Ebola, Spanish Flu, and Us

By Bobby Halton

As a service, we pride our- selves in being always ready, ever present, and prepared as best we can. Part of that preparation needs to be an understanding of the potential for disaster, disease, and terrorism to affect our community and those we have sworn to protect and serve. Firefighters, EMTs, and paramedics were all watching the news in Dallas recently when a Dallas Fire Department paramedic unit became involved in the current Ebola issue here in the United States. Ebola has always been tremendously feared, and rightfully so: It is a devastating and deadly disease. But until the death of Liberian national Thomas Eric Duncan, no one in the United States had ever died of Ebola or, until the two nurses became infected, had contracted the disease here. Much is known about the disease and yet there is still much more to learn. There is hope for a new treatment involving, of all things, tobacco, but the process to create it takes six months, and the need for it appears to be growing as this editorial is being written.

Part of being prepared requires we understand history, that we pay attention to trends, and that we continuously engage in pre-mortem activities where we evaluate worst-case scenarios. Many think that safety is largely something you can count; unfortunately, this Ebola outbreak is a low-frequency/high-consequence event that the counting of errors has done little to predict or help mitigate.

Many people today believe that problems are easily defined by the presence of errors or the absence of errors and that solutions are obtainable in hours. The problem with this thinking is that it completely ignores the complexity of today’s society and that to be effective, solutions must consider the past, the present, and the future. Those solutions take time to formulate and to enact. They require that we look at safety as an ethical consideration and not just something we count on a ledger.

The fire service must engage in constant scenario planning for the eventuality of dealing with the possibilities of many dangers including terrorist attack, chemical or biological weapons, acts of nature, failures of technology, human error, and pandemic disease. As we are seeing with this current Ebola outbreak, a pandemic disease may be the most threatening scenario we may ever face. It would not be the first time mankind has dealt with a devastating disease. In three different centuries, the bubonic plague wiped out large portions of the known world. In the early days of our nation, the yellow fever killed more than 14,000 across the American South.

Currently, the Ebola virus requires direct contact with some bodily fluid, but what if it becomes airborne? Then all bets are off, and this is where pre-mortem scenario planning and ethical and thorough preparation have the potential to save millions.

Recall history and the influenza pandemic from 1918 to 1920 called the “Spanish flu.” No one is really sure how the Spanish flu began, but there are theories that it came from the burning of manure. The index patient was a U.S. Army cook named Albert Gitchell, who took ill in April 1918. As a cook, he had contact with the entire base. Within one day of his falling ill, 107 of his fellow soldiers were infected; within a week, more than 500.

The Spanish flu spread quickly throughout the military base and the U.S. Army. It was a fast-acting virus; within days, its victims were in excruciating pain and suffering from pneumonia-like symptoms. The government then was also slow to react and gave the public very little information regarding the condition of the soldiers in the U.S. Army or how many of them were sick. And, much like today, little was done to isolate the soldiers to help stop the spread of disease. On the contrary, the soldiers were continually being shipped out, much like how air travel from the affected regions of the world continues unimpeded now.

Spanish flu was everywhere within weeks in the United States and within months around the world. It is noteworthy that 53,000 soldiers died in combat in World War I but 63,000 soldiers died from the flu. The government was at a loss to explain what was happening, so it released the story that it was a result of chemical warfare in Europe. It’s estimated that the flu affected one in every three Americans; of course, the story of chemical warfare fell apart under scrutiny.

To combat the outbreak, local authorities began to control the spread of the flu with travel restrictions. Measures were taken to reduce the size of crowds in shopping centers and other public events. Tens of thousands of Americans volunteered during this time in hospitals to aid the sick. Schools were closed, and university campuses ceased activities. Those in infected homes had to display placards on the windows. There were shortages of caskets and gravediggers, and funeral homes were overcrowded. No American was safe; even President Woodrow Wilson contracted the disease in 1919; he survived.

One interesting aspect of this flu was that the majority of the people who died were between the ages of 15 and 34. In 1920, just as mysteriously as it began, the Spanish flu disappeared, leaving almost 40 million people dead.

Ben Franklin said, “Experience keeps a dear school, but fools will learn in no other, and scarce in that.” The fire service can ill afford to play the fool, nor will we-it’s not in our nature. But we certainly must demand that those who dare be reminded of the consequences.