The Dress Rehearsal Not The Show?

by Les May

EVERY year we have a ‘flu season’.  It runs from week 40 of one year to week 20 of the next. There are two peaks, one before Christmas and the other after. Sometimes these are caused by different influenza ‘types’.  People like me toddle off to the medical centre and get a ‘jab’ each October which gives us short term immunity to the strains circulating in the world that year.  It’s all well understood. Some years it is worse than other, but by and large the system works.

• But it only works so long as the influenza virus behaves itself reasonably well. It didn’t in mid 1917 or early 1918.  Somewhere in the middle of America a new, more virulent strain emerged which was more deadly to the youngish than the old.   It spread through the training camps preparing young American men to fight in the Great War.   Woodrow Wilson despatched 300,000 of them to Europe in crowded troop ships.  The rest, as they say, is ‘history’.

No one could foresee the emergence of Covid19, so the need for massive quantities of PPE and the death traps that care homes became could not be foreseen either.  Or so the story goes.

But what we do know is that every so often the influenza virus ceases to behave in manner we have found a way of dealing with. When it will do this cannot be predicted, but that at some time it will is a certainty.  It is, in that famous phrase, ‘a known unknown’.  We know it will happen, but we don’t know when.  In the past century this has happened four times; Spanish flu 1918-20, Asian flu 1957-58, Hong Kong flu 1968-69, Swine flu 2009-10.

Had the virus which emerged in China last year been a new and more virulent form of our old enemy, the influenza virus, something akin to the 1918 form, Johnson and the Tories would have been equally deep in the ‘do-do’, because they still would not have had enough PPE.

The fact that the virus causing Covid19 is ‘new’ has allowed the government to shield itself from the more serious criticism that it had become complacent about the possibility of having to deal with an influenza pandemic, not just ‘seasonal flu’.   It is not only the government which has become complacent, we, the public, have as well.

Every year we have reminders of the slaughter in the Great War, we have memorials to those killed and many of us will remember the names of relatives who were amongst them.  The people who might have known the names of relatives who died of Spanish flu themselves died in the 1980s and 90s, so it has never embedded itself in the public consciousness.

Influenza usually has a mortality rate in the region of 1 to 2 people in a thousand which is probably slightly less than that of Covid19.  Spanish flu had a mortality rate estimated as high as 1-200 per thousand people infected in some areas. Even at low mortality rates if enough people become infected the number of deaths will be large; so far more than 300,000 people are thought to have died from Covid19. Spanish flu killed some 50 million people.

Equally important is the social disruption a flu pandemic will cause.  The means by which the person to person transmission can be reduced are identical to those which have been applied to combat the spread of Covid19, social distancing, good hand/nose/mouth hygiene school closures, work from home etc.

Politicians who are capable of thinking strategically would recognise that a flu variant equal in killing power to that which caused the 1918-20 pandemic could arise at any time and would have in place strategies for coping with it.  On this basis the Johnson government, and perhaps the people advising it on public health matters, have failed miserably, but would any recent government have done any better?   Once you are in thrall to market forces you buy where things are cheapest.

Such strategies would include not just larger stocks of PPE, but would include support for a national garment sector making such PPE which could increase production rapidly in case of need, ditto manufacturers of face masks, ventilators, anti-viral drugs, realistic assessment of the capacity of care homes and similar facilities to isolate sick residents, etc.  Had these already been in place because someone had recognised the possibility of a new and more virulent form of influenza arising, the number of deaths from Covid19 would probably have been lower.

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