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Learning From the Past and Living in the Present –towards a shared story for COVID-19

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Those that fail to learn from history are doomed to repeat it

Winston Churchill

It was the spring of 1918 that modern history’s deadliest pandemic first began in Europe. News of infections and deaths were initially censored in many countries in order to keep morale high for the soldiers of the World War that continued to rage amidst the pandemic’s first wave. It was Spain that openly communicated about the flu’s spread which is why many thought that this was where it began.

The first wave of this Spanish Flu passed without much notice. There were many cases of moderate symptoms, some isolated outbreaks of rapidly progressive disease, but relatively few deaths . The second wave, in the Fall of 1918, was much more deadly. People throughout Europe, North America and Asia died within hours or days of contracting the infection. While the first wave seemed to kill mostly older people, the second wave took the lives of children and young adults as well. Entire families died and many children were orphaned. Factories and other businesses closed due to too few employees. Hospitals were overrun with patients and, in some cases, a lack of healthy physicians and nurses. In some towns there were not even enough farmers to harvest food.

As tens of thousands of soldiers returned to America from the war in Europe, they carried with them this novel influenza, and the disease spread like wildfire all over the United States. Many American cities underreported the spread of the virus and the rising death toll, so as not to incite panic in a country recovering from war. This led to poor decisions and, ultimately, greater mortality. At that time, without antivirals or vaccines, it was the cities and countries which responded swiftly and decisively with physical distancing, masks and lockdown measures which fared better, whilst cities that delayed, or waivered, in their public health response, suffered greatly.

In St. Louis, Missouri, within days of the first Spanish Flu cases, people were quarantined, public spaces (such as schools, libraries, church and theatres) were closed, and mask wearing was compulsory — with steep fines for those who did not wear them. In Philadelphia, by contrast, the increasing cases of flu and rising deaths were dismissed by local officials as a variant of a normal, seasonal illness, and a large parade was even held on September 28, 1918, with tens of thousands of people in attendance. In the following 10 days, 1000 Philadelphians died. In studies of Spanish Flu, done by the Harvard School of Public Health, a direct correlation was found between the public health measures implemented by US cities and the eventual peak death rate from the pandemic. Philadelphia had a peak death rate that was 8 times that of St. Louis. Between 1918-1920 there were an estimated 50 million people who died of the Spanish Flu worldwide.

A similar narrative is currently playing out across the globe as different countries, provinces and cities respond, in varying ways, to this global challenge of COVID-19. In the USA there are currently 74 deaths per 100 000 people from COVID-19 infection. In several American cities, health care systems have been overwhelmed with tragic instances of overcrowded intensive care units, mass grave sites, and health care workers themselves infected — thus weakening health care capacity.

In Canada, so far, we are seeing 29 deaths per 100 000 people from COVID-19, though our provincial statistics vary depending upon the swiftness and degree of public health response. In BC there are 8 deaths per 100 000 people, while in Quebec there are 82. In Scandinavia, Sweden, which elected to keep schools, businesses and borders open initially in the pandemic, has 10 times the per capita deaths compared to neighbouring Finland, whose public health response to COVID-19 were swift and measured.  Vietnam, which closed its borders immediately and implemented widespread lockdown at the start of the pandemic, has one of the lowest number of infections and death rates from COVID 19 in the world, despite directly bordering China where the pandemic began.

In these modern times, we have access to improved health care, greater hygiene and public health knowledge, and advances in vaccine and treatment therapies unlike anything seen throughout history. We have the ability to communicate public health information and recommendations to remote corners of our communities. And we have a more educated public as to the importance of health and hygiene. However, what we also have is an ever-expanding, counter-culture narrative, fed by social media and alternative news outlets, that seriously threatens our capacity to control this pandemic.

What is your story?

Truth is slippery. As global citizens we have seen this play out in American politics, the Cold War, and in many international conflicts throughout history. Personally, we can see how this affects our own lives when our beliefs lead us to see the world in a particular way that can often separate ourselves from others and, sometimes, from the reality that is before us. Lee Poulos, a Vancouver based psychologist and mind/body expert describes a belief as such:.

“ A belief is a thought in a conscious mind, reenforced by repetition and experience, and constantly seeking reinforcement to stay alive”.  

If I am a fervent supporter of Donald Trump then my beliefs will seek reinforcement through the relationships I make (and avoid), through the media I listen to, and the information that I am willing (and unwilling) to consider. Our beliefs can actually blind us to what is right here, and deafen our minds and hearts to what is actually happening.

Our greatest challenge of this pandemic is not the infection rate of COVID-19, whether it is spread by aerosol vs droplet, nor our ability to produce and distribute effective PPE or a vaccine. Our greatest hurdle to stemming the spread and mortality of this virus is ultimately human. It lies within the stories we are telling ourselves regarding COVID-19, and the behaviors we adopt (or don’t) based on our particular narrative.

This pandemic has caused so much suffering since March 2020. Worldwide, close to 1.5 million people have died directly related to COVID-19. Many more people have been hospitalized or have suffered prolonged illness and disability.  People have lost their jobs, businesses have closed, family members are isolated and mental health challenges rise insidiously in children, youth and adults — with increased rates of drug use, overdose, domestic violence and loneliness.

Triggered by our own suffering, and that of those around us, it is easy to want to believe a different story from the one that is offered by our health authorities, public health experts and governments.

Is COVID 19 truly that dangerous?

Isn’t it just a bad flu?

I do not know anyone with COVID, so is it that concerning?

Do these restrictions really make any difference?

This may affect older people, but I am young and healthy. Why do I need to change?

There is a tempting and contagious narrative unfolding. One that is fed by our own fatigue and frustration, and the suffering in our own lives that has arisen within the container of COVID.  So many of us are tired of Zoom meetings, working from home, missing our key relationships, and the personal challenges of financial distress.  How easy it becomes to retreat into doubt and questioning?  Thanks to the algorithms embedded in our social media and news apps we are fed even more stories that reenforce our existing beliefs and, in turn, only bellow a growing narrative of conspiracy and denial.

And yet the statistics are sobering. In Canada, as of November 2020, there are 340 000 COVID cases and this is rising swiftly. As of this writing, 11 700 Canadians have died of this disease since March (this compares to 3500 deaths in one whole year from influenza). Currently, 36% of all ICU beds in Manitoba are taken up by COVID patients and, despite knowing so much more about the virus, its spread and how to flatten the curve, our numbers and deaths continue to rise

If I can’t see it, it’s not there

In the 19th century, a Hungarian physician by the name of Ignaz Semmelweis was practicing in a Vienna hospital maternity ward where he noticed 18% of new mothers were dying of a common illness of the day — childbed fever. In a comparable ward of the same hospital, staffed by midwives, only about 2 percent of women died of this illness. Before the knowledge of germ theory, physicians were often found dissecting cadavers, or doing open surgeries, with bare hands, and then proceeding directly to maternity wards to deliver babies. Semmelweis deduced that there was ‘something’ on the physicians’ hands being transmitted between the cadavers and the mothers that was leading to childbed fever. By implementing hand washing on this ward, the death rate promptly decreased down to 1%. This example was repeated at several other hospitals. However, when this research was shared in the medical community, it was instantly rebuked and, sadly, Ignaz Semmelweis died, castaway by his own medical profession. It was 14 years after his death that the research was eventually published and germ theory began to gain greater acceptance.  

The narrative of the day, in Semmelweis’ time, was that the only way disease could be transmitted was through toxic odors in the air (miasma theory). The idea that physicians could somehow be carrying some element of disease transmission on their hands was preposterous and insulting to the medical profession. The narrative of that day prevented the physicians, and other health care providers, from ‘seeing’ a truth that could have saved millions of women’s lives.

As a physician, I have had many conversations with patients and friends around COVID. “Have you ever even seen a case?” several have asked me, suspiciously, looking for a reinforcement of their story and the hope that my “no” could be yet another confirmation that COVID-19 is not that big of a problem. No reason to worry. No reason to change what we do. Just an exaggeration, right?

It is true that we have been able to slow the spread of COVID with some of the distancing measures we have taken. Washing hands, physical distancing, avoiding gatherings, maintaining bubbles, wearing masks all work together in slowing transmission of this, and any, respiratory virus. However, as we have seen after holidays and celebrations, when we begin to relax our efforts, and gather in groups, so we witness our numbers of COVID-19 cases increase. And while 80% of COVID cases in Canada are mild, 15% are serious and 5% are critical. As our number of cases increase we will begin to see more hospitalizations and more deaths. Knowing someone with mild disease, who recovers completely, unfortunately does not change this statistical fact.

We’re all in this together

I know that we are tired of COVID.  We are feeling a myriad of emotions – anger, frustration, sadness, fatigue, helplessness, and apathy. It is at these times of challenge that we are hardwired to fight, flee or freeze. Threatened, we fight for personal rights and personal choice. We flee from common sense and science, and into our comfortable stories of ‘me’ and ‘mine’. And we freeze into places of helplessness, complacency and inaction.

Viruses do not care what story you are telling yourself.  The Spanish Flu of 1918 did not discriminate based on religion, ethnicity, or belief. However, cities and countries which heeded its reality fared better to ones which did not. COVID-19, and all of the restrictions and challenges it involves, is not personal. It affects everyone. We live in an interdependent world. Economic change, environmental challenge, and global warming remind us just how much individual and collective decisions affect us all, no matter our citizenship, culture or belief. What we know of COVID, so far, is that those who live in poverty; people with chronic health conditions; and our elders are at much higher risk of developing serious illness from this virus. It was Mohandas Gandhi who said in 1931 “A nation’s greatness is measured by how it treats it’s weakest members”

At the time of writing this article the World Health Organization reported 36 000 deaths worldwide from COVID-19 in the past week alone. Many of these deaths represent those our most vulnerable. This pandemic is not over. In the Spring of 1918, the first wave of the Spanish Flu caused mostly mild to moderate disease in the majority of people infected. News was censored, many cities and countries dismissed, or downplayed, the risk, and it was the second wave of Spanish flu that spread throughout the world with a resounding devastation that still reverberates through Time.   We are now entering the second wave of our own pandemic. Then and now the same public health measures of quarantine, physical distancing, hand washing and mask wearing determine how deeply populations will be affected. We have been here before…

The invitation right now is for each of us to remember that we are not alone. We are part of a community of neighbours, co-workers, family, friends, and many others who share our villages, towns and cities. The story you are telling yourself with respect to COVID does not only affect you,…it affects all of us. During a pandemic, wearing a mask is a gesture of respect and care for one another.  Physical distancing is an act of love. Hand washing protects not only yourself, but also those around you.  This needs to be a time of unity. Separation will only cause much more suffering. People are dying, families are struggling, and our economies continue to decline. Denying this virus, and the recommendations of thousands of educated scientists and public health specialists throughout the world, will not make this pandemic, and its widespread repercussions, go away. Not wearing a mask, refusing to physically distance, and telling yourself that this is not real will not change the pandemic’s tragic reality unfolding all around you.

History ever whispers its lessons to us. COVID 19 is not the first pandemic, and will not be the last, our species will bear witness to. Our challenge is whether we can work together – as individuals, families, communities and nations – to quell the spread of this virus, using the very same wisdom that helped our ancestors in pandemics of past.

Stories are powerful. Our beliefs and narratives about ourselves, our place in the world and, yes, this COVID-19 pandemic, ultimately affect our behavior and how we show up as a member of our human family. Whilst our political, economic, and religious narratives may vary, may a shared story of compassion, care and unity be held up, in our own history, as our greatest triumph in recovering from this collective challenge we face.

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