Soldiers stationed on U.S. Army Garrison Casey conduct pre-screening processes on individuals awaiting entry to the base, USAG-Casey, Dongducheon, South Korea, Feb. 26, 2020. (U.S. Army photo by Sgt. Amber I. Smith)

1918 Flu Sheds Light on How COVID-19 Could Affect Critical Infrastructure

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Today we are facing a novel coronavirus (COVID-19) disease that has possible global pandemic possibilities and many of the same characteristics as the 1918 influenza pandemic, to include a case fatality rate (mortality rate) around 2-3 percent. While the causative agents of influenza and COVID-19 are different, the best-available information on the virus transmissibility, commonly referred to as the basic reproduction number (R0) – pronounced “R naught”[1] – is similar to that of the 1918 influenza virus at that time, which resulted in a global pandemic.

In order to offer a scale of comparison, the following Table 1 displays COVID-19’s Case Fatality Rate and R0 value, in comparison to that of commonly known virus infections, including past influenza viruses and the influenza virus of 1918:

Table 1 – Case Fatality Rate and R0 for Viral Infectious Disease.[2]

An R0 for an infectious disease event is generally reported as a single numeric value or low–high range, and the interpretation is typically presented as straightforward: an outbreak is expected to continue if has a value >1 and terminate if R<1.[3] An R<1 in effect burns itself out faster than its ability to infect other hosts to propagate the virus.

From an infrastructure standpoint, the main difference today versus 1918 is that we live in a highly coupled modern society whose 16 interdependent and critical infrastructure sectors are affected by significant instability. Like previous pandemics from 1918 on, the instability from a COVID-19 pandemic would be workforce absenteeism caused by death, sickness, fear, caring for family members, and/or grief of loss. The U.S. critical infrastructures sectors are:

·  Chemical ·  Financial Services
·  Commercial Facilities ·  Food and Agriculture
·  Communications ·  Government Facilities
·  Critical Manufacturing ·  Healthcare and Public Health
·  Dams ·  Information Technology
·  Defense Industrial Base ·  Nuclear Reactors, Materials, and Waste
·  Emergency Services ·  Transportation Systems
·  Energy ·  Water and Wastewater Systems

 

The effects of a COVID-19 pandemic to a particular infrastructure sector depends heavily on the level of absenteeism within that sector, the level of niche expertise required to sustain that sector, and the percentage of the population trained, able, and willing to ramp-up and sustain the sector if required.

The 1918 influenza pandemic sheds some light on how a COVID-19 pandemic may affect our critical infrastructure. An interesting study looking at the economic impact of the 1918 pandemic cited newspaper articles that showed the effects of workforce absenteeism.[4] The study summarized an article entitled “How Influenza Affects Business” from a newspaper called The Arkansas Gazette, dated Oct. 19, 1918:

  • “Merchants in Little Rock say their business has declined 40 percent. Others estimate the decrease at 70 percent.”
  • “The retail grocery business has been reduced by one-third.”
  • “The only business in Little Rock in which there has been an increase in activity is the drug store.”

The same study summarized another article, titled “Influenza Crippling Memphis Industries,” from a newspaper called The Commercial Appeal, dated Oct. 5, 1918:

  • “Industrial plants are running under a great handicap.”
  • “Out of a total of about 400 men used in the transportation department of the Memphis Street Railway, 124 men were incapacitated yesterday. This curtailed service.”
  • “The Cumberland Telephone Co. reported more than a hundred operators absent from their posts. The telephone company asked that unnecessary calls be eliminated.”

What has changed significantly in the past 100 years is how highly complex and coupled our infrastructure sectors are today. For example, in 1918, electrical generation, transmission, distribution, and consumption were isolated islands often confined to U.S. cities and immediate suburbs but running at different frequencies, whereas today the electrical power grid is highly integrated and operating all at one frequency. Even more complex, all of the 15 remaining infrastructure sectors are interdependent on electrical power, which is the energy sector, for their operation.

Another large shift in the last 100 years has been the privatization following government deregulation of decades past. The end result is commercial companies with different modes of operation, record keeping, reporting, maintenance programs, capital investment priorities, and continuity of operation plans. As such, this often leaves the federal government in a position where it can only strongly recommend a course of action versus dictate a course of action.

Another shift is that many infrastructure sectors today require high-niche expertise, such as information technology knowledge, communication skills, pharmaceutical technicians and pharmacists, specialty manufacture, etc. The challenge is that there is a smaller population percentage that can perform these functions due to the years of education, training, and prior on-the-job experience necessary to perform successfully and safely. Lesser effect will occur in those infrastructure sectors that require lower-niche expertise, such as truck drivers, bus drivers, ship hands, etc. For example, in the Healthcare and Public Health infrastructure sector, the rudimentary task (lower-niche expertise) of administering pre-packaged antiviral medications or vaccinations is much different than the process of patient tracheal intubation or establishing an intravenous line (higher-niche expertise). The point being, different sectors can react faster to high absenteeism than other sectors; however, effective coordination of a unified private-sector response will be very difficult, if not impossible, during a potential COVID-19 pandemic.

The U.S. critical infrastructure sectors will be impacted by a COVID-19 pandemic in countless ways due to absenteeism of the associated workforce who sustain it. The first-order effects to certain sectors may result in unintended second- and third-order effects to other sectors, to include cascading and escalating effects. An example of escalating effect would be the prolonged loss of electricity to a rail switching hub that would result in significant congestion across the entire rail system. An example of cascading effect would be a power outage that propagates other power outages across a region. The influenza pandemics of the 20th century each possessed three waves over an 18-month period with the second wave most virulent. It is possible the COVID-19 may behave similarly and that high absenteeism would in certain sectors occur in waves.

The following is just an illustration of what may occur to some of our infrastructure sectors in a COVID-19 pandemic environment with anticipated high absenteeism.

  • Commercial Facilities: Tourism industry will greatly shrink, and brick-and-mortar entertainment facilities and various commercial enterprises will be impacted. Greater telework and home isolation will cause a shift away from restaurants and other workday establishments. Various public venues like theaters, concert halls, and shopping malls will be greatly impacted.
  • Critical Manufacturing & Defense Industrial Base: Just-in-time manufacturing will be impacted, access to key production materials will be delayed, production lines will slow or be closed, some workers will be sent home, and innovation will be stymied.
  • Emergency Services: Police, emergency medical technicians, and firefighters will be stretched thin. Products and supplies need to sustain the sector may be difficult to acquire – respirators, drugs, masks, rubber gloves, fuel, etc.
  • Energy: Electrical outages will likely not occur but, if so, they will be minor and sparse. The flow of natural gas will see little to no impact based on the built-in lag. Worldwide refinery of petroleum will be impacted and logistics of moving fuel oil, diesel fuel, gasoline, and lubricants will be affected, which is likely to further exacerbate critical manufacturing and the defense industrial base.
  • Food and Agriculture: Food shortages may occur in some locations mainly due to transportation delays. Some agricultural farms may go unharvested or unprocessed due to the lack of labor. Some animal processing and movement to market may be delayed.
  • Government Facilities: Various aspects of government services across federal, state, and local levels will be delayed or slowed, to include corresponding losses of data and eventual rework.
  • Healthcare and Public Health: Elective surgeries and procedures may be delayed, doctors and nurses will be stretched thin, drugs and medication shortages will occur, and respirators will be in short supply. The bottom line is that critical COVID-19 patients require a high level of care and isolation, which will overwhelm this sector to the point that many seeking care will simply be turned away.
  • Information Technology: Internet services and websites may become slow or unstable as data farms become underserved by technicians.
  • Transportation: All modes of transportation – airline, ship, rail, trucking – will be impacted at times by a lack of qualified personnel to operate. Maritime ports may be closed at different peaks of the pandemic. Public transportation will also be greatly impacted.
  • Water and Wastewater Systems: Boil-water orders may occur sparsely and fixes to water and sewage lines will be slow.

There are three things that can greatly exasperate the nation’s critical infrastructures during a possible COVID-19 pandemic. The first being a worldwide economic downturn and a U.S. economic recession, which will affect jobs and livelihoods. The second being seasonal storm damages from flooding, hurricanes, and tornadoes, which will overstretch emergency response personnel further and recovery from such events will take significantly longer. The third being unnecessary travelers entering the U.S., to include illegal immigrants, who may be infected or the walking well, who must be quarantined, housed, and/or treated.

The public notifications during the 1918 pandemic illustrated how the U.S. population tried to avoid infection. Guidance such as to avoid those who are sneezing and coughing, avoid crowds, stay at home if you have a cold, and cover your mouth when you cough and sneeze. The photographic evidence of the 1918 pandemic showed those wearing masks, temporary hospital wards with spaced cots and isolation sheets hung, and many public signs advising people not to spit; spitting was more prevalent due to higher rates of tobacco use. Most all of these historic pandemic strategies are directly applicable, and many are echoed in public media today, to lessen the transmissibility and case fatality rate of a COVID-19 pandemic. Slowing transmissibility will buy time for antiviral and vaccine development, as well as have an overall positive effect in protecting the functionality of our critical infrastructure sectors.

  • Local
    • Encourage greater handwashing with soap or alcohol-based hand sanitizers
    • Encourage personal protective equipment: face masks/shields, gloves, glasses
    • Encourage purchasing of home provisions to sustain a family 2-plus weeks
    • Encourage self-quarantine if symptomatic or near symptomatic people/areas
    • Encourage self-reporting to health officials if quarantined or symptomatic
    • Encourage isolation away from others if symptomatic
    • Encourage the following of direction by local, state, and national level officials
    • Encourage checking in on neighbors, especially the elderly
    • Discourage attending crowded gatherings
    • Discourage non-essential workers from coming to work if they can telework
    • Curtail movement within communities
  • State
    • Encourage the staggering of business hours to prevent overcrowding
    • Encourage employer telework across all infrastructure sectors where feasible
    • Encourage closure of public/private schools once infections become prevalent
    • Discourage the movement across communities
    • Curtail large gatherings: stadiums, auditoriums, theaters, museums, lectures, etc.
  • National
    • Encourage antiviral development and distribution
    • Encourage vaccine development and distribution
    • Encourage greater public-private commercial partnerships
    • Encourage metering of limited resources by a personal identifier
    • Encourage clear communication at the local, state, and national levels
    • Encourage greater surveillance protocols at entry into U.S. to include quarantines
    • Curtail unnecessary entry into the U.S.

Much has been said in the public media about masks not serving as a viable means to prevent infection from COVID-19. However, what is not mentioned is that wearing personal protective equipment (PPE) – masks, glasses, gloves – does serve as a key reminder to the wearer not to unconsciously touch their mouth, nose, and eyes, where mucous membranes serve as a key pathway for the virus into the body. Homemade masks or shields can be made to serve that purpose so that the Healthcare and Public Health sector can have access to the PPE they require to be effective. Upon removal of any PPE, the wearer should wash their hands immediately and not handle the PPE. The sick should wear a mask to reduce virus dispersal in their breath and from talking, coughing, and sneezing.

 

About the Authors:

Mitchell Simmons Ph.D., Lieutenant Colonel, U.S. Air Force (Retired) is the Associate Dean for Academic Affairs in the School of Science & Technology Intelligence at the National Intelligence University (NIU) in Bethesda, Maryland.  He has over 25 years of experience in areas of continuity of operations and government, critical infrastructure, infrastructure vulnerability, infrastructure targeting, and assessment of domestic and foreign infrastructure.  He has written on the topic of highly contagious influenza pandemics and its impact on infrastructure. 

Charles Stiles, Captain, U.S. Navy (Retired) currently supports the Joint Staff Requirements (JRO J8) office in the Pentagon as a senior analyst for Chemical, Biological, Radiological, and Nuclear Defense. He is a NIU alumni and former Director of Health Services Integration, and former Plans, Operations and Medical Intelligence Officer, whose last assignment was Navy Warfare Development Command in Norfolk, Virginia.  Charles has over 30 years’ experience as a Medical Service Corps officer (MSC) within the U.S. Navy medical community where he has served in numerous assignments, to include the Ebola response.  He has written on the topic of the 1918 pandemic influenza and the readiness of today

[1]  Delameter, Paul, L., Street, Erica J, et. Al “Complexity of the Basic Reproduction Number (Ro)” https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article accessed March 3

[2]  Chen, Jieliang, Pathogenicity and transmissibility of 2019-nCoVdA quick overview and comparison with other emerging viruses, Microbes and Infection, https://doi.org/10.1016/j.micinf.2020.01.004

[3]  Delameter, Paul, L., Street, Erica J, et. Al “Complexity of the Basic Reproduction Number (Ro)” https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article accessed March 3

[4] Garrett, T., A., Economic Effects of the 1918 Influenza Pandemic Implications for a Modern-day Pandemic, Federal Reserve Bank of St. Louis, November, 2007.

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Mitchell E. Simmons Ph.D. MSA MSME, Lieutenant Colonel, United States Air Force (Retired) is the Program Director in the School of Science and Technology Intelligence at the National Intelligence University in Bethesda, Maryland. Dr. Simmons has almost 25 years’ experience in acquisition, engineering, and infrastructure vulnerability within and supporting the Intelligence Community. His expertise includes physical and functional vulnerability of hardened and deeply buried targets and critical infrastructure from traditional and asymmetric threats. The author is responsible for the content of this article. The views expressed do not reflect the official policy or position of the National Intelligence University, the Department of Defense, the U.S. Intelligence Community, or the U.S. Government.

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