">other schools shuttered for up to 15 weeks</a>. </p>
<p>School closings typically halted formal learning. For some kids, it meant extra playtime, while others went back to work at home or on family farms. Schools sometimes compensated for lost instructional time by shifting the academic calendar or mandating Saturday attendance.</p>
<h2>Radio school</h2>
<p>In 1937, a severe polio epidemic hit the U.S. At the time, this contagious virus had no cure, and it crippled or paralyzed some of those it infected. Across the country, playgrounds and pools closed, and children were banned from movie theaters and other public spaces. Chicago had a record 109 cases in August, <a href="https://www.newspapers.com/clip/59889301/delay-opening-on-orders-of-health/">prompting the Board of Health to postpone the start of school</a> for three weeks. </p>
<p>This delay sparked the first large-scale “radio school” experiment through a highly innovative – though largely untested – program. Some 315,000 children in grades 3 through 8 continued their education at home, receiving lessons on the radio.</p>
<p>By the late 1930s, radio had become a popular source of news and entertainment. <a href="https://www.tandfonline.com/doi/pdf/10.1207/s15506878jobem4802_2?casa_token=9kx859uJE7gAAAAA:dgAGC-vA_ON5H2g3LdannS-gRe_qKkLpor1njpho3Qqp5aDZXCCJLV2ylcLnUdpdxCcKnT_3V5sR">Over 80% of U.S. households owned at least one radio</a>, though fewer were found in homes in the southern U.S., in rural areas and among people of color. </p>
<p>In Chicago, teachers collaborated with principals to create <a href="https://nyti.ms/34bojSX">on-air lessons</a> for each grade, with oversight from experts in each subject. Seven local radio stations donated air time. September 13 marked the first day of school. </p>
<p>Local papers printed class schedules each morning. Social studies and science classes were slated for Mondays, Wednesdays and Fridays; Tuesdays, Thursdays and Saturdays were devoted to English and math. The on-air school day began with announcements and gym. Classes were short – just 15 minutes – providing simple, broad questions and assigning homework. </p>
<p>The objective was to be “<a href="https://www.newspapers.com/clip/59889812/broadcast-food-for-thought-chicago/">entertaining yet informative</a>.” Curriculum planners incorporated an engaging commercial broadcasting style into the lessons. Two principals monitored each broadcast, providing feedback to teachers on content, articulation, vocabulary and general performance. When schools reopened, students would submit their work and take tests to show mastery of the material.</p>
<p>Sixteen teachers answered phone calls from parents at the school district’s central office. After the phone bank logged more than 1,000 calls on the first day, they brought five more teachers on board. </p>
<p>News stories reporting on this novel radio school approach were mostly positive, but a few articles hinted at the challenges. Some kids were distracted or struggled to follow the lessons. There was no way to ask questions in the moment, and kids needed more parental involvement than usual. </p>
<p>In general, media coverage focused on the innovation of the delivery method. Access issues received little attention. Even Superintendent William Johnson <a href="https://nyti.ms/34bojSX">didn’t know how many students tuned in</a> for the lessons.</p>
<p>Radio instruction officially ended at the end of September when schools reopened. Though the program ran for less than three weeks, it transformed the role of local radio in Chicago education. The experiment initiated a partnership between the city’s public schools and local radio stations, which was quickly cemented in the formation of the <a href="https://ecommons.luc.edu/cgi/viewcontent.cgi?article=3272&context=luc_diss">Chicago Radio Council</a>. The council produced educational shows, broadcasted educational conferences and supplemented specific grade-level curriculum.</p>
<p>The partnership also brought more radios into schools, with teachers required to include on-air programs in their lesson plans. It also offered opportunities for students to participate in newscasts, radio round tables and other programming. </p>
<h2>Remote learning 2020</h2>
<p>Fast forward to 2020. When the current pandemic shut down schools last spring, nations around the world instituted remote learning. But many countries used multiple platforms: About three-quarters also offered classes on television and about half used radio learning – which was particularly important in developing nations.</p>
<p>Instruction through multiple technologies helps, but many kids simply have no access. Approximately <a href="https://data.unicef.org/resources/remote-learning-reachability-factsheet/">one-third</a>) of students worldwide cannot participate in digital or on-air education because they don’t own a computer, TV or radio, lack reliable internet access or live in remote areas that lie beyond the range of broadcasts.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<h2>Lessons from Chicago</h2>
<p>Chicago’s handling of remote education during its 1937 polio epidemic offers lessons on ways to use technology to address the current educational disruptions. But even where most students have access to reliable internet service, the pandemic has highlighted the mass-scale burdens of the digital divide. </p>
<p>One example comes from Southern California, where <a href="https://www.latimes.com/california/story/2020-08-13/online-learning-fails-low-income-students-covid-19-left-behind-project">a survey of 45 school districts</a> found substantial differences in distance learning among children living in high-poverty communities compared with those in more affluent areas. State officials estimate that California’s students need more than a million computers – and additional hot spots. </p>
<p>This highlights the need for funding in the U.S. – and in nations worldwide – to address technological inequalities in schools and to teach educators, administrators, parents and students how to better use digital platforms.</p>
<p>This pandemic could reshape education once school safely shifts back to the classroom. Innovative use of digital tools and platforms could enrich curriculum, provide online makeup material and create new ways to connect with students beyond the traditional modes of learning. It would also reduce the environmental impact from distributed papers and help teachers, students and parents to more easily connect outside of the classroom.</p>
<p>Pandemic teaching may not just be a temporary means to an end. It could ultimately improve education, much like Chicago’s radio experiment in 1937.</p><img src="https://counter.theconversation.com/content/143797/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This isn’t the first time America’s schoolchildren have studied remotely – and Chicago’s 1937 ‘radio school’ experiment shows how technology can fill the gap during a crisis.Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1430832020-08-03T12:24:27Z2020-08-03T12:24:27ZWhat literature can tell us about people’s struggle with their faith during a pandemic<figure><img src="https://images.theconversation.com/files/350266/original/file-20200729-23-188tshx.jpg?ixlib=rb-1.1.0&rect=8%2C4%2C989%2C624&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A scene from Giovanni Boccaccio's 'The Decameron' – sales of which have reportedly risen during the pandemic.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Waterhouse_decameron.jpg">John Waterhouse/Lady Lever Art Gallery</a></span></figcaption></figure><p>A <a href="https://www.washingtonpost.com/religion/2020/04/30/coronavirus-deepening-more-religious-black-protestants/">recent Pew Research poll</a> found that religious faith had deepened for a quarter of Americans because of the coronavirus pandemic. </p>
<p>Some might indeed take solace in religion at a time of uncertainty, such as a pandemic, but the <a href="https://www.sc.edu/study/colleges_schools/artsandsciences/dllc/our_people/mueller_agnes.php">literary texts that I teach</a> in my university course, “Pandemics in Literature,” suggest that this is not always the case: Faith may deepen for some, while others may reject or abandon it altogether. </p>
<h2>Christianity and the Black Death</h2>
<p>In one of the most well known works of pandemic literature, Giovanni Boccaccio’s “The Decameron” – sales of which have <a href="https://www.townandcountrymag.com/leisure/arts-and-culture/a31540805/decameron-sudden-popularity-coronavirus/">reportedly risen</a> during the coronavirus – <a href="https://www.gutenberg.org/files/23700/23700-h/23700-h.htm">faith and religion are mocked</a> and satirized. </p>
<p>“The Decameron” is a set of one hundred stories told by seven young women and three young men quarantined from the Black Death on the outskirts of medieval Florence. Interestingly, “The Decameron” is the earliest and <a href="https://www.oxfordbibliographies.com/view/document/obo-9780195399301/obo-9780195399301-0203.xml">most significant text</a> that shows a rejection of Christianity at a time when most of Europe was still under the powerful influence of the Catholic Church and its teachings. </p>
<p>In Boccaccio’s massive collection of novellas, monks and other dignitaries of the Church are ridiculed, disparaged and shown in their human fallibility. For example, in the fourth story on the first day, an abbot and a monk conspire to bring a willing young girl into a monastery – an act that is celebrated by the narrators as brave and laudable, even though this went against every religious and moral doctrine of the time. </p>
<p>This and other stories show that personal faith or the church and priests are never able to help humans in their vulnerability. Instead, it is earthly love or passion that become the driving forces of human behavior.</p>
<p>Both the structure and the representatives of the Catholic Church as well as the possibility for individual, personal faith are rejected in Boccaccio’s collection. </p>
<h2>Religion in the time of cholera</h2>
<p>In German writer Thomas Mann’s well-known novella of 1912, “<a href="https://archive.org/details/DeathInVenice">Death in Venice</a>,” an outbreak of cholera affects the protagonist Gustav von Aschenbach, a learned man. </p>
<p>On the face of it, Mann’s novella does not seem to engage with religion or faith. Yet, Aschenbach’s character is deeply rooted in the religious principles and values of a Protestant work ethic. For Mann, Aschenbach’s service to art and literature is like religion because of his dedication – he writes stoically every day, even when it’s difficult.</p>
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<a href="https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=605&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=605&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=605&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=761&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=761&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350262/original/file-20200729-31-1g8v60p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=761&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">British actor Dirk Bogarde and Swedish actor Bjorn Andresen on the set of ‘Death in Venice.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/british-actor-dirk-bogarde-and-swedish-actor-bjorn-andresen-news-photo/607398934?adppopup=true">Sunset Boulevard/Corbis via Getty Images</a></span>
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<p>When Aschenbach decides to travel to cholera-stricken Venice, he is seduced by the Polish boy Tadzio, who not only unleashes Aschenbach’s sudden homoerotic desire but also leads him to feast on cholera-infested strawberries that eventually kill him.</p>
<p>Since Tadzio, the object of Aschenbach’s forbidden love, is always an object of adoration and never a subject, it is easy to regard him as a personification of art. Aschenbach’s admiration of Tadzio is almost religious: Tadzio is depicted as an “angel” when he is seen to follow “the Summoner,” the angel of death, embodied by Tadzio: “It seemed to him the pale and lovely Summoner out there smiled at him and beckoned; (…) And, as so often before, he rose to follow.” </p>
<p>In the face of cholera, religion, in “Death in Venice,” gets replaced with art as a spiritual experience; earthly love becomes a substitute for personal faith.</p>
<h2>1918 flu and personal faith</h2>
<p>The title of Pulitzer Prize-winning American writer Katherine Anne Porter’s short story “<a href="https://archive.org/details/in.ernet.dli.2015.184599">Pale Horse, Pale Rider</a>” of 1936 is clearly a reference to the Bible.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=472&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=472&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=472&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=593&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=593&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350265/original/file-20200729-15-j51280.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=593&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Illustration of ‘Death on a Pale Horse.’</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Albert_Pinkham_Ryder#/media/File:Albert_Pinkham_Ryder_002.jpg">Albert Pinkham Ryder/The Cleveland Museum of Art</a></span>
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<p>The story borrows its title from Revelation 6:1-8, with the four horsemen of the Apocalypse as the Conqueror on a white horse, War on a red horse, Famine on a black horse and Death on a pale horse. </p>
<p>There are almost no literary works dealing with the 1918 influenza pandemic, except for Porter’s short story. A narrator tells the story of Miranda, a newspaper woman, and Adam, a soldier, and the suffering that both endure because of their influenza illnesses. Adam eventually succumbs, but Miranda only learns of his death later.</p>
<p>Before Adam’s death, Miranda and Adam recall prayers and songs from their childhood faith. They both say that now “<a href="https://archive.org/stream/in.ernet.dli.2015.27876/2015.27876.Pale-Horse-Pale-Rider_djvu.txt">[i]t doesn’t sound right, somehow</a>,” meaning their childhood songs and prayers are no longer valuable, and their attempt to take comfort in the bluegrass song “Pale Horse Pale Rider” in the face of Adam’s impending death fails, too. </p>
<p>There is little scholarship on Porter’s interesting story, but English professor <a href="https://www.canisius.edu/academics/our-schools/college-arts-sciences/directory/jane-fisher">Jane Fisher</a> <a href="https://link.springer.com/chapter/10.1007%2F978-1-137-05438-8_5">aptly notes</a> how Porter invokes new literary techniques and lessons learned from the Black Death in “Pale Horse, Pale Rider.” While personal faith is in this story under consideration as a source of solace and relief, it is ultimately rejected. </p>
<h2>Rethinking religion?</h2>
<p>Other literary works that engage with pandemics show a similar course, both in highbrow and more popular genres. Albert Camus’ “The Plague” of 1947 was celebrated as an existentialist classic, where faith and religion have no place and individual effort is impossible. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>In Stephen King’s 1978 tome “The Stand,” all characters surviving the apocalyptic and fictitious “super-influenza” appear apathetic, beyond religion. And Fermina Daza, the lover of the main protagonist in Gabriel García Márquez’s “Love in the Time of Cholera” grows to despise her religion. </p>
<p>We do not yet fully know how the coronavirus will affect societies in either deepening ties to faith or disillusionment from religious institutions. But it will be interesting to see what today’s authors will write about how humanity survived the pandemic of 2020.</p><img src="https://counter.theconversation.com/content/143083/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Agnes Mueller does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Narratives throughout history illustrate how pandemics make people grapple with their faith, leading them to deepen religious beliefs or reject them altogether.Agnes Mueller, Professor of German and Comparative Literature, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1416872020-07-13T11:53:58Z2020-07-13T11:53:58ZMask resistance during a pandemic isn’t new – in 1918 many Americans were ‘slackers’<figure><img src="https://images.theconversation.com/files/345886/original/file-20200706-3943-5gsic4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Policemen in Seattle, Washington, wearing masks made by the Red Cross, during the influenza pandemic, December 1918</span> <span class="attribution"><a class="source" href="https://catalog.archives.gov/id/45499339">National Archives</a></span></figcaption></figure><p>We have all seen the alarming headlines: Coronavirus cases are <a href="https://www.pbs.org/newshour/health/coronavirus-cases-are-rising-in-40-of-50-u-s-states">surging in 40 states</a>, with new cases and hospitalization rates climbing at an alarming rate. Health officials have warned that the U.S. must act quickly to halt the spread – or we risk losing control over the pandemic. </p>
<p>There’s a <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fcloth-face-cover.html">clear consensus</a> that Americans should wear masks in public and continue to practice proper social distancing. <a href="https://www.pewresearch.org/fact-tank/2020/06/23/most-americans-say-they-regularly-wore-a-mask-in-stores-in-the-past-month-fewer-see-others-doing-it/">While a majority of Americans</a> support wearing masks, widespread and consistent compliance has proven difficult to maintain in communities across the country. Demonstrators gathered outside city halls in <a href="https://www.12news.com/article/news/local/valley/anti-mask-rally-to-protest-mask-mandate-held-in-scottsdale/75-94cd29b2-9630-457d-8116-a6a6d32af281">Scottsdale, Arizona</a>; <a href="https://www.statesman.com/news/20200628/alex-jones-leads-anti-mask-protest-at-capitol">Austin, Texas</a>; and other cities to protest local mask mandates. Several <a href="https://www.washingtonpost.com/nation/2020/06/26/sheriffs-mask-covid/">Washington state and North Carolina sheriffs have announced they will not enforce their state’s mask order</a>.</p>
<p>I’ve <a href="https://www.researchgate.net/scientific-contributions/38950136_J_Alexander_Navarro">researched</a> the <a href="http://www.influenzaarchive.org/about.html">history of the 1918 pandemic</a> extensively. At that time, with no effective vaccine or drug therapies, communities across the country instituted a host of public health measures to slow the spread of a deadly influenza epidemic: They closed schools and businesses, banned public gatherings and isolated and quarantined those who were infected. Many communities recommended or required that citizens wear face masks in public – and this, not the onerous lockdowns, drew the most ire.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=526&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=526&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=526&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=661&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=661&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345895/original/file-20200706-3980-1euqqs7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=661&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Officials wearing gauze masks inspect Chicago street cleaners for the flu, 1918.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/chicago-illinois-inspecting-chicago-street-cleaners-for-news-photo/514910726">Bettman/Getty Images</a></span>
</figcaption>
</figure>
<p>In mid-October of 1918, amidst a raging epidemic in the Northeast and rapidly growing outbreaks nationwide, the <a href="https://www.usphs.gov/">United States Public Health Service</a> circulated leaflets recommending that all citizens wear a mask. The Red Cross took out newspaper ads encouraging their use and offered instructions on how to construct masks at home using gauze and cotton string. Some state health departments launched their own initiatives, most notably California, Utah and Washington.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>Nationwide, posters presented mask-wearing as a civic duty – social responsibility had been embedded into the social fabric by a massive wartime federal propaganda campaign launched in early 1917 when the U.S. entered the Great War. San Francisco <a href="https://quod.lib.umich.edu/f/flu/1620flu.0009.261/1/--proclamation-of-mayor-asks-masks-for-all?rgn=full+text;view=image;q1=conscience%2C+patriotism+and+self-protection+demand+immediate+and+rigid+compliance">Mayor James Rolph announced</a> that “conscience, patriotism and self-protection demand immediate and rigid compliance” with mask wearing. In nearby Oakland, <a href="https://quod.lib.umich.edu/f/flu/8540flu.0007.458/1/--wear-mask-says-law-or-face-arrest?rgn=full+text;view=image;q1=Face+Arrest">Mayor John Davie stated</a> that “it is sensible and patriotic, no matter what our personal beliefs may be, to safeguard our fellow citizens by joining in this practice” of wearing a mask.</p>
<p>Health officials understood that radically changing public behavior was a difficult undertaking, especially since many found masks uncomfortable to wear. Appeals to patriotism could go only so far. As one Sacramento official noted, people “must be forced to do the things that are for their best interests.” The Red Cross <a href="https://quod.lib.umich.edu/f/flu/1440flu.0007.441/1/--wear-a-mask-and-save-your-life?rgn=full+text;view=image;q1=wear+a+mask">bluntly stated</a> that “the man or woman or child who will not wear a mask now is a dangerous slacker.” Numerous communities, particularly across the West, imposed mandatory ordinances. Some sentenced scofflaws to short jail terms, and fines ranged from US$5 to $200. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=479&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=479&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=479&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=601&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=601&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345891/original/file-20200706-4000-1ruwuu5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=601&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Collage of newspaper headlines related to the previous year’s influenza pandemic, Chicago, Illinois, 1919. Headlines include ‘Police Raid Saloons in War on Influenza,’ ‘Flu Curfew to Sound for City Saturday Night’ and ‘Open-Face Sneezers to Be Arrested.’</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/collage-of-various-newspaper-headlines-related-to-the-news-photo/1219167361">Chicago History Museum/Getty Images</a></span>
</figcaption>
</figure>
<p>Passing these ordinances was frequently a contentious affair. For example, it took several attempts for Sacramento’s health officer to convince city officials to enact the order. In Los Angeles, it was scuttled. A draft resolution in Portland, Oregon led to heated city council debate, with <a href="https://quod.lib.umich.edu/f/flu/2510flu.0008.152/1/--decline-in-flu-cases-expected?rgn=full+text;view=image;q1=Decline+in+Flu+Cases+Expected">one official declaring</a> the measure “autocratic and unconstitutional,” adding that “under no circumstances will I be muzzled like a hydrophobic dog.” It was voted down. </p>
<p>Utah’s board of health considered issuing a mandatory statewide mask order but decided against it, <a href="https://quod.lib.umich.edu/f/flu/9830flu.0009.389/1/--dr-beatty-makes-plain-his-position-on-mask-question?rgn=full+text;view=image;q1=makes+plain+his">arguing</a> that citizens would take false security in the effectiveness of masks and relax their vigilance. As the epidemic resurged, Oakland tabled its debate over a second mask order after the mayor angrily recounted his arrest in Sacramento for not wearing a mask. A <a href="https://quod.lib.umich.edu/f/flu/3360flu.0007.633/1/--flu-masking-ordinance-is-turned-down?rgn=full+text;view=image;q1=Flu+Masking+Ordinance+is+Turned+Down">prominent physician in attendance commented</a> that “if a cave man should appear…he would think the masked citizens all lunatics.”</p>
<p>In places where mask orders were successfully implemented, noncompliance and outright defiance quickly became a problem. Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day. One Denver salesperson refused because she said her “nose went to sleep” every time she put one on. <a href="https://quod.lib.umich.edu/f/flu/6190flu.0003.916/1/--masks-not-popular-many-people-ignore-health-board-rules?rgn=full+text;view=image;q1=many+people+ignore">Another said</a> she believed that “an authority higher than the Denver Department of Health was looking after her well-being.” As <a href="https://quod.lib.umich.edu/f/flu/2290flu.0003.922/3/--new-orders-are-issued?page=root;rgn=full+text;size=200;view=image;q1=New+Orders+are+issued">one local newspaper put it</a>, the order to wear masks “was almost totally ignored by the people; in fact, the order was cause of mirth.” The rule was amended to apply only to streetcar conductors – who then threatened to strike. A walkout was averted when the city watered down the order yet again. Denver endured the remainder of the epidemic without any measures protecting public health.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=823&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=823&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=823&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1034&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1034&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345897/original/file-20200706-4008-zh4ckj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1034&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Precautions taken during the 1918 flu pandemic would not allow anyone to ride street cars without a mask. Here, a conductor bars an unmasked passenger from boarding.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/precautions-taken-during-spanish-influenza-epidemic-would-news-photo/1223011380">Universal History Archive/Getty Images</a></span>
</figcaption>
</figure>
<p>In Seattle, streetcar conductors refused to turn away unmasked passengers. Noncompliance was so widespread in Oakland that officials deputized 300 War Service civilian volunteers to secure the names and addresses of violators so they could be charged. When a mask order went into effect in Sacramento, the police chief instructed officers to “Go out on the streets, and whenever you see a man without a mask, bring him in or send for the wagon.” Within 20 minutes, police stations were flooded with offenders. In San Francisco, there were so many arrests that the police chief warned city officials he was running out of jail cells. Judges and officers were forced to work late nights and weekends to clear the backlog of cases.</p>
<p>Many who were caught without masks thought they might get away with running an errand or commuting to work without being nabbed. In San Francisco, however, initial noncompliance turned to large-scale defiance when the city enacted a second mask ordinance in January 1919 as the epidemic spiked anew. Many decried what they viewed as an unconstitutional infringement of their civil liberties. On January 25, 1919, approximately 2,000 members of the “Anti-Mask League” <a href="https://quod.lib.umich.edu/f/flu/1320flu.0009.231/1/--new-cases-of-influenza-at-low-record?page=root;rgn=full+text;size=150;view=image;q1=New+Cases+of+Influenza+at+Low+Record">packed the city’s old Dreamland Rink</a> for a rally denouncing the mask ordinance and proposing ways to defeat it. Attendees included several prominent physicians and a member of the San Francisco Board of Supervisors.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/346412/original/file-20200708-3978-bycckm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Poster of a Red Cross nurse wearing a gauze mask over her nose and mouth – with tips to prevent the influenza pandemic.</span>
<span class="attribution"><a class="source" href="https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101580385-img">The National Library of Medicine/NIH</a></span>
</figcaption>
</figure>
<p>It is difficult to ascertain the effectiveness of the masks used in 1918. Today, we have a <a href="https://doi.org/10.1038/s41591-020-0843-2">growing body of evidence</a> that well-constructed cloth face coverings are <a href="https://doi.org/10.1377/hlthaff.2020.00818">an effective tool</a> in slowing the spread of COVID-19. It remains to be seen, however, whether Americans will maintain the widespread use of face masks as our current pandemic continues to unfold. Deeply entrenched ideals of individual freedom, the lack of cohesive messaging and leadership on mask wearing, and pervasive misinformation have proven to be major hindrances thus far, precisely when the crisis demands consensus and widespread compliance. This was certainly the case in many communities during the fall of 1918. That pandemic ultimately <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">killed about 675,000 people in the U.S</a>. Hopefully, history is not in the process of repeating itself today.</p>
<p><em>This article was updated to correct the location of sheriffs mentioned.</em></p><img src="https://counter.theconversation.com/content/141687/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The University of Michigan Center for the History of Medicine received funding from the US Centers for Disease Control and Prevention for a portion of its research on the 1918 influenza pandemic. J. Alexander Navarro was a member of that team of researchers.</span></em></p>As the US battled the 1918 influenza pandemic, some communities staged contentious battles against wearing masks. Sound familiar?J. Alexander Navarro, Assistant Director, Center for the History of Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1407012020-07-12T11:25:44Z2020-07-12T11:25:44ZComparing COVID-19 to past world war efforts is premature — and presumptuous<figure><img src="https://images.theconversation.com/files/345918/original/file-20200706-3953-1sm6t6x.jpg?ixlib=rb-1.1.0&rect=35%2C70%2C4661%2C2894&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Donald Trump is no Winston Churchill and the coronavirus pandemic is not like a world war.</span> <span class="attribution"><span class="source">(AP Photo/Tim Ireland)</span></span></figcaption></figure><p>The collective effort to fight the coronavirus pandemic has been called the defining moment of the 21st century, or <a href="https://www.forbes.com/sites/kenrapoza/2020/04/01/battling-coronavirus-is-pushing-world-growth-to-zero-requiring-a-world-war-approach/#5b4016825007">this generation’s Second World War</a>. </p>
<p>There may be some truth to these analogies, but it’s premature — and even presumptuous — to put the present into a historic context.</p>
<p>Pandemics have always shaped human history. Starting in the year 541, <a href="https://www.pnas.org/content/116/51/25546">the Plague of Justinian</a> killed 50 million people — possibly half the world’s population — in just a few years. In the mid-14th century, <a href="https://www.livescience.com/what-was-the-black-death.html">the Black Death</a> claimed approximately 200 million lives with massive political, social and economic impacts.</p>
<p>Plagues resurfaced dozens of times over the next 300 years. Smallpox haunted Europe and Asia for centuries and <a href="https://www.cdc.gov/smallpox/history/history.html">then went with colonizers to the New World</a>, <a href="https://www.macleans.ca/news/canada/how-a-smallpox-epidemic-forged-modern-british-columbia/">wiping out Indigenous populations</a>. </p>
<p>Just over a century ago, influenza claimed between 50 and 100 million lives — roughly five per cent of the population — while the world fought the Great War. It’s debatable how much the pandemic affected the war, but there’s little doubt the war shaped the flu by putting millions in close proximity and providing the means for quick global transmission. </p>
<h2>Flu claimed as many as the Great War</h2>
<p>Just like today, Canada was not spared. About 55,000 Canadians died in the 1918-19 flu, nearly the same <a href="https://www.warmuseum.ca/firstworldwar/history/after-the-war/legacy/the-cost-of-canadas-war/">as the losses in what became known as the First World War</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=551&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=551&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345921/original/file-20200706-27824-15i802k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=551&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A burial scene in France during the First World War. The 1918 flu killed almost as many Canadians as were lost in the Great War.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/ (National Archives of Canada</span></span>
</figcaption>
</figure>
<p>Montréal and Toronto were particularly hard hit. Schools, businesses and public places closed. Debates raged about the efficacy of wearing masks. People practised social distancing, while physicians urged quarantine. Eaton’s and other stores <a href="https://earlycanadianhistory.ca/2020/03/23/killer-advertising-how-canadians-were-sold-the-1918-1919-influenza-pandemic/">advertised cure-alls</a>. When the worst passed, there were phased reopenings. A federal department of health was created. The economy rebounded.</p>
<p>We have learned many lessons from 1918 — about basic sanitation, quarantine, drugs, immunizations and more. But we still have much to learn. </p>
<p>COVID-19 has taken an enormous toll. With 12 million confirmed cases and more than 550,000 dead, it could remain a serious global threat for years, maybe decades.</p>
<p>Fears of a virulent “second wave” are acute, especially with the first wave still wreaking havoc. The economic costs might prove incalculable. Political and social instabilities are rising, <a href="https://www.thestatesman.com/opinion/covid-threat-imrans-regime-1502891466.html">even threatening some regimes</a>.</p>
<h2>A limited analogy</h2>
<p>But while the pandemic might seem like a “war,” there are serious limitations to the analogy.</p>
<p>Leaders invoke comparisons to bolster their images: <a href="https://www.bbc.com/news/av/world-us-canada-52915972/white-house-likens-trump-to-churchill-in-ww2">likening themselves to Winston Churchill</a> or Franklin D. Roosevelt, even if they don’t fully understand what either did in response to crisis.</p>
<p>Curiously, some have talked about COVID-19 having <a href="https://www.bloomberg.com/opinion/articles/2020-03-24/coronavirus-recession-it-will-be-a-lot-like-world-war-ii">the same impact on the economy as a world war</a> when in fact <a href="https://www.veterans.gc.ca/eng/remembrance/history/historical-sheets/industry">the Second World War required total production</a>, not the paring down to an essential economy that has happened during the coronavirus pandemic.</p>
<p>COVID-19 is also not bombing cities. It does not have a political ideology. It does not harbour <a href="https://www.cambridge.org/ca/academic/subjects/politics-international-relations/international-relations-and-international-organisations/irredentism-european-politics-argumentation-compromise-and-norms?format=HB&isbn=9780521895583">irredentist claims</a>, or seek to “right” historical “wrongs.” It is not exterminating millions in concentration camps.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345922/original/file-20200706-22-c3su36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Donald Trump has likened himself to a war-time president as his administration struggles with its response to the coronavirus pandemic. Here, Trump and First Lady Melania Trump visit the Second World War memorial in Washington last May to commemorate the 75th anniversary of Victory in Europe Day.</span>
<span class="attribution"><span class="source">(AP Photo/Evan Vucci)</span></span>
</figcaption>
</figure>
<p>Although disconcerting, business closures and social distancing are not akin to living under enemy occupation. Aside from front-line workers, most of us have endured inconveniences, not sacrifices. Soldiers are not dying in trenches or on the beaches. Ordering from Amazon and binge-watching Netflix cannot be compared to Stalingrad, Iwo Jima or <a href="https://www.iwm.org.uk/history/what-was-the-battle-of-verdun">Verdun</a>, let alone Auschwitz. </p>
<h2>Building unity</h2>
<p>Likening the pandemic to war, however, can convey a sense of urgency to those who don’t understand the consequences of inaction. It can push reluctant leaders to put public health ahead of politics. It can build a sense of collective responsibility and unity. As part of our collective memory and identity, wars can represent inspirational virtues. We might aspire to the fortitude of those who persevered through two world wars and the Great Depression.</p>
<p>But outright comparisons to the suffering and sacrifice of millions in vastly different contexts is disrespectful and doesn’t help the current fight against COVID-19. What we are living through now is important, but it’s not war. </p>
<p>It will be a long time before we might consider anything about COVID-19 history, but historical perspective can help us better understand this pandemic — and potentially better manage it. Understanding the magnitude of wars would help too.</p>
<p>German philosopher <a href="https://www.goodreads.com/quotes/12801-we-learn-from-history-that-we-do-not-learn-from">Friedrich Hegel famously said</a>: “We learn from history that we do not learn from history.” Thinking in historical terms might help us better understand ourselves: what we have endured and what we need to do, together, in future crises. In the case of this current crisis, let’s hope Hegel was wrong.</p><img src="https://counter.theconversation.com/content/140701/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arne Kislenko does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s always dangerous to put present-day events into historic perspectives. That’s especially true when political leaders have compared the coronavirus pandemic to a war effort.Arne Kislenko, Associate Professor of History, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1415732020-07-06T12:15:21Z2020-07-06T12:15:21ZWhat makes a ‘wave’ of disease? An epidemiologist explains<figure><img src="https://images.theconversation.com/files/345387/original/file-20200702-111353-1ssbj5o.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5247%2C3613&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Daily deaths from COVID-19 have rarely been below 600 in the U.S. since March.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-walks-past-a-memorial-dedicated-to-those-who-lost-their-news-photo/1215876863">Angela Weiss/AFP via Getty Images</a></span></figcaption></figure><p>Panic about a second wave of coronavirus cases is “<a href="https://www.wsj.com/articles/there-isnt-a-coronavirus-second-wave-11592327890">overblown</a>,” Vice President Mike Pence wrote in June, implying the U.S. has COVID-19 under control. On the other hand, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warns that the U.S. is still firmly <a href="https://www.wsj.com/articles/fauci-warns-of-coronavirus-resurgence-if-states-dont-adhere-to-safety-guidelines-11592338771">within a first wave of cases</a>.</p>
<p>As media broadcast information about daily increases in the number of cases, it’s hard not to wonder which way the country is headed. Have the weeks and months of lockdown really helped? What do the trends in diagnoses and deaths mean for the course of the pandemic? Is the U.S. stuck in a first wave? Through the worst of it? Headed for a second round? </p>
<p>Six months into the pandemic, people are looking for ways to make sense of what’s happening. Talking about waves of disease, with the implication of predictable rises and falls, is part of that. <a href="https://scholar.google.com/citations?user=RNembkwAAAAJ&hl=en&oi=ao">As an epidemiologist</a>, I know that disease waves aren’t scientifically defined. But looking to the history of previous epidemics and other countries’ current COVID-19 outbreaks can be useful.</p>
<p><iframe id="Aus4p" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Aus4p/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Characterizing a wave</h2>
<p>There’s no strict definition for what is or is not an epidemic wave or phase. A wave implies a rising number of sick individuals, a defined peak, and then a decline. The word “wave” implies a natural pattern of peaks and valleys; it hints that even during a lull, future outbreaks of disease are possible.</p>
<p>Historical outbreaks of infectious diseases offer some models for how the course of a disease like COVID-19 might unfold over time.</p>
<p>Some diseases come in somewhat predictable seasonal waves, with higher transmission rates at some times of the year than at others. Seasonal coronaviruses, <a href="https://www.cdc.gov/coronavirus/types.html">like 229E or HKU1</a>, which cause the common cold, have a high point from around December through March, according to <a href="https://doi.org/10.1093/infdis/jiaa161">research in the U.S.</a> <a href="https://doi.org/10.1371/journal.pone.0201497">and elsewhere</a>.</p>
<p>Several factors influence whether a particular disease is seasonal in nature. Some pathogens may spread less well <a href="https://doi.org/10.1007/s10453-007-9068-9">with greater humidity</a>. Annual epidemics, like of <a href="https://doi.org/10.1111/j.1752-8062.2010.00257.x">influenza</a> may occur because of climate or patterns of social mixing – often driven by the school year or people staying inside more during the winter.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p>It’s possible that SARS-CoV-2, the coronavirus that causes COVID-19, <a href="https://doi.org/10.1001/jamanetworkopen.2020.11834">spreads more efficiently</a> under certain weather conditions. But recent outbreaks in Florida, Arizona, Texas and Southern California suggest that warm or humid weather is <a href="https://theconversation.com/coronavirus-may-wane-this-summer-but-dont-count-on-any-seasonal-variation-to-end-the-pandemic-136218">not sufficient to stop the spread of the disease</a>. Some scientists <a href="https://doi.org/10.1126/science.abb5793">model that SARS-CoV-2 will eventually become seasonal</a> like other coronaviruses.</p>
<p>Waves and seasonal dynamics are also affected by levels of immunity in the human population. As more individuals become immune to a pathogen, its spread slows and eventually stops as the virus runs out of new people to infect. The U.S. is nowhere near <a href="https://theconversation.com/herd-immunity-wont-solve-our-covid-19-problem-139724">what epidemiologists call herd immunity</a> in the general population, however; mathematical modelers suggest at least <a href="https://science.sciencemag.org/content/early/2020/06/22/science.abc6810">between 43% and 60%</a> of people would need to be immune to SARS-CoV-2 for that to be the case. </p>
<h2>Ebb and flow, 150 years of influenza waves</h2>
<p>Some of the current talk of coronavirus waves likely stems from comparisons with past epidemics that did show these peaks and troughs of infections.</p>
<p>University of Oxford scholars of evidence-based medicine Tom Jefferson and Carl Heneghan have <a href="https://www.cebm.net/covid-19/covid-19-epidemic-waves/">summarized past waves in respiratory virus pandemics</a> over the previous 150 years. For example, the 1889-92 influenza outbreak had three distinct waves, which <a href="https://doi.org/10.1016/j.vaccine.2011.03.063">differed in their virulence</a>. The second wave was much more severe, particularly in younger adults.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=294&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=294&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=294&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=370&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=370&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=370&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Three waves of death: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919. The waves were broadly the same globally during the pandemic.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.3201/eid1201.050979">Taubenberger JK, Morens DM. 1918 Influenza: the Mother of All Pandemics. Emerg Infect Dis. 2006;12(1):15-22.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The current COVID-19 pandemic is often compared to the 1918 H1N1 influenza pandemic, which had <a href="https://doi.org/10.3201/eid1201.050979">three distinct waves</a> over the course of a year. The proportion of influenza patients who were severely ill or died was much higher in the last two waves compared to the first. It’s unclear whether being infected earlier on protected individuals during later waves.</p>
<p>More recently, the 2009 H1N1 influenza pandemic, though mild, had two distinct waves; this virus still commonly shows up in seasonal influenza outbreaks. A study of H1N1 influenza in 2009-2010 found that the second wave <a href="https://doi.org/10.1503/cmaj.100746">affected more older people</a>, with underlying conditions.</p>
<p>Insight from the past suggests that discrete waves result as a disease spreads into and out of a population. Different waves can have different features, too, regarding factors like disease severity or which populations are most affected.</p>
<h2>What’s happening now in the US</h2>
<p>SARS-CoV-2 infections in the U.S. are on the rise. Some of this increase may be <a href="https://twitter.com/realDonaldTrump/status/1275381670561095682">driven by more widespread testing</a> now. But the <a href="https://coronavirus.jhu.edu/data/new-cases-50-states">increases felt in many large states</a> – Texas, California, Florida – are a result of more community transmission.</p>
<p>Currently, even with an increase in the number of cases in many parts of the U.S., there has not been a corresponding increase <a href="https://coronavirus.jhu.edu/data/state-timeline/new-deaths/texas/0">in the number of deaths</a>.</p>
<p><iframe id="20tXh" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/20tXh/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The story from Iran <a href="https://twitter.com/florian_krammer/status/1276326535901970432">may offer</a> a cautionary note. From a peak of over 3,000 cases confirmed per day in early April, it declined to less than 1,000 by May, from which it has climbed <a href="https://coronavirus.jhu.edu/data/new-cases">to hover</a> around 2,500 daily confirmed cases as of the end of June. The <a href="https://www.worldometers.info/coronavirus/country/iran/">rise in the number of deaths</a> did not occur until the second half of June. This is likely due to the time lag between when someone is infected and when they die.</p>
<p>Accordingly, U.S. states currently experiencing an uptick in COVID-19 confirmed cases could see a notable increase in deaths within a few weeks. The average age of those infected is getting younger, though, complicating predictions about a death toll.</p>
<p><iframe id="v4Oss" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/v4Oss/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The U.S. is not yet in a second wave and increasingly it looks like the country may not see one. Instead, the U.S. may sustain a constant first wave that just continues to crest. The political willpower necessary to limit transmission through robust, ongoing lockdown measures seems, unfortunately, to have been snuffed out.</p>
<p>But arguing about whether the U.S. is in a second wave, the first wave, or wave 1.5 ultimately doesn’t matter. Whichever it is, the commonsense actions everyone can currently take to limit the spread of infection remain the same: Staying home when possible, wearing a mask and socially distancing when out, and frequently washing hands will help speed our way beyond this pandemic, regardless of what wave we’re in.</p><img src="https://counter.theconversation.com/content/141573/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abram Wagner receives funding from the NIAID and the NSF. </span></em></p>There’s no scientific definition for a wave of disease – and no evidence that the original onslaught of coronavirus in the US has receded much at all.Abram L. Wagner, Research Assistant Professor of Epidemiology, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1405192020-07-06T12:13:43Z2020-07-06T12:13:43ZLessons from the 1918 pandemic: A U.S. city’s past may hold clues<figure><img src="https://images.theconversation.com/files/342022/original/file-20200616-23276-1gja8tr.jpg?ixlib=rb-1.1.0&rect=184%2C109%2C3484%2C4267&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A list of rules from the U.S. Public Health Service in 1918 to reduce the chances of contracting or spreading the devastating flu pandemic. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/rules-to-reduce-the-spread-of-spanish-flu-posting-by-the-us-news-photo/699913383?adppopup=true">Getty Images / Fototeca Storica Nazionale</a></span></figcaption></figure><p>Coronavirus infection rates continue <a href="https://coronavirus.jhu.edu/us-map">to rise</a>, with the number of new cases climbing in <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html#states">dozens of states</a> and the U.S. reporting <a href="https://www.nytimes.com/2020/07/01/world/coronavirus-updates.html">record numbers of cases on individual days</a>. Hospitalization across the U.S. has dramatically jumped; some cities are <a href="https://www.cnn.com/2020/07/02/health/coronavirus-hospitalizations-rates-rise/index.html">seeing surges</a> that threaten to <a href="https://www.cbsnews.com/video/overwhelmed-houston-hospitals-transfer-coronavirus-patients-to-other-cities-as-cases-spike/">overwhelm</a> their health care systems. </p>
<p>Meanwhile, the demonstrations over the police killing of George Floyd brought tens of thousands into the streets, congregating shoulder-to-shoulder. Many are the victims of tear gassing by police, potentially increasing the risk of transmission and infection. The latest models indicate COVID-19’s U.S. death toll could <a href="http://www.healthdata.org/covid/updates">reach 170,000 by October</a>. A second wave this fall – or the continuation of an unabated first wave – could make that number even higher. </p>
<p>But these are not unprecedented times. </p>
<p>As a <a href="http://chm.med.umich.edu/about/j-alexander-navarro-phd/">historian of medicine</a> at the University of Michigan, I am a student of the 1918 influenza pandemic. It remains the deadliest public health event in recorded history. There are lessons to be learned from what happened a century ago. True, there are differences between then and now. Then we were a nation at war, with an economy led by manufacturing and a male-dominated workforce. We had far less medical and scientific knowledge. And it was an entirely different virus. But striking similarities exist between how we reacted to the pandemic in 1918, and how we’re responding now.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342026/original/file-20200616-23231-1vfuz7v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the U.S., 675,000 died from the 1918 influenza pandemic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/red-cross-house-at-u-s-general-hospital-during-influenza-news-photo/1223011438?adppopup=true">Getty Images / Universal History Archive</a></span>
</figcaption>
</figure>
<h2>Lessons from the last century</h2>
<p>The city of Denver, Colorado, is perhaps the most relevant case study. As the epidemic skyrocketed, officials ordered the immediate closure of schools, churches, and places of public amusement. Indoor public gatherings were banned. Such action, it was argued, would save lives and money.</p>
<p>The business community agreed. <a href="https://quod.lib.umich.edu/f/flu/6200flu.0004.026/1/--denver-closes-churches-and-theaters?rgn=full+text;view=image;q1=Denver+Closes+Churches+and+Theaters">One theater owner put it this way:</a> “I shall sacrifice gladly all that I have and hope to have, if by so doing I can be the means of saving one life.” </p>
<p>That noble sense of civic duty quickly faded as townspeople took to congregating outdoors. They met in the busy downtown shopping district and at outdoor church services and lodge meetings. Business owners and those thrown out of work by the closure orders decried these gatherings; they were bearing the brunt of the closures, they said, while the public shirked its duty. Denver’s health officer, calling out the <a href="https://www.influenzaarchive.org/cities/city-denver.html#">“criminal neglect”</a> of those at the open-air assemblies, added outdoor gatherings to the prohibitions. </p>
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<p>Within just two weeks of the closures, residents grew restless. As records of new cases leveled off, many demanded an end to both the closure order and gathering ban. Giving in to the pressure, the mayor and health officer announced the measures would be lifted on Nov. 11, 1918. That day – in a horrible twist of fate – turned out to be Armistice Day. Thousands thronged the streets, hotels, theaters, and auditoriums of Denver to celebrate both the end of World War I and the pandemic. But only one of them was truly over. </p>
<p>Health authorities realized a new surge of influenza deaths were likely but acknowledged there was little they could do. “There is no use trying to lay down any rules regarding the peace celebration,” <a href="https://quod.lib.umich.edu/f/flu/7900flu.0004.097/1/--big-increase-in-flu-feared-as-result-of-packed-city-streets?rgn=full+text;view=image;q1=Big+Increase+in+Flu+Feared+as+Result+of+Packed+City+Streets">said one official</a>, “as the lid is off entirely.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342301/original/file-20200616-23261-1sr22px.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients with the Spanish flu at a barracks hospital in Fort Collins, Colorado, 1918.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/view-of-victims-of-the-spanish-flu-cases-as-they-lie-in-news-photo/906330984?adppopup=true">Getty Images / Photo Quest</a></span>
</figcaption>
</figure>
<h2>The next wave hits</h2>
<p>The surge came hard and fast. Within a week, physicians reported hundreds of new cases and dozens of deaths per day. Officials responded with another set of closure orders and gathering bans. Theaters, bowling alleys, pool halls, and other places of public amusement were shut down. Affected business owners, complaining they were singled-out, formed an “amusement council,” and demanded the city close all places of congregation or issue a mask order. City officials acceded. They put a mask order in place.</p>
<p>Enforcement was an issue. Residents routinely refused to wear masks even when threatened with arrest and hefty fines. The mayor soon realized the futility of the order. “Why, it would take half the population to make the other half wear masks,” <a href="https://quod.lib.umich.edu/f/flu/0210flu.0004.120/1/--police-will-enforce-flu-masking-order?rgn=full+text;view=image;q1=Police+Will+Enforce+Flu+Masking+Order">he said</a>. “You can’t arrest all the people, can you?” Officials then backed off again: they would recommend mask use, not require it.</p>
<p>Except for streetcar conductors. They still had to wear them, said the city. Bristled at being singled out, the conductors threatened to strike. A walkout was averted when city officials again watered down the order. Conductors only had to wear them during rush hour commutes. The new provisions were all but useless, and a few days later the mask rule was abolished. </p>
<p>Denver’s epidemic continued for several months. It was unchecked by any public health orders, save for isolation and quarantine for those with the illness. The result: a second spike of deaths higher than the first, and one of the <a href="https://jamanetwork.com/journals/jama/fullarticle/208354">nation’s largest per capita death tolls</a>.</p>
<h2>History could repeat itself</h2>
<p>Surely at least some of this sounds familiar. If Denver’s story tells us anything, it is that we must do better than in 1918. All of us must continue to combat COVID-19 with face masks and social distancing in public. <a href="https://royalsocietypublishing.org/doi/10.1098/rspa.2020.0376">Recent studies</a> show <a href="https://www.pnas.org/content/early/2020/06/10/2009637117">face masks</a>, along with hand sanitation and social distancing by a majority of the population, can quickly bring this pandemic under control. </p>
<p>Those levels of compliance, however, might become increasingly difficult. In 2020, we are bristling much the same way they did in 1918. A century ago, masks were widely despised; many today feel the same way. Yet if we don’t take these measures seriously, we will likely face a resurgence of the virus.</p>
<p>If the past offers us any perspective into the future, it is this: returning to the sweeping closures and stay-at-home orders that we’re emerging from may be difficult. It proved all but impossible to do so a century ago. It very well may prove impossible today.</p><img src="https://counter.theconversation.com/content/140519/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Alexander Navarro receives funding from The US Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the National Endowment for the Humanities. </span></em></p>How politicians and the public in Denver, Colorado handled the 1918 flu epidemic is relevant to today.J. Alexander Navarro, Professor of History of Medicine, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1410322020-06-30T12:19:30Z2020-06-30T12:19:30ZThe US isn’t in a second wave of coronavirus – the first wave never ended<figure><img src="https://images.theconversation.com/files/344629/original/file-20200629-155345-y2nrtn.jpg?ixlib=rb-1.1.0&rect=5%2C44%2C3482%2C2439&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The U.S. as a whole is facing a huge surge in coronavirus cases, but the differences between states like New York and Florida are striking.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/man-wears-a-face-mask-as-he-check-his-phone-in-times-square-news-photo/1207979953?adppopup=true">Kena Betancur/1207979953 via Getty Images</a></span></figcaption></figure><p>After sustained declines in the number of COVID-19 cases over recent months, restrictions are starting to <a href="https://nymag.com/intelligencer/2020/06/failed-us-reopening-serves-up-a-feast-for-the-coronavirus.html">ease across the United States</a>. Numbers of new cases are falling or stable at low numbers in some states, but they <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html">are surging in many others</a>. Overall, the U.S. is experiencing a sharp increase in the number of new cases a day, and by late June, had surpassed the peak rate of spread in early April. </p>
<p>When seeing these increasing case numbers, it is reasonable to wonder if this is the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30845-X/fulltext">dreaded second wave of the coronavirus</a> – a resurgence of rising infections after a reduction in cases.</p>
<p>The U.S. as a whole is not in a second wave because the first wave never really stopped. The virus is simply spreading into new populations or resurging in places that let down their guard too soon.</p>
<p><iframe id="D0knc" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/D0knc/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>To have a second wave, the first wave needs to end</h2>
<p>A wave of an infection describes a large rise and fall in the number of cases. There isn’t a precise epidemiological definition of when a wave begins or ends. </p>
<p>But with talk of a <a href="https://www.theguardian.com/world/2020/jun/27/new-covid-19-clusters-across-world-spark-fear-of-second-wave">second wave in the news</a>, as an <a href="https://www.american.edu/cas/faculty/mhawkins.cfm">epidemiologist and public health researcher</a>, I think there are two necessary factors that must be met before we can colloquially declare a second wave. </p>
<p>First, the virus would have to be controlled and transmission brought down to a very low level. That would be the end of the first wave. Then, the virus would need to reappear and result in a large increase in cases and hospitalizations. </p>
<p>Many countries in <a href="https://doi.org/10.1038/s41562-020-0908-8">Europe and Asia have successfully ended the first wave</a>. <a href="https://www.theguardian.com/world/2020/jun/08/new-zealand-abandons-covid-19-restrictions-after-nation-declared-no-cases">New Zealand</a> and <a href="https://www.newyorker.com/magazine/2020/06/08/how-iceland-beat-the-coronavirus">Iceland</a> have also made it through their first waves and are now essentially coronavirus-free, with very low levels of community transmission and only a handful of active cases currently. </p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p>
<p>In the U.S., cases spiked in March and April and then trended downward due to social distancing guidance and implementation. However, the U.S. never reduced spread to low numbers that were sustained over time. Through May and early June, numbers plateaued at <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html">approximately 25,000 new cases daily</a>.</p>
<p>We have left that plateau. Since mid-June, cases have been surging upwards. Additionally, the percentage of COVID-19 tests that are returning positive <a href="https://coronavirus.jhu.edu/testing/individual-states/arizona">is climbing steeply</a>, indicating that the increase in new cases is not simply a result of more testing, but the result of an increase in spread. </p>
<p>As of writing this, new deaths per day <a href="https://www.nbcnews.com/health/health-news/coronavirus-deaths-united-states-each-day-2020-n1177936">have not begun to climb</a>, but some hospitals’ intensive care units have <a href="https://www.newsweek.com/texass-largest-hospital-reaches-100-percent-icu-capacity-1513481">recently reached full capacity</a>. In the beginning of the outbreak, deaths often lagged behind confirmed infections. It is likely, as Anthony Fauci, the nation’s top infectious-disease specialist said on June 22, that <a href="https://www.washingtonpost.com/health/coronavirus-deaths-lag-behind-surging-infections-but-may-catch-up-soon/2020/06/24/22263b50-b620-11ea-a510-55bf26485c93_story.html">deaths will soon follow the surge in new cases</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344632/original/file-20200629-155303-f53zoh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">After months of strict social distancing rules, New York has reduced its new cases to a fraction of what they were in April and is still being cautious.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/NYC-enters-Phase-2-Reopening-6-26-20/0d49884b9787416b92c0e5607d154fa4/128/0">John Nacion/STAR MAX/IPx 2020/AP Images</a></span>
</figcaption>
</figure>
<h2>Different states, different trends</h2>
<p>Looking at U.S. numbers as a whole hides what is really going on. Different states are in <a href="https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html">vastly different situations right now</a> and when you look at states individually, four major categories emerge.</p>
<ol>
<li><p>Places where the first wave is ending: States in the Northeast and a few scattered elsewhere experienced large initial spikes but were able to mostly contain the virus and substantially brought down new infections. <a href="https://www.nytimes.com/interactive/2020/us/new-york-coronavirus-cases.html">New York</a> is a good example of this. </p></li>
<li><p>Places still in the first wave: Several states in the South and West – see <a href="https://www.nytimes.com/interactive/2020/us/texas-coronavirus-cases.html">Texas</a> and <a href="https://www.nytimes.com/interactive/2020/us/california-coronavirus-cases.html">California</a> – had some cases early on, but are now seeing massive surges with no sign of slowing down. </p></li>
<li><p>Places in between: Many states were hit early in the first wave, managed to slow it down, but are either at a plateau – like <a href="https://www.nytimes.com/interactive/2020/us/north-dakota-coronavirus-cases.html">North Dakota</a> – or are now seeing steep increases – like <a href="https://www.nytimes.com/interactive/2020/us/oklahoma-coronavirus-cases.html">Oklahoma</a>.</p></li>
<li><p>Places experiencing local second waves: Looking only at a state level, <a href="https://www.nytimes.com/interactive/2020/us/hawaii-coronavirus-cases.html">Hawaii</a>, <a href="https://www.nytimes.com/interactive/2020/us/montana-coronavirus-cases.html">Montana</a> and <a href="https://www.nytimes.com/interactive/2020/us/alaska-coronavirus-cases.html">Alaska</a> could be said to be experiencing second waves. Each state experienced relatively small initial outbreaks and was able to reduce spread to single digits of daily new confirmed cases, but are now all seeing spikes again.</p></li>
</ol>
<p>The trends aren’t surprising based on how states have been dealing with reopening. The virus will go wherever there are susceptible people and until the U.S. stops community spread across the entire country, the first wave isn’t over. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/344634/original/file-20200629-155330-davgh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The 1918 flu came back with a vengeance after a mutation and lack of preparedness set the stage for tens of millions of deaths during the second wave.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/image-shows-warehouses-that-were-converted-to-keep-the-news-photo/520830329?adppopup=true">Universal History Archive/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>What could a second wave look like?</h2>
<p>It is possible – though at this point it seems unlikely – that the U.S. could control the virus before a vaccine is developed. If that happens, it would be time to start thinking about a second wave. The question of what it might look like depends in large part on everyone’s actions. </p>
<p>The <a href="https://dx.doi.org/10.1086%2F592454">1918 flu pandemic</a> was characterized by a mild first wave in the winter of 1917-1918 that went away in summer. After restrictions were lifted, people very quickly went back to pre-pandemic life. But a second, deadlier strain came back in fall of 1918 and third in spring of 1919. In total, <a href="https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm">more than 500 million people were infected</a> worldwide and upwards of <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">50 million died</a> over the course of three waves.</p>
<p>It was the combination of a quick return to normal life and a mutation in the flu’s genome that made it more deadly that led to the horrific second and third waves.</p>
<p>Thankfully, the coronavirus appears to be much more <a href="https://doi.org/10.1016/j.meegid.2020.104351">genetically stable</a> than the influenza virus, and thus less likely to mutate into a more deadly variant. That leaves human behavior as the main risk factor. </p>
<p>Until a <a href="https://theconversation.com/what-needs-to-go-right-to-get-a-coronavirus-vaccine-in-12-18-months-136816">vaccine or effective treatment is developed</a>, the tried-and-true public health measures of the last months – <a href="https://theconversation.com/this-simple-model-shows-the-importance-of-wearing-masks-and-social-distancing-140423">social distancing,</a> <a href="https://theconversation.com/masks-help-stop-the-spread-of-coronavirus-the-science-is-simple-and-im-one-of-100-experts-urging-governors-to-require-public-mask-wearing-138507">universal mask wearing</a>, frequent hand-washing and avoiding crowded indoor spaces – are the ways to stop the first wave and thwart a second one. And when there are surges like what is happening now in the U.S., further reopening plans need to be put on hold.</p><img src="https://counter.theconversation.com/content/141032/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Hawkins receives funding from USDA. </span></em></p>The recent spike in new coronavirus cases in the US is not due to a second wave, but simply the virus moving into new populations or surging in places that opened up too soon.Melissa Hawkins, Professor of Public Health, Director of Public Health Scholars Program, American UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1405122020-06-28T06:00:28Z2020-06-28T06:00:28ZHistory’s crystal ball: What the past can tell us about COVID-19 and our future<figure><img src="https://images.theconversation.com/files/341599/original/file-20200613-153812-ecogag.jpg?ixlib=rb-1.1.0&rect=15%2C170%2C1268%2C1334&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A Cholera Patient, Random Shots No. 2. Cartoon by British satirist Robert Cruikshank, circa 1832.</span> <span class="attribution"><a class="source" href="https://wellcomecollection.org/works/rxhb8pnf/items?canvas=1">(Wellcome Library)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>During this pandemic, historians have been consulted like the Oracle of Delphi. Is COVID-19 like the Black Death? The 1918 flu? What <a href="https://www.youtube.com/watch?v=67PCp1IP2MY">lessons of history</a> can be applied to today? </p>
<p>But can history show us what we want to know? </p>
<p>In some ways, yes. In others, <a href="https://doi.org/10.1016/S0140-6736(20)30468-2">no</a>. And we need to broaden what we ask. </p>
<p>As a <a href="https://medhumanities.mcmaster.ca">historian of medicine</a>, North Africa and France, I find we are using some lessons but ignoring others. Pandemic histories are useful, but how they connect with race, public health, revolution, labour, gender and colonial histories will help us explain the present and predict the future. </p>
<h2>Lessons learned: COVID-19 responses using pandemic history</h2>
<p>Some history lessons have been put to use right away, like social distancing. </p>
<p>At University of Michigan, Dr. <a href="http://doi.org/10.1001/jama.298.6.644">Howard Markel</a> compared <a href="https://www.influenzaarchive.org/">cities in the United States</a> during the 1918-19 flu pandemic and showed the U.S. Centers for Disease Control and Prevention how early, strict social distancing measures worked to slow infection rates. Countries around the world now use his concept, “<a href="https://historynewsnetwork.org/article/174690">flattening the curve</a>.” </p>
<p>Not bad for the history of medicine, a field the <a href="https://doi.org/10.1016/S0140-6736(14)61050-3"><em>Lancet</em> declared “moribund” in 2014</a>.</p>
<h2>Lessons ignored: Poverty and racism make you sick and dead</h2>
<p>Other pandemic lessons have been ignored, and they tragically unfold anew. </p>
<p>The poor, the vulnerable and workers die in greater numbers. Social reformer <a href="https://www.jstor.org/stable/45130826">Dr. Rudolph Virchow wrote in 1848</a>: </p>
<blockquote>
<p>“Medical statistics will be our standard of measurement; we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.” </p>
</blockquote>
<p>Poor neighbourhoods have the highest death tolls. <a href="https://www.esri.com/news/arcuser/0311/visualizing-disease.html">Reformers’ maps</a> from the 1800s demonstrated this in the United Kingdom (<a href="https://navigator.health.org.uk/content/edwin-chadwicks-report-sanitary-conditions-labouring-population-great-britain-was-published">Edwin Chadwick, 1834</a>) and <a href="https://doi.org/10.1136/jech.2009.087957">France</a> (<a href="http://classiques.uqac.ca/classiques/villerme_louis_rene/tableau_etat_physique_moral/tableau_etat_physique_intro_tyl.html">Réné Villermé, 1832</a>). The same pattern has emerged in 2020 in New York (the <a href="https://www.washingtonpost.com/national/bronx-new-york-yankee-stadium-coronavirus/2020/04/21/3b38b460-8182-11ea-a3ee-13e1ae0a3571_story.html?fbclid=IwAR21ozAr9Tmgr0ggGqMqil-npVQb2eXpoBQwp8cEgeFMXM_wLAooWP_Nl5I">Bronx</a>) and Montréal (<a href="https://www.cbc.ca/news/canada/montreal/montreal-discrimination-covid-19-rich-poor-1.5551622">North Montréal</a>). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342838/original/file-20200618-41200-1y9dce2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Chadwick’s sanitary map of the town of Leeds, showing highest death rates from cholera in the poorest districts. Published in Chadwick’s 1834 <em>Report on the Sanitary Conditions of the Labouring Population of Great Britain</em>.</span>
<span class="attribution"><span class="source">(Wellcome Collection)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>A pandemic is not the great equalizer, contrary to Madonna’s “<a href="https://www.youtube.com/watch?v=5UYU4Slh34I">Reflections from the Bathtub</a>.” </p>
<p>Inequality of income, housing, work and opportunity are the inequities that made death “<a href="https://doi.org/10.1017/S0025727300035390">a social disease</a>” for social reformers Chadwick, Villermé and Virchow. We now call these factors the “<a href="https://doi.org/10.1016/S2213-2600(20)30234-4">social determinants of health</a>.” </p>
<p>That is why <a href="https://montreal.ctvnews.ca/systemic-racism-in-canada-reflected-in-health-income-and-other-indicators-1.4981632">structural racism</a> can be a death sentence. Data show that pandemics have disproportionately affected <a href="https://www.vox.com/coronavirus-covid19/2020/4/18/21226225/coronavirus-black-cdc-infection">African Americans</a> and <a href="https://indiancountrytoday.com/news/a-lethal-epidemic-that-decimated-and-annihilated-indigenous-people-S0N6A0miSU-njrNO8qDmGA">Indigenous Peoples</a>. Virchow demanded social justice as the solution: full employment, higher wages and universal education. </p>
<p>Policy-makers had months to protect vulnerable populations from COVID-19. Why didn’t they? </p>
<p>History explains that too.</p>
<h2>Cholera: Change happens when people rise up</h2>
<p>If history shows one thing, it’s that rich people and politicians do not want to pay for sewers, schools, hospitals, old age pensions or worker safety. The deaths of the poor themselves did not move politicians in France, Germany or Britain to big policy changes.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=817&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=817&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=817&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1027&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1027&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341602/original/file-20200613-153808-nvp98e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1027&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A visit by French authorities to the cholera hospital, 1884.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/u35gkmj5">(Wellcome Collection)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Like the 19th-century economist <a href="http://www.esp.org/books/malthus/population/malthus.pdf">Thomas Malthus</a>, some elites even argued that such deaths are “natural,” or in Texas recently, <a href="https://www.vanityfair.com/news/2020/03/dan-patrick-coronavirus-grandparents">beneficial to society</a>.</p>
<p>So how does change come? </p>
<p>Change came because people rose up in a series of <a href="https://www.theguardian.com/world/from-the-archive-blog/2018/may/18/1848-year-of-revolution-archive">political revolutions across Europe in 1848</a>. Workers rose in massive strikes and revolutionary action. The fear of Marxist revolution brought <a href="https://www.smithsonianmag.com/history/bismarck-tried-end-socialisms-grip-offering-government-healthcare-180964064/">health care and the welfare state to the people in Bismarck’s Germany</a>.</p>
<p>And <a href="https://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504">cholera pandemic</a> also showed elites their vulnerability. If enough people are sick, if the air and water are contaminated, even rich people can die. Today you can tour the <a href="https://lithub.com/on-and-in-the-sewers-and-sewage-that-transformed-paris/">magnificent sewers of Paris</a> and drink filtered water in <a href="https://www.newstatesman.com/science-tech/coronavirus/2020/04/how-coronavirus-crisis-echoes-europe-s-19th-century-cholera">Hamburg</a>, because the rich realized they can get sick too.</p>
<p><a href="https://pagesix.com/2020/03/22/madonna-calls-coronavirus-the-great-equalizer-in-bizarre-bathtub-video/">Madonna was right on that one</a>.</p>
<h2>Health and rights are inseparable</h2>
<p>If enough people get sick and hungry and angry, there will be revolution. </p>
<p>We <a href="https://www.independent.co.uk/news/world/europe/bastille-day-2016-what-is-it-when-france-national-holiday-parade-say-in-french-a7136431.html">wave flags for France on July 14</a>, the anniversary of the storming of the Bastille in 1789 that launched the French revolution. But the day before, “<a href="http://doi.org/10.2307/202442">bread riots</a>” broke out and people carried food away. The combination of tyranny and physical suffering started the revolution.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=491&fit=crop&dpr=1 600w, https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=491&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=491&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=617&fit=crop&dpr=1 754w, https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=617&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/342639/original/file-20200618-41213-11g3y8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=617&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘A part of the armed populace went to the convent of St. Lazarus to demand subsistence. Having been refused, they forced the gates, committed excesses, liberated all prisoners and carried away in triumph a great quantity of flour’ on July 13, 1789.</span>
<span class="attribution"><a class="source" href="https://www.parismuseescollections.paris.fr/fr/musee-carnavalet/oeuvres/pillage-par-les-brigands-de-la-prison-de-saint-lazare-le-13-juillet-1789-3#infos-principales">(Collections des musées de la Ville de Paris)</a></span>
</figcaption>
</figure>
<p>Health and human rights are inseparably tied together. A government that does not allow its citizens to survive, to eat, to breathe, to live, is illegitimate. By what right does it rule? The current protests in the U.S. demanding recognition of African American lives illustrates this <a href="https://www.juancole.com/2020/06/george-killing-american.html">fundamental nature of politics</a>. </p>
<p>A contemporary example of revolution to demand health and rights was the Arab Spring in 2011. A young man, <a href="https://www.aljazeera.com/news/2015/12/mohamed-bouazizi-arab-spring-worth-dying-151228093743375.html">Mohamed Bouazizi</a>, lit himself on fire and his fellow citizens saw themselves in his suffering: I also cannot eat, work, have shelter or raise a family in this country. Tunisia toppled its president and <a href="https://www.aljazeera.com/news/africa/2014/01/tunisia-assembly-approves-new-constitution-201412622480531861.html">wrote a new constitution</a>. </p>
<p>Authoritarianism is <a href="https://www.nytimes.com/2020/06/13/world/coronavirus-updates.html">bad for health</a>, because public health relies on good governance.</p>
<p>Democracy is good for health. In 1794, French revolutionaries created the first public health system, for the “<a href="https://jhupbooks.press.jhu.edu/title/citizen-patient-revolutionary-and-imperial-paris">citizen-as-patient</a>.”</p>
<h2>Lessons from COVID-19 to global health history</h2>
<p>COVID-19 is also teaching history new lessons.</p>
<p>For one, pandemics were widely considered a thing of the past. </p>
<p>The “developed” world expected that modern sanitation and medicine would eliminate infectious disease as a primary cause of death, known also as the “<a href="https://apps.who.int/iris/handle/10665/58102">epidemiologic transition thesis</a>.” </p>
<p>But “re-emerging infectious diseases” challenge this story. They are produced by modern economic and social practices.</p>
<p><a href="https://www.facebook.com/watch/?v=276202313546512">Environmental destruction</a> opens pathways for viruses to jump from animals to humans; COVID-19, SARS, AIDS, H1N1 and the 1918 flu are all such “zoonotic” diseases. </p>
<p><a href="https://www.ucpress.edu/book/9780520229136/infections-and-inequalities">Modern injustices</a> like <a href="https://theconversation.com/coronavirus-canada-stigmatizes-jeopardizes-essential-migrant-workers-138879">labour exploitation</a>, <a href="https://www.cbc.ca/news/canada/montreal/quebec-inmate-dies-covid-19-1.5577736">inhumane incarceration</a> and overcrowded <a href="https://www.macleans.ca/news/the-struggle-to-stay-safe-from-covid-19-in-a-refugee-camp/">refugee camps</a> directly contribute to disease spread by creating unsafe living and working conditions.</p>
<p>COVID-19 is helping societies <a href="https://nypost.com/2020/06/07/british-protesters-topple-125-year-old-statue-of-slave-trader/">rethink</a> their <a href="https://www.bbc.com/news/world-europe-53017188">histories</a>, and how we should write <a href="https://www.theguardian.com/commentisfree/2020/jun/01/george-floyd-protests-cornel-west-american-democracy">history itself</a>.</p><img src="https://counter.theconversation.com/content/140512/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ellen J Amster does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pandemic histories are useful for understanding COVID-19, but how they connect with race, public health, revolution, labour and colonialism are needed to explain the present and predict the future.Ellen J Amster, Associate Professor, Hannah Chair in the History of Medicine, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1399512020-06-19T12:08:03Z2020-06-19T12:08:03Z5 ways the world is better off dealing with a pandemic now than in 1918<figure><img src="https://images.theconversation.com/files/340708/original/file-20200609-21219-1akjwt.jpg?ixlib=rb-1.1.0&rect=21%2C359%2C4794%2C3227&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Emergency hospital during influenza epidemic at Camp Funston in Kansas around 1918. </span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Emergency_hospital_during_Influenza_epidemic,_Camp_Funston,_Kansas_-_NCP_1603.jpg">National Museum of Health and Medicine</a></span></figcaption></figure><p>Near the end of the First World War, a deadly flu raced across the globe. The influenza pandemic became the most severe pandemic in recent history, infecting about one-third of the world’s population between 1918 and 1920 and killing between <a href="https://pubmed.ncbi.nlm.nih.gov/11875246/">50 and 100 million people</a>. It was caused by an <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">H1N1 virus</a> that originated in birds and mutated to infect humans. </p>
<p>Now a century later the world is amidst another global pandemic caused by a zoonotic disease that “jumped” from wildlife to people, a novel coronavirus known as SARS-CoV-2. While we do not want in any way to diminish the hundreds of thousands of personal tragedies caused by this virus, we see reasons to be optimistic. If managed competently, this fight may turn out differently, resulting in lower rates of infection and mortality and, possibly, fewer deaths. </p>
<p>We are part of a team of social scientists that span the fields of epidemiology, geography, history, urban planning and Asian studies who have studied how the influenza pandemic played out in Asia, an understudied region where the largest number of people died. There have been vast advancements in communications, science and medicine over the past 100 years, which may create a better outcome in today’s pandemic. </p>
<h2>Communication</h2>
<p>A hundred years of innovation in communication has dramatically changed our ability to quickly exchange vital data. Back in 1918, <a href="https://doi.org/10.1016/0308-5961(93)90050-D">early phone lines</a> were still being laid, and in many places the <a href="https://www.history.com/topics/inventions/telegraph">telegraph</a> was the only way to communicate. Public information came mainly from daily newspapers or was spread by word of mouth. It was difficult to share information about the new disease, its most common symptoms and the populations at greatest risk – or alert people about what was coming their way. There were no coordinated <a href="https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html#learning">pandemic response plans</a> in place.</p>
<p>By contrast, the world has been able to <a href="https://coronavirus.jhu.edu/map.html">track this epidemic</a> in real time, and scientists have quickly identified those <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html">most at risk</a> of adverse outcomes: seniors and those with compromised immunity or preexisting conditions such as asthma, diabetes, lung disease or serious heart conditions. Armed with knowledge, <a href="https://theconversation.com/how-leadership-in-various-countries-has-affected-covid-19-response-effectiveness-138692">countries that tested extensively, implemented effective contact tracing and enacted strong national lockdown</a> and social distancing policies have “flattened the curve” of infections and deaths. </p>
<p>Rapid dissemination of research on this novel virus has alerted doctors to serious symptoms, including its ability to trigger <a href="https://doi.org/10.1016/j.thromres.2020.04.013">blood clots and strokes</a> as well as symptoms similar to <a href="https://doi.org/10.1016/S0140-6736(20)31129-6">Kawasaki Syndrome</a> in young children – important information for assessment and treatment of patients.</p>
<h2>Better social distancing</h2>
<p>One of the reasons the influenza pandemic thrived in 1918 was because of <a href="https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-12-9">overcrowded living conditions</a>. Though influenza viruses spread most efficiently in cool, dry environments, the 1918 flu thrived in the tropics because of dense populations. India was the hardest-hit nation: As many as <a href="https://link.springer.com/article/10.1007%2Fs13524-012-0116-x">14 million</a> people died in the British-ruled districts alone, with the death rate more than <a href="https://muse.jhu.edu/article/4826">10 times higher than in Europe</a>. <a href="https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-12-9">Our research shows</a> that the most crowded areas suffered the highest losses. </p>
<p>With today’s response protocols in place, countries including <a href="https://theconversation.com/how-germany-is-managing-its-coronavirus-epidemic-and-reacting-with-disdain-to-trumps-policies-134758">Germany</a>, <a href="https://theconversation.com/clear-consistent-health-messaging-critical-to-stemming-epidemics-and-limiting-coronavirus-deaths-134529">Singapore</a> and <a href="https://theconversation.com/how-south-korea-flattened-the-coronavirus-curve-with-technology-136202">South Korea</a> were able to rapidly enact measures to prevent contagion by enforcing lockdowns, shelter-in-place rules and social distancing orders. To date, these interventions have <a href="https://www.nature.com/articles/s41586-020-2404-8_reference.pdf">prevented or delayed</a> about 62 million confirmed cases and averted 530 million infections across Asia, Europe and North America. </p>
<h2>Nutrition</h2>
<p>In 1918, India’s colonial administrators noted that the poor and malnourished were much more likely to succumb to flu than the more affluent. Overall, people across the world are better nourished today. While malnutrition remains a global crisis, the World Health Organization reports that daily food consumption <a href="https://www.who.int/nutrition/topics/3_foodconsumption/en/">rose by 25%</a> between 1965 and 2015. To the extent that <a href="https://academic.oup.com/cid/article/46/10/1582/294025">better nutrition strengthens the immune system</a>, we are in a better position to fight off infection than our ancestors were in 1918.</p>
<h2>Disease demographics</h2>
<p>During the 1918 pandemic, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088249/">pregnant women were at particularly high risk</a>. Statistics reported monthly from Buffalo, New York, show the extent of the tragedy. At the height of the pandemic in October 1918, premature births more than doubled, reaching 57 a month; stillbirths rose to 76, an 81% jump. In Massachusetts, the number of women who died during or right after childbirth more than tripled to 185. In a study in Maryland, <a href="https://academic.oup.com/aje/article/187/12/2585/5060947">half of all pregnant women who developed pneumonia died.</a> </p>
<p>They were part of a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6187799/">particularly hard-hit demographic</a>: This flu disproportionately affected healthy women and men in the prime of their lives, 20-40 years old. It also killed many <a href="https://www.researchgate.net/profile/Ida_Milne/publication/280492506_'Through_the_eyes_of_a_child_-_Spanish_influenza_remembered_by_survivors'/links/55b660be08ae9289a08aecdd/Through-the-eyes-of-a-child-Spanish-influenza-remembered-by-survivors.pdf">children</a> under five years of age. </p>
<p>This is not the case with COVID-19. While <a href="https://www.thelancet.com/lancet/article/s0140-6736(20)30365-2">expectant mothers</a> are at greater risk from infectious disease outbreaks and should take extra precautions, there is scant evidence that COVID-19 infection impacts childbirth, the growing fetus, <a href="https://www.ajog.org/article/S0002-9378(20)30343-4/pdf">babies</a> or <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-in-babies-and-children/art-20484405">young children</a> in the same way that the influenza pandemic did. COVID-19 is also far less deadly for <a href="https://www.pnas.org/content/117/18/9696.short">young adults</a>.</p>
<h2>Better medical science</h2>
<p>Today’s medical technologies are infinitely more advanced than they were a century ago. During the 1918 pandemic, medical researchers were <a href="https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html">debating</a> whether the disease was viral or bacterial. Doctors didn’t yet know influenza viruses existed. Without tests or vaccines, there was limited ability to prevent or contain the spread.</p>
<p>There were few treatment options for those who developed pneumonia, a common complication: Antibiotics were still years away, and <a href="http://rc.rcjournal.com/content/56/8/1170">mechanical ventilation</a> wasn’t available. </p>
<p>Today’s innovations allow us to rapidly detect outbreaks, inoculate large numbers of people and better treat severely ill patients. Scientists were able to <a href="https://www.biorxiv.org/content/10.1101/2020.01.24.919183v2">sequence the COVID-19 genome</a> within seven weeks of the first reported hospitalized case in Wuhan, China, enabling rapid development of tests and identification of possible targets for treatments and <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2005630">vaccines</a>. </p>
<h2>Word of caution</h2>
<p>While these factors give cause for optimism and it is unlikely that COVID-19 will take as many lives as the 1918 H1N1 pandemic, that event offers important cautionary lessons.</p>
<p>Depending on the location and timing, influenza pandemic infections came in waves, each ranging from <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-510">a few weeks to a few months</a>. The timing and duration of these spikes was influenced by <a href="https://doi.org/10.1093/aje/kwy209">transportation routes</a>, overcrowding and <a href="https://doi.org/10.1073/pnas.0611071104">social distancing measures</a>. In some places, the pandemic dragged on for two years. </p>
<p>Recent data shows that globally, rates of infection are <a href="https://www.theguardian.com/world/2020/jun/12/global-report-who-warns-of-accelerating-infections-in-africa-but-says-severe-cases-not-going-undetected">on the rise</a>. But the fact that there is hope in the form of a possible vaccine is an indication of the vast progress humanity has made in the century since the outbreak of the influenza pandemic. </p>
<p><em>This article was updated to change references to the 1918 pandemic to the influenza pandemic.</em></p>
<p>[<em>You’re smart and curious about the world. So are The Conversation’s authors and editors.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklysmart">You can get our highlights each weekend</a>.]</p><img src="https://counter.theconversation.com/content/139951/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Research reported here was based in part on data collected with support from the National Institute on Drug Abuse of the National Institutes of Health under award number R21DA025917. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Eva Kassens-Noor does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A century ago, the influenza pandemic killed about 50 million people. Today we are battling the coronavirus pandemic. Are we any better off? Two social scientists share five reasons we have to be optimistic.Siddharth Chandra, Professor, James Madison College and Director, Asian Studies Center, Michigan State UniversityEva Kassens-Noor, Associate Professor, Urban & Regional Planning Program and Global Urban Studies Program, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1408772020-06-17T11:42:18Z2020-06-17T11:42:18ZThe slow recovery after the combined shock of Spanish flu and the first world war – Recovery podcast part three<figure><img src="https://images.theconversation.com/files/342186/original/file-20200616-23231-wz4g4g.jpg?ixlib=rb-1.1.0&rect=3%2C32%2C2392%2C1814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">US soldiers with influenza at Aix-Les-Bains in France in 1918.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:USCampHospital45InfluenzaWard.jpg">U.S. Army photographer via Wikimedia Commons</a></span></figcaption></figure><p>In this third episode of <a href="https://theconversation.com/uk/topics/recovery-series-87523">Recovery</a>, a series from <a href="https://theconversation.com/uk/topics/the-anthill-podcast-27460">The Anthill Podcast</a> exploring key moments in history when the world recovered from a major crisis or shock, we’re looking at what happened after the combined shocks of the Spanish flu and world war one. </p>
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<p>It was called the Spanish flu because the first reports of the virus were in Spanish newspapers, due to wartime censorship restrictions elsewhere. The 1918-19 flu was the worst pandemic in human history. More than half the world’s population was infected. Estimates for the number of people who died range from between 20 and <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">50 million</a>. And this off the back of a devastating world war in which <a href="http://www.centre-robert-schuman.org/userfiles/files/REPERES%20%E2%80%93%20module%201-1-1%20-%20explanatory%20notes%20%E2%80%93%20World%20War%20I%20casualties%20%E2%80%93%20EN.pdf">9.7 million military personnel and another 10 million civilians died</a>.</p>
<p>To find out about the recovery after these combined shocks of war and pandemic, we hear from three experts in this episode who study the period. </p>
<p>Caitjan Gainty, lecturer in the history of science, technology and medicine at King’s College London, explains what measures were put in place to recover from the Spanish flu and how the pandemic led to a rethink in the way cities and buildings were designed, and a focus on fresh air. </p>
<p>Tim Hatton, professor of economics at the University of Essex, outlines how an economic boom followed the end of the war due to pent-up demand, but it was followed by a severe economic slump and high unemployment. He explains what policies were introduced to help the recovery and why that recovery was patchy in the UK. </p>
<p>And Chris Colvin, senior lecturer in economics at Queen’s University Belfast, tells us why it’s so hard to unpick the economic impact and recovery from the Spanish flu from the recovery from the first world war. And he explains why in their desire to return to what they thought of as “normal”, some politicians decided to reintroduce the gold standard in the early 1920s, with mixed consequences. </p>
<p>You can read more about the <a href="https://theconversation.com/uk/topics/spanish-flu-11781">Spanish flu on The Conversation here</a> as well as other articles in our <a href="https://theconversation.com/uk/topics/recovery-series-87523">Recovery series</a> to accompany this podcast. </p>
<p><em>This episode was produced by Gemma Ware and Annabel Bligh, with sound design by Eloise Stevens.</em></p>
<p><a href="https://pca.st/5Hul"><img src="https://images.theconversation.com/files/321533/original/file-20200319-22598-afljnr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=212&fit=crop&dpr=1" alt="Listen on Pocket Casts" width="268" height="68"></a> <a href="https://castbox.fm/channel/The-Anthill-id2625863?country=gb"><img src="https://images.theconversation.com/files/321531/original/file-20200319-22632-t8ds9t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=232&fit=crop&dpr=1" width="268" height="70"></a> </p>
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PODCAST: The third part of a series from The Anthill Podcast on how the world recovered from major crises throughout history focuses on the recovery after 1918.Gemma Ware, Host, The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1384032020-06-16T11:52:55Z2020-06-16T11:52:55Z3 lessons from how schools responded to the 1918 pandemic worth heeding today<figure><img src="https://images.theconversation.com/files/341577/original/file-20200612-153858-1xbbl4y.jpg?ixlib=rb-1.1.0&rect=200%2C1364%2C5547%2C3128&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These kids learned about staying healthy in schools around the time of the 1918 pandemic.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/cornelluniversitylibrary/3855996841/">Cornell University Library</a></span></figcaption></figure><p>Much like what has <a>happened in 2020</a>, most U.S. schools closed during the <a href="https://doi.org/10.1377/hlthaff.28.6.w1066">1918 influenza pandemic</a>. Their doors were shut for up to four months, <a href="https://timesmachine.nytimes.com/timesmachine/1918/10/13/113306166.html?pageNumber=18">with some exceptions</a>, to <a href="https://www.doi.org/doi:10.1001/jama.298.6.644">curb the spread of the disease</a>.</p>
<p>As a professor who <a href="https://www.bu.edu/amnesp/profile/mary-battenfeld/">teaches and writes about children’s history</a>, I have studied how schools responded to the 1918 influenza pandemic. Though wary of painting the past with the present’s favorite colors, I see three main lessons today’s educators and policymakers can draw from how schools and communities responded to the last century’s pandemic.</p>
<h2>1. Invest in school nurses</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862335/">School nurses were transformative</a> when they were first <a href="https://www.workingnurse.com/articles/lina-rogers-the-first-school-nurse">introduced in 1902</a>.</p>
<p>Rather than simply send sick students home, where they would miss school while receiving no treatment, nurses cared for children’s illnesses and <a href="https://www.lillianwald.com/?page_id=846">provided health information to their families</a>.</p>
<p>After a study showed that <a href="https://www.doi.org/10.3912/OJIN.Vol22No03Man03">nurses cut student absences in half</a>, more and more cities funded them. Within 11 years of the first nurse being hired, <a href="https://muse.jhu.edu/article/504874">nearly 500 U.S. cities employed school-based medical professionals</a>.</p>
<p>In 1919, nurse S.M. Connor, while apologizing for not doing more “owing to the handicap of the influenza epidemic,” submitted a report to the Neenah, Wisconsin school board of her work. Connor made 1,216 home visits, took children to doctors and delivered community health talks, in addition to conducting <a href="http://dx.doi.org.ezproxy.bu.edu/10.1108/HER-01-2016-0001">school-based examinations and follow-up</a>.</p>
<p>In November 1918, New York City Health Commissioner Royal Copeland underscored the role of school nurses. Being under “the constant observation of qualified persons” gave students “a degree of safety that would not have been possible otherwise” and “gave us the opportunity to educate both the children and their parents to the demands of health,” he said in a report titled “<a href="https://timesmachine.nytimes.com/timesmachine/1918/11/17/98275182.pdf?pdf_redirect=true&ip=0">Epidemic Lessons Against Next Time</a>.”</p>
<h2>2. Partner with other authorities</h2>
<p>In a version of the African proverb “<a href="https://www.npr.org/sections/goatsandsoda/2016/07/30/487925796/it-takes-a-village-to-determine-the-origins-of-an-african-proverb">It takes a village to raise a child</a>,” a study of <a href="http://dx.doi.org.ezproxy.bu.edu/10.1377/hlthaff.28.6.w1066">schools in 43 cities during the 1918 pandemic</a> identified “planning that brings public health, education officials, and political leaders together” as key to successful responses.</p>
<p>In Milwaukee, Wisconsin and Rochester, New York, school and health officials combined forces with organizations representing immigrant communities. In Los Angeles, the mayor, health commissioner, police chief and school superintendent collaborated to monitor infection rates, provide teachers additional training, and create and deliver homework for <a href="https://www.influenzaarchive.org/cities/city-losangeles.html#">90,000 schoolchildren</a>.</p>
<p>Such cooperation also helped schools as they reopened.</p>
<p>In St. Louis, while schools were closed, police cars became ambulances, and teachers worked in health agencies. Students returned to school November 14, but by the month’s end the city saw a new influenza surge, leading to another school closure.</p>
<p>Political, health and education leaders designed a gradual reopening that saw high schools open first, followed a month later, <a href="https://www.influenzaarchive.org/cities/city-stlouis.html#">once cases in younger children had dropped, by elementary schools</a>. Thanks to these <a href="https://www.nationalgeographic.com/history/2020/03/how-cities-flattened-curve-1918-spanish-flu-pandemic-coronavirus/">collaborative efforts</a>, St. Louis had 358 deaths per 100,000 people, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158768/">among the best outcomes in the country</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1271006427381932032"}"></div></p>
<h2>3. Tie education to other priorities</h2>
<p>In 1916 the <a href="https://files.eric.ed.gov/fulltext/ED542176.pdf">U.S. Bureau of Education</a> proclaimed that the “education of the schools is important, but life and health are more important.”</p>
<p>Reformers of the period, known as the <a href="http://www.loc.gov/teachers/classroommaterials/presentationsandactivities/presentations/timeline/progress/">Progressive Era</a>, took that notion to heart. In addition to school nurses, they established <a href="https://nursingclio.org/2017/09/14/a-well-balanced-serving-of-school-food-history-with-a-side-of-grassroots-reform/">school lunch programs</a>, built playgrounds and promoted outdoor education.</p>
<p>They attacked <a href="http://www.encyclopedia.chicagohistory.org/pages/976.html">societal barriers to child health and welfare</a> by enacting <a href="https://socialwelfare.library.vcu.edu/programs/child-welfarechild-labor/child-labor/">child labor laws</a>, making <a href="https://eric.ed.gov/?id=ED119389">school attendance compulsory</a> and improving the <a href="https://www.doi.org/10.2105/AJPH.2018.304354">tenement housing where millions of children lived</a>.</p>
<p>By the time the pandemic hit, President Woodrow Wilson had declared 1918 the “<a href="https://www.doi.org/10.2105/AJPH.2018.304354">Children’s Year</a>.” Schools stood ready to deliver <a href="http://hdl.handle.net/2027/spo.1440flu.0011.441">not only lessons but food</a> and <a href="http://www.muse.jhu.edu/article/504874">health care</a>.</p>
<p>When schools reopened, children could learn in what Copeland described as “<a href="https://www.nytimes.com/2020/04/02/nyregion/spanish-flu-nyc-virus.html">large, clean, airy school buildings</a>” with outdoor spaces.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341496/original/file-20200612-153849-imf5tu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children playing on a Boston rooftop in 1909.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/item/2018674290/">Lewis Wickes Hine/Library of Congress</a></span>
</figcaption>
</figure>
<h2>Heeding those lessons in 2020</h2>
<p>A century after Americans learned the importance of investing in school nurses, <a href="https://www.usnews.com/news/articles/2016-03-23/the-school-nurse-scourge">fewer and fewer schools employ them</a>. Only <a href="https://nurse.org/articles/school-nurse-shortage/">60% of schools have a full-time nurse</a>, and about 25% have no nurse at all. A recent analysis concluded that reopening safely will cost an additional <a href="https://www.asbointl.org/asbo/media/documents/Resources/covid/COVID-19-Costs-to-Reopen-Schools.pdf">US$400,000 per district</a>, on average, to hire more school nurses.</p>
<p>These figures are higher for urban schools that educate more students of color, poor students and immigrants, and come as the pandemic’s economic fallout is already <a href="https://www.npr.org/2020/05/26/858257200/the-pandemic-is-driving-americas-schools-toward-a-financial-meltdown">causing districts to cut budgets</a>.</p>
<p>Even so and despite the federal government’s <a href="https://www.nytimes.com/2020/05/15/us/politics/betsy-devos-coronavirus-religious-schools.html">sometimes divisive response</a>, local communities, as in 1918, are fighting this devastating pandemic with teamwork. <a href="https://www.boston.gov/departments/treasury/boston-resiliency-fund">In Boston</a>, <a href="https://resurrectionproject.org/chicagofund/">Chicago</a>, <a href="https://www.dallasnews.com/opinion/commentary/2020/05/04/dallas-is-coming-together-to-help-amid-coronavirus-dont-fall-back-into-old-patterns-when-this-is-over/">Dallas</a>, <a href="https://www.sierrahealth.org/donate4sacramento">Sacramento</a> and elsewhere, city councils, school districts, nonprofits, and labor and business groups are working together to meet their communities’ needs. </p>
<p>And a movement, spurred by anger over the <a href="https://theconversation.com/us/topics/george-floyd-87675">death of George Floyd</a>, police brutality and widespread concerns about <a href="https://www.npr.org/2020/06/11/875023672/4-ways-racial-inequity-harms-american-school-children">systemic racism</a>, is demanding that all jurisdictions spend <a href="https://www.theguardian.com/us-news/2020/jun/04/defund-the-police-us-george-floyd-budgets">less on the police</a> especially now, when the challenges brought about by the pandemic make <a href="https://whdh.com/news/educators-call-for-billions-more-in-federal-aid-for-k-12-schools-2/">funding for public schools</a> more essential than ever.</p>
<p>[<em>You’re too busy to read everything. We get it. That’s why we’ve got a weekly newsletter.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybusy">Sign up for good Sunday reading.</a> ]</p><img src="https://counter.theconversation.com/content/138403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Battenfeld does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>School systems realized that they couldn’t deal with the pandemic on their own.Mary Battenfeld, Clinical Professor of American and New England Studies, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1384082020-06-15T12:23:50Z2020-06-15T12:23:50ZWhat the archaeological record reveals about epidemics throughout history – and the human response to them<figure><img src="https://images.theconversation.com/files/341667/original/file-20200614-153862-12o8vrv.jpg?ixlib=rb-1.1.0&rect=121%2C23%2C3619%2C2594&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dead men do tell tales through their physical remains.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Italy-Uffizi-Ancient-Cemetery/49b445301cb148e29d0654254d397c18/2/0">AP Photo/Francesco Bellini</a></span></figcaption></figure><p>The previous pandemics to which people often compare COVID-19 – the <a href="https://theconversation.com/compare-the-flu-pandemic-of-1918-and-covid-19-with-caution-the-past-is-not-a-prediction-138895">influenza pandemic of 1918</a>, the <a href="https://theconversation.com/coronavirus-and-the-black-death-spread-of-misinformation-and-xenophobia-shows-we-havent-learned-from-our-past-132802">Black Death bubonic plague</a> (1342-1353), the <a href="https://www.newyorker.com/magazine/2020/04/06/pandemics-and-the-shape-of-human-history">Justinian plague</a> (541-542) – don’t seem that long ago to archaeologists. We’re used to thinking about people who lived many centuries or even millennia ago. Evidence found directly on skeletons shows that infectious diseases have been with us since our beginnings as a species.</p>
<p><a href="https://scholar.google.com/citations?user=HtKKK9AAAAAJ&hl=en">Bioarchaeologists</a> <a href="https://scholar.google.com/citations?user=pW_XmM4AAAAJ&hl=en&oi=ao">like</a> <a href="https://scholar.google.com/citations?user=MtpPBa4AAAAJ&hl=en&oi=ao">us</a> analyze skeletons to reveal more about how infectious diseases originated and spread in ancient times.</p>
<p>How did aspects of early people’s social behavior allow diseases to flourish? How did people try to care for the sick? How did individuals and entire societies modify behaviors to protect themselves and others?</p>
<p><a href="https://doi.org/10.1515/anre-2016-0001">Knowing these things</a> might help scientists understand why COVID-19 has wreaked such global devastation and what needs to be put in place before the next pandemic.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338844/original/file-20200601-95024-11z243w.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These round lesions are pathognomonic signs of syphilis.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Clues about illnesses long ago</h2>
<p>How can bioarchaeologists possibly know these things, especially for early cultures that left no written record? Even in literate societies, <a href="https://southburnett.com.au/news2/2019/11/13/researchers-uncover-hidden-toll/">poorer and marginalized segments</a> were rarely written about.</p>
<p>In most archaeological settings, all that remains of our ancestors is the skeleton. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341261/original/file-20200611-80750-47wdov.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Tuberculosis leaves telltale markings in the spine.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>For some infectious diseases, like <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=1036">syphilis</a>, <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=353">tuberculosis</a> and <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=279">leprosy</a>, the location, characteristics and distribution of marks on a skeleton’s bones can serve as distinctive “<a href="https://www.medicinenet.com/script/main/art.asp?articlekey=6386">pathognomonic</a>” indicators of the infection.</p>
<p>Most skeletal signs of disease are non-specific, though, meaning bioarchaeologists today can tell an individual was sick, but not with what disease. Some diseases never affect the skeleton at all, including plague and viral infections like HIV and COVID-19. And diseases that kill quickly don’t have enough time to leave a mark on victims’ bones.</p>
<p>To uncover evidence of specific diseases beyond obvious bone changes, bioarchaeologists use a variety of methods, often with the help of other specialists, like geneticists or parasitologists. For instance, analyzing soil collected in a grave from around a person’s pelvis can reveal the remains of <a href="https://doi.org/10.15184/aqy.2019.61">intestinal parasites</a>, such as tapeworms and round worms. Genetic analyses can also identify the <a href="https://www.dur.ac.uk/archaeology/research/projects/all/?mode=project&id=667">DNA of infectious pathogens</a> still clinging to ancient bones and teeth.</p>
<p>Bioarchaeologists can also estimate age at death based on how developed a youngster’s teeth and bones are, or how much an adult’s skeleton has degenerated over its lifespan. Then demographers help us draw age profiles for populations that died in epidemics. Most infectious diseases disproportionately affect those with the weakest immune systems, usually the very young and very old.</p>
<p>For instance, the Black Death was indiscriminate; <a href="https://www.americanscientist.org/article/the-bright-side-of-the-black-death">14th-century burial pits</a> contain the typical age distributions found in cemeteries we know were not for Black Death victims. In contrast, the 1918 flu pandemic was unusual in that it <a href="https://doi.org/10.1371/journal.pone.0069586">hit hardest those with the most robust immune systems</a>, that is, healthy young adults. COVID-19 today is also leaving a recognizable profile of those most likely to die from the disease, targeting <a href="https://www.bloomberg.com/opinion/articles/2020-05-07/comparing-coronavirus-deaths-by-age-with-flu-driving-fatalities">older and vulnerable people</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html">particular ethnic groups</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=611&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=611&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=611&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=768&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=768&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341585/original/file-20200613-153827-mjcx87.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=768&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ground penetrating radar shows mass graves from the small Aboriginal settlement of Cherbourg in Australia, where 490 out of 500 people were struck down by the 1918-1919 influenza pandemic, with about 90 deaths.</span>
<span class="attribution"><span class="source">Kelsey Lowe</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We can find out what infections were around in the past through our ancestors’ remains, but what does this tell us about the bigger picture of the origin and evolution of infections? Archaeological clues can help researchers reconstruct aspects of socioeconomic organization, environment and technology. And we can study how variations in these risk factors caused diseases to vary across time, in different areas of the world and even among people living in the same societies.</p>
<h2>How infectious disease got its first foothold</h2>
<p>Human biology affects culture in complex ways. Culture influences biology, too, although it can be hard for our bodies to keep up with rapid cultural changes. For example, in the 20th century, highly processed fast food replaced a more balanced and healthy diet for many. Because the human body evolved and was <a href="https://global.oup.com/academic/product/mismatch-9780192806833?cc=us&lang=en&">designed for a different world</a>, this dietary switch resulted in a rise in diseases like diabetes, heart disease and obesity.</p>
<p>From a paleoepidemiological perspective, the most significant event in our species’ history was the adoption of farming. <a href="https://www.khanacademy.org/humanities/world-history/world-history-beginnings/birth-agriculture-neolithic-revolution/v/how-did-agriculture-grow">Agriculture arose independently</a> in several places around the world beginning around 12,000 years ago.</p>
<p>Prior to this change, people lived as hunter-gatherers, with <a href="https://doi.org/10.1016/j.jas.2016.02.003">dogs as their only animal companions</a>. They were very active and had a well balanced, varied diet that was high in protein and fiber and low in calories and fat. These small groups experienced <a href="https://doi.org/10.1016/j.jas.2018.07.010">parasites</a>, <a href="https://doi.org/10.1016/j.ijpp.2017.01.004">bacterial infections</a> and <a href="https://www.nytimes.com/2016/10/18/science/first-boomerang-victim-australia.html">injuries</a> while hunting wild animals and occasionally fighting with one another. They also had to deal with <a href="https://doi.org/10.1016/j.jasrep.2018.03.019">dental problems</a>, including extreme wear, plaque and periodontal disease.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1744&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1744&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341497/original/file-20200612-153832-7gh3c9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1744&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A healed fracture of the lower leg bones from a person buried in Roman Winchester, England.</span>
<span class="attribution"><span class="source">Charlotte Roberts</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>One thing hunter-gatherers didn’t need to worry much about, however, was virulent infectious diseases that could move quickly from person to person throughout a large geographic region. Pathogens like the influenza virus were not able to effectively spread or even be maintained by small, mobile, and socially isolated populations.</p>
<p>The advent of agriculture resulted in larger, sedentary populations of people living in close proximity. New diseases could flourish in this new environment. The transition to agriculture was characterized by <a href="https://doi.org/10.1126/science.1208880">high childhood mortality</a>, in which approximately 30% or more of children died before the age of 5.</p>
<p>And for the first time in an evolutionary history spanning millions of years, different species of mammals and birds became intimate neighbors. Once people began to live with newly domesticated animals, they were brought into the life cycle of a new group of diseases – called <a href="https://www.who.int/topics/zoonoses/en/">zoonoses</a> – that previously had been limited to wild animals but could now jump into human beings.</p>
<p>Add to all this the stresses of poor sanitation and a deficient diet, as well as increased connections between distant communities through migration and trade especially between urban communities, and <a href="https://boydellandbrewer.com/urban-bodies-communal-health-in-late-medieval-english-towns-and-cities.html">epidemics of infectious disease</a> were able to take hold for the first time.</p>
<h2>Globalization of disease</h2>
<p>Later events in human history also resulted in major epidemiological transitions related to disease.</p>
<p>For more than 10,000 years, the people of Europe, the Middle East and Asia evolved along with particular zoonoses in their local environments. The animals people were in contact with varied from place to place. As people lived alongside particular animal species over long periods of time, a symbiosis could develop – as well as immune resistance to local zoonoses.</p>
<p>At the beginning of modern history, people from European empires also began traveling across the globe, taking with them a suite of “Old World” diseases that were devastating for groups who hadn’t evolved alongside them. Indigenous populations in <a href="https://australianstogether.org.au/discover/australian-history/colonisation/">Australia</a>, <a href="https://doi.org/10.4269/ajtmh.16-0169">the Pacific</a> and <a href="https://www.sciencemag.org/news/2015/06/how-europeans-brought-sickness-new-world">the Americas</a> had no biological familiarity with these new pathogens. Without immunity, one epidemic after another ravaged these groups. Mortality estimates range between 60-90%.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=753&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=753&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=753&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=947&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=947&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341336/original/file-20200611-80778-1qo67z2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=947&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This skull of a person who lived more than 2,600 years ago in Peru shows evidence of a surgery, maybe to treat a head wound.</span>
</figcaption>
</figure>
<p>The study of disease in skeletons, mummies and other remains of past people has played a critical role in reconstructing the origin and evolution of pandemics, but this work also provides evidence of <a href="https://www.nytimes.com/2012/12/18/science/ancient-bones-that-tell-a-story-of-compassion.html">compassion and care</a>, including medical interventions such as <a href="https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/">trepanation</a>, <a href="https://www.discovermagazine.com/planet-earth/13-000-year-old-fillings-prove-ancient-dentistry-was-brutal">dentistry</a>, <a href="https://theconversation.com/severed-limbs-and-wooden-feet-how-the-ancients-invented-prosthetics-77741">amputation and prostheses</a>,
<a href="https://www.history.com/news/ancient-medicines-from-shipwreck-shed-light-on-life-in-antiquity">herbal remedies</a> and <a href="https://www.forbes.com/sites/kristinakillgrove/2018/02/28/largest-collection-of-ancient-surgical-tools-was-found-here-not-at-pompeii/#5241f662317f">surgical instruments</a>.</p>
<p>Other evidence shows that people have often done their best to protect others, as well as themselves, from disease. Perhaps one of the most famous examples is the <a href="https://www.bbc.com/news/uk-england-derbyshire-51904810">English village of Eyam</a>, which made a self-sacrificing decision to isolate itself to prevent further spread of a plague from London in 1665.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338847/original/file-20200601-95009-1t6jb06.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A tuberculosis sanatorium in São Paulo, Brazil, in the late 1800s.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/ydhjdjb4">Wellcome Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In other eras, people with tuberculosis were placed in sanatoria, people with leprosy were admitted to specialized hospitals or segregated on islands or into remote areas, and urban dwellers fled cities when plagues came.</p>
<p>The archaeological and historical record are reminders that people have lived with infectious disease for millennia. Pathogens have helped shape civilization, and humans have been resilient in the face of such crises.</p><img src="https://counter.theconversation.com/content/138408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Westaway receives funding from the Australian Research Council. </span></em></p><p class="fine-print"><em><span>Charlotte Roberts and Gabriel D. Wrobel do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People have lived with infectious disease throughout the millennia, with culture and biology influencing each other. Archaeologists decode the stories told by bones and what accompanies them.Charlotte Roberts, Professor of Archaeology, Durham UniversityGabriel D. Wrobel, Professor of Anthropology, Michigan State UniversityMichael Westaway, Australian Research Council Future Fellow, Archaeology, School of Social Science, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1381062020-06-14T12:29:02Z2020-06-14T12:29:02ZVaccinations skipped during COVID-19 shutdown may lead to outbreaks of other diseases<figure><img src="https://images.theconversation.com/files/341306/original/file-20200611-80789-1p00yas.jpg?ixlib=rb-1.1.0&rect=641%2C0%2C7279%2C5379&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization estimates that 117 million people worldwide may have missed a vaccination during the COVID-19 pandemic.</span> <span class="attribution"><span class="source">(Shutterstock))</span></span></figcaption></figure><p>Although COVID-19 is a new illness caused by a new virus, the fallout from the COVID-19 shutdown may put the world at risk for outbreaks of old illnesses: ones that were practically eradicated through vaccination.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&rect=181%2C0%2C4204%2C2711&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children may be falling behind on scheduled vaccinations during the COVID-19 shutdown.</span>
<span class="attribution"><span class="source">(Shutterstock))</span></span>
</figcaption>
</figure>
<p>The World Health Organization estimates that <a href="https://www.who.int/immunization/diseases/measles/statement_missing_measles_vaccines_covid-19/en/">117 million people worldwide</a> will miss out on vaccinations for preventable diseases due to COVID-19. Closer to home, the Canadian Paediatric Society is worried that Canadians will <a href="https://www.cbc.ca/news/health/covid-19-child-immunizations-1.5543286">fall behind</a> on their vaccination schedules. Vaccines are one of the most important public health tools at our disposal. Ignoring vaccinations can have dire consequences. </p>
<h2>Lessons from 1918</h2>
<p>I am a historian of medicine. I study the history of infectious diseases and vaccination. In recent months, I have focused my research on the understudied effects of the 1918 flu pandemic on public health in Canada. </p>
<p>The experience of the 1918 influenza should act as a warning for provincial public health programs. My research shows that in the years after the 1918 flu, Canada suffered a series of outbreaks of <a href="https://www.cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf">smallpox and typhoid</a> after vaccination took a backseat to the pandemic.</p>
<p>Provincial governments need to have a plan to get children back on track when COVID-19 subsides, or run the risk of creating an environment ripe for outbreaks of vaccine-preventable diseases such as measles.</p>
<h2>Establishing public health measures</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=626&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=626&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=626&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Walter Reed Hospital flu ward in Washington D.C. during the flu epidemic of 1918-19.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Before the 1918 flu, local public health programs were temporary, and workers were volunteers. In 1923, the Health Board of Québec provided financial support to create <a href="https://utorontopress.com/ca/public-health-in-the-age-of-anxiety-2">permanent public health units</a>. As part of this, it instituted a hygiene week, when the government educated communities about the importance of public health measures, including vaccination. Ontario followed suit, in 1924, when the chief officer of health helped develop full-time public health units for the province. </p>
<p>Though it may seem that the 1918 flu directly spurred the development of permanent public health units and sophisticated routine vaccine programs, the truth is more complicated. My study of public health reports shows that after the 1918 flu, cases of smallpox and other preventable diseases spiked. </p>
<p>In 1920, Canada had 2,553 cases of smallpox, compared to a baseline of a couple hundred a year. Cases continued climbing to a peak of <a href="https://www.museumofhealthcare.ca/explore/exhibits/vaccinations/smallpox.html">3,300 in 1927</a>, before declining to near zero in the 1940s. In 1923, Cochrane, Ont. had an outbreak of typhoid with <a href="https://www.cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf">800 cases and 50 deaths</a>. With a population of 3,400, cases represented almost a quarter of the population. </p>
<h2>Outbreaks in the wake of 1918 flu</h2>
<p>It is difficult to track vaccination uptake in the early 1900s, because records of vaccination during this period were spotty at best. Nonetheless, these lapses in public health expose failures to maintain adequate vaccination levels in communities across Canada in the wake of the 1918 flu, which interrupted many aspects of life including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862334/">commerce, religion and vaccination</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-taming-of-polio-and-the-challenge-of-the-flu-116100">The taming of polio and the challenge of the flu</a>
</strong>
</em>
</p>
<hr>
<p>After the 1918 flu, however, public health officers did not take measures necessary to make up for lost time and missed vaccinations. It was not until several outbreaks had occurred, such as the one in Cochrane, that public health authorities regained control over preventable diseases. </p>
<p>Getting infectious diseases under control meant ensuring shots were administered as part of routine vaccination programs. This was a messy process and it did not happen all at once. However, by 1940 Toronto acheived the distinction of being the first city with a population over 500,000 to report <a href="https://utorontopress.com/ca/public-health-in-the-age-of-anxiety-2">no cases of smallpox</a>. Toronto achieved this by tracking vaccinations closely and by advertising smallpox vaccination at the same time every year.</p>
<h2>Vaccine misinformation</h2>
<p>Today, Canadian vaccination programs are threatened by vaccine misinformation, rejection and apathy. At the same time, a growing number of Canadians are <a href="https://www.cfp.ca/content/65/3/175">hesitant to vaccinate</a>. These factors leave Canada with slim margins on maintaining herd immunity, which refers to the point at which the percentage of people immunized ensures protection of the whole community from disease. Even before COVID-19, Canada has had outbreaks of measles in under-vaccinated communities. In 2019, Canada reported <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/measles-rubella-surveillance/2019/week-52.html">113 cases of measles</a>. </p>
<p>The COVID-19 pandemic has created many problems that will need attention. Already provinces are creating step-by-step plans to <a href="https://globalnews.ca/news/6920122/coronavirus-heres-how-provinces-plan-to-emerge-from-covid-19-lockdown/">reopen their economies</a>. What is needed now is for provinces to create step-by-step plans for identifying and contacting those who have fallen behind on their vaccinations.</p><img src="https://counter.theconversation.com/content/138106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek Cameron received funding from the Social Science and Humanities Research Council. </span></em></p>Children may have fallen behind on their vaccination schedules during the pandemic, increasing the risk that COVID-19 may be followed by outbreaks of once-eradicated diseases.Derek Cameron, PhD Candidate in History, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1388952020-06-04T12:30:13Z2020-06-04T12:30:13ZCompare the flu pandemic of 1918 and COVID-19 with caution – the past is not a prediction<figure><img src="https://images.theconversation.com/files/338988/original/file-20200601-95059-1dvefet.jpg?ixlib=rb-1.1.0&rect=298%2C306%2C4701%2C3349&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A pandemic from a century ago doesn't necessarily chart the course of the pandemic happening now.</span> <span class="attribution"><a class="source" href="http://hdl.loc.gov/loc.pnp/npcc.18661">National Photo Company Collection/Library of Congress Prints and Photographs Division/Library of Congress Prints and Photographs Division</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>People have turned to historical experience with influenza pandemics to try to make sense of COVID-19, and for good reason.</p>
<p>Influenza and coronavirus share basic similarities in the way they’re transmitted via respiratory droplets and the <a href="https://theconversation.com/viruses-live-on-doorknobs-and-phones-and-can-get-you-sick-smart-cleaning-and-good-habits-can-help-protect-you-133054">surfaces they land on</a>. Descriptions of H1N1 influenza patients in 1918-19 echo the respiratory failure of COVID-19 sufferers a century later. Lessons from efforts to mitigate the spread of flu in 1918-19 have justifiably guided this pandemic’s <a href="https://doi.org/10.1001/jama.298.6.644">policies promoting nonpharmaceutical interventions</a>, such as physical distancing and school closures.</p>
<p>Current discussions about scaling back social distancing measures and “opening up” the country frequently refer to <a href="https://www.washingtonpost.com/history/2020/05/24/second-wave-pandemic-flu-1918-coronavirus/">“waves” of disease</a> that characterized the dramatic mortality of H1N1 influenza in <a href="https://printabletemplates.com/cidrap-covid19-viewpoint/">three major peaks in 1918-19</a>. As COVID-19 rates begin to steady in some parts of the U.S., people today are nervously eyeing the <a href="https://www.jstor.org/stable/44446153">“second wave” of influenza</a> that came in autumn 1918, that pandemic’s deadliest period.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=294&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=294&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=294&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=370&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=370&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338977/original/file-20200601-95032-126zcl7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=370&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Three waves of death during the pandemic: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919. The waves were broadly the same globally.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.3201/eid1201.050979">Taubenberger JK, Morens DM. 1918 Influenza: the Mother of All Pandemics. Emerg Infect Dis. 2006;12(1):15-22.</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Waves evoke predictability, however, and COVID-19 has been hard to predict. Despite the valuable lessons drawn from past influenza outbreaks, <a href="https://doi.org/10.1097/CCM.0b013e3181ceb25b">how pandemic influenza struck in 1918</a> isn’t a template for what will happen with COVID-19 in the coming months.</p>
<p>As a <a href="https://scholar.google.com/citations?user=41RCe6UAAAAJ&hl=en&oi=ao">historian</a> and <a href="https://scholar.google.com/citations?user=ubfhdQwAAAAJ&hl=en&oi=ao">a virologist</a>, we believe this comparison of two pandemics has contributed to public confusion about what to expect from “flattening the curve.” Key divergences in the sociopolitical contexts of 1918-19 and now, in addition to clear virologic differences between influenza and SARS-CoV-2, the virus that causes COVID-19, mean their courses are not perfectly matched.</p>
<h2>Influenza pandemic a product of that time</h2>
<p>Today’s citizens may consider the 2020 world to be dramatically more connected than in the past. But World War I and soldier mobilization created a <a href="https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article">situation well-suited to influenza dispersal</a>. While the origin of the deadly strain of 1918 H1N1 remains obscure, evidence indicates that soldiers on the move drove circulation.</p>
<p>Young American men left their homes – rural farms, small towns, crowded cities – and traveled around the world. They gathered by the thousands in military training camps and on troop ships, and then at the front in Europe. Civilians globally continued to work in crucial areas of economic production that required movement through the same transit hubs soldiers used. The disease’s first wave occurred in spring and early summer 1918 amid these movements.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=671&fit=crop&dpr=1 600w, https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=671&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=671&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=844&fit=crop&dpr=1 754w, https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=844&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/338987/original/file-20200601-95032-p504e7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=844&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">H1N1 flu stowed away with soldiers returning from World War I.</span>
<span class="attribution"><a class="source" href="https://www.loc.gov/pictures/item/2004676948/">Keystone View Co./Library of Congress Prints and Photographs Division</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In theaters of war in Europe, Africa and western Asia, soldiers mingled with their global compatriots. When they demobilized, they passed through major transit hubs back to their homes around the world, interacting with more people.</p>
<p>The extraordinarily deadly second wave of influenza in autumn 1918 diffused linearly <a href="https://www.routledge.com/The-Spanish-Influenza-Pandemic-of-1918-1919-New-Perspectives/Killingray-Phillips/p/book/9780415510790">along rail and sea routes, then radiated outward</a> to wreak havoc on previously unexposed populations globally. In some areas, this period was followed by a less deadly third winter wave of disease in early 1919.</p>
<p>Medical historians conservatively estimate that influenza killed <a href="https://muse.jhu.edu/article/4826">50 million people globally, with 675,000 in the United States</a> between 1918 and 1920. After that, this strain of flu receded, likely due to changes in the virus itself and the fact that most people had already been exposed and developed immunity or died.</p>
<p>Because the <a href="https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/pandemic-timeline-1918.htm">waves of pandemic flu did recede</a>, it’s tempting to imagine today’s pandemic following a similar trajectory. However, fundamental differences between the biology of SARS-CoV-2 and influenza viruses make it hard to chart the future of COVID-19 based on what happened in the early 20th century.</p>
<h2>SARS-CoV-2 and flu are biologically different</h2>
<p>Both the new coronavirus and influenza have genetic material in the form of RNA. RNA viruses tend to accumulate a lot of mutations as they multiply – they typically don’t double-check copied genes to correct errors during replication. These mutations can occasionally <a href="https://doi.org/10.1038/s41579-018-0115-z">lead to significant changes</a>: The virus might change the species it infects or cell receptor it uses, or it could become more or less deadly, or spread more or less easily.</p>
<p>Uniquely, influenza’s genetic material is organized in segmented chunks. This idiosyncrasy means the virus can trade entire segments of RNA with other influenza viruses, enabling rapid evolution. <a href="https://doi.org/10.1128/JVI.01680-06">Influenza also has a distinct seasonality</a>, circulating much more during the winter months. As virus strains circulate, oscillating seasonally between the Northern and Southern Hemispheres’ wintertimes, they mutate rapidly. This capacity for quick adaptation is why you need to get a new flu vaccination annually to protect against new strains that have emerged in your area since last year.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339563/original/file-20200603-130929-vfsouc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">SARS-CoV-2 makes many copies of itself once it successfully infects a human cell.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/coronavirus-3d-render-royalty-free-image/1208505324">dowell/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Coronaviruses actually do proofread their copied RNA to fix inadvertent errors during replication, which decreases their relative mutation rate. From the originally sequenced SARS-CoV-2 in Wuhan, China in December 2019 to recently banked sequences from the U.S., there are <a href="https://nextstrain.org/ncov/global?c=clade_membership">fewer than 10 mutations in 30,000 potential locations in its genome</a>, despite the virus having traveled around the world and through multiple generations of human hosts. <a href="https://doi.org/10.1128/JVI.00694-10">Influenza makes 6.5 times more errors</a> per replication cycle, independent of entire genome segment swaps. </p>
<p>The relative genetic stability of SARS-CoV-2 means that future peaks of disease are unlikely to be driven by natural changes in virulence due to mutation. Mutation is unlikely to contribute to predictable “waves” of COVID-19.</p>
<p>It’s also currently <a href="https://theconversation.com/coronavirus-may-wane-this-summer-but-dont-count-on-any-seasonal-variation-to-end-the-pandemic-136218">unknown if SARS-CoV-2 will be influenced by the seasons</a>, like influenza. It has already successfully spread in many climates. It’s hard to attribute recent <a href="https://coronavirus.1point3acres.com/en">declines in the rate of new cases</a> to warmer weather – they’re occurring in the wake of various strict nonpharmaceutical interventions.</p>
<p>All this means that oscillations in COVID-19 cases are unlikely to come with the predictability that discussions of influenza “waves” in 1918-19 might suggest. Rather, as SARS-CoV-2 continues to circulate in nonimmune populations globally, physical distancing and mask-wearing will keep its spread in check and, ideally, keep infection and death rates steady.</p>
<p><iframe id="Aus4p" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Aus4p/6/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>As states loosen nonpharmaceutical interventions, the U.S. will likely experience a long plateau of continued new infections at a steady rate, punctuated by periodic local flares. These outbreaks will not be driven by SARS-CoV-2 mutation or virulence, but by the further exposure of nonimmune people to the virus. Future spikes in COVID-19 cases and deaths will very likely be driven by what people do.</p>
<p>This scenario will continue <a href="https://www.nytimes.com/2020/05/01/opinion/sunday/coronavirus-herd-immunity.html">until the U.S. population gains herd immunity</a>, ideally accelerated by vaccination. Unfortunately, this process may be measured in years rather than months.</p>
<h2>One virus’s pattern is not a prediction</h2>
<p>People seek answers from the experiences of influenza in 1918-19 for a fundamental reason: It ended.</p>
<p>History shows the pandemic ebbed after a final, third wave in spring 1919 without the benefit of an influenza vaccine (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139605/">available only in the mid-1940s</a>) or a molecular or serologic test, or effective antiviral therapy, or even the support of mechanical ventilation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=515&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=515&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339564/original/file-20200603-130903-12se3mo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=515&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The earlier pandemic does hold lessons for the current one, including the value of wearing masks to stop the virus’s spread.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/two-men-wearing-and-advocating-the-use-of-flu-masks-in-news-photo/3333532">Topical Press Agency/Hulton Archive via Getty Images</a></span>
</figcaption>
</figure>
<p>Today we’re living through a novel pandemic. By and large, people are actively collaborating in unprecedented measures to disrupt transmission of SARS-CoV-2. Scanning the historical record is one way to draw our own lives into focus and perspective. Unfortunately, the end of influenza in summer 1919 does not portend the end of COVID-19 in the summer of 2020.</p>
<p>The pandemic’s scientific complexities are formidable challenges. They’re playing out in a global economy that has ground to a halt, with resultant increasing pressures to reopen communities, and a technologically advanced and interconnected society – all issues that our predecessors a century ago did not have to consider.</p>
<p><em>Jessica Pickett, Ph.D., a principal consultant with Tomorrow Global, LLC, contributed to this article.</em></p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for The Conversation’s newsletter.</a>]</p><img src="https://counter.theconversation.com/content/138895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megan Culler Freeman receives funding from the Pediatric Infectious Diseases Society/St. Jude Children's Hospital Fellowship in Basic and Translational Research.</span></em></p><p class="fine-print"><em><span>Mari Webel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Differences in the viruses’ biology and societal contexts mean there’s no guarantee today’s pandemic will mirror the ‘waves’ of infection a century ago.Mari Webel, Assistant Professor of History, University of PittsburghMegan Culler Freeman, Pediatric Infectious Diseases Fellow, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.