“The more you know about the past, the better prepared you are for the future.” —Theodore Roosevelt (1858-1919)

Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the name of the virus that causes the COVID-19 (coronavirus disease noted in 2019) that has been plaguing our nation of late. Since the disease is prevalent throughout the world, it meets the definition of a pandemic. COVID-19 is certainly not our first pandemic in the United States. Human immunodeficiency viruses (HIV), the virus that causes acute immunodeficiency syndrome (AIDS), is a pandemic that humans have been struggling with for decades. Infectious diseases are part of the human condition. It is in the fabric of our collective history. Through the ages, our customs, economies, even our nursery rhymes (“ring-a-round the rosie” referred to a red circular rash characteristic in some forms of plague) have been profoundly influenced by viruses and bacteria. Admittedly, the impact of COVID-19 on our culture has been profound, deeply painful and unprecedented in most people’s memory alive today. It would be a mistake though to suggest this situation is novel or could not have been foreseen.

As I have noted in other editorials, our society lived through one of the most significant pandemics in history in terms of death with the 1918 Spanish Flu caused by the H1N1 influenza A virus. It is estimated (records were not as sophisticated as today) that between 50 and 100 million people succumbed to the virus worldwide, including over a half-million Americans. American leaders and health officials had to confront this massive epidemic with far less understanding of viruses and how they spread or cause disease. Then, as today, the only real defense against the spread of H1N1 was social distancing. National Geographic provides a fascinating look into how American cities at that time responded to H1N1.1 Following the first known case of Spanish Flu that occurred on a Kansas military base in March 1918 (remember the United States was involved in World War I and Americans were traveling around the globe in unprecedented numbers) the disease rapidly spread throughout the United States. Then, as today, major cities were largely left to their own devices regarding their response to the outbreak. Philadelphia and St. Louis developed their first cases at relatively the same time, but their answers were quite different. Philadelphia responded to their first case by instituting efforts to limit individuals coughing or sneezing in public. Leaders then went on with a long-planned public parade in support of the war effort that was attended by more than 200,000 people crowded together. As expected, H1N1 cases and deaths spiked in Philadelphia. St. Louis, in stark contrast, instituted strict restrictions against public gatherings and quarantined flu victims in their homes. In the end, St. Louis experienced a death rate half that of Philadelphia. Interestingly, when St. Louis and other cities attempted to relax restrictions after social isolation seemed to be working, they experienced a second, more substantial spike in cases and deaths (sound familiar?). It is also probably important to note that the 1918 Spanish Flu did not end in American until 1920.

What can we learn from this history? Based on events in the news, it appears the adage from German philosopher Georg Hegel remains prescient in that, “the only thing we learn from history is that we learn nothing from history.” I find this genuinely tragic. Unlike our American ancestors struggling through a devastating pandemic in 1918, today we enjoy unprecedented advantages allowing citizens to work and play while social distancing on the Internet, resilient food and utility distribution, and a global scientific community that had the genome of SARS-CoV-2 sequenced within weeks of its discovery. Of course, the list of advantages that 2020 Americans enjoy compared to 1918 Americans is extensive, not to mention we are not fighting a world war, as the country was at that time.

Yet, despite all the improvements in science, infrastructure, and public health that we enjoy today, we have recent news images of Americans carrying assault-style rifles in protest over state and local efforts to contain the COVID-19 pandemic through social distancing. The ridiculousness of bringing an assault rifle to a viral outbreak protest would be the source of considerable laughter if these images were not so tragic. COVID-19 patients and their healthcare providers understand the deadly seriousness of this pandemic. The ill-informed, although loud, protests of some Americans that public health measures to contain the virus are a violation of their freedom is as sad and pathetic as it is dangerous. Personal freedom is your right, up and until your actions in the name of liberty impinge upon my freedom or the general freedom of the population. This understanding of freedom is particularly poignant regarding COVID-19 because an individual’s actions in limiting the spread of the virus (or not as in the case of assault rifle-wielding protestors) directly impacts on the public’s right to live.

President Theodore Roosevelt (my favorite past-president) provides modern Americans with a clear and unequivocal pathway for responding to the COVID-19 pandemic. We have a road map of how to respond effectively to a deadly virus and limit the spread and minimize deaths by learning from our collective American history. In the past, during a broader and more deadly viral outbreak of H1N1, aggressive social isolation worked to contain the epidemic. Relaxation of those isolation standards resulted in more intense infection rates and higher death rates. Why would this physics of viral transmission and death from 1918 somehow be different in 2020? What is different today is our ability to maintain social distancing through modern infrastructure and science while exploring novel ways to work, learn, play and interact with each other in the new COVID-19 reality. Improvements in testing for the SARS-CoV-2 virus and the development of vaccines for this virus are advancing at a pace that our ancestors could not imagine. In the meantime, we must rely on the lessons of our past as a guide to maximize Americans’ survival while we provide time for modern science to produce new answers. Assault rifles are not useful in this war. Our best weapon, then as now, is social distancing.

  1. https://www.nationalgeographic.com/history/2020/03/how-cities-flattened-curve-1918-spanish-flu-pandemic-coronavirus/#close. Accessed 5/14/2020.