COVID-19 AND THE SPANISH FLU PANDEMIC OF 1918-19

HOWARD PHILLIPS

October 1918 was the height of the Spanish influenza pandemic in Cape Town, South Africa. A leading
community worker asked his good friend Dr. Frederick Willmot, the state’s assistant medical officer of
health, the following: “Will you answer a straightforward question? Are we going to be wiped out?” Willmot
hesitated before replying, “I’ll tell you what I would not tell any other man in the Union of South Africa, for
the first time in my life I’m panicky, and believe we are.”

Just like a century ago, people are looking for answers in the face of a pandemic. In the deluging coverage
of COVID-19, comparisons with the catastrophic Spanish influenza pandemic of 1918-19caused by
the H1N1 influenza A virus have been common.

What does the dire Spanish flu calamity teach us about how to combat COVID-19 more effectively?

In short, it warns us that when a highly infectious epidemic breaks out, a country cannot act fast enough
before the disease enters the runaway stage. Missing this window of opportunity makes curbing it
thereafter extremely difficult — if not impossible.

Similarities Between the Spanish Flu and COVID-19

Back in 1918, in the midst of World War I, the world was slow in its response to the disease, which had
broken out in the military camps of the United States and then spread to Europe. In neutral Spain, the
uncensored press had given it prominence, resulting in the misnomer “Spanish” flu. From Europe, it rapidly
swept around the globe in less than a year, killing more than 50 million people — roughly 3 percent of the
earth’s population. It was the worst pandemic of modern times in terms of its speed, range, and toll, which
dwarfed the number of battlefield deaths in World War I.

On the face of it, the two pandemics have much in common. Both, it would seem, originated in what is
termed a “zoonotic spillover,” which refers to the transmission or crossover of a virus from an animal
reservoir to humans (influenza from aquatic birds and SARS-Cov2 probably originally from bats). Both were
and are highly infectious, being spread through the air by coughing or sneezing (i.e., aerosol or droplet
infection), or by touching infected surfaces. By these means, the Spanish flu and COVID-19 raced around
the globe at the speed of the fastest transport system of the day (steamships and steam locomotives in
1918, and jet aircraft in 2020). Both produced symptoms like difficulty in breathing, fever, coughing and
sneezing, while both could open a pathway to pneumonia and death.

Just like the Spanish flu, there is currently no preventive vaccine for COVID-19, and in both cases
treatment was primarily supportive and aimed at alleviating symptoms. Both pandemics swamped existing
health facilities. In both cases — as in all epidemics — people looked to assign blame for causing the
pandemic, with those blamed (“them”) usually being individuals or countries deemed neglectful of public
health or hostile to “us” for some nefarious reason.

Differences Between the Spanish Flu and COVID-19

However, probing below these features reveals significant differences between the two pandemics, which
go well beyond the 102 years separating them and their respective contexts. These differences are
important and useful in providing perspective on the current crisis.

Firstly, the incubation periods for the Spanish Flu and COVID-19 differ markedly. The incubation period of
the virulent Spanish flu was very short — a day or two — while that of COVID-19 can stretch to a fortnight,
facilitating its unnoticed, asymptomatic spread or “stealth transmission,” as it has been termed. That, plus
the speed of international travel today, helps to account for the galloping pace at which COVID-19 has
spread compared to the Spanish flu.

Secondly, the first two waves of the Spanish flu were not caused by an identical influenza virus.
The causative pathogen of the first wave from March to June 1918 (which yielded the inaccurate tag
“Spanish”) was certainly very infectious, but it was far less lethal than that which drove the second wave
from August to December. The latter combined both infectiousness and lethality and, consequently, was
responsible for most of the 50 million deaths attributed to the pandemic. As far as can be determined at this
distance in time, its lethality arose from the fact that it penetrated deep into a victim’s lungs straightaway,
where its virulence could either trigger an overreaction into overdrive by the immune system, filling the
lungs with liquid antibodies that caused acute respiratory distress, or make the victim susceptible
to bacterial pneumonia. Thus far, it seems that the COVID-19 coronavirus has not mutated into a killer of
the same intensity, perhaps because it does not immediately penetrate the lungs, thereby giving the
immune system a chance to counter it before it seriously affects the respiratory system.

This difference is evident in the age profile of those claimed by the two pandemics. In 1918, mortality was
highest by far among young adults aged 18-40, whose immune systems were very robust and which
consequently over-responded excessively, often with fatal results. So far in 2020, the elderly whose
immune systems are on the wane and the immunocompromised of all ages have made up the bulk of the
novel coronavirus dead.

The overall case fatality rates of the two pandemics — insofar as the official figures can be relied on — also
show a sharp distinction. In the countries hit hardest by COVID-19 that have credible data — Italy and
Spain — case fatalities appear to be between 11 and 8.5 percent, respectively, as of late March 2020. In
the United Kingdom and France, case fatality rates are around 6 percent. In 1918, even though the
statistics are much less reliable, it is clear that the worst case fatality rates were of a different order,
with Tahiti at 20 percent and Western Samoa at 24.7 percent.

That such extensive case-fatality rates for COVID-19 are so easily available points to a very different public
health context in which the two pandemics have played out. In 1918, the causative pathogen of Spanish flu,
the influenza A virus (H1N1), had not yet been discovered — indeed, the existence of viruses was not yet
known — and there was no overarching international health authority to collect, collate, and circulate data.
World War I was still under way, putting strong military and political pressure not to make the extent and
gravity of the pandemic known lest it alert the enemy to possible military weakness. Within many countries,
public health systems outside of the military were very rudimentary and identification, isolation, contact
tracing, and quarantining were impracticable given the severity of disruption caused by the Spanish flu.
Ultimately, the needs of the military trumped any idea of restricting recruitment, training, and the dispatch of
soldiers aboard overcrowded troop trains and troopships to the battlefield.

This stands in sharp contrast to the situation in the world of 2020, with a ubiquitous World Health
Organization, with its International Health Regulations platform, and states that are willing to implement
draconian measures in order to safeguard the health of their populations and economies. They may be
involved in total war, as their predecessors were in 1918, but the world now faces a war against a virus, not
humans.

Lessons for the Present Crisis

Clearly, though the two pandemics share some features, they also differ in very significant ways. Is there
thus any benefit in comparing the two? My answer is “yes,” on two scores.

Firstly, because doing so emphasizes the critical importance — as in all infectious diseases — of strictly
enforcing isolation, quarantine, and social distancing early enough to check the runaway spread of the
disease. Secondly, and perhaps more fundamentally, because the catastrophe of the Spanish flu is a dire
warning 102 years later as to what may happen if vigorous measures of prevention and containment are
not enforced now. The world should take and implement hard decisions immediately to avoid an even
greater catastrophe later — millions of lives are at risk.

Howard Phillips is Emeritus Professor of History at the University of Cape Town. He is co-editor
of The Spanish Influenza Pandemic of 1918-19: New Perspectives (Routledge Studies in the
Social History of Medicine), and the author of Plague, Pox and Pandemics: A Jacana Pocket
History of Epidemics in South Africa(Jacana Media) and of In a Time of Plague: Memories of the
Spanish Flu Epidemic of 1918 in South Africa (Van Riebeeck Society/HiPSA).
https://warontherocks.com/2020/04/covid-19-and-the-spanish-flu-pandemic-of-1918-19/

What the author of 'The Great Influenza: The Story of the Deadliest Pandemic in

History' can teach us about coronavirus

(CNN)I've been reading a great book about a horrific pandemic that gripped the world more than a
century ago, John M. Barry's "The Great Influenza: The Story of the Deadliest Pandemic in History."

Mr. Barry, a professor at the Tulane University School of Public Health and Tropical Medicine, was nice
enough to do an e-mail interview with me about the subject of his book and what we can learn from it.

Tapper: John, thanks for doing this. I have a lot of questions about your great book! First one: What
lessons can we learn from the influenza pandemic of 1918-19 that we should be applying today?

John Barry: There are several and I think they are all important.

No. 1, authorities need to tell the truth, even when it's uncomfortable -- especially when it's uncomfortable.
This is important for two reasons. First, it lessens fear. People are always more afraid of the unknown. When
people don't think they're getting a straight message they feel uncertain. In a horror movie, it's always
scariest before the monster appears. Once the fear becomes concrete we can deal with it. We can deal with
reality. Second, if you want people to comply with your recommendations -- and compliance is crucial to
success -- they have to believe you and trust you. If they doubt you they will ignore you. In Singapore, the
Prime Minister told blunt truths at the beginning, ended panic buying and, more importantly, it's one reason
Singapore has gotten way ahead of the virus.

In 1918 in Philadelphia, for example, people were lied to and the city all but fell apart. Volunteers were called
for again and again and again, but no volunteers came forward. People were starving because no one had
the courage to bring them food. In San Francisco, city leaders jointly signed a statement, full page in the
paper, "WEAR A MASK AND SAVE YOUR LIFE." They did not know masks did no good, but the point is
that the city functioned well, even though people were afraid -- with the result that, in another example,
when schools closed teachers volunteered as anything from ambulance drivers to telephone operators.

Tapper: The President recently referred to the 1918-1919 influenza as being much deadlier than
Covid-19, saying, "If you got it you had a 50/50 chance or very close of dying." Is that accurate?

Barry: Not even close. The 1918 virus was deadlier than Covid-19, but in the West it had about a 2% case
mortality rate. In the rest of the world it was much worse, not because western medical care was better but
because in the West people had been exposed to other influenza viruses, which provided some natural
cross-protection. In much of the undeveloped world people had seen few influenza viruses, and sometimes
none so it was higher there, but nothing like 50%.

Tapper: Covid-19 started in Wuhan, China, and the Chinese government tried to keep it quiet and
even silenced those sounding the alarms. While different from the World War I-era US culture of
downplaying, if not suppressing bad news, and the WW1 French/British/German policy of outright
censoring bad news. Do you think the lack of transparency cost lives today too? In other words: a
lesson not learned by the Chinese?

Barry: Clearly the lack of transparency cost lives in China and will cost many more lives around the world.
I'm no expert on China, but my guess is that was the typical bureaucratic response of underlings afraid to
send bad news up the ladder so they tried to hide it. I doubt that it was a decision by top leadership, which
I think did learn from SARS. If they had been truthful and had responded aggressively, we would be in a far
better position. By contrast, the Chinese scientific community was open from the beginning, posting the
genetic sequence of the virus as soon as they had it. That was hugely important and gave us a head start
on drugs and a vaccine.
Tapper: One of the cruel ironies your book captures is how unfair it is for people to refer to the 1918-
1919 influenza as the Spanish Flu. The Spanish didn't have censorship so their newspapers were the
first to acknowledge the pandemic -- but it didn't originate there. And other countries weaponized
that press freedom against them.

Barry: That's true that it did not start in Spain. We're not sure where it did start -- the leading hypotheses
are China, the US, France and Vietnam, but it could have started somewhere else and definitely did not start
in Spain. It did get its name because Spain was not at war and its press wrote freely about it, especially
after the King got sick. But that occurred during the first spring wave, which was mild -- so mild that some
medical journal articles suggested it wasn't influenza because not enough people were dying. So I don't
think it was a conscious effort to point the finger at some malignant outside force. Calling Covid-19 "the
Chinese virus" by contrast seems to be a conscious political strategy.

Tapper: Your mention of the relatively mild first spring wave in 1918 reminds me that that pandemic
had several waves. Dr. Anthony Fauci, the director of the National Insitute of Allergy and Infectious
Diseases, says we should all prepare for such a thing in the current crisis. How did the waves work
in 1918-1919 and what lessons can we glean?

Barry: In 1918, we had a generally mild spring wave, which was hit or miss. New York, Chicago and
Louisville, among other places here and around the world, had pronounced but localized outbreaks yet Los
Angeles did not record a single spring death from influenza. Although it was generally mild, there were plenty
of hints that it could be very deadly. In one small Army post, for example, it killed 5% of the soldiers. In
Louisville, it was pretty bad. Then came the lethal second wave that hit in September. Probably two-thirds
of the deaths worldwide occurred between late September and late December. Then came a third wave in
March and April 1919, lethal by any standard except the second wave.

There is absolutely no indication -- zero, not the slightest hint anywhere in the world -- that Covid-19 will
become more virulent than it is now, so we can relax on that question. Don't worry about it. However, I do
expect it to come and go in several waves, and I expect it to become endemic -- it will be here forever. But
that is not necessarily scary. Right now no human's immune system has ever seen it before. As our bodies
become familiar with it, there's a very good chance we will be able to deal with it much better naturally, even
without a vaccine or drugs.

As far as lessons, this is a marathon. We can't wait out the virus. But we also need to get ahead of it, get all
sorts of things in place, before we restart the economy or we will be in big trouble

Tapper: President Trump on Thursday said he is "hearing it loud and clear from everybody" that
people want to go back to work. He said, "We may take sections of the country, we may take large
sections of our country that aren't so seriously affected and do it that way, but we have to start the
process pretty soon." What do you think?

Barry: To do that now would be disastrous. The virus will get everywhere, and I mean everywhere. There
are ways to get parts and even all of America back to work eventually, but they are complex.
Right now, as far as regions where so far there is little transmission, Singapore and South Korea have
created models for what to do, but right now we don't have the resources to follow their lead even in places
that so far have little community transmission. First, we need capability for all sorts of surveillance starting
with tests, which are still not available in anywhere near quantities needed. In fact right now people are
running out reagents that make the tests work. Once we do solve the testing problem, if there are still regions
without much community transmission, we can use tests and contact tracing and isolation and quarantine
as those countries did to keep them operating, but all that has to be enforced rigidly. Rigidly. Any leakage
will likely launch an explosive outbreak.

Tapper: Soldiers and other service members were at real risk then and now because of travel and
close quarters. How did the militaries of the world deal with the 1918-1919 influenza?

Barry: The 1918 virus killed the young, not the elderly. Well over 90% of the excess mortality was in people
UNDER 65, roughly two-thirds of the deaths were age 18-50, and the peak age for death was 28. Soldiers
were, of course, in the age group that was the prime target. The US military training camps obviously had
high mortality. There's an important lesson from them. There were 120 camps. Ninety-nine of them imposed
some form of isolation and quarantine. Twenty-one did not. There was no difference in morbidity and
mortality ... that sounds discouraging but if you look deeper you see two very important lessons in that data.

First, they had to sustain these measures over time and most camps got sloppy after a few weeks, so the
initial benefits were lost. That's one lesson. You have to keep doing it to have impact.

Second, only a very few camps rigidly enforced all measures. Those few camps did succeed in flattening
the curve substantially, but there were so few their results were submerged in the larger purely statistical
study. Lesson is: you have to do it right, six feet apart, wash your hands etc, all the time, every time.

Now in an Army barracks, of course, it is much harder to achieve social distancing than the way most people
live. So, in one sense civilians have an easier time in getting results -- if they do what they should do and
they keep doing it.

Tapper: Leaders during times such as these have to strike a balance between acknowledging ugly
facts and projecting hope, admitting struggles and failures, and confidently leading the public out of
the darkness. How did US leaders do it then versus now?

Barry: Woodrow Wilson never made a public statement about the pandemic. Never. And because of the
war he had created a propaganda machine whose architect wrote, "The force of an idea lies in its
inspirational value. It matters very little if it is true or false." So to keep morale up during the war, the
government lied. National public health leaders said things like, "This is ordinary influenza by another name."
They tried to minimize it. As a result, more people died than would have otherwise. Also, since people very
quickly learned this was not ordinary influenza -- people could die in 24 hours, symptoms could be as
terrifying as bleeding from the nose, mouth, eyes and ears -- and because they could not trust what they
were being told, real terror gripped some people, so much so that society itself began to fray and it became
everyone for himself. That's different from most disasters, when people come together to help each other.
In a very few places, like San Francisco, leaders were blunt about the threat. Those cities functioned much
better. The community did come together.

Tapper: How did communities come together?

Barry: In San Francisco, which functioned better than other cities I know of, there was plenty of fear but
also a tremendous, well-organized volunteer effort. Every block was taken care of to make sure people got
food and, if sick, were taken to emergency hospitals. After the outbreak, the San Francisco Chronicle
crowed that when the city's history was written "one of the most thrilling episodes will be the story of how
gallantly the city of Saint Francis behaved when the black wings of war-bred pestilence hovered over the
city." Very few places could say that, but even in Philadelphia -- which all but disintegrated into chaos,
where desperate calls for citizen volunteers went unanswered -- when the city asked police for four
volunteers to remove bodies from homes, more than 100 police officers volunteered.

Tapper: It's cliché to quote Santayana but it's just true: those who forget the past are condemned to
repeat it. Did people all too readily forget the 1918-19 influenza?

Barry: Whenever someone quotes Santayana, I quote Hegel: what we learn from history is that we learn
nothing from history. The George W. Bush administration was determined to prove Hegel wrong and to learn
the lessons of 1918. Led by an assistant secretary of Health and Human Services named Stewart Simonson,
and backed up by the President himself, they created an infrastructure to prepare for a pandemic. President
Barack Obama continued it and did in fact respond well both to H1N1 and Ebola. Trump spent January,
February, and part of March forgetting every lesson. Hopefully his change of tone, now 11 days old,
continues -- although his desire to start everything up again in a few weeks suggests otherwise.

Tapper: Last question -- and thank you so much for your time! How did the world get through the
Influenza of 1918-1919? What did they do that we need to be doing more of?

Barry: Basically, in 1918 they just survived it. Most cities did impose social distancing but too late -- the
virus was already disseminated by the time the measures were imposed, so they had little effect. In a few
exceptions, like St. Louis, they did succeed in flattening the curve. The result was 675,000 dead Americans,
adjusted for population growth that's equivalent to about 2 million today. That influenza virus was more
lethal than Covid-19 but Covid-19 is likely to infect more people, so even with a lower case fatality rate you
could see a huge death toll -- unless we act.

Eventually people's immune systems did become accustomed to the virus and became capable of dealing
with it more effectively. In addition the virus itself seemed to change. Eventually it morphed into seasonal
flu.

I agree with Tony Fauci. This virus is likely to be around from now on. It's not going away. My hope is natural
immunity along with drugs and vaccines will significantly diminish the threat of Covid-19.

CORRECTION: This story has been updated to accurately convey Barry's reference to social distancing of
six feet apart.

https://edition.cnn.com/2020/03/27/politics/interview-john-barry-great-influenza/index.html

The Health 202: Twelve takeaways from the 1918 flu epidemic
that help us think about the novel coronavirus

For most of the seven years John M. Barry spent writing his book about the 1918 flu pandemic, he
wanted to abandon the project. He’d originally wanted to write about the U.S. home front during
World War I.

“Every day I wished I hadn’t signed the contract,” Barry told me over the phone.

Not anymore. Barry’s work “The Great Influenza” has become a must-read in the age of the novel coronavirus.
The 546-page book describes how a highly lethal virus killed around 50 million people worldwide
between the spring of 1918 and early 1920 — more casualties than from any other pandemic, ever.
This H1N1 virus – which historians believe originated in Kansas, likely passed from a pig to a human
– struck near the end of the first World War, first among troops who then passed it to the civilian
population.

The book inspired President George W. Bush to develop a comprehensive pandemic plan, for which
the Centers for Disease Control and Prevention called on Barry as a subject-matter expert. In 2005,
the National Academies of Sciences named it the year’s outstanding book on science or medicine.

These days, the book is a bestseller on Amazon and Barry has offered historical perspective surrounding
covid-19, the disease caused by the novel coronavirus, in multiple op-eds.

He’s optimistic the current pandemic won’t be nearly as lethal. The virus isn’t becoming more
virulent, the government and media are taking it more seriously and a vaccine is in the works,
he notes. The key to an effective pandemic response, he says, is for health officials
to tell the truth about it. That didn’t happen in 1918 — far from it.

“There was no Tony Fauci back then,” Barry said, referring to the director of the Institute for
Infectious Diseases at the National Institutes of Health, who has become a prominent leader in
the response effort.
Your Health 202 author recently finished reading “The Great Influenza.” Here
are the 12 things we found most interesting:
Doctors didn’t initially think the first wave was influenza because it was too mild.
Historians believe someone from Haskell County, Kan., initially carried a mild version of the
virus to a huge Army base in March 1918, where it then swept through the world that spring,
transmitted largely by troops packed in close quarters in barracks and on ships. But the
symptoms were so mild that troops called it “three-day fever.”

Even doctors questioned whether the disease was influenza. The symptoms were “of very short
duration and so far absent of relapses or complications,” three British doctors wrote in the
Lancet medical journal in an issue dated July 13,1918.

Doctors also doubted it was influenza in the second wave — but then because it was so deadly.
When a more strident form of the virus started arriving in the United States in August after
being transported to Europe and back again — largely via Navy ships — medical workers
noticed dramatic and deadly complications. Victims who had developed pneumonia were so
severely deprived of oxygen they turned blue, sometimes a very dark blue.

Direly ill patients would also sometimes bleed from their mouth, nose or even ears. Between 5
and 15 percent of men hospitalized in Army camps bled from the nose, the result when blood
flooded deeply diseased lungs.

Throughout fall 1918, this aggressive form of the virus swept through the U.S. and
the world in a second wave, ultimately killing 0.65 percent of all Americans and
double that percentage of young people. Italy lost 1 percent of its population to the virus,
the worst death rate of any developed country. Less developed countries were especially
vulnerable; historians estimate Mexico lost between 2.3 percent and 4 percent of its entire
population.

At the time the virus struck, civilian medical care had deteriorated because of the
war.
It was several years into World War I, and the U.S. military had employed many of the best
doctors and nurses to care for 4 million enlisted Americans. The doctors who remained civilians
tended to be either older — and therefore unaware of the latest medical advances — or
incompetent younger ones. So when the outbreak spread from military bases, major U.S. cities
were woefully ill-equipped to respond.

Like today, ships were hot spots.

Troops returning to the United States from European countries brought back the newly
aggressive virus starting in August. Many of them had been in Brest, France — a port town were
death rates soared so high the naval hospital was overwhelmed.

The first of the U.S. cases was reported in a barracks operated by the Navy in Boston, where as
many as 7,000 sailors in transit ate and slept. On Aug. 27, two sailors reported sick. The next
day, it was eight sailors. The day after that, 58 men were admitted to the sick bay.

The first terrible outbreak was in Camp Devons, a military base 35 miles northwest of Boston.
The base hospital, designed to hold just 1,200, was filled with more than 6,000 at one point,
with men lying in hallways and on porches, where they died. Sailors also spread the virus to
New Orleans, Philadelphia and New York.
Philadelphia was hit hardest of all U.S. cities.
The already overcrowded city was fertile ground for an epidemic. So many people died that
undertakers were overwhelmed and would drive patrol wagons through the streets so that
family members could load the bodies. Sometimes, bodies would lie on beds for days as others
in the household were too sick to remove them.

San Francisco acted most aggressively to stop the spread.

In the current pandemic, San Francisco's mayor was the first to order a citywide lockdown. It
was the same in 1918 — and it helped the city avoid widespread deaths initially. San Francisco's
public health director quarantined all naval installations, organized a citywide effort to prepare
and urged people to wear masks.

But despite these efforts, the city was still struck by the pandemic's third wave, in winter 1919.
The flu hit eastern cities far harder, but in the end San Francisco suffered the most deaths of
any city on the West Coast.

Federal and state officials consistently played down the illness.

Wilmer Krusen, Philadelphia's public health director, only agreed to monitor the situation a
full week after the virus first appeared in the city. Krusen insisted to reporters — who believed
him — the influenza was only “old-fashioned influenza or grip.”

He allowed a major parade to be held on Sept. 28, where several hundred thousand people were
jammed along the route. Within 72 hours, every bed in the city's 31 hospitals was filled. People
were trying to bribe nurses $100 to let them in. On the third day after the parade, 117 people
died in a single day. Krusen didn't ban public meetings until Oct. 3.

Some public officials even said fear made people more vulnerable to the disease. The Arizona
Board of Health told people, “Don’t worry,” to avoid contracting the flu. Newspapers across the
country perpetuated this myth.

The Public Health Service told people to do things such as “choose and chew” their food well.
The agency, which took the lead on public health before the Centers for Disease Control and
Prevention was created in the 1940s, fell far short in its response. Its leader, Rupert Blue, made
early missteps that allowed the virus to take hold and spread throughout the country. Nor did
the service offer any treatment or vaccine for the flu.

The agency did distribute information to the public about how to fight the illness, although it
was far too late to do any good. It sent ready-to-print plates to 10,000 newspapers, which said
the following: “Remember the three Cs, clean mouth, clean skin, and clean clothes…Keep the
bowels open…Food will win the war…Help by choosing and chewing your food well.”

President Woodrow Wilson never once publicly addressed the flu — even though he got it, too.
Wilson was confined to his bed for several days while in Paris in early 1919 to negotiate the end
of the war. Some historians believe he was affected neurologically by a bad case of the flu, so
much so that he yielded to demands by the French despite previously threatening to return
home without a treaty.

“Influenza did weaken him physically, and — precisely at the most critical point of negotiations
— influenza did at the least drain from him stamina and the ability to concentrate,” Barry writes.
“That much is certain. And it is almost certain that influenza affected his mind in other, deeper
ways.”
Newspapers told people the disease was subsiding while it was actually exploding.
The Public Ledger in Philadelphia continually minimized the danger. It claimed Krusen's ban
on public gatherings was not “a public health measure,” writing, “There is no cause for panic
or alarm.” As daily deaths numbered in the 200s and 300s in the following days, the paper
quoted public health officials as saying the peak of the epidemic had been reached.

This kind of propagandizing was common in media outlets throughout the country.
Newspapers also ran all kinds of ads propagating false information about how to treat or
prevent the virus, such as recommendations to keep one's feet dry or instructions on making a
gas mask.

A third wave in early 1919 killed 11,000 people in New York City and Chicago.
In some areas, including Phoenix, San Francisco and parts of Michigan and Georgia, the third
wave killed more people than the second wave. Officials in Savannah, Ga., who had reopened
public gathering places, re-closed them on Jan. 15 with even stricter rules than before.

India was the hardest-hit of any country.

At peak, more people in Bombay died every day than during the 1900 bubonic plague. More
than 10 percent of known cases resulted in death.

One doctor in Punjab, the region hit hardest, wrote that hospitals were so “choked that it was
impossible to remove the dead quickly enough to make room for the dying…Nearly every
household was lamenting a death and everywhere terror reigned.”

AHH: Congress has spent a breathtaking amount of money on the coronavirus response.
The $2.2 trillion legislation will boost the national debt to unprecedented levels, exceeding the
size of the economy by the end of fiscal 2020 and soon surpassing the prior record after World
War II, according to the Committee for a Responsible Federal Budget, The Washington Post’s
Dan Balz writes.
Does that mean bigger government is here to stay? Conservative Republicans supported the
massive spending bills, but the consensus on a more involved government is showing signs of
fading. Yet advocates for bigger government may have the upper hand.

“Conservatives recognize the ground may be shifting in ways advantageous to those on the
other side of the debate,” he writes. “More spending seems inevitable, particularly for public
health and potentially for programs such as paid sick leave or family leave.”

Another round of spending is expected. And higher taxes could be necessary down the
road to repay the debt Washington is incurring.
Former Federal Reserve chair Janet L. Yellen said the experience “could be paradigm shifting.”

William Galston of the Brookings Institution said the moment could end a cycle that began
with the past decade’s Great Recession and the tea party revolt in 2009 that triggered forces
that helped elect President Trump. “So the movement that began in opposition to a bailout is
ending in an administration that finds itself forced to sponsor — and in many respects urge on
— the largest expansion of government financial activity in our history,” Galston said.

What happens next?

“The pandemic has exposed crippling weaknesses in the federal government and troubling
vulnerabilities in society that will be more difficult to ignore when the crisis begins to ease. For
the first time, many Americans are looking to government for their very economic survival. In
time, that could make them look at government differently,” Balz writes.
OOF: Dozens of antibody tests on the market weren’t vetted by federal health regulators.
The Food and Drug Administration has allowed more than 90 antibody tests on the market
without prior review, our Post colleague Laurie McGinley reports.

That includes some antibody tests — meant to identify those who overcame covid-19 and
developed an immune response — that are of uncertain quality and have been marketed
fraudulently.

There’s concern that unvetted tests could spark confusion.

If the tests are inaccurate, for one, they could say that individuals have immunity when they
don’t.

“The emergence of dozens of tests never reviewed by the FDA — many of which are being
aggressively marketed — could confuse doctors, hospitals, employers and consumers
clamoring for the products, according to critics who say the agency’s oversight of the tests has
been lax,” Laurie writes. “The questions are taking on special importance as federal and state
officials debate strategies, including using serological testing, to help determine when they can
end state and local lockdowns.”

Now, the Food and Drug Administration has stepped up warnings about such tests. FDA
Commissioner Stephen Hahn said during a Washington Post Live interview that “people should
be very cautious” about tests that haven’t received emergency use authorization from the
agency.

The government "raised the official toll in Wuhan by 50% to 3,869 deaths,” the Associated
Press’s Ken Moritsugu reports. “While China has yet to update its national totals, the revised
numbers push up China’s total to 4,632 deaths from a previously reported 3,342.”

But the jump in numbers is not necessarily a surprise. "It is virtually impossible to get an
accurate count when health systems are overwhelmed at the height of a crisis —
and they confirm suspicions that many more people died than the official figures
had showed,"Ken writes.

There have been long-running questions about the accuracy of China’s official case count,
leading to “accusations that Chinese officials were seeking to minimize the impact of the
outbreak and could have brought it under control sooner.”

According to Wuhan’s coronavirus response headquarters gave a few reasons for the
undercount, saying it was part a result of mistaken reporting by medical staff, deaths at
institutions that weren’t linked to the epidemic information network, and deaths that occurred
outside hospitals.

U.S. experts working at the World Health Organization sent the Trump administration real-time
information as the coronavirus emerged.
More than a dozen researchers, physicians and public health experts, many from the Centers
for Disease Control and Prevention, were at the U.N. agency’s Geneva headquarters as the
coronavirus emerged late last year. They sent information about its emergence and spread to
administration officials, The Post's Karen DeYoung, Lena H. Sun and Emily Rauhala report.
A spokeswoman for the Department of Health and Human Services, Caitlin B. Oakley,
confirmed to The Post that HHS had 17 staff members, including 16 from the CDC, at the WHO
“working on a variety of programs, including covid-19 and Ebola.”

President Trump, which is withholding WHO funds, says the agency failed to communicate the
extent of the virus’s threat and that such a failure is to blame for the rapid spread in the United
States. He has also criticized Chinese leadership for withholding information.

Oakley said the presence of CDC staffers didn't mean the agency's leaders were being forthright.
“[J]ust because you have Americans embedded in WHO providing technical assistance does
not change the information you are getting from WHO leadership.”

Some state leaders are chiding Trump for encouraging anti-shutdown protests.
Maryland Gov. Larry Hogan (R) said Trump’s comments defending protesters were unhelpful
and nonsensical. Virginia Gov. Ralph Northam (D) suggested Trump is focused on protests
because he has not been able to provide more critical tests, our colleagues Luz Lazo, Erin Cox
and Hannah Natanson report.

In an interview on CNN, Hogan said he understood the desire to restart the economy, but said
doing so soon would be reckless.

“I understand the frustration among the people that want to get things open right away. I’m
frustrated, too. I wish I had someone to protest to,” Hogan said. He added: “I don’t think it’s
helpful to encourage demonstrations and encourage people to go against the president’s own
policy…It just doesn’t make any sense.”

Some of the anti-quarantine protests are stemming from pro-gun activists on Facebook.
There are far-right, pro-gun activists pushing for anti-quarantine demonstrations across the
United States. It’s the “latest illustration that some seemingly organic demonstrations are being
engineered by a network of conservative activists,” our Post colleagues Isaac Stanley-Becker
and Tony Romm report.

The social media groups have continued to expand after Trump endorsed such protests in a
series of tweets on Friday, suggesting citizens should “liberate” states.

“The Facebook groups target Wisconsin, Ohio, Pennsylvania and New York, and they appear
to be the work of Ben Dorr, the political director of a group called ‘Minnesota Gun Rights,’ and
his siblings, Christopher and Aaron,” they write. “…The online activity helps cement the
impression that opposition to the restrictions is more widespread than polling suggests. Nearly
70 percent of Republicans said they supported a national stay-at-home order, according to a
recent Quinnipiac poll. Ninety-five percent of Democrats backed such a measure in the
survey.”

Congress on coronavirus
Congressional leaders are close to a deal with the administration on more coronavirus relief.
The $400 billion-plus deal would bolster funding for a small-business loan program that dried
up because of high demand, our Post colleagues Erica Werner and Jeff Stein report. It would
also include about $100 billion in additional funding for hospitals and coronavirus testing.
At his daily coronavirus task force briefing last night, Trump said they are “getting close to a
deal.” “We have some very good negotiations going on right now, and I think you could have a
nice answer tomorrow,” he said.

“The deal would add about $300 billion to the Paycheck Protection Program for small
businesses that was swamped by demand in the three weeks since Congress created it as part
of a $2 trillion coronavirus rescue bill,” Erica and Jeff report.

“It also would add $60 billion to a separate emergency loan program for small businesses that
also is out of money, Senate Minority Leader Charles E. Schumer (D-N.Y.) said on CNN. The
agreement would include $75 billion for hospitals and $25 billion for testing, which have been
major Democratic demands. Some of the money in the small-business program would be
directed specifically to rural and minority businesses, said people familiar with the plan who
spoke on the condition of anonymity to describe it.”

Coronavirus latest
Here are other headlines and developments to catch up on this morning.

What does a return to normal look like?

• Before the economy can truly recover, people must feel confident in returning to their
pre-pandemic lives, our Post colleague Ashley Parker reports. No such confidence
currently exists. A Pew Research Center poll released Thursday found three-fourths of
U.S. adults believe the worst is yet to come, and two-thirds worry about easing restrictions
too soon.
• A new Wall Street Journal-NBC News poll also found nearly six in 10 say they’re
concerned lifting stay-at-home orders too quickly will fuel the pandemic and lead to more
lives lost, the Wall Street Journal’s Catherine Lucey reports.
• Before the nation can reopen, researchers at Harvard University say coronavirus testing
needs to triple, the New York Times’s Keith Collins reports.
• Researchers are racing to understand what level of immunity those who have recovered
from covid-19 have, and how long immunity will last, the Wall Street Journal’s Robert Lee
Hotz reports.
In the states:
• Trump said the government will ramp up efforts to acquire critical testing supplies after
numerous Democratic and Republican governors said the administration hasn’t done
enough, our Post colleagues Shane Harris, Felicia Sonmez and Mike DeBonis report.
• California and Florida have released the names of nursing homes in their states that have
had coronavirus cases, The Post’s Meryl Kornfield reports.
The hardest hit:
• We don't know how many American have lost their health insurance during the pandemic.
But our colleague Amy Goldstein writes there are some clues, such as the 22 million
workers who have filed unemployment claims since mid-March. “The latest census data
show that job-based coverage accounted for 55 percent of Americans’ health insurance,
though the kinds of work disappearing the most — restaurant jobs and others in the
service industry — have always been less likely to offer health benefits,” she adds.
On the front lines:
• Doctors across the country as well as in Spain, the United Kingdom and China are
wondering where all the heart attack, stroke, appendicitis or bowel obstruction patients
have gone. The concern is there’s a “sub-epidemic of people who need care at hospitals
but dare not come in,” The Post’s Lenny Bernstein and Frances Stead Sellers report.
 • One in three jobs held by women has been designated essential amid the pandemic, the
New York Times’s Campbell Robertson and Robert Gebeloff report, citing an analysis of
census data and federal essential worker guidelines. They add that nonwhite women are
more likely to be doing such essential work than anyone else.

https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2020/04/20/the-health-
202-twelve-lessons-the-1918-flu-epidemic-can-teach-us-about-the-novel-
coronavirus/5e9c413388e0fa101a765def/

Akibat Covid-19, Toko Offline Beralih Jadi Online

Ekonomi belanja online virus corona
Annisa ayu artanti • 20 April 2020 12:26
Jakarta: Platform belanja digital, Tokopedia, mencatat fenomena perubahan pola penjualan di tengah wabah
korona (covid-19). Banyak toko ritel konvensional menjual barangnya dengan cara online.

COO Tokopedia Melissa Siska Juminto mengatakan jumlah penjual di Tokopedia mengalami peningkatan yang
tinggi, khususnya penjual yang menjajakan kebutuhan kesehatan dan personal care.

"Penjual juga meningkat 2,5 kali lipat karena permintaannya juga sangat tinggi," kata Melissa menjawab
pertanyaan Medcom.id, Senin, 20 April 2020.

Ia menuturkan transaksi untuk kategori kesehatan dan personal meningkat tiga kali lipat. Bahkan, khusus
penjualan masker meningkat 200 kali lipat.

"Dalam pandemi ini berubah sekali. Orang dulu belanja elektronik, fesyen, dan beauty, pindah ke kesahatan
dan personal care," ucapnya.

Di sisi lain, tak hanya toko kesehatan dan personal care yang bergabung di Tokopedia. Melissa juga
menyebutkan jumlah penjual di toko makanan dan minuman juga mengalami peningkatan.

Mereka banyak yang menjual jamu, rempah-rempah, dan minuman kesehatan untuk menambah daya tahan
tubuh saat wabah korona.

"Tren-tren restoran juga bergabung di Tokopedia. Jadi menjualnya tidak hot food, jadi berubah. Banyak juga
jual kopi literan. Ini jualnya juga mulai unik," tukasnya.

E-commerce Dorong Perekonomian Indonesia,

selama Pandemi Covid-19
Pemerintah juga mulai melirik sektor e-commerce sebagai salah satu solusi untuk mengatasi defisit pajak
akibat pelambatan ekonomi.

Bisnis.com, JAKARTA - Perusahaan-perusahaan e-commerce di Indonesia membukukan kenaikan volume

penjualan dengan semakin banyaknya masyarakat yang menerapkan physical distancing di tengah wabah
Covid-19.
Pemerintah juga mulai melirik sektor e-commerce sebagai salah satu solusi untuk mengatasi defisit pajak akibat
pelambatan ekonomi.
Dibandingkan dengan Malaysia dan Singapura, pemerintah Indonesia enggan menerapkan prosedur karantina
yang ketat karena khawatir akan dampak ekonomi dan sosial.
Namun, pemerintah memutuskan untuk menerapkan lockdown secara parsial di Jakarta yang sudah
berlangsung selama dua minggu sejak 10 April dan memerintahkan perkantoran untuk tutup, melarang
perkumpulan lebih dari lima orang, mengurangi jam operasional transportasi umum, dan melarang dine-in di
restoran.
Penerapan lockdown bertujuan untuk mencegah penyebaran virus corona yang sudah menjangkit 5136 orang
dan menyebabkan 469 kematian per 15 April di Indonesia. Jakarta yang padat penduduk dianggap sebagai
pusat penyebaran virus corona di dalam negeri, di mana hampir 50% kasus corona di seluruh Indonesia berasal
dari ibu kota.
Sebelum lockdown diterapkan, banyak perusahaan besar di Jakarta yang mulai memberlakukan kebijakan
bekerja dari rumah yang awalnya sempat diajukan oleh pemerintah pusat dan daerah. Selain itu, sejumlah mal,
toko, dan restoran juga berinisiatif mengurangi jam operasional, beralih ke layanan online, dan bahkan
menghentikan kegiatan usaha secara total.
Sebelum toko-toko yang menjual barang non-pokok ditutup, sudah banyak masyarakat yang lebih memilih
untuk belanja online seiring dengan peningkatan jumlah kasus Covid-19. Berikut beberapa kinerja dan transaksi
yang dibukukan ecommerce selama masa pandemi seperti dikutip dari siaran pers Oxford Bussiness Group.
Bukalapak salah satu dari lima perusahaan startup unicorn di Indonesia yang memiliki valuasi mencapai US$1
miliar memperluas pilihan produk sembako selama beberapa minggu terakhir untuk memenuhi kebutuhan
konsumen yang berdiam di rumah.
“Perusahaan membukukan kenaikan transaksi pada platform e-commerce serta bertambahnya pengguna baru
karena adanya pergeseran model bisnis UMKM dan perubahan perilaku konsumsi, ”ujar Fajrin Rasyid, Co-
founder and President Director Bukalapak dikutip dari siaran persnya.
Secara terpisah, Blibli mengungkapkan bahwa penjualan produk sembako, pembersih, sanitasi, masker
kesehatan, dan vitamin mengalami peningkatan selama beberapa minggu terakhir. Perusahaan e-commerce
tersebut juga membukukan peningkatan permintaan terhadap peralatan memasak, video game, dan peralatan
olahraga karena masyarakat Indonesia mulai menyesuaikan diri untuk menghabiskan waktu di rumah.
Sebaliknya, permintaan terhadap produk smartphone, otomotif, sepatu, pakaian formal, dan tiket liburan
semakin turun karena keadaan perekonomian yang tidak menentu serta kekhawatiran kesehatan sehingga
masyarakat mulai mengurangi konsumsi yang tidak terlalu dibutuhkan.
E-commerce sebenarnya sudah mampu menarik banyak konsumen di Indonesia bahkan sebelum terjadinya
wabah Covid-19. E-commerce juga merupakan salah satu pendorong utama yang menjadikan Indonesia
sebagai negara dengan nilai ekonomi digital terbesar di Asia Tenggara mencapai $40 miliar pada tahun 2019
dan dipresiksi meningkat hingga $130 miliar pada tahun 2025.
Dengan semakin banyaknya toko retail dan konsumen yang terpaksa beralih ke e-commerce, pertumbuhannya
dapat ditingkatkan lebih jauh.
“Sebelum Covid-19, e-commerce hanyalah sebuah pilihan. Namun untuk sekarang, penting sekali bagi toko
retail dan produsen untuk menjual produk melalui platform e-commerce agar mampu mempertahankan bisnis
mereka. Hal ini akan memberikan dampak jangka panjang yang positif karena konsumen akan semakin terbiasa
berbelanja secara online, ”ujar Kusumo Martanto, CEO Blibli.
Sementara itu, perubahan dinamika pasar yang disebabkan oleh pandemi juga menciptakan peluang bagi
layanan pengiriman makanan online. Pemimpin pasar seperti Go-Food dan Grab Food – yang dapat diakses
melalui Go-Jek dan Grab – telah menerapkan mekanisme pengiriman tanpa kontak dan prosedur kebersihan
yang ketat untuk terus melayani konsumen.
Pelaku industri mengatakan bahwa pasar pengiriman makanan di Indonesia berpotensi meningkat dua kali lipat
pada tahun 2020 akibat dari wabah Covid-19.
Perubahan kebijakan perpajakan
Untuk mengimbangi dampak ekonomi akibat pandemi, pemerintah telah mempercepat upaya reformasi
perpajakan, termasuk pengenaan pajak atas transaksi pada platform e-commerce asing.
Pemerintah mengantisipasi adanya penurunan pendapatan pajak sebesar 10% tahun ini setelah menyalurkan
berbagai bantuan dan insentif yang bertujuan untuk membantu usaha-usaha yang terdampak virus corona.
Keuangan publik juga diperkirakan akan terpengaruh akibat dari penurunan pendapatan minyak dan gas karena
permintaan dan harga global yang juga semakin menurun.
“Pendapatan pajak di Indonesia akan bergerak menuju perpajakan digital seiring dengan transaksi online yang
terus meningkat signifikan, terutama selama pandemi Covid-19,” ujar Menteri Keuangan Sri Mulyani Indrawati
dalam konferensi pers online awal bulan ini.
Pasca penerbitan Perppu Nomor 1 Tahun 2020 pada tanggal 31 Maret, pajak pertambahan nilai PPN sebesar
10% akan dikenakan atas barang dan jasa yang dijual melalui platform elektronik asing yang tidak memiliki
entitas fisik di Indonesia, termasuk layanan ritel online, media streaming, e-learning, aplikasi, dan layanan cloud.
Masyarakat Indonesia merupakan pengguna setia platform sosial media internasional seperti Facebook dan
Twitter, serta situs streaming seperti Netflix dan Spotify. Layanan video over internet protocol (VoIP) seperti
Zoom juga semakin populer sejak adanya kebijakan berkerja dari rumah yang diterapkan beberapa perusahaan
sejak bulan Maret.
Sebelumnya, platform-platform ini dapat menghasilkan pendapatan yang signifikan di Indonesia tanpa
dikenakan pajak. Namun, hal ini akan berubah dengan adanya regulasi baru apabila platform tersebut memiliki
produk, penjualan, atau pengguna aktif di Indonesia yang memenuhi kriteria untuk dikenakan pajak.
Peraturan pelaksanaan akan diterbitkan untuk menjelaskan lebih lanjut mengenai teknis pengenaan pajak –
termasuk pajak penghasilan – terhadap perusahaan e-commerce asing yang memiliki keberadaan ekonomi
yang signifikan di Indonesia.
"Apabila regulasi baru dapat diterapkan dengan efektif, hal ini akan berdampak baik bagi perusahaan e-
commerce dalam negeri karena dapat menciptakan level playing field," ujar Martanto.
https://ekonomi.bisnis.com/read/20200417/12/1228750/e-commerce-dorong-perekonomian-
indonesia-selama-pandemi-covid-19-

E-commerce provides economic boost for Indonesia as shoppers migrate

online during the Covid-19 pandemic

IndonesiaRetail
Economic News
16 Apr 2020
Text size +-
Recommend

E-commerce firms in Indonesia are reporting higher volumes of online sales as consumers practise
social distancing amid the Covid-19 outbreak, with the government looking to the flourishing
sector as one means of addressing tax shortfalls resulting from the wider economic slowdown.
Compared to neighbouring Malaysia and Singapore, the Indonesian government had been reluctant to implement
strict quarantine procedures due to fears over the economic and social impact.

However, a partial two-week lockdown was imposed on the capital Jakarta from April 10, involving the closure of
offices, a ban on gatherings of more than five people, reduced operational hours for public transport and an end to
in-restaurant dining.

The lockdown was announced in an effort to contain the spread of the coronavirus, with Indonesia reporting 5136
cases and 469 deaths as of April 15. The densely populated capital is considered the epicentre of Indonesia’s
outbreak, accounting for almost 50% of all cases.

Prior to the announcement of the partial lockdown, many major companies in Jakarta were already implementing
work-from-home policies following requests from the national and local governments. In addition, some malls,
retailers and restaurants had taken unilateral decisions to reduce business hours, switch to online operations or
suspend commercial activities completely.

Rising digital demand

Even without enforced closures of brick-and-mortar retail stores selling non-essential items, shoppers have been
increasingly turning to online channels to make purchases as the Covid-19 case count has risen.

E-commerce marketplace Bukalapak, which is one of Indonesia’s five unicorn start-ups valued at over $1bn, has been
expanding its grocery selection in recent weeks to cater for the needs of stay-at-home consumers.

“We can't answer for other e-commerce platforms, but we have seen a spike in transactions on our platform, with
growth in new users due to shifts in the MSME [micro-, small and medium-sized enterprise] business model and
consumption behaviour,” Fajrin Rasyid, co-founder and president of Bukalapak, told OBG.

Elsewhere, online mall Blibli reported that sales of groceries, cleaning and sanitising products, surgical masks and
vitamins have all experienced increases over recent weeks. In addition, the e-commerce firm has recorded heightened
demand for cooking appliances, video games and exercise equipment as Indonesians adjust to spending more time at
home.

Conversely, Blibli logged noticeable demand declines in segments such as smartphones, automotive, shoes, formal
dress and travel, as the uncertain economic climate and public health outlook began to weigh on discretionary
consumption.

E-commerce was already gaining significant traction in Indonesia prior to the Covid-19 outbreak, with the sector one
of main driving forces behind the county’s emergence as South-east Asia’s largest digital economy, valued at $40bn in
2019 and expected to be worth $130bn by 2025.

Now that more retailers and consumers are being forced to explore e-commerce options, growth could be accelerated
even further.

“While e-commerce was just an option before Covid-19, it is now essential for retailers and producers to sell their
products through e-commerce platforms in order to survive. The long-term impact will be positive for online shopping
as it will start to become habitual for consumers,” Kusumo Martanto, CEO of Blibli, told OBG.

Meanwhile, the shifting market dynamics caused by the pandemic are also creating opportunities in the online food
delivery market. Market leaders Go-Food and Grab Food – which are integrated within the multipurpose ride-hailing
apps Go-Jek and Grab, respectively – have been promoting contactless delivery mechanisms and strict cleanliness
procedures to continue serving consumers.

Industry leaders told OBG that the Indonesian market for food delivery could potentially double in size in 2020 as a
result of the Covid-19 disruption.
Tax framework adapts

As part of efforts to offset the economic impact of the pandemic, the government has been accelerating planned tax
reforms, including the introduction of taxes on transactions involving offshore e-commerce platforms.

The government is anticipating a 10% decline in tax revenues this year due to relief and incentive measures
introduced to help businesses manage the coronavirus-related downturn. Public finances are also expected to be
impacted by reduced oil and gas revenues resulting from falling global demand and prices.

“Indonesia’s tax base will move towards digital taxation as online transactions have been growing significantly,
especially during the Covid-19 pandemic,” Sri Mulyani Indrawati, the minister of finance, told a teleconferenced press
briefing at the start of this month.

Following the March 31 issuance of Government Regulation in Lieu of Law 01/20, value-added tax – which is currently
set at 10% – can be charged on goods and services sold through electronic platforms that do not have a physical
presence in the country. This includes services related to online retail, streaming media, e-learning, apps, and cloud
services.

Indonesians are avid users of international social media platforms such as Facebook and Twitter, as well as streaming
sites such as Netflix and Spotify, while video over internet protocol (VoIP) service Zoom has been growing in
popularity since some companies began to implement work-from-home procedures in March.

Previously, such platforms could generate significant business in Indonesia without incurring local taxes, but this
should change under new regulations if their gross circulated product, sales or active users in Indonesia meet the
stipulated criteria.

Implementing regulations will be published at a later date to provide further details on how domestic tax laws -
including those related to income tax - will be applied to offshore e-commerce firms deemed to have a signficant
economic presence in Indonesia.

“If the new rules can be applied effectively then they will be good for local e-commerce firms as they will help to level
the playing field,” Martanto told OBG.

https://oxfordbusinessgroup.com/news/e-commerce-provides-economic-boost-indonesia-shoppers-
migrate-online-during-covid-19-pandemic

6 lessons we can learn from past pandemi

By Lisa Marshall • Published: April 8, 2020

With 1.4 million confirmed cases and 81,000 deaths worldwide as of this writing, the coronavirus
pandemic has become a global tragedy unlike any in our lifetimes. But, as historians remind us, this is
neither our first nor our most deadly war with an infectious disease.

A century ago, the flu epidemic of 1918 swept the globe, killing as many as 100 million people—5% of
the world’s population—before social distancing helped curb its spread. In the early 1780s, smallpox
ravaged the American West, ripping through indigenous communities with case fatality rates of 38%
or higher and leading to the development of the world’s first vaccine less than two decades later.

Other outbreaks—from cholera in the 1830s to HIV-AIDS in the 1980s—brought xenophobia along
with disease and revealed that fear and blame can distract from efforts to find a cure.

“Epidemics highlight the fault lines in our society,” says CU Boulder history Professor Elizabeth Fenn,
a Pulitizer Prize winning writer, scholar of epidemics and author of Pox Americana: The Great
Smallpox Epidemic of 1775-82. “They reveal our weaknesses, but they also illuminate the profound
kindness, generosity and cooperation we are capable of. We have a lot to learn from them.”
Here’s a look at some of those lessons:

Lesson No. 1: Names matter

Contrary to popular belief, the flu epidemic of 1918—commonly referred to as the Spanish flu—did
not originate in Spain, but likely got its start at a military base in Fort Riley, Kansas.

“It was designated the Spanish flu completely erroneously, only because Spain put out the first news
accounts of it,” says CU Boulder history Professor Susan Kent, author of The Influenza Pandemic of
1918–1919.

Spain was neutral at the time, she notes, so the country was free of the media blackouts that (in the
spirit of wartime morale) prohibited warring countries like Germany, the United States and France
from reporting on illness.

Some scholars have since suggested that dubbing it the Spanish flu sent the inaccurate message that it
was a distant threat, delaying steps to prevent it in the United States.

Similar themes resonate today, Kent notes, in the debate over terms like “Wuhan flu” and “Chinese flu”
to describe coronavirus.

Lesson No. 2: Social distancing works

In 1918, as in 2020, travel swiftly spread the virus, with U.S. soldiers traveling to the East Coast and
on to European battlefields and carrying it with them.

“The reason it was so deadly and passed so quickly across the entire world was that it took place
during wartime,” Kent says. “That’s not unlike this moment of massive globalization we are living in
now.”

Without the luxury of today’s high-tech microscopes and genetic sequencing, researchers wrongly
assumed it was bacterial, and efforts to treat it or vaccinate against it failed. With no other tools to rely
on, towns ultimately closed schools, theaters and libraries. The National Hockey League called off the
Stanley Cup. Military leaders quarantined troops, and public servants were urged to wear masks.

In all, 675,000 people died in the United States, more than died in World War II. But it could have been
more.

“The only way to prevent its spread was to isolate people from one another. Some communities did
that and fared well. Others did not and suffered high death rates,” says Kent. “That lesson for us now is
crucial. If we don't learn from it, shame on us.”

Lesson No. 3: Viruses don’t spare the young

The influenza epidemic of 1918 was most likely to hit the young and healthy, felling people ages 15 to
45 with swift lethality.

“They got sick so rapidly, some literally dropped in the streets,” Kent recalls, noting that their faces
often turned bluish red due to lack of oxygen.
As it turned out, the patients’ own robust immune systems were part of the problem, unleashing a
torrent of virus-fighting molecules called cytokines that latched on to lung tissue causing lethal
damage.

While the demographics of coronavirus are very different—it’s hitting older populations and the
immune-compromised the hardest—its behavior in the young and healthy is eerily similar to that of
the virus a century ago. Recent news reports point to immune responses called “cytokine storms” as a
likely cause of the collateral damage occurring in younger patients.

“Exactly the same thing occurred in 1918,” Kent notes. “Strong immune systems overwhelmed the
other organs of the body, especially the lungs.”

That realization is already sparking new ways of thinking about treatments for COVID-19.

Lesson No. 4: Inoculation works

During the smallpox epidemic that swept across North America from 1775 to 1782, Revolutionary
War soldiers took an unusual approach to protecting themselves from the virus known as Variola
major. In a process known as variolation (a.k.a. inoculation), they took virus-loaded material from an
infected person’s smallpox pustule, carved an incision into the flesh of a healthy solder, and rubbed it
in.
Recipients of variolation invariably got the disease, so were quarantined. About 5% died. But most got
a mild version of the smallpox disease.

“There is no question that it worked,” says Fenn. “Assuming you lived through it, you would garner
immunity and go about the world without worrying about smallpox.”

Years later, in 1796, Edward Jenner, who himself had been variolated as a child, would try a similar
method, taking lesion material from a woman who had cowpox and rubbing it into the wound of an 8-
year-old boy. When he later tried to infect the boy with smallpox, no disease developed.

The concept of vaccination—named after the Latin word for cow, or vacca, was born.

Fast forward to today, and variolation has come full circle, as researchers explore the idea of using
“convalescent plasma” (survivor blood believed to contain antibodies to COVID-19) as a treatment.

Lesson No. 5: Don’t blame the sick

With the spread of coronavirus has come a wave of anti-Asian backlash in cities across the globe,
driven in part by the fact that the illness emerged in the Chinese city of Wuhan and swept through the
Chinese population first.

That’s nothing new, says Fenn.

“We are very prone to blaming the people who get sick,” she says. “It’s happened over and over
throughout history.”

During the cholera epidemics that hit from the 1830s to 1860s, white protestants shunned Irish
immigrants as vectors of the scourge. In the 1950s, as polio swept the nation, African Americans and
the poor were targeted. In the 1980s, blame was placed on the LGBTQ community for spreading HIV-
AIDS.
“While people dithered around blaming (HIV-AIDS) on gay lifestyles or nightclub dancing, precious
years of looking for pathogens were lost,” Fenn says.

In contrast, Fenn notes, the World Health Organization in 1980 announced that smallpox was officially
the first and only human infectious disease to be eradicated.

How was that accomplished? Through collaboration.

“Today, we can learn and act upon the fact that global cooperation and sharing of knowledge will help
us deal with these outbreaks, or we can shut ourselves away and insist on going alone,” says Kent.

Lesson No. 6: This can end

As horrific as coronavirus is, Kent does not believe its death toll will reach the meteoric levels of the
flu epidemic of 1918. Our public health systems, scientific tools and medical supplies (albeit in short
supply) are far better.

In comparison to past pandemics, we also have a head start in tackling this one, adds Fenn.

“This is the first pandemic of this scope where we have known what the pathogen is from the very
start.”

The coming months will no doubt be painful, but with social distancing in place, herd immunity
building and collaborative work underway to develop treatments and a vaccine, Fenn and Kent are
hopeful.

Now, all we need is time.

Says Fenn: “I would suggest that this is a time for us to pay attention and learn what this illness
reveals about us, so we can take that knowledge forward.”

The Supply Side: What consumer behaviors will persist after

COVID-19 subsides?
RETAILTHE SUPPLY SIDE

The COVID-19 (coronavirus) pandemic has redefined retail for American consumers who are largely
hunkered down at home and going out only for groceries and consumables. That has meant far more
shoppers have taken advantage of ordering online with curbside pickup options for groceries and medications.

More than 630,000 retail stores have been shuttered and millions of retail employees furloughed while the
stores remain full of spring merchandise that will likely have to be discounted when the COVID-19 outbreak
subsides. Retail experts agree COVID-19 will likely be the demise of some retail banners should the
shutdown linger into the early summer.

The National Retail Federation (NRF) estimates the shuttered stores will lose an estimated $400 billion from
the shutdown.

Carol Spieckerman, CEO of Spieckerman Retail, said the pandemic spells trouble for JCPenney and other
companies that rely on soft-line (apparel) sales. She said pent-up demand for those categories will benefit
the retailers who make it through. Spieckerman said COVID-19 has caused many new consumers to order
products online and buy more categories sight unseen.

“Consumers will be more comfortable relinquishing control in general, particularly when it comes to picking
and choosing food items like produce and meat,” Spieckerman said. “At the same time, there will be a
lingering expectation of vigilance around cleanliness and sanitation in-store. The affinity for touch-less
commerce will increase and smart retailers will proactively build these capabilities in anticipation.”

Jason Long, CEO of St. Louis-based Shift Marketing, said the strong retailers will get stronger, and the weak
will get weaker or die altogether.

“Obviously, Amazon benefits [reporting their visits are up 32%]. The larger players such as Walmart, Costco,
[and] Home Depot benefit as they’re seen as stock up destinations [that] have also built out their online/pickup
platforms and were prepared better than many for the online surge,” Long said.

Kohl’s has drawn down $1 billion from an existing credit line to shore up cash reserves to weather the
shutdown, and Neiman Marcus is contemplating bankruptcy.

Like Spieckerman, Long expects the shift to e-commerce and delivery will continue to accelerate. He said no
matter how long the economic downturn continues, the recovery will likely take some time. He sees a new
normal will develop over the next five years.

“A lot of retailers won’t survive five years, and the shift to online ordering will be profound. But that, of course,
varies by channel. Home Depot and Lowe’s stores will still be popular in five years as people pick out their
gardening flowers and supplies,” Long said.

He said one trend that might have been derailed because of COVID-19 is the pre-owned and used clothing
craze. Long said that now seems less sanitary than many would want.

He said those who stocked up on food and survival items were often ridiculed in the past, but the behavior
has become more mainstream in recent weeks. He predicts retailers will continue to see mini-preppers who
won’t soon forget running out of toilet paper, cleaning supplies, hand sanitizers or basic over-the-counter
meds and will begin to build a stash ahead of the next crisis.

Long said teens who are picking a career field might think twice about being a nurse or first responder, jobs
that look more dangerous than they did a month ago. He also sees a continued trend toward healthy living
as those who smoke, have diabetes or respiratory illness have higher casualties when exposed to COVID-
19.

Profitero reports a “fitness freakout” that has taken hold as gyms, spin cycling and other fitness locations
have shut down. They report workout equipment topped the needs hierarchy during COVID-19. The search
term “workout equipment” increased 14 fold over the past two weeks on Amazon.com. Other behaviors
include a “nesting” phase as more consumers are confined to their homes. Profitero found the searches for
“bread machines” rose 13 fold and “board game” searches were up six times their normal volume in the past
two weeks.

Scott Benedict, professor of retail at Texas A&M University and a former Walmart executive, said some of
the behaviors displayed now will remain long after the crisis has passed.
“There has been significant growth in online account creation and app downloads,” Benedict said. “The
utilization of these accounts as a purchase portal, as well as a digital marketing portal for retailers, will last
long after this crisis has passed.”

Benedict said the industry has seen a 12 times increase in industry online account creation and a triple
increase in retail app downloads in recent weeks. Benedict also said increased investment in BOPIS
capabilities (buy online pick-up in-store) will be robust for retailers and restaurants whose investment was
perhaps limited before the crisis but saw how critical that infrastructure proved to be during recent weeks. He
said brand relationships will also likely strengthen between consumers and the retailers who were there for
them during the COVID-19 outbreak.

“From grocery chains and pharmacy chains that delivered goods without a delivery fee, had special shopping
hours for elderly customers, relentlessly cleaned and restocked stores and made heroes of their workforce
… including mass merchants like Walmart, Target, Costco and Sam’s Club … consumers will likely have a
stronger attachment to them and to their brands because of how they conducted themselves in difficult times,”
Benedict said.

He said COVID-19 could also make emergency preparedness a bigger focus for families. He expects they
will keep pantries well stocked with basic necessities, as well as cleaning supplies and disinfectants in their
homes even after the immediate crisis is over.

“In addition, retailers … indeed all businesses … will be adding a new chapter to their emergency plans,”
Benedict said. “Hurricanes, tornados, floods and other natural disasters will now be joined by global
pandemics as a key element of retailers emergency planning and preparation.”

Editor’s note: The Supply Side section of Talk Business & Politics focuses on the companies,
organizations, issues and individuals engaged in providing products and services to retailers. The Supply
Side is managed by Talk Business & Politics and sponsored by Propak Logistics.

https://talkbusiness.net/2020/04/the-supply-side-what-consumer-behaviors-will-persist-after-covid-19-
subsides/