Peak Oil Medicine

In short: It is astounding to see what could be achieved with limited scientific knowledge but with an abundance of common sense. I hope that we can rediscover and apply this type of approach while we still have abundant oil and a (relatively) stable climate.

Some random thoughts about the paper
It is obvious from the paper that practitioners of public health in the early twentieth century:

• Recognised that influenza was caused by a micro-organism that could be transmitted by droplets (note that we now know that it is a virus rather than a “bacillus” due to electron microscopy).
• Understood the need for isolation to prevent cross-infection.
• Acknowledged that health care workers (HCW) had to be protected from infection, but also that HCW could be the vector that transferred illness from one patient to another.
• Realised the effects of the environment (especially wet and cold conditions) and psychological factors (especially worry or stress) on immunity and vulnerability to infection.
• Understood that overcrowding alone was enough to initiate an infectious outbreak; conversely, there was also recognition that such overcrowding had to be remedied before an outbreak could be controlled.
• Recognised the role of secondary bacterial pneumonia as a cause of death in those with influenza; the converse situation was also acknowledged.

Conclusion
As there were no antibiotics or antivirals available in 1918, the crux of infection control was breaking the train of transmission through quarantine, isolation and reducing overcrowding. A secondary strategy was to give patients the best known supportive care (including rest, optimal nutrition, fresh air and sunlight).

Not only is such an approach demonstrably effective, it is also low-tech, cheap, and able to be used everywhere an outbreak occurs. It may also be the last best option for managing multi-resistant TB, HIV, MRSA and other “superbugs”.

Finally, be optimistic. If they could do it then (during World War I), we should certainly be able to do it now. It is just a matter of remembering what we knew then, and forgetting some of what we know now.

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