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72 Science & technology The Economist April 25th 2020

2 been the lack of a strong signal from the Pandemics past and present It was he who spotted, in 2013, that within
federal government that more are need- the two-decade cohort of susceptible indi-
ed—though that changed on April 21st A lesson from viduals in 1918 there was a particular spike
when Congress approved the spending of in mortality among those exactly 28 years
$25bn on testing. The two main suppliers history old. Even members of the cohort younger

of nasal swabs in America, Copan and Puri- or older than this did considerably better.
tan, make just 6m a week between them. Working with a team of immunologists,
Roche says that it is currently capable of microbiologists and infectious-disease ex-
supplying “millions” of tests per month. A peculiarity of Spanish flu may shed perts, Dr Gagnon pointed out that cytokine
light on covid-19
That a firm like Roche is still thinking in storms were unlikely to be solely responsi-
terms of tests per month, rather than tests t is nowwell established that developing ble for this spike, since the immune sys-
per day or per week, does, though, suggest Ithe symptoms of covid-19 when you are tems of 28-year-olds are just as likely to
there is a long road ahead. old is extremely dangerous, but not so risky overreact in such a manner as those of 20-
Paul Romer, a professor at New York when you are young. That might seem un- year-olds. He also argued that the notion of
University and winner of the 2018 Nobel remarkable. Old people are less resilient, older generations having developed im-
prize in economics, who also advised on and more likely to have specific confound- munity through exposure to earlier viruses
the Rockefeller Foundation’s work, says ing health problems like diabetes. How- does not hold up, since this, too, would
that university laboratories have already ever, this pattern—that the young live have left those under 28 just as vulnerable
shown they could get around supply issues through infection while the old die—is by as 28-year-olds.
in the ramping-up of testing. “If you look at no means the norm. The influenza out- Instead of these ideas Dr Gagnon and
reagent bottlenecks, people have found break of 1918-19, known (unfairly to Span- his colleagues support an alternative hy-
other reagents that they can swap out in- iards) as the “Spanish” flu, for example, pothesis, developed by Dennis Shanks of
stead of the fda-approved ones. They’ve proved particularly harmful to those aged the Australian Army Malaria Institute, in
shown you don’t even need to include the between 20 and 40, and thus apparently in Queensland, and John Brundage of the
rna extraction [from throat-swab sam- their prime. Some suspect that fact may Armed Forces Health Surveillance Centre,
ples] that requires these reagents.” Freeing cast light on the, albeit different, age-relat- in Maryland. This is that, in some circum-
universities and research institutions ed susceptibility to covid-19. stances, early exposure to a virus can harm
from red tape would be crucial, he believes, One suggestion to explain what hap- subsequent immune responses rather than
in ensuring any efficiencies and new dis- pened in 1918 is that those older than 40 helping them.
coveries that simplify or speed up testing tended to survive because they had ac-
are able to spread rapidly. quired protective immunity from an earli- Learning the wrong lesson
er round of influenza to which younger Dr Shanks and Dr Brundage observed that
Don’t stop me now generations had not been exposed. A sec- in 1890, the birth year of those who were 28
Scaling up testing infrastructure will also ond is that the more potent immune sys- in 1918, a different and less lethal strain of
face regulatory hurdles. For example, tems of the young overreacted to the 1918 vi- influenza, known as Russian flu, spread
swabs on their way to be tested are classi- rus for some reason, and that this triggered around the world. They also knew from ex-
fied as a biohazard in the United States, and in them a cataclysmic, frequently fatal, im- periments on pigs, conducted by others,
require special containers and shipping mune response known as a cytokine storm. that exposure to one virus during early life
protocols. Building and managing such an (Cytokine storms, as it happens, are some- has the potential to make infections of oth-
unprecedented amount of testing capacity times a cause of death in cases of covid-19.) er, quite different, viruses later on much
in such a short space of time will also need Alain Gagnon, a demographer at the more severe than they otherwise would
co-ordination. The Harvard group pro- University of Montreal, in Canada, has have been. Based on these observations
poses the formation by the federal govern- been studying the matter for several years. they argued that the immune systems of
ment of a Pandemic Testing Board to over- those exposed to Russian flu as newborn
see these decisions. It would be composed babies—a period of life when immune sys-
of leaders from business, government and tems are especially attuned to learning
academia, among others, and would be giv- about which pathogens are circulating—
en powers to oversee the construction of learnt about Russian flu all too well. As a
laboratory capacity and to ensure the sup- consequence, when faced 28 years later
ply and distribution of the materials need- with Spanish flu viruses they mounted the
ed to carry out the tests themselves. wrong response (ie, to Russian flu rather
The cost for all this? The Harvard group than to the real threat).
estimates around $15bn per month and Nor is the example of 1918 unique. Ac-
that it would need to be in operation for a cording to Dr Gagnon, people who were
year or more, depending on when (and if) themselves born during that epidemic
treatments and vaccines became available. showed increased vulnerability to the
That price tag may seem eye-watering, but Hong Kong flu of 1968. And those born dur-
lockdown costs far more. Estimates place ing the Asian flu of 1957 showed higher
the cost to America of the pandemic at up mortality in the face of swine flu in 2009.
to $400bn a month. Given the alternative, He therefore wonders if something similar
building the largest medical-testing sys- is going on now, with elderly people
tem the world has ever seen is a steal. 7 mounting inappropriate immune respons-
es that reflect the infections of their youth.
Correction: Last week (April 18th, “Scorched earth”) Since all of his examples relate to influenza
we wrote about the work of Park Williams of the viruses, which are different beasts from co-
Lamont-Doherty Earth Observatory, in New York ronaviruses, this is speculation. But it is a
state. Unfortunately, the piece subsequently
referred to him as “Dr Parker”. Apologies both to line of inquiry that might be worth follow-
readers and to the man himself. Plus ça change, plus c’est la même chose ing once the immediate crisis is over. 7