By Deborah Prabhu
and Allan Bonner
Troy Media contributors
Where will the COVID-19 pandemic fit into history? What will be the lessons learned, if any?
Our guess is we’re learning how little we did to prepare and how much we’re guessing in response as we go along.
We had three pandemics in the 20th century.
The
Spanish Flu in 1918-20 probably killed as many as 100 million people.
We say probably because records weren’t accurate and the pandemic
happened in part during a war. The official death toll is about 40
million.
We
don’t see many popular culture references to this event – people
wearing masks in movies, newsreels or in photographs of the era. But
they did. A new biography of Ronald Reagan by Bob Spitz notes that even
in the small towns of the U.S. Midwest, masks were handed out but
usually only voluntarily worn. In passing, he notes that the Spanish Flu
killed 25 million people in three months. We’re nowhere near there yet.
The 1957-68 flu may have killed two million people and the Hong Kong Flu in 1968-69 may have killed about one million.
The World Health Organization has estimated that an avian flu might kill between eight million and 350 million people.
The
severe acute respiratory syndrome (SARS) event in 2003 was
statistically irrelevant with 8,000 cases worldwide and 800 deaths.
Two
million people die from diarrhea each year, more than 40,000 North
Americans die from ordinary flu, about 50,000 die on highways and
perhaps 5,000 die from food poisoning.
Very
few people died from a later bird flu – the toll was in the low
hundreds. We also had swine flu, avian flu, MERS and other smaller
events.
So
how little we prepared is easy to document. After all these events, we
were still shaking hands and crowding together. We did little to combat
regular flu or food poisoning, didn’t stockpile supplies, and the list
goes on.
These things were occasionally discussed in medical journals, documentaries and news reports, but then we went back to sleep.
Imagine
if we’d really attacked the annual flu or food poisoning with hand
washing, general cleanliness, mandatory shots and so on.
Imagine
if we’d required workers in hospitals and seniors centres to use new
scrubs when arriving for a shift, not wear them on the streets, and only
work in one facility. An old study in United Kingdom hospitals notes
how filthy physicians’ ties and pagers were, to the point that ties were
banned. Other studies show how infrequently lab coats are washed.
Other
preventive measures might have included getting off high-fructose corn
syrup, improving diet in other ways and taking other dietary
precautions, improving and promoting better general health, and using
new, wearable technology to monitor blood pressure, respiration and
other health indicators.
Why
didn’t cities, hospitals, states, provinces, national governments and
others stockpile enough personal protective equipment for this event?
Masks, gowns and gloves aren’t that expensive.
Why don’t urban emergency plans feature more pandemic advice?
Many don’t mention the word.
What
were the plans in cities for remote working, cleaning transit vehicles,
using vending machines for food, handling retail sales on sidewalks and
so on?
Why did we keep using fragile supply chains and just-in-time delivery?
We manufactured our own shortages.
We could have banned the international trade in exotic animals for pets and eating.
In
the same way that our foreign policy tries to promote democracy and
governance issues around the world, we could have also promoted
sanitation.
That’s all evidence of a lack of preparation.
As
for the information we’re receiving, a lay person could be forgiven for
assuming that experts are guessing. We’ve seen models predicting
American deaths ranging from 38,000 to 2.5 million. That’s too broad a
range for a scientist to express without significant contextualization.
Let’s look at British epidemiologist Neil Ferguson’s predictions for past events and this pandemic.
In
2005, an epidemiological model by Ferguson predicted that bird flu
might kill 200 million worldwide. The death toll four years later was
282.
On
his advice, during the swine flu epidemic, the U.K. government
indicated that Britain’s “worst-case scenario” was that the disease
would claim 65,000 lives. The death toll was 457.
Some years before, he feared deaths from mad cow disease would reach 50,000. The actual number was 177.
In
a paper he co-authored paper in March, Ferguson and his colleagues
estimated the COVID-19 pandemic would result in “approximately 510,000
deaths in G.B. and 2.2 million in the U.S.” That prediction was based on
the assumption that only drug-free interventions were being used.
We
always knew the big risks: animal-to-human transmission and then
human-to-human. We also knew the impact of a new strain, rendering
current drugs ineffective.
All
this has come to pass with the current pandemic. But why have
predictions on impact been so broad and so off the mark (thus far)?
There
have been improvements in science and public health over the last
century. The flu virus wasn’t isolated in a lab until long after the
Spanish Flu, so there were lots of guesses. Guesses included that the
flu was spread by musty books.
We
now have better sanitation, hand-washing and fitness. But diet,
including obesity and other pre-existing conditions, may be worse.
The
Spanish Flu was spread in part by soldiers crammed into close quarters
and the Hong Kong flu was spread in part by soldiers returning to the
United States from Vietnam.
That’s
not happening now. But we have an aging and thus more vulnerable
population and seniors homes are a relatively new way of housing this
population. They’ve been hard hit.
There
may be some immunity to certain strains of flu for those who have lived
through the pandemics of 1957 and 1968, and even the smaller events
such as swine and avian flu. That may mean that the healthy group of
teens who seem to be shunning preventive measures could be at greater
risk. There’s more travelling these days, and a virus catches a ride on
an airplane instead of a slow boat.
With
all those variables, it’s a wonder any prediction is even close to
accurate. But there’s another challenge, and that’s with modelling
methods.
There’s
a trend to using computer models and engineering techniques to predict
future impact. This makes sense. We can’t infect real people to see what
happens.
But
many of the models assume an outcome based on current behaviour and
events. We highly suspect that behaviour and events will change. We know
this from other models. Media reports, social cues – what your friends
and neighbours are doing – and many other variables affect outcomes.
A
scientific model has to make certain assumptions. But those
assumptions, like product labelling, should be front and centre in the
publication of models. Some models assume all variables remain constant,
which isn’t going to happen. Other models assume behaviour in one
country will be mirrored in another, and that’s also not going to
happen.
Pollsters
provide product labelling. If they don’t, their work is subject to
ridicule. A poll is a snapshot in time but time is marching on with all
variables changing. Pollsters remind consumers that the poll is only
accurate within four percentage points, 19 times out of 20. They also
publish the sample size and whether they interviewed people in person,
on the phone or via the Internet. All these methods can make a
difference.
Unfortunately,
when scientific models are translated from medical journals to daily
newspapers, any disclaimers seem to be downplayed. And some researchers
like to get into the daily press and may highlight scary findings, but
not be good at contextualizing them. The result is now a lack of trust
in these scientific findings.
That
lack of trust is translating into a lack of compliance. Pandemic
infections and deaths are rising in several U.S. states that have opened
up too soon. How this will impact the trust in elected and appointed
officials remains to be seen, but it’s not good news in a democracy.
Dr.
Deborah Prabhu, MBBS, graduated with distinction as a physician and
worked in medicine in India before moving to Toronto. Dr. Allan Bonner,
MSc, DBA, is a crisis manager based in Toronto.
