A tale of two Hamilton doctors: One took on Spanish flu, the other COVID-19
Imagine two doctors a century apart, both in Hamilton with a similar problem.
One was trying to find a cure to help seriously ill Spanish flu patients in 1918 and the other a treatment for COVID-19 over the past 1 1/2 years.
You would think with all the medical advances over the decades there would not be much common ground.
Yet, they both were chasing down the same therapeutic idea.
Could antibodies in blood from people who became sick and recovered be used to treat others? Could lessons learned in the biology of one patient be passed on? If the virus is spread from one person to another, maybe bodily defences could be shared as well.
Let's flash back to October 1918 in Hamilton. A fellow named Dr. William Jaffrey, a bacteriologist by training, was the city's pathologist. He was under a lot of pressure with hundreds of people dying in Hamilton from Spanish flu, a horrific virus that rose out of the last gasps of the First World War to wreak further catastrophe on the world.
Jaffrey took out notices in local newspapers to ask Hamiltonians who survived Spanish flu to make blood donations to create serum for the very sick. He wasn't the only medical practitioner who was experimenting with the therapy. But he was a very enthusiastic proponent.
Save a Life," said the headline in the Hamilton Herald. In order to prepare serum for the cure of Spanish influenza, it is necessary to have blood from those who have been infected and whose temperatures are again normal ... Only a small quantity of blood is necessary to save a life. If you are recovered, give some of your blood ..."
Jaffrey reported the therapy was having positive results. A doctor, who was in critical condition with the virus, was given a series of injections and made an astonishing recovery. Many other patients showed improvement after going through the treatment, he said.
But, what do we make of this today? How valid are anecdotes about the antidote?
At first blush, the theory is very tantalizing ... Biologically, it makes sense," says Dr. Donald Arnold, a hematologist and McMaster professor of medicine. He helped lead a recently published $5.5 million study that took a definitive look into the viability of the technique known as convalescent plasma therapy with COVID patients.
But Arnold's research was emphatic. The technique, with COVID patients in a controlled experiment at least, was ineffective.
At the end of the day, the trials showed it didn't do anything. It showed the plasma had no effect on (COVID patients requiring) intubation or death," he says. It doesn't work, and it may even be dangerous.
A big problem is it's not possible to know everything about the antibodies in the donor as well as antibodies the recipient might already have. Maybe things will line up for the patient's benefit, but it is a bit of a crap shoot.
There are so many variables at play. The person who is getting the plasma may have some antibodies on their own already. They can battle it out for which ones get to the virus and which ones don't."
Over the years, the therapy has also been tried with Ebola and SARS, among other infectious diseases. And many doctors, like Dr. Jaffrey, have noted improvements with patients.
There were some interesting observations that people were making, just like this doctor (Jaffrey) back in 1918, who said he gave it to this person, and he miraculously walked out of the hospital."
But maybe the patient got better for another reason. That is where the McMaster study - published in September in the journal Nature Medicine - came in, to see if a certain link between plasma transfusions and improved health could be established.
The new research only looked at COVID-19, but it's felt the results shed light on the effectiveness of plasma convalescent therapy with other infectious diseases as well.
The study included 940 patients at 72 hospitals in Canada, the United States, and Brazil and was a collaboration between McMaster Centre, the Canadian Transfusion Research Network, Canadian Blood Services and Hema-Quebec. It involved McMaster, the University of Montreal, and the University of Toronto, with the universities of Ottawa and British Columbia taking part.
A couple of weeks ago I wrote about cholera burial fields in Hamilton from the devastating 1832 and 1854 epidemics and how little is known about hundreds of bodies that were interred in unmarked graves.
That's also true to some extent with Hamiltonians who died in the 1918 Spanish flu pandemic.
Records being what they were at the time, numbers are not clear. Retired McMaster anthropology professor Ann Herring, who has done extensive research on pandemics and epidemics in Hamilton, says estimates range from 418 to 635 deaths in Hamilton from October to December 1918, the deadliest months. Others would have died through 1919 during a less severe wave but no one has any idea how many.
A large number were buried at Hamilton Cemetery in an unmarked section, as well as in individual plots that are marked.
A search of records some years ago found 265 graves at the cemetery on York Boulevard that listed the cause of death as Spanish influenza, or influenza, from October 1918 to January 1919. But there would have been others categorized differently, perhaps as pneumonia, so they would not have been counted.
So, what can we take from this to compare the severity of Spanish flu to COVID-19? The short answer is that in Hamilton, so far, the Spanish flu pandemic was much more deadly on a per capita basis. The number of recorded deaths then and now is similar. (There have been about 415 COVID fatalities in the city so far.) But Hamilton has five times the population than it did in 1918, so the percentage of people who died from COVID is five times lower.
Even one death is too many. But I suspect we will come to realize more fully - here and around the world - that modern medical science, vaccinations and the heroics of front-line health professionals have done miracles to save lives against a deadly foe as ominous as what the world experienced at the close of the of First World War.