As the number of countries reporting incidences of patients with Coronavirus symptoms rises, fear and panic has gripped the world even harder, with suggestions that it could be the worst pandemic the world has seen. So, what has the been the worst the world has seen historically and how does it compare to what we know about the Coronavirus thus far? This piece in The Atlantic, attempts just that. Dr Jeremy Brown, the author of the article is an emergency physician and the author of Influenza: The 100-Year Hunt to Cure the Deadliest Disease in History, a book about the Great Flu that killed millions in 1918 and whether the world is prepared for the next epidemic. Whilst Dr Brown allows for the possibility for the unknown unknown about Coronavirus, he reassuringly writes about the vast advances in medical science which should prevent this from coming any closer to the Great Flu. For example, back then it took almost 15yrs to simply trace the root cause of the flu to the influenza virus. “The contrast with the coronavirus, which causes the disease COVID-19, could not be greater. From the very start of the outbreak, scientists suspected a virus. Within two weeks, they had identified it as a coronavirus, sequenced its genome, and discovered that the most likely animal hosts were bats. This information, which was published by a Chinese team, was instantly shared across the scientific community, allowing research labs around the world to begin the long and complicated process of understanding the virus, and finding a vaccine and a cure. We may not have beaten the enemy yet, but we certainly know a great deal about him.
The Great Influenza Pandemic of 1918 occurred in the pre-antibiotic era. Although antibiotics do not treat viruses, they do treat the secondary bacterial infections that sometimes follow. These secondary infections cause severe pneumonia, and were likely responsible for most of the deaths in 1918. Back then, there was little to offer. Physicians recommended quinine (not helpful), dry champagne (ditto, though more fun), and phenolphthalein (a cancer-causing laxative). During an earlier outbreak of influenza, in 1916, British military physicians had even tried bloodletting as they treated dying soldiers. When it failed, they suggested it had simply not been tried soon enough in the course of the disease. Patients survived in spite of their doctors.
Today we live in a world that is flooded with antibiotics. And although there is concern that bacteria are becoming ever more resistant to them, antibiotics remain an overwhelmingly powerful tool to treat secondary bacterial pneumonia. Early case reports describe these infections in COVID-19 patients, and we have every reason to believe that for many, though sadly not all, antibiotics will provide a cure.
We also have another class of drugs available today: antivirals, which directly target the virus responsible for a disease. There are at least four approved antiviral medications, some given orally and others intravenously. They are not as effective as we would like, but they have been given to a number of very sick COVID-19 patients. Whether those antiviral medications or the antibiotics that are often given in tandem are responsible for successful outcomes is hard to determine. But we have options that were simply undreamed of a century ago.”
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