The last most remembered pandemic can be traced to the general crisis facilitated by the First World War. The “Spanish Flu”, as it was popularly known, was connected to a strain of the influenza viruses, which was in circulation among troops from 1916 onwards. By 1918, the virus strain triggered a full-blown pandemic, spreading in waves that lasted up till the spring of 1920.

The pandemic was inseparable from the unprecedented conditions created by the War itself. Movement of large troops, overcrowded military camps, and overflowing hospitals were fertile ground for the spread of the respiratory contagion. Together, the filth of the trenches and military camps, as well as widespread festering war injuries and rampant malnutrition that bred immuno-compromised conditions facilitated easy spread of the disease among troops. Later, returning troops became super-spreaders of the contagion, as in the case of Bombay where the pandemic broke out in June 1918, following the return of troops via ships.

War-time hardship borne by large sections of the civilian poor, particularly enhanced poverty and malnutrition, coincided with overburdened healthcare systems that were reeling under the impact of the War. The fallout of this was a devastating death toll once the contagion reached the wider community. Estimated mortalities vary between the conservative figure of 17 million to a much higher figure of 50 million, with approximately 12 million deaths being reported from India alone.

Significantly, recent studies have strongly emphasized that the majority of deaths associated with the pandemic were cases of comorbidity, i.e. the combination of influenza with pre-existing diseases in circulation and adverse medical conditions. A marked comorbidity was most evident in the case of those suffering from Tuberculosis (TB). Notably, the Spanish Flu pandemic overlapped with a fresh spurt of TB during the same period. Recent research thus points to the fact that the influenza contagion was only partially to blame for the massive loss of life, making it imperative for us to compare the Spanish Flu pandemic with the contemporaneous Covid-19 scenario.

Importantly, there is an eerie similarity in the vulnerable conditions that our response to Covid-19 has fostered and the conditions which allowed for the easy spread of the Spanish Flu in 1918-19. It has been shown that the Spanish Flu ploughed through the populations of Iran and India in the background of preexisting conditions of drought, food shortages triggered by heavy grain exports to England, as well as cholera. At present, the ensuing Covid-19 triggered lockdown has accentuated similar vulnerabilities of food crisis, malnutrition, etc. In such conditions, while the severity of Covid-19 may come down in coming weeks, the disease may combine with debilitating ground realities so as to live longer at the subterranean level within the community.

Unfortunately our single disease-centric approach has blinded us to the intersectional axes around which a disease has devastating effects. In the current context, we have seen singular prominence being assigned to Covid-19 over and above other contagious and lethal diseases in circulation. This is despite the Central government’s own statistics pointing to comorbidities in majority of the deceased who tested positive for Covid-19. One wonders then how a line has even been drawn between dying of Covid-19 and dying with Covid-19.

The question that emerges is how some diseases gain prominence and are declared epidemics/pandemics, while other infectious diseases pervasively circulating within large sections of the population continue to draw little attention. In reality, our ways of knowing and understanding things about diseases are shaped by the biases of ‘scientific’ research. Class, region and other social dynamics tend to influence mainstream epidemiology, and the overall disease monitoring system sponsored by governmental and global health agencies. Essentially, diseases are being selectively discovered and are usually identified as an epidemic when they have a signaling effect for the scientific community. In majority of instances, it is only when there is a threat of transmission to the well-to-do sections of society or wealthier regions that the disease actually has such a signaling effect. Expectedly, the adverse medical conditions prevalent among the labouring poor and poorer regions continue to be left unidentified by the lax disease monitoring system.

The underlying biases of scientific research which are fuelled by the interests of private pharmaceutical companies, in addition to the lack of priority that governments assign to general healthcare and diseases of the poor, actively prevent the discovery of the specific cause (aetiology) behind numerous diseases and ailments. Many ailments are simply clubbed together under catch-all-categories like ‘Respiratory Tract Infection’, ‘Urinary Tract Infection’, ‘Fever of Unknown Origin’, ‘Acute Undifferentiated Fever’, etc. These disease are often more contagious and fatal than those which gain prominence. However, given their incomplete diagnosis, it is at most symptomatic treatment which is made available to the common masses; leading to persistent spread of the disease and continuous heavy loss of life.

Even when the aetiology of a contagious disease and its treatment are well known, the disease’s prevalence does not generate the adequate reaction. TB, a disease largely associated with the poor, is a suitable example. Sources highlight that every ten seconds a person contracts TB, pointing to a very high R0 (basic reproduction number) for the disease. With four to five lakh persons succumbing to the disease every year in India, TB has not only a higher mortality rate than Covid-19 so far, but is clearly an undeclared persistent silent epidemic. Given these silent epidemics and the general poor health conditions of the vast majority, the disruption of public hospitals’ routine services – like out-patient department services – during the lockdown have had dangerous ramifications for the millions of poorer citizens dependent on public healthcare. Ironically, with Covid-19 projected as the only, or rather, lonely threat, there is no comparative analysis of mortality rates of prevailing diseases.

This may appear as a shallow whataboutery that seeks to draw attention away from a concrete crisis. However, such an approach is firmly anchored on the specificity of the crisis at hand. It recognizes that our population is falling prey to the sinister synergy between co-existing diseases and the vulnerabilities fostered by the overall functioning of our socio-economic system. Given these realities, what is more sinister is the predominance of the vertical model of health intervention, which is driven by global health agencies and pharmaceutical companies’ singular interest in Covid-19. The vertical model propagates surgical mode of intervention on a singular disease; leaving unaddressed the collateral damage, i.e. increasing fatality rates of numerous other debilitating diseases and illnesses prevalent within the population, which only horizontal health intervention or an expansive public healthcare system can resolve. Hence, it is imperative that we stop ignoring other identified and unidentified infectious diseases plaguing our population, many of which have the propensity to combine with Covid-19 to unleash devastating effects.

For the human race that has seen approximately 100 billion of its specie die in the past fifty thousand years, death is an inescapable reality. What has changed now, of course, is our enhanced ability to systematically track down death to specific causes. With its national level tracker for Covid-19 deaths, perhaps India for the first time has launched a daily tracker for deaths caused by a disease. If only there had been a daily national tracker for other diseases then the singular prominence given to Covid-19 may not have preoccupied us as it currently has.

Maya John is a social scientist teaching in Delhi University and is researching on the history of modern epidemiology. She has been associated with the Left movement for two decades


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