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As the COVID-19 pandemic has worsened rapidly over the past few weeks, comparisons have been made with the great influenza pandemic of 1918, with people asking “Are we about to see a repeat of that global disaster?” History doesn’t actually repeat: it only appears to. Different circumstances will produce different outcomes in different places, even from the same infectious disease.

Here in New Zealand we have been better prepared than most countries for a pandemic, with a comprehensive and recently updated plan for influenza. So far the government and Ministry of Health have been guided by that plan, and have mounted a measured step-by-step response, aimed at ‘flattening the curve’ of cases. Some of us had been asking for an earlier school closure, but as soon as there was clear evidence of community spread the authorities announced a Level 3 emergency and moved within 48 hours to a complete Level 4 lockdown. One of the big lessons of 1918 had been applied: respond quickly or it will run away out of control.

Some countries had not learned that lesson. The forecasts for the UK and North America are grim, because they failed to take the threat seriously enough or respond early enough. A week is a long time in a pandemic, as Wellington discovered in November 1918, when delay proved dangerous and resulted in a death rate nearly twice that of Christchurch.

So far New Zealand appears to have mainly done the right things, and in a reasonably timely fashion. Our leadership so far has been superb. But our pandemic planning was done mainly with influenza in mind, and here we are confronted by a novel coronavirus. In the race to find a vaccine the scientific world is quickly finding out a lot more about the virus itself, but we don’t really know as yet how this particular virus will behave as it passes through large populations. COVID-19 is highly infectious, with high case fatality for the elderly.

The 1918 A/H1N1 influenza pandemic saw three distinct waves across 18 months. The first wave was quite mild, a doctor’s delight: “many people sick, not many dying”. But the second wave later in the year was much more severe and killed an estimated 50 million people. The third wave in 1919 was less severe, and did not affect all countries equally. Australia came through with a very low death rate, whereas some regions in Japan suffered losses almost as bad as in 1918.  

Will this COVID-19 pandemic be all over in one wave, or will it recur? The 1889–94 ‘Russian’ flu pandemic kept coming back in successive waves, but with declining death rates and a low overall mortality of only about one million. We are in uncharted waters with COVID-19. Computer modelling has been exceptionally helpful in predicting the short-term curve, based on normal epidemiological patterns, the reproduction rate of the virus, and the effect of mitigation measures. We can only hope that this virus stays stable and does not start transmuting into anything nastier.

In some respects COVID-19 is already much nastier than flu for the elderly. The 1918 virus tended to produce secondary infections of bacterial pneumonia, and most people had a fighting chance of recovering from that, but COVID-19 seems to penetrate much deeper into the lungs, causing destructive viral pneumonia. As patients become breathless, they lack oxygen, and need mechanical respiration in order to survive.

We have all been shocked by the scenes in hospitals in Northern Italy, where predominantly elderly patients have been dying in large numbers. In Spain old folks have been left to die alone. Though India has at last moved to a lockdown, it remains to be seen how that vast population will cope with rapidly escalating infection rates, and the possibilities for much of Africa are almost too terrible to think about. Nick Wilson’s modelling now warns that if the present strategy fails New Zealand could be facing a very severe outcome, with 8,000 to 14,000 deaths. But China has shown that drastic measures can eliminate the infection.

Whether this pandemic comes to be called ‘the Exodus of the Elderly’ or ‘the Pensioners’ Plague’ is up to some future historian to decide, but one thing is starkly clear at this point. If present measures fail, this could be the most severe test our hospital system has ever had to face. Doctors and nurses, ambulance paramedics and rescue helicopter staff are our front-line fighters, supported by an army of orderlies, aides, carers and other staff. Retired medical personnel are now coming forward, as in the UK, to bolster the response. In 1918 many doctors and nurses caught the flu, and over 50 of them died.

In Italy and Spain people have been clapping to show their appreciation for the desperate efforts of hospital staff. We must work harder to ensure that things don’t get that bad here, but whatever happens we will certainly owe our medical sector enormous gratitude. ‘Elimination’ is now the goal and staying at home is the best way the rest of us can help to ‘break the chain’ and ensure that our hospital system does not collapse under the strain. Yet that also reduces herd immunity, and increases the prospect of reinfection if elimination fails, before a vaccine becomes available. This may only be the start of a prolonged crisis, in which our resilience and ingenuity as a nation is put to the test.

‘Kia kaha’. We are all in this together.

Dr Rice is Emeritus Professor of History at the University of Canterbury and author of Black November: the 1918 Influenza Pandemic in New Zealand (second edition, 2005), Black Flu 1918: the story of New Zealand’s worst public health disaster (2017) and That Terrible Time: Eye-witness Accounts of the 1918 Influenza Pandemic in New Zealand (2018).

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Acknowledgements

Correspondence

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Correspondence Email

geoff.rice@canterbury.ac.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

As the COVID-19 pandemic has worsened rapidly over the past few weeks, comparisons have been made with the great influenza pandemic of 1918, with people asking “Are we about to see a repeat of that global disaster?” History doesn’t actually repeat: it only appears to. Different circumstances will produce different outcomes in different places, even from the same infectious disease.

Here in New Zealand we have been better prepared than most countries for a pandemic, with a comprehensive and recently updated plan for influenza. So far the government and Ministry of Health have been guided by that plan, and have mounted a measured step-by-step response, aimed at ‘flattening the curve’ of cases. Some of us had been asking for an earlier school closure, but as soon as there was clear evidence of community spread the authorities announced a Level 3 emergency and moved within 48 hours to a complete Level 4 lockdown. One of the big lessons of 1918 had been applied: respond quickly or it will run away out of control.

Some countries had not learned that lesson. The forecasts for the UK and North America are grim, because they failed to take the threat seriously enough or respond early enough. A week is a long time in a pandemic, as Wellington discovered in November 1918, when delay proved dangerous and resulted in a death rate nearly twice that of Christchurch.

So far New Zealand appears to have mainly done the right things, and in a reasonably timely fashion. Our leadership so far has been superb. But our pandemic planning was done mainly with influenza in mind, and here we are confronted by a novel coronavirus. In the race to find a vaccine the scientific world is quickly finding out a lot more about the virus itself, but we don’t really know as yet how this particular virus will behave as it passes through large populations. COVID-19 is highly infectious, with high case fatality for the elderly.

The 1918 A/H1N1 influenza pandemic saw three distinct waves across 18 months. The first wave was quite mild, a doctor’s delight: “many people sick, not many dying”. But the second wave later in the year was much more severe and killed an estimated 50 million people. The third wave in 1919 was less severe, and did not affect all countries equally. Australia came through with a very low death rate, whereas some regions in Japan suffered losses almost as bad as in 1918.  

Will this COVID-19 pandemic be all over in one wave, or will it recur? The 1889–94 ‘Russian’ flu pandemic kept coming back in successive waves, but with declining death rates and a low overall mortality of only about one million. We are in uncharted waters with COVID-19. Computer modelling has been exceptionally helpful in predicting the short-term curve, based on normal epidemiological patterns, the reproduction rate of the virus, and the effect of mitigation measures. We can only hope that this virus stays stable and does not start transmuting into anything nastier.

In some respects COVID-19 is already much nastier than flu for the elderly. The 1918 virus tended to produce secondary infections of bacterial pneumonia, and most people had a fighting chance of recovering from that, but COVID-19 seems to penetrate much deeper into the lungs, causing destructive viral pneumonia. As patients become breathless, they lack oxygen, and need mechanical respiration in order to survive.

We have all been shocked by the scenes in hospitals in Northern Italy, where predominantly elderly patients have been dying in large numbers. In Spain old folks have been left to die alone. Though India has at last moved to a lockdown, it remains to be seen how that vast population will cope with rapidly escalating infection rates, and the possibilities for much of Africa are almost too terrible to think about. Nick Wilson’s modelling now warns that if the present strategy fails New Zealand could be facing a very severe outcome, with 8,000 to 14,000 deaths. But China has shown that drastic measures can eliminate the infection.

Whether this pandemic comes to be called ‘the Exodus of the Elderly’ or ‘the Pensioners’ Plague’ is up to some future historian to decide, but one thing is starkly clear at this point. If present measures fail, this could be the most severe test our hospital system has ever had to face. Doctors and nurses, ambulance paramedics and rescue helicopter staff are our front-line fighters, supported by an army of orderlies, aides, carers and other staff. Retired medical personnel are now coming forward, as in the UK, to bolster the response. In 1918 many doctors and nurses caught the flu, and over 50 of them died.

In Italy and Spain people have been clapping to show their appreciation for the desperate efforts of hospital staff. We must work harder to ensure that things don’t get that bad here, but whatever happens we will certainly owe our medical sector enormous gratitude. ‘Elimination’ is now the goal and staying at home is the best way the rest of us can help to ‘break the chain’ and ensure that our hospital system does not collapse under the strain. Yet that also reduces herd immunity, and increases the prospect of reinfection if elimination fails, before a vaccine becomes available. This may only be the start of a prolonged crisis, in which our resilience and ingenuity as a nation is put to the test.

‘Kia kaha’. We are all in this together.

Dr Rice is Emeritus Professor of History at the University of Canterbury and author of Black November: the 1918 Influenza Pandemic in New Zealand (second edition, 2005), Black Flu 1918: the story of New Zealand’s worst public health disaster (2017) and That Terrible Time: Eye-witness Accounts of the 1918 Influenza Pandemic in New Zealand (2018).

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Acknowledgements

Correspondence

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Correspondence Email

geoff.rice@canterbury.ac.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

View Article PDF

As the COVID-19 pandemic has worsened rapidly over the past few weeks, comparisons have been made with the great influenza pandemic of 1918, with people asking “Are we about to see a repeat of that global disaster?” History doesn’t actually repeat: it only appears to. Different circumstances will produce different outcomes in different places, even from the same infectious disease.

Here in New Zealand we have been better prepared than most countries for a pandemic, with a comprehensive and recently updated plan for influenza. So far the government and Ministry of Health have been guided by that plan, and have mounted a measured step-by-step response, aimed at ‘flattening the curve’ of cases. Some of us had been asking for an earlier school closure, but as soon as there was clear evidence of community spread the authorities announced a Level 3 emergency and moved within 48 hours to a complete Level 4 lockdown. One of the big lessons of 1918 had been applied: respond quickly or it will run away out of control.

Some countries had not learned that lesson. The forecasts for the UK and North America are grim, because they failed to take the threat seriously enough or respond early enough. A week is a long time in a pandemic, as Wellington discovered in November 1918, when delay proved dangerous and resulted in a death rate nearly twice that of Christchurch.

So far New Zealand appears to have mainly done the right things, and in a reasonably timely fashion. Our leadership so far has been superb. But our pandemic planning was done mainly with influenza in mind, and here we are confronted by a novel coronavirus. In the race to find a vaccine the scientific world is quickly finding out a lot more about the virus itself, but we don’t really know as yet how this particular virus will behave as it passes through large populations. COVID-19 is highly infectious, with high case fatality for the elderly.

The 1918 A/H1N1 influenza pandemic saw three distinct waves across 18 months. The first wave was quite mild, a doctor’s delight: “many people sick, not many dying”. But the second wave later in the year was much more severe and killed an estimated 50 million people. The third wave in 1919 was less severe, and did not affect all countries equally. Australia came through with a very low death rate, whereas some regions in Japan suffered losses almost as bad as in 1918.  

Will this COVID-19 pandemic be all over in one wave, or will it recur? The 1889–94 ‘Russian’ flu pandemic kept coming back in successive waves, but with declining death rates and a low overall mortality of only about one million. We are in uncharted waters with COVID-19. Computer modelling has been exceptionally helpful in predicting the short-term curve, based on normal epidemiological patterns, the reproduction rate of the virus, and the effect of mitigation measures. We can only hope that this virus stays stable and does not start transmuting into anything nastier.

In some respects COVID-19 is already much nastier than flu for the elderly. The 1918 virus tended to produce secondary infections of bacterial pneumonia, and most people had a fighting chance of recovering from that, but COVID-19 seems to penetrate much deeper into the lungs, causing destructive viral pneumonia. As patients become breathless, they lack oxygen, and need mechanical respiration in order to survive.

We have all been shocked by the scenes in hospitals in Northern Italy, where predominantly elderly patients have been dying in large numbers. In Spain old folks have been left to die alone. Though India has at last moved to a lockdown, it remains to be seen how that vast population will cope with rapidly escalating infection rates, and the possibilities for much of Africa are almost too terrible to think about. Nick Wilson’s modelling now warns that if the present strategy fails New Zealand could be facing a very severe outcome, with 8,000 to 14,000 deaths. But China has shown that drastic measures can eliminate the infection.

Whether this pandemic comes to be called ‘the Exodus of the Elderly’ or ‘the Pensioners’ Plague’ is up to some future historian to decide, but one thing is starkly clear at this point. If present measures fail, this could be the most severe test our hospital system has ever had to face. Doctors and nurses, ambulance paramedics and rescue helicopter staff are our front-line fighters, supported by an army of orderlies, aides, carers and other staff. Retired medical personnel are now coming forward, as in the UK, to bolster the response. In 1918 many doctors and nurses caught the flu, and over 50 of them died.

In Italy and Spain people have been clapping to show their appreciation for the desperate efforts of hospital staff. We must work harder to ensure that things don’t get that bad here, but whatever happens we will certainly owe our medical sector enormous gratitude. ‘Elimination’ is now the goal and staying at home is the best way the rest of us can help to ‘break the chain’ and ensure that our hospital system does not collapse under the strain. Yet that also reduces herd immunity, and increases the prospect of reinfection if elimination fails, before a vaccine becomes available. This may only be the start of a prolonged crisis, in which our resilience and ingenuity as a nation is put to the test.

‘Kia kaha’. We are all in this together.

Dr Rice is Emeritus Professor of History at the University of Canterbury and author of Black November: the 1918 Influenza Pandemic in New Zealand (second edition, 2005), Black Flu 1918: the story of New Zealand’s worst public health disaster (2017) and That Terrible Time: Eye-witness Accounts of the 1918 Influenza Pandemic in New Zealand (2018).

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Acknowledgements

Correspondence

Geoffrey Rice, Professor, University of Canterbury, Christchurch.

Correspondence Email

geoff.rice@canterbury.ac.nz

Competing Interests

Nil.

Contact diana@nzma.org.nz
for the PDF of this article

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