Medical History

Lessons From Past Pandemics Can Provide a Road Map for the Future

Every pandemic reveals more than it creates.

By David Hackett April 27, 2020

Image: Shutterstock

Looking through the prism of history for perspective on the COVID-19 pandemic, eyes have focused on the Spanish Flu of 1918-19, which infected one-third of the world’s population and killed 50 million people, including 675,000 Americans. But two other pandemics, both nearly forgotten, offer both striking parallels and sharp distinctions to our current plight.

 The Asian Flu of 1957-58 killed more than 1.1 million people globally and 116,000 in the United States, mostly children and the elderly, according to the Centers for Disease Control. A decade later, a new virus strain, the Hong Kong Flu, claimed 1 million deaths worldwide and as many as 100,000 in the United States, also mainly children and the elderly, the CDC says. That contrasts to the Spanish Flu, which was especially lethal for people in the primes of their lives, between 20 and 40. (As of April 27, about five months into the COVID-19 pandemic, there have been 3,017,806 confirmed cases of COVID-19 and close to 210,000 deaths globally. The U.S. is closing in on 1 million COVID-19 cases and more than 56,000 deaths.)  

Even if you were alive in the years of the Asian and Hong Kong pandemics, you might not have much, if any, memory of them. In 1957, the biggest stories involved the Cold War, the civil rights fight in Little Rock, Arkansas, and, upliftingly, the first year a vaccine for polio was widely available. The Hong Kong Flu of 1968 has largely been forgotten in a tumultuous year that included the assassinations of the Rev. Martin Luther King Jr. and presidential candidate Robert F. Kennedy, and a nation mired in the Vietnam War. In contrast to the COVID-19 pandemic, the country continued to operate as normal. In 1968, for example, the nation’s gross domestic product increased by 4.9 percent and the unemployment rate was 3.4 percent.

“There were no social distancing recommendations from the government, closures of public spaces or mandatory business closings in either of those pandemics,” says Jacob Steere-Williams, a professor at the College of Charleston who specializes in medical history. “If you were sick, you were told not to come to work or to stay home from school. That was about the extent of the warnings.”

Steere-Williams says that after the Spanish Flu, it took decades for scientists to realize that the influenza virus was constantly changing and that a new strain could produce another pandemic—as it did in 1957 with the Asian Flu.

History might have recorded a much different outcome from that pandemic if not for the heroic efforts of a microbiologist named Maurice Hilleman. When cases of the 1957 Asian Flu began to spread, Hilleman recognized it could become a pandemic. Hilleman, then chief of the department of respiratory diseases at what is now Walter Reed Army of Institute of Research, found that the only people who had antibodies to the virus were elderly survivors of another pandemic, in 1889.

Then, like now, some leaders in the United States dismissed warnings of a pandemic. According to a 2019 article in the University of Chicago Magazine, both the U.S. Public Health Service and the military’s Influenza Commission called Hilleman “crazy.” Undeterred, Hilleman developed a vaccine and worked directly with six U.S. manufacturers to mass produce it, bypassing entirely the U.S. vaccine regulatory agency.

His genius did not stop there. Growing up in a farm in Miles City, Montana, Hilleman knew that farmers killed their roosters in the fall—but he persuaded farmers to keep their roosters alive to help produce the millions of fertilized eggs needed to incubate the virus and make a vaccine.

 The result was that, by the late fall of 1957, when the Asian Flu was striking the United States, the nation had 40 million doses of vaccine. The virus claimed 70,000 lives, but the toll may have been 1 million deaths without Hilleman’s efforts, the University of Chicago Magazine reported.

Just over a decade later, the Hong Kong Flu began to spread into a pandemic. As with the Asian Flu, the Hong Kong Flu offers striking similarities and distinct differences to the COVID-19 outbreak—as well as a warning about what may be to come. The Wall Street Journal reported that one of the first cities engulfed by the Hong Kong Flu was Wuhan—the same Chinese city in which COVID-19 started—“before racing across the globe on commercial flights and ships, eventually killing more than 1 million people, over 100,000 of them in the United States.” Infection spread to Vietnam and, in a dose of morbid irony, some U.S. soldiers carried it with them when they returned home.

Like now, and unlike the Asian Flu in the 1957, no Maurice Hilleman was standing in the way with millions of vaccines. The Hong Kong Flu, according to the Wall Street Journal, triggered a state of emergency in New York City and half the workforce in France was disabled. The Hong Kong Flu killed 60,000 in the then-divided German nations; there were so many corpses that garbage collectors were called in to bury the dead. That contrasts to COVID-19, in which Germany’s social distancing and testing efforts limited the death count to under 6,000 through April 26. The country is moving toward reopening.

 The Hong Kong Flu also offers one striking dissimilarity to the current pandemic—and another critical unknown.

Despite the massive number of infections and deaths, the Hong Kong Flu did not dominate the news cycle. There was no social distancing, but nor was there a cacophony of disparate opinions on social media or gun-toting protesters gathering on town squares. 

“People got their news from the newspaper,” Steere-Williams says. “They weren’t inundated with images from overrun hospitals or constantly updated death tolls. There was much more trust in the scientific community.”

Death, in those years, was also filtered through a hardened perspective. Medical historian Malte Thiessan told the Wall Street Journal that German authorities played down the Hong Kong Flu pandemic because it mainly affected the children and the elderly. Just a quarter-century removed from the horrors of World War II, tens of thousands of lost lives did not resonate as deeply.

A vaccine against the Hong Kong Flu took more than a year to develop and mass produce. In its absence, a second wave of the virus, which hit in 1969-70, proved deadlier in many nations than the first wave. The virus was mitigated by immunity some people still had from the Asian Flu a decade earlier, as well as antibiotics and improved medical care in general. Still, that possible parallel amplifies the warnings from Dr. Anthony Fauci and others that, absent a vaccine, we should prepare for a second wave of the COVID-19 virus.

Steere-Williams says a career studying maladies such as the influenza pandemics has taught him to question everything. For example, the CDC reports that 100,000 Americans died from the Asian Flu. Other estimates say 70,000. The CDC also reports that 100,000 Americans died from the Hong Kong Flu, but the Neiman Foundation says it was 33,500.

“I pretty much look at every number out there as being wrong,” he says.

 Steere-Williams is convinced, however, that every pandemic “reveals more than it creates.” In the case of COVID-19, the virus has exposed the nation’s political polarization, pitting scientists against government leaders and their followers, who claim the threat is overstated or even a hoax.

But perhaps the most important lesson that previous pandemics tell us is that, even when a vaccine is discovered and distributed to contain COVID-19, another strain of the ever-changing influenza virus is lurking on the horizon, ready to challenge assumptions, reveal our divisions and call forth our scientists and government leaders to win another battle against a microscopic-sized enemy.

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