Lessons From History: What Can We Learn From 300 Years of Pandemic Flu That Could Inform the Response to COVID-19?

The unexpected temergence ofthe current pandemic triggered an accelerated process of research on the virus (SARS-CoV-2) and the disease (COVID-19). Since COVID-19 behaves as a typical respiratory transmitted disease, additional insights related to its epidemiology and potential containment strategies could be obtained by studying past pandemics of influenza. The history of influenza pandemics over the past 300 years has been described in much detail by K. David Patterson1 with 10 major ones occurring at a frequency of three per century. The first worldwide flu pandemic of the 18th century (1729-1730) had significant morbidity but relatively low mortality. The second pandemic (1732-1733), most likely caused by an antigenically different influenza virus, was also associated with high morbidity and low mortality. A more intense pandemic occurred in 1781 to 1782, infecting an estimated 70% to 80% of the population, although mortality again remained low. The first two influenza pandemics of the 19th century occurred in 1830 to 1831 and in 1833. The first one was of moderate intensity; the second one was more lethal. The third pandemic of the century occurred in 1889 to 1890, during which the disease was rapidly disseminated around the entire world but resulted in relatively low mortality. This pandemic was the first to occur after the formulation of the germ theory of disease, when the medical community was abandoning the old ideas about miasmas, or atmospheric perturbations, as the cause of epidemics and replacing these with the modern concepts of transmissible microbial agents. The germ theory of disease provided a theoretical framework for future preventive intervention, including clean water, general hygiene, and the now popular social-distancing strategies.