Lessons from Spanish flu?: Support social distancing

The World Health Organisation (WHO) has recommended social distancing as a key strategy in halting the spread of the coronavirus disease. This calls for maintaining physical distance or staying far away from each other by at least a metre or three feet so as to prevent the transmission of the disease from person to person.

The strategy is extremely significant in the campaign against Covid-19 as the disease can also be spread through respiratory droplets.

When infected people cough or sneeze, they spray small liquid droplets from their nose or mouth, which contain the Covid-19 virus. Those that are too close to them are at risk of breathing in the droplets and end up getting the disease.

Social distancing also limits the number of people an infected person can interact with — and spread the virus to — especially before they realise that they have the disease.

This is because those with Covid-19 can spread the ailment at least five days before they develop symptoms.

Even though social distancing cannot totally prevent the spread of coronavirus, it plays a significant role in slowing down the spread of the ailment which had infected close to 800,000 people by yesterday.

Most importantly, the strategy ensures that arising cases are kept within manageable levels that a country’s healthcare system can handle. This is called ‘flattening the curve’.

If transmission occurs rapidly and Covid-19 cases peak, the cases end up becoming overwhelming, hence making it impossible for hospitals and health workers to offer adequate medical care to patients.

This leads to unnecessary deaths and suffering, as is the case in Italy, whose death toll of over 11,500 is now the highest in the world.

In Kenya, the government has initiated a raft of measures aimed at enhancing social distancing, such as closure of schools, banning public gatherings and limiting the number of passengers that public transport vehicles can carry.

Most significantly, it has initiated a daily curfew starting from 7pm to 5am.

During this period, all Kenyans — save from those offering critical services — are required to be indoors (preferably at home) so as to further enhance effectiveness of social distancing. However, enforcing these new restrictions has not been easy.

Many Kenyans have complained and described the measures as a either draconian, especially due to the way police enforce them, or a bother to their lives.

But history offers proof that even though social distancing may appear to inconvenience people, it holds the key to saving mankind from the devastating effects of contagious disease outbreaks.

An article published in the Journal of the American Society of Cytopathology offers a stark historical reminder that during disease pandemics such as Covid-19, individuals can only ignore social distancing recommendations at their own peril.

The article’s author, Dr Stefan Pambuccian, reviewed multiple published data and research dating back to the infamous Spanish Flu (also known as the 1918 flu pandemic) that lasted from January 1918 to December 1920. It is estimated that about 500 million people — or one-third of the world’s population (at the time) — became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the US alone.

Just like Covid-19, the Spanish Flu (caused by the H1N1 virus with genes of avian origin) had neither a cure nor a vaccine to prevent it.

The flu’s impact was more devastating than coronavirus because it killed both the young and old, including those of otherwise good health.

Despite this bleak outlook, the findings of the study revealed that US cities which adopted early, broad isolation and prevention measures – such as closing of schools and churches, banning of mass gatherings, case isolation and disinfection or hygiene measures — had lower disease occurrence and death rates from the flu.

These cities included San Francisco, St. Louis, Milwaukee and Kansas City, which collectively had between 30 and 50 percent lower disease and mortality rates than cities that enacted fewer and later restrictions.

“The stricter the isolation policies, the lower the mortality rate,” says Dr Pambuccian, a pathologist and vice-chair of the Department of Pathology and Laboratory Medicine at Loyola University Chicago Stritch School of Medicine

He studied the Spanish Flu, including prevention measures and outcomes, to help develop standards for staffing and safety in the cytology lab, where infectious diseases like Covid-19 are diagnosed and studied at the cellular level.

“Like today, not everyone in 1918 and 1919 thought the strict measures were appropriate or effective at the time. An estimated 675,000 people died in the US from the Spanish flu. And there was scepticism that these policies were actually working. But they obviously did make a difference,” writes Dr Pambuccian.

He notes that although the world is a much different place than it was hundred years ago, the efficacy of the measures instituted during the 1918 to1919 pandemic “gives us hope that the current measures will also limit the impact of the Covid-19 pandemic”.

Past studies have also offered useful lessons from the Spanish Flu pandemic.

A 2007 study published in the Proceedings of the National Academy of Sciences (PNAS) journal indicated that US cities which put in place social distancing strategies and went a step further to make it difficult for people to ignore the recommendations – just as Kenya is doing now – had a reduced disease burden.

For these cities, it wasn’t just enough to tell people to stay at home. They made it harder for people to break the rules by prohibiting just about every aspect of public life — from attending schools and eating in restaurants, as well as patronising entertainment venues.

Aside from initiating social distancing measures early, these countries also ensured that the restrictions were sustained, lasting until the virus really seemed to go away. And if the virus came back, the measures were quickly redeployed.