To Survive Next Pandemic, We Must Not Forget COVID Like We Forgot the 1918 Flu

The second Moderna shot made me sick — as predicted. A 24-hour touch of what an alarmed immune system feels like left me all the more grateful for my good fortune in avoiding the real thing and for being alive at a time when science had devised a 95% effective vaccine in record time.

To distract myself from the fever as I tried to sleep, I visualized strands of synthetic messenger RNA floating into my cells to produce the alien spike protein that attracted my warrior T-cells. I drifted off envisioning an epic micro-battle underway in my blood and had a series of weird nightmares. At about two a.m., I woke up sweating, disoriented, and fixated on a grim image from one of the studies I had consulted while writing my own upcoming book, Virus: Vaccinations, the CDC, and the Hijacking of America’s Response to the Pandemic, on the Covid-19 chaos of our moment. In his Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver, Arthur Allen described how, in the days of ignorance — not so very long ago — doctors prescribed “hot air baths” for the feverish victims of deadly epidemics of smallpox or yellow fever, clamping them under woolen covers in closed rooms with the windows shut.

Mildly claustrophobic in the best of times, my mind then scrabbled to other forms of medical persecution I’d recently learned about. In the American colonies of the early eighteenth century, for example, whether or not to take the Jenner cowpox vaccine was a matter of religious concern. Puritans were taught that they would interfere with God’s will if they altered disease outcomes. To expiate that sin, or more likely out of sheer ignorance, medical doctors of the day decreed that the vaccine would only work after weeks of purging, including ingesting mercury, which besides making people drool and have diarrhea, also loosened their teeth. “Inoculation meant three weeks of daily vomiting, purges, sweats, fevers,” Allen wrote.

To clear my thoughts, to forget, I opened my window, let in the winter air, and breathed deep. I then leaned out into the clean black sky of the pandemic months, the starlight brighter since the jets stopped flying and we ceased driving, as well as burning so much coal.

Silence. An inkling of what the world might be like without us.

Chilled, I lay back down and wondered: What will the future think of us in this time? Will people recoil in horror as I had just done in recalling, in feverish technicolor, the medically ignorant generations that came before us?

The Glorious Dead

When America reached the half-million-dead mark from Covid-19 at the end of February, reports compared the number to our war dead. The pandemic had by then killed more Americans than had died in World War I, World War II, and the Vietnam War combined — and it wasn’t done with us yet. But the Covid dead had not marched into battle. They had gone off to their jobs as bus drivers and nurses and store clerks, or hugged a grandchild, or been too close to a health-care worker who arrived at a nursing home via the subway.

Every November 11th, on Veterans Day, our world still remembers and celebrates the moment World War I officially ended. But the last great pandemic, the influenza epidemic of 1918-1920 that became known as “the Spanish flu” (though it wasn’t faintly Spain’s fault, since it probably began in the United States), which infected half a billion people on a far less populated planet, killing an estimated 50 million to 100 million of them — including more soldiers than were slaughtered in that monumental war — fell into a collective memory hole.

When it was over, our grandparents and great-grandparents turned away and didn’t look back. They simply dropped it from memory. Donald Trump’s grandfather’s death from the Spanish flu in 1919 changed the fortunes of his family forever, yet Trump never spoke of it — even while confronting a similar natural disaster. Such a forgetting wasn’t just Trumpian aberrance; it was a cultural phenomenon.

That virus, unlike Covid-19, mainly killed young healthy people. But there are eerie, even uncanny, similarities between the American experience of that pandemic and this one. In the summer of 1919, just after the third deadly wave, American cities erupted in race riots. As with the summer of 2020, the 1919 riots were sparked by an incident in the Midwest: a Chicago mob stoned a black teenager who dared to swim off a Lake Michigan beach whites had unofficially declared whites-only. The boy drowned and, in the ensuing week of rioting, 23 blacks and 15 whites died. The riots spread across the country to Washington, D.C., and cities in Nebraska, Tennessee, Arkansas, and Texas, with Black veterans who had served in World War I returning home to second-class treatment and an increase in Ku Klux Klan lynchings.

As today, there were similar controversies then over the wearing of masks and not gathering in significant numbers to celebrate Thanksgiving. As in 2020-2021, so in 1918-1919, frontline medics were traumatized. The virus killed within hours or a few days in a particularly lurid way. People bled from their noses, mouths, and ears, then drowned in the fluid that so copiously built up in their lungs. The mattresses on which they perished were soaked in blood and other bodily fluids.

Doctors and nurses could do nothing but bear witness to the suffering, much like the front-liners in Wuhan and then New York City in the coronavirus pandemic’s early days. Unlike today, perhaps because it was wartime and any display of weakness was considered bad, the newspapers of the time also barely covered the suffering of individuals, according to Alex Navarro, editor-in-chief of the University of Michigan’s Influenza Encyclopedia about the 1918 pandemic. Strangely enough, even medical books in the following years barely covered the virus.

Medical anthropologist Martha Louise Lincoln believes the tendency to look forward — and away from disaster — is also an American trait. “Collectively, we obviously wrongly shared a feeling that Americans would be fine,” Lincoln said of the early days of the Covid-19 pandemic. “I think that’s in part because of the way we’re conditioned to remember history… Even though American history is full of painful losses, we don’t take them in.”

Guardian columnist Jonathan Freedland argues that pandemic forgetting is a human response to seemingly pointless loss, as opposed to a soldier’s death. “A mass illness does not invite that kind of remembering,” he wrote. “The bereaved cannot console themselves that the dead made a sacrifice for some higher cause, or even that they were victims of an epic moral event, because they did not and were not.”

Instead, to die of Covid-19 is just rotten luck, something for all of us to forget.

Who Will Ask Rich Men to Sacrifice?

Given the absence of dead heroes and a certain all-American resistance to pointless tragedy, there are other reasons we, as Americans, might not look back to 2020 and this year as well. For one thing, pandemic profiteering was so gross and widespread that to consider it closely, even in retrospect, might lead to demands for wholesale change that no one in authority, no one in this (or possibly any other recent U.S. government) would be prepared or motivated to undertake.

In just the pandemic year 2020, this country’s billionaires managed to add at least a trillion dollars to their already sizeable wealth in a land of ever more grotesque inequality. Amazon’s Jeff Bezos alone packed in another $70 billion that year, while so many other Americans were locked down and draining savings or unemployment funds. The CEOs of the companies that produced the medical milestone mRNA vaccines reaped hundreds of millions of dollars in profits by timing stock moves to press releases about vaccine efficacy.

No one today dares ask such rich men to sacrifice for the rest of us or for the rest of the world.

The pandemic might, of course, have offered an opportunity for the government and corporate leaders to reconsider the shareholder model of for-profit medicine. Instead, taxpayer money continued to flow in staggering quantities to a small group of capitalists with almost no strings attached and little transparency.

A nation brought to its knees may not have the resources, let alone the will, to accurately remember how it all happened. Congress is now investigating some of the Trump administration’s pandemic deals. The House Select Committee on the Coronavirus Crisis has uncovered clear evidence of its attempts to cook and politicize data. And Senator Elizabeth Warren led somewhat fruitful efforts to expose deals between the Trump administration and a small number of health-care companies. But sorting through the chaos of capitalist mischief as the pandemic hit, all those no-bid contracts cut without agency oversight, with nothing more than a White House stamp of approval affixed to them, will undoubtedly prove an Augean stables of a task.

In addition, looking too closely at the tsunami of money poured into Big Pharma that ultimately did produce effective vaccines could well seem churlish in retrospect. The very success of the vaccines may blunt the memory of that other overwhelming effect of the pandemic, which was to blow a hole in America’s already faded reputation as a health-care leader and as a society in which equality (financial or otherwise) meant anything at all.

Forgetting might prove all too comfortable, even if remembering could prompt a rebalancing of priorities from, for instance, the military-industrial complex, which has received somewhere between 40% and 70% of the U.S. discretionary budget over the last half century, to public health, which got 3% to 6% of that budget in those same years.

The Most Medically Protected Generation

For most Americans, the history of the 1918 flu shares space in that ever-larger tomb of oblivion with the history of other diseases of our great-grandparents’ time that vaccines have now eradicated.

Until the twentieth century, very few people survived childhood without either witnessing or actually suffering from the agonies inflicted by infectious diseases. Parents routinely lost children to disease; people regularly died at home. Survivors — our great-grandparents — were intimately acquainted with the sights, smells, and sounds associated with the stages of death.

Viewed from above, vaccines are a massive success story. They’ve been helping us live longer and in states of safety that would have been unimaginable little more than a century ago. In 1900, U.S. life expectancy was 46 years for men and 48 for women. Someone born in 2019 can expect to live to between 75 and 80 years old, although due to health inequities, lifespans vary depending on race, ethnicity, and gender.

The scale of change has been dramatic, but it can be hard to see. We belong to the most medically protected generation in human history and that protection has made us both complacent and risk averse.

The history of twentieth-century vaccine developments has long seesawed between remarkable advances in medical science and conspiracy theories and distrust engendered by its accidents or failures. Almost every new vaccine has been accompanied by reports of risks, side effects, and sometimes terrible accidents, at least one involving tens of thousands of sickened people.

Children, however, are now successfully jabbed with serums that create antibodies to hepatitis B, measles, mumps, rubella, diphtheria, tetanus, pertussis — all diseases that well into the twentieth century spread through communities, killing babies or permanently damaging health. A number of those are diseases that today’s parents can barely pronounce, let alone remember.

Remembering Is the Way Forward

The catastrophe of the Spanish flu globally and in this country (where perhaps 675,000 Americans were estimated to have died from it) had, until Covid-19 came along, been dropped in a remarkable manner from American memory and history. It lacked memorial plaques or a day of remembrance, though it did leave a modest mark on literature. Pale Horse, Pale Rider, Katherine Anne Porter’s elegiac short story, for instance, focused on how the flu extinguished a brief wartime love affair between two young people in New York City.

We are very likely to overcome the virus at some point in the not-too-distant future. As hard as it might be to imagine right now, the menace that shut down the world will, in the coming years, undoubtedly be brought to heel by vaccines on a planetary scale.

And in this, we’ve been very, very lucky. Covid-19 is relatively benign compared with an emergent virus with the death rates of a MERS or Ebola or even, it seems, that 1918 flu. As a species, we will survive this one. It’s been bad — it still is, with cases and hospitalizations remaining on the rise in parts of this country — but it could have been so much worse. Sociologist and writer Zeynep Tufekci has termed it “a starter pandemic.” There’s probably worse ahead in a planet that’s under incredible stress in so many different ways.

Under the circumstances, it’s important that we not drop this pandemic from memory as we did the 1918 one. We should remember this moment and what it feels like because the number of pathogens waiting to jump from mammals to us is believed to be alarmingly large. Worse yet, modern human activity has made us potentially more, not less, vulnerable to another pandemic. A University of Liverpool study published in February 2021 found at least 40 times more mammal species could be infected with coronavirus strains than were previously known. Such a virus could easily recombine with any of them and then be passed on to humanity, a fact researchers deemed an immediate public health threat.

In reality, we may be entering a new “era of pandemics.” So suggests a study produced during an “urgent virtual workshop” convened in October 2020 by the United Nations Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (ISPBES) to investigate the links between the risk of pandemics and the degradation of nature. Due to climate change, intense agriculture, unsustainable trade, the misuse of land, and nature-disrupting production and consumption habits, more than five new infectious diseases emerge in people every year, any one of which could potentially spark a pandemic.

That ISPBES study predicted that “future pandemics will emerge more often, spread more rapidly, do more damage to the world economy, and kill more people than Covid-19, unless there is a transformative change in the global approach to dealing with infectious diseases.”

Is our species capable of such a change? My inner misanthrope says no, but certainly the odds improve if we don’t delete this pandemic from history like the last one. This, after all, is the first pandemic in which the Internet enabled us to bear witness not only to the panic, illness, and deaths around us, but to the suffering of our entire species in every part of the globe in real time. Because of that alone, it will be difficult to evade the memory of this collective experience and, with it, the reminder that we are all made of the same vulnerable stuff.