• Original Articles By Dr. Lavin Featuring Expert Advice & Information about Pediatric Health Issues that you Care the Most About

    COVID Update May 1, 2023: Lessons on COVID from 1918 – Powerful Presentation from John Barry


    • Virus– a type of germ that consists solely of a bit of genetic material (DNA or RNA) wrapped in a protein coat.  The coat gets the genes into the target cell where the genes force the cell to make zillions of new viruses (genes and protein coat), and on it goes.
    • Variant- also known as a mutation, a variant strain of a virus is the same species of virus but with a change in the genetic code.  The change is minor if it has no impact on contagious the new variant is, or how deadly it is, or if it allows the virus to neutralize our vaccines. Variants that substantially increase harm are now listed by Greek letters, the most troublesome one now is Omicron.
    • Coronavirus– a species name of a number of different viruses.  Called corona because its protein coat is studded with spike shapes that form a crown, halo, or corona of spikes
    • SARS-CoV-2– the specific name of the new coronavirus
    • COVID-19-the name of the illness that the new coronavirus is causing
    • Endemic– an illness always present in a region.  One could say strep throat is endemic in the US
    • Epidemic– a sudden burst of an illness that comes and goes over a limited time
    • Pandemic– an epidemic that bursts across the world not just one region
    • Spreadability– how contagious is the disease, how many people will end up infected
    • Symptoms- the experience of being ill, for example- fever, cough, headaches, loss of smell etc.
    • Asymptomatic– literally means “without symptoms”.  For COVID-19 it refers a person infected with the virus but has no and will have not symptoms
    • Presymptomatic– This is a person who was infected with SARS-CoV-2, and will feel sick, but hasn’t yet
    • Severity– what harm does the disease cause, in terms of  how sick you get and how many it will kill
    • Mask- a mask is a loose-fitting cloth or textile that covers the mouth and nose loosely.  A surgical mask is a mask used in surgery
    • Respirator-  for the purposes of the COVID-19 pandemic and other respiratory illnesses, a respirator is a mask that fits very snugly or tightly to the user’s face.  An N95 mask is a respirator.
    • PCR Test–  swabs the nose to detect the genes of the COVID virus.  The genes if detected are almost certainly there, but they can persist long after contagion ends.  Very few false positives, positives can be trusted.
    • Antigen Test (the home kit)- swabs the nose to detect the proteins on the coating of the COVID virus, the spike proteins.  If it does not detect those proteins, you are almost certainly not infected, negatives can be trusted.  These proteins are also on the coating of many common cold viruses, so one positive test may indicate you have a cold rather than COVID.  Two positive home tests though reliably indicate you have COVID.
    • Vaccine Terms
    • Vaccine or Immunization– a dose of a substance that activates your immune system, as if you have the actual infection you are hoping to prevent, leaving you in fact protected from having that infection.
    • Efficacy– the percentage of people immunized with a particular vaccine who will not get infected if exposed to the target infection.  For example, a COVID-19 vaccine will be said to be 95% effective if 95% of people immunized with that particular COVID-19 vaccine will not get COVID-19 if exposed to COVID-19
    • Valence- The valence of a vaccine tells us how many types of the virus the vaccine protects against are in the vaccine.  The Omicron COVID booster vaccine has two Omicron variant types it protects against, BA.4 and BA.5, and so it has two valences, or is called the bivalent COVID vaccine
    • mRNA– DNA works by dictating exactly which proteins your cell will make.  The message on how to construct each protein is delivered to the cell machinery that makes proteins by a piece of genetic material called messenger RNA, or mRNA
    • mRNA vaccine– an mRNA vaccine places a small bit of mRNA code that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected
    • Viral vector vaccine– a viral vector vaccine takes a harmless virus that is known to infect people reliably and places that weakened virus in a person where that virus will in fact infect the person.  The virus is not only weakened, but also attached to a set of genes  that makes your cells make a protein that is the protein from a virus that alerts your immune system and activates it to make protections against you being infected.


    As the result of the tremendous efforts of my longtime colleague, Dr. Carl Weitman, the extraordinary pediatric neuropsychologist, John Barry presented his observations in Cleveland last week.

    It turns out that Carl is the president of the Board that runs the Allen Memorial Medical Library, a treasure in the CWRU library system and one of the finest medical libraries in the nation.  Carl also is an avid historian, and has been a student of the deadly 1918 Influenza Pandemic which was far more deadly than COVID.

    John Barry wrote the book on the subject, The Great Influenza:  The Story of the Deadliest Pandemic in History.

    I was so pleased to be able to attend the event at the Allen library, and learned quite a bit, about 1918, and today.

    So I thought I would share some highlights.  The highlights fall into two categories:  what the germs did, and what we the people did:

    The Germs

    • The 1918-1921 influenza pandemic killed as many as 150 million people.  Massive, without parallel, even by the Black Death.  This one influenza virus killed people very, very quickly.  On the Fiji islands, once the virus landed, it killed about 16% of the total population in little more than 2 weeks!
    • The 1918 pandemic influenza virus turns out to have been able to infect essentially every virus.
    • 1918 pandemic influenza virus infected nearly every organ, including muscle causing death of any part of any organ.
      • Keep in mind when viruses hurt muscles they cause true muscle ache and weakness.
      • Damage to this organ could prove fatal or cause lifelong heart failure
      • Like COVID, this virus could dangerous lung damage, and did so more severely and often and rapidly than COVID
      • Damage to the brain could cause the brain fog familiar to COVID, but also permanent coma like paralysis as seen in Awakenings.  Notably infected people ended up with sharply increased risk of suicide and suicidal behavior.  Is there a parallel after COVID?
    • Both COVID and the 1918 influenza virus caused cytokine storms, wild explosions of reactions from our immune system to kill cells with the viruses in them, but when carried to far, kill too many of our cells, and then, death
    • COVID poses more threat because now we have many immunocompromised people present
    • The 1918 influenza and COVID deaths had very different patterns of death.
      • In 1918, the deadly influenza virus killed mostly 20-40 year olds.  In some communities a full 3% of all workers died in a short 3 month blast.  Elderly were less likely to be killed by this virus
      • For COVID, a strong majority of all the deaths happened in the elderly.  The younger the safer.

    We the People

    • Both in 1918 and 2020, the Federal government chose to not respond, to not protect the nation, with some differences.
      • In 1918, when the pandemic exploded, the US was facing World War I and President Wilson feared responding to the pandemic could slow troop recruitment and transport, and risk losing the war.  It was forbidden to talk about or publish news on the pandemic, imagine.
      • In 2020, the Federal government did achieve a bold success in Operation Warp Speed, allowing the world to have access to life saving vaccine in record time.
      • In 2020, at the same time the White House decided to flatly deny the clear threat, wasting the only opportunity to prepare the nation to protect itself.
      • In both 1918 and 2020, the nation’s public health infrastructure was severely decentralized, even today we have no modern data processes to have real time access to real time trends
    • People got tired of bothering to avoid death by pandemic infection
      • In 1918, the pandemic hit in 4 waves, each quite deadly.  After the third wave, Americans declared they had enough.   The country went from pandemic panic and caution to the Roaring Twenties.  The apathy was so intense that despite a large number killed, there is little record of the 4th wave, and most histories only cite 3 waves.
      • In 2020-2023, after experiencing the original, delta, and now omicron variant waves, again the nation has embraced apathy, allowing the virus to kill about 60,000 of us a year with almost no care.
    • Both viruses led to striking patterns of death directly defined by what communities chose to care about.
      • In 1918, in the United States, death directly followed choices made in various cities.  The most striking contrast is between Philadelphia and San Francisco.
        • Philadelphia chose to actively deny the power of the virus.  When it was raging they still chose to hold major parade events.  This led to such a surge of death, bodies had to be piled on city blocks for wagons to load and remove.
        • San Francisco chose to take the threat of death seriously.  Before the 1918 flu virus struck city leaders and their citizens agreed to take precautions, stay home as much as possible, and in 1918, embrace wearing masks.  No bodies piled up on the blocks of San Fran, it had far fewer deaths
      • For COVID, the split was by political party.
        • The Republican Party went the way of Philadelphia in 1918, choosing to actively deny the ability of the virus to cause harm and death.  This choice showed dramatic impact once the COVID vaccine became available.  The choice to deny the power of the virus led to the choice to not immunize.  Counties with low immunization rates have dominated the deaths by COVID in 2022 and 2023.
        • The Democratic Party went the way of San Francisco in 1918, choosing to actively see what COVID can do, and what people can do to protect themselves.  Again, the impact of such a decision became dramatic once vaccines became available.  The choice to see the harm COVID can do led to higher immunization rates and far fewer killed by the virus.

    Some Thoughts on it All from John Barry

    • Three Big Reasons Nations Succeeded in Keeping Deaths from COVID low
      • The people trusted their leaders and institutions and each other
      • The nation’s leaders and institutions spoke the truth about the pandemic to their nation
      • The nation’s information and response structures had clear centralized leadership
    • The United States failed to have any of these three features of a modern nation for the first yaer or so of the pandemic.  Even today, states led by leaders who deny how germs work have actually passed laws to force states to embrace ignorance.  Over half, 26, of all states in America have laws that actually prohibit public health science or agencies to have authority to protect its citizens from deadly infections.
    • In contrast, Japan had all 3, and the result was told in deaths.  Japan had 10% fewer deaths, per capita than the United States.  Our choice as a nation to distrust each other, of some of our leaders to deny the facts, and to refuse to invest in modern public health data and response structures cost us the needless loss of hundred of thousands of lives.
    • Around the world, labs that study the most dangerous germs simply do not have enough security of lab process, they are leaky.  Mr. Barry leans towards thinking COVID arose naturally but cannot rule out a lab leak.  Either way, we now know lab leaks of dangerous germs can light a pandemic that kills millions, we need modern, tight labs that do NOT leak.
    • Science has the power to detect when new viruses emerge.  The NIH was founded in response to the 1918 pandemic, but it took until 1928 before it began to act.  As a result of many years of work, now around the world, stations exist to test for emerging influenza viruses, to detect the next great pandemic early, get the vaccine ready in time to save millions of lives.  We do NOT have such stations in place to a great enough degree to catch other non-influenza pandemic viruses in time.  Perhaps we will be like humanity in 1918 and take some years to really get our responses in order, we hope we will.
    • Respiratory viruses mutate rapidly, and now and then they will change into a historic killer.  The last really big killer was a new influenza virus, in 1918, killing as many as 150 million people.  COVID was deadly, but not quite the big one, killing as many as 20 million so far.  A new one could show up any day, and kill at the level of the big ones, 100, 200, even 300 million people.
    • The question is next time, will humanity choose to catch it early, develop vaccines in time, decide to accept the facts, have leaders who know the facts and nations where people trust each other to believe the facts and act accordingly.   If the answer is yes, there may never be another big killer like in 1918, if the answer is no, there certainly will.


    Bottom Lines:

    1. Thanks to Dr. Carl Weitman, my neuropsychology colleague and friend, Cleveland was treated to a rare evening of deep insight into the great 1918 influenza pandemic and lessons from it and our current pandemic of COVID.
    2. Humanity will always be infected by viruses of the nose and lung.  Fortunately over the years all of them cause almost only mild colds.  But such respiratory viruses change a lot and also infect many, many animals, including most mammals and many birds.  So from time to time a new respiratory virus will emerge capable of spreading around the world and killing hundreds of millions of us.
    3. The experiences of the emergence of one of history’s greatest killers in 1918, and our current very dangerous killer teach us that the ability of a killer virus to kill us relies largely on something unrelated to the virus, and entirely related to us, the humans.  At any moment, we always will choose, do we want leaders we trust, do we want to trust each other, do we want to know facts, do we want to structure our use of data and ability to respond in a way that can provide timely responses?  If no, we will see more deadly pandemics and see millions die.  If yes, we will not.  I know which way I prefer.
    4. Like so much in our lives, in our human lives, we have the imagination to help each other, to learn, to respond effectively to what causes us harm.  But tragically we also have the power to avoid all this, to use our imagination to fear, to deny, to blame.
    5. Let us use the tragedy of today’s COVID and yesterday’s 1918 pandemics to really see we can have a bright future.

    To your health,
    Dr. Arthur Lavin

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