May 2003

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The difference a century can make

By Ruth SoRelle, MPH

In 1918, a devastating influenza pandemic killed between 20 million and 40 million people worldwide. Ten times as many American soldiers died of the flu in that one year than had died in World War I, which had just ended. It was a global disaster.

The cause of the influenza outbreak was a virus. The reasons it spread so fast and so far and with such devastation included a lack of communication and a dearth of knowledge about viruses and how to stop them. People were struck with the disease on the street and, at times, were dead before the sun rose again. The deaths from this pandemic decreased the projected life span of people in the United States by 10 years. The flu struck those in the prime of life, ages 20 to 40, the hardest.

Physicians and nurses were hard hit by the disaster as well, and many cities were at a loss to care for those who were ill because they were without sufficient medical personnel. In many places, burying the dead was an overwhelming chore, and civic officials found themselves hard put to manage that task.

Consider the case today of Sudden Acute Respiratory Syndrome or SARS. Like the flu, it hits people fast and hard. Today, however, hospitals are equipped to support the patients during their fight against the disease. When health care personnel began to fall prey to the disease’s bite, the World Health Organization and the federal Centers for Disease Control put out the word about the need for strict precautions in caring for those with the illness.

Public health detectives quickly jumped to the ready, looking for the source of the disease in the tissues of those who were ill and looking for the manner in which it had spread. Hong Kong officials quickly located the Metropole Hotel as a hot spot. One infected businessman from China had stayed there and spread the disease among workers and other guests. An apartment building in Hong Kong proved to be a secondary source of spread.

Across the world, governments worked to keep those believed to have come into contact with the new coronavirus and those infected by it quarantined or isolated from the rest of the population. Where possible, the quarantine was voluntary. If not, it was quickly made mandatory.

Toronto moved quickly to care for those who were ill and prevent transmission of disease. Vietnam, another hotspot, did the same. They are no longer under what the CDC calls a “travel advisory” but instead are under an alert that lets travelers know that the disease exists in an area but does not advise against nonessential travel to that locale. Hong Kong, China and Taiwan remain under “travel advisories,” which recommend that those who do not have an urgent need to travel to those places postpone their trips.

SARS has been identified around the world, but the spread of information about it has been even faster than the virus itself. It appears for now that the epidemic will not become a devastating pandemic.

The major reason is the fast and free flow of information. China, the country hit hardest, suffers today because some of its officials attempted to hide the fact that the disease existed there. It was a decision for which those officials appear to have suffered, but people with SARS will suffer even more as the nation attempts to get the disease under control.

In 1918, waves of disease spread around the world, and there was little to be done. Today, the technology of medicine is better, but the technology of information transmission is even more important and even faster. It has taken both types of technology to keep SARS under control. It will take even more cooperation to determine how to stop this latest killer. It would be wise to remember the lesson of 1918.

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