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| Women wearing face masks against the 1918 flu pandemic |
It is a well-hackneyed, over-used nostrum that those who do not learn from history are bound to relive it; yet it is as relevant as ever in 2020 as the world reels from the impact of the first truly global pandemic since the 1918 to 1919 H1N1 “Spanish influenza”.
Covid-19 and H1N1 are both viruses that likely have their origin in poor animal husbandry, and both posed strikingly similar challenges to governments. The rapid onset of a new disease combined with gross economic inequality, ever faster modes of mass transit and increasingly diverse sources of information are also notably similar.
Influenza is a long-recognised disease recorded as far back as Hippocrates and Livy in classical times, but its pathology remained a mystery. By 1500 its range of symptoms, normally involving increased body temperature, sweats and nausea, were attributed by Italian doctors to the influence or “influenza” of either the cold or the stars. From the Enlightenment onwards, mass outbreaks were studied more scientifically and after the 1891 Russian flu epidemic doctors had formed the view that it was caused by a germ - anything from bad water to smog was seen as a potential breeding ground for what one medical professor referred to as “very clever little beasts”.
Influenza isn’t a germ, but rather a virus – Latin for poison – a tiny, non-cellular agent that is not alive but replicates inside the living cells of a host organism. They are sub-microscopic – 100,000 would just cover a fingernail. In 1918, before the invention of electron microscopes, this meant scientists were finding germ cultures that caused secondary infections rather than the primary viral source. Consequently, although some of the precautionary measures that were implemented were effective for both types of threat, there was a significant lack of understanding about how flu was transmitted.
The pandemic originated in the mid-West of the USA where in January, an unusually aggressive strain of flu emerged among livestock farmers in rural Haskell County in Kansas. The outbreak disappeared after 7 weeks, but one local farmer, Albert Gitchel, was shortly after drafted into the army ahead of deployment to the Great War front in Europe. He worked at Fort Riley as a cook before falling ill on 11 March. By the end of the month, 1126 of his comrades had joined him and 46 had died.
The disease was far more virulent than previous influenzas – tingling fingers led rapidly to high temperatures and severe vomiting. While many recovered quickly, the symptoms were more persistent in others and after 5 or 6 days developed into fatal respiratory infections. Although some medical scientists and doctors like William Welch urged quarantine measures, the US Army continued deploying infected regiments across the Atlantic Ocean on cramped troop ships where the virus spread exponentially.
In this way, the flu reached Europe. Army bases such as the British at Etaples became centres of infection as men moved to and from the cramped conditions of the trenches to equally packed barracks before embarking on crowded trains and ships back to England for leave. By July, Manchester recorded its first cases, while the German army delayed its final major offensive as the virus decimated its’ ranks.
The virus reached neutral Madrid and the King of Spain succumbed. Ironically, his death and the uncensored debate about it in the Spanish press led to the unwarranted moniker of the “Spanish flu” (resulting in hostility to Hispanic people back in the USA where the “Spanish Lady”, a skeleton in a black flamenco dress, became an icon of both the disease and naked racism).
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| Dr James Niven took the initiative in Manchester |
Yet it was a Scots-born Manchester doctor, James Niven, who from the outset identified that this flu was far more aggressive and needed a proactive response. He lobbied to close schools, distributed at his own expense over half a million posters urging personal protective measures and presented the first public health films with a character called Dr Wise advising on social distancing and masks. The city’s death rate was possibly as low as one eighth of the norm, though it didn’t spare Niven from eventual suicide.
After a summer lull, an even more virulent strain emerged in September. Victims were much more prone to fatal secondary infections, many dying with a characteristic deep blue skin tone resulting from pus-filled lungs starving the body of oxygen.
Cities like Sheffield and mining communities across Yorkshire were particularly badly affected owing to the close working and badly ventilated conditions in heavy industry and mines, as well as often cramped housing. The illness led some to desperation – Joseph Meek, a Normanton miner, in a curious harbinger of 2020, drank carbolic disinfectant not to cure but to kill himself, while some parents facing their own deaths killed their children for fear of no one being left to care for them.
Yet the government continued with its complacency, advising treatments such as rest – impossible for people scraping by in a time with no sick pay – consuming Bovril and opium, or even inhaling potash. Trains and trams ran unaffected and shops, pubs and theatres stayed open. Where local authorities did take measures, these were half-hearted – in York, for example, American soldiers were banned from cinemas, but locals were free to attend.
Other countries similarly had at best disparate and inconsistent responses: in the USA, municipalities often took responsibility for public health and were often at odds with the preferences of state governors. While some areas had draconian rules on, for example, mask wearing, others were much more lax and in several cities demonstrations were held to complain about measures viewed as affronts to American individualism. All the same, the Federal government passed the Defense of the Realm Act to censor any stories in the press that it deemed could spread “fear or dismay” – a bizarre line of reasoning not unknown to the President of the USA in 2020’s pandemic.
Nevertheless, the USA reeled from the disease. Cities became ghost towns as it spread and mass graves became commonplace. In all some 550,000 US citizens were to die of the flu – 40% of all the US military casualties in the Great War succumbed to it rather than German guns. And the end of the conflict brought little lasting relief - armistice celebrations in November led to a further round of infections, unwittingly causing many more deaths around the world.
By the turn of the year however, the virus had largely run its course in Europe and North America. A final wave in Spring 1919 was much milder as the virus had by then infected most of those it could – cleverly, they know not to completely destroy their hosts, although in June one of its final victims was Yorkshireman Mark Sykes, of Levantine Sykes-Picaud infamy. (He was dug up in 2008 to recover viral remains to help treat the Swine flu outbreak, a variant of H1N1.)
Of course, alongside France and the USA, Britain was an imperial power and trade and military activities carried it round the planet to their colonies. India, where British military railways injected the virus across the sub-continent, was to endure over 17 million casualties, while one in fifty Africans – one in ten in Tanzania – perished. China and Russia were also badly affected, though civil wars in both countries meant only estimates are possible.
Notably, Australia quarantined itself, banning all entrants – like its New Zealand neighbour now, it consequently avoided the devastation wreaked elsewhere. At home, working class civilians and troops were by far the worst affected. Over 30,000 British troops had succumbed, while in the UK itself around 200,000 people died, with many others facing long-term problems.
In all one in three of the global population was infected
and between 2.5% and 10% of those died – btween 100 million and as many as 200 million people,
depending on the estimate. The normal flu death rate was about 0.1% by comparison.
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| Angela Friedman survived both pandemics. | |
However, viruses are much better understood and treated infintely more effectively by modern medicine, leading to a significantly lower death rate. Parallel to this, the implementation of social distancing, protective face masks, and proper quarantines - rather than the confused, partial ones in the UK - clearly make a significant difference.
This is borne out in many places, but perhaps most poignantly by Sweden's ultimately awful death totals following its decision to avoid large-scale lockdowns. Per capita, with 36 covid deaths per million, Sweden stands between the UK (35 deaths pm) and USA (43 deaths pm) in having a high level of deaths - in contrast, its more precautionary neighbours in Norway (6 deaths pm) and Denmark 10 deaths pm) have very substantially lower mortality rates. (Source - Statista)
One heartening personal story of how things have changed is that of Angela Friedman, who was born on a migrant ship from Italy to New York during the 1918 pandemic. Aged 101, she survived contracting covid-19 earlier this year - in spite of previously suffering cancer, sepsis, internal beleeding and several miscarriages. Angela may have superhuman genes, as her daughter proudly declared, but even with these her chances of survival were doubtlessly much better this year than when she was born.
While the current pandemic is dreadful, having taken over a million lives and blighted millions more, and has been badly managed by many governments, the death rate is much lower than 1918-1919: a year which now stands as a striking example of what happens when almost nothing is done at all. It is a lesson right-wing politicians in the UK, USA, Brazil and India would have done well to have learned rather than indulging conspiracy theories about Big Pharma or secret Chinese biological warfare - both with striking antecedants in 1918 when either asprin manufacturers or the Kaiser were blamed for the flu.
Fortunately, most countries have taken a more collective and interventionist approach to the current public health emergency, otherwise there is no doubt the death toll would be much, much higher. Strong public health systems have proven their efficacy: such as the one in socalist Cuba, the South Korean track and trace process and the remarkable achievements of the west African country Senegal which, with few medical resources, has achieved the second lowest death rate on the planet by drawing on its long experience of fighting infectious diseases such as ebola and dengue fever.
Yet so too remain the true causes of our maladies – the exploitation of our environment and animals; the inequality of our health, housing and welfare systems; and politicians who advocate for profit over people and planet. We live in a world where, in the middle of this pandemic, water, that most natural and life-essential substance, has become a tradable commodity on the Futures market - this means people are now speculating on its availability to profit from its anticipated (and from investors' perspective, its preferred) scarcity.
This is the same world where an invisible dot with some nasty prongs has almost brought our system to its knees in a matter of weeks, so you might be forgiven for hoping we would have learned to treat our habitat with greater respect and vow to pursue new ways of living in harmony with each other and our environment. Yet so far, such a change is, to put it mildly, elusive.
Covid is not so much an existential biological threat to our species as a piercing wake up call we ignore perhaps literally at our peril. The next pandemic may well be much worse, and much sooner than we imagine, as we continue to degrade our world and tangle and tear and transform the very threads of existence. All for cash.
Capitalism remains the true virus - and socialism the only effective vaccine.
Below: from the British Film Institute; a colourised version of the 1918 public health film Dr Wise
