“Those who cannot remember the past are condemned to repeat it.” Wise words, written by George Santayana, in the early 1900s. A century later we might consider them prophetic.

The Spanish Flu of 1918 is lost to our collective memory, except, perhaps among a few centenarians. As Covid-19 spreads, a look back may save us from past mistakes and help prepare for the future. 

So, here’s the first lesson. This is our headline: our species has survived pandemics since our history began. So, we can do it again.

The invisible enemy appears to have the advantage. We have no cure. As “the curve” rises in many nations and the average age of victims falls, we have no idea how deeply the enemy has infiltrated. But we have tools to block its transmission: quarantine, handwashing and restricted movement. And, of course, brave heroes of public health.

Those of us whose life’s work is invested in researching and curing infectious diseases look to every source of knowledge, scientific, social, medical and historical to find clues to defeat disease, both now and into the future.

History can help us now.

“Quarantine” is of Italian origin, meaning 40 days. In 14th century Venice, ships were forcibly moored for 40 days to stop the spread of viruses.

Around 430 BC, the earliest recorded pandemic, possibly typhoid, swept across Africa and into Europe. It gave Spartans the upper hand over Athenians and changed the course of history.

In the 11th century it was leprosy, spreading right across Europe, forcing millions of people into isolated lives of cruel disability. It lingered in Europe for generations.

Black Death, the most famous pandemic swept East to West between 1347 and 1351, taking with it one third of the globe’s population. This was the plague against which the Italians quarantined ships. The plague was so deadly that England and France called a truce in their war, while the Vikings ended their exploits in North America. It is also credited with wiping out Europe’s leprosy and its sufferers whose immune systems were already compromised. 

European explorers carried diseases when they travelled in the 15th century. By 1520, the Aztec Empire was destroyed by a smallpox strain, carried by enslaved peoples from Africa.

One in 5 died in London and thousands of dogs and cats, suspected as vectors, were slaughtered during The Great Plague of 1665.

Cholera, regrettably is still a common illness, killing up to 140,000 people annually. There have been seven cholera pandemics since 1817. That first outbreak killed a million people in Russia before being carried by British soldiers to India where it stole millions more lives.

In 1855, the Third Plague Pandemic which started in China, spread to India and then Hong Kong claiming over 15 million victims in its path.

The flu pandemics began in 1889. The first, called the Russian Flu because it originated in Siberia, marched across Europe to bring an end to 360,000 lives. The Spanish Flu of 1918 claimed 50 million lives.

The Spanish Flu has scary familiarity. There were no drugs or vaccines available to fight against it. Schools, entertainment and businesses were closed. People were ordered to wear masks. The primary weapons in the war were isolation, quarantine, hygiene, and the curtailment of public gatherings.

Despite the absence of treatment and drugs, the flu threat disappeared by summer of 1919. We learn from the Spanish Flu that pandemics, like all things, eventually run their course. We also learn that the steps we are taking now have delivered the desired result in the past. While we wait for this pandemic to pass, we are best advised to do everything we can to isolate and o keep infected people from circulating in the general population.

Looking back allows us to anticipate action for the future. There’s a recurring theme in history: since disease respects no boundaries, we are collectively vulnerable as a whole species. No country, regardless of how developed its health system may be is immune to pandemic. Our global health system is a network of interdependent systems. The chain is only as strong as its weakest link. 

Almost 900 million people live in urban slums across Africa and Asia while 2.4 billion people have no access to toilet facilities. Social distancing and isolation, the luxuries of developed nations, aren’t even dreams in these places. Millions will  die in these places during this pandemic. Their curve will never be plotted because there is no medical care and there will be no proper diagnosis. These places are weak links in our global health systems. They are potential sources of the next pandemic.

If we want to protect ourselves from future pandemics, richer nations need to invest in global health and development now. We cannot hope to maintain our global health without addressing the needs of all people everywhere. 

George Santayana summed it up well. “A man’s feet should be planted in his country, but his eyes should survey the world.”