Homœopathic Links 2020; 33(02): 071-074
DOI: 10.1055/s-0040-1712958
Editorial
Thieme Medical and Scientific Publishers Private Ltd.

World Under Siege: Spanish Flu 1918 vis-à-vis COVID-19

S.R. Sharma
1  Senior Consultant Homoeopath, Former Scientist-3, Central Council for Research in Homoeopathy, Ministry of AYUSH, New Delhi, India
› Author Affiliations
Further Information

Address for correspondence

S.R. Sharma
RZ-101/10B, Lane No. 5, Mohan Nagar, Pankha Road, New Delhi
India   

Publication History

Publication Date:
03 June 2020 (online)

 

A century ago, Spanish Flu ravaged across the globe killing millions, devastating the world economy and creating a socio-political turmoil. Today the world is struggling again against coronavirus disease (COVID-19) crisis. Despite landmark achievements in the field of medicine and advent of antiviral therapeutic interventions and measures, humanity finds itself as helpless as it was a hundred years ago.

Globally, the influenza pandemic of 1918 killed more people in a year than what the Black Death of the Middle Ages (bubonic plague) killed in a century; it killed more people in 24 weeks than AIDS killed in 24 years wrote John M. Barry, historian and author, in his book The Great Influenza: The Story of the Deadliest Pandemic in History.[1] This scourge in human history claimed around 50 million lives and shattered the world economy already in crisis as an aftermath of World War I. The Newspapers carried reports about a ‘fever epidemic’ that was sweeping throughout the world. The communication between states and cities was stopped, workshops got shut and most offices discovered that their staff had suddenly taken leave but nobody realised the magnitude of what was about to unfold. The main remedy prescribed in the news articles: Not to worry and go to bed.[2]

The 1918 H1N1 Virus

In 1951, 30-three years later, Johan Hultin, a 25-year-old microbiologist and PhD student from the University of Iowa, US, set out on an unusual mission. His destination was a graveyard frozen in permafrost nestled inside an ocean-side village in Alaska. Hultin was looking for traces of a virus, frozen in time, within the tissues of those buried during the deadliest pandemic of the 20th century. A full reconstruction of the virus in 2005 by Dr. Terrence Tumpey showed that no other influenza virus was as dangerous and virulent as the one that surfaced in 1918.[3]

The deaths were often violent: the infected coughed up blood; they bled from their ears and noses and had extremely painful body aches. The pandemic took shape in two phases—a milder form in early 1918 when the virus affected the sick and the elderly, while the healthier recovered swiftly. The second wave beginning August was deadly, ravaging the stronger immune system of younger adults.[2]


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SARS-CoV-2

Nearly hundred years later in 2019, a large number of cases of severe unexplained pneumonia started getting reported from Wuhan, which in a few days were confirmed by Chinese Health authorities to be due to Coronavirus.

A 50-year-old man who died of pneumonia was thoroughly studied including his clinical presentation and post-mortem biopsies. The clinical and pathological features greatly resembled those seen in SARS and Middle Eastern respiratory syndrome (MERS). This patient was admitted to a fever clinic with symptoms of fever, chills, cough, fatigue and shortness of breath. He reported a recent travel history to Wuhan. X-ray images showed rapid progression of pneumonia with multiple patchy shadows in both lungs. A throat swab sample confirmed by real-time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) assay that the patient had SARS corona virus, a novel virus which was never seen in humans earlier and was named (2019 - nCoV). Flow cytometric analysis of peripheral blood showed lymphocytopenia where CD4 and CD8 T cells were substantially reduced. Lymphopenia is a common feature in the patients with this disease and might be a critical factor associated with disease severity and mortality. Histopathological examination of post-mortem biopsies showed bilateral diffuse alveolar damage with cellular fibromyxoid exudates, evident desquamation of pneumocytes (alveolar cells) and hyaline membrane formation, indicating acute respiratory distress syndrome (ARDS). Histopathological findings of this first case study facilitated understanding of the pathogenesis of ARDS caused by coronavirus. Considering its virulence, intensity and communicability, the World Health Organization (WHO) declared it a pandemic and the International Committee on Taxonomy of Viruses (ICTV) named the virus severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and the illness caused by this virus as COVID-19.[4]


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Present Scenario

COVID-19 may end up pushing the world closer to how it looked in 1918. Since there were no vaccines to protect and no antiviral agents to treat influenza, control efforts were limited to isolation, personal hygiene and sanitation and limiting public gatherings. Strangely, similar steps are being followed now also for the containment of current outbreak. The only difference is information dissemination through a variety of mediums available now. The electronic media has launched massive awareness IEC (information, education and communication) campaign which is proving a great tool in combating and preventing the spread of COVID-19.

The devastation of the 1918–19 influenza pandemic is well known; medicines employed to treat influenza were Aspirin (antipyretic, analgesic) and Quinine (anti-malarial drug). The Infectious Diseases Society of America suggested a surprising factor in the high death toll, the misuse of Aspirin.[5] Today in current pandemic also medicines used are quite similar that is Paracetamol (antipyretic, analgesic) and Hydroxychloroquine (again an antimalarial drug) along with some other medicines such as anti-viral, antibiotics, even steroids are also being administered if necessary. However, no pharmaceutical products have yet been shown to be safe and effective. Intensive care measures employed are CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure) and ventilators. Life support measures which were not available a century ago have drastically reduced the morbidity and mortality associated with COVID-19.

The possibility of convalescent plasma therapy (CPT) is being explored for critically ill COVID-19 patients. CPT is a treatment where plasma obtained from blood of recovered patients is given to treat those who are critically ill. Initial small trials have shown encouraging results. Despite best efforts world over, the containment of the pesky coronavirus remains elusive. In the absence of preventive vaccines and targeted specific treatment for COVID-19, experts are pinning hopes on emergence of ‘Herd Immunity’. But we are not yet close to achieving herd immunity against the SARS-CoV-2. At least 50% of the population would have to be immune for achieving it. Herd immunity can only be achieved by preventive vaccination and exposure to virus. Possibility of preventive vaccine is not in sight shortly. However, the cost of acquiring herd immunity by exposure is enormous in terms of human life. Till the time of writing this editorial, the ‘Worldometer’ available at https//www.worldometers.info/coronavirus, a reference web page providing real-time world statistics of SARS-CoV-2, there are over 3,154,442 identified cases of COVID-19 worldwide with 2,18,795 (6.93%) fatalities.


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Impact

The projected impact is going to be huge. Going by the current trend, this pandemic is likely to cause colossal life loss due to no specific medicine known to combat the virus on one hand and its severity and high communicability on the other. Analysis of mortality data available till date shows elderly people, people having other co-morbidities such as diabetes, hypertension, asthma and COPD, heart diseases or otherwise immuno-compromised are highly vulnerable. Additionally, the burden of vector borne diseases such as malaria, dengue and other endemic diseases prevalent in some parts of the world will increase more so in developing countries.

Limited access to health care providers, restricted movements due to mandated lockdown and social distancing almost world over, diversion of health care infrastructure and logistics to fight COVID-19, will certainly increase the burden of non-communicable diseases (NCD). The gravity is understandable when 71% of deaths globally are due to NCD alone.[6]

Exponential growth and spread of COVID-19, if go unabated for a considerable period, will decidedly aggravate nutritional deficiencies especially in poor and developing countries, thus, neutralising the efforts of organisations like WHO and UNICEF in implementation of various programmes and social welfare schemes.

The mental toll of protracted lockdown and quarantine cannot be underestimated. Currently around 4 billion people globally are living under some kind of lockdown or quarantine. Restriction of movement of people is further augmented by looming threat of infection and death, anxiety, fear of losing loved ones and financial hardship. This invisible psychological trauma is certainly going to take mental toll in the form of short term and long term ‘Trauma-related mental health disorder’ which includes low mood, psychological stress, depression, insomnia, anxiety, anger, irritability and emotional exhaustion. People should devise their own ways and means to make this isolation less traumatic. Early intervention, before consolidation of memory has taken place, may reduce associative connections to mental traumas, preventing the accumulation of traumatic memories and thus can mitigate the psychological toxic effects of COVID-19 lockdown. The World Health Organization recommends protocols such as R-TEP (Recent Traumatic Episode Protocol)[7] and G-TEP (Group Traumatic Episode Protocol) for trauma-related mental health disorders.[8]

The year 2020 could see the worse economic fallout since the Great Depression in the 1930s. The United Nations Secretary General Antonio Guterres has termed the coronavirus pandemic as the most challenging crisis since World War II and International Monetary Fund (IMF) chief Kristalina Georgieva declared that the COVID-19 pandemic has driven the global economy into a downturn that will require massive funding to help developing nations.[9]


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Homeopathy in the Treatment of Epidemics

The role of Homoeopathy is well known in earlier epidemic and pandemic diseases. In 1815 Hahnemann treated 180 patients during a typhus outbreak in Leipzig and lost only two patients. Homeopathy was used during the Asiatic Cholera Pandemic of 1826–37. In 1830–31 during the outbreak in St. Petersburg, Hahnemann's nephew, a homeopathic physician, wrote to Hahnemann about the epidemic. Hahnemann suggested two to three remedies that might be used for the various stages of the illness as well as sanitary measures to be implemented. Many lives were saved.[10]

The success story of homeopathy during the Spanish Flu pandemic of 1918–19 is well known. In those days, there were no governmental agencies to record and transmit statistical data. All we have are reports from individual doctors from various regions who treated Spanish Flu with Homoeopathic medicines without the use of Aspirin and Quinine. Mortality recorded was as low as1.5% in comparison to the patients treated with Aspirin and Quinine where average mortality was 30%. Gelsemium and Bryonia were found to be most useful remedies.[11]

In the current coronavirus pandemic, 80% of the infected are getting mild symptoms or no symptoms (asymptomatic). Many of them either go unnoticed or require no treatment except isolation and self-quarantine and recover at home. Remaining 20% turn severe with breathlessness (15%) and even critical (5%) developing respiratory failure, septic shock and multiple organ failure etc. These patients warrant hospitalisation, intensive care, artificial ventilation and other specialised care. It is seen that the countries who have mandated national childhood Bacille Calmette-Guérin (BCG) vaccination schemes are the least sufferer in the prevalent pandemic unlike the countries where BCG vaccination is not being offered as a part of their national immunisation programmes. These submissions are based on short-term observations and data analysis. It is premature to draw any conclusions whether BCG vaccination can offer broad protection to morbidity and mortality associated with COVID-19.[12] Presuming BCG vaccination imparts some sort of resistance to SARS-CoV-2 virus, it seems that there exists some unexplained phenomenon between tubercular diathesis and COVID-19. Further comparing the pathognomonic characteristics of the drug with the lung pathogenesis of COVID-19, Bacillinum and Tuberculinum Aviaire are the nearest similimum found in Materia Medica. If there is some relationship between BCG and resistance to the disease, then Bacillinum and Tuberculinum, Aviaire can play a significant role in combating acute respiratory distress syndrome caused by the coronavirus. Burnett recommends Bacillinum in frequent doses and high dilution for ‘constitutions whose blood serum and defective phagocytes do not defend them against microbic infections’.[13] Dr Francois Cartier, Physician to Hospital St. Jacques, Paris, has found it particularly useful in cases where there was ‘excessive mucopurulent bronchial secretion threatening to occlude the lungs’. At the international Homoeopathic Congress held in 1896, he stated in his paper as under[14]:

  • ‘The influenza microbe always imitates to a remarkable degree the microbe of tuberculosis in certain instances; and if we wish to effect a cure on the laws laid down by Hahnemann in certain forms of influenzal bronchitis, we must frequently seek for the simillimum in the virus of tuberculosis’. He referred Bacillinum, Tuberculinum and Aviaire as viruses of tuberculosis.

  • ‘Influenzal bronchitis is markedly accompanied by all incessant cough and by grave general symptoms. There is more frequently acute than passive, obstructive and dyspnoeic congestion I am inclined to prefer Aviaire to Bacillinum in such cases’.

  • ‘The congestion which accompanies the influenza is sudden and severe; within twenty-four hours the lung is invaded, and fine rales are soon heard’.

  • ‘It seems that Aviaire does not act in diminishing the cough like an anodyne or a narcotic, but braces up the whole organism’.

  • He reported success stories of ten cases of influenza culminating into lung congestion and bronchitis with grave general symptoms such as fever, incessant cough and expectoration with Aviaire.


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Major Takeaway

In the absence of effective pharmaceutical products for COVID-19, the second line of thought is pinned on immunity boosters. With the perception of enormity of the problem, the Govt. of India has assigned an important role to the Ministry of AYUSH which also includes HOMOEOPATHY to work out pharma products and measures to brace up the immunity. This is in concordance with the observations made by the stalwarts a century ago that Homoeopathy works by bracing up the whole organism and not by merely mitigating the symptoms. A very interesting experiment with Homoeopathic medicine Arsenicum album 30 was conducted on 2,625 persons, who had come in contact with active COVID-19 patients, at 179 quarantine centres in Gujarat, India. This experiment was conducted from 10th to 23rd April for 14 days after obtaining consent from all subjects for administration of homoeopathic prophylactic Arsenicum album 30. Government spokesperson Jayanti Ravi, Principal Secretary, Department of Health, Gujarat, presented the outcome of this experiment in a press conference. She stated, ‘None except eleven quarantined persons who received Arsencum album 30 tested positive for COVID-19, after 14 days’. Further the researchers in a footnote of their report highlighted that these eleven people were only able to take the dose for 3 days as compared with rest who took the actual prescription dose for 7 days. In this experiment, the sample size is reasonably acceptable and the outcome decidedly encouraging for homoeopathy. This paves the way for integrated approach in the fight against COVID-19.

The COVID-19 pandemic has plunged the humankind into a state of destitution and gloom, but the world will rise to the challenge like the Phoenix rises from the ashes .


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Conflict of Interest

None declared.


Address for correspondence

S.R. Sharma
RZ-101/10B, Lane No. 5, Mohan Nagar, Pankha Road, New Delhi
India