Various governors and the president are pondering what to do during the current COVID-19 pandemic regarding ending social distancing and opening up the economy.
There is a lot to learn from studying the 1918 H1N1 influenza pandemic. What do we need to focus on if restrictions are relaxed?
First some facts: The 1918 flu hit the U.S. in three waves. The first wave came in March 1918 and tailed off by the early summer. But there were still low levels of virus circulating around. The first wave was bad, but didn't hold a candle to what was going to come.
In early fall 1918 the second wave began. The second wave was a true terror, accounting for most of the deaths seen in the pandemic. This highly fatal wave subsided in early winter.
But the 1918 flu was not done. There was a third wave, stronger than the first but not as bad as the second, in late winter to the early summer of 1919. When it was all done, more people had died worldwide from the 1918-1919 pandemic (50 million) as died in all of World War I (20 million military and civilian). In the U.S. 675,000 died.
This week experts from the Centers for Disease Control have warned that they fully expect a surge in COVID-19 cases this fall.
This means that if we see the number of new cases drop this summer, it does not signal "mission accomplished." It means that our leadership in Washington and the states have three to four months to prepare for the potential next wave.
This means that opening up the economy, while important, should not be the sole focus of our leaders.
Equal effort before this fall should be on having adequate supplies of ventilators, personal protective equipment, COVID-19 testing and potential vaccines or treatments.
While developing a vaccine is the ultimate key, it is likely a vaccine will not be ready until sometime well into 2021. This is because of the need to do controlled studies to assure any vaccine is effective and safe.
The need to rely only on controlled studies to determine effectiveness and safety is emphasized by a recent study that looked at the use of chloroquine, a possible treatment for COVID-19 that President Trump has advocated based on nonscientific word-of-mouth reports. The study had to be stopped after 11 of 81 patients died after developing irregular heartbeats. The FDA has further stated that neither hydroxychloroquine or chloroquine is effective or safe for COVID-19.
All of us should be concerned that federal response to provide COVID-19 testing has been woefully late and inadequate.
If you test large numbers of people then you can quarantine only those testing positive and people with whom they had contact, while leaving the rest of the population able to circulate and work with social distancing. Stay-at-home orders for the general population are necessary when you have no idea who has the virus and who doesn't.
But so far only about 3.2 million Americans (1%) have been tested. Infectious disease experts indicate more testing is needed before lifting restrictions.
Fortunately many governors have stepped into the federal leadership vacuum. Gov. JB Prizker was among the first to issue a stay-at-home order in response to the pandemic. His actions were not only science-based but often well ahead of the federal response.
However only the federal government has the financial resources to help the states to adequately meet this crisis. If the White House focuses on economic recovery without significant efforts to prepare for a possible fall surge, it could be a failure of leadership that will impact all of us well past the November election.
Dr. Stephen Soltys is a retired physician who still teaches medical students on a voluntary basis.