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The Covid-19 Pandemic- history repeating itself


Sorry but I am at heart a medical science geek and I found this report by Brussow et al, "Clinical evidence that the pandemic from 1889 to 1891 commonly called the Russian flu might have been an earlier coronavirus pandemic", fascinating. It's a long hard read so I have provided a quick brain fog summary and then taken the most salient pieces from the article and cobbled it together to make it a bit easier to digest.


Quick brain fog summary

Contemporary medical reports from Britain and Germany on patients suffering from a pandemic infection between 1889 and 1891, which was historically referred to as the Russian flu, share a number of characteristics with COVID-19. Most notable are aspects of multisystem affections comprising respiratory, gastrointestinal and neurological symptoms including loss of taste and smell perception; a protracted recovery resembling long covid and pathology observations of thrombosis in multiple organs, inflammation and rheumatic affections. As in COVID-19 and unlike in influenza, mortality was seen in elderly subjects while children were only weakly affected. Contemporary reports noted trans-species infection between pet animals or horses and humans, which would concur with a cross-infection by a broad host range bovine coronavirus dated by molecular clock arguments to an about 1890 cross-species infection event.


Introduction

The COVID-19 human tally stands in mid-May 2021 at 3.3 million notified deaths, but, when based on estimates of excess mortality worldwide, extra fatality might come close to 10 million deaths, approaching the dimension of the Spanish flu pandemic. However, drawing inferences from a distinct viral infection might be misleading since influenza viruses and coronaviruses differ too much in biological properties. In the present Lilliput, we explore experiences from the ‘Russian flu’ pandemic of 1889 to 1891 as a possible comparator to COVID-19. The ‘Russian flu’ pandemic claimed the lives of an estimated 1 million humans from a world population of 1.5 billion people and represents thus one of the great epidemics of the 19th century (Valleron et al., 2010).



The British Parsons Report

In 1891 a 344-page ‘Report on the Influenza Epidemic of 1889–90 by Dr. Parsons with an Introduction by the Medical Officer of the Local Government Board’ appeared in London, summarizing the worldwide epidemiological data for the pandemic. It also presents data on the symptoms observed in patients from different institutions in England.


As well as studying patients at St Thomas's Hospital the Parson report continues with observations from 70 infected adult patients in an asylum of the insane in Edinburgh, published by the British Medical Journal on February 1st, 1890. The major symptoms were:


  • great weakness (92%)

  • frontal headache (88%)

  • pain in limbs (84%)

  • giddiness (81%)

  • loss of appetite (78%)

  • coryza - nasal discharge associated with common cold (77%)

  • bronchitis (77%)

  • nausea (62%)

  • vomiting (38%)

  • diarrhoea (25%).


Observations resembling COVID-19

A number of observations described in the Parsons report resemble more characteristics of COVID-19 than those of influenza. Notable are:

  • Light affection in adolescents: ‘Among 177 cases in a girl’s school reported in the British Medical Journal of February 22nd, 1890 headache (98%), watery eyes (96%) and flushed face (80%) were the major symptoms. Among 85 adolescent boys frontal headache was the only symptom observed in more than 50% of the cases.’

  • Children are relatively spared: in the words of the Parsons report ‘It was by many considered that children were not so liable to contract Influenza as adults, but the large per-centage affected in some schools and training ships negatives this view. It seems, however, generally agreed that children who contracted Influenza did not have it so severely as adults, suffering less pain and being sooner convalescent.’

  • Age as risk factor for mortality: ‘Influenza was a disease especially fatal to elderly persons’.

  • Comorbidity as risk factor for mortality: ‘An attack of Influenza greatly tends to bring about or hasten a fatal termination if occurring in a patient who is already the subject of organic disease of the heart, phthisis pulmonalis (today: pulmonary tuberculosis), or pulmonary emphysema; and also, according to the statistics of Dr. Bertillon, diabetes or cerebral disease. It is also especially dangerous to persons advanced in life.’

  • Gender bias for morbidity: ‘Some medical men stated that more males suffered than females.’

  • Long haulers: ‘The long enduring evil effects of an access of Influenza in a large proportion of cases suggests that the materies morbi is only slowly extinguished in or eliminated from the system. Some subjects experience a weekly attack or relapse for many weeks after the primary access. It may take the form of great impairment of mental and physical power, or the more definite shape of vertigo or cardiac depression with general arterial relaxation necessitating recourse to the recumbent position.… Relapses …are of frequent occurrence; they occurred in 9% of the cases.’

  • Pathology:

"the local phenomena may be the result of minute thromboses in the different organs of the body’ and ‘of the complications the most frequent are inflammatory conditions of the respiratory organs, as pneumonia, bronchitis, and pleurisy, and to these the mortality ascribed to it is chiefly due".
  • Multisystem disease: ‘By many observers three forms of Influenza have been recognized, viz.: A. Nervous, B. Catarrhal, C. Gastric. These three forms have all been observed in cases occurring together under the same roof, and are evidently mere varieties of the same disease.’

Presymptomatic transmission: ‘It has been suggested by a German observer that the patient may be capable of communicating infection, while as yet only in the stage of incubation. If so, this would help to explain the rapid spread of the disease.’

Occasional symptomatic reinfection: ‘A case is recorded in the British Medical Journal of February 15th, 1890, in which a patient who had suffered from Influenza in France in December 1889, had another attack in England in January 1890.’

Lack of immune protection from previous influenza epidemic: ‘The persons now living who passed through the (influenza) disease in 1847 are of course comparatively few, but such persons have not been exempt from the present epidemic.’


Are we at a turning point of the COVID-19 pandemic, with case numbers decreasing in countries where vaccination is increasing, or have we still not reached the peak of the pandemic yet? How many infection waves will we still see and what will the future of the SARS-CoV-2 virus be? Will it disappear or become endemic? It is difficult to give answers to these questions. Mathematical models provide some predictions, but some basic parameters are still so poorly defined or constrained by epidemiological data making predictions rather uncertain. Therefore, one might be tempted to take historical pandemics as paradigms to provide us with past experience and a framework for possible outcomes of the COVID-19 pandemic. Instead of predictions, this approach could provide insights from "retrodictions".


Rose Cottage Doc says:

The COVID-19 pandemic is quite unique and has been called a once in a lifetime medical emergency. Our governments and health systems keep referring to it as a "new disease" and as a result of this have struggled to provide adequate care at the initial stages and for those with persistent symptoms. Certain groups in our communities deny the Covid-19 pandemic even exists. If we look back at our history we can see populations have been significantly struck by coronaviruses causing deaths and long term disability so why are people finding it so hard to accept this reality now? The clues were always there.


References

https://sfamjournals.onlinelibrary.wiley.com/doi/10.1111/1751-7915.13889?fbclid=IwAR0fkwzdq1CzCN1dUqEey-gATs6shlCvD_WXkpz84Di1MJhbEXEPQ5qWrqk

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