From 1918 to COVID-19, world has been asleep on pandemic threats

If Rip Van Winkle, a fictional character from a famous short story, had gone to sleep at the height of the 1918 flu and woken up in the middle of the current coronavirus pandemic, instead of 20 years later, he would have noticed nothing had changed — except for the fortunes of the Trump family.

He would have noticed the same kind of panic, an equal amount of confusion and a similar helplessness among healthcare experts and governments. Surprised, he would have wondered, did nothing change in the past 100 years?

The 1918 pandemic, popularly but erroneously called Spanish flu (ispanka), hit the world in three waves. The first of these, in March, was mild and most people felt mildly sick and recovered. But, the virus that caused it became more virulent by August and returned with a vengeance, felling millions of people across the globe. By the time the third wave had receded, a third of the population had been infected and more than 50 million people had died, most of them in the 20-40 age group.

The trajectory of the illness now sounds familiar. It started with a sore throat, mild fever, and headache. In some people, it went on to cause pneumonia and, subsequently, death. Almost all the deaths were caused by inflammation of lungs — a result of build-up of fluids and destruction of tissues — caused by a cytokine storm, or opportunistic bacterial infections. Those with comorbidities like diabetes, tuberculosis, and heart disease suffered the most.

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In India, the pandemic was extremely ferocious. It raced across the country for almost a year and killed more than 12 million people. Among its famous victims was Mahatma Gandhi, who suffered a serious bout of diarrhoea and almost gave up on life. On the eastern edge of the country, Rabindra Nath Tagore lost several members of his family to the pandemic.

When the pandemic hit the world, like in 2020, nobody knew how to deal with it. The entity called virus — literally, something like poison — had not even been identified, so there was no scope for a treatment protocol. The pandemic was attributed to rats, bacteria, foul gases, and god’s wrath. Medics experimented with high doses of aspirin and anti-malarials (sounds familiar?). Others recommended treatments ranging from cigarette smoke and alcohol at the one end and ayurvedic vaccines and iodine at the other. But, in the end, governments were left with just one option — quarantining people and drawing sanitary lines, which, like in 2020, were flouted by people who believed the sickness would spare them.

The biggest effort was expanded on fighting over the origin of the illness. The British blamed the Germans, the Germans blamed the French and the Americans thought it had come from China. Research now points at three possible points of origin: the usual suspect China, a farm in Kansas, and a military base on the French-British border. But, Spain got inextricably linked to it for a weird reason — one of the most famous early victims was its king, Alfonso XIII.

Winkle would have seen a similar blame game between Donald Trump and China, a mad scramble for antimalarials and worldwide lockdowns and concluded that nothing has changed. That the current outbreak is not hurting children too much, like in 1918, would have been the only consolation.

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It is amazing, no? In one hundred years, the only thing that the governments could think of as a defence against a pandemic was just a lockdown, relying only on social distancing. And, the only thing medical science could throw at the new virus was a cocktail of untested drugs, including antimalarials like hydroxychloroquine.

Why did things not change in a century? The answer is simple: the world forgot the lessons of the 1918 pandemic. Instead of spending on healthcare and vaccines, governments across the world started diverting funds to other sectors. Spending itself on defence and creating value for businesses became the defining mottos of most governments and enterprises.

India, for example, spends just around 1.65 per cent of its GDP on healthcare, and around 2.4 per cent on its defence.

There have been warnings of several pandemics in the world. In the first twenty years of this century, the world has had outbreaks of Ebola, H1N1, Sars, Zika, and bird flu (H5N1). There may be a few more as global temperatures rise — they make viruses adept to higher temperatures — and natural habitats of birds and wild animals get destroyed. But, the 2020 pandemic has shown that global governments are just not willing to spend money on getting ready for a lethal pandemic. After every outbreak gets controlled, vaccines under development get shelved; the hunt for new antiviral medicines gets called off; and the world goes back to raising carbon emissions and destroying natural resources and habitats.

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The 2020 pandemic would hopefully have a lasting impact on healthcare policies. Countries like India would, maybe, realise that when you spend just a pittance on healthcare, a large amount of GDP gets wiped out within weeks because of lockdowns, medical emergencies, and disruption of supply chains. The goal now has to be healthcare for all, at affordable prices; and the motto, as the prime minister said, has to be: jaan hai to jahaan hai (the world exists only if you are alive).

In addition, governments across the world would have to realise that a pandemic doesn’t respect borders. A disease may start in China, or Kansas, but it will end up shrouding the world with death, sickness, and recession within weeks. So, as former prime minister of Britain Gordon Brown hopes, there will now be global efforts to deal with global problems like pandemics, global warming, and depleting water reserves.

Maybe, the world will realise it can’t go to sleep like Winkle for another 20 years.

P.S.: On waking up, Winkle would have noticed one big change. Trump’s grandfather, an immigrant from Germany, left behind a small fortune for the family after he died because of the 1918 flu. The immigrant’s widow and son invested the inheritance in real estate. The rest, as they say, is history.