[OPINION] Pandemics come in waves, not in a single stroke

Pippo Carmona
'As the Duterte government mulls the end of its constantly changing lockdown measures, with no coherent transition policy and no mass testing conducted, Filipinos might be in for an unpleasant surprise'

 

As the COVID-19 pandemic continues to devastate the global market, governments the world over are already looking forward to lifting their quarantine and lockdown measures as soon as possible, hoping to rescue their dying economies before it’s too late.

The idea is simple: the pandemic has reached its peak, we’ve protected as many lives as we can, and now it’s time to save the economy.

This call for a return to economic and social normalcy, amid a pandemic, is dependent on a naive optimism, undergirded by myopia. When you enter an Olympic marathon and plan to win it even when you don’t have a history of running races, you endanger yourself with the harsh demands of such an elite activity. This short-sightedness means looking forward without realizing that there are potential dangers ahead, ones we could have easily avoided if we had only learned from past mistakes and triumphs.

This limitation has many dangerous reprisals, especially for public health and epidemiology. The late Harvard ecologist Richard Levins warned that, “The extrapolation from only the most recent history is too short a time frame. If we look instead at the longest available historical records we see that diseases come and go,” often in regular intervals.

And as the Duterte government mulls the end of its constantly changing lockdown measures, with no coherent transition policy and no mass testing conducted, Filipinos might be in for an unpleasant surprise. Because as it stands, history tells us that pandemics come not in a single stroke, but rather in waves. (READ: Salceda fears second wave, cites poor contact tracing and testing)

Another one is about to crash on us if we don’t take precaution. 

Patterns of plague

The most well-known pandemic in human history, the Black Death, is often seen as a singular eruption of infectious disease. But that is not so. The pandemic that struck Europe in the 1340s was actually the second time the bubonic plague caused havoc on European soil, which is why it is sometimes dubbed the “second wave of bubonic plague.” While not of the same strain, the pathogen that caused the “Plague of Justinian” in the 6th century, Yersinia pestis, was the same bacterium that caused the Black Death in the middle ages. It would later go on to cause a third spell of bubonic plague in Asia in the 1800s.

An even closer look at the mediaeval experience reveals that within the second wave of bubonic plague were many routine undulations of the disease that kept Europe awash in infection. 

A Mongol attack on Kaffa (now Feodosia, Crimea) in 1346 brought the plague from Asia to Europe. Italian merchant ships anchored at Kaffa’s ports escaped the conflict and set sail for Constantinople (now Istanbul), unknowingly bringing with them the contagion. Constantinople was then, as is now, a major commercial hub where many merchant caravans and ships from Africa, Asia Minor, and Europe were stationed. So when the fleeing Italian ships arrived in the city in 1347, the pathogen was welcomed by many able hosts willing to give it a free ride to destinations far and wide.

From there it didn’t take long for the plague to spread like wildfire. In September of that year, the bubonic plague had reached the French city of Marseille. By November, the infected ships coming from Kaffa had reached their home ports in Italy, slowly spreading the disease all across the Italian peninsula while also dropping it off in the many ports they had stopped at for provisions and rest. By March of the following year, the plague had reached the Mediterranean coasts of Spain. The whole of England was engulfed with the disease by 1349.

But this was just the first of many waves yet to come. According to scientific estimates, the Black Death continued to reemerge in cycles of 10 to 20 years for the next 4 centuries. Sometimes the cycles were shorter, other times longer. Venice would experience 22 outbreaks of the plague from 1361 to 1528, according to Brian Pullan in Wage Earners and the Venetian Economy, 1550-1630. The city later faced another plague eruption in 1575-1577 where 50,000 perished. 

In some cases, instead of growing weaker, the scourge maintained strength and grew even deadlier. From 1348 to 1665, London would suffer from 40 outbreaks, with each killing about 20% of its population. When it first struck the city in 1348, it took the lives of 40,000 Londoners within 18 months. In the 1665 Great Plague of England, it only took 7 months for 100,000 of London’s inhabitants to meet their doom.

Of course, there were many contingent factors at play that influenced the high number of fatalities. But the main point here is that infectious diseases can readily exploit changing human conditions in its capacity to kill, and it will keep on doing so again and again.

History hits back

The relatively recent 1918 flu pandemic, estimated to have killed around 20-40 million people, serves as the best historical example resembling our current predicament. It can tell us what to expect if we commit the same mistakes that led to the outbreak. 

Like the Black Death, the flu pandemic also occurred in waves, although in a much shorter time frame. It struck in 3 waves, with the second proving to be the most fatal and destructive of the 3. These fatal tides of flu, however, could have been easily avoided if certain political decisions were cognizant of the history of infectious diseases.

As the United States of America was preparing to join World War I, its officials decided that they needed to recruit more troops to its reserve. So in June 1917, a plan to build 32 large training camps, each big enough to house around 20,000-50,000 personnel, was passed. Things went as designed and were going quite well, until March 1918 when the encampment in Kansas reported 100 cases of flu among its ranks. This was the first wave of flu in ascendance.

But instead of taking this as a moment for pause and reconsideration, US government officials went ahead with their plans and sent more than a hundred thousand troops to Europe each month starting in May of that year. Sailing the Atlantic with the soldiers was the influenza virus, ready for a new lease on life in war-torn Europe.

Back in the US, cities planned mass-attended programs aimed at soaking Americans in patriotic zeal to rouse public support for its wartime efforts. Concerns that these might help spread the disease were easily quashed by the demands of war mobilization.

In Philadelphia, an ill-advised parade on September 28, 1918 pushed through, with an estimated 200,000 people in attendance. The city’s streets were packed with people of all ages, cheering the soldiers about to be sent abroad, drowning the city in a frenzy of applause and salutations. Two days later, the Philadelphia’s health director Dr Wilmer Krusen declared that the city was seized by an epidemic. By the next month, the city would be riddled with unburied corpses from flu fatalities. 

The parade in Philadelphia was one of the key events that ushered the deadliest wave of the flu. Had major cities heeded sound advice, canceled their celebrations, lengthened establishment closures, and instead enhanced public sanitation and information drives, the second wave’s impact would’ve been reduced to a considerable degree.

Willful ignorance of history coupled with the refusal to prioritize public health over military and economic policies created suitable conditions from which the flu would further proliferate and mutate.

A century later, history hits back hard at the modern world for refusing to learn. A second wave of COVID-19 infections are being reported in China and South Korea after both countries prematurely lifted their lockdown measures in favor of a hasty return to normalcy. Many other countries are also bound for another spell, with some already prepared and some still reeling from the initial devastation. (READ: As lockdowns lift, ‘second wave’ concerns grow)

Inaction at the interim

As proven many times, the negligence of history almost always leads to disaster. But what if we do learn from history and act accordingly – will it actually yield desirable results? The example of Vietnam concurs.

As the first country to have eradicated SARS back in 2003, Vietnam holds an impressive reputation for handling infectious disease outbreaks well. Their success can largely be attributed to the country’s ideological adherence to materialism both in science and history. 

True to form, Vietnam exceeded expectations yet again when they immediately acted decisively to contain SARS-CoV-2 after the first cases were reported within their borders. To date, there have been zero COVID-19 casualties in the country. 

Vietnam’s successful COVID-19 approach combines the use of modern technology with lessons from their past SARS experience, which World Health Organization epidemiologist Aileen Plant describes as “real, old-fashioned infectious disease containment.” Integrating online platforms such as Tik-Tok, Facebook, and Instagram into their national containment strategy helped the Vietnamese government spread important sanitation reminders and eased the implementation of their “old-fashioned” aggressive mass-testing and tracing efforts.

Unfortunately, not everyone followed Vietnam’s lead. 

After SARS subsided in the early 2000s, researchers immediately alarmed government agencies and private institutions that this could only be the first of many coronavirus outbreaks. They also knew that bats are reservoirs of the virus, and that more sampling and research are needed to ascertain future outbreak possibilities. 

As these scientists echoed their concerns, government officials and private medical institutions responded with a resounding yawn. Then 2020 came to validate their warnings. 

And yet, some politicians are still adamant at refusing to acknowledge history. Just recently, EcoHealth Alliance, a non-profit organization studying bat coronaviruses in China, had their research grants terminated by American president Donald Trump.

We lost valuable time doing nothing at the interim. The time between the SARS outbreak and today’s COVID-19 pandemic would’ve been enough to develop a pan-coronavirus inhibitor drug, or even better, a universal coronavirus vaccine. It was also enough time for us to have identified the likeliest hotspots for an outbreak, giving us the opportunity to conduct intervention initiatives.

And now that the coronavirus has taken a new and more virulent form, we can only rue the missed chances of having impeded COVID-19 from growing into a pandemic. Along with this regret is the frustration that hundreds of thousands have needlessly died from a preventable tragedy. Even greater is the feeling of extreme indignation, as governments are keen to commit the same mistakes done in the past for the sake of the economy. 

Rest assured that the economy will survive in one way or another. But many of those who mainly power it, the workers, won’t be. When the economy “reopens” workers will be exposed to conditions that greatly increase their risks of infection. History now confronts us: either we empower workers to become the waves of necessary change or we let them walk blindfolded towards the shore, only to be drowned in another wave of COVID-19. – Rappler.com

Pippo Carmona is a biologist and historian of medicine. He writes history and science ramblings in his blog, SCALPEN