The second and most lethal wave of the 1918 Spanish flu swept through towns and cities in weeks. It peaked fast and uncontrolled and was devastating.
The American historian John M Barry, whose 2004 account of the 1918 pandemic is one of the best and most detailed, was asked last week to reflect on how it compared to Covid-19. There were plenty of similarities.
“Leaders said things like, ‘This is an ordinary influenza by another name,’ and ‘You have nothing to fear if proper precautions are taken’.”
There were also key differences: “The length of time Covid-19 takes to work its way into the body is considerably longer. Influenza in 1918 to 1920 would burn through a community in six to 10 weeks, and then you forget about it. That’s not going to be the case with [Covid-19].”
These are wise words.
Every day at the Downing Street press conference ministers and their scientific advisers present charts which track the virus’s path through Britain. Then come the questions: Have we hit the peak? How far away is it? And when is all going to be over?
George Batchelor, co-founder of Edge Health, which models demand for NHS hospital trusts, thinks a peak of new cases came in early April.
“Admissions to hospitals and ward bed usage has also peaked and started to fall. Critical care bed usage is probably peaking today, more or less. It lags behind hospital admissions because of the longer length of stay. And deaths have probably peaked, or will do in the next two to three days.”
Mr Batchelor, like others, is careful to include the necessary caveats.
There are complex and suboptimal issues to do with the Government’s data, most notably in the area of social care, where there is mounting evidence of serious under-reporting.
It may turn out that the spread of the virus in care homes has been “re-seeded” in the past few weeks by the aggressive discharging of patients from NHS hospital beds.
Dr Jamie Wilson, a former NHS psychiatrist and chief executive of Hometouch, a specialist care provider for the elderly, suspects many deaths reported in care homes were caused by the NHS decanting Covid-positive patients into them from mid-March.
A government document, Covid-19 Hospital Discharge Service Requirements, published on 19 March, directed that elderly hospital patients be moved into nursing homes or other social care accommodation to free up hospital capacity. Unbelievably, given how poorly equipped most nursing homes are and the unique frailty of their residents, the document states: “Some of these patients may have Covid-19, whether symptomatic or asymptomatic. All of these patients can be safely cared for in a care home if this guidance is followed.”
Dr Wilson said: “To mandate that care homes should take back Covid+ patients with such a high risk of cross infection and high mortality rate in vulnerable residents seems unfathomable. Surely the sensible policy would have been to limit care home admissions and offer safer alternatives. The tragedy is that this was preventable, as there is capacity in the live-in care sector.”
The live-in care sector houses vulnerable people in self-contained accommodation, often their own home, where they live alone with a single carer. Councils could have placed Covid patients in these more secure units rather than large homes but they tend to be more expensive.
The crisis currently playing out in Britain’s care homes may or may not alter the course of the epidemic. But either way it is unlikely to help with the bigger question of how long it will take for life to return to normal.
That, as the American historian hints, will not be a rapid process.
If the curve of the Spanish flu was a brutal Matterhorn-shaped peak with an unmistakable summit, the peak we are scaling is a squatter, flatter affair – a Snowdon or Kilimanjaro.
It’s flatter not only because of the nature of the virus but because lockdown flattened the summit. The benefits are that far fewer will die – an estimated 20,000 compared with 240,000 – but it also means we will plateau for longer and the trek back down will be long and arduous.
There is also the threat of resurgence. We suppressed the peak of Covid-19 but the virus could bounce back when we revert to normal. The challenge is to make our way safely and calmly down the other side.