It would seem intuitive that a global pandemic would increase reliance on medical care as well as the trust people hold in public health agencies, but you would be mistaken. The covid pandemic caused a rather dramatic shift in public confidence due to intense politicization over mitigation measures causing us to ask how medical confidence might rebound.
Coupled with the pandemic’s persistent effects, this shift grew large enough to influence public utilization of available resources. Moreover, the relentless nature of the SARS-CoV-2 variants continued to routinely upend the workplace, our school systems, and a majority of social interactions for people of all ages.
While we eagerly await the final stages in restoring normality, scientific uncertainty still exists as to what caused the viral infection, the frequency of mutations, and the long-term effects that might persist beyond initial recovery.
During the endemic phase, the public will continue to expect advancements in health technology, disease surveillance, and medical care, in addition to, the creation of new vaccines for endemic disease management. To gain a better understanding as to how medical confidence might rebound, take a look at what happened in the wake of past pandemics.
Transitioning from a Pandemic to an Endemic
With an untreated survival rate of 50 percent, one of the worst pandemics in history arrived in Europe (from Mongolian origins) in 1347. Caused by a bacterium transmitted by flea bites from infected rodents, the bubonic plague lasted for five years and accounted for up to 50 million deaths. According to a History Channel article on The Black Death, the European aristocracy was faced with a disrupted feudal system.
That led to the Renaissance period of unprecedented opportunity for new ideas, new sciences, and new art concepts. But just over three hundred years later, the world was again hit with intermittent (endemic) periods of bubonic plague that often became so severe the scientific concept of population census was developed for officials to estimate the number of people who died.
The 1918 spread of H1N1 influenza virus worldwide had surprisingly high mortality rates among young people. On the 100th year anniversary, and ten years after the 2009 H1N1 pandemic, the Centers for Disease Control and Prevention (CDC) reflected on the groundbreaking research accomplished while seeking to understand the deadliest pandemic in modern history.
It was estimated that over 500 million people (or about 1/3rd of the world’s population) were infected by the virus. With no vaccine to protect against influenza and no antibiotics to treat secondary infections, the 1918 pandemic lowered the average life expectancy in the United States by more than a dozen years.
Sometimes referred to as the “Spanish Flu”, this misnomer came from a false belief Spain was the epicenter for infection during the latter part of World War I. Many years later, researchers would find an avian link to the flu as medical confidence grew worldwide.
Reconstructing the Past to Prepare for the Future
During the 1918 pandemic, physicians were dealing with many unknowns but tried everything they knew to treat people stricken with the virus. However, only one therapeutic measure proved to be marginally successful: the transfusing of blood from a recovered patient to a newly infected patient. For generations, researchers remained relatively clueless about the disease believing bacteria had caused the pandemic.
Because of the potentially devastating effects a pandemic could have on soldiers, the U.S. Armed Forces Institute of Pathology took the lead in 1995 and succeeded in recovering lung tissue from archival samples taken from two World War I soldiers and an Inupiat woman buried in a permafrost mass grave in Alaska. Perfectly preserved, she also had died in 1918 from the disease.
Although Dr. Terrence Tumpey might not be a household name, his role as head of Immunology and Pathogenesis at the Centers for Disease Control and Prevention led to a personal experience that most scientists can only imagine. Working with a plasmid DNA strand isolated by a team of scientists at Mount Sinai, Tumpey was the first microbiologists to physically reconstruct the virus.
For safety reasons, the CDC determined only one person would be granted laboratory access, so Terrence Tumpey, Ph.D., became the first person to study the live 1918 virus. Continuing to expand testing and flu surveillance capacity around the world will be important for how medical confidence might rebound, but solutions need to come much faster in the future.
Improving on an Inadequate Global Capacity
Prior to the recent covid pandemic, the world had experienced three additional pandemics that were less severe and had considerably lower mortality rates than the Spanish Flu. Since penicillin was not discovered until ten years after the 1918 pandemic, neither intensive support nor mechanical ventilation were available. That left doctors with very few treatment options.
There were no centralized agencies to take a lead role in diagnostic testing that could help identify infection in 1918, so the federal government had no way to implement interventions. In fact, it would take the founding of the World Health Organization and the CDC before a global influenza surveillance and response network was established to monitor the emergence of novel flu viruses. Now we know, early plans also should include non-pharmaceutical interventions like limiting in-person events and large gatherings.
Developing effective therapeutics can help to reverse eroding confidence in medical interventions as well as protect the public our doctors serve. At the street level, this requires the nation’s medical schools to continue graduating well educated and highly committed students to become practicing professionals in a broad range of medical specialties.
Should another severe pandemic happen tomorrow; it would likely overwhelm the world’s health care infrastructure leaving doctors and nurses struggling to meet the global demand for urgent care. Research does suggest, as we wait to see how medical confidence might rebound, improving surveillance capacity worldwide, implementing national pandemic plans, and continuing to invest in developing and stock piling vaccines are prudent strategies.
COVID-19 challenged society to reexamine the balance between personal freedom and public health. Here at WolfPacc, we help each student recognize his or her dream in becoming a well-prepared practicing physician that helps oversee the diagnosis, management, and prevention of disease. To learn more about our advanced training programs for MDs, DOs, and IMGs, contact us today at 904-209-3140.
