As the US and other parts of the world begin the transition out of lockdown in hopes of returning to normal, consistent warnings of a second wave of coronavirus infections and deaths are sounded by medical experts and historians alike. This week, Anthony Fauci said a second wave was “inevitable.” This warning is a reflection on the Spanish Flu Pandemic of 1918 that came in three waves over the course a year, the second wave being the deadliest of them all. But much of our understanding of what causes a second wave is misguided. The greatest threat and concern of a second wave is well within our grasp to contain, but we will not do it through an impatient rush to return to normal.
The Second Wave of 1918
The Spanish Flu pandemic began in March 1918. The first wave ended around July. At that time, many believed their local communities were experiencing a familiar but severe case of influenza. The world did not realize the levels of suffering that were about to be unleashed. The infamous second wave of the pandemic began at the end of August 1918 and continued through November, claiming more deaths than all of World War I, which was occurring simultaneously.
It was the second wave of the Spanish Flu that included the iconic moments often recalled more than a century later. Overwhelmed morgues stacked dead bodies like cordwood. Mass graves were dug in some areas to relieve cities of the collection of flu victims’ corpses. Municipalities ordered residents to wear masks. Spitting in public was outlawed. Daily life ground to a halt. Theaters closed along with the schools. In October alone, nearly 200,000 Americans died in the second wave of the pandemic. Unlike previous outbreaks of influenza, young and generally healthy individuals suffered the most. The second wave claimed millions of lives aged 25–35.
Both the first and second waves were contagious, but the second was far more deadly than the first and experts debate to this day what caused the second wave’s higher mortality rates. A widely accepted theory suggests the virus mutated between phases one and two; thus, a deadlier strain nearly crippled the global population. This speculation is impossible to prove because there are no strains of the Spanish Flu virus to study and compare between the first and second waves.
The Facts
The 1918 Spanish Flu pandemic was unique because of its multiple waves. There were previous influenza outbreaks, but they were generally constrained to specific geographies. The bulk of the Spanish Flu’s death and carnage occurred when the outbreak stretched beyond those prior borders and limitations during the second wave. Other influenza outbreaks since 1918 have also had mixed results when it comes to the presence of waves.
The Asian Flu Pandemic of 1957 hit the globe in two waves killing an estimated 1.1 million people worldwide; 116,000 of those deaths were in the United States. Although it was global and its death total enormous, the impact of the 1957 pandemic was limited by the rapid developments of a vaccine to fight the pandemic.
The 1968 Hong Kong Flu pandemic killed an estimated 1 million people worldwide. There were two waves in this pandemic as well, and the second was far more deadly, particularly among the elderly than the first.
In 2009 the first pandemic of the 21st century, H1N1, included two waves in the United States and other parts of the world, but curiously only one wave occurred in China.
Pandemic waves are not guaranteed, and their historical record is inconsistent. Mountains of circumstantial evidence suggest this is because the variable that causes second waves in a pandemic is not the virus itself but the public’s relationship to the virus.
The True Threat of a Second Wave
In all four pandemics mentioned above, the US was far more susceptible to multiple waves of the outbreak than many other parts of the world. China was spared a second wave in 2009, but the US was not. In 2009, China, like today, extended enormous measures to suppress the H1N1 pandemic. The US did not.
In 2009, although there were more than 60 million confirmed H1N1 cases worldwide, only 980 US schools dismissed. For many Americans, life went on as usual even as the Centers for Disease Control & Prevention consistently escalated their levels of alarm for months.
Meanwhile, in China, an aggressive national surveillance system was employed to prevent the spread of the virus. Thermal scanners were installed in airports to detect heightened temperatures in travelers. The government distributed health questionnaires to travelers, and if they confirmed symptoms, all asymptomatic contacts, both suspected or confirmed, were quarantined for seven days. Ambulances transferred suspected H1N1 carriers from airports to hospitals, thereby limiting further contact with the public at large.
The differences in the approach by the two countries could not be starker, and the results already mentioned told the story of which method was more effective. The US had a second wave. China did not have a second wave.
Frequently missed in the telling of the 1918 Spanish Flu pandemic’s second wave is the historical context that facilitated that event and the massive death tolls that followed. The second wave occurred at the height of World War I. More than 4.7 million American personnel transferred across the Atlantic Ocean to participate in the fighting in Europe. Included among that number was over 30% of America’s medical personnel. As the effects of the pandemic worsened throughout Europe and the United States, leaders refused to impose levels of quarantine and isolation that may have reduced its deadly effects because they were concerned such actions would harm the war effort. Civilians kept going to work. Soldiers kept traveling from one continent to another. Trains were full of sick passengers. Barracks and trenches were full of sick soldiers. And most of these victims were in that curious age bracket of 25–35 that dominated the death counts in the pandemic’s second wave.
The second wave in the pandemic of 1918 was not the result of a virus mutation but the result of unprecedented global human behavior during a pandemic. There is never a good time to fight a world war, but the occasion of a deadly pandemic suggests there may be times that are better than others.
Will We Have A Second Wave?
The 2020 Coronavirus Pandemic may be approaching the end of its first wave. A second wave is not guaranteed. Strict management by governments in South Korea and China have made sure a second wave did not break out there — so far. The nature of America’s government and culture does not allow for the same measures of surveillance and control exercised in China. To that end, it is up to the American public to prevent a second wave in the US.
Although the United States leads the world in confirmed coronavirus cases and deaths currently, there is reason to believe the first wave has still not concluded. The list of states with 500 or more confirmed cases per day did not shorten but increased in the last week. The outbreak may be past its peak in New York, but there is plenty of evidence to suggest this is not the case for many other states across the country.
Americans are growing impatient under lockdown. Cell phone data shows that for the past two weekends, fewer and fewer Americans are staying home. The government, state and national, is concerned about growing economic risks as the lockdowns persist. Many small business owners are worried about the state of their livelihoods. The list of reasons to end the lockdowns and push back to normal is long, and the only significant opposition to this move is the lurking threat of a second wave.
Unfortunately, if the unprecedented steps we took to put our national society and economy on hold since the middle of March prove effective, the results will only boost the misplaced confidence that the threat of the coronavirus is overblown. More and more states and local governments feel they have little option except to bow to this pressure and open back up for business.
Now is the moment when the coronavirus pandemic either fades into the history books or unfolds to a new scale of unprecedented death and disease for Americans. The arrival of a second wave is dependent upon how Americans behave in the next few weeks. Our greatest enemy is our rush to normalcy that might be farther away than we realize. It is a cultural vulnerability, but our rush to liberation from lockdown may prove to be our undoing.
