I love this quote from Winston Churchill, and often try and slip it into teaching sessions, and any conversation actually! But over that past year or so I have been wondering whether we might be able to use history to help us better understand the Covid-19 pandemic. My reason for this curiosity is that we have 4 common cold coronaviruses that infect humans, but it is likely that they didn’t originally start in humans but rather crossed from an animal into us in the past, and therefore we may have had a coronavirus pandemic before… we just didn’t know it or maybe we have forgotten it. Therefore, is there any evidence in the historical medical literature that would help us understand what might happen as the Covid-19 pandemic progresses? I do love dusty old medical “history” books…
Firstly, has there been any likely pandemic for other possible coronaviruses… I was wondering if the so called “Russian Flu” of 1889-90 might be just the thing I’m looking for…
Firstly, has there been any likely pandemic for other possible coronaviruses… I was wondering if the so called “Russian Flu” of 1889-90 might be just the thing I’m looking for…
In 1892, William Osler described some aspects of the recently occurred Russian Flu pandemic in the 1st edition of his book The Principles and Practice of Medicine. Sir William Osler is widely regarded as the Father of Modern Medicine, he has a room named after him at the Royal College of Physicians in London, and is a bit of a hero of mine. I also have a lot of his books! He says:
“In October of 1889 it [Russian Flu] prevailed extensively in St. Petersburg… and the disease rapidly became epidemic.”
The disease is caused by “a specific virus [a term used to describe any microscopic organism] of the most intense infectiveness”… “conveyed along lines of travel”.
In Osler’s Modern Medicine, 1907, William Osler is even more descriptive of the Russian Flu:
“The origin of this pandemic, like many others, is uncertain. The outbreak in Hong Kong in the fall of 1888, in Buchara in the middle of May, 1889, or in Tomsk in the beginning of October, may have been the starting point of the epidemic which occurred in St. Petersburg toward the end of October. By November the disease had swept through Germany and France; by December through Austria, Sweden, Denmark, Switzerland, Italy, Spain, Portugal, Belgium and the Netherlands, England, the Balkan States, and North America. By March, it had reached India and Australia; by April and May, China and the Gold Coast of West Africa. Berlin was invaded the middle of November, Paris from the 17th to the 20th of November, London the second week of December, Boston and New York the 17th December. Within a year if had visited nearly all parts of the world”. He describes further waves of infections in autumn 1891 and spring 1892.
Osler also says that the infection was worse in older people, those with pre-existing respiratory diseases, heart disease and diabetes. One of the features that cropped up in the Russian Flu pandemic was a higher rate of blood clots (thrombosis) in those who died and underwent post mortem. Eerily familiar huh?!
I find reading this really quite spooky. In 1892 William Osler had no idea about the cause of these respiratory infections, bacteria were a new discovery and viruses as we understand them today had not been discovered at all. But people like William Osler were great observers. His words are so descriptive; you can see how the Russian Flu pandemic spread around the World using travel routes - doesn’t it just sound like Covid-19?!
The aspects of these descriptions that have made me ask whether the cause of Russian Flu could have been a coronavirus and not an influenza virus are:
So, am I the only one who wonders if Russian Flu might actually have been a coronavirus and not flu at all? Can we use our past experiences to help us understand how the Covid-19 pandemic will evolve? Can we learn from history so we are not doomed to repeat it?
Let’s see if there is any other evidence for Russian Flu being Russian Covid…
Evidence that “Russian Flu” was a coronavirus
It is impossible to say for certain what caused the Russian Flu pandemic because there is no tissue or genetic evidence to back up any conclusions. Does that mean you can just make a theory up then?!! No!!! It has been proposed by others too that Russian Flu wasn’t an influenza virus, but could have been due to a coronavirus.
In fact, there is pretty good “circumstantial” evidence that Russian Flu was actually a common cold coronavirus known as OC43. The current evidence revolves around three areas:
The first bit of evidence to support the argument is that OC43 spilled over at the time of Russian Flu. A study from 2005 showed that OC43 is genetically related to a bovine coronavirus (BCoV), sharing up to 99.6% similarity of genes. This is very close and suggests a recent common ancestor. In fact, the same study mapped the genetics of OC43 and BCoV back to look when the 2 viruses diverged and found it to be about 1890. This is the time at which the virus spilled over into humans from cattle and corresponds to the exact timing of the Russian Flu pandemic (1889-90).
So, did something happen around 1870-1890 that might have given the opportunity to allow the spillover of OC43 from cattle to humans? In fact, at this time there was an outbreak in cows of a “highly infectious respiratory disease” spreading around the World which led to mass culling of cattle in many countries. The disease was historically thought to have been the contagious bovine pleuropneumonia, now known to be caused by Mycoplasma mycoides mycoides. This would have been indistinguishable from other bovine respiratory infections such as coronavirus-associated shipping fever disease (associated with a high mortality and caused by a coronavirus) which was discovered in 1996 in animals being shipped around the World!.
The cull of the infected animals in the 1880s would have given plenty of opportunity for whatever was causing the infection in the cattle to spillover into the humans carrying out the culling work. With no PPE in those days it is very unlikely that any infection control precautions would have been in place to prevent cross infection. So, if there was something infectious in the cattle it is pretty inevitable it would have infected the humans in close association with them and a mass spillover could have occurred.
The final piece of evidence for Russian Flu being a coronavirus is the similarity between the historical descriptions of the infection and modern descriptions of known coronavirus diseases; in particular the mention of high fevers, neurological symptoms and thrombosis.
Covid-19 is often associated with high fever, headaches, loss of taste and smell, fatigue, cognitive disturbance and encephalopathy. Whilst these can sometimes occur with influenza, they are more common with Covid-19. In addition, thrombosis is a marked feature of Covid-19, occurring mainly in weeks 2-3, and a relatively common cause of Covid-19 death. The descriptions of the clinical features of Russian Flu appear to have more in common with Covid-19 then influenza.
So that’s the positive evidence for OC43 being the cause of Russian Flu, but let’s balance this! What about the evidence for Russian Flu actually being influenza?
Evidence that “Russian Flu” was really influenza
The conventional theory about the cause of Russian Flu being influenza is that at the time most respiratory illnesses were called “Flu”; as this episode started in Russia it was called Russian Flu. It wasn’t very scientific in those days! A serology study conducted in 2014 suggested the cause of Russian Flu was Influenza A Virus subtype H3N8.
This was based upon looking at the 1918 Flu pandemic, so it wasn’t actually looking at Russian Flu! They were looking for why 1918 Flu was so bad. They found that those with the highest mortality during the 1918 Flu pandemic also had antibodies to Influenza A Virus H3N8 and were aged 25-29 (people born between 1889 and 1893). They therefore made an association between H3N8 and 1889-1893, taking this to be cause and effect. But they haven’t “tested” older people who also should have had antibodies against H3N8 from the same time period. They haven’t shown that H3N8 antibodies were “developed” IN 1889-1893 during the Russian Flu pandemic, these antibodies could in fact have developed in 1894, 1895, or any year up until 1918! More likely in my view is that this high mortality group were the “working age” group, who were mixing most for employment and socially and therefore had high rates of transmission. Personally, I think this study is a flawed argument for the cause of Russian Flu being H3N8. Just think about it and compare this scenario: a person dies from a heart attack but has a positive PCR for SARSCoV2; did Covid-19 cause the heart attack or did the years of hypertension and smoking coincide with a pandemic?
Ultimately to prove the cause of Russia Flu you have to find and identify the virus and no one has done this for certain yet.
The verdict
So, what do you think? Was Russian Flu caused by a coronavirus such as OC43, or influenza? Do you care? Well, you’ve read to the end of the blog so you must care a little!? I believe it was a novel coronavirus.
I think it’s a useful question to ask because if Russian Flu was due to OC43 then we know the pandemic eventually settled down (Hooray!) and OC43 became a common cold virus. If this is the case we could use this historical evidence from Russian Flu to help predict what might happen with Covid-19 and plan accordingly… It’s a thought….
Another thought is that back in 1907 William Osler already knew what to do in a pandemic (but maybe nobody read his book!):
“During epidemics persons of extremes of age should be protected with especial care. When possible isolation should be practiced. Infected boats should not land passengers at uninfected ports. Mass meetings should be discouraged. Infected children should be kept from school.”…
…. “Every infected individual should understand that his sputum is a danger to others”… “In coughing or sneezing, expelled particles of sputum should be caught in a piece of cloth placed in front of the mouth”…. “Dusting the rooms of influenza patients should be done with a damp cloth; sweeping with a dampened broom”… “Sun light and fresh air limit the danger”.
Maybe the politicians didn’t pay enough attention to history and so we have all been doomed to repeat it.
References
“In October of 1889 it [Russian Flu] prevailed extensively in St. Petersburg… and the disease rapidly became epidemic.”
The disease is caused by “a specific virus [a term used to describe any microscopic organism] of the most intense infectiveness”… “conveyed along lines of travel”.
In Osler’s Modern Medicine, 1907, William Osler is even more descriptive of the Russian Flu:
“The origin of this pandemic, like many others, is uncertain. The outbreak in Hong Kong in the fall of 1888, in Buchara in the middle of May, 1889, or in Tomsk in the beginning of October, may have been the starting point of the epidemic which occurred in St. Petersburg toward the end of October. By November the disease had swept through Germany and France; by December through Austria, Sweden, Denmark, Switzerland, Italy, Spain, Portugal, Belgium and the Netherlands, England, the Balkan States, and North America. By March, it had reached India and Australia; by April and May, China and the Gold Coast of West Africa. Berlin was invaded the middle of November, Paris from the 17th to the 20th of November, London the second week of December, Boston and New York the 17th December. Within a year if had visited nearly all parts of the world”. He describes further waves of infections in autumn 1891 and spring 1892.
Osler also says that the infection was worse in older people, those with pre-existing respiratory diseases, heart disease and diabetes. One of the features that cropped up in the Russian Flu pandemic was a higher rate of blood clots (thrombosis) in those who died and underwent post mortem. Eerily familiar huh?!
I find reading this really quite spooky. In 1892 William Osler had no idea about the cause of these respiratory infections, bacteria were a new discovery and viruses as we understand them today had not been discovered at all. But people like William Osler were great observers. His words are so descriptive; you can see how the Russian Flu pandemic spread around the World using travel routes - doesn’t it just sound like Covid-19?!
The aspects of these descriptions that have made me ask whether the cause of Russian Flu could have been a coronavirus and not an influenza virus are:
- The speed of spread without an obvious super spreader event (the 1918 Flu pandemic in contrast spread rapidly due to demobilisation after World War I)
- The intense infectiveness (SARS CoV2 is more infectious than influenza, R0 3 vs 1.5)
- The risk factors for severe disease match those for Covid-19
- Fever is a prominent feature
- Neurological features were more common with Russian Flu than other influenza epidemics described
- Thrombosis was a feature at post mortem
So, am I the only one who wonders if Russian Flu might actually have been a coronavirus and not flu at all? Can we use our past experiences to help us understand how the Covid-19 pandemic will evolve? Can we learn from history so we are not doomed to repeat it?
Let’s see if there is any other evidence for Russian Flu being Russian Covid…
Evidence that “Russian Flu” was a coronavirus
It is impossible to say for certain what caused the Russian Flu pandemic because there is no tissue or genetic evidence to back up any conclusions. Does that mean you can just make a theory up then?!! No!!! It has been proposed by others too that Russian Flu wasn’t an influenza virus, but could have been due to a coronavirus.
In fact, there is pretty good “circumstantial” evidence that Russian Flu was actually a common cold coronavirus known as OC43. The current evidence revolves around three areas:
- The time at which OC43 spilled over into humans
- The animal reservoir of the original OC43 before spillover
- The similar clinical symptoms of Russian Flu and OC43
The first bit of evidence to support the argument is that OC43 spilled over at the time of Russian Flu. A study from 2005 showed that OC43 is genetically related to a bovine coronavirus (BCoV), sharing up to 99.6% similarity of genes. This is very close and suggests a recent common ancestor. In fact, the same study mapped the genetics of OC43 and BCoV back to look when the 2 viruses diverged and found it to be about 1890. This is the time at which the virus spilled over into humans from cattle and corresponds to the exact timing of the Russian Flu pandemic (1889-90).
So, did something happen around 1870-1890 that might have given the opportunity to allow the spillover of OC43 from cattle to humans? In fact, at this time there was an outbreak in cows of a “highly infectious respiratory disease” spreading around the World which led to mass culling of cattle in many countries. The disease was historically thought to have been the contagious bovine pleuropneumonia, now known to be caused by Mycoplasma mycoides mycoides. This would have been indistinguishable from other bovine respiratory infections such as coronavirus-associated shipping fever disease (associated with a high mortality and caused by a coronavirus) which was discovered in 1996 in animals being shipped around the World!.
The cull of the infected animals in the 1880s would have given plenty of opportunity for whatever was causing the infection in the cattle to spillover into the humans carrying out the culling work. With no PPE in those days it is very unlikely that any infection control precautions would have been in place to prevent cross infection. So, if there was something infectious in the cattle it is pretty inevitable it would have infected the humans in close association with them and a mass spillover could have occurred.
The final piece of evidence for Russian Flu being a coronavirus is the similarity between the historical descriptions of the infection and modern descriptions of known coronavirus diseases; in particular the mention of high fevers, neurological symptoms and thrombosis.
Covid-19 is often associated with high fever, headaches, loss of taste and smell, fatigue, cognitive disturbance and encephalopathy. Whilst these can sometimes occur with influenza, they are more common with Covid-19. In addition, thrombosis is a marked feature of Covid-19, occurring mainly in weeks 2-3, and a relatively common cause of Covid-19 death. The descriptions of the clinical features of Russian Flu appear to have more in common with Covid-19 then influenza.
So that’s the positive evidence for OC43 being the cause of Russian Flu, but let’s balance this! What about the evidence for Russian Flu actually being influenza?
Evidence that “Russian Flu” was really influenza
The conventional theory about the cause of Russian Flu being influenza is that at the time most respiratory illnesses were called “Flu”; as this episode started in Russia it was called Russian Flu. It wasn’t very scientific in those days! A serology study conducted in 2014 suggested the cause of Russian Flu was Influenza A Virus subtype H3N8.
This was based upon looking at the 1918 Flu pandemic, so it wasn’t actually looking at Russian Flu! They were looking for why 1918 Flu was so bad. They found that those with the highest mortality during the 1918 Flu pandemic also had antibodies to Influenza A Virus H3N8 and were aged 25-29 (people born between 1889 and 1893). They therefore made an association between H3N8 and 1889-1893, taking this to be cause and effect. But they haven’t “tested” older people who also should have had antibodies against H3N8 from the same time period. They haven’t shown that H3N8 antibodies were “developed” IN 1889-1893 during the Russian Flu pandemic, these antibodies could in fact have developed in 1894, 1895, or any year up until 1918! More likely in my view is that this high mortality group were the “working age” group, who were mixing most for employment and socially and therefore had high rates of transmission. Personally, I think this study is a flawed argument for the cause of Russian Flu being H3N8. Just think about it and compare this scenario: a person dies from a heart attack but has a positive PCR for SARSCoV2; did Covid-19 cause the heart attack or did the years of hypertension and smoking coincide with a pandemic?
Ultimately to prove the cause of Russia Flu you have to find and identify the virus and no one has done this for certain yet.
The verdict
So, what do you think? Was Russian Flu caused by a coronavirus such as OC43, or influenza? Do you care? Well, you’ve read to the end of the blog so you must care a little!? I believe it was a novel coronavirus.
I think it’s a useful question to ask because if Russian Flu was due to OC43 then we know the pandemic eventually settled down (Hooray!) and OC43 became a common cold virus. If this is the case we could use this historical evidence from Russian Flu to help predict what might happen with Covid-19 and plan accordingly… It’s a thought….
Another thought is that back in 1907 William Osler already knew what to do in a pandemic (but maybe nobody read his book!):
“During epidemics persons of extremes of age should be protected with especial care. When possible isolation should be practiced. Infected boats should not land passengers at uninfected ports. Mass meetings should be discouraged. Infected children should be kept from school.”…
…. “Every infected individual should understand that his sputum is a danger to others”… “In coughing or sneezing, expelled particles of sputum should be caught in a piece of cloth placed in front of the mouth”…. “Dusting the rooms of influenza patients should be done with a damp cloth; sweeping with a dampened broom”… “Sun light and fresh air limit the danger”.
Maybe the politicians didn’t pay enough attention to history and so we have all been doomed to repeat it.
References
- The Principles and Practice of Medicine 1st Edition 1892, William Osler, D Appleton and Company
- Osler’s Modern Medicine 1st Edition 1907, William Osler and Thomas McCrae, Lea Brothers & Co.
- Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus, Worobey M, Guan-Zhu H, Rambaut A. PNAS 2014. 111: 22; 8107-8112
- Complete genomic sequence of human coronavirus OC43: molecular clock analysis suggests a relatively recent zoonotic coronavirus transmission event. Vijgen L, Keyaerts E, Moes E, et al. J Virol 2005. 79: 3; 1595-1604
- An uncommon cold. King A. New Scientist May 2020. 33-35
- Hunting for previous coronavirus pandemics using corpus linguistic analysis of 19th century British newspapers. Solovejute R and Gatheter D, www.preprints.org (not peer reviewed) 2021
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