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UPFRONT: History Is Bound to Repeat Itself – This Is Not Just the Flu

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Almost 100 years ago, soldiers at Camp Funston, Kansas, were coming down with acute flu-like symptoms, including high fever, respiratory distress, and coughing. In a month, almost 25% of the soldiers (1,100) fell ill and 46 had died. As these troops fanned out all over Europe to fight in World War I, the now infamous and poorly named Spanish Flu spread with them, eventually infecting 500 million (25% of the population) and claiming more than 50 million souls. The pandemic lasted around 1 year.

In early December 2019, a brave young ophthalmologist in Wuhan, China, sounded the alarm to some of his classmates of a new pneumonia linked to the Huanan Seafood Wholesale Market. Instead of heeding his warning, the leadership ignored it until it was too late, and the SARS-CoV-2 virus gained a foothold, doubling every week, and spreading rapidly worldwide, aided by our air transit system. Containment failed. Now we are talking about “flattening the curve.” We will not be able to eliminate this virus; it is here for good. Unlike the Spanish Flu, we do not know how long this pandemic will last or how many people will succumb.

In 1918, ordinary citizens and governments on the East Coast did not heed the warnings about Spanish Flu. A large parade that was held in Philadelphia despite warnings to the director of public health resulted in the eventual death of 15,000 people. Even the US Surgeon General said that “There is no cause for alarm if precautions are observed.” Thankfully, in the absence of commercial air travel, western cities had more time to prepare; they shut down and escaped almost unscathed.

The similarities between the Spanish Flu and COVID-19 are eerie. While SARS-CoV-2 is not as lethal as the H1N1 influenza A virus that caused Spanish Flu, and COVID-19 appears to be worse in older patients, whereas the Spanish Flu preyed on younger patients (maybe because older people had survived a pandemic in 1830), both cause cytokine storms and acute respiratory distress syndrome and/or bacterial bronchopneumonia. Absent a few brave governors, there has been a total lack of leadership from our public officials like there was a hundred years ago. Public health infrastructure was nonexistent then and is surprisingly porous today, with only a few brave physicians from the US National Institutes of Health and Centers for Disease Control and Prevention speaking the truth. Also, like the revelers in Philadelphia, we had spring breakers frolicking on Florida’s beaches. It’s just the flu, my uninformed friends and even health care workers say. Will shutting it down this late work? I don’t know. I hope so.

I don’t know which model the US death rate will follow — Italy’s or South Korea’s. As I write this, I fear we will not be like our Asian friends, who have done an amazing job limiting the spread. Moreover, because SARS-CoV-2 has a long incubation period, I worry that lifting some of the tough restrictions too soon will allow resurgence of infection, like the second wave of Spanish Flu. We may be in for a long summer. Stay safe. Isolate. Educate. RP

For the latest American Academy of Ophthalmology recommendations to ophthalmologists on the novel coronavirus, referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), please visit aao.org/coronavirus .