By: Ashikin
13.4.2020
As new, venomous diseases, such as SARS and Covid-19, arise, the race starts discovering new treatments and medications for those affected. Governments are imposing quarantine and isolation as the global crisis progresses, and public meetings are discouraged. Health authorities followed the same strategy 100 years ago, when influenza spread all over the world. Outcomes were mixed. Yet reports from the 1918 pandemic show one strategy little-known today was successful in dealing with influenza. In the weeks and months ahead, some hard-won lessons from the biggest pandemic in recorded history might benefit us in the weeks and months ahead.
Simply stated, medics found that those treating outside with extreme ill flu improved better than those treated indoors. A combination of fresh air and sunshine seems to have reduced patient deaths; and medical-staff infections. [1] Scientific evidence for this is available. Research has shown that air outside is a good disinfectant. New air can kill other unhealthy germs and the flu virus. Equally, sunlight is germicidal and there is now evidence it can kill the flu virus.
Influenza patients getting sunlight at the Camp Brooks emergency open-air hospital in Boston. Medical staff were not supposed to remove their masks. (National Archives – Photo Credit: Medium.com)
`Open-Air' Treatment in 1918
Some of the worst places to be during the great pandemic were military barracks and troop-ships. Staff shortages and insufficient ventilation placed soldiers and sailors at high risk of contracting influenza and other diseases that often accompanied it.[2,3] As with the latest outbreak of Covid-19, most of the victims of the so-called 'Spanish flu' did not die from influenza: they died from pneumonia and other complications.
The city of Boston was especially badly hit when the influenza pandemic reached the east coast of the United States in 1918. Thus the State Guard built an emergency hospital. They took ships in Boston harbour in the worst cases for sailors. The medical officer at the hospital had found the most critically ill sailors were in poorly ventilated areas.
And by placing them in tents he gave them as much fresh air as possible. And they were taken out of their tents in good weather, and placed in the heat. Bringing the wounded soldiers outside was standard practice at this time. Open-air therapy, as known, has been commonly used on Western Front casualties. And for another rising and frequently deadly respiratory infection it became the treatment of choice of the time; tuberculosis.
Patients were placed in their beds outside to breathe natural fresh air. And they were nursed with the door open day and night, in cross-ventilated hospitals. The open-air system remained widespread until it was replaced by antibiotics in the 1950s.
Doctors at the hospital in Boston who had first-hand experience with open-air therapy were persuaded the treatment was successful. This was given up elsewhere. Unless one study is right, deaths among hospital patients were reduced from 40% to around 13%.[4] According to the Massachusetts State Guard surgeon general:
`The efficacy of open air treatment has been absolutely proven, and one has only to try it to discover its value.’
Fresh Air is a Disinfectant
Infectious germs that are often present in traditional hospital wards were less likely to be exposed to patients treated outside. In what must have been a relatively sterile climate, they breathed clean air. We know this because scientists from the Ministry of defence demonstrated in the 1960s that fresh air is a natural disinfectant [5]. There is something they call the Open Air Factor in nature that is much more dangerous to airborne bacteria — and the influenza virus — than indoor air. We couldn't define precisely what the reason for open air is. But they found that it was effective at night as well as during daytime.
Their research has also shown that the disinfecting properties of the Open Air Component can be retained in enclosures — if ventilation levels are kept high enough. Significantly, the levels they found are the same as those for which cross ventilated hospital wards were built, with high ceilings and wide windows [6]. But by the time the scientists learned that antibiotic therapy had replaced open-air therapy. Since then, fresh air's germicidal effects have not been used in the prevention of diseases, or in hospital design. But dangerous bacteria have become highly antibiotic resistant.
Sunlight and Influenza Infection
Putting sick patients out of the sun may have helped as it inactivates the influenza virus.[7] It often destroys lung bacteria and other diseases in hospitals.[8] Army surgeons regularly used sunshine to treat contaminated wounds during the First World War[9]. They had known that it was a disinfectant. What they didn't realize is that if sunlight is high enough, one advantage of putting patients out in the sun is that they can synthesize vitamin D in their bodies. Until the 1920s, this was not known. Low levels of vitamin D are now associated with respiratory infections, and can increase the vulnerability to influenza [10]. Also, our body’s biological rhythms appear to influence how we resist infections.[11] New research suggests they can alter our inflammatory response to the flu virus.[12] As with vitamin D, at the time of the 1918 pandemic, the important part played by sunlight in synchronizing these rhythms was not known.
Face Masks Coronavirus and Flu
Actually, surgical masks are lack in China and elsewhere. These were worn 100 years ago to try to avoid the transmission of the influenza virus during the great pandemic. While surgical masks that give some protection against infection they do not seal around the face. And they don't flush out particles that are low in the water. In 1918, someone who had contact with patient at the emergency hospital in Boston. It consisted of five gauze layers mounted onto a wire frame that protected the nose and mouth. The frame was designed to match the wearer's face and avoid rubbing of the mouth and nostrils by the gauze filter. The masks were replaced every two hours; sterilized correctly, and put on with fresh gauze. They were a forerunner of the N95 respirators that are currently in use in hospitals to protect medical staff from airborne infection.
Temporary Hospitals
Hospital workers continued to uphold high levels of personal and environmental hygiene. It certainly played a major part in the relatively low infection rates and deaths recorded there. Another factor was the speed at which they built their hospital and other temporary open-air facilities to cope with the surge in patients with pneumonia. Many countries are not prepared for a major influenza pandemic today. [13] If there is one, their health systems will be overwhelmed. Vaccines and antiviral drugs may be of benefit. Antibiotics can function well for pneumonia and other complications. Yet they do not have access to any of the world's population. If another 1918 comes, or the Covid-19 crisis gets worse, history suggests it might be prudent to have tents and pre-fabricated wards ready to deal with large numbers of seriously ill cases. Plenty of fresh air and a little sunlight might help too.
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SOURCES:
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7. Schuit M, Gardner S, Wood S et al. The influence of simulated sunlight on the inactivation of influenza virus in aerosols. J Infect Dis 2020 Jan 14;221(3):372–378. doi: 10.1093/infdis/jiz582.
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9. Hobday RA. Sunlight therapy and solar architecture. Med Hist 1997 Oct;41(4):455–72. doi:10.1017/s0025727300063043.
10. Gruber-Bzura BM. Vitamin D and influenza-prevention or therapy? Int J Mol Sci 2018 Aug 16;19(8). pii: E2419. doi: 10.3390/ijms19082419.
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12. Sengupta S, Tang SY, Devine JC et al. Circadian control of lung inflammation in influenza infection. Nat Commun 2019 Sep 11;10(1):4107. doi: 10.1038/s41467–019–11400–9.
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14. Hobday Richard (2020), Coronavirus and the Sun: A Lesson from the 1918 Influenza Pandemic. Retrieved from: https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-lesson-from-the-1918-influenza-pandemic-509151dc8065