In times of COVID, let’s take a look at the previous 1918 pandemic

In times of COVID-19, let’s take a look at the 1918 pandemic, and compare that to the current situation. Perhaps, the world is very different now, but the pandemic was deadly then, and is deadly now. Almost two years into the current pandemic, and the world is still battling COVID-19 and the health systems are still struggling to manage it.

Spanish Flu – Initial start and spread

The world in 1918 was very different from what it is today. Cities were smaller, commercial air travel by plane was still science fiction, messaging still meant sending written letters by post, and horse-drawn carriage was still the mode of transport for many. It had been over three years since World War I had started, and the US had only recently entered the war and was mobilizing and training people fast for it. That meant millions of new recruits would be crammed in barracks and millions of new workers would enter cities and factories to manufacture both, bullets and bandages, for the war, overcrowding cities that didn’t have sufficient housing. Beds would sleep two people, and when they were vacated, two new people would cram into the same uncleaned space. During the winter, new recruits would huddle together around a heat source often in closed spaces to preserve the warmth. There was an unusual level of mobility due to the war which meant people were moving from place to place more frequently, in steamships and trains, much like in the globalized world of today.

Against this backdrop, during the frigid winter months at the start of 1918, a rural village in Kansas, Haskell County, became the starting point of a truly devastating pandemic. People suffering from influenza usually shed virus and infect others no more than seven days after infection. The virus would have stayed in the isolated corner of Kansas but for the fact that a large army base was not far from there and every now and again people travelled from this isolated corner to the army base, Camp Funston, which was the second-largest cantonment in the country and held on average 50,000 new young troops. And there was a constant stream of soldiers and personnel that moved from Funston to other army bases around the country. Two weeks after the first case in Funston, influenza surfaced at two army bases in Georgia over 1500km away. What started as a drizzle here and there, turned into a torrential downpour soon after. By the end of spring, 24 of the 36 largest army bases in the US experienced an influenza outbreak. And 30 of the 50 largest US cities in the country also experienced “excess mortality” from influenza and most of these cities were adjacent to military facilities.

Influenza virus is like a black cloud in the sky. Sometimes, the black cloud just drizzles a few drops on a high population region and moves on. Sometimes it can cause a rather heavy downpour and result in disruptions lasting a few hours.

Then there is that rarest of rare events when so much rain falls in such a short amount of time, it causes flash floods and widespread damage. That cloud has burst, and the water just falls onto the city below like a waterfall, causing lasting devastation. That influenza virus results in a pandemic.

By April, the larger outbreaks had started to happen in Europe, starting from France where American troops had disembarked for the war. The first wave of the virus was not as deadly but was debilitating enough that it interfered with the war and slowed the movement of troops. By May the virus had reached Spain, which was neutral during the war. Because of this, the press was not censored, unlike in France, UK and Germany, and the newspapers freely reported on the disease, especially when the Spanish king fell seriously ill. So even though the origin of the virus was in the US, it came to be known as the Spanish flu because only the Spanish reporting was being picked up by other countries.

Spanish Flu – Deaths

The 1918 influenza virus resulted in more deaths than the total deaths, military and civilian, resulting from World War 1. Moreover, it killed more people than any other pandemic in human history in raw numbers, although the plague in the 1300s had killed a larger proportion of the population in Europe.

Epidemiological estimates put deaths due to the virus between 50 and 100 million. The Spanish flu was unusual because it killed people in the prime of their life more often than the elderly and infants. In fact, nearly half of those that died were people in their 20s and 30s. Upper estimates put the death rate in young adults at almost 10%. The virus killed with great intensity and speed. Two-thirds of all that died, died in only 6 months. It killed more people in 24 weeks than AIDS has killed in 24 years.

COVID-19 in comparison has so far reported 5.2 million deaths worldwide, as of December 2021. Actual estimates may be more. The world population in 2021 is 7.75 billion while in 1918 was 1.8 billion, giving a sense of ferocity and lethality of the 1918 pandemic. Also, the majority of deaths due to COVID-19 are in people who are older or immunocompromised with 93% of the deaths among people older than 50 and 75% of the deaths in people older than 65 in the US.

How was the 1918 pandemic similar to the COVID-19 pandemic?

Like COVID-19, the 1918 pandemic also saw a shortage of nurses. Most nurses were called for the war effort. Approximately 80% of nurses from the east coast cities of the US were abroad during the war. Most countries reported a shortage of nurses, doctors, and hospital beds. But unlike COVID-19 where treatment and care is being provided in hospitals for moderate to severe cases, in the 1918 pandemic, most victims received care at home. Regardless, each pandemic overwhelmed the healthcare system.

There was no vaccine available to prevent the spread then. Only non-pharmaceutical interventions- handwashing, wearing face masks, quarantine, restricting social gathering, were used. And because of quarantines, restrictions on using public transport, and general fear in the public, the economy suffered.

Since N95 masks were only invented in the 1990s, nurses in 1918 relied on cloth/gauze masks. During COVID-19, the shortage of PPE equipment, including N95 masks, was a major concern for many health care providers around the world.

The field of medicine has come a long way since 1918. Apart from greater understanding and effectiveness of non-pharmaceutical interventions, antiviral drugs are now available to treat some flu illnesses and strong antibiotics can treat secondary bacterial infections like pneumonia. WHO, which was only founded in 1948 also has a global influenza surveillance system that gives scientists better insight into the spread of the virus and its variants, providing lawmakers with crucial insights that have allowed some countries to prevent overloading their health care systems and given them better knowledge of the course that the virus would take.
Better research capabilities and the internet has allowed faster dissemination of research in almost “real-time” that has enabled health care providers to adapt faster to combat the symptoms and give them more ability to prevent deaths.

Where are we now in terms of COVID-19 ….

Having said that, have we really come a long way? Two years into the COVID-19 pandemic and we are still not very safe. Most scientists and public health experts will agree that no one is safe from the pandemic until everyone is.
Even though the current pandemic has brought about many conversations around health equity and fighting the pandemic together, a lot of it only seems to be talk. The global effort to help those with the least resources is not very evident.

Yes, we have vaccines and treatment regimens to tackle COVID-19, but until everyone has equal access to those, we will only be going in circles.

The current Omicron variant may appear to be less severe, but its fast spread can potentially have an impact, especially amongst those that lack immunity. Furthermore, the newer variants that may emerge may act differently and vaccines will have to be tailored accordingly. Hence, until the virus spread is controlled everywhere, the cycle will continue and we will be left at the mercy of the virus. The only way to fight this pandemic and go back to the normal world is by thinking about everyone.

Hence, I say it again ….. No one is safe, until everyone is safe.

Author – Radha Shukla

References: 

The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry
Comparing the Spanish flu and COVID19 pandemics: Lessons to carry forward by Karen R. Robinson PhD, RN, FAAN
https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-u

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Judit Banhazi

Specialty
Value and Access

Role
Vice President

Degree
MD Medicine, JD Law

Judit Banhazi

MD Medicine, JD Law

Judit Banhazi, based in Basel, Switzerland, brings over 20 years of experience in HEOR, Market Access, and Health Policy.
She has led HEOR strategies in hematology and initiated EU HTA policy activities. Judit began her career as a physician and has worked at prime global pharma companies. Her academic prowess is excellent with a peculiar combination of an MD in Medicine and a JD in Law, she has been at forefront of health economics by being involved in HTA policy discussions with EFPIA and HTAi.
Known for her collaborative spirit and practical approach, Judit is passionate about learning and delivering quality work. Outside of work, she enjoys spending time with family and friends, travelling, and running.

Adam Ball

Specialty
Business Development Manager

 

Adam Ball

Business Manager

I am delighted to be part of the team here at ConnectHEOR. To tell you a bit about me, I have 10 years experience within Talent Acquisition within HEOR, RWE and Market Access. I have built a global network during this time and am excited to utilize this to help us grow as business. 

 

Outside of work I love sports, playing football and squash regularly, as well as going to the gym. I also enjoy watching sports mainly football and tennis. I have a new born daughter too so she is taking up a lot of my time and is a bundle of joy. I also play drums and like to think I have a broad taste in Music.

 

Eleni Tente

Specialty
Medical writing, Evidence planning

Role
Consultant, Medical writer

Degree
PhD – Molecular biology and genetics

Eleni Tente

PhD – Molecular biology and genetics

Eleni Tente is an experienced medical writer with proven ability to translate complex scientific information into clear, concise, and impactful content to diverse audiences. She has a strong background in integrated evidence planning, publications, internal communications and e-learning development, complemented by an understanding of various therapeutic areas.

Eleni holds a PhD in molecular biology and genetics from the University of Cambridge and an MSc in plant genetic manipulation from the University of Nottingham.

In her free time, Eleni enjoys diving into a good book, fishing along the coast, or planning her next thrilling scuba diving adventure to swim with sharks.

Syed Salleh

Specialty
HTA Modelling and Discrete-event Simulation

Role
Consultant, Modeling & Analytics

Degree
PhD – Health & Related Research

Syed Salleh

PhD. Health & Related Research

Syed Salleh brings extensive experience in HTA modeling, having successfully led the development of both de novo and adaptation models for HTA listings across multiple countries, including Malaysia, Philippines, and the UK. His work spans key therapeutic franchises such as oncology, cardiometabolic, and respiratory. Syed has also delivered critical insights to healthcare professionals through MYSPOR, ITTP, and IKN virtual CME events and numerous publications.

He holds a PhD in Health and Related Research from the School of Health and Related Research (ScHARR) at the University of Sheffield, UK, with a specialization in HTA and operational research, specifically in discrete-event simulation (DES) technique.

During his time in a leading pharmaceutical company, Syed played a key role in securing the listing of several key products in the Malaysia Ministry of Health Formulary and served as the primary contact for DES-related projects.

Besides work, Syed enjoys traveling, listening to music, and spending quality time with his family.

Thai-Son Tong

Specialty
Model Conceptualization and Data Analytics

Role
Senior Consultant

Degree
PhD – Health Economics

Thai-Son Tong

PhD. Health Economics

Thaison Tong has extensive work experience in health economics, decision modelling and big data analysis. He has a unique mix of experience in HEOR and RWE related research in academia and pharmaceutical industry. His expertise lies in health technology assessments (HTA), health economic modelling, simulation modelling, big data analytics and decision analysis. He has hands-on experience in a range of software and programming languages including R, R Shiny, R Markdown, Python, MS Excel, VBA, and Simul8. He has substantial experience of the health care system in the UK and other European countries.

Thaison has direct experience in building cost-effectiveness models from scratch and conducting big data analysis in several disease areas including dementia, vascular disease, and cancer.

Thaison’s PhD focus was to develop a de novo patient level model for the evaluation of different cognitive screening tests for early detection of dementia and mild cognitive impairment in primary care. He also looked at different methods for conducting economic evaluation in health care taking a broader/societal perspective. In addition, he investigated the use of Multiple Criteria Decision Analysis (MCDA) for economic evaluation.

Thaison also holds Academic Researcher position in School of Health and Related Research (ScHARR), University of Sheffield, UK and Honorary Researcher position in University of Bristol, UK.

Thaison’s likes to meditate, and play badminton, basketball and tennis.

Shilpi Swami

Specialty
Consulting and strategy

Role
Vice President

Degree
MSc. International Economics

Shilpi Swami

MSc. International Economics

Shilpi Swami is a seasoned Health Economics and Outcomes Research (HEOR) expert with experience spanning across multiple healthcare systems and therapy areas. At her current role of Vice President, HTA and Strategy, ConnectHEOR, she provides technical and strategic leadership. Additionally, Shilpi serves as the Member Engagement Co-Chair at ISPOR Oncology Special Interest Group.

Shilpi has a comprehensive track record of leading HTA submissions and devising market access strategies on a global scale, including the EU-5, Canada, US, Latin America, Australia, and Asia. Shilpi has worked across various sectors within health economics, including academia, consulting, and biopharma. This multidimensional experience equips her with a unique ability to offer strategic insights from various stakeholders’ perspectives.

Formerly a Research Fellow at the University of York, Shilpi has made significant contributions to public health projects and the development of best practices in the academic side of health economics. In her professional endeavors, she remains dedicated to improving healthcare through data-driven insights and evidence-based research

Hugo Pedder

Specialty Statistical Analysis and Evidence Synthesis

Role Senior Consultant

Degree PhD – Statistical Modelling

Hugo Pedder

PhD – Statistical Modelling

Hugo brings in a wealth of experience to ConnectHEOR from his extensive work in academia, focusing primarily on evidence synthesis and meta-analysis. Hugo holds PhD in Statistical Modelling from University of Briston and MSc in Medical Statistics from the London School of Hygiene and Tropical Medicine, and his background in neuroscience remains a passionate interest. Alongside working with ConnectHEOR, Hugo continues to part of NICE committee. His expertise includes advanced indirect treatment comparisons technique and has extensive experience of working with the NICE in UK. 

Beyond professional endeavors, Hugo is an enthusiastic outdoor adventurer, particularly enjoying mountain activities, climbing and ski mountaineering. From building rafts to exploring rivers in north of Sweden, he has lived an adventurous life outside of work and plans to continue to do so.

Kunal Hriday

Specialty
Data science and Strategy

Role
Senior Consultant

Degree
MSc. Quantitative Economics

Kunal Hriday

MSc. Quantitative Economics

Kunal Hriday is a business strategy and data science professional with experience in helping organizations crack through notorious business challenges. Kunal is proficient in business analytics, data analytics, product lifecycle management and business development. Working as a Data analytics consultant he has spent time in problem solving across variety of industries including Banking, logistics and Health and is now fully dedicated to HEOR. Kunal has hands on experience in various statistical programming tools and languages like R, Python, SAS, Excel VBA, Data Robot and data visualization tools like Power BI, Tableau and SAS VA.

Kunal also holds a Masters in Quantitative Economics from Indian Statistical Institute and a bachelors degree in Business Economics. Excellent in business communication, he is passionate about studying environmental economics and related theories of welfare optimization.

Raju Gautam

Specialty
Evidence Review

Role
Principal Consultant

Degree
PhD (Pharmacy)

Raju Gautam

PhD Pharmacy

Raju Gautam spearheads evidence review at ConnectHEOR and  has extensive work experience in evidence review and synthesis, value communications, scientific publications, medical writing and project management.
His expertise lies in systematic and targeted literature reviews, meta-analyses, network meta-analyses, value communications (AMCP and Global Value Dossiers), RWE study design and publications (manuscripts, posters, and abstracts).
He has experience working in Global pharma companies, consulting and CRO environment for several therapy areas including Cardiovascular, Oncology, Neurology, Respiratory, Ophthalmic, Rare Diseases, and Vaccines. He has more than 40 publications in international journals as an author.
Raju also likes jogging, yoga and meditation.

Radha Sharma

Specialty:
Patient preference research, survey, In-depth interviews, COA, Evidence review and conceptualisation of study

Role:
Director – Patient-Centered Outcomes Research

Degree:
MBBS (Bachelor of Medicine and Bachelor of Surgery), PhD (Global Public Health) – University of York

Radha Sharma

PhD (Global Public Health)

Radha Sharma spearheads Patient-Centered Outcomes Research at ConnectHEOR. She has a background in medicine, public health, and epidemiology.

Her expertise includes global health research, preference elicitation, mixed-method studies, consensus workshops, qualitative health research, epidemiological analysis of big data sets, RWE study design, scientific writing, and literature reviews. Her primary focus is integrating patient perspectives into all stages of health technology assessment (HTA) and healthcare decision-making processes.

Her extensive expertise in mixed-method studies and active patient/stakeholder engagement ensures that her research is methodologically rigorous and patient-centric. Radha is an avid hiker and enjoys exploring the beautiful Canadian Rockies.

Kate Ren

Specialty
Statistical Analysis and Evidence Synthesis

Role
Director of Statistics

Degree
Ph.D Probability and Statistics

Kate Ren

PhD Probability and Statistics

Kate spearheads Statistics and Evidence Synthesis at ConnectHEOR. She has more than 10 years of experience in conducting statistical analysis in HTA. Kate has PhD in Probability and Statistics specialising in Bayesian methods in clinical trial design.

She specializes in Bayesian methods in health economics and the elicitation of experts’ beliefs and has extensive experience of conducting evidence synthesis, including, meta-analysis, network meta-analysis, MAIC, STC, ML-NMR etc. Besides working with ConnectHEOR, she is also a part of NICE Committee and University of Sheffield.

Tushar Srivastava

Specialty
Decision Modelling and AI Initiatives

Role
Director and Principal Consultant

Degree
MSc – Statistics and Computing

Tushar Srivastava

MSc – Statistics and Computing

Endorsed as a ‘Global Talent’ by prestigious ‘The Royal Society, UK’, Tushar is dynamic and enjoys approaching complex problems with a holistic approach. He also holds an MSc. in Statistics and has authored a handbook on higher Mathematics, “A concise handbook of vector space theory and field theory, Srivastava T.”

In ConnectHEOR, Tushar spearhead all HEOR activities.

Tushar’s technical expertise lies in different techniques including cost-effectiveness modelling, budget impact modelling, simulation modelling, statistical modelling and indirect comparisons analysis. He brings a unique blend of academic research, technical modelling and statistical skills and industry professionalism to support the life science industry at every stage of the product life cycle. He has a good experience in statistical analyses, including survival analysis and health related quality of life data analysis from clinical trials.

Besides work, Tushar enjoys playing badminton, jogging, and meditating.