The 1918 flu pandemic was caused by an H1N1 virus with genes of avian origin. We remember it as the Spanish Flu because it was reported that way. The virus was first identified in military personnel in spring 1918. It spread rapidly with perhaps 500 million people becoming infected worldwide, one third of the world’s population, and it is estimated that 50 million died. Death rates were high in the under-five’s, and there was high mortality in otherwise healthy people, including those aged between 20 and 40. With no vaccine and no antibiotics to treat secondary infections the Spanish Flu was rampant.
The 1918 flu became commonly known as the “Spanish Flu” or the “Spanish Lady” in the United States and Europe because of military censorship. Spain was neutral in World War 1, news of the virus first made headlines in Madrid in late-May 1918, amplified when King Alfonso XIII came down with a nasty case a week later. Censorship ensured that the virus could only be read about in stories from Spain. The Spanish preferred to call it the “French Flu”. Scientists are still unsure where it originated – France, China, Britain and the United States have all been suggested. It was first confirmed amongst troops at Fort Riley, Kansas in March 1918 subsequently carried to France and by June 31,000 cases had been recorded in Britain.
The Covid-19 pandemic has targeted a different age group and despite efforts by President Trump to brand it as “Kung Flu” or the “Chinese Virus” the virus has not yet acquired a nationality. The International Committee on Taxonomy of Viruses (ICTV) named the current pandemic virus in February 2020 as “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”. The name recognises the relationship to the earlier strain of corona virus (CoV-1) responsible for the 2003 SARS outbreak. The World Health Organization (WHO) announced “COVID-19” as the name of this new disease on 11 February 2020.
Why does this matter?
Recognising the likely consequences of the growth of social media in 2015 the WHO “identified best practices for the naming of new human diseases, with the aim to minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.” The WHO advised that people’s names, geographic locations, classes of animals and “cultural, population, industry or occupational references,” should not be used. So far this advice has held for the strain: COVID-19.
Not so for the variants. Names have consequences. Alan McNally professor in Microbial Genomics at the University of Birmingham wrote in the British Medical Journal a week ago, that the obsession with SARS-CoV-2 variants and designating them with a place of origin, “is an unfortunate stigma that should be avoided at all costs given that where a virus is first detected is not necessarily where it originated.”
I can vouch for the sense of stigma. I live in Kent. In December the local and international media was fearfully reporting variant B.1.1.7 , the Kent variant, sweeping across the United Kingdom and dominating infections due to an increase in transmissibility. There is now concern about the Brazilian variant because of concerns about its propensity for causing re-infections. More of the South African variant shortly. As Professor McNally points out the “obsession with variants is now becoming as contagious as the virus, and unfortunately it also provokes similar knee jerk reactions.”
Viruses mutate all the time, mutations lead to new variants. A few of those new variants are “of concern” because they increase transmissibility, evade vaccine protection or result in higher mortality in those infected. The very success of vaccination programmes may result in the development of new variants. For sure it makes no sense to create an environment where there is a reduction in genomic sequencing and surge testing. It may not be in your national interest if genomic sequencing attaches your national identity to a new variant or if by surge testing you create an impression that the new variant originated in your country – remember Spanish Flu.
The South Africa variant, is more properly known as VOC202012/02, shares the N501Y mutation to the spike protein but also has a number of other mutations including E484K. Public Health England reports that: “Laboratory tests have shown that the E484K mutation may be able to escape the body’s antibodies to some extent and is therefore of potential public health concern, so it’s one we’re monitoring closely.” There are now reported to be 141 confirmed cases in the UK. the deputy chief medical officer has urged people not to “panic” over the South African coronavirus variant, saying it is not likely to become the dominant strain in the near future. Researchers in South Africa found the new variant in January, genomic sequencing and surge door-to-door testing in the UK has discovered cases without any link to travel or known cases.
Writing in The Times Ivan Fallon has written that “South Africa is now seen as the scariest destination on earth because of this so called new Bogey Man variant” and pointed out that it has achieved this status because of the extent of analysis on new variates being done in South Africa. South Africa is reopening its beaches, parks and rivers. The alcohol sales ban has been eased, and the nine o’clock curfew has been put back to 11pm, with restaurants allowed to serve wine. A month ago South Africa was recording more than 20,000 new cases a day. Last week it was running at less than 4,000. But Fallon writes about the stigma left by the “South African virus”. “Emirates and half a dozen other airlines have extended their bans on flights, and British Airways plans not to resume flying until April 15. Hotels are empty and the Stellenbosch vineyards, while open again, are almost deserted. Top Kruger game reserves are offering discounts of up to 90 per cent, hoping to tempt South Africans who are virtually their only customers.”
Fallon quotes Professor Willem Hanekom, a leading virus specialist, “It’s not a matter of location,” “It’s due to South Africa’s excellent network of viral surveillance, which even the US doesn’t have in place yet. And to the fact that we owned up.” Fallon also quotes Professor Alex van den Heever, of the Wits School of Governance, who proffers “the most plausible theory yet: the virus has already done its job. Most South Africans, he says, may have had it and developed antibodies. Officially, there have been 1.5 million cases in South Africa over the past year. Van den Heever, on the basis of exhaustive studies and a large body of evidence, reckons the true figure is at least six million and possibly as many as nine million.”
There are still many known unknowns and almost certainly some unknown unknowns. There will be more “variants of concern” identified and doubtless more travel bans and as countries try to block the import of new potentially more dangerous variants. They will be named after the place they are first identified, not necessarily where they originate. Those countries with surge testing and genomic sequencing will report more variants, some of which will be “of concern”. Currently nearly all international travel from the UK is illegal and there is no definite date for the resumption of international leisure travel. South Africa, with 32 other countries, is on the UK red list with a pre-departure Covid-19 test and 10 days quarantine in an approved hotel required on arrival in the UK.
Broad spectrum vaccines are some way off and as with flu it may be necessary to vaccinate the particularly vulnerable annually. Learning to live with Covid-19 will not be easy and will be disruptive of international travel for some time yet. Travel bans have real consequences – good and bad. They will be contested.