Winter is coming.
In the early spring of 1918, the United States was mobilizing for World War I. Young men traveled from their hometowns to military training camps. But a new threat, essentially unknown to the nation in the pre-24-hour news-cycle age, began to emerge. It was a threat of infectious disease. Before it was over, a new strain of influenza would kill up to 100 million people worldwide.
1918 and 2020 are decidedly different times. The remarkable scientific advances of the 20th and 21st centuries, though founded in the early decades of the former, were yet to be realized in 1918. Molecular biology did not even exist. Nevertheless, lessons learned from previous epidemics, such as smallpox and cholera, had taught the scientific community about our microbiological foes. The field of epidemiology had been established. The concept of vaccination, while still in its infancy, was understood and had already demonstrated its usefulness in fighting smallpox, one of the plagues of the Middle Ages.
Yet the circumstances of the last great pandemic were not entirely unlike the current one. The viruses were different (influenza versus coronavirus), the technology was different and geopolitical issues related to World War I (which definitely contributed to the spread of influenza) have no counterpart in 2020. The differences largely stop there.
The “Great Influenza” of 1918, like the novel coronavirus that causes COVID-19, was a new lethal strain of an otherwise common type of virus. The new strain in both instances was previously unknown to humans and so all are susceptible. In both instances, transmission is known to be aided by human-to-human contact and respiratory transmission (think nose, mouth, lungs). In both instances, the most likely effective strategy at reducing spread is a combination of public health measures, ranging from physical distancing to avoidance of public gatherings, mask wearing and hand hygiene.
And in both instances, though significant on its arrival in the early spring, the virus surged the next fall and winter. The worst months of the 1918-19 flu pandemic were from October 1918 through March 1919.
Many factors can potentially explain this sudden rise in illness frequency and severity during the colder months, but the gathering of people indoors is certainly not least among them.
And so we find ourselves in the middle of our own pandemic – not unlike our great-grandparents’ generation (my father’s grandfather died suddenly in 1918 in the prime of his life, likely from flu). Now, as then, we are experiencing a surge in infections not just locally, but nationally and globally. Now, as then, we must redouble our public health efforts (avoidance of gatherings, physical distancing, mask wearing and hand hygiene). Now, as then, there is hope – perhaps more hope than could be gathered at this point in 1918.
While the coming winter months will likely bring more cases, they also likely will bring the promise of vaccines to combat the virus. While vaccines will not eliminate the need for public health measures, especially in the near term, they could offer a new tool to combat the virus.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.