The question was relatively simple, but the answer bogglingly complex: How would a contagion with the ferocity of the century-old Spanish ‘Flu react when it met the modern world of mass tourism and Amazon? And what should the global response be when it came?
Among those who had read, studied, or helped imagine the impact over these past hundred years, Bill Gates and his 2015 TED Talks warning seemed to reach the widest audience. But the certainty of a plague upon our various houses had always been known among historians, epidemiologists, international public health organisations, and the well-informed reader.
With the Spanish ‘Flu as a yardstick, the potential has always been a straightforward, incontestable fact. In a world of 1.9 billion, the Spanish 'Flu killed somewhere between 20-100 million people (the number is contested). In a far more crowded world of 7.5 billion today, would it circle the globe in a day, an uncontainable contagious inferno, killing millions of people, disrupting society and government, and bringing chaos to industry and healthcare?
Or would human ingenuity, expressed so beautifully in the power and reach of invention, combine to defeat it? The answer is a mixed one which #Covid-19 is gradually revealing. It's also revealing that even plague can be used as a political weapon, as Conservatives and Liberals go to ideological war over what is or what might be. But more of that after my list of 5 innovations (below ;-)
While countries like Italy and Spain, with some of the best social welfare health systems in the world, struggle to contain the death rate, there is still no comparison with what is about to happen in Africa’s slums, Pakistan’s crowded cities, the enclosed totalitarian states of North Korea and Turkmenistan, in illiberal states like Russia, or the refugee camps of Idlib in Syria. Those will be the real proving grounds for what might have happened in a place like Australia.
In 1918, the world was still at war, and planes still didn't have the reach to cross the great oceans. Submarine telegraph cables could carry the news of viral outbreaks, but telephone calls from London to Washington weren’t possible until the 1940’s. Trains moved huge numbers of troops across webs of European networks, but the Model T Ford hadn’t quite yet put a car in every home. The world still moved largely at the pace of the stride.
A microscope that combined with an electric light source was just a few decades old, but the electron microscope, with its application in virology, was more than a decade away. In China, vaccination had apparently been deployed against smallpox since the 16th century, but the kinds of secondary bacterial infections that killed millions of people weakened by the Spanish ‘Flu would not be treatable until Alexander Fleming’s accidental discovery of the power of funghi in his laboratory a decade later.
So, leaving aside penicillin, the computer, the semi-conductor and the conductive properties of silicon, the World Wide Web, the Wi-Fi router, modern serology, the electron microscope, and the smart phone and apps (I sound like Monty Python, what did the Romans ever do for us?), here’s my hit list of inventions since 1918, or quantum improvements in innovation, that are combining to overcome #Covid-19 in the well-heeled world, and which might help mitigate the inevitable, quickly upcoming, and far-greater viral slaughter in poor nations:
1. The disposable glove. The first rubber glove with a medical application seems to have emerged from Johns Hopkins University in 1889, but it was Ansell’s 1964 production of the thin disposable glove that led to the gloved nurse, or the food-handler slicing your sandwich (the company is more famous for the equally widely used Ansell condom which must be booming in our times of self-isolation). The disposable glove plays a vital role today as a shield against physical contagion, as a breaker in the causal infection chain, and as an emblem of public compliance with preventive health measures.
2. The mechanical ventilator. The principles of negative pressure ventilation, a process used when muscles collapse and cannot inflate the lungs, was understood from the 17th century. It was the invention in 1928 of the iron lung to treat polio victims that paved the way for the modern ventilator (Australia had a hand in reducing the vast cost with the Both Respirator). Reinvention is afoot again as doctors learn to share scarce modern intubation ventilators between patients, and companies turn their production lines over to quickly reproducible models, or 3D printing is brought online to rapidly reproduce at small cost the single most vital piece of ICU machinery needed today.
3. The checklist. This astonishingly simple procedural device is the liturgy for modern medicine, and flying. Every time your pilots fire up engines, they read the same dull sermon from a checklist that reminds them, no matter how bleary-eyed, to turn the gas on. Similarly, gone are the days when a doctor galloped up to a hospital, slapped his horse’s sweaty flanks, wiped his brow sweat with his hand, stubbed out his cigar on the surgical table, kissed the nurse, and set to work in a bacterial haze slicing open victims (an idyll now suborned by women in the profession). Checklists provide a neutral device that overrides hierarchy and dictates common team behaviour, such as scrubbing hands. They are immutable.
4. Network theory + graphic visualisation = health surveillance. In 1854 John Snow, considered the pioneer of public health epidemiology, had used a graphic visualisation to communicate in simple terms to politicians and the public that a contaminated water pump was the source of a typhus outbreak in London (below). Network theory really took off in the 1930s, meaning that increasing complexity in biology, sociology and eventually computerisation and information contagion could be understood at a glance. The modern graphic, underwritten by computer science, brilliant design, and the narrative urgency of journalism, illuminates things like the exponential capacity of a single silent viral spreader in the community, and the consequent power of health surveillance and containment, a la the Singapore, Vietnam, Taiwan and Hong Kong Covid-19 response.
John Snow's epidemiological map, showing the pump at the centre of the 1854 typhoid outbreak in Soho, London.
5. The Decision Point, and modern management theory. Leadership is more complex than ever, with ministers expected to be on top of multiple intricate sets of detail upon which to base quick-fire decisions. Those decisions that have led to lock-downs, and the basic leadership requirement of political imagination, would be impossible without a capacious sense of government, scientific organisation, and society at large. Management theory for Systems (entropy and synergy); Administration (organisation, coordination, command and control); the management of Production; organisational Learning and Adaptation; and Risk, Disruption, and Contingency management all have a role in shaping leadership decisions that are composed of dazzling detail.
Those decisions will be sorely tested. A plague on one house is nothing like that on another. The sharp divisions between rich and poor nations, and effect of the distribution of benevolent and often simple common goods such as those listed above, are about to be thrown into sharp numerical relief. Sluggers on each side of the political divide should keep their powder dry, because we cannot know the true numerical proportions of Covid-19 yet, for the very simple reasons I've written about, and we're unlikely to know for years.
Of course, there's nothing simple about a contagion under any circumstances. In places like Pakistan, Bangladesh (where one UN internal memo posits a possible 2 million deaths), or Russia, we’ll count the bodies against annual expected deaths, broadly standardise the measures used to reach those numbers, and eventually we’ll have answers on the rough mortality rate of #Covid-19 in a way never possible with the Spanish 'Flu.
Then we’ll drill into the variables, each attached to a decision point, or a social fact unique to each country, or the availability of different kinds of ventilators, and the arguments will continue for years over what should have been done.
Meanwhile, we rely on the astonishing rate of innovation that has quickly emerged as health, social, and political systems are being, distressingly but thankfully, stress-tested throughout the world:
O for a Muse of fire, that would ascend
The brightest heaven of invention
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