Read: You’re likely to get the coronavirus
The contrast with the coronavirus, which causes the disease COVID-19, could not be greater. From the very start of the outbreak, scientists suspected a virus. Within two weeks, they had identified it as a coronavirus, sequenced its genome, and discovered that the most likely animal hosts were bats. This information, which was published by a Chinese team, was instantly shared across the scientific community, allowing research labs around the world to begin the long and complicated process of understanding the virus, and finding a vaccine and a cure. We may not have beaten the enemy yet, but we certainly know a great deal about him.
The Great Influenza Pandemic of 1918 occurred in the pre-antibiotic era. Although antibiotics do not treat viruses, they do treat the secondary bacterial infections that sometimes follow. These secondary infections cause severe pneumonia, and were likely responsible for most of the deaths in 1918. Back then, there was little to offer. Physicians recommended quinine (not helpful), dry champagne (ditto, though more fun), and phenolphthalein (a cancer-causing laxative). During an earlier outbreak of influenza, in 1916, British military physicians had even tried bloodletting as they treated dying soldiers. When it failed, they suggested it had simply not been tried soon enough in the course of the disease. Patients survived in spite of their doctors.
Today we live in a world that is flooded with antibiotics. And although there is concern that bacteria are becoming ever more resistant to them, antibiotics remain an overwhelmingly powerful tool to treat secondary bacterial pneumonia. Early case reports describe these infections in COVID-19 patients, and we have every reason to believe that for many, though sadly not all, antibiotics will provide a cure.
We also have another class of drugs available today: antivirals, which directly target the virus responsible for a disease. There are at least four approved antiviral medications, some given orally and others intravenously. They are not as effective as we would like, but they have been given to a number of very sick COVID-19 patients. Whether those antiviral medications or the antibiotics that are often given in tandem are responsible for successful outcomes is hard to determine. But we have options that were simply undreamed of a century ago.
The advent of modern hospitals, intensive-care units, and medical specialists have changed the response to disease over the past century. During the 1918 influenza pandemic, hospitals offered very few treatments, and many patients were crowded into shared wards where dozens or even hundreds of other people lay coughing, separated from one another by only a flimsy cotton sheet. Victor C. Vaughan, a prominent physician and dean of the medical school at the University of Michigan, left an eyewitness account of the carnage at a field hospital. “I see hundreds of young, stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more,” he wrote in his memoir. “They are placed on the cots until every bed is full and yet others crowd in. The faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.” Vaughan was humbled by a plague he could not treat. “The deadly influenza,” he concluded, “demonstrated the inferiority of human interventions in the destruction of human life.”