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Infectious Disease, Then and Now

Infectious Disease, Then and Now

Balancing the risks.

CDC Image https://www.cdc.gov/coronavirus/2019-ncov/images/2019-coronavirus.png

I grew up in an era when nearly all children got a series of diseases that are now mostly distant memories. The vast majority of us survived, unlike in previous periods:

Before the Modern Revolution child mortality was very high in all societies that we have knowledge of – a quarter of all children died in the first year of life, almost half died before reaching the end of puberty

Hundreds of years ago, even royalty was not immune. Look at the record of the children of Peter the Great, for example. It’s horrific. It’s also one of many reasons people tried to have as many children as possible, although a lot of women died in childbirth or shortly after. That was another terrible risk that was common in prior eras. What earlier generations had to endure in the way of sickness and death was hard for most of us to even imagine.

It was much better when I was growing up. But still, in a few short years and while a toddler I had measles, mumps, rubella (then commonly called “German measles”), and chickenpox, and that’s just the diseases I remember having. Polio was rather common, too, although a vaccine came along when I was a very young child. That event was a big big deal, and Salk was considered a hero.

My only cousin had developed measles encephalitis when I was about two, and died a few years later of complications from it. I remember his death very very well and his disabilities too. That’s the sort of thing that makes a deep impression on a child. Another couple who were good friends of my parents had lost a child from measles even before I was born. I heard my parents talk about that, too.

No one had to impress on me the seriousness of measles. I knew. And polio? We saw the photos of all those kids in the iron lungs, and we knew children walking around with braces on their legs.

It’s a beautiful thing that the incidence of most of those diseases has gone way down, a significant reduction in human suffering and loss, and that most people alive in the US today lack personal experience of them. But there’s been a cost, too. It includes the increasing decline of our psyches’ ability to withstand and endure the possibility of an increase in disease and mortality that mirrors even the relatively modest amount that my generation experienced.

Of course, I wasn’t around for the 1918 flu pandemic, and I wasn’t around when smallpox and tuberculosis or the Black Death killed a far higher percentage of the people then living on earth than any of the plagues of my life have come close to killing. I cannot even imagine how terrible those things were; I don’t also want to imagine. And I doubt that people of the time took them in stride at all. I think a good part of the dread and fear now is that in the back of our minds – or for some people, even the front of our minds – we know that such catastrophes are still possible. Human beings know they are intensely vulnerable, and when we become afraid, we can visualize that chasm looming before us.

But COVID-19 is not shaping up to be that sort of magnitude event (the Black Death is estimated to have killed between 30 and 60 percent of the population of Europe, for example), and there’s no reason to think it will be. However, although many measures are prudent – handwashing increased testing, hospital preparedness, some means of social distancing at least for a while – the degree of fear I see and hear is far higher than anything I can recall in my life around medical events that probably killed at least as many people as this one is likely to do.

As Clark Whelton, the author of this City Journal essay entitled “Say Your Prayers and Take Your Chances: Remembering the 1957 Asian flu pandemic,” writes:

It’s not that Asian flu—the second influenza pandemic of the twentieth century—wasn’t a serious disease. Worldwide, this flu strain killed somewhere between 1 and 2 million people. More than 100,000 died in the U.S. alone. And yet, to the best of my knowledge, governors did not call out the National Guard, and political panic-mongers did not blame it all on President Eisenhower. College sports events were not cancelled, planes and trains continued to run, and Americans did not regard one another with fear and suspicion, touching elbows instead of hands. We took the Asian flu in stride. We said our prayers and took our chances.

Today, I look back and wonder if an oblivious America faced the 1957 plague with a kind of clueless folly. Why weren’t we more active in fighting this contagion? Could stricter quarantine procedures have reduced the rate of infection and lowered the death toll? In short, why weren’t we more afraid?

It’s a good question, and he answers that back then, we were more used to infectious diseases. But a result of that is that we would have had to have closed down shop indefinitely because there were so many infectious illnesses around all the time that there was no way to escape. You might say we were fatalistic. You might say we were resigned. You might say we were stupid. You might say we assumed the risk, or you might say we understood there were also drawbacks to that sort of reaction.

Right now, we are trying to err on the side of caution, hoping to avert a situation such as that Italy is facing, or worse. Time is of the essence. But we are also balancing that with the economic risks of such a shutdown, especially if prolonged. The idea is that not shutting down this way would have a significant chance of leading to even higher risks later on than shutting down and that some pain now will prevent even more significant pain then.

[Neo is a writer with degrees in law and family therapy, who blogs at the new neo.]

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Comments

Great post. I’m old enough to remember family losses due to diseases that have since been “cured.”

I wonder how many “anti-vaxxers” will be elbowing to the front of the line to get the Wuhan vaccine if/when it is available.

    redc1c4 in reply to Paul. | March 17, 2020 at 5:50 pm

    none.

    they all dies when “Net Neutrality” went away, remember?

    the death toll was YUGE! 😉

    SpeakUpNow in reply to Paul. | March 18, 2020 at 6:14 pm

    Thanks so much for this posting. I was thinking the same think, but you went ahead and did lots of research. The economic devastation all these draconian measures are causing may not be worth the reduction of Corona virus cases and fatalities. I think we and all the other countries are going way overboard in dealing with this. Keeping people indoors for months also has its repercussions. Depression and suicides will increase. I am at a loss to explain the mass hysteria.

My cousin was stricken with polio from the neck down she was paralyzed, age 16, and lived well into her 40’s. The sad part was it didn’t need to happen, the vaccine had been out for 2 years but her parents didn’t take their children in for it. My aunt, her mother, lost her only brother at age 13 to polio… I never could find the grace to forgive her

My sister, brother and I had polio, a very mild form thank God ages 2,3,4… often thought what if…

Kids had braces on legs, affected thin, paralyzed arms. We all knew why, didn’t have to ask

When the vaccine came out, the gyms were packed with parents and kids, it was a righteous day, and Salk was certainly a hero.

My mother worked in a children’s hospital, full of kids in iron lungs. I was one of the first people in the country to get the Salk vaccine, and later the Sabin vaccine.

You cannot imagine the hysteria over polio. It disproportionately affected the children of rich people.

My father said they didn’t have enough dirt in their diet to build up their immune systems. He said everyone in India got polio, and no one was paralyzed.

That was in the early 50s. That theory got sidelined for 60 years, when it resurfaced as the cause of allergies.

2018, 52,000 deaths from influenza. How may quarantines were issued? 2009, the Swine Flu, 20,000 fatalities. How many quarantines? And, the list goes on and on. All of these diseases resulted in fatalities and no major actions were taken. Did the nation melt down? No. Was a significant portion of the population [50+%] killed off in these actions? No. So, again, how is COVID-19 different from earlier outbreaks? Anybody got the answers? And, what about the economy? Restaurant closings result in lay-offs of most of the wait staff, and much of the kitchen staff. How many thousands of people will be affected by the economic down turn? How many millions? What will this do to the future tax burden shouldered by Americans? What will that do to economic recovery?

Setting yourself on fire because you have the flu is simply insane. And that is the exact course of action which this nation is taking with COVID-19.

The medical pundits are all focused upon minimizing the effects of Corvid as much as possible. They do not care about the “health” of the patient [the USA] after they virus has been “subdued”. It is not in their area of expertise, so they ignore it. Do not put total faith in the “expertise” of these “experts”.

    InEssence in reply to Mac45. | March 17, 2020 at 10:17 pm

    Apparently everyone wants to “error on the side of caution.” I’m sure about the “error” part. No politician has thought this through. Our hospitals are not overflowing, and the USA only has one case for every 50,000 people. The economic damage is far greater than the health concern at this point.

    paracelsus in reply to Mac45. | March 18, 2020 at 11:32 am

    Yeah! but this will have, or so they think, the double benefit of keeping The Donald from being re-elected.

    our elected betters are consulting with and listening to academics.
    these people only know theory and probability. this is their “moment to shine” and they don’t want to waste it. the director of the WHO isn’t an MD. he has his education in public health.

Excellent. Truly excellent. I have been observing and trying to understand the fear, panic and inability to adjust as we go through this.

The best I can come up with is that those of us who have faced the possibility of death have come to terms with our mortality. I don’t mean in a fatalistic way, simply that for most of us having faced death, we came to realize that we could choose cowering in a corner or to carry on with our duties in a prudent, sober manner maintaining an awareness and respect for the threat at hand.

Innovations in medical treatment, public health improvements and vaccination has removed many of the historical threats. The proportion of workers who are in occupations with a degree of danger in the 21st century vs the early 20th century is dramatically less. Despite two decades of ‘ the War on terror’ we have far fewer active duty military personnel today vs the number in 1990. Likewise we have far fewer troops and veterans with actual combat experience than past generations.

In sum our collective society, as a whole, is not used to nor has experience with functioning while in imminent danger or daily risk. Psychologically they are unable to cope because having never been in a tight spot they are only now having to process the the one true fact of life; death.

The continuous fanning the flames of doom by many MSM is particularly unhelpful. However, many may simply be ill equipped either by experience or temperament to maintain a rational outlook in their reporting.

Comanche Voter | March 17, 2020 at 5:26 pm

Polio is a disease of cleanliness. The polio bacteria is carried in the gut. If you have a case of polio at or below the age of 5 or 6, it’s no worse than a cold. OTOH if the polio bacteria attacks some in their teens or early 20s paralysis or worse ensues. I’m of an age where I saw people slightly older than myself who’d contracted the disease in their early 20’s–and then spent the rest of their life in a wheelchair. I know a couple of luckier ones who need an armbrace crutch to walk, but can get around.

In the United States it was the advent of adequate sanitary sewer systems in cities that brought the scourge of polio that terrified mothers and fathers from say 1905 to 1955—kids who had access to clean water (and who had flush toilets in their bathrooms) didn’t contract polio at age 4 or 5. With worse public sanitation in the latter half of the 19th century most kids had a case when they were young.

As for infant mortality; my mother was born on a ranch in Oklahoma in 1918. She had a younger sister. She had four older brothers who all died before the age of 5. Since it was a day’s ride on horseback to the nearest doctor the fact that all four boys died of childhood diseases was no surprise.

What doesn’t help are all these so called experts claiming that millions of people will die from this!

Mass hysteria is going to kill more people than this fucking virus!

Twenty-four years associated with this nation’s military (eight USAF, sixteen AirNG) quickly removed any concern about needles. Since I and many others were tasked to go anywhere on a moment’s notice, we were vaccinated against some of the wildest diseases existing in the modern world – cholera, yellow fever, plague, many others. I have scrupulously gotten my flu shot every fall for decades and gladly accepted pneumonia and shingles more recently. This along with the shots we all got in the 50s and 60s make me wonder if we Boomers might be healthier than more recent generations.

The anti-vaxxers are a joke, and a cruel one to their children. The only explanation I can think of is they were asleep in the sixth grade when the rest of us were learning about germ theory and good hygiene.
.

Mortality from flu in a bad year for flu is typically about 0.1%

Mortality from this coronavirus in Italy is now at about 7%.

The difference between 0.1% and 7% is nearly two orders of magnitude: hardly insignificant! To be sure, Italy has one of the lowest birth rates in the world, and therefore a population that skews elderly. But there’s also the effect of just too many sick people for everyone who’s sick to receive quality medical life-support measures.

Overall I expect the USA will not look like Italy; nonetheless, there’s significantly more risk here than is present in a typical seasonal flu season.

As for past epidemics, well, it’s not nearly as deadly as the 1918 flu (and especially so for those who are young and in good health). Nor does it mostly threaten children, as polio did.

Although when it comes to polio, one might recognize the role of the March of Dimes (aka “National Foundation for Infantile Paralysis”) in scaring the crap out of everyone as an effective means to raise funds.

And while New York City can close its schools, restaurants and bars, it can’t very well close its subway. Although many New Yorkers seem to be doing their best to avoid it, its daily use remains a daily necessity for many.

And if you wish to contemplate the hard choices people made in the past when threatened by epidemics, you might look up “variolation” (the practice of deliberately infecting oneself and one’s family with smallpox, before the Jenner vaccine was available).

    CommoChief in reply to Albigensian. | March 17, 2020 at 7:20 pm

    No doubt that, based on current reports, Italy seems hard hit in comparison to other nations. Why? What makes them different?
    Basic demographic data
    Median age Italy 46
    Median age U.S. 38
    % of population over 55 years Italy 34%
    % of population over 55 years U.S. 28%
    Italy is the 5th oldest nation in terms of population age.

    This isn’t all about age. Italy is the only European nation to sign on to China’s one road program, so they have more interchange of population between Italy and China. So obviously more potential for exposure.

    Finally, Europeans still smoke, they smoke a lot. Even if many have stopped following Doctor’s advice they weakened their respiratory system over previous years. When I was stationed in Europe it was as if the cultural/social view of smoking we experienced in the U.S. had been passed by.

    I am sure their are other factors that could be used to help explain why Italy’s situation of higher morbidity rates appears unique.

      Mac45 in reply to CommoChief. | March 17, 2020 at 8:15 pm

      Actually, Italy has a much more elderly population than the US. It’s medical care system is noticeably inferior to that in the US. Then you have hygiene and lifestyle choices which are markedly different, between the two countries. Now, South Korea is a much closer match to the US than is Italy. In South Korea, the mortality rate was closer to 0.17% than 2-8%, as reported from other places in the world. While still higher than the mortality rate of influenza a and b, we still have very little accurate information on COVID-19, in the US. As we get more statistical facts from expanded testing, we will be better able to accurately judge what the mortality rate will actually be, for the US population. Remember, we have 87 deaths in the US. 1/4 of these deaths came from a single elderly living facility in Washington state.

      The problem that America faces, is that its leaders are looking at it as though the US was a house infested with termites. The current answer to that seems to be to burn down the house. Or at least, use a flame thrower to kill the termites. Once you do that, how expensive is it rebuild the house? And, can it be rebuilt, at all?

        CommoChief in reply to Mac45. | March 17, 2020 at 9:06 pm

        Mac45,

        Exactly my point. The population of Italy is way older than the U.S. plus they have a large amount of economic ties to China. The U.S. has a much better and more robust healthcare system as a whole, though in many rural counties many of the small hospitals have closed and some simply don’t have the population/economic base to support clinic level primary care.

        Bottom line is comparing the potential impact for covid-19 in the U.S. vs the rest of the world is going to overstate the potential impact. Those doing so are verging on intentionally damaging the U.S. The U.S., as a whole, will absolutely weather this better than the rest of the world.

      SpeakUpNow in reply to CommoChief. | March 18, 2020 at 6:20 pm

      It’s probably an understaffed and underequpped medical system

    From what I have read, those mortality rates are comparing apples and oranges. In the case of the mortality rate for the flu, it includes estimates of how many people likely have the flu, but are unconfirmed. In the case of the mortality rate for the Corona Virus, it only includes confirmed cases of infection. The actual mortality rates, from what I’ve read, based on confirmed cases, are around 10% for the flu, and 3.4% for the Corona Virus.

    paracelsus in reply to Albigensian. | March 18, 2020 at 11:39 am

    Please read the commentary from the Higher Institute of Health, according to what was reported by the President of the Institute, Silvio Brusaferro, during the press conference held today (13 March) at the Civil Protection in Rome available here (translated from Italian):
    Rome, 13 Mar 19:12 – (Agenzia Nova) – There may be only two people who died from coronavirus in Italy, who did not present other pathologies. This is what emerges from the medical records examined so far by the Higher Institute of Health, according to what was reported by the President of the Institute, Silvio Brusaferro, during the press conference held today at the Civil Protection in Rome. “Positive deceased patients have an average of over 80 years – 80.3 to be exact – and are essentially predominantly male,” said Brusaferro. “Women are 25.8 percent. The average age of the deceased is significantly higher than the other positive ones. The age groups over 70, with a peak between 80 and 89 years. The majority of these people are carriers of chronic diseases. Only two people were not presently carriers of diseases “, but even in these two cases, the examination of the files is not concluded and therefore, causes of death different from Covid-19 could emerge. The president of the ISS has specified that “little more than a hundred medical records” have so far come from hospitals throughout Italy.

    These are the first minimum detailed data provided so far by the Civil Protection on the causes of death of coronavirus patients. At present, in fact, the authorities are unable to distinguish those who died from the virus, from those who, on the other hand, are communicated daily to the public, but who were mostly carriers of other serious diseases and who, therefore, would not have died from Covid-19. In response to a question from “Agenzia Nova”, in fact, Brusaferro was unable to indicate the exact number of coronavirus deaths. However, the professor clarified that, according to the data analyzed, the great majority of the victims “had serious pathologies and in some cases the onset of an infection of the respiratory tract can lead more easily to death. To clarify this point , and provide real data, “as we acquire the folders we will go further. However, the populations most at risk are fragile, carriers of multiple diseases “. (Rin) © Agenzia Nova – Reproduction reserved

Just FYI for New Neo and LI staff: Facebook is suppressing this article for “violation of community standards”. I cannot share it or link it in that platform. Once again, I am baffled at what they are trying hold as a violation…

This is so much about the feels and totally devoid of logic. Mostly I see it as a test of how much crap .gov thinks they can get away with under the guise of “an emergency.” 98% of the AA meetings in PDX have been shut down now, mostly by the physical locations hosting them. That should work out well. From what I have seen every single measure taken has caused more harm that help. Still a real-time episode of The twilight Zone, but the epilogue will likely be “Orange Man Bad.”

FWIW, my laptop internet access is via coffee shops and the library and the former re closing like dominoes while the latter shutdown over the weekend. I can access LI via the phone but have forgotten pwd so can’t post from there, and the way I type on a phone, you wouldn’t want to see those messages anyway.

Those who wanted more nannying from the Nanny State are getting it good and hard. Too bad the rest of us are, too.

This is what makes me scream!

*Death Rate = (number of deaths / number of cases) = probability of dying if infected by the virus (%). This probability differs depending on the age group. The percentages shown below do not have to add up to 100%, as they do NOT represent share of deaths by age group. Rather, it represents, for a person in a given age group, the risk of dying if infected with COVID-19.

from: https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

It isn’t the death rate if infected, it is the death rate from a “confirmed” infection, and more than likely can represent an erroneous 10 or 100X rate based on whether 90 or 99% of the infections go undetected. The probelm is that the news is running with a 3% death rate (averaged, I guess) when in fact the real death rate is likely down in the <0.05% region of the seasonal flu.

As I pointed out last week, the Japanese paper from the cases on that stranded cruise liner did not have a single denominator listed except the total number of people on the ship, which worked out to 600/3000 approx or 20% infection rate in a very very closed system. So 150M in America? I think not. But then, I possess common sense (an a research science background).

The media is deliberately distributing unreliable statistics, and if you don't believe me, Bloomberg has $1M for you. 😉

    CommoChief in reply to MajorWood. | March 17, 2020 at 9:13 pm

    Can still get the money if I agree with you that the MSM is overwrought and/or intentionally hyping this out of proportion?

Bill Gates is trying to eradicate polio, but is being opposed in Nigeria by the Islamic terrorists.

The latest WHO advisory seems to indicate that COVID-19 enters the body thru the eyes

    InEssence in reply to Neo. | March 17, 2020 at 10:22 pm

    Most infectious diseases do that. People rub their eyes with dirty hands, and the infection start. Don’t touch your eyes, nose, or mouth with dirty hands.

I was only 5 or 6 when the Salk vaccine became available, and I remember it pretty vividly because of the huuuge affect it had on my parents. Before that vaccine, they were constantly worried that their kids would be afflicted. After Salk, it was like they had no worries whatsoever.

Italy might be a bad comparison, I thought it was report days ago that Italy was going to triage treatment, in other words if you were elderly you would not receive treatment so the probably of death was very high, and that would result in higher mortality numbers. Also does anyone know if Italy is a government run health care(single payer, medicare for all type system)

What I am seeing is the world completely panicking over this virus that is deadly to almost exclusively those over 70 and having preexisting health/respiratory issues. Instead of targeting the elderly with all the precautions we could muster, we are instead shutting down everything everywhere. Who can afford to pay their bills when they are out of work? What business can continue to stay viable after two, three, or however many months this will go on?
>
Our and the world’s economies were shaky to start with and now this flu is turning into a self inflicted black swan that threatens to usher in an economic disaster worse than the Great Depression. Given the information in this article and understanding what the upcoming economic disaster will look like, he question that arises is “Is this response to the Covid-19 virus worth it?” Personally, I think not and I am over 70 with a history of respiratory health issues.

Great observations — conveyed via thinking and writing at the same, great level! Really thought-provoking, informative, and wholly edifying.

(I gotta ask, please, as a really trivial aside and being intrigued, why the repetition in the pen name?)

A huge part of the difference between 2020 and 1957 (or between 2020 and 2009, for that matter) is the ascendancy of social media. It is one of the most effective panic-spreaders ever invented.

Why do I keep thinking of the story my folks read to me at bedtime, Chickin-lickin (Chicken Little): the original, not the Disney version, where she runs around the barnyard telling all the animals “the sky is falling” and gets eaten by the fox, who is “taking her to tell the king.”

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