In this month’s State of the State podcast from Michigan State University’s Institute for Public Policy and Social Research, Matt Grossmann, Charley Ballard, and Arnold Weinfeld discuss the latest news in Michigan politics and economy. Then the trio welcomes Siddharth Chandra to the conversation to discuss his research on the potential for future pandemic reemergence.
After a decade studying a flu virus that killed approximately 15,000 Michigan residents, Chandra, a professor in MSU’s James Madison College, saw his research come to life as he watched the spread of the COVID-19 pandemic.
“It was so surreal,” said Chandra, who has a courtesy appointment in epidemiology and biostatistics. “All of a sudden, I was living my research.”
Chandra’s research is published in the American Journal of Public Health with co-authors Julia Christensen, a graduate of James Madison College; Madhur Chandra, Senior Community Epidemiologist with the Ingham County Health Department and graduate of the Department of Epidemiology and Biostatistics at MSU; and Nigel Paneth, professor of epidemiology and biostatistics and pediatrics at MSU.
Using influenza infection and mortality data on Michigan from 1918-1920, Chandra identified four distinct waves. The first large peak was in March 1918. “After a second spike in cases in October 1918, the governor instituted a statewide ban on public gatherings,” Chandra said. “Much like the restrictions that were put in place during the COVID-19 pandemic.”
After three weeks, the number of cases decreased and the ban was lifted, which led to another peak in December 1918. “The ban didn’t stop the spread of the flu. It just delayed the spike in cases,” he said.
Chandra mapped the data showing the peaks and spikes in cases from October 1918 and December 1918 and tracked flu virus case growth by county over time. In October, counties in the southern part of the state and near the Mackinac Straits had the highest numbers but by December, the highest numbers of cases were in the heart of the state.
The most surprising piece of data came 18 months later in February 1920, when a statewide explosion of cases created a massive spike even larger than the one in October 1918. For Chandra, it is an educated guess as to the reasons for this delayed increase.
“Assuming it’s the same influenza virus, World War I ended in 1918 and the men were coming home to their families,” he said. “We had a mobile agent that brought the virus home to infect family members, which would explain the increase in cases among children and the elderly.”
Unfortunately, there is not a way to confirm this, Chandra noted. “We would need samples from patients in 1920 from across the state. Then, we would need to compare those with samples from patients in 1918 from across the state, and that’s not likely to happen.”
The weather may have also been a factor since cool temperatures with low humidity likely provided optimal conditions for the virus to live and spread. Another factor that played a role was the absence of a vaccine.
“In 1918, there was no hope for a vaccine. In 2021, we have a vaccine available,” he said.
One of the key insights from the 1918 pandemic that can inform the public health response to the 2020 COVID-19 pandemic is the number of people who are susceptible to the virus. Which means that it is possible that a spike like the February 1920 one will occur in late 2021 or early 2022.
“So many people will remain susceptible until they get vaccinated,” Chandra said. “Bad things can still happen a year or two from now even if we see a decrease in the number of cases now. We still have over 200 million people walking around who are susceptible to the virus, including myself.”
Written by Emilie Lorditch
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Unknown Speaker 0:00
Welcome to state of the state the monthly roundup of policy and research for the state of Michigan, brought to you by the Institute of Public Policy and Social Research at Michigan State University, and our friends here at WK our studios. I'm Arnold weinfeld, Associate Director for the Institute. I'm joined by co hosts Institute director, Dr. Matt Grossman, and MSU economist Dr. Charlie Ballard, will be joined by our guest, Dr. Siddharth Chandra, a professor in the Department of opinion, biology and biostatistics at MSU. Dr. Chandra is also a professor of economics and James Madison College, and director of the Asian Studies Center. We'll be discussing his latest work on pandemic reemergence and comparing the 1918 pandemic with our current situation. Dr. Chandra, tell us a little bit about your work.
Unknown Speaker 0:49
Well, so the main theme of the most recent paper that we published on the 1980s influenza pandemic, is that the pandemic actually took probably took two years to unfold in Michigan. And it consisted of four waves of what epidemiologists call excess mortality. The first wave occurred in March of 1918. It was a relatively mild wave, and everybody thought by about April that we were done with it. Unfortunately, it revisited us the the influenza in October 1918, with a massive wave of excess mortality, that was brought under control very briefly. But then we had another wave in December in January of 1980, and 9019. And then when that subsided, and everybody thought they were finally done with the pandemic, the largest wave of all, visited Michigan in February 1920. So that's really the main, the main message of of the researchers pandemics, like the 1918 influenza pandemic, and actually take a long time to work their way through populations.
Unknown Speaker 2:05
And of course, this was during a time when we did not have vaccines. So was a large part of the public health, safety around social gathering, limiting social gatherings and maskings. And how did that all play a role?
Unknown Speaker 2:25
Well, probably the most well known move that was made by our legislature, actually not by a legislature by the governor. So the governor at the time was Albert sleeper. And he imposed a ban on public gatherings in October, in the third week of October 1918, in response to that massive second wave that was visiting Michigan. And when we look at cases, and deaths from influenza during the weeks of 1918, October and November 1918, we see that the measures actually brought the wave under control. So the number of cases fell quite rapidly. And so the number of deaths, unfortunately, three weeks after he imposed the ban on public gatherings, partly due to pressure from the business, community and economic interests, he relaxed the ban. And, unfortunately, that coincided with thanksgiving, and then the Christmas holiday when a lot of people get together. And so we had yet another wave. So you know that there are some very interesting parallels between what happened in 1918. And what we're seeing in Michigan today, for example, the three week social distancing orders that the governor put into place a few weeks ago.
Unknown Speaker 3:44
Yeah, I did. You're right. It's very similar patterns with or without a vaccine, not just to note here in Michigan, but certainly even even around the world. What do you see as the implication, you know, we were just talking about economic pressures that are underlying the economy, moving out of the pandemic. And so how do you see the economy moving forward in this kind of an up and down? I mean, I was reading the other day where we're folks, you know, it's going to be summertime soon, and many people are being afforded an opportunity to get the shot and our drug companies are saying that they're going to be producing even more the vaccine. And what do you see in terms of the pent up social demand, I think of individuals, you know, across the country and across the world, as the summertime is almost upon us and having an impact.
Unknown Speaker 4:47
So I preface what I'm going to say by by going back to what Charlie said a little bit earlier. And and you know, what he said is there there's probably going to be there probably already has been A bifurcation between haves and have nots during the pandemic. But you know, for those, and it is the majority of the working population who have managed to continue to work, because the kind of work that they do, has not been heavily disrupted by the pandemic. For them, we're going to see, you know, there's there's a lot of pent up demand. And I think as as soon as the vaccines start reaching large segments of the population and the economy opens up, we're going to see, I think, a spike in demand for travel and recreation related sectors of the economy. We were discussing the other day that you know, things like exercise equipment for the home, you know, orders for those kinds of goods have already spiked, as people reallocate their income away from, you know, what they would do under normal times, under normal circumstances, into these more sort of COVID friendly, if you will, activities. So I do see, in addition to the stimulus that's coming away from the federal government, I think there's going to be a little added shot of stimulus in the form of Consumer Expenditure in the coming months as as people, you know, as the as the economy opens up, and people start getting up.
Unknown Speaker 6:19
So what what do you take as the lessons for for today? I mean, one reading might be, we've never been able to keep it on lockdown, or changed our activities for a long period, and we're sort of destined to see these spikes later on. Another might be that, you know, that we should, we should take a more long term approach, what how do you see it?
Unknown Speaker 6:42
Um, you know, from the from the health standpoint, so let me put a hypothetical situation on the table, right? What if we were able to, and this is completely unrealistic right now, given the state of technology? But what if we were able to more rapidly develop vaccines, right, and test them and roll them out? Um, you know, what would that do? I think that is an area that, you know, we should really look into, you know, we've, you know, through the National Institutes of Health and other types of, you know, health research organizations, we've made phenomenal advances in medicine over the past 100 years. And I think, looking into whether there are ways in which vaccines can be developed and rolled out more rapidly, and maybe there are and maybe there aren't, I think that is a very interesting direction in which we should think about going,
Unknown Speaker 7:34
certainly, these vaccines were developed in record speed. And that's that's the very good news. Not so good news, that the beginning of the rollout of the vaccine was very bumpy. From the middle of December to well, into January, just there were lots of glitches in the system, lots of organizational problems, but it certainly appears that that pat pace of vaccination has, has picked up a lot. And that's, well, I'll give you a personal anecdote, I got my second Pfizer dose yesterday, so I'm well on the way to being pretty well protected from this thing. And, and echoing what was just said, I think I'm gonna be traveling more in in the coming months than I was able to for the last year.
Unknown Speaker 8:23
May I add to that, Charlie, another response to Matt's question, and that is, you know, the importance of history, right? We were taught a lesson in 1918, we had this pandemic, it was a viral pandemic, there was no cure for it. And in fact, at that time, there was not even a hope for a vaccine. We could have learned from it. We could have put measures into place based on what happened then, to prevent a number of things that have happened to us this time around from happening, unfortunately, and some very well known, epidemiologists have called the 1918 influenza pandemic, the Forgotten pandemic, unfortunately, we forgot about the pandemic, right. pandemics are going to keep coming. There are going to be new viruses in the future. Some of them are going to be respiratory in nature, they're going to cause the kinds of problems that the 1918 influenza pandemic caused, that the covid 19 pandemic is causing, we're going to see these come again, let's not forget this tie.
Unknown Speaker 9:23
In so what might some of those have been? Or could be Dr. Chandra?
Unknown Speaker 9:28
Well, so so I'm actually going back to the point that Charlie made about vaccine rollout. Right. You know, what went wrong there? Why is the US lost 500,000 lives? What are the kinds of things we are doing that we shouldn't be doing? I personally think, and and some of this is cultural, right? I think that the emphasis on on personal liberty and freedom is very important, right? And it's something we really cherish and value in our society. But I think there are times When we need to be cognizant that, you know, individual actions have consequences for other people, that can be far more detrimental to them than they might be to ourselves. And we really do need at in times of crisis like this to be a lot more considerate for other people than I think a lot of a lot of people have been.
Unknown Speaker 10:21
And that's certainly my concern. I think with the summer months coming up here, you know, we might be able to speed up the vaccination process. And it's possible that I mean, I'm hopeful that President Biden is correct that at some point this summer, we'll have had vaccinated nearly the entire population. I'm hopeful, I can't say that I'm confident, but I am hopeful. And as the summer months and warmer, whether it comes whether people are vaccinated or not, whether they choose to get the vaccine or not, things are going to open up one way or the other governor Whitmer the other day, noted that there are some less restrictions on the way I just think, at this point in time, human nature is going to play a much larger role, whether you want to call it cultural in terms of freedoms and liberties, or just human nature. You know, a lot of us have been working from home for a year now. As you noted, some of us have, have had to continue to work even even during the pandemic. So I'll be very, very interested to see what happens during these upcoming spring and summer months. Then as we get back into the fall, are we going to have another spike? Keep reading it almost every day about new mutations. There was one in the paper yesterday in the news yesterday about one specific to New York, that might actually itself be, you know, be so called immune to the vaccine. So I'm going to be very interested to see what happens. I know that I'm going to continue personally to be wary and hope at some point in time this spring or summer, I'm able to get the shot myself.
Unknown Speaker 12:17
If I may follow up on on what you said. The jury's still out on whether that 1920 a wave of excess deaths was caused by the same pathogen that are the same virus that caused the 1918 deaths, right? Was it a totally different virus? Was it a mutated version of the 1918 virus? Or was it the same virus? So So the point you make is a is a very important one. You know, we don't know what's coming, there is a possibility that the virus may mutate and cause another wave of excess mortality, because it has defenses against the vaccines that we are rolling out. Definitely an important point and another possible lesson from the 1918 pandemic.
Unknown Speaker 13:03
We've had in our lifetime, HIV, which HIV AIDS which has killed 10s of millions worldwide, especially in parts of Africa, although I did it more slowly. And then we've had SARS MERS Zika. Ebola, so it shouldn't come as a big surprise that we have had this contagion. The one thing that made this one worse was that the COVID-19 is a combination of asymptomatic transmission and and virulence that has made it hard to to tamp down. Dr. shaundra. How would you compare the this virus with the one of a century ago? Is it similar in the degree of virulence? Is it worse or not as bad?
Unknown Speaker 13:52
You know, so, then again, the science is not sort of very precise, right? You get different estimates of variance depending on the population that the virus is circulating in climatic conditions, nutritional genetic, all kinds of other factors. But I think generally speaking, it seems to have a lot of the features in terms of, you know, what we call reproduction number, so the the number of cases that will be caused by one case, right, in a population that is has been hitherto unexposed to the virus, so it has a lot of the features of the 1918 virus. I did want to add, Charlie to what you said earlier that in addition to all those other pandemics that you talked about, we actually had an influenza pandemic as recently as 2009. And that was caused by an h1 in one virus, which is a descendant of the virus that caused the 1918 influenza, right. So, um, so there are pandemics, you know, it could very well be that this Corona virus, this version of it has descendants in the future that emerge that That goes pandemics as well.
Unknown Speaker 15:03
Well, very, very interesting work. Dr. Chandra, I think, you know, always looking at history gives us a clue to the future. And, you know, I think with some precision that we're going to see additional pandemics, Charlie, you noted, others that have been upon us and Ebola has again reared its ugly head, in Western Africa. And if those of us that have never experienced any Ebola outbreak, which most of the world has not far, far worse virus and disease than what we're experiencing now. So I think Dr. Chandra, you're absolutely right, we have to take this moment in time and prepare ourselves for future outbreaks. Any other thoughts you'd like to leave us with?
Unknown Speaker 15:52
I think the message of the importance of history is probably the most important. You know, we will have pandemics like this in the future. And whatever we can learn from COVID-19 and influenza 1918, we should pick up I would like to make a pitch for, you know, more research on vaccine development, it seems like if there is a silver bullet, and all of this is the development of vaccines, there may be things that we aren't yet thinking about that could potentially speed up those processes. If we can invest in finding out how we might be able to do that. I think that could yield a lot of benefit, both in terms of health, and in terms of the economy in the future.
Unknown Speaker 16:31
Well, thank you so much for joining us, Dr. Chandra, and for your work, Matt and, Charlie, any any final thoughts?
Unknown Speaker 16:37
Well, I'll I'll just echo and maybe more controversial, a few things that we've been saying, which is that we do have some good news. You know, we are making progress. The vaccine story is amazing. And some of it came from, you know, some institutions that that we normally have some skepticism about. big government has been very useful. big corporations, including research entities and pharmaceutical companies, and big science and universities and research, all funded with tax dollars have been extremely influential in solving helping solve not only this crisis, but the others that Charlie mentioned.
Unknown Speaker 17:22
And at least in the next couple of months, it's still important even though we're making very rapid progress with vaccination is still really important for people to to wear their masks practice social distancing, we're not out of the woods yet. Well,
Unknown Speaker 17:34
thank you, Charlie and Matt as always, and Dr. Chandra, that's all the time we have on this edition of state to state. My thanks again to Russ Wade and the folks at Wk AR for the support of this program. Join us again next month on state of the state
Transcribed by https://otter.ai