Pandemic In 1918 Essay
Abstract
In 1918, the world experienced its most deadly modern pandemic, the H1N1 influenza virus named the Spanish Flu. Killing between 20 and 40 million people worldwide, the pandemic has not since been repeated on such a large scale. This paper provides a background of the 1918 virus and its effects followed by an examination of the danger represented by the H5N1 Avian Flu virus of 1997. Finally, it discusses the potential international economic impact of a modern pandemic like the Spanish Flu, should such a virus materialize again.
Thesis
The post-World War II world can be characterized by unparalleled connectivity and a shrinking of the world’s metaphoric size. In many ways, this has been useful to humanity, promoting growth, understanding, mobility, and, for the most part, prosperity. However, such an environment represents a fertile killing ground for a virus capable of being easily transmitted between humans. Since 1918, the world has not faced a worldwide pandemic on the scale represented by the Spanish Flu; when it does, the economic effects of such virus is unknowable. However, some estimates have been made, although with the world lacking such a megadeath in its recent history, it is possible that these estimates are optimistic.
The Deadly Foe
In 1918, the world’s most deadly serial killer came out of the shadows. It usually …show more content…
started with a cough. Sometimes it would start with a headache, but with a world at war and an economy in the doldrums, most people ignored a simple headache. But the cough…wet and heavy, it arrived unannounced as the harbinger of death’s shadow. It didn’t seem to care if you were young or healthy…in fact it liked you that way.
Within hours, dark brown spots would appear on its victim’s skin. Lungs began to struggle as liquid replaced most of the air. Eventually, often times the same day the cough started but usually within 24 to 48 hours, its victim’s extremities would begin to turn blue as the body found it increasingly difficult to deliver oxygen (Barry 2004). Within hours, the serial killer would claim its next victim.
It is not clear where this serial killer was born; some say Kansas City. But it appears that it spent the summer of 1918 in France. Soon after, it travelled to Spain, where it was referred to as the French Flu. But in the first twenty years of the 21st century, Spain’s influence was waning, so France and others chose to refer to it as the Spanish Flu. Lack of consonance aside, the moniker stuck and now the enemy had a name (Iezzoni 1999).
By 1920 as its trail of devastation began to end. In its wake, an estimated 500 million worldwide were infected with somewhere between 20 and 40 million dead (The Economist, 2011). To put this in perspective, the War to End All Wars, sometimes referred to as World War I, killed around 15 million people (White n.d.).
As devastating as these deaths were, the collateral effects of the Spanish Flu were substantial as well. The Flu travelled along the most common trade routes and was therefore found in the most important economic destinations of the time, including North America, Europe, Asia, Africa, Brazil, and the South Pacific (Taubenberger 1997).
In the United States, where the most detailed reports were recorded, railways were shut down or restricted through much of 1918. At the Flu’s apex, even funerals, where loved ones gathered together to bury another victim, represented public threats to health and safety. As such, many communities limited funerals to 15 minutes (Billings 1997).
Arrayed against this deadly murderer was very little. Medicine, though greatly advanced relative to just a few short years earlier, still did not fully understand germ theory and though the principles of transmission were understood by doctors, the populace of the world did not understand today’s hygiene standards. Moreover, television had not been invented and communication with each nation’s population was slow and problematic.
Ironically, this lack of communication may have been an asset as well. Although the public in many countries began to worry about contracting the Spanish Flu, the lack of 24-hour news organizations may have limited the panic to some extent. But with an attack rate of 25% and a mortality rate of 2.5%, the psychological impact of the Spanish Flu was deep (James & Sargent 2006).
A Modern Equivalent
In modern nomenclature, flu viruses are categorized by two types of proteins that they have on their outer skin. One is shaped like a spike and called haemagglutinin. The second is shaped more like a mushroom or tall maple tree and is called a neurominidase. Depending on who you ask, there have been fifteen different haemagglutinins and nine different neurominidases identified (Davies 2000). When combined together, there is a theoretical possibility of over 387 million virus combinations, making the production of an effective vaccine very difficult. Scientists, being short on creativity, label these various viruses based on which haemagglutinin (H) and neurominidase (N) a particular virus exhibits (e.g. H1N1, H1N2, etc.).
In 1997, Hong Kong was a bad place to be a chicken. The farmers’ markets in Hong Kong, so critical to a culture that values fresh food, can be found teeming with various fresh produce, fish, poultry, and other goods. But in 1997, something was killing the chickens at a truly alarming rate. The killer this time was H5N1. H5 viruses live most of their lives at peace with birds, surviving inside their guts. But when there is a mutation, it can become deadly. In 1997, authorities in Hong Kong had little choice than to destroy nearly every chicken on the island. The economic impact of this act alone was likely large within the agriculture industry in Hong Kong and others since chicken is such a common staple in island Chinese diets. But the H5N1 virus represented an agricultural and economic issue rather than a public health issue. H5 simply was not adapted to human immune systems (Davies 2000).
But on May 14, 1997, a concerned mother and father brought their 3-year old boy to a community hospital. The boy had a cough for the previous five days and was not getting better. When the staff at the community hospital could not identify what was wrong with him, they recommended his transfer to Queen Elizabeth Hospital in Kowloon. The symptoms noted by staff at Queen Elizabeth included hypoxia (inability of the blood to carry enough oxygen)and severe build-up of fluid in his lungs. The boy died just 12 days after his first cough. The cause of death was listed as acute respiratory failure. His death, though tragic, did not set off alarms (Davies 2000).
It was not until nearly three months later when a sample from the boy’s lungs was identified by the Dutch National Institute of Public Health as an H5 virus. No one believed the Dutch…not the authorities in Hong Kong, not the Centers for Disease Control (CDC) in Atlanta, maybe not even the Dutch themselves. H5 was a bird virus. It did not infect humans let alone kill them. More than likely, the H5 diagnosis was a laboratory mistake, a contamination of testing equipment. H5 simply did not kill humans (Davies 2000).
And then a two-year old boy from outside Hong Kong came down with a cough and a severe sore throat. This time, quick action by the hospital saved the boy and he was discharged two day later. But the specimen taken from his nose and throat was conclusive: it was H5. Now the alarms had gone off.
The Spanish Flu of 1918 was H1N1. In Hong Kong at the turn of the millennium, humans encountered a different flu variant, the H5N1(97). Why did the alarms go off this time? Because it was deadly and because it liked young and strong victims. The death rate of the H5N1 virus was around 60%, far higher than the 2% mortality rate of the Spanish Flu (Taubenberger 1997). However, what really concerned the experts was that, like the Spanish Flu, it killed young, presumably healthy individuals.
Keiji Fukuda (at the time, with the CDC), said:
[some of the early victims] were basically healthy young adults. These are not the kinds of people you normally see dying from influenza, you don’t normally see them dying in these sorts of percentages when they’re hospitalized, and most of them died from illnesses generally consistent with viral pneumonia – so it’s very similar to the picture we saw in 1918. It’s disturbingly similar.
Thankfully, H5N1 was missing one key component that the H1N1 Spanish Flu had: easy transmission between humans. The Spanish Flu was transferred between humans with remarkable ease (Davies 2000). There is a story (probably not apocryphal but unconfirmed nonetheless) of four women playing bridge together one night in 1918. Overnight, three of the women died from the Spanish Flu (Billings 19997). From what authorities were able to tell, the victims of H5N1 all had prior contact with infected chicken or chicken byproducts (Davies 2000). But that doesn’t make humans safe. The influenza virus, in all its H and N variants, it well known to be perpetrator of a process called antigenic shift. This is the process whereby a virus adapts itself to a new type of host. H5N1 shifted to humans but did not fully adapt to allow transmission between humans, still appearing to require an intermediate host (the chicken). But since these viruses mutate all of the time, further shifting is entirely possible. So too is a mutation that allows airborne transmission.
That did not occur in 1997. But researchers believe that H5N1(97) may still be out there somewhere. Indeed, this virus, or one substantially like it, resurfaced briefly in Southeast Asia in 2004 (World Health Organization 2010). If it undergoes further antigenic shift and mutates to become airborne or surface-borne, there is every reason to believe that it could be as deadly as or more deadly than the H1N1 Spanish Flu (Davies 2000).
The Economic Impact of a H5N1(2018) Human Virus
It is important to note that he Spanish Flu of 1918 was considered exceptional (International Monetary Fund 2006). However, for the purpose of this paper, this economic assessment will assume that the H5N1(97) virus becomes more adaptable to humans and transmittable like the H1N1 virus of 1918. In order to estimate the economic impact of a new Spanish/Avian Flu pandemic on today’s population, three areas of focus should be addressed:
1) What are the estimates for deaths associated with such a pandemic?
2) What, if anything, is different in the world today relative the 1918 when the Spanish Flu pandemic was at its apex?
3) What could the total costs associated with the pandemic rise to?
Death Estimates
To estimate the number of potential deaths from a new virus, first we must understand the increased connectivity of humans relative to 1918. As discussed supra, the Spanish Flu followed common trade and communication routes throughout the world. It also returned home with American soldiers repatriating from Europe as World War I ended. H5N1(2018), on the other hand, would find a world made much smaller by the intervening 100 years of human progress. Instead of taking boats, H5N1(2018) can fly! As a point of reference, in 2011 the Hong Kong International Airport serviced approximately 148,000 passengers per day (Hong Kong International Airport 2011). In 1997, H5N1 took twelve days to kill its first victim reported victim (Davis 2000). Cutting that time by 75% (assuming that the level of sickness would eventually prevent any travel) still provides 600,000 potential exposures in less than a week. Assuming multiple carriers and potential destinations (and therefore additional exposures), the number of exposures is nearly infinite.
In 1954, one of the first (or very first, depending on how you measure) shopping malls in the world opened in Southfield, Michigan. The Northland Shopping Center allowed pedestrians from all over metro Detroit, a major metropolitan area, to shop, meet, and eat in an enclosed center of stores (Hardwick 2004). Today, there are over 49,000 shopping malls in the United States (U.S. Census Bureau 2010). Whether it be air travel, social integration, shopping, driving, or the workplace, there is little doubt that the world that H5N1(2018) would be born into would be highly interconnected , posing substantial challenges and risks to policy makers encountering such an epidemic. Assuming, then, that H5N1(2018) breaks containment, there is a substantial likelihood that it would spread throughout the world. Assessing the economic impact of such an eventuality is difficult and necessarily depends upon the details of the virus (its attack rate, incubation period, mortality rate, etc.). But some estimates can be made.
The fatality rate of the Spanish Flu was approximately 2% to 2.5%. The fatality rate of H5N1(97) was approximately 60% (Davies 2000). The good news is that a fatality rate like the latter would make the virus self-correcting; in a short period of time, many of the potential hosts would be immune or dead. Therefore since the goal is to consider the economic impact of a global pandemic, it appears appropriate to estimate a mortality rate in between, but closer to the Spanish Flu rate. For the purpose of this paper, we will assume a 3.5% mortality for those infected with H5N1(2018).
Through simple extrapolation, then, we have potential worldwide deaths of approximately 245 million (7 billion people times 3.5% mortality rate). Thankfully, the attack rate of the Spanish Flu was only 25% (Meltzer, Cox, & Fukuda 1999). Attack rates for H5N1(97) are difficult to compute since that virus still appeared to require an intermediate host . Modern knowledge of preventative measures (washing hands, covering mouth, etc.) might mitigate this rate while the interconnectedness of the world might exacerbate it. Therefore, lacking details to the contrary and assuming a 25% attack rate, the potential worldwide estimate of deaths might reach or exceed around 61,250,000.
To put this in perspective, the Tohoku earthquake and tsunami in Japan in 2011 killed approximately 13,000 people. The 2004 tsunami in Indonesia killed approximately 300,000 (Kurczy n.d.). Our hypothetical H5N1(2018) then represents a natural disaster in human terms that is two orders of magnitude worse. However, while the two disasters described above represented substantial property damage, H5N1(2018) would be almost entirely human related (albeit it much higher). In some ways, this lack of property damage would be worse; much of the rebuilding that occurs after a natural disaster affecting property may cause at least temporary increases in economic activity. With H5N1, the buildings and structures remain whereas the people are removed. Therefore, when estimated the economic impact, we are better served by comparing it to similar viral outbreaks in modern time rather than the natural disasters associated with earthquakes, tsunamis, hurricanes, and the like.
Differences in Modern World
Generally, much of the research shows that the economic effects of major natural disasters, while significant in the short-term, have relatively small effects in the long-term. In fact, most history shows that the aggregate effects of large natural disasters, property-related or otherwise, are less than initially expected and that the indirect effects of such disasters are often smaller than the direct effects of disasters (James & Sargent 2006).
Even when the impact of the Spanish Flu was examined directly, the economic impact appeared noticeable but small. Retail sales had small decreases during the apex of the Flu but quickly recovered; Pullman rail and New York City Public Transit dipped and then spiked rapidly; most other data remained flat or improved (James & Sargent 2006). In fact, because the Spanish Flu coincided with the end of World War I, much of the data could be explained by cessation of hostilities and the resumption of more normal trade relations. However, much of this research neglects to address fundemental differences in the world today. For instance, in 1918, while most households in the developed world had an average of 1.3 newspapers delivered daily (James & Sargent 2006), none of them had multiple 24-hour news channels with menacing graphics and music to accompany stories about worldwide death. Likewise, while radio was an effective means of communication, the level of interconnectedness represented by the internet, with the millions of unconfirmed blogs and rumor sites, is impossible to discount. The psychological impact of the new virus might be much worse than any previous pandemic. In addition to greater real-time media attention, the communication and internet technology would provide a greater opportunity for the workforce to be absent. This capability may represent a two-edged sword. While telecommuting would allow much of the modern world to avoid going to a workplace, a very significant portion of the workforce still requires attendance. The availability of telecommuting to one portion of the population may, in fact, cause greater decreases in efficiency. For instance, modern technology would allow a Certified Public Accountant to complete much of the audit work for a client remotely; however, if the on-site audit of the client’s offices could not be completed because the client’s workers began substantial and prolonged telecommuting, the CPA’s audit work cannot be completed. One person’s abscense, even due to telecommunity, can ruin more than one person’s work day. And, telecommmuting may encourage people to stay home. Utlimately, the absenteeism rate of a modern pandemic cannot be predicted.
However, one estimate put single-city absenteeism peaks at around 10%-11% higher during such an outbreak (James & Sargent 2006). If single-city absenteeisms peaked that high and rolled throughout the world (i.e. spreading from city to city as the pandemic spreads), substantial temporary disruptions would likely occur, requiring many businesses to begin implementing their Business Continuity Plans (BCP). The degree to which such BCPs would mitigate losses due to absenteeism would depend upon the efficacy and forethought of the plans
themselves. Finally, given the financial turmoil that exists in the world today, there is one other area that should be addressed, namely the fiscal condition of much of the world. With Greece ready to leave the Euro, the United States’ continual ineffectual debates regarding its budget deficits, Japan’s nearly two decades of malaise, and the world’s general unease about the status of the total economy, a major pandemic might find fertile ground in which to make headway. There is little doubt that a major H5N1(2018) outbreak would require a substantial expenditure of resources as health care is distributed and law and order is maintained. With little warning, then, many countries would be faced with substantial fiscal pressure. In 1918, most of the world was on a full war footing, spending as much as their respective economies could produce (and them some). It remains to be seen whether similar decisions would be consistently made in the face of H5N1(2018).
Total Costs
In 1999, the CDC estiamted that the total cost of a flu pandemic similar to the Spanish Flu would cost approximately $164 billion, adjusted to 2012 for inflation (Meltzer, Cox, & Fukuda 1999). As recently as 2010, the US represented nearly 25% of the world’s GDP. (Wolfram Alpha 2012) Assuming that the rest of the world reacted similarly, the total costs of such an epidemic might exceed $650 billion (GDP based). However, lesser developed nations might lose a greater number of people given lesser access to healthcare and inability to be absent from employment or social interactions. Ultimately, the total costs of such a pandemic is unknowable in advance and cirus specific. But what is known is that it would be substantial.
Conclusion
The Spanish Flu was deadly. There is little reason but to believe that its eventual scion will be deadly as well. At the end of the day, the costs associated with a pandemic will have to be borne by the world. Those costs are likely to be high, estimated conservatively herein at $650 billion in direct and indirect costs. The human costs, of course, will be even higher. With regard to trade and international interconnectedness, the extent of damage will be virus-specific. What is known, however, is that H5N1(2018) would find fertile ground in a world made smaller by air travel and economic interdependence. Certainly, tourism and air travel are likely to be decimated in the short-term. Other industries may fare better. It is believed by most that the long-term effects of a virus similar to the 1918 Spanish Flu will be economically negligible. While that may be the case, the opportunity exists for a megadeath scenario that the world has not seen in sixty years. It is, therefore, entirely likely that in the face of over 60 million deaths worldwide, things will be much worse than predicted. References
Barry, John. (2004). The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Viking Publishing.
Billings, Molly (1997). The Influenza Pandemic of 1918. Retrieved June 2, 2012 from http://virus.stanford.edu/uda/.
Davies, Pete (2000). The Devil’s Flu. New York: Henry Holt & Company, LLC.
The Economist (2011). A Deadly Balance. The Economist. Retrieved from http://www.economist.com/node/21542156.
Hardwick, Jeffrey M. (2004). Mall Maker: Victor Gruen, Architect of an American Dream. New York: Pennsylvania Press.
Hong Kong International Airport (2011). Finalized Civil International Air Traffic [fact sheet]. Retrieved from http://www.hongkongairport.com/eng/pdf/business/statistics/2011e.pdf
Iezzoni, Lynette. (1999). Influenza 1918. New York: TV Books, LLC.
International Monetary Fund (2006). The Global Economic and Financial Impact of an Avian Flu Pandemic and the Role of the IMF. Retrieved from http://www.imf.org/external/pubs/ft/afp/2006/eng/022806.pdf.
Kurczy, Stephen (n.d.). Japan tsunami is small compared to five of world 's biggest tsunamis [online exclusive]. The Christian Science Monitor. Retrieved June 2, 2012 from http://www.csmonitor.com/World/Global-Issues/2010/1028/Japan-tsunami-is-small-compared-to-five-of-world-s-biggest-tsunamis/1883-Krakatoa-tsunami
Meltzer, M., Cox, Nancy., & Fukuda, Keiji (1999). The Economic Impact of Pandemic Influenza in the United States: Priorities for Intervention. Emerging Infectious Diseases. 5(5) Retrieved from http://wwwnc.cdc.gov/eid/article/5/5/99-0507.htm.
Open Flights LLC (2012). ContentShare. Retrieved June 2, 2012 from http://openflights.org/data.html
Taubenberger, Jeffery et al., "Initial Genetic Characterization of the 1918 "Spanish" Influenza Virus," Science 1997, 275: 1793-96.
U.S. Census Bureau (2010). Holiday Shopping and Stats [fact sheet]. Retrieved from http://blogs.census.gov/2010/12/02/holiday-shopping-and-stats/
White, Matthew (n.d.). Source List and Detailed Death Tolls for the Primary Megadeaths of the Twentieth Century. Retrieved June 2, 2012 from http://necrometrics.com/20c5m.htm#WW1.
Wolfram Alpha LLC (2012). Wolfram|Alpha. Retrieved June 2, 2012 from http://www.wolframalpha.com/input/?i=us+gdp+as+percentage+of+world
World Health Organization (2005). Implementation of International Health Regulations – 2005. Report on the Review Committee on the Functioning of the International Health Regulations (2005) in relation to Pandemic (H1N1) 2009. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf.
World Health Organization (2010). Limiting Spread. Retrieved from http://www.who.int/influenza/resources/research/research_agenda_influenza_stream_2_limiting_spread.pdf.
In 1918, the world experienced its most deadly modern pandemic, the H1N1 influenza virus named the Spanish Flu. Killing between 20 and 40 million people worldwide, the pandemic has not since been repeated on such a large scale. This paper provides a background of the 1918 virus and its effects followed by an examination of the danger represented by the H5N1 Avian Flu virus of 1997. Finally, it discusses the potential international economic impact of a modern pandemic like the Spanish Flu, should such a virus materialize again.
Thesis
The post-World War II world can be characterized by unparalleled connectivity and a shrinking of the world’s metaphoric size. In many ways, this has been useful to humanity, promoting growth, understanding, mobility, and, for the most part, prosperity. However, such an environment represents a fertile killing ground for a virus capable of being easily transmitted between humans. Since 1918, the world has not faced a worldwide pandemic on the scale represented by the Spanish Flu; when it does, the economic effects of such virus is unknowable. However, some estimates have been made, although with the world lacking such a megadeath in its recent history, it is possible that these estimates are optimistic.
The Deadly Foe
In 1918, the world’s most deadly serial killer came out of the shadows. It usually …show more content…
started with a cough. Sometimes it would start with a headache, but with a world at war and an economy in the doldrums, most people ignored a simple headache. But the cough…wet and heavy, it arrived unannounced as the harbinger of death’s shadow. It didn’t seem to care if you were young or healthy…in fact it liked you that way.
Within hours, dark brown spots would appear on its victim’s skin. Lungs began to struggle as liquid replaced most of the air. Eventually, often times the same day the cough started but usually within 24 to 48 hours, its victim’s extremities would begin to turn blue as the body found it increasingly difficult to deliver oxygen (Barry 2004). Within hours, the serial killer would claim its next victim.
It is not clear where this serial killer was born; some say Kansas City. But it appears that it spent the summer of 1918 in France. Soon after, it travelled to Spain, where it was referred to as the French Flu. But in the first twenty years of the 21st century, Spain’s influence was waning, so France and others chose to refer to it as the Spanish Flu. Lack of consonance aside, the moniker stuck and now the enemy had a name (Iezzoni 1999).
By 1920 as its trail of devastation began to end. In its wake, an estimated 500 million worldwide were infected with somewhere between 20 and 40 million dead (The Economist, 2011). To put this in perspective, the War to End All Wars, sometimes referred to as World War I, killed around 15 million people (White n.d.).
As devastating as these deaths were, the collateral effects of the Spanish Flu were substantial as well. The Flu travelled along the most common trade routes and was therefore found in the most important economic destinations of the time, including North America, Europe, Asia, Africa, Brazil, and the South Pacific (Taubenberger 1997).
In the United States, where the most detailed reports were recorded, railways were shut down or restricted through much of 1918. At the Flu’s apex, even funerals, where loved ones gathered together to bury another victim, represented public threats to health and safety. As such, many communities limited funerals to 15 minutes (Billings 1997).
Arrayed against this deadly murderer was very little. Medicine, though greatly advanced relative to just a few short years earlier, still did not fully understand germ theory and though the principles of transmission were understood by doctors, the populace of the world did not understand today’s hygiene standards. Moreover, television had not been invented and communication with each nation’s population was slow and problematic.
Ironically, this lack of communication may have been an asset as well. Although the public in many countries began to worry about contracting the Spanish Flu, the lack of 24-hour news organizations may have limited the panic to some extent. But with an attack rate of 25% and a mortality rate of 2.5%, the psychological impact of the Spanish Flu was deep (James & Sargent 2006).
A Modern Equivalent
In modern nomenclature, flu viruses are categorized by two types of proteins that they have on their outer skin. One is shaped like a spike and called haemagglutinin. The second is shaped more like a mushroom or tall maple tree and is called a neurominidase. Depending on who you ask, there have been fifteen different haemagglutinins and nine different neurominidases identified (Davies 2000). When combined together, there is a theoretical possibility of over 387 million virus combinations, making the production of an effective vaccine very difficult. Scientists, being short on creativity, label these various viruses based on which haemagglutinin (H) and neurominidase (N) a particular virus exhibits (e.g. H1N1, H1N2, etc.).
In 1997, Hong Kong was a bad place to be a chicken. The farmers’ markets in Hong Kong, so critical to a culture that values fresh food, can be found teeming with various fresh produce, fish, poultry, and other goods. But in 1997, something was killing the chickens at a truly alarming rate. The killer this time was H5N1. H5 viruses live most of their lives at peace with birds, surviving inside their guts. But when there is a mutation, it can become deadly. In 1997, authorities in Hong Kong had little choice than to destroy nearly every chicken on the island. The economic impact of this act alone was likely large within the agriculture industry in Hong Kong and others since chicken is such a common staple in island Chinese diets. But the H5N1 virus represented an agricultural and economic issue rather than a public health issue. H5 simply was not adapted to human immune systems (Davies 2000).
But on May 14, 1997, a concerned mother and father brought their 3-year old boy to a community hospital. The boy had a cough for the previous five days and was not getting better. When the staff at the community hospital could not identify what was wrong with him, they recommended his transfer to Queen Elizabeth Hospital in Kowloon. The symptoms noted by staff at Queen Elizabeth included hypoxia (inability of the blood to carry enough oxygen)and severe build-up of fluid in his lungs. The boy died just 12 days after his first cough. The cause of death was listed as acute respiratory failure. His death, though tragic, did not set off alarms (Davies 2000).
It was not until nearly three months later when a sample from the boy’s lungs was identified by the Dutch National Institute of Public Health as an H5 virus. No one believed the Dutch…not the authorities in Hong Kong, not the Centers for Disease Control (CDC) in Atlanta, maybe not even the Dutch themselves. H5 was a bird virus. It did not infect humans let alone kill them. More than likely, the H5 diagnosis was a laboratory mistake, a contamination of testing equipment. H5 simply did not kill humans (Davies 2000).
And then a two-year old boy from outside Hong Kong came down with a cough and a severe sore throat. This time, quick action by the hospital saved the boy and he was discharged two day later. But the specimen taken from his nose and throat was conclusive: it was H5. Now the alarms had gone off.
The Spanish Flu of 1918 was H1N1. In Hong Kong at the turn of the millennium, humans encountered a different flu variant, the H5N1(97). Why did the alarms go off this time? Because it was deadly and because it liked young and strong victims. The death rate of the H5N1 virus was around 60%, far higher than the 2% mortality rate of the Spanish Flu (Taubenberger 1997). However, what really concerned the experts was that, like the Spanish Flu, it killed young, presumably healthy individuals.
Keiji Fukuda (at the time, with the CDC), said:
[some of the early victims] were basically healthy young adults. These are not the kinds of people you normally see dying from influenza, you don’t normally see them dying in these sorts of percentages when they’re hospitalized, and most of them died from illnesses generally consistent with viral pneumonia – so it’s very similar to the picture we saw in 1918. It’s disturbingly similar.
Thankfully, H5N1 was missing one key component that the H1N1 Spanish Flu had: easy transmission between humans. The Spanish Flu was transferred between humans with remarkable ease (Davies 2000). There is a story (probably not apocryphal but unconfirmed nonetheless) of four women playing bridge together one night in 1918. Overnight, three of the women died from the Spanish Flu (Billings 19997). From what authorities were able to tell, the victims of H5N1 all had prior contact with infected chicken or chicken byproducts (Davies 2000). But that doesn’t make humans safe. The influenza virus, in all its H and N variants, it well known to be perpetrator of a process called antigenic shift. This is the process whereby a virus adapts itself to a new type of host. H5N1 shifted to humans but did not fully adapt to allow transmission between humans, still appearing to require an intermediate host (the chicken). But since these viruses mutate all of the time, further shifting is entirely possible. So too is a mutation that allows airborne transmission.
That did not occur in 1997. But researchers believe that H5N1(97) may still be out there somewhere. Indeed, this virus, or one substantially like it, resurfaced briefly in Southeast Asia in 2004 (World Health Organization 2010). If it undergoes further antigenic shift and mutates to become airborne or surface-borne, there is every reason to believe that it could be as deadly as or more deadly than the H1N1 Spanish Flu (Davies 2000).
The Economic Impact of a H5N1(2018) Human Virus
It is important to note that he Spanish Flu of 1918 was considered exceptional (International Monetary Fund 2006). However, for the purpose of this paper, this economic assessment will assume that the H5N1(97) virus becomes more adaptable to humans and transmittable like the H1N1 virus of 1918. In order to estimate the economic impact of a new Spanish/Avian Flu pandemic on today’s population, three areas of focus should be addressed:
1) What are the estimates for deaths associated with such a pandemic?
2) What, if anything, is different in the world today relative the 1918 when the Spanish Flu pandemic was at its apex?
3) What could the total costs associated with the pandemic rise to?
Death Estimates
To estimate the number of potential deaths from a new virus, first we must understand the increased connectivity of humans relative to 1918. As discussed supra, the Spanish Flu followed common trade and communication routes throughout the world. It also returned home with American soldiers repatriating from Europe as World War I ended. H5N1(2018), on the other hand, would find a world made much smaller by the intervening 100 years of human progress. Instead of taking boats, H5N1(2018) can fly! As a point of reference, in 2011 the Hong Kong International Airport serviced approximately 148,000 passengers per day (Hong Kong International Airport 2011). In 1997, H5N1 took twelve days to kill its first victim reported victim (Davis 2000). Cutting that time by 75% (assuming that the level of sickness would eventually prevent any travel) still provides 600,000 potential exposures in less than a week. Assuming multiple carriers and potential destinations (and therefore additional exposures), the number of exposures is nearly infinite.
In 1954, one of the first (or very first, depending on how you measure) shopping malls in the world opened in Southfield, Michigan. The Northland Shopping Center allowed pedestrians from all over metro Detroit, a major metropolitan area, to shop, meet, and eat in an enclosed center of stores (Hardwick 2004). Today, there are over 49,000 shopping malls in the United States (U.S. Census Bureau 2010). Whether it be air travel, social integration, shopping, driving, or the workplace, there is little doubt that the world that H5N1(2018) would be born into would be highly interconnected , posing substantial challenges and risks to policy makers encountering such an epidemic. Assuming, then, that H5N1(2018) breaks containment, there is a substantial likelihood that it would spread throughout the world. Assessing the economic impact of such an eventuality is difficult and necessarily depends upon the details of the virus (its attack rate, incubation period, mortality rate, etc.). But some estimates can be made.
The fatality rate of the Spanish Flu was approximately 2% to 2.5%. The fatality rate of H5N1(97) was approximately 60% (Davies 2000). The good news is that a fatality rate like the latter would make the virus self-correcting; in a short period of time, many of the potential hosts would be immune or dead. Therefore since the goal is to consider the economic impact of a global pandemic, it appears appropriate to estimate a mortality rate in between, but closer to the Spanish Flu rate. For the purpose of this paper, we will assume a 3.5% mortality for those infected with H5N1(2018).
Through simple extrapolation, then, we have potential worldwide deaths of approximately 245 million (7 billion people times 3.5% mortality rate). Thankfully, the attack rate of the Spanish Flu was only 25% (Meltzer, Cox, & Fukuda 1999). Attack rates for H5N1(97) are difficult to compute since that virus still appeared to require an intermediate host . Modern knowledge of preventative measures (washing hands, covering mouth, etc.) might mitigate this rate while the interconnectedness of the world might exacerbate it. Therefore, lacking details to the contrary and assuming a 25% attack rate, the potential worldwide estimate of deaths might reach or exceed around 61,250,000.
To put this in perspective, the Tohoku earthquake and tsunami in Japan in 2011 killed approximately 13,000 people. The 2004 tsunami in Indonesia killed approximately 300,000 (Kurczy n.d.). Our hypothetical H5N1(2018) then represents a natural disaster in human terms that is two orders of magnitude worse. However, while the two disasters described above represented substantial property damage, H5N1(2018) would be almost entirely human related (albeit it much higher). In some ways, this lack of property damage would be worse; much of the rebuilding that occurs after a natural disaster affecting property may cause at least temporary increases in economic activity. With H5N1, the buildings and structures remain whereas the people are removed. Therefore, when estimated the economic impact, we are better served by comparing it to similar viral outbreaks in modern time rather than the natural disasters associated with earthquakes, tsunamis, hurricanes, and the like.
Differences in Modern World
Generally, much of the research shows that the economic effects of major natural disasters, while significant in the short-term, have relatively small effects in the long-term. In fact, most history shows that the aggregate effects of large natural disasters, property-related or otherwise, are less than initially expected and that the indirect effects of such disasters are often smaller than the direct effects of disasters (James & Sargent 2006).
Even when the impact of the Spanish Flu was examined directly, the economic impact appeared noticeable but small. Retail sales had small decreases during the apex of the Flu but quickly recovered; Pullman rail and New York City Public Transit dipped and then spiked rapidly; most other data remained flat or improved (James & Sargent 2006). In fact, because the Spanish Flu coincided with the end of World War I, much of the data could be explained by cessation of hostilities and the resumption of more normal trade relations. However, much of this research neglects to address fundemental differences in the world today. For instance, in 1918, while most households in the developed world had an average of 1.3 newspapers delivered daily (James & Sargent 2006), none of them had multiple 24-hour news channels with menacing graphics and music to accompany stories about worldwide death. Likewise, while radio was an effective means of communication, the level of interconnectedness represented by the internet, with the millions of unconfirmed blogs and rumor sites, is impossible to discount. The psychological impact of the new virus might be much worse than any previous pandemic. In addition to greater real-time media attention, the communication and internet technology would provide a greater opportunity for the workforce to be absent. This capability may represent a two-edged sword. While telecommuting would allow much of the modern world to avoid going to a workplace, a very significant portion of the workforce still requires attendance. The availability of telecommuting to one portion of the population may, in fact, cause greater decreases in efficiency. For instance, modern technology would allow a Certified Public Accountant to complete much of the audit work for a client remotely; however, if the on-site audit of the client’s offices could not be completed because the client’s workers began substantial and prolonged telecommuting, the CPA’s audit work cannot be completed. One person’s abscense, even due to telecommunity, can ruin more than one person’s work day. And, telecommmuting may encourage people to stay home. Utlimately, the absenteeism rate of a modern pandemic cannot be predicted.
However, one estimate put single-city absenteeism peaks at around 10%-11% higher during such an outbreak (James & Sargent 2006). If single-city absenteeisms peaked that high and rolled throughout the world (i.e. spreading from city to city as the pandemic spreads), substantial temporary disruptions would likely occur, requiring many businesses to begin implementing their Business Continuity Plans (BCP). The degree to which such BCPs would mitigate losses due to absenteeism would depend upon the efficacy and forethought of the plans
themselves. Finally, given the financial turmoil that exists in the world today, there is one other area that should be addressed, namely the fiscal condition of much of the world. With Greece ready to leave the Euro, the United States’ continual ineffectual debates regarding its budget deficits, Japan’s nearly two decades of malaise, and the world’s general unease about the status of the total economy, a major pandemic might find fertile ground in which to make headway. There is little doubt that a major H5N1(2018) outbreak would require a substantial expenditure of resources as health care is distributed and law and order is maintained. With little warning, then, many countries would be faced with substantial fiscal pressure. In 1918, most of the world was on a full war footing, spending as much as their respective economies could produce (and them some). It remains to be seen whether similar decisions would be consistently made in the face of H5N1(2018).
Total Costs
In 1999, the CDC estiamted that the total cost of a flu pandemic similar to the Spanish Flu would cost approximately $164 billion, adjusted to 2012 for inflation (Meltzer, Cox, & Fukuda 1999). As recently as 2010, the US represented nearly 25% of the world’s GDP. (Wolfram Alpha 2012) Assuming that the rest of the world reacted similarly, the total costs of such an epidemic might exceed $650 billion (GDP based). However, lesser developed nations might lose a greater number of people given lesser access to healthcare and inability to be absent from employment or social interactions. Ultimately, the total costs of such a pandemic is unknowable in advance and cirus specific. But what is known is that it would be substantial.
Conclusion
The Spanish Flu was deadly. There is little reason but to believe that its eventual scion will be deadly as well. At the end of the day, the costs associated with a pandemic will have to be borne by the world. Those costs are likely to be high, estimated conservatively herein at $650 billion in direct and indirect costs. The human costs, of course, will be even higher. With regard to trade and international interconnectedness, the extent of damage will be virus-specific. What is known, however, is that H5N1(2018) would find fertile ground in a world made smaller by air travel and economic interdependence. Certainly, tourism and air travel are likely to be decimated in the short-term. Other industries may fare better. It is believed by most that the long-term effects of a virus similar to the 1918 Spanish Flu will be economically negligible. While that may be the case, the opportunity exists for a megadeath scenario that the world has not seen in sixty years. It is, therefore, entirely likely that in the face of over 60 million deaths worldwide, things will be much worse than predicted. References
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