AQP Book Club | Pale Rider: The Spanish Flu of 1918 and How it Changed the World

By: Jessica Horn and Emily Bak

Part 1 | History Repeats Itself

We knew that selecting a book about the Spanish Flu for the second installment of our book-club series in the midst of a current global pandemic was going to be unsettling. What we could not have possibly braced ourselves for was just how scary it was to read about a time, more than a century ago, that so closely mirrors what we’re living through today. Curious to learn more about how our past would relate to our present, “Pale Rider: The Spanish Flu of 1918 and How it Changed The World,” written by Laura Spinney, left us spooked and wondering what could have been learned to avoid similar mistakes today.

Why hasn’t this epic event infecting one in three people on earth (500 million people at the time), with casualties surpassing World War I and World War II – and possibly both combined (anywhere between 50-100 million deaths from 1918-1920) – been emphasized more in our approach to this pandemic? Measures taken such as school and church closures, suspension of public gatherings, and social distancing were put into effect during the Spanish flu, but later on in the pandemic and after many casualties. After knowing that these control measures worked, how could we have not acted faster when it would have resulted in saved lives? It’s infuriating! Spinney acknowledges this by dedicating a whole section of her book to reasons why pandemics are often forgotten. “Two world wars, the rise and fall of communism, perhaps some of the more spectacular episodes of decolonization,” are the events that we see when looking back at the twentieth century. While the impact of these events is more concrete, the Spanish flu was truly the most dramatic event of them all. Spinney asks, “…who wants to rehearse the details of a pandemic? A war has a victor, but a pandemic has only vanquished.”

While we don’t want to belabor how shameful it is that we didn’t learn from our mistakes sooner, we do want to highlight parallels we’ve found to be most striking because the learnings from this book have allowed us to understand our own experience better. Further, after digesting the book together, our feelings of frustration evolved into ones of hope. We realized that we see innovations in healthcare every day through the work that we do, and rather than focus on what we could have done differently, we look to the promise of the future. Covid-19 has highlighted a lot of gaps in our system and drawn attention to companies that have been striving to fill them, even before this all began. When we inevitably face another pandemic somewhere in the (hopefully very distant) future, innovations and changes in our industry will prepare us to meet those challenges.

Part 2 | Parallels Between 1918 and 2020:

Topic 1918 2020
Social Determinants of Health
  • Highest death rates are in impoverished populations, mostly made up of ethnic minorities and immigrants. This population lived in crowded conditions, with bad diets and poor access to healthcare, and were said to be
    more susceptible to illness because they lacked drive and self-discipline, and were already prone to these diseases
  • According to the CDC, racial and ethnic minority groups have an increased risk of severe illness due to Covid-1.9
  • Hispanics or Latinos have a rate of .4 times, and Non-Hispanic American Indians and African Americans have a rate of about 5 times that of non-Hispanic white people
Government Preparedness
  • Cities were “totally unprepared for the tidal wave of sickness that now overtook it” (pg.50)
  • Doctors were overwhelmed with patients that would show up at their homes
  • Lack of food, attacks on bakeries and warehouses
  • Hospitals are overwhelmed as they experience a lack of resources, equipment and beds
  • Lack of testing
  • Government offers PPP Loans to small businesses to help them retain their employees
  • Grocery stores are also experiencing shortages of items likes toilet paper and hand sanitizer
Behavioral Health
  • Both mandatory and voluntary structure was put in place to contain the disease
  • Sense of fatigue among the population as people weren’t able to live their normal lives
  • Restrictions felt difficult to understand and follow
  • Isolation and other factors have contributed to more awareness and conversation around mental health
  • More companies are implementing mental health initiatives, and mental health resources are becoming more readily available
Controlling the Spread
  • Methods used to prevent the spread included using a handkerchief to cover one’s face and opening windows at night
  • There would be a severe punishment if one broke quarantine or sanitary regulations (pg.101)
  • States have shut down,store have closed,there are limits to how large groups can be in a public setting,masks are required in public,and people are forced to socially distance
  • A study conducted in 2007 using data from 1918 recognized that some of the tactics being used today such as “banning mass gatherings and imposing the wearing of masks collectively cut the death toll in some American
    cities by up to 50 percent” (pg.205)

Part 3 | A Closer Look

Social Determinants of Health

Sadly, this public health emergency, just like the Spanish flu, has brought to light that populations living in low-income areas without access to safe living conditions, healthy food, and proper healthcare, are at higher risk of Covid-related illness and death. For example, Black people account for 24% of Covid-19 deaths, even though they make up 13% of the population. In the wake of Covid-19, companies like Cityblock Health have really emerged as leaders in addressing the needs of complex populations through technology and personalized care. This value-based care company meets patients where they are by opening clinics in low-income urban communities.

Solera Health, a company that builds programs to improve health and well-being, understands the key to better health is through community. They raised a substantial Series C round in 2019 enabling them to expand their offerings and majorly focus on addressing behavioral and social determinants of health like food insecurity, tailored food programs, and social isolation, specifically for individuals managing diabetes. It is clear to us how, by approaching healthcare holistically, we can help to reduce the disproportionate impact of Covid-19 – and all future pandemics – on underserved populations. In a post Covid-19 era, it’s promising that companies like these will limit the barriers that inhibit access to care, and hopefully remove them completely.

Telemedicine

The pace of telemedicine adoption has skyrocketed since the onset of the pandemic, as patients and providers alike have had no choice but to find ways to engage virtually. What acted as a major roadblock before, reimbursement policies for virtual care in the wake of Covid-19 have changed and allowed for telemedicine companies to finally see their solutions surge in adoption and engagement. Changes in policies have broadened access to care by the sheer fact that doctors can now provide treatment across state lines and at the same reimbursement rate as an in-person visit, removing an obstacle that prevailed in the past. Take Boulder Care as an example of a company that existed pre-Covid: a platform tackling opioid addiction completely virtually. They recognized the need for people to receive Medicated Assisted Treatment from the comfort of their homes and were already partnering with innovative health plans who understood that gap. Upon the arrival of Covid-19, Boulder’s solution has become even more of a necessary resource for people who can’t physically go into these treatment facilities.

Another example of a company that saw a major opportunity in this new climate is Curve Health. Curve offers a virtual hospital solution to limit avoidable ED visits by facilitating remote care and its reimbursement while creating a data bridge between healthcare systems and SNFs. With some of the most vulnerable to Covid-19 residing within the SNF population, Curve’s technology helps to reduce the strain and destructive effects the virus has had on these facilities. Now that people have been forced to realize the benefits of telemedicine and have seen the immediate impact this technology can offer patients requiring high touch care, it’s likely the demand for at-home treatment will continue to rise and hopefully remain prevalent.

Behavioral Health

The time we’re living in now is terrifying. What once seemed like mundane tasks, whether it was going to the grocery store or grabbing a cup of coffee in the morning, are now inundated with the risk of infection and the unknown severity associated with contracting the virus itself. Even if our own physical health has not been affected, the constant fear and guilt that people we love could get sick because of our actions is constantly in the back of our minds. Not only is there a fear of getting sick, but the economic impact from the pandemic has touched us all, whether we’re one of millions of people who have lost their jobs, have faced salary reductions, or are experiencing a lag in business growth. On top of everything, we’re quarantined and cannot rely on friends or colleagues for support and comfort in the ways we’re accustomed to. This feeling of isolation and loneliness all leads to huge amounts of stress and trauma that can stay with us for years to come. It has become clearer now than ever before how our mental wellbeing directly impacts our overall health. It’s not just a comorbidity, but a full-blown illness like any other chronic disease.

Companies like AbleTo and Quartet, leading providers of virtual mental health treatment, have already been scaling, but continue to grow to meet the larger demand of patient needs during this time. Newer teletherapy solutions like Alma Health are flourishing as not only is there a greater demand for therapy, but also a greater need for that therapy to be virtual. Employers recognize the importance of supporting their employees and adopting solutions like Eden Health to keep employees healthy, happy, and motivated.

Furthermore, in light of discussions around racial inequalities, it’s important to acknowledge some of the amazing companies and organizations that are building new behavioral health resources or partnering with existing organizations to address the specific needs of diverse populations. The Loveland Foundation, which is raising a therapy fund for black women and girls, has partnered with well-known virtual behavioral health provider, Talkspace. Another example is Henry Health, a provider of “culturally intentional” mental health treatment, aiming to increase the life expectancy of black men by 10 years through their services.

After even the first few pages of reading “Pale Rider,” we were eager to write and expose the similarities between the world we live in now and the world 100 years ago. Despite feeling discouraged initially, we have come to believe that Covid-19 will act as a catalyst to fully realize a forever-changed healthcare world because of the innovations in technologies we are forced to adopt during this pandemic. Virtual care and telemedicine in conjunction with heightened awareness around mental health and breaking down barriers to care access – the next pandemic doesn’t stand a chance!