Table 4.

Previous Pandemics

Pandemic	Organism	Impact	Lessons Learned
1918 Spanish Flu	H1N1 Influenza	50,000,000 deaths	Secondary bacterial infection was a leading cause of mortality including healthcare workers who were at risk and suffered increased mortality
2003 SARS	SARS-CoV-1 Coronavirus	744 deaths	WHO International Health Regulations for prompt coordinated global alerts and action
			Highlighted weakness in healthcare infrastructure
2005 Avian Flu	H5N1 Influenza	<1,000 deaths	Updated WHO Pandemic Preparedness
			US Department of Health and Human Service’s Pandemic Influenza Plan established guidelines for local, state, and national agencies
2009 Swine Flu	H1N1 Influenza	151,700–575,400 deaths	WHO defined requirements for “Pandemic”*
			Importance of PPE (N95)
			Highlighted lack of hospital infrastructure
2015 Zika Virus	Zika Virus	2,656 cases of microcephaly	Need for government support for long-term funding to allow companies and research institutes to develop vaccines and clinical trials
			Need for proactive investment versus reactionary investment during outbreaks
2019 COVID-19	SARS-CoV-2 Coronavirus		Expedite drug approval via FDA
			Enact Defense Production Act to expedite production of needed supplies
			Expand COVID-19 rapid testing
			Close borders early to visitors from all affected countries as well as Canada and Mexico
			Enact coronavirus economic stimulation plans to buffer and later restore the economy

*New virus emerges in humans, minimal or no population immunity, causes serious illness with high mortality/morbidity, spreads easily from person to person.

FDA, Food and Drug Administration.

From Kilbourne¹⁸ and Madhav et al.¹⁹