We have recently lived through the pandemic of our times. Although there is the potential for future challenges that have similarities to SARS-CoV-2 and COVID-19, it is unlikely that many of us living today will be around to remember this when the next challenge comes along. We have seen a great deal of mistake and misstep in this instance, and reflection is perhaps a worthy use of a few moments.
Beginning in March 2020, we were unequivocally told much about this virus, experts provided the government with advice and we were exposed to their predictions and prognostications in the news. For example, we were told not to wear masks, and later told absolutely to wear masks. That debate even included then U.S. Surgeon General Jerome Adams. See Show me the Science (September 2021). We were told it was not airborne, and then eventually that it was (is). Two years after it first appeared in America (they think), there are various mysteries that remain for investigation despite all we have been told.
Some of the contradiction and policy decision making was perhaps not based on science. We saw wholesale lockdowns, shutdowns, reactions, and precautions, all largely based on consensus, fear, and perhaps an overabundance of caution. The caution was perhaps driven by the potential for widespread death. Let's face it, the potential for millions dead was a very scary proposition in March 2020, and the reality of the deaths now experienced remains sobering. In discussing the science, it is notable that the source of SARS-CoV-2 was not unequivocally identified, and the exact path that led it to human infection remains unclear today. Two years since our first infections and we don't yet definitively know the source.
When the miracle occurred, See The Future's So Bright (February 2021), I reminisced at the many scientists that had found the potential for a vaccine within a single year after infection began to be fanciful and doubtful. But, in less than a year, there was a vaccine (to be fair, there was more than one). Those scientists that doubted it were wrong. Public statements by so-called experts and scientists (opinion, without data) about the vaccine effort and its rapidity were possibly responsible for various people's reluctance to accept the vaccination when it did become available. Despite those public opinions, in the first year after the vaccine debuted, "over 200 million Americans, just over 60% of the population, had been fully vaccinated," according to CNBC.
Science, in its real terms of hypothesis, testing, and conclusions, has really only just begun to address many of our COVID questions. This was illustrated recently in a great program produced by ACOEM regarding "Long COVID," a reference to the ongoing symptomatology and complaints of those who have recovered from the infection but continue to suffer. To a person, those experts noted that there remains much to learn and that studies and proofs are only just beginning to bring data. Those symptom challenges will likely be a part of our national health considerations for many years to come, and as such will be part of workers' compensation and the tens of thousands of already accepted workers' compensation COVID-19 claims.
Throughout the pandemic, there have been those who drew parallels to the 1918 influenza pandemic. I referenced it in Occupational Disease and the 1918 Flu (July 2020). It is mentioned again in West Nile Disease in Comp (August 2020), and yet again in Disease and Causation (February 2022). There are some parallels in terms of both disease and workers' compensation implications. However, as the data is accumulated, it appears that there may be valid parallels to draw regarding other pandemics as well.
And, it turns out, that sometimes the challenges of our natural world can be beyond the present ability of science to grasp and explain. The Microsoft Network recently published a critique on the 1918 scientific reactions, and illustrated the dangers of consensus among the scientific community. The article is titled The 1918 pandemic mistake that changed medicine forever.
This describes a "bacteriologist named Richard Pfeiffer" and his error of 1892. He, and other scientists, did not then grasp that the flu resulted from a virus (there were things science did not then know). Researching the "suite of infectious respiratory symptoms" then referred to as flu, this scientist/researcher then connected the disease instead to "a new bacterium in 1893."
Through a series of experiments on "31 patients who had died in the flu pandemic of 1889-90," Pfeifffer "discovered a new type of bacterium," "bacterium Bacillus influenzae" (which became in common parlance "Pfeiffer's Bacillus"). He concluded that this was "the exciting causes of influenza.” The article noted this scientist's stature and standing, and noted "his stature was such that people readily believed him." (side note, Society is often impressed with consensus of physicians, or dentists or others).
When the 1918 flu later struck, "multiple groups developed and administered vaccines" which were often "based on the assumption that . . . bacillus caused the disease." There was, it seems, some degree of consensus among the experts regarding what they were dealing with and how best to proceed. This included "then-U.S. Surgeon General Rupert Blue" (see also, above, re other surgeon general in 2020). Those vaccines, of course, did not prevent the flu. However, the article notes some remaining consensus that various other infections were perhaps prevented by those injections, and thus "reduced deaths from secondary infections." They did not, however, stop the flu virus.
The article notes that the story of this German scientist of such stature is "a potent reminder of the challenges scientists face when a novel microscopic threat emerges." In 1918-19 "tens of millions were dead across the globe," and both cause and mechanism still largely eluded science. However, some degree of consensus drove the response nonetheless. It was decades ("roughly 40 years") before "scientists eventually discovered the viral strain that caused the 1918 pandemic." Those many vaccinations then, based upon the bacterium theory, were largely mistakes. Mistakes in which seemingly wide swaths of the era's scientists engaged through the consensus, or "group think," of the moment. See Consensus in the Absence of Proof (January 2021).
The article notes that "the scientists" at that time “were very thoughtful, smart, hard-working people, doing their very best, using their knowledge base and their technology.” However, their collective efforts aptly demonstrated that science had not fully grasped the threat with which humanity was confronted, and consensus proved a poor substitute for science. However, their work undoubtedly led to new treatments for other diseases, hastened the formation of national and global public health institutions, and left us better prepared to deal with modern pandemics, including COVID-19.
The scientists in 1919 continued to research. They collected pathology samples and did examinations and experiments. They identified the so called "Pfeiffer's bacillus" in some samples, but larger "teeming colonies of Streptococcus, Pneumococcus, and Staphylococcus aureus." They also found the "Pfeiffer's bacillus" in the lungs of "many healthy people" and were troubled by that incongruity.
They performed tests by "spray(ing) a pure culture of Pfeiffer's bacillus into volunteers' noses," but they did not become ill. And, experiments continued, became bolder. Despite various exposures to the "Pfeiffer's bacillus," the article notes "no one got sick." This direct exposure experiment process is called "human challenge" and it has begun anew with COVID-19, as reported by Reuters. In that article, note how many similarly intentionally-infected subjects did not contract COVID-19 (47%). Note that. Some people do not contract COVID-19 when they are intentionally, directly, and completely exposed. Might we still have things to learn?
One of those studying and experimenting in 1919 later reflected that “We entered the outbreak with a notion that we knew the cause of the disease. Perhaps, if we have learned anything, it is that we are not quite sure what we know.” Perhaps, that caution remains yet today as we face new challenges? There is room for experimentation, gathering of real data, and study.
The bacteria and the flu were studied for years after "Flu deaths finally returned to pre-pandemic levels in 1921." Science worked on the potential causes, and focused still on this bacillus. In 1933 researchers began to focus strongly on a virus. It would not be until 2005 that science would determine conclusively "the deadly strain that caused the 1918 pandemic . . . was H1N1, and it had leapt from birds to humans." Over 80 years of work and science were needed for somewhat definitive answers on H1N1.
That H1N1 flu killed "At least 50 million people . . . in 1918." It evolved to an endemic state and has since killed "tens of millions of people" more. MSN notes that science method has improved in the century since. In 1918, there were "no standardized methods of research or testing, virtually no peer review, and no common protocols for clinical trials." Our evolution since then has included better communication and critical thinking, guidelines for trials, even the establishment of National Institutes of Health, and global efforts through the World Health Organization.
And progress continues. A 2005 paper suggested that neither H1N1 or SARS-CoV-2 was the first virus to "leap" from one species to another. There is study now to determine if a coronavirus "leapt from cows to people" in 1890 when Pfeiffer was studying the bacillus. There are symptom similarities cited between the 1890 event and COVID-19 ("including the loss of taste and smell, seizures, and long recovery periods"). Some therefore now wonder if "the 1889 pandemic was not caused by a flu virus at all, but by the CO43 coronavirus." Maybe humans have lived through other coronavirus "leaps?" Science, it seems, does not have all the answers, and in some instances perhaps even struggles with finding the questions (whether that event was a coronavirus is only now being considered over 100 years later).
The MSN article cites one scientist explaining that "it's a modern mistake to think the researchers working during past pandemics were missing the obvious." Instead, the point is that much remains unknown, even now. He contends that even today
"we're still in the dark about some aspects of COVID-19, including its origins, its long-term impacts on the body, and its ultimate evolutionary trajectory."
He contends that in another century, "there are definitely going to be insights that should have been quote-unquote ‘obvious' to us now." And, he reminds us "that's the way of science.” It is not exact, all encompassing, and conclusory. Science is evolving and developing. There are new discoveries, theories, and proofs. Despite the inclination to blindly and obediently "follow the science," and its best consensus of today, perhaps the better course is to challenge the science and seek further discovery and illumination? If not, we might still be treating the flu virus as a bacillus and how many more millions might continue to suffer without the now ubiquitous influenza vaccines that evolved from better study and focus?
The science has admirable moments. The miracles of vaccination and prevention are clear. But, the consensus of the moment can be wrong, has been wrong, and time will be required to validate or disprove that to which consensus leaps.
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