A history of pandemics: Lessons we can learn from the past

Oh, how our world has changed over the past 3 months since the publication of our February issue! The world as we knew it then has been put literally “on hold” since mid-March. The dental hygiene profession too has been put “on hold” and fear has set in as to what the new “normal” will look like. I keep hearing that the world has never experienced anything like this before, yet history tells us otherwise. Epidemics and pandemics have been documented since ancient times; more recently, the world has experienced the SARS outbreak (2003), followed by H1N1, Ebola, and Zika outbreaks.

Communicable diseases have been in existence since the days of the hunter–gatherers more than 10,000 years ago but were contained within their nomadic circles. However, when civilizations shifted to a more agrarian lifestyle, with land cultivation and the emergence of more structured communities, diseases such as malaria, leprosy, influenza, tuberculosis, and smallpox began to appear. Yet epidemics were still largely containable as there were not a lot of mechanisms for travel to other countries and continents. Changes began to take place as early as 430 BC in Athens, during the Peloponnesian War, when the earliest recorded actual pandemic occurred, spreading from Athens to Libya, Ethiopia, and Egypt, killing almost two-thirds of the population in those countries. ¹

As larger cities developed, plagues began to appear. In 1350, the Black Death was responsible for killing one-third of the entire world population. ¹ In 1665, the bubonic plague appeared in London, followed by 7 major cholera pandemics beginning in 1817, which eventually spread worldwide. Together the bubonic plague and cholera killed millions. ¹ The most noteworthy large-scale pandemic that occurred closer to our modern day was the Spanish flu of 1918–19, which manifested at the very worst time possible when the world was engaged in the First World War. This avian-borne flu was responsible for infecting over 500 million people worldwide and taking over 50 million lives. ^1,2 It was thought to have begun in Madrid, thus it became known as the Spanish flu. Interestingly, there have been reports that it actually began in Kansas and was spread by soldiers who travelled to Europe, Asia, and beyond. Spain was neutral during the war and thus had no reporting restrictions, unlike the countries at war, whose media were forbidden to report on anything that could distract from the war effort. ²

Closer to home, Canada was struck particularly hard by the Spanish flu, losing approximately 55,000 people to the virus, in addition to the loss of nearly 60,000 soldiers over the course of the war. ³ The Spanish flu was definitely a wake-up call for Canada, and it resulted in the creation of the Federal Department of Health in 1919, making public health a shared responsibility of local, provincial, and federal governments. For the first time, the state assumed a prominent role in ensuring the health and well-being of Canadians. ³

Salme E Lavigne

The Spanish flu arrived through the port cities of Halifax, Quebec City, and Montreal, and then made its way west across the rest of Canada. The first wave occurred in spring 1918 and spread rapidly as no quarantine measures were put in place, although government officials prohibited public gatherings and isolated the sick, but with little effect. As infections increased, the work force began to diminish, with health care workers being hit the hardest and the economy paralyzed. Little did they know that a second, much deadlier wave would arrive in fall 1918. Cases had dropped during the summer and the world thought the worst had passed. However, it was literally “the calm before the storm.” ² The virus had mutated, re-emerging as an even more virulent strain, and rapidly spread once again throughout the world, largely attributed to the global movement of soldiers. This second wave had no mercy, killing the young, the old, and those in between. ² Blame was placed on both government and public health officials in North America and Europe, who were unwilling to impose a quarantine, given that they were still at war and needed their munitions factories to remain open. ² Another cause of their lack of containment of the virus was that science had not progressed enough to even identify a virus through a microscope, so they had neither the knowledge nor the technology to find a vaccine or a cure. In fact, they believed the cause of the outbreak to be a bacterium, Pfeiffer’s bacillus. After an enormous global death toll from the second wave, 2 more waves of the pandemic occurred in spring and fall 2019, but fortunately were not as severe as the second wave. This was most likely due to the end of the war, resulting in less movement of the world population.

I could not help but draw some comparisons to what went on during the Spanish flu just over 100 years ago with what is going on today with COVID-19. Interestingly, both manifest as severe lung diseases resulting in pneumonia and patients literally “drowning in their own fluid filled lungs,” unable to breathe. ² The Spanish flu, however, was an H1N1 infection unlike the current coronavirus. The lack of knowledge about quarantining the population most likely played a major role in the severe death toll and recurring waves of infection back then. As I watch the news and hear about people resisting the use of face masks today, the same thing occurred during the Spanish flu, particularly in the United States where people argued that it was against their civil rights to be forced to wear a mask! ² Does this sound a bit familiar? Nonetheless, most people complied with the mandate to wear a mask, which unfortunately may not have been very effective because even surgical masks in those days were made of gauze—hardly able to filter out most microbes let alone very tiny viruses.

I cannot help but be thankful that we are now in the year 2020 and not 1918, when the identification, study, and treatment of viruses was still in its infancy. While the global nature of today’s society may be the reason the coronavirus outbreak became a pandemic so rapidly, we do now have the benefit of a worldwide army of excellent, experienced medical scientists and epidemiologists who are working together to find a vaccine and explore ways to cure or, at the very least, minimize the effects of this illness.

In Canada, I feel we are particularly fortunate to have excellent public health and health care infrastructures that have risen to the challenge of guiding us through these unsettling times with remarkable speed and professionalism. With mandated quarantines and self-isolation, hand-washing and physical distancing reminders on a daily basis, along with the cooperation of the majority of Canadians who are following the advice of our experts, we are in a much better position to fight this invisible enemy than many other countries. This silent invader is relentless, so for now, we must continue to be vigilant and continue to take very small steps forward and listen to our medical advisers and scientists. The coronavirus is not going away any time soon and, until we have sufficient testing and contact tracing in place, it will be difficult to move forward in a significant way. The most important lesson we should learn from history is the real possibility of a second or even third wave if we let down our guard too soon.

As frustrating as life is at the moment, particularly with the near shutdown of our economy, let’s think about how fortunate we are to be able to communicate and remain connected with our families, friends, and colleagues through a variety of media, such as FaceTime, video conferencing, email, and social media. In addition, we are inundated with local, national, and global news on a continuous basis through print publications and television broadcasting. Can you imagine how horrible it must have been ,100 years ago to not have any means of electronic communication? Although telephones were invented in the late 1800s, widespread distribution for domestic use did not occur until after 1920. Similarly, radios were introduced into Canadian homes around 1920 and televisions did not appear in people’s homes until the 1950s. Thus, the only source of information in 1918 to keep people informed about the pandemic was the newspapers! I am grateful for all of these “luxuries” we now enjoy and for the wonderful health care workers, scientists, and other essential workers who are helping to keep us healthy and making our lives better during these challenging times.

Finally, I recognize what a difficult time this has been for our profession financially and the many obstacles that will have to be overcome as dental hygienists slowly and incrementally return to work. I am sure you are aware that the workplace will be significantly different moving forward, particularly prior to the availability of a vaccine. Please ensure that you stay updated with and follow the latest recommendations from your professional association and provincial regulatory authority. Unfortunately, you may find that some employers wish to cut some corners that may put you and your clients at risk. Stand firm, stay safe, and stay vigilant! We can overcome this crisis together if we all follow the rules and listen to the experts. Keep in mind that “this too shall pass.”

You may not always have a comfortable life. And you will not always be able to solve all the world’s problems all at once. But don’t ever underestimate the impact you can have, because history has shown us that courage can be contagious,and hope can take on a life of its own.

—Michelle Obama