Ebola and the 1918 Influenza Pandemic--What’s in Common?
Although there are some striking differences between what happened in 1918 (regarding the Influenza pandemic) and what has thus happened with Ebola in 2014, there are, amazingly, a number of interesting similarities. Of Course, no one knows what role Ebola may yet play in the next 5 years (possibly disappearing for another long period or possibly mutating into something as lethal as the flu virus of 1918) but one thing can be relied upon: Ebola is going to be around for years to come.
Even without being able to tell what Ebola will do in the future, one can certainly make comparisons based on what has already happened. The 1918 flu pandemic (apparently forgotten by many people) has much to teach us about infectious diseases. Although some people think that what happened then is not likely to happen today (because, supposedly, we at least know about viruses and what can be done to fight them), what they forget is that in some ways we are actually worse off when it comes to staving off a possible pandemic.
For one thing, we are now better connected geographically than ever in terms of commercial air, sea and over-land travel. Thanks to avionics, for example, there is no such thing as a completely "remote" region. Not only that, but our economies are too intricately and intimately tied for countries to easily and quickly isolate each other--assuming the need arose for such drastic action.
Yet, that would be the only way to effectively stave off a pandemic.
Other things to keep in mind are the following 10 connection-proving realities regarding the 2014 Ebola outbreaks and the flu pandemic of 1918:
1. They both involved a highly infectious/contagious (zoonotic) virus that leads to human disease with high mortality rates. Of course, not all viruses lead to (in fact, most don't) human disease. Those that do, however, are usually difficult to treat, difficult to diagnose (since they can't even be seen by the strongest microscopes), and usually involve changing pathogenic circumstances (because of mutation and evolution).
2. Both were greatly underestimated. When the flu strain started wreaking havoc in the medical community, action against the threat was sporadic, disorganized and poorly-coordinated. Of course, back then doctors didn't even know that the disease was caused by a virus; additionally, the public health system was in disarray. While some things have improved since then, the response that has been mounted against Ebola, some people would say, has been equally poorly-coordinated. Perhaps too confident that the disease was definitely not airborne (in spite of incomplete scientific certainty to that effect when the outbreaks were first recognized), authorities have, at best moved lackadaisically against the outbreaks (at least in the US).
3. Both may carry long-term, on-going medical ramifications for survivors. Some people think that survivors of Ebola (or of the flu strain seen 1918) are completely out of danger if they survive the incubation period. There is scientific evidence, however, that suggests otherwise--albeit some of this "evidence" is merely anecdotal. Some people, for example, posit that President Woodrow Wilson was never the same after catching (and luckily surviving) the flu. Historical medical records show that some people, having had their immune systems weakened, succumbed to other infirmities (e.g., pneumonia) after overcoming (and sometimes while experiencing) the flu. Survivors of Ebola have sometimes complained of things like hair loss, sensory changes, and some inflammatory disorders; actually, other medical issues may develop subsequent to or because of the anatomical/physiologic burdens inflicted by Ebola.
4. Both can easily be confused with other ailments, have led to wrong diagnoses, and may not even be properly identified as the cause of death (in some cases). This was a huge problem in1918, as doctors struggled to determine exactly what it was they were dealing with--especially since the symptoms mimicked other common-at-the-time medical problems. Ironically, Ebola can easily be confused with the flu. In third world countries (which lack the expertise and facilities available in developed countries) the problem is even worse, especially in terms of diagnostics. It's suspected, for example, that some of the people who have died from Ebola were probably not diagnosed accurately (instead being officially listed as having died from other causes)--meaning that the fatality rates thus far reported are probably higher than meets the eye.
5. Both were to be ideally treated with vaccines. Finding a vaccine, however, can be a very time-consuming process; even when one is found that is relatively safe, affordable and fairly proficient, it is not likely to afford life-long protection from all strains/types of hemorrhagic fever disease pathogens.
6. The symptomatology of the two are every similar, especially in the more severe or peculiar cases. Both, for example, produce pervasive body aches, joint discomfort, fatigue, stomach/digestive issues, eye problems, body rashes, fever, chills, and even bleeding (sometimes, for the flu, caused by subcutaneous emphysema and lack of oxygen to the integumentary system and the organs).
7. Both took the world by almost complete surprise. Even though Ebola has been around since the70s and 80s (and probably even much farther than that, according to some bio-historians), it came as "news" to many people (some of whom had never heard of it) when the outbreaks in Africa were finally given the lime light they merited. When the flu broke out in 1918, people were preoccupied with WWI and other major events of that era; the flu, in other words, wasn't really paid the attention it deserved until the outbreaks eventually turned into out-of-control epidemics. Today, people have been equally distracted by many other things, even if a world war is not (yet) going on.
8. Both have shown that developed countries are grossly unprepared for a highly-infectious airborne disease. No, Ebola has not been declared airborne but, had it been, it would have most probably gotten out of control very quickly. After all, people who had been working with Ebola-infected patients (or even who had been diagnosed with the virus) were not properly isolated or quarantined--some were even allowed to travel around as if Ebola were a predictable/stable pathogen (even though it is not). In 1918, the same kind of careless, negligent attitude led to millions of dead victims. Medical systems in 1918 were quickly overwhelmed and Ebola has shown (in some people's opinion) that the same would probably happen today if a pathogen as infectious as the flu virus of 1918 made an appearance today.
9. Both disrupted global economies in significant ways. There is no telling how much business Africa has lost (in tourism alone) because of Ebola--even in African countries not yet affected. Even though no epidemic has erupted in the US (though they cannot be discounted in the future), the American economy has also taken a big hit. Many people, for example, have been afraid to fly (especially to African countries) because of fear of Ebola. The US will also be forced to spend millions on Ebola-related foreign aid, prevention equipment/training (for US hospitals, etc.) and the development of medicines to treat Ebola. This is money that could have been used for other perhaps more financially lucrative purposes.
10. They both involved viral diseases featuring an over-reaction of the immune system. This partly explains why, for example, the 1918 flu killed mostly people in the prime of their lives (as opposed to hitting primarily the old, immune-compromised and already-sick); after all, the healthy and young, having the strongest immune systems, were prone to have the strongest types of over-reaction of the immune system. Both the flu and Ebola viruses overwhelm the immune system which, in turn, becomes its own worst enemy (something these viruses count on in their "strategies" of pathogenicity--not bad for essentially brainless microorganisms!).
Conclusion
There are many differences between the flu pandemic of 1918 and the Ebola outbreaks/epidemics of 2014. Fortunately, for example, Ebola has not infected (nor has it killed) as many people as the flu did in 1918. Also, the fact that the flu was airborne made the virus much easier to transmit, more difficult to stop, and, finally trickier to treat, once it was properly identified as a ruthless killer.
In spite of the differences, however, the similarities cannot be ignored. In fact, it's the similarities that perhaps can teach us the most--not the least of which is the fact that these infectious viruses cannot be underestimated. Any virus with high infectiousness or contagiousness needs to be treated with the utmost respect.
To that end, containment protocols need to be developed that can be implemented quickly and effectively. Failure to do so can easily--to put it mildly--lead to far-reaching and expansive devastation. If nothing else, the flu pandemic of 1918 proved that fact beyond a shadow of a doubt!
Copyright, 2014. Fred Fletcher. All rights reserved.
References and Resources
1. http://www.nytimes.com/2014/04/30/science/in-1918-...
2. http://www.sciencedaily.com/releases/2007/01/07011...
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC200252...
