Does the 1918 pandemic offer any indications of the occurrence of COVID-19?

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Karen Baldridge rolled up her sleeve to get her Covid-19 booster.

“I try to make myself babies and do everything I can to stay healthy,” she said last week at Excela Square in Norwin. “I feel like there is a 90% chance I won’t get it (Covid) but when I get it I don’t feel like I’m getting it that bad and I don’t feel like that it lasts so long. ”

Baldridge, a 70-year-old North Huntingdon resident, is among the 56% of people in the United States who are fully vaccinated against Covid. In Pennsylvania, according to the Centers for Disease Control and Prevention, it belongs to nearly 58% of the total population and nearly 69% of those 18 and over who are fully vaccinated.

Vaccines are hailed by the medical community as the fastest, safest way for society to overcome the Covid-19 pandemic. Their availability is arguably the biggest difference between today’s pandemic and the 1918 flu pandemic.

This historic event, say some medical experts, can help shape the current one – and provide clues as to where Covid-19 could lead.

‘Self-inflicted’

The United States recently surpassed the death toll from the so-called Spanish flu pandemic – a mark that was unthinkable 18 months ago. As of Friday, the US dwarfed 700,000 deaths, and there have been approximately 4.8 million Covid deaths worldwide, according to the Johns Hopkins Coronavirus Resource Center.

The 1918 pandemic killed at least 675,000 lives nationwide and 50 million worldwide, according to the Centers for Disease Control and Prevention. However, the United States has tripled its population in the last century.

“We are 100 years further advanced than we were then,” said Dr. Nate Shively, Infectious Disease Expert at Allegheny Health Network. “I think many would find this a little daunting, only that the pandemic continues to burn, even though we now really have all the tools in hand to bring it close to the end. And we just don’t use these tools effectively. “

Medical experts name the vaccine as the most effective tool. The Pfizer booster shot was recently approved by the Food and Drug Administration and Centers for Disease Control and Prevention to expand protection for Americans who are older or have pre-existing conditions.

Yet many remain skeptical.

Dr. Amesh Adalja, a Pittsburgh-based infectious disease expert and senior scientist at the John Hopkins Center for Health Security, called it “inexcusable” that the number of Covid-19 deaths in the US eclipsed that of the 1918 pandemic.

When people died of the flu in 1918, they didn’t have access to vaccines and today’s modern science. With the significant medical advances made over the past 100 years, America should deal much better with this pandemic, Adalja said.

“What we do in the United States is self-inflicted,” he said. “We can explain it by the fact that people are not open to science and openly defy it.”

“Prices are more important”

Dr. Donald Burke, a distinguished professor – and former dean – at the University of Pittsburgh Graduate School of Public Health, is an expert in the use of computer models and simulations to guide public health decisions.

He said it was important to consider the death rate, not just the total number of deaths.

In Pennsylvania, Covid-19 has killed more than 29,000 people, according to the state Department of Health. Keystone State was among the states hardest hit by the 1918 pandemic, which claimed more than 60,000 lives, according to the University of Pennsylvania.

The 1918 flu is believed to have caused approximately 4,500 deaths in Pittsburgh and an additional 2,000 deaths in Westmoreland County. Covid-19 deaths have so far reached 2,100 in Allegheny County and 840 in Westmoreland.

“Although the death rates are similar, the death rates – that is, the rate per 100,000 people or per inhabitant unit – are now about three times lower with Covid than with influenza,” said Burke. “Totals are important, but the rates are more important to understanding the effects.”

The 1918 flu pandemic mainly affected younger population groups, with a “large proportion of deaths” occurring in people between the ages of 18 and 30. This is unusual for influenza and particularly stressful for society, said Burke as “everyday life”. Functions of society are more dependent on this age group. “

Was never gone

There’s no simple definition of when a pandemic ends, said Seema Lakdawala, an associate professor who studies flu viruses in the Pitt School of Medicine’s Microbiology and Molecular Genetics Department.

The first U.S. cases of the 1918 pandemic were reported in March of that year, when more than 100 soldiers fell ill in Fort Riley, Kansas, according to the CDC. That was nearly a year after the United States entered World War I, with troop movements cited as a factor in spreading the disease.

The flu was rampant in Paris in early 1919 when the treaty to end the war was negotiated.

Lakdawala noted that the H1N1 virus, which was responsible for the 1918 pandemic, never went away, killing many people each year.

It was not until the 1930s that the virus was recognized as the cause. A control vaccine was first recommended in 1960.

Even with vaccines, tens of thousands of Americans die from the flu every year, Lakdawala said. In 2017-18, 80,000 people died from seasonal flu, she said.

Still, Lakdawala, who is also a member of Pitt’s Center for Vaccine Research, said vaccines are the safest way to control the spread of viruses – rather than trying to achieve herd immunity through natural infections.

In addition to the risk of death, she said: “Obviously, infection with the virus has long-term consequences. We have had it for over a year now and we have long term “Covid symptoms” including adverse effects on breathing and lung function.

“As viruses replicate and spread through the population, they will evolve,” she said. “If we had a higher vaccination, we would have less transmission and less diversity” with the Covid virus. “It’s not that it’s going to go away, but it would definitely be slowing down.”

“Pandemic Will Ease”

Burke said he anticipates the Covid-19 pandemic will end similarly to the 1918 flu epidemic – by turning into a seasonal virus that never really goes away.

The 1918 flu “blew through the world,” he said, infecting huge swaths that gained natural immunity – the only answer at the time since vaccines were not yet a reality.

But Covid-19 vaccines are available and highly effective, Burke said. Once enough people have immunity – either to the disease or to a vaccination – the pandemic will subside, he said.

Even if vaccine uptake doesn’t improve, Adalja said, the pandemic will still recede. But it will do so because people become infected with the virus and gain natural immunity instead of being vaccinated. With an infection, however, there is a risk of death, said Adalja.

“No matter what happens, the pandemic will subside because people are infected. Vaccines dampen the effects of the pandemic, but the final common path will be the same, ”Adalja said.

That’s what happened with the 1918 flu, Burke said.

“It didn’t cause another major new pandemic, but it did cause the seasonal flu and it mutates and evolves and causes significant disease – but never pandemic proportions,” Burke said. “I wouldn’t be surprised if Covid does pretty much the same thing. It’s unlikely to go away after a year or two because there are large parts of the world that are not immune and not vaccinated.

“As long as there are populations on the planet that are vulnerable, the virus will be transmitted.”

One positive outcome of the 1918 pandemic, though a long time coming, was the creation of the World Health Organization. Excela Latrobe’s pediatrician, Dr. David Wyszomierski, who researched the previous pandemic, noted that WHO developed a global surveillance system in 1952 to track different strains of influenza.

He said that like the flu, the Covid virus “can alter some of its genetic material to become more contagious or pathological”. It did so with the advent of the Delta variant cited in the recent surge in hospital admissions and deaths.

With another flu season approaching, Wyszomierski stressed the importance of getting a Covid-19 vaccine and an influenza vaccine for those eligible.

“Absolutely not spared”

It could require over 90% of the population to gain some form of immunity before the pandemic subsides, Shively said. Once under control, it will likely become another of the “endemic coronaviruses.”

Four other coronaviruses circulate in the human population as colds, Burke said. Covid-19 is likely to join their ranks.

“If you look at the molecular evolutionary pattern, it looks like (coronaviruses) invaded humans at least hundreds of years ago,” he said. “Maybe it happens every centuries or so that a virus skips over and makes it into humans and then settles into that balance.”

Nevertheless, there is always the risk of another serious pandemic, experts warn.

“We are absolutely not going to be spared a new pandemic – be it 100 years in the future or later this year before it goes away,” Shively said.

The risk of pandemics spreading is higher today than ever, said Burke. As the world becomes more interconnected, viruses have made it easier to travel globally – while many epidemics in the past died out on a continent or a remote corner of the world.

Several viruses in recent years, like Ebola and H1N1, have the potential to cause a devastating global pandemic, Shively said. They just didn’t.

“Preparing for the next pandemic and learning lessons from it is something we can win as a country and as an international community,” he said. “When another pandemic will occur is difficult to say, but there will be another pandemic. We need to take steps to make sure we are prepared when the time comes. “

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